After completing the chapter, you will be able to accomplish the following:

1. Provide patient teaching regarding deep-breathing exercises, coughing, and splinting of an incision.
2. Provide patient teaching regarding leg exercises.
3. Provide safe and effective care for the preoperative patient.
4. Provide safe and effective care for the postoperative patient.
5. Apply a forced-air warming device.

• Assessment
• Clinical Decision Making/Clinical Judgment
• Comfort
• Safety

• anesthetic
• atelectasis
• deep vein thrombosis (DVT)
• elective surgery
• hemorrhage
• hypothermia
• perioperative nursing
• perioperative phase
• postanesthesia care unit (PACU)
• thrombophlebitis

A wide range of illnesses and injuries may require treatment that includes some type of operative or invasive procedure that is performed in the operating room or surgical suite and are referred to as surgery (AORN, 2020). Surgical procedures may be inpatient, performed in a hospital; or ambulatory or outpatient, performed in a hospital-based surgical center, a freestanding surgical center, or a surgeon's office. In an ambulatory or outpatient center, the patient goes to the surgical area the day of surgery and returns home on the same day.

Nursing care provided for the patient before, during, and after surgery is called perioperative nursing. Perioperative nursing involves providing care for the patient during the perioperative phase; before (preoperative), during (intraoperative), and after surgery (postoperative). The nursing process is used during each phase to meet physical and psychosocial needs and to facilitate the patient's return to health.

Whether the surgery is performed in the inpatient or outpatient setting, one of the most significant roles of the perioperative nurse is that of collaborator—the nurse working directly and indirectly with other nurses, surgeons, support personnel, anesthesia professionals, perioperative services executives, quality improvement personnel, and risk management experts (Taylor et al., 2020). Evidence-based practice that considers patient and family/caregiver preferences, clinical expertise of the health care provider, and the best evidence available informs decision making at all stages of the perioperative process. The ultimate, shared goal is to provide safe, quality care for the vulnerable perioperative patient (AORN, 2020).

The nurse follows specific criteria and guidelines while conducting the preadmission assessment, preparation, and patient education. This preoperative care can be provided through a telephone call or a face-to-face interview with the patient. A preoperative teaching plan should include preoperative instructions and patient preparation. This teaching should include both the patient and the patient's family members/caregivers or guardian/significant others. For certain types of elective surgery, such as joint replacements, patients may participate in a group patient teaching session before their admission to the hospital. Refer to Fundamentals Review 6-1, 6-2, and 6-3.

The postoperative care of the patient begins immediately after the surgical procedure is completed. This involves a short stay in the postanesthesia care unit (PACU) or other recovery area for about 1 to 2 hours, depending on the type of surgery and the patient's condition. After this time period and when the patient's condition is stabilized, the patient may be transferred either to the intensive care unit (ICU), to the surgical unit in the hospital, or, if the surgery was ambulatory, the patient will be discharged to home. Nursing care throughout the postoperative period includes ongoing assessments, monitoring for complications, implementing specific nursing interventions, and patient and family/caregiver teaching, as needed (Hinkle et al., 2022; Robertson & Ford, 2020). Before discharge from either the hospital or the ambulatory care unit, all patients will receive both oral and written discharge instructions and information about follow-up care (Hinkle et al., 2022). In addition, to ensure early identification of complications and address any patient concerns, the patient may receive a follow-up telephone call the next day after discharge.

With an increasing trend toward short-stay or same-day surgical treatment, the nursing interventions in each phase of perioperative nursing care may vary somewhat, but they remain basically the same. While caring for the surgical patient, the nurse should keep in mind that a surgical procedure of any extent is a stressor that requires physical and psychosocial adaptations for both the patient and the family/caregivers (Fundamentals Review 6-4).

This chapter will cover the skills the nurse needs to provide safe perioperative nursing care in the pre- and postoperative phases.

1. Preoperative medications may be prescribed for administration before transfer to the preoperative holding area or for administration in the preoperative holding area. The nurse needs to call the nursing staff in the preoperative holding area. The nurse should explain the circumstances, identify the prescribed medication, and state that the medication was not administered. Depending on facility policy and procedure, the nurse should also notify the health care team, in this case the surgeon, of the missed medication dose. It is important that the appropriate health care personnel are aware of the missing dose of medication, so that appropriate action can be taken to ensure the patient receives the required medication to prevent intraoperative or postoperative complications.
2. The nurse needs to consider the onset of action and peak effect of the administered medication. If the appropriate time has not lapsed for the medication to take effect, the nurse should provide further explanation and reassurance to the patient. The nurse should initiate additional nonpharmacologic interventions to aid in pain management (refer to Chapter 10, Comfort). If the pain persists, the nurse should perform a complete pain assessment (refer to Chapter 10, Comfort). In addition, the nurse should assess for other postoperative complications. Pain can be a clue to other problems, such as hemorrhage. The nurse should notify the primary care provider of the initial assessment findings, information regarding analgesics administered, nonpharmacologic interventions, and the patient's response to interventions. In addition, some patients do not obtain adequate relief from the initial analgesic prescribed and require a change in analgesics to achieve adequate pain management.
3. Monitor the patient's temperature at least every 30 minutes while using the forced-air device. If rewarming a patient with hypothermia, do not raise temperature too quickly to prevent a rapid vasodilation effect. The nurse should not have waited 60 minutes to recheck the patient's temperature. Ms. Gibbs is experiencing the effects of rapid vasodilation, resulting in lowered blood pressure and increased heart rate. The nurse should discontinue the forced-air warming device. Assess the patient's cardiovascular and respiratory status. Notify the primary care provider of the assessment findings. Provide for the patient's safety; make sure the call bell is within reach and instruct the patient to remain in bed, to avoid a fall or other injury related to hypotension. Monitor the patient's vital signs at least every 30 minutes. Be prepared to reapply the forced-air heating device if the patient's temperature drops below prescribed limits.