Chapter 9: Concepts of Care for Perioperative Patients

The preoperative phase encompasses systematic patient assessment, verification of informed consent, identification of surgical risk factors through review of comorbidities and medication interactions, and delivery of targeted patient education addressing anxiety reduction and procedural expectations. Nurses evaluate nutritional and hydration status, screen for contraindications related to anticoagulant and herbal supplement use, and reinforce critical behavioral preparation including nothing-by-mouth protocols and deep breathing techniques for postoperative pain management. During the intraoperative phase, nurses assume specialized roles as scrub nurses, circulating nurses, or registered nurse first assistants, maintaining surgical asepsis and sterile field integrity while monitoring for acute complications including malignant hyperthermia, unintended hypothermia, and excessive blood loss. Implementation of the Joint Commission's Universal Protocol through surgical time-out procedures verifies correct patient identity, surgical site, and planned intervention, establishing critical safety checkpoints that prevent never events. The postoperative phase prioritizes immediate physiologic stabilization in the post-anesthesia care unit, focusing on airway patency, adequate oxygenation, hemodynamic stability, and neurologic recovery before progression to phase two recovery and discharge. Nurses systematically assess and prevent postoperative complications including hemorrhage, hypoxemia, venous thromboembolism, surgical site infection, and urinary retention while managing pain, nausea, and hypothermia. Throughout the entire perioperative continuum, nursing practice emphasizes patient and family advocacy, psychosocial support, discharge education encompassing wound management and activity progression, and recognition of early warning signs requiring clinical intervention. The chapter reinforces how clinical judgment, infection prevention protocols, and effective communication among surgical team members reduce morbidity and mortality while promoting timely functional recovery and patient satisfaction.