The person undergoing surgery

1. DK/CIII/surgical pt1
The person undergoing surgery

2. DK/CIII/surgical pt2
The person undergoing surgery
If you work in a hospital, you may have contact with
a person before and after surgery. In nursing
facilities, many residents are recovering from
surgery. Many post operative patients need home
care. Your role in caring for surgical patients
depends on certain factors:
The employer’s policies
Whether the surgery was major or minor
The person’s condition before surgery
The person’s condition after surgery

3. DK/CIII/surgical pt3
Preoperative Care
The preoperative phase
begins when surgical
intervention is first
considered and ends
when the patient is
admitted to the
operating theatre
Preparations for
surgery depend on
diagnosis & type of
surgery

4. DK/CIII/surgical pt4
Pre operative preparation including client
communication/teaching
An important part of modern surgery is day surgery, also know
as ambulatory surgery. Advance surgical techniques and
better client preparation have allowed for clients to be admitted,
operated on and discharged in the same day. All types of
anaesthesia can be used.
Surgery is treating diseases, injuries and deformities by
operation. As part of the client’s preparation you may need to
discuss various terms used to describe surgery.

5. DK/CIII/surgical pt5
Types of surgery
Elective surgery is done for the person’s well-being.
It is not life saving and may not be necessary for the
person’s health. The surgery is scheduled well
ahead of time, allowing the person to be well
prepared psychologically and emotionally and
leaving time for any pre testing to be done.
Urgent surgery is necessary for the person’s health.
It must be done soon to prevent damage or disease.
Emergency surgery is done immediately It is life
saving and the need is sudden and unexpected.

6. DK/CIII/surgical pt6
Surgical intervention
May be directed towards:
a tumour (excess of tissue)
A defect (deficiency of tissue)
A deformity (displacement of structures)
Or the removal of foreign bodies (non-living
material)

7. DK/CIII/surgical pt7
Methods of performing surgical
procedures:
open surgery e.g. mastectomy – external
surgical wound
closed surgery e.g. T.U.R.P. – wound is
internal
minimal access e.g. laparoscopic –
minimal external wounds and faster
recovery time

8. DK/CIII/surgical pt8
Preparation
Providing information
Teaching activities
Examining/assessing the individual
Performing laboratory tests and diagnostic
studies
Gaining the individual’s informed consent
Preparing the individual psychologically and
physically

9. DK/CIII/surgical pt9
The person needs to be prepared for
what happens before after and during
surgery.
Physical and psychological
preparation is necessary.
Often the person who needs
to have surgery experiences
many fears,
- fear of loss of an organ,
- who will care for the
children,
- how will they cope with the
pain,
- will they survive?

10. DK/CIII/surgical pt10
Purpose of surgery
diagnostic surgical exploration to aid
diagnosis e.g. biopsy to determine
presence and/or extent of pathology
Constructive restores function lost or
reduced (congenital anomalies) e.g.
congenital defects
transplant due to organ damage
reconstructive restores function or
appearance to traumatised or
malfunctioning tissues e.g. fractures
palliative relieve or reduce intensity of
disease symptoms e.g. colostomy to
bypass inoperable bowel obstruction
from cancer
Cosmetic to improve appearance e.g.
rhinoplasty, repairing burns scars.

11. DK/CIII/surgical pt11
Common Fears and Concerns of
Surgical Patients
·The fear of cancer ·The fear of prolonged recovery
·The fear of body disfigurement and scarring·The fear of more surgery and treatments
·The fear of disability ·The fear of being separated from family and
friends
·The fear of pain ·The fear of tubes, needles and other
equipment
·The fear of dying ·Concerns
·The fear of anaesthesia and it’s effects·Who will look after the partner
·The fear of going to sleep and not waking up·Who will take care of the pets
·The fear of exposure ·Who will pay the bills
·The fear of complications ·Who will take care of the unit

