Chapter 16: Perioperative Nursing Care

The preoperative phase establishes the foundation for surgical success through informed consent verification, ensuring patients understand procedures and retain decision-making autonomy. Nurses implement nothing-by-mouth protocols, conduct skin antisepsis, and educate clients on essential preoperative exercises including deep breathing, coughing, and leg movements to prevent postoperative complications. Psychosocial preparation involves addressing patient anxiety, clarifying misconceptions, and providing reassurance while maintaining cultural sensitivity. Safety mechanisms form a critical barrier against adverse events, including identification verification, allergy documentation, removal of valuables and prosthetics, and implementation of surgical site marking and timeout procedures to eliminate wrong-site surgery. The immediate postoperative phase requires systematic assessment across multiple physiological systems. Respiratory monitoring focuses on oxygen saturation, breath sound quality, and secretion clearance using incentive spirometry and suctioning techniques. Cardiovascular assessment includes vital sign trends, bleeding evaluation, and deep vein thrombosis prevention through sequential compression devices and early mobilization. Neurological status assessment, pain management through multimodal approaches including patient-controlled analgesia, and gastrointestinal function monitoring with attention to bowel sounds and oral intake progression constitute essential elements of recovery care. Wound assessment identifies signs of infection, monitors drain output, and recognizes early indicators of dehiscence or evisceration requiring emergency intervention. The chapter emphasizes recognition and management of common postoperative complications including pneumonia, atelectasis, hypoxemia, hemorrhage, hypovolemic shock, urinary retention, constipation, and paralytic ileus. Temperature regulation, integumentary integrity maintenance, and renal function monitoring complete the holistic assessment framework. Discharge planning for ambulatory surgical patients includes detailed home care instructions, activity restrictions, medication management, and clear guidelines for seeking medical attention when concerning symptoms develop.