Question

Describe the stages of the perioperative process. Discuss interventions/duties that the nurse performs with each stage.

Answer 1

Ans) As a patient moves through the three phases of the operative process (preoperative, intraoperative, and postoperative), the perioperative nurse must adapt the assessment to the setting.

- Assessment is the relevant collection of data regarding the surgical patient.

- This information can be retrieved through various avenues and doesn't need to be repeated through all the phases of the surgical patient's operative process.

- The concise assessment needs to be relevant to the patient's surgical procedure with adequate information to provide individualized, safe care.

- With all these concepts in mind, it's apparent the perioperative nurse could benefit from a succinct assessment tool when navigating through the assessment.

Tools of the trade
- Data collection is a progressive and orderly process. Optimizing the most efficient assessment begins with reviewing the patient's history using either a paper chart or an electronic version. Previous surgical history, review of systems, current medical diagnosis, indication for surgery, type of surgery, allergies, as well as physiologic assessment parameters such as diagnostic studies, labs, and X-ray results, can all be obtained through these resources.

Getting to know your patient:
- The perioperative nurse can perform the face-to-face assessment in the preoperative designated area. This should include an additional physical assessment as well as a psychosocial assessment. During this time, the perioperative nurse can assess the patient's perception of the surgical procedure, what knowledge they have of the procedure including informed consent, expectations of care, stress level, cultural or religious beliefs, support from family or significant others, or any nonverbal behavior.

- This is also a time to build rapport with the patient. These psychosocial parameters build confidence in the patient's perception of their care as well as aid the perioperative nurse in developing the best plan of care for the individual patient. This is not the time to repeat the findings from previous data collection.

- Documentation of the assessment is completed according to the policy and procedures of the organization.

- The findings may be completed either in a written or electronic document/flowsheet.

Patient assessments can be individualized and should include the following:

* identification of patient; two identifiers are needed, usually name and date of birth (this may be individualized according to the specific organization)

* operative procedure; side (if applicable), location and site marking

* preoperative teaching, patient understanding, and verbalization of procedure

* informed consent documented

* mental/physiological status

* pre-op orders; check history, electronic record

* range of motion/mobility

* internal/external prosthesis

* sensory impairments or language barrier

* cultural differences, religious/spiritual needs

* cardiovascular and respiratory status (vital signs within +/-20% baseline, airway patent, maintain oxygen saturation at 92% or +/- 2% of baseline)

* nutritional status (N.P.O.)

* pain or discomfort (ongoing assessment of level of pain or discomfort)

* surgical specialty assessment as appropriate: cardiovascular, pulmonary, neurologic, orthopedic, gastrointestinal, gynecological, ophthalmic

* presence of prosthetics or corrective devices

* personal belongings and their location

• * medications and allergies (obtain from patient's history)

* skin condition

* family/friends/significant others present.

A vital part of patient safety:
- Perioperative nursing assessments are succinct and pertinent to the patient's surgical procedure. Repetition needs to be reduced as the patient's history and data can be retrieved from a variety of resources such as the history, electronic record, patient's interview, and physical assessment. The assessment is critical for safe patient-care delivery.