pre_and_post_operative_care education.pptx

Educational

1. Pre & postoperative care

2. contents Classification of surgery Stages of peri -operative period .

3. Classifications of Surgery Based on Urgency: I Emergency: immediately II Urgent: 24-30 hours III Required: need surgery in upcoming weeks IV Elective: Should have V Optional: Not necessary – a choice

4. Based on purposes: Diagnostic Curative/ablative Palliative Re-constructive Transplant exploratory

5. Types of surgical procedure Open surgery Keyhole surgery Laparoscopic surgery

6. pre-operative period

7. Pre operative care is care given before surgery when physical and psychological preparation are mad for the operation according to individual needs. Preparing a patient for surgery will help the patient recover physically and psychologically and prevent post-operative complications.

8. Cont,,,, Pre- operative tasks include: diagnostic tests Informed consent Psychological preparations Physical preparation Pre- operative check list

9. Pre-operative diagnostic tests  Blood analyses such as : CBC , RFT , viral screening , blood grouping & cross matching , RBS X-ray studies ECG & ECHO Urine studie s

10. Informed Consent One of the basic rights of all patients is the right to accept or refuse medical and surgical treatment. surgeon and/or anesthesiologist - has obtained the patient’s consent . patient understands, the following: 1) His/her diagnosis 2) The nature of the surgery/procedure

11. Cont,,,, 3) Why the surgery/procedure is being done. 4) The risks and benefits of the surgery/procedure. 5) The risks and benefits of not having the surgery/procedure performed. 6) What outcome she/he can expect. 7) What the post-operative period and the recovery period will be like. 8) Alternatives to the surgery/procedure and their risks and benefits All of this should be discussed with the patient and the patient will then sign a surgical consent form.

12. Preoperative Psychological Preparation

13. Psychological Preparation and Support The patient is often having surgery because he/she has a serious illness, so surgery is a stressful experience and it can be frightening . psychological preparation and support are important in the pre-operative period.

14. Respecting Spiritual and Cultural Beliefs Help patient obtain spiritual help if he or she requests it; respect and support the beliefs of each patient. When assessing pain, remember that some cultural groups are unaccustomed to expressing feelings openly. Individuals from some cultural groups may not make direct eye contact with others; this lack of eye contact is not avoidance or a lack of interest but a sign of respect.

15. Cont,,,,, Listen carefully to patient, especially when obtaining the history. Correct use of communication and interviewing skills can help the nurse acquire invaluable information and insight. Remain unhurried, understanding, and caring.

16. Pre-Operative Teaching The most important areas to cover in pre-operative teaching are : surgical procedure. operative day. post-operative period . post-operative exercises .

17. Post-Operative Exercises Teaching post-operative exercises before surgery gives the patient a stress-free and pain-free time to practice these exercises. Types of post op exercises : 1-Coughing exercises are a very effective way to prevent post-operative lung infections. Coughing will help expand the lungs and bring up secretions,

18. Cont,,,, patient perform 5-10 cough and 5-10 deep breaths every two hours. 2-Deep breathing:????? breathing exercises can also be done using an incentive spirometer.

19. incentive spirometer

20. Cont ,,,, 3-Turning : Turning from side to side prevents skin damage, increases circulation, and prevents secretions from pooling in the lungs and causing an infection. 4-Walking : preventing post-operative complication, specifically pulmonary complications and peripheral blood clots

21. Cont,,,, 5-Exercises: Patients who have had orthopedic surgery are typically required to perform specific exercises during the post-operative period.

22. Preoperative physical preparations

23. Preoperative physical preparations NPO Skin Preparation Bowel Preparation Dress patient a hospital gown. Cover patient’s hair completely with a disposable paper cap. remove dentures or plates. Remove jewelry, including wedding rings

24. Assist patients (except those with urologic disorders) to void immediately before going to the operating room.

25. Pre-Operative Checklist The pre-operative check list is the final document that must be completed before the patient is transferred to the operating room . It indicates that all the necessary preparations for surgery have been completed.

26. MEDICATION

27. Protocol: Medications to not take on morning of surgery Diuretics or weight loss medications Potassium supplements or Vitamins Diabetes medications Oral diabetes medications are typically held on the day of surgery Basal Insulin(e.g. Lantus) is taken at half dose (on night before surgery) Bolus Insulin (e.g. Lispro) is held at home while NPO

28. Protocol: Medications to avoid in the perioperative period Medications associated with bleeding risk Perioperative Anticoagulation NSAIDs Antiplatelet Agents ح0000000000000000حم Aspirin Herbal preparations

29. Transporting Patient to Operating Room Send the completed chart with patient to operating room; attach surgical consent form and all laboratory reports and nurses’ records, noting any unusual last minute observations that may have a bearing on the anesthesia or surgery at the front of the chart in a prominent place. Take the patient to the preoperative holding area, and keep the area quiet, avoiding unpleasant sounds or conversation. Attending to Special Needs of Older Patients

30. Attending to the Family’s Needs Assist the family to the surgical waiting room, where the surgeon may meet the family after surgery. Reassure the family they should not judge the seriousness of an operation by the length of time the patient is in the operating room.

31. Cont,,, Inform those waiting to see the patient after surgery that the patient may have certain equipment or devices in place (ie, IV lines, indwelling urinary catheter, nasogastric tube, suction bottles, oxygen lines, monitoring equipment, and blood transfusion lines).

32. Pre Operative Nursing Assessment

33. Pre Operative Nursing Assessment Age Nutritional and Fluid Status Drug and Alcohol use Respiratory Status Cardio vascular Status pt. ‘s level of education, knowledge about his/her situation & surgery

34. Cont,,,,, Infection Other system (renal, hepatic, immune) Psychosocial, spiritual and cultural beliefs Medications

35. Pre operative nursing diagnosis ND : Deficient Knowledge related to the surgical process Planned & E.O.C: Pt verbalize understanding her/his condition, surgery , post op expectations Nursing interventions : Assess pt’s level of understanding, cognitive status , knowledge about surgical process Review recourses teaching materials Teach pt and discuss pre& post op procedures & expectations, instructions

36. ND : Fear / Anxiety related to perceived threat of the surgical procedure and separation from supportive system. Planned & expected outcome : The patient will be able to express him/ her fears , anxiety will be reduced Nursing intervention: Provide psychosocial support. Be a good listener, be empathetic, and provide information that helps alleviate concerns.

37. Cont,,,, During preliminary contacts, give the patient opportunities to ask questions and to become acquainted with those who might be providing care during and after surgery. Explore any fears with patient, and arrange for the assistance of other health professionals if required. Teach patient cognitive strategies that may be useful for relieving tension, overcoming anxiety, and achieving relaxation, including imagery, distraction, or optimistic affirmations.

38. Post-Operative Period

39. Post-Operative Period It can be divided into two periods as following: (1)Immediate Post-Op PACU Assist and monitor patient in post-anesthetic stage Airway, circulation, hemorrhage, nausea/vomiting (2) Late /Recovery period Clinical Unit Discharge home

40. PACU

41. Post-Operative Period Nursing assessment post operatively Primary focus on: Neurological status Vital Signs Pain Respiratory function Circulatory function Surgical site. Fluid status. Nutritional status

42. Any question