8-1. INTRODUCTION

a. Perioperative refers to the total span of surgical intervention. Surgical intervention is a common treatment for injury, disease, or disorder. The surgeon intervenes in the disease process by repairing, removing, or replacing body tissues or organs. Surgery is invasive because an incision is made into the body or a part of the body is removed.

b. Perioperative patient care is a variety of nursing activities carried out before, during, and after surgery. The perioperative period has three phases:

(1) The preoperative phase begins with the decision that surgical intervention is necessary and ends when the patient is transferred to the operating room table.

(2) The intraoperative phase is the period during which the patient is undergoing surgery in the operating room. It ends when the patient is transferred to the post-anesthesia recovery room.

(3) The postoperative phase lasts from the patient's admission to the recovery room through the complete recovery from surgery.

8-2. THE SURGICAL EXPERIENCE

a. Surgery is classified as major or minor based on the degree of risk for the patient. Surgery may be classified as elective, meaning that it is necessary but scheduled at the convenience of the patient and the health care provider. When surgery must be done immediately to save the patient's life, a body part, or bodily function, it is classified as emergency surgery. Regardless of whether the surgery is major or minor, elective or emergency, it requires both physical and psychosocial adaptation for the patient and his family. It is an important event in a person's life.

(1) Minor surgery is brief, carries a low risk, and results in few complications. It may be performed in an outpatient clinic, same-day surgery setting, or in the operating suite of a hospital.

(2) Major surgery requires hospitalization, is usually prolonged, carries a higher degree of risk, involves major body organs or life-threatening situations, and has the potential of postoperative complications.

b. Surgery produces physical stress relative to the extent of the surgery and the injury to the tissue involved. Surgical intervention may be for one or more reasons. The following descriptors classify surgical procedures by purpose:

(1) Ablative--removal of a diseased organ or structure (e.g., appendectomy).

(2) Diagnostic--removal and examination of tissue (e.g., biopsy).

(3) Constructive--repair a congenitally malformed organ or tissue. (e.g., harelip; cleft palate repair).

(4) Reconstructive--repair or restoration of an organ or structure (e.g., colostomy; rhinoplasty, cosmetic improvement).

(5) Palliative--relief of pain (for example, rhizotomy--interruption of the nerve root between the ganglion and the spinal cord).

(6) Transplant--transfer an organ or tissue from one body part to another, or from one person to another, to replace a diseased structure, to restore function, or to change appearance (for example, kidney, heart transplant; skin graft).

c. The physical stress of surgery is greatly magnified by the psychological stress. Anxiety and worry use up energy that is needed for healing of tissue during the postoperative period. One or more of the following may cause the patient psychological stress.

(1) Loss of a body part.

(2) Unconsciousness and not knowing or being able to control what is happening.

(3) Pain.

(4) Fear of death.

(5) Separation from family and friends.

(6) The effects of surgery on his lifestyle at home and at work.

(7) Exposure of his body to strangers.

d. Surgical procedures usually combine several classifications and descriptors. For example, a trauma patient may require major, reconstructive, emergency surgery. Regardless of the risk, any surgery that imposes physical and psychological stress is rarely considered "minor" by the patient.