Perioperative Nursing Theory, Case Study of Jessica

This paper discusses the case study of Jessica and explores the perioperative nursing theory. It covers the preoperative, intraoperative, and postoperative phases of nursing care.

Perioperative Nursing Theory, Case Study of Jessica 1
Perioperative Nursing Theory, Case Study of Jessica
Student Name
Institution Affiliation
Facilitator
Course
Date

Perioperative Nursing Theory, Case Study of Jessica 2
Perioperative Nursing Theory, Case Study of Jessica
Surgery is among the sensitive nursing care practices which must be handled with a lot of
care for the end results to be positive. It is commonly believed to be a matter of life and death
practice which can easily cause sleepless nights for victims. For that matter, before patients
undergo surgery, they must be prepared both physically and psychologically. Also, when it
comes to surgery, doctors must strictly follow the stipulated procedures to avoid complications
associated with the practice. After the operation, the patient must continue to be supported so as
to ensure systematic and fast healing. This nursing care has been summarized as perioperative
nursing care. Perioperative nursing care is described in three phases: preoperative phase,
intraoperative phase, and postoperative phase.
Preoperative phase describes the preparation procedure done to a patient before
undergoing the ideal operation. Intraoperative phase, on the other hand, describes the procedure
followed by a doctor when performing the operation while the postoperative phase entails the
support given to a patient after undergoing operation until full recovery (Qing et al, 2016, p.149).
This paper considers the case study of Jessica, a 40-year old in her journey from the time her
appendicitis became worse, through appendectomy to recovery. The paper will be divided into
four sections; the first section will describe the case of Jessica in her journey of appendicitis, the
second section will be the preoperative phase, the third section will be the intraoperative phase
and finally the postoperative phase, all in consideration to the case of Jessica.
Appendicitis is a health condition characterized by an inflamed appendix. Appendix, on
the other hand, is the finger-like a pouch that projects from the cecum or the start of the colon.
Mainly, the appendix becomes inflamed because of bacterial infections on its tissues which is

Perioperative Nursing Theory, Case Study of Jessica 3
signaled by the development of pus within the lumen. Bacterial infections in the appendix are as
a result of mechanical blockage of the appendix by foreign substances or thick mucus (Berman,
Snyder and Frandsen, 2016).
As an orphan, Jessica had been raised by a guardian who cared less about her wellbeing
in the environment. For that matter, as an infant, Jessica would consume everything on her site,
right from soil particles, fruit seeds to chewing plants. This had continued for a while until she
was grown up enough to differentiate between consumable and non-consumable things. At the
age of 14 years, Jessica started to complain of aching pain between her umbilicus and the lower
right abdomen. Her pain was sharp and could increase with her movements such as joking,
walking or running (Shih and Meldrum, 2018, p.20). According to her testimony, the pain would
be accompanied by nausea, fever, loss of appetite, vomiting and abdominal swelling. Jessica’s
condition had been linked with her adolescent as it had started at the time when her adolescent
symptoms started. She did not seek medical attention for that case because she expected her
condition to disappear with time. Unfortunately, her condition continued to worsen. At the age of
20 years, she visited a clinic where she was diagnosed with appendicitis.
Following her diagnosis with appendicitis, the doctor prescribed some medication to her
because he believed that her condition was not extreme to demand an operation. The doctor had
prescribed prophylactic antibiotics on her which was expected to eradicate the infections which
were affecting her appendix and prevent more complications. After the eradication of the
infections and prevention of further complications, it was expected that her appendix would
recover and carry its work normally (Arakelian et al, 2017, p.2530). The doctor had prescribed
piperacillin and zosyn, an agent which acted as a beta-lactamase inhibitor with piperacillin.

