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PERIOPERATIF
PENDAHULUAN
Perioperatif
:
Praoperatif,
Intraoperatif,
Pascaoperatif
Praoperatif Peran keperawatan perioperatif
dimulai ketika keputusan untuk intervensi bedah
dibuat & berakhir ketika pasien dikirim ke meja
operasi
Intraoperatif dimulai ketika pasien masuk ke
kamar bedah & berakhir saat pasien dipindahkan ke
ruang pemulihan
Pascaoperatif dimulai masuknya pasien ke ruang
pemulihan & berakhir dengan evaluasi tindak lanjut
pada tatanan klinik atau rumah
Purpose
Examples
Elective
Tonsillectomy, hernia
repair, cataract extraction
and lens implantation,
hemorrhoidectomy
Urgent
Removal of gallbladder,
coronary artery bypass,
surgical removal of a
malignant tumor, colon
resection, amputation
Control of hemorrhage;
repair of trauma,perforated
ulcer,intestinal obstruction;
tracheostomy
Purpose
Examples
Diagnostic
To make or confirm a
diagnosis
Ablative
Breast
biopsy,
bronchoscopy,
laparotomy
gastrectomy,
amputation
Palliative
colon
laparoscopy,
exploratory
subtotal
partial
resection,
Colostomy,
dbridement
To relieve or reduce
intensity of an illness; necrotic tissue
is not curative
of
Purpose
Examples
Scar revision, plastic surgery, skin
graft, internal
fixation of a fracture, breast
reconstruction
Kidney, liver, cornea, heart, joints
Endoscopic thoracoscopy
EXPECTED RESULT
RISKS
General
Total unconscious
anesthesia state, placement of a
tube into the trachea
EXPECTED RESULT
RISKS
Infection, convulsions,
weakness, persistent
numbness, residual pain, injury
to blood vessels
Infection, convulsions,
persistent numbness, residual
pain, injury to blood vessels
Local
anesthesia
EXPECTED RESULT
Reduced pain
RISKS
Increase anxiety
Occasional
allergic
reaction
Cross-section of injection sites for peripheral nerve, epidural and spinal blocks.
PREOPERATIVE
PHASE
Kuswantoro Rusca Putra, S.Kp.M.Kep
Assessment
O Nursing History
O Medical History
O Medications (Herbs, Allergies)
O Age-Related Considerations
O Social and Cultural Considerations
O Spiritual Considerations
O Psychosocial Status
O Physical Assessment
O
O
O
ing anesthesia
Bromide in medications (e.g., Sominex): Can
accumulate and produce signs and symptoms of
dementia
Drugs with anticholinergic effects: Increase the
potential for confusion
Steroids: Suppress immunity
Nonsteroidal anti-inflammatory medications:
Increase the risk of stress ulcers and displace
other drugs from blood proteins
ASSESSMENT QUESTIONS:
PSYCHOSOCIAL STATUS
O Why are you having surgery?
O When did this problem start?
ASSESSMENT QUESTIONS:
PSYCHOSOCIAL STATUS
O Are you experiencing any discomfort or pain?
O What are you expecting from this surgery?
Nursing Interventions
Obtain and record baseline vital
signs.
Assess peripheral pulses.
Teach leg exercises, turning, and
ambulating.
Document normal activity levels
and tolerance of fatigue.
Monitor fluid administration rate.
Allow sufficient time for effects of
medications to occur.
Nursing Interventions
Nursing Interventions
Nursing Interventions
Monitor amount and times
of voiding.
Monitor fluid and electrolyte
status.
Maintain and record intake
and output.
Nursing Interventions
Gastrointestinal
Increased gastric pH
Obtain baseline weight.
Prolonged gastric emptying Monitor nutritional status
time
(weight, laboratory data).
Decreased hepatic blood flow, Observe for prolonged
liver mass, and enzyme
effects of medications.
function
Nursing Interventions
Integumentary
Decreased vascularity
Assess skin status.
Decreased skin moisture and Monitor fluid status.
elasticity
Pad and protect bony
Decreased subcutaneous fat
prominences.
Monitor skin for pressure
areas.
