Plan of Care Updates for Certified Perioperative Nurse (CNOR)

Plan of Care Updates

Guidelines:

• The perioperative nursing care plan should be reviewed and updated continuously throughout the duration of perioperative care
  • Utilize the nursing process
  • NANDA
  • Communication
  • Physiological responses
  • Behavioral and emotional responses
  • Perioperative safety based on individual patient assessment
    • Existing implants, pacemakers, AICD
  • Critical thinking

Considerations:

• Age and Developmental stage
• Changes in planned versus actual procedure
• Patient response to interventions
• Individualized plan of care
• Team communication
• Shared goals/outcomes

Nurse’s role:

• Update plan of care as needed
  • Nursing process
  • NANDA (nursing diagnoses)
  • Team Communication
  • Physiological responses
  • Behavioral and emotional responses
  • Perioperative safety based on individual patient assessment
    • Existing implants, pacemakers, AICD
  • Critical thinking

Pitfalls:

• Failing to individualize the plan of care
• Failing to continually assess and evaluate
• Failing to identify shared goals/outcomes
• Failing to communicate
• Failing to update the plan of care

Examples:

• Your patient is undergoing a laparoscopic abdominal procedure that has unexpectedly converted to open. How might this change in planned versus actual procedure change the plan of care?
  • Apply the nursing process
  • Assessment, Diagnosis, Outcome Identification, Planning, Implementation, Evaluation
  • Increased risk of retained surgical items
  • Increased risk of bleeding, infection, pain, etc.
  • What were the shared goals pre-operatively?
  • Update the family if appropriate
  • Team communication
  • Critical thinking

Linchpins (Key Points):

• The nursing process is continual
• The plan of care should be updated as needed
• The perioperative nurse should utilize critical thinking skills
• Team communication is key to patient safety