Chapter 15: Perioperative Nursing Care

Perioperative nursing encompasses the three distinct phases of surgical care: preoperative preparation, immediate postoperative recovery, and management of potential complications. During the preoperative phase, nurses ensure informed consent is obtained prior to sedation administration, coordinate physical preparation through NPO requirements and bladder emptying, and deliver comprehensive patient education on breathing exercises, incentive spirometry, leg exercises, incision splinting techniques, and pain management strategies. Critical safety protocols include verification of client identity and surgical site marking through the time-out procedure, confirmation of allergies particularly latex sensitivity, and removal of all prosthetic devices and jewelry. The postoperative phase prioritizes maintaining airway patency and monitoring oxygen saturation above ninety-five percent while assessing cardiovascular stability through pulse checks, capillary refill evaluation, and screening for venous thromboembolism through antiembolism stockings and compression devices. Nurses monitor neurological status as anesthesia effects resolve, encourage early mobilization to prevent complications, assess return of protective reflexes and bowel motility before resuming oral intake, and maintain strict monitoring of urine output at minimum thirty milliliters per hour. Wound assessment focuses on detecting excessive bleeding, signs of infection, and proper drain function using appropriate sterile or clean dressing techniques. Major postoperative complications require specific interventions: atelectasis and pneumonia are addressed through repositioning and incentive spirometry; pulmonary embolism demands immediate oxygen therapy and surgeon notification; hemorrhage and shock necessitate pressure application, leg elevation, and fluid resuscitation; thrombophlebitis requires extremity elevation without leg dangling and anticoagulation therapy; paralytic ileus is managed with nasogastric decompression; and wound infections are monitored for fever and purulent drainage. Surgical emergencies including wound dehiscence and evisceration demand immediate intervention with sterile moist dressings and emergency surgical preparation. Ambulatory discharge requires assessment of alertness, stable vital signs, voiding capability, ambulation tolerance, minimal pain and bleeding, and availability of responsible adult transportation, with discharge teaching addressing incision care, medication compliance, nutritional requirements for healing, activity restrictions, and recognition of complication warning signs.