Perioperative Care

Perioperative Care
The care of the surgical patient ideally begins when the patient is first informed of
the need for surgery. The surgical procedure may be a sudden, unexpected event for
the patient, resulting in stress and anxiety, such as necessary surgery following
trauma, or may be something that the patient has planned, such as a liposuction, far
in advance. The more time the patient has to prepare for surgery, both physically
and emotionally, the better able the patient is to cope with the physiological stresses
of the surgery. Nurses are in a position to care for the patient, provide necessary
education, act as patient advocate, and encourage health promotion behaviors.
Surgical Classifications

The American Society of Anesthesiology categorizes surgical procedures based on
the degree of risk to the patient. The urgency, location, extent, and reason for the
procedure are all considered, as well as the patient’s age; preexisting cardiovascular,

respiratory, and neurologic status; endocrine disorders; malignancies; nutritional,
fluid, and electrolyte status; abnormal laboratory findings; abnormal vital signs; and
presence of infection. The risks of doing the surgery are weighed against the risks of
not doing the surgery. There are some cases in which the risk of surgery is very high,
but the patient may certainly die if the surgery is not performed (patients with uncon-
trolled internal bleeding following a gunshot or stabbing, for example).
The anatomical location of the surgery will affect the degree of risk to the patient.
Surgical procedures performed within the thoracic cavity or skull are a greater risk
to the patient than procedures performed on the extremities. Surgical procedures
involving vital organs such as the heart, lungs, or brain carry a higher risk. The pro-
cedures that involve a greater potential for blood loss, such as vascular surgery, also
involve greater risk.
The degree of urgency of the procedure is described as emergent, urgent, or elec-
tive. Emergent procedures need to be performed immediately after identifying the
need for surgery. Examples include surgery to stop bleeding from trauma, shooting,
or stabbing, or a dissecting aortic aneurysm. Urgent procedures are scheduled after
the determination of surgical need is made. Examples include tumor removal and
removal of kidney stones. Elective procedures are scheduled in advance at a time
that is convenient for both patient and surgeon. Postponement of the surgery for
several weeks or even months will not cause harm to the patient. Examples include
joint replacement procedures and cosmetic procedures.
The extent of the surgery will affect the risk to the patient. The more extensive
the surgical procedure, the greater the potential risk to the patient. More exten-
sive surgical procedures cause more physical insult to the body and typically require
a longer duration of anesthesia. The anesthesia can also cause stress to the patient’s
system, interact with medications in the patient’s system, and must be metabolized
out of the body.

The reason for surgery is another way that surgical procedures are classified. The
purpose may be diagnostic, curative, restorative, palliative, or cosmetic. Diagnostic
procedures are performed to obtain a biopsy for definitive diagnosis of a mass.
Curative procedures are performed to remove a diseased area, such as a lumpec-
tomy for breast cancer or an appendectomy. Restorative procedures are performed
to restore function, such as joint replacements. Palliative procedures are proce-
dures are performed primarily for comfort measures, such as tumor debulking.
Cosmetic procedures are typically performed at the patient’s request; at times
some cosmetic procedures may fall into restorative (repairing damage or a con-
genital defect), curative, or diagnostic (in the setting of skin cancer).
The perioperative period can be broken down into the preoperative (time before
the surgery), intraoperative (time during the surgery), and the postoperative (time
following the surgery until recovery) periods.