13 Surgery (Perioperative Client) Nursing Care Plans

March 1, 2014

Surgical intervention may be needed to diagnose or cure a specific disease process, correct a deformity, restore a functional process or reduce the level of dysfunction. Although surgery is generally elective or pre-planned, potentially life-threatening conditions can arise, requiring emergency intervention.

Nursing Care Plans

Nurses have a variety of roles and functions associated with the patient’s surgical management. Nurses provide care of a client before, during, and after surgical operation, this is collectively called as Perioperative Nursing. It is a specialized nursing area wherein a registered nurse works as a team member of other surgical health care professionals. Absence or limitation of preoperative preparation and teaching increases the need for postoperative support in addition to managing underlying medical conditions.

Here are 13 perioperative nursing care plans (NCP):

Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

Lack of exposure/recall, information misinterpretation
Unfamiliarity with information resources

Possibly evidenced by

Statement of the problem/concerns, misconceptions
Request for information
Inappropriate, exaggerated behaviors (e.g., agitated, apathetic, hostile)
Inaccurate follow-through of instructions/development of preventable complications

Desired Outcomes

Verbalize understanding of disease process/perioperative process and postoperative expectations.
Correctly perform necessary procedures and explain reasons for the actions.
Initiate necessary lifestyle changes and participate in treatment regimen.

Nursing Interventions	Rationale
Assess patient’s level of understanding.	Facilitates planning of preoperative teaching program, identifies content needs.
Review specific pathology and anticipated surgical procedure. Verify that appropriate consent has been signed.	Provides knowledge base from which patient can make informed therapy choices and consent for procedure, and presents opportunity to clarify misconceptions.
Use resource teaching materials, audiovisuals as available.	Specifically designed materials can facilitate the patient’s learning.
Implement individualized preoperative teaching program:
Preoperative or postoperative procedures and expectations, urinary and bowel changes, dietary considerations, activity levels/ transfers, respiratory/ cardiovascular exercises; anticipated IV lines and tubes (nasogastric [NG] tubes, drains, and catheters).	Enhances patient’s understanding or control and can relieve stress related to the unknown or unexpected.
Preoperative instructions: NPO time, shower or skin preparation, which routine medications to take and hold, prophylactic antibiotics, or anticoagulants, anesthesia premedication.	Helps reduce the possibility of postoperative complications and promotes a rapid return to normal body function. Note: In some instances, liquids and medications are allowed up to 2 hr before scheduled procedure.
Intraoperative patient safety: not crossing legs during procedures performed under local or light anesthesia.	Reduced risk of complications or untoward outcomes, such as injury to the peroneal and tibial nerves with postoperative pain in the calves and feet.
Expected or transient reactions (low backache, localized numbness and reddening or skin indentations).	Minor effects of immobilization and positioning should resolve in 24 hr. If they persist, medical evaluation is required.
Inform patient or SO about itinerary, physician/SO communications.	Logistical information about operating room (OR) schedule and locations (recovery room, postoperative room assignment), as well as where and when the surgeon will communicate with SO relieves stress and mis-communications, preventing confusion and doubt over patient’s well-being.
Discuss individual postoperative pain management plan. Identify misconceptions patient may have and provide appropriate information.	Increases likelihood of successful pain management. Some patients may expect to be pain-free or fear becoming addicted to narcotic agents.
Provide opportunity to practice coughing, deep-breathing, and muscular exercises.	Enhances learning and continuation of activity postoperatively.