Perioperative Nursing Theory, Case Study of Jessica 4
These two antibiotics were really helpful on Jessica because they reduced the severity of the
symptoms. For twenty years she kept using the antibiotics. However, at the age of 40 years, her
condition became worse because her body had developed resistance for the two antibiotics. On
admission, the doctor confirmed that Jessica’s appendix was almost rupturing. Rupturing of the
appendix would release bacteria into the rest of her abdomen which would lead to a potentially
life-threatening infection. Jessica was supposed to undergo appendectomy because it was the
only option to control her condition (White and Spruce, 2015, p.50).
Before Jessica could be allowed to sign a consent form which would render her
dependent on the skill, integrity, and knowledge of the surgeon who would operate her in the
next five days, she was prepared physically and psychologically. The scope of activities during
this phase included the establishment of a baseline assessment in the clinical setting, being taken
through a preoperative interview and then being prepared for the anesthetic which would be
given before the surgery (Sweeney et al, 2017, p.10). During this phase, the nurse in charge of
her assessed and corrected all the physiological and psychological problems which would
increase the surgical risk on Jessica, instructed and demonstrated the exercises that would benefit
Jessica postoperatively and then planning for discharge and the projected changes in lifestyle due
to the surgery was done.
Through the physiologic assessment, the health history of Jessica was obtained through
physical examinations where vital signs were noted and a database established for future
comparisons. Among the assessments which were done included: nutritional status needs, fluid,
and electrolyte imbalance, drug and alcohol use, respiratory status, cardiovascular status, hepatic
and renal function, endocrine function, presence of trauma, immunologic function and previous

Perioperative Nursing Theory, Case Study of Jessica 5
medication therapy. As an old patient, the doctor had to make some gerontologic considerations
like monitoring Jessica for subtle clues that could indicate underlying problems since elder
patients usually have less physiologic reserves (Wilson et al, 2017).
After undergoing a nursing diagnosis, it was revealed that Jessica had an anxiety related
to the surgical experience and the possible outcome of her surgery. The risk of ineffective
therapeutic management regiment was found to be high because Jessica lacked efficient
knowledge of preoperative and postoperative procedures and protocols. Also, Jessica had some
fear related to the perceived threats of surgical procedures and separation from the support
system. Lastly, it was revealed that Jessica had deficient knowledge of the surgical process
(Gillespie et al, 2018, p.12).
Considering Jessica’s assessment, some nursing interventions were done in order to
prepare her for the surgery. To reduce her anxiety and fear for instance, the nurse provided her
with psychosocial support, she was given enough time to as any questions she had so that she
could be acquainted with the healthcare team which would be taking care for her after the
surgery, her worries and concerns about the impending surgery were acknowledged, some of her
fears like losing fertility as a result of the surgery were also noted and a session with
gynecologist organized and lastly, she was taught cognitive strategies which would enable her to
relieve tension, achieve relaxation and overcome anxiety (Cats et al, 2018, p.620).
To manage Jessica’s nutrition and fluids, ordered nutritional support was provided to
correct any nutrient deficiency and provide enough proteins for her body tissues before surgery.
Jessica was also given instructions in regard to the oral intake of food and water. According to

Perioperative Nursing Theory, Case Study of Jessica 6
the instructions, she was supposed to withhold the intake of food and water for 8 to 10 hours
before the operation (Rödel et al, 2015, p.980). As an older patient, the chances of being
dehydrated were high and hence encouraged on the importance of taking fluids by mouth before
surgery.
Other interventions which Jessica went through were: being taught on deep breathing and
coughing exercises, pain management and preparation for surgery. Under deep breathing and
coughing exercise intervention, Jessica was taught on ways to promote consequent blood
oxygenation and optimize lung expansion after anesthesia, was taught how he would control pain
and minimizes pressure on the incision line by splinting it, was informed on the available
medications that would relieve pain after surgery (Leong et al, 2017, p.2255). On pain
management, Jessica was instructed to take medications as prescribed during her postoperative
period, was informed on the use of oral analgesic agents before surgery and how to use a pain
rating scale to promote pain management. Lastly, Jessica was taught on how to prepare for
surgery. Among the ways which were tackled under this point included the use of germicide two
days to surgery, to shave the area around the operation point and to ensure that her hair was
completely covered before entering the surgery room.
The intraoperative is the phase that extends spans from the moment a client gets admitted
in an operation room through anesthesia administration, the surgical procedure until the patient is
moved to the post-anesthesia care unit (PACU). This phase promotes the principle of asepsis,
hemostasis, safe administration of anesthesia and homeostasis (Brode et al, 2017, p.2855).

