Pre & post operative nursing care

kindly see this for the pre and postoperative care of the patient.
this is also helpful for those worked in the hospital setup.

1. MR. ABHIJIT BHOYAR Lecturer M. sc. nursing PRE & POST OPERATIVE NURSING CARE

2. SURGERY DEFINITION surgery can be defined as the art and science Of treating diseases, injuries and deformities by operation and instrumentation

3. SURGICAL PROCEDURE COMMONLY GROUPED ACCORDING TO THE: A) PURPOSES Diagnostic  Palliative Ablative Reconstructive or cosmetic Transplant or corrective Curative Repairative Restorative

4. B) DEEGRY OF URGENCY EMERGENCY SURGERY IMMEDIATE URGENT ELECTIVE SURGERY REQUIRED RECOMMENDED OPTIONAL C) DEEGRY OF RISK INVOLVED MAJOR SURGERY MNOR SURGERY

5. PREOPERATIVE CARE OF PATIENT PSYCHOLOGICAL PREPARATION OF THE PATIENT Discuss with the patient to give full information about the surgery, such as . Type of surgery Consequence of surgery (if it is done and if it is not done) The problems to be faced (disabilities expected) Expected duration of hospitalization Expected time of resuming duty (if employed) PREOPERATIVE CARE OF THE PATIENT BEGINS AS SOON AS THE SURGEON MAKES A DIAGNOSIS AND DECIDES THAT AS OPERATION IS NECESSARY FOR THE PATIENT

6. 2. ERADICATE FEAR OF OPERATION FROM THE PATIENT Allow patient to ask the questions. Introduce patient to some other patient who recover from that same diagnosis. Explain about surgery, anesthesia Explain regarding meal. Cost of surgery Treatment/investigations done before surgery and its purposes Necessary arrangements to be made about the family, financial matters, work, hospitalization, etc

7. 3. MEET THE SPIRITUAL; NEEDS OF THE PATIENT Help the patient to meet the ministers of his religion, if requested by the patient

8. 4. OBTAIN INFORMED CONSENT Obtain the consent from the patient/ guardian for each operation after explaining the nature of the operation and anaesthesia. Never compel the patient/ guardian to give their consent Explain the complications that may occur when they is under anaesthesia. The language used in the consent form should be by the patient/ guardian, who gives the signature Obtain consent for major diagnostic procedure

9. 5. BUILD UP THE GENERAL HEALTH OF THE PATIENT & CORRECTION OF DISEASE PROCESS FOR SPEEDY RECOVERY Assist doctor for examination. Carry out the all the examination by the doctors ordered Collect all the baseline date which is required arranged for the blood donor Maintained diet

10. 6. PREOPERATIVE TEACHING Stop smoking (if the patient is a smoker) Maintain personal hygiene Deep breathing and coughing exercises to prevent chest complications. Active and passive exercises of the limbs to prevent postoperative thrombus (blood clot) Control of visitors to prevent cross infection

11. 7. SURGICAL PREPARATION OF THE SKIN Shaving Maintained personal hygiene Paint the area of the surgical site

12. 8. PREPARATION OF THE PATIENT ON THE EVENING BEFORE OPERATION Remove all jewellary Get the order from the physician for immediate preoperative care Medication given by doctors order if necessary Shave the surgical area Give enema at evening

13. 9. PREPARATION OF THE PATIENT ON THE DAY OF SURGERY Help the patient to go to the toilet Remind the patient and relative about fasting. Check the doctors order Check the operation site preparation Introduce nasogastric tube, urinary catheter, etc if ordered Stop all medication unless special ordered by the doctor

14. 10. SENDING THE PATIENT TO OPERATING ROOM Administered the premedication to the patient Check the vitals Changed the patient dress Ask the patient to void. Transfer the patient on the trolley Never leave the patient alone Send all the charts with the patient Send the patient with attendant.

15. NURSING DIAGNOSIS OF THE PRE-OPERATIVE CLIENT 1. Anxiety related to lack of knowledge about pre-operative routines and post-operative care. 2. Fear related to effect of surgery and ability to function in usual roles. 3. Fear related to the risk of death.  4. Anxiety related to the outcome of exploratory surgery for malignancy. 

16. 5. Fear related to loss of control during anaesthesia or up during anaesthesia.  6. Anxiety related to the perceived inadequate post operative analgesia. 7. Sleep pattern disturbance related to hospital routine and psychological stress.

17. 8 . potential for risk of aspiration related to the position used for surgery and anaesthesia. 9. potential for risk of perioperative positioning injury related improper positioning and inadequate support 10. Potential for impaired skin integrity related to surp.cal incision and infection. 11. Potential for altered tissue perfusion related to anaesthetic drugs.

18. INTRAOPERATIVE CARE When the client arrives in the operating room three groups of personnel are involved in the care: 1. THE ANESTHETIC TEAM 2. THE SURGICAL TEAMS 3. THE OPERATING ROOM NURSES These team have the role that is in the circulating and scrubbing.

19. INTRAOPERATIVE NURSING FUNCTION CIRCULATING ACTIVITIES INCLUDE A ssuring for the cleanliness, Proper temperature, Humidity and lighting, The safe functioning of the equipment The availability of the supplies. THE SCRUB ACTIVITIES INCLUDING Scrubbing for the surgery, Setting up the sterile table, Preparing suture, Special equipment necessary for the surgery .