12. DK/CIII/surgical pt12
Nursing Assistant responsibilities in
caring for the person who has fears
and concerns:
Listen to the person who
voices fears or concerns
about surgery
Refer any questions about
the surgery or it’s results to
the nurse
Explain any procedures you
do
Perform your tasks in a
competent and confident
manner

13. DK/CIII/surgical pt13
The Pre-operative Period
The doctor or registered nurse will do any pre-
operative teaching. Once the doctor explains what is
going to be done the person may sign a consent
form should they wish to proceed. The registered
nurse does the pre-operative teaching and tells the
person what to expect after surgery.
It is not your role to educate the patient, but you
should be aware of what is happening so you
can give efficient basic care.

14. DK/CIII/surgical pt14
Pre operative preparation
elective:
pre-admission clinics/tests
early intervention programs
patient education/assessment
referral
emergency
day only/short stay/long stay:
transit lounge/pre-op prep areas

15. DK/CIII/surgical pt15
Anaesthesia
Factors influencing the choice of anaesthetic include :
1. Nature of the surgery (length & complexity of
of operation).
2. Client’s status (pre-existing medical
conditions).
3. Anatomical & physiological conditions.
4. Client preference.

16. DK/CIII/surgical pt16
Anaesthesia
Anesthesia blocks the perception of pain.
Anesthesia is classified according to the CNS effects:
i) local – the loss of sensation without the loss of consciousness
ii) regional – the loss of sensation to a region of the body without loss of
consciousness when a specific nerve or group of nerves is blocked
with the administration of a local anaesthetic
iii) general – the loss of sensation with loss of consciousness,+/- skeletal
muscle relaxation, analgesia and elimination of the somatic, autonomic
and endocrine responses

17. DK/CIII/surgical pt17
awareness of patient teaching
deep breathing and coughing exercises
pain management (including PCA)
moving and changing position
wounds, drains, intravenous infusions,
indwelling catheters, nasogastric tubes
specialised surgical procedures

18. DK/CIII/surgical pt18

19. DK/CIII/surgical pt19
anti-embolic stockings
support blood vessels
prevent stasis
prevent thrombus formation

20. DK/CIII/surgical pt20
pre-op
base line data collection (including weight)
skin preparation ( you may be involved with this),
according to policy
clipping
showering
total body wash
gastrointestinal preparation, e.g. bowel preparation
fasting regimes ( NBM 6-8 hours before) there
should be a sign above the person’s bed and the
water jug should be removed.

21. DK/CIII/surgical pt21
Pre-Operative Checklist
Item Time Rationale
1. Operative area shaved1 day pre- op or
in OT
Hairs – harbour micro-organisms -
obscure op site
2. Special skin
preparation
1-2 days pre-op
morning of op
Decreases risk of infection.
3. Weight 1 day pre-op Calculation of drug dosage
Baseline for comparison
4. Consent Pre-op Legal purposes – written consent
necessary for operative procedures
5. Bowel preparation Night before Prevents incontinence during
anaesthesia. Decreases risk of post-op
discomfort and abdominal distension.

22. DK/CIII/surgical pt22
Pre-Operative Checklist
Item Time Rationale
6. Premedication givenAs ordered Promotes relaxation.
Reduces apprehension.
Dries up oral secretions.
Decreases risk of
inhalation.
7. Natural teeth
Dentures – in situ
Removed
Prior to transfer to OT May be dislodged during
anaesthesia.
8. Make up; nail polish,
jewellery,
hairpins, contact lenses
removed
Day of surgery Nail polish – easier to
observe the individual for
cyanosis. Prosthesis – may
cause injury. Jewellery – may
come in contact with metal
and burn individual if
diathermy used.

23. DK/CIII/surgical pt23
Pre-Operative Checklist
Item Time Rationale
9. Temp:
Chart
Pulse:
Resp:
B.P.:
On admission and
on day of surgery
Abnormality may mean postponement of
operation
10. NBM:
- Morning op
-- afternoon op
-Usually 12mn
night before
- 6 hrs prior
Present of food/fluid causes vomiting
and risk of inhalation.
11. Intragastric
tube in situ
As ordered Aspiration of stomach contents and
decompression of stomach.