Perioperative Nursing Theory, Case Study of Jessica 7
Jessica’s intraoperative phase began when she was received in ward 16 (surgical area)
and lasted until she was transferred to ward 19 (recovery area). Although the surgeon played the
most important role in the phase, there were other team members who contributed to the success
of the surgery. The surgeon acted as the leader during the operation and his role was to perform
safe and effective surgery. Other team members in the operation room were: Anesthesiologist,
Scrub Nurse or Assistant and circulating nurse (Unkart et al, 2017, p.3170). The anesthesiologist
role was to provide a smooth induction of Jessica’s anesthesia in order to prevent excessive pain.
Also, this team member was responsible for maintaining an adequate degree of relaxation to
Jessica during the surgical procedure. Apart from that, the anesthesiologist continually monitored
the physiologic status of Jessica, which included systematic circulation, oxygen exchange, and
neurologic status. He continually updated the surgeon on any impending complications.
The scrub or assistant nurse was responsible for preparing surgical set-ups, maintaining
surgical asepsis while handling and draping instruments. He also assisted the surgeon by passing
sutures, supplies and instruments. Lastly, the circulating nurse was entitled to respond to the
requests of the surgeon and the anesthetist, deliver supplies to the sterile field, obtain supplies
and carry out nursing care plans for Jessica (Lau et al, 2016, p.1300). Other functions of the
circulating nurse in the operation room were to maintain cleanliness in the OR, ensure proper
humidity, lighting, and temperatures in the OR, and ensure that equipment was functioning well,
monitoring aseptic techniques and coordinating the related personnel.
The anesthesia administered to Jessica controlled the pain during the surgery and all the
other medical procedures. In Jessica’s case, anesthesia was achieved through the use of
medicines and close monitoring to keep her comfortable. It helped control Jessica’s breathing,

Perioperative Nursing Theory, Case Study of Jessica 8
blood flow, blood pressure, and heart rate. Among the two types of anesthesia; General and
epidural anesthesia, Jessica was given the general anesthesia because the sensation was required
over her whole body (Predina et al, 2018, p.905).
The general anesthesia on Jessica worked in four stages. The first stage which was the
onset or induction stage extended from the administration of the anesthesia until Jessica lost
consciousness. Although she was ringing and buzzing in her ears, she was unable to move easily.
The second stage which was also the excitement or delirium stage extended from the moment
she lost her consciousness to the time she lost the reflex lid. It was the stage characterized by
shouting, struggling and crying because the anesthetic had not been administered in a quick and
smooth manner. The third stage was the surgical anesthesia which extended from the time
Jessica lost the reflex lid to the time she lost most reflexes. It was achieved through a continued
administration of vapor (Amofah et al, 2017, p.64). Jessica had turned unconscious and was
lying quietly on the table. The final stage was the medullary stage, which was reached after too
much anesthesia had been administered into her body. It at this stage that respiratory or cardiac
arrest was evident on her. The surgeon, however, to prevent cyanosis development, he hurriedly
finished the operation and immediately discontinued the anesthetic.
The last phase was the postoperative phase which extended from the time Jessica was
transferred to the postanesthesia care unit (PACU) to the time she was taken back to the surgical
unit to be discharged from the hospital. This phase, the main focus was to re-establish Jessica’s
physiologic balance, help in pain management and prevent further complications on her general
health. For these goals to be achieved, the nurse in charge performed a careful assessment of
Jessica.

Perioperative Nursing Theory, Case Study of Jessica 9
During the assessment session, special consideration to Jessica’s incision site, vascular
status and exposure were implemented by the nurse before she could be transferred from the
operating room to PACU. Every time Jessica was moved, the nurse could first consider the
location of surgical incision to avoid further strain on sutures. Jessica had come out of the
operating room with drainage tubes and hence her position could be adjusted from time to time
in order to prevent the obstruction on the drains (Brown et al, 2017, p.1050).
Other assessments done on Jessica included the air exchange status and her skin color, a
neurologic status which mainly entailed her level of consciousness and Glasgow coma scale to
determine her neurologic status. Her cardiovascular status was also assessed by determining her
vital signs in the immediate postoperative period and skin temperature. Lastly, the operative site
was examined to ensure that the dressings were okay.
After the assessment, Jessica remained under the postoperative nursing care for six days
before she was discharged. Under the postoperative nursing care, a number of activities were
involved. First, her airway was kept in place until she was fully awake. The airway had been
allowed to remain in place while Jessica was unconscious in order to keep the passage open and
prevent her tongue from falling back (Rödel et al, 2015, p.980).
Regarding her breathing, bilateral lung auscultation was done frequently, she was rested
and maintained in a lateral position to promote chest expansion and facilitate breathing and
ventilation. Jessica’s orientation was assessed and periodically evaluated in order to identify
signs of cerebral function alteration which suggests impaired oxygen delivery. Jessica was also
turned frequently to facilitate breathing and ventilation (Silva et al, 2016, p.500).

