Summary

Surgical procedures are classified as emergent, urgent, expedited (scheduled), and elective. Emergent surgeries are performed immediately to save a life, limb, or an organ. Urgent surgeries are performed for a condition with acute onset or clinical deterioration of life, limb, or organ survival. Expedited surgeries are when a patient is stable but requires early intervention for a condition. Elective surgeries are scheduled in advance and are not performed to save a life.

During the last couple of decades, surgical advancements have been made exponentially to include robotic surgery, telesurgery, surgical uses of AI, Multi-Angle Rear-Viewing Endoscopic tooL (MARVEL), and 3-D printing. In many way, these advancements have made surgery safer and more available to a greater number of people. However, there are risks, and many are exorbitantly expensive and therefore prohibitive.

There are several types of anesthesia used in medical procedures and surgeries: general anesthesia, MAC/moderate sedation, regional anesthesia, and local anesthesia. Each type of anesthesia has advantages, disadvantages, potential side effects, and appropriate applications based on the procedure to be performed, patient factors, and required depth of anesthesia. The nurse must be aware of how anesthesia providers evaluate and monitor patients to ensure safe and effective anesthetic management for procedures.

The preoperative stage encompasses a broad spectrum of activities aimed at preparing the patient for surgery. The nurse is tasked with key steps, like conducting detailed medical and medication reviews to identify any factors that might influence surgical outcomes or anesthesia plans. This stage also involves the nurse providing patient education, including managing expectations regarding postoperative pain and recovery as well as discussing preoperative fasting and medication adjustments. The nurse also assesses the patient’s nutritional status, psychological well-being, and any cultural or religious considerations that may affect care. The nurse then coordinates with the surgical team to ensure all preoperative documentation, including informed consents and advance directives, is collected and managed. All of the data come together as part of a comprehensive pain management plan that incorporates both pharmacological and nonpharmacological strategies tailored to the patient’s needs and preferences.

The perioperative nurse acts as an advocate for the patient, ensuring that their cultural, spiritual, and emotional needs are respected and integrated into the care plan. By establishing a rapport with the patient and their family, the nurse helps by alleviating anxiety, addressing concerns, and facilitating a smooth transition to the intraoperative stage.

All of the nurse’s tasks in the preoperative stage are integral to patient safety, optimizing surgical outcomes and enhancing the overall patient experience. Taking a holistic approach to preoperative preparation demonstrates the importance of thoroughness, empathy, and collaboration in achieving successful surgical outcomes for patients.

The intraoperative stage is the core of the surgical experience, where all the planning and preparation come into play. Successful surgery ultimately comes down to the effective collaboration of a multidisciplinary team, each member with a distinct role, who can carry out their work with skill and diligence.

Patient safety during surgery is the priority, and the nurse’s role is vital in realizing that goal. The patient is at their most vulnerable when they are unconscious and completely reliant on medical science and the key players in the OR. The nurse, then, must act as the patient’s eyes and ears, ensuring that the patient has a voice even when they are unable to speak for themselves. Understanding and mitigating potential complications like anesthesia awareness, malignant hyperthermia, intraoperative vomiting and aspiration, and positioning injuries are all aspects of providing competent care. Nurses must be able to recognize these risks, advocate for the patient, and work with the team to implement appropriate interventions—which, at times, may be life-and-death decisions.

The postoperative stage is focused on promoting healing, preventing complications, and facilitating a smooth transition back to normal routines. The role of the nurse is to provide vigilant monitoring, advocate for the patient, coordinate care, and educate patients to empower them in their own recovery.

There are distinct stages of postoperative recovery including the immediate (phase I and phase II), intermediate, and convalescent stages of recovery. The key responsibilities of nurses throughout these stages are assessing vital signs and system functioning, managing pain, preventing infection, encouraging mobility, and preparing the patient for discharge and long-term recovery.

The nurse must also factor in special considerations for providing care to patients after surgical procedures, such as pain medication management, discharge planning, specific requirements for bariatric surgery patients, and the unique developmental needs of geriatric and pediatric patients. The nurse must be equipped to recognize potential complications, develop a plan, intervene effectively, and provide support for a patient’s ongoing recovery.