24. DK/CIII/surgical pt24
Pre-Operative Checklist
Item Time Rationale
12. Stomach aspirated
Time:
Amount:
If emergency op and patient has
had food during the past 6 hours.
13. Voided/Catheterised
Time:
Amount:
Urinalysis:
1 hr pre-op
Morning of op
To prevent incontinence and
prevent injury to bladder.
Detect renal dysfunction.
14. X rays with patient
(eg
Orthopaedic,
Gallbladder)
E.C.G.
To accompany
patient to OT
For referral by surgeon.
For referral by anaesthetist.

25. DK/CIII/surgical pt25
Pre-Operative Checklist
Item Time Rationale
15. Outpatient clinic notesTo accompany patient to
OT
For referral by
anaesthetist and surgeon.
16. All current and
previous history notes
To accompany patient to
OT
For referral by
anaesthetist and surgeon.
17. Blood cross matched
and typed
Day before Possible need for
transfusion.

26. DK/CIII/surgical pt26
Pre-Operative Checklist
Item Time Rationale
18. No. of blood bottles in
O.T. fridge
Day of op Easy access if transfusion necessary
19. Night sedation Night before To relax, decrease anxiety.

27. DK/CIII/surgical pt27
Recovery room

28. DK/CIII/surgical pt28
Post-op
- preparing the patient’s room (surgical bed, placing
equipment and supplies in the room, as directed by
the nurse)
- observations: You may be assigned to measure vital
signs and observe the patient’s condition.
- Other observations: time and amount of first
voiding, FBC.
-care of drips/drains ( If the drip is not dripping, do
not touch the drip(IV), inform the RN) Inform the
registered nurse of the appearance of bright red
blood from the drainage tubes or suction tubes.

29. DK/CIII/surgical pt29
Post-op assessment
Vital signs
Colour
Level of consciousness
(LOC)
Wound dressing
Drainage from urinary
catheter
Presence of discomfort
or pain

30. DK/CIII/surgical pt30
Post op
An IV (intravenous catheter) in your
hand or arm to provide fluids and
medicines until you are able to drink
fluids well.
A face mask or tube under your nose to
supply oxygen.
A tube to drain urine from your bladder.
You may feel the urge to urinate even
though your bladder is empty.
An NG (nasogastric) tube through your
nose into your stomach to help prevent
nausea and vomiting.
Wound drains to help your incision
heal.
Leg wraps that inflate and deflate
and/or elastic stockings to help
circulation in your legs while you are less
active.


31. DK/CIII/surgical pt31
Post op
Remember: The post-op person is NBM
until they have been given permission by
the doctor to progress to a different diet.
The registered nurse will tell you when to
change the signs above the patient’s bed.

32. DK/CIII/surgical pt32
Subsequent post-op care
Assessing respiratory and circulatory needs
Comfort needs
Nutritional and fluid needs
Elimination needs
Movement and exercise needs
Hygiene needs
Psychological needs
Protection and safety needs
Wound care needs (including drainage tubes, sutures and
clips)
Observe for complications
Preparation for discharge

33. DK/CIII/surgical pt33
Complications
Pain
Haemorrhage
Shock (hypovolaemic) respiratory complications (pneumonia,
atelectasis)
Thrombophlebitis
Pulmonary embolism
Nausea and vomiting (N&V)
Abdominal distension
Paralytic ileus
Urinary retention
Wound infection/dehiscence/evisceration

34. DK/CIII/surgical pt34
Operative procedures
Some examples include:
Prostatectomy
Hysterectomy
Cholecystectomy
Appendicectomy
Tonsillectomy
(Breast) lumpectomy
Hip replacement
Knee replacement

35. DK/CIII/surgical pt35
Operating room

36. DK/CIII/surgical pt36

37. DK/CIII/surgical pt37