Perioperative Nursing Theory, Case Study of Jessica 10
To maintain the circulation of blood over her whole body, Jessica’s vital signs would be
obtained from time to time and any abnormalities reported. Her intake and output were closely
monitored. To ensure her body temperature was in the right range, hourly assessment of
temperature would be done to detect hypothermia. Also, Jessica’s postanesthesia shivering
would be monitored from time to time. A therapeutic environment was also be provided by
giving her warm blankets when she complained of coldness (Zech, Hendrich and Pfeifer, 2015,
p.1070).
Lastly, to ensure fluid balance in her body, Jessica’s skin color and turgor were assessed
and evaluated from time to time. Also, the evidence of electrolyte imbalances such as body
weakness and nausea were being monitored closely. Fluid imbalances were also closely
monitored through the assessment of decreased blood pressure, increased pulse rate and
decreased central venous pressure (Scholz et al, 2018, p.206). Jessica’s safety was also given the
first priority through supporting and padding her pressure areas to avoid muscle strain and nerve
damage. Her dressing was also examined frequently to identify possible constriction.
In summary, this paper has scrutinized the case of Jessica, a 40-year-old woman who
underwent surgery following her appendix complications. The paper has explained the journey
of Jessica from the time she was admitted in the hospital for appendectomy to the time she left
the hospital guided by the perioperative nursing theory which entails three phases: preoperative
phase, intraoperative phase, and postoperative phase.

Perioperative Nursing Theory, Case Study of Jessica 11
References
Amofah, H.A., Broström, A., Eide, L.S.P.E., Fridlund, B., Haaverstad, R.H., Hufthammer,
K.O.H., Kuiper, K.K.J.K., Schjott, J.S., Ranhoff, A.H.R. and Norekval, T.M.N., 2017. Factors
associated with disturbances in sleep-wake pattern in octogenarian patients in the early
postoperative phase after surgical aortic valve replacement. In European Journal of
Cardiovascular Nursing (Vol. 16, No. Suppl. 1, pp. S63-S64). Sage Publications.
Arakelian, E., Swenne, C.L., Lindberg, S., Rudolfsson, G. and von Vogelsang, A.C., 2017. The
meaning of person‐centred care in the perioperative nursing context from the patient's
perspective–an integrative review. Journal of clinical nursing, 26(17-18), pp.2527-2544.
Berman, A., Snyder, S. and Frandsen, G., 2016. Kozier & Erb's Fundamentals of Nursing:
Concepts, process and practice. Boston, MA: Pearson.
Brode, C., Ratcliff, M., Reiter-Purtill, J., Hunsaker, S., Helmrath, M. and Zeller, M., 2018.
Predictors of Preoperative Program Non-Completion in Adolescents Referred for Bariatric
Surgery. Obesity surgery, 28, pp.2853-2859.
Brown, P.D., Ballman, K.V., Cerhan, J.H., Anderson, S.K., Carrero, X.W., Whitton, A.C.,
Greenspoon, J., Parney, I.F., Laack, N.N., Ashman, J.B. and Bahary, J.P., 2017. Postoperative
stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain
disease (NCCTG N107C/CEC· 3): a multicentre, randomised, controlled, phase 3 trial. The
Lancet Oncology, 18(8), pp.1049-1060.
Cats, A., Jansen, E.P., van Grieken, N.C., Sikorska, K., Lind, P., Nordsmark, M., Kranenbarg,
E.M.K., Boot, H., Trip, A.K., Swellengrebel, H.M. and van Laarhoven, H.W., 2018.