20. POST OPERATIVE CARE 1. PREPARATION OF POST ANESTHETIC BED & RECEPTION OF THE PATIENT Prepare bed for the patient There should be adequate number of people to transfer the patient Received patient without disturbing the devices attached to the patient

21. Check operation site for the bleeding or any discharge. Keep the patient well covered and comfortable Never leave the patient alone Observe the patient for swallowing reflex. If not present keep the patient in a sideling position to prevent the tongue falling back and obstructing the airway Check the doctors order

22. 2. CARE OF THE PATIENT WHO IS UNDER THE EFFECTS OF ANAESTHESIA Patient needs close and diligent observation until the patient fully recover from anaesthesia. This will help to detect the early signs of complications after surgery and the nurse will be able to respond immediately. A noisy breathing is indicative of airway obstruction that can occur due to the tongue falling back and obstructing the pharynx, or fluid collected in the airway passages or fluids aspirated into the lungs. Apply suction immediately, send call the surgeon and the anaesthetist.

23. Keep the patient in a suitable position that will be helpful to drain out the vomitus , blood and secretions collected in the mouth and will prevent them aspirating into the lungs. This position is maintained until protective reflexes are returned. The oro -pharyngeal airway left in the mouth of the patient should be removed as soon as the patient has regained the cough and swallowing reflexes Excessive secretions in the mouth or anywhere in the respiratory passage can lead to airway obstruction. It should be sucked out . If intra-tracheal suctioning is necessary, always use sterile technique .

24. If the patient is cyanosed , administer oxygen inhalation. At the same time, find out the cause and remove the cause. prolonged oxygen therapy should be guided by arterial blood as determinations A weak thready pulse with a significant fall in blood pressure may indicate circulatory failure . It may also indicate loss from the body. The surgeon and the anaesthetist should informed. In order to prevent injury from falls from bed, put the rails on the bed. Till the patient recover from the effects of anaesthesia, the nurse should not leave the patient Alone

25. Patient recovering from anaesthesia may ask for drinking water Unless the patient has fully regained the swallowing reflex, drinking water may choke the patient; it should not be given. As the patient is recovering from the effects of anaesthesia, the patient may become restless due to the discomfort caused by the presence of those devices attached to the patient, such as i.v . sets, urinary catheters, drainage tubes etc. The nurse should help the patient by giving adequate explanations

26. Keep the family informed of the successful completion of surgery, transfer of the patient from the operating room to recovery room etc. These information will reduce their anxiety. If possible, allow the relatives to meet surgeon to clear their doubts .

27. 3. OBSERVATION OF THE PATIENT IN THE POST OPERATIVE PERIOD Close and diligent observation by the nurses are important to detect complications in the early stages, and thus, save the patient. On the first post operative day the patient needs close and frequent observations : e.g., the vital signs are checked every 15 minutes or more frequently The main points that should be observed are : Vital signs —blood pressure, pulse rate, respiratory rate, skin colour, skin temperature. Intake and output — I.V. fluids, oral fluids taken by the patient, naso -gastric aspiration, wound drainage, blood loss. Abdominal girth in patients with abdominal distension .

28. Urinary output - time and amount. Bowel movements . Signs of hypo/ hypervolaemia . Any breathing difficulties . Pain over the calf muscles. Operation site for bleeding, drainage Any specific observation as told by the surgeon and according to the operation done.

29. 4. CARE OF WOUND Check Dressing Dressing should be regular Skin care Infection control Proper diet

30. 5. DIET OF THE PATIENT All patients, except patients who had abdominal surgery, may start the normal diet, if desired so, on the first day. Remember to exclude nausea and vomiting due to the effect of anaesthesia . patient who had abdominal surgery, but did not involved the intestine or stomach, can have the clear fluids on the day after the surgery . Gradually, it can change into soft diet and then normal diet .

31. Patients who are with specific diseases, for which they scare taking special diets, should continue to observe the control of their diet as ordered by the doctor (e.g., a diabetic patient ) Remember, the patients who had undergone any type of surgery need a diet rich in vitamins and minerals .

32. 6. POST OPERATIVE HEALTH TEACHING All patients need health teaching according to the education at background of the patient. Teach the patient following points Maintenance of personal hygiene . Diet that is allowed for the patient; any control on the diet . Ambulation ; activities that are permitted, as well as restricted . Any adjustments to be made in the occupation of the patient.

33. Any drugs to be taken post operatively; the side effects and precautions . Date on which the patient may resume duty . Learning of any particular procedure to be carried out postoperatively, e.g., care of the colostomy. When the patient is unable to perform the procedure, teach the patient's relatives . Future treatment that may be needed for the patient in any other hospital e.g., radiation therapy for cancer patients.

34. NURSING DIAGNOSIS OF POST OPERATIVE CLIENTS Ineffective airway clearance related to effects of medications and anaesthetic agents . Ineffective breathing pattern related to pain, surgical incision and medications . Risk for altered body temperature, hypothermia — related to the use of drugs, infusion of cold fluids, inhalation of cold gases etc . Risk for injury related to post anaesthetic status . Pain related to surgical incision and reflex muscle spasm .

35. Altered nutrition, less than body requirements . Risk for fluid volume deficit related to loss of fluid during surgery and inadequate intake of fluid after surgery . Nausea and vomiting related to gastrointestinal distension medication, anaesthetic effect and stimulation of vomiting centre or chemoreceptor's trigger zone . Risk for infection related to surgical incision, inadequate nutrition and fluid intake, presence of environmental pathogens, invasive catheter and immobility . Altered urinary elimination related to decreased activity, effects of medication and reduced intake of fluid .

36. THANK YOU