Chapter 50: Perioperative Nursing Care

Perioperative Nursing Care begins by establishing the scientific basis for surgical care, classifying procedures by seriousness (major or minor), urgency (elective, urgent, or emergency), and purpose (diagnostic, ablative, palliative, reconstructive, or cosmetic). A major focus is placed on assessing surgical risk factors, including the American Society of Anesthesiologists (ASA) Physical Status Classification System, and managing co-morbidities such as obesity, obstructive sleep apnea (OSA), fluid and electrolyte imbalances, and immunosuppression. The text outlines the critical nursing responsibilities in the preoperative phase, such as conducting thorough health histories, reviewing medications for potential interactions, identifying allergies (specifically latex sensitivity), and ensuring informed consent is properly documented. Considerable attention is given to preoperative education, where nurses teach patients about diaphragmatic breathing, coughing techniques, and the use of incentive spirometers to prevent respiratory complications like atelectasis and pneumonia. The intraoperative section differentiates between the roles of the circulating nurse and the scrub nurse, emphasizing their collaboration in maintaining sterile technique and patient safety through "time-outs" and the prevention of "never events" like wrong-site surgery. It also covers various types of anesthesia—general, regional, local, and conscious sedation—and the management of intraoperative emergencies like malignant hyperthermia. The postoperative discussion moves through phases of recovery, starting with immediate stabilization in the Postanesthesia Care Unit (PACU), where airway patency and hemodynamic stability are paramount. The chapter details the prevention and management of postoperative complications, including hemorrhage, deep vein thrombosis (VTE), paralytic ileus, urinary retention, and wound dehiscence or evisceration. Finally, it addresses restorative care through multimodal pain management, early mobility protocols to prevent hospital-associated deconditioning, and interprofessional collaboration for effective discharge planning.