Perioperative Nursing Theory, Case Study of Jessica 12
Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for
resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. The
Lancet Oncology, 19(5), pp.616-628.
Gillespie, B.M., Harbeck, E.B., Falk-Brynhildsen, K., Nilsson, U. and Jaensson, M., 2018.
Perceptions of perioperative nursing competence: a cross-country comparison. BMC
nursing, 17(1), p.12.
Lau, D., Hervey-Jumper, S.L., Chang, S., Molinaro, A.M., McDermott, M.W., Phillips, J.J. and
Berger, M.S., 2016. A prospective Phase II clinical trial of 5-aminolevulinic acid to assess the
correlation of intraoperative fluorescence intensity and degree of histologic cellularity during
resection of high-grade gliomas. Journal of neurosurgery, 124(5), pp.1300-1309.
Leong, T., Smithers, B.M., Haustermans, K., Michael, M., Gebski, V., Miller, D., Zalcberg, J.,
Boussioutas, A., Findlay, M., O’Connell, R.L. and Verghis, J., 2017. TOPGEAR: a randomized,
phase III trial of perioperative ECF chemotherapy with or without preoperative chemoradiation
for resectable gastric cancer: interim results from an international, intergroup trial of the AGITG,
TROG, EORTC and CCTG. Annals of surgical oncology, 24(8), pp.2252-2258.
Predina, J.D., Newton, A.D., Keating, J., Dunbar, A., Connolly, C., Baldassari, M., Mizelle, J.,
Xia, L., Deshpande, C., Kucharczuk, J. and Low, P.S., 2018. A phase I clinical trial of targeted
intraoperative molecular imaging for pulmonary adenocarcinomas. The Annals of thoracic
surgery, 105(3), pp.901-908.

Perioperative Nursing Theory, Case Study of Jessica 13
Qing, Y., Tan, S., Zhu, Y. and Yang, S., 2016. Application of Integrative Medicines of TCM and
WM Combined with Fast-track Surgery Concept in Perioperative Nursing in Colorectal
Surgery. Journal of Kunming Medical University, 37(12), pp.148-150.
Rödel, C., Graeven, U., Fietkau, R., Hohenberger, W., Hothorn, T., Arnold, D., Hofheinz, R.D.,
Ghadimi, M., Wolff, H.A., Lang-Welzenbach, M. and Raab, H.R., 2015. Oxaliplatin added to
fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally
advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre,
open-label, randomised, phase 3 trial. The Lancet Oncology, 16(8), pp.979-989.
Rödel, C., Graeven, U., Fietkau, R., Hohenberger, W., Hothorn, T., Arnold, D., Hofheinz, R.D.,
Ghadimi, M., Wolff, H.A., Lang-Welzenbach, M. and Raab, H.R., 2015. Oxaliplatin added to
fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally
advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre,
open-label, randomised, phase 3 trial. The Lancet Oncology, 16(8), pp.979-989.
Scholz, A., Bothmer, J., Kok, M., Hoschen, K. and Daniels, S., 2018. Cebranopadol: a novel,
first‐in‐class, strong analgesic: results from a randomized phase IIa clinical trial in postoperative
acute pain. Pain physician, 21(3), pp.E193-E206.
Shih, F. and Meldrum, J., 2018. A Voice from Within: Intra-operative nursing considerations for
Auditory Brainstem Implants. The Dissector, 46(1), pp.16-20.
Silva, C.R., Andrade, L.B., Maux, D.A., Bezerra, A.L. and Duarte, M.C., 2016. Effectiveness of
prophylactic non-invasive ventilation on respiratory function in the postoperative phase of

Perioperative Nursing Theory, Case Study of Jessica 14
pediatric cardiac surgery: a randomized controlled trial. Brazilian journal of physical
therapy, 20(6), pp.494-501.
Sweeney, N., Allen, K., Miller, B., Nolan, T. and Sheerin, K., 2017. Perioperative nursing
management of donor and recipient patients undergoing face transplantation. AORN
journal, 106(1), pp.8-19.
Unkart, J.T., Chen, S.L., Wapnir, I.L., González, J.E., Harootunian, A. and Wallace, A.M., 2017.
Intraoperative tumor detection using a ratiometric activatable fluorescent peptide: a first-in-
human phase 1 study. Annals of surgical oncology, 24(11), pp.3167-3173.
White, S. and Spruce, L., 2015. Perioperative Nursing Leaders Implement Clinical Practice
Guidelines Using the Iowa Model of Evidence‐Based Practice. AORN journal, 102(1), pp.50-59.
Wilson, L., McGrath, R., Saunders, M., Mattioni, C., Trinkaus, D. and Schaffer, D.L., 2017.
Incorporating a Collaborative Perioperative Training Program in Undergraduate Nursing
Education.
Zech, A., Hendrich, S. and Pfeifer, K., 2015. Association between exercise therapy dose and
functional improvements in the early postoperative phase after hip and knee arthroplasty: An
observational study. PM&R, 7(10), pp.1064-1072.