Use minimal amounts of
tape on dressings and
intravenous sites
Factors to Assess
General survey
Skin
Factors to Assess
Chest and lungs
Cardiovascular system
Factors to Assess
Abdomen
Neurologic system
Factors to Assess
Musculoskeletal
system
NURSING DIAGNOSIS
Nursing
Diagnoses
Grieving
Related Factors
Any condition that is
perceived as a
potential loss, such as
physical ability and
appearance following
surgery
Sample Defining
Characteristics
Verbalizations of
distress at the
potential loss
Denial of the
potential loss
Altered eating
habits, sleep
patterns, activity
level, and/or libido
NURSING DIAGNOSIS
Nursing
Diagnoses
Anxiety
Related Factors
Sample Defining
Characteristics
NURSING DIAGNOSIS
Nursing
Diagnoses
Risk
Infection
Related Factors
Sample Defining
Characteristics
Risk Factors
Obesity
Aging
Immunosuppression
Malnutrition
Outcome Identification
and Planning
Specific appropriate outcomes include that the
patient:
O Is physically and emotionally prepared for
surgery
O Demonstrates turning, coughing, and deepbreathing exercises
O Verbalizes understanding of postoperative
pain management
O Maintains fluid intake and nutritional balance
to meet needs
Implementing
Preparing the patient psychologically through
communicating
Preparing the patient psychologically through
teaching
Teaching about surgical events and
sensations
Teaching about pain management
Teaching about physical activities (Deep
Breathing, Coughing, Incentive Spirometry,
Leg Exercises, Turning in Bed)
Implementing
Preparing the Patient Physically
COMMON CIRCULATORY
COMPLICATIONS AFTER SURGERY
AND ANESTHESIA
Thrombophlebitis: Inflammation of a vein with
COMMON RESPIRATORY
COMPLICATIONS AFTER SURGERY
AND ANESTHESIA
Pulmonary embolism: A blood clot that has
INTRAOPERATIVE
PHASE
Assessment
O Nurses in surgical scrub attire identify the
Assessment
O They may also carry out required immediate
NURSING DIAGNOSIS
Nursing
Diagnoses
Risk
for
Imbalanced
Fluid
Volume
Related Factors
Hemorrhage
Failure of
regulatory
mechanisms
Sample Defining
Characteristics
Increased pulse
rate with
decreased
volume
Decreased blood
pressure
NURSING DIAGNOSIS
Nursing
Diagnoses
Risk
for
Perioperative
Positioning
Injury
Related Factors
Any lengthy
surgical
procedure
requiring special
intraoperative
positioning
Sample Defining
Characteristics
Risk Factors
Aging
Obesity
Anesthesia, with
resulting
sensory/perceptual
alterations
Emaciation
Outcome Identification
and Planning
Some expected outcomes are that the patient
will:
Remain free of neuromuscular injury
Remain free from wrong site, wrong side, wrong
procedure surgery
Maintain fluid and electrolyte balance
Maintain skin integrity (other than for the
incision)
Have symmetric breathing patterns
Outcome Identification
and Planning
Some expected outcomes are that the patient
will:
Be free of injury from burns, retained foreign
objects (inaccurate count of supplies), and
medication errors
Remain free from surgical site infection
Maintain normothermia
Implementing
Positioning
Draping
Documenting
Transferring to the Postanesthesia Care Unit
PASCAOPERATIVE
PHASE
Immediate Postoperative
Assessment and Care
O Respiratory Status
O Cardiovascular Status
O Central Nervous System Status
O Fluid Status
O Wound Status
O Pain Management
O General Condition
Factors to
Assess
move
Factors to
Assess
Position
safety
Factors to
Assess
Other tubes
Comfort
NURSING DIAGNOSIS
Nursing
Diagnoses
Risk
Infection
Related Factors
Sample Defining
Characteristics
Risk Factors
Obesity
Aging
Immunosuppression
Malnutrition
Presence of incision
Decreased ability to cough,
deep breathe, use incentive
spirometer
Presence of drains, tubes,
and catheters
Insertion site for intravenous
therapy
NURSING DIAGNOSIS
Nursing
Diagnoses
Disturbed
Body Image
Related Factors
Sample Defining
Characteristics
NURSING DIAGNOSIS
Nursing
Diagnoses
Acute Pain
Related Factors
Sample Defining
Characteristics
NURSING DIAGNOSIS
Nursing
Diagnoses
Urinary
Retention
Related Factors
Sample Defining
Characteristics
Outcome Identification
and Planning
The patient will:
Carry out leg exercises every 2 to 4 hours.
Deep breathe and cough effectively every 2 hours.
Verbalize decreasing levels of pain.
Have a balanced intake and output.
Regain normal bowel and bladder elimination.
Exhibit a healing surgical incision.
Remain free of infection.
Verbalize any concerns about appearance of
wound.
Verbalize and demonstrate wound self-care.
Implementing
Preventing Cardiovascular Complications
Hemorrhage
Shock
Thrombophlebitis
Preventing Respiratory Complications
Pulmonary embolus
Pneumonia
Atelectasis
Implementing
Preventing Surgical Site Complications
Infection, dehiscence (wound closure
separation), and evisceration (protrusion of
intra-abdominal organs)
Preventing Respiratory Complications
Promoting a Return to Health
Elimination needs
Fluid and nutrition needs
Comfort and rest needs