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PRE & POST OPERATIVE�CARE

Group Members

  • Cecilia Y. Sandor
  • Eunice Boamah
  • Philomena O. Apaah
  • Jarib Ali

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OVERVIEW

By the end of this presentation, you should refresh your knowledge on the;

  • Definition & examples of a surgical operation
  • Care of patients before surgery
    • Psychologically
    • Physically
    • Physiologically
  • Receiving clients from surgery
  • Care of patients after surgery

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SURGICAL OPERATION

  • A medical procedure involving an incision with instrument, performed to repair damage or arrest disease in a living body.
  • Operations (surgeries) take place in an Operating Room (O.R), also called theatre.
  • A surgeon performs a surgery.

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EXAMPLES OF SURGICAL OPERATIONS

  • Herniorrhaphy – repair of hernia

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  • Hydrocelectomy – removal of hydrocele.

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EXAMPLES OF SURGICAL OPERATIONS – CONT.

  • Appendectomy – removal of the appendix

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  • Caesarean section – delivery by surgery commonly known as CS

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EXAMPLES OF SURGICAL OPERATIONS – CONT.

  • Hysterectomy – removal of all or part of a woman’s uterus

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  • Mastectomy – complete removal of the breast

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EXAMPLES OF SURGICAL OPERATIONS – CONT.

  • Prostatectomy – removal of the prostate gland

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  • Laparotomy – incision into the abdominal cavity, for diagnosis (Exploratory) or in preparation for major surgery (Minor).

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EXAMPLES OF SURGICAL OPERATIONS – CONT.

  • Skin grafting – transplant of a piece of living tissue.

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  • Debridement of wound, burns or infection - removal of damaged tissue or foreign objects from a wound

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PRE-OPERATIVE CARE

The management of a patient before they are sent to the O.R.

Preparation for surgery begins the moment the patient decides to undergo surgery.

A legal (documented) consent is taken from the patient, if they can legally sign for themselves, or from their care taker. The nurse ensures this consent has been taken by the performing surgeon.

Pre-Operative care can be categorized into;

  • Psychological care – mental state
  • Physiological care – body functioning
  • Physical care - fitness

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PRE-OPERATIVE CARE – CONT.

  • The mental state of a patient can affect their assessment findings, such as vital signs, hence psychological care is crucial.
  • Explain the need for surgery to the patient and/or care taker of the child, stating the benefits, risks and success rate to allay fears and anxiety. E.g.;
    • Fear of loss of body image – inform them of gradual restoration of body image as recovery progresses.
    • Fear of disability
    • Fear of paralysis from anesthesia – inform them of well trained professional who has had success with other patients.
  • Seek for the patient and/or care taker’s knowledge on the surgery and correct any misconceptions.
  • Reassure the patient &/or care taker
  • Be honest

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PRE-OPERATIVE CARE – CONT.

  • If possible, introduce the patient to other patients who have successfully undergone similar surgery and have recovered or are recovering.
  • Provide diversional therapy.
  • Orientate patient to the ward explaining hospital routine to the client and their family, also orientate client to theatre and equipment there.
  • Provide reading material available on the condition and surgical operation.
  • Humans dwell on hope, allow the patient and/or care taker to practice their religion or culture if it doesn’t compromise the surgery.
  • Find their funding source (socio-economic) and recommend support programs available.

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PRE-OPERATIVE CARE – CONT.

The chance that a malfunctioning body would develop surgical complication is highly probable.

  • Check, document and communicate vital signs, especially if any abnormality is recorded.
  • Attain medical and surgical history.
  • Check requested labs, x-rays, ECG etc. and ensure patient undertakes them to rule out possible underlying conditions.
  • Ensure enough bed rest by nursing client on a comfortable bed, serving prescribed pain medications as ordered, and making the environment conducive e.g. nursing in a dim & nicely scented room.

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PRE-OPERATIVE CARE – CONT.

  • It is best to have an operation with an empty bowel since most anesthesia impairs muscle activity including the G.I Tract.
  • If enema is ordered, do it the night before surgery or as per the doctor’s order.
  • Ensure Nil per Os ‘8 – 12’ hrs before surgery, check with performing surgeon if unsure.
  • Administer pre-meds such as antibiotics ordered to be served as a prophylaxis.
  • Obtain, document and communicate allergy and treatment preferences such as blood transfusion alternatives preferred.

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PRE-OPERATIVE CARE – CONT.

The physical appearance of a ‘patient for surgery’ is important. E.g. a bushy private parts isn’t ideal for an inguinal hernia repair.

  • Bath or clean the patient. If necessary, shave the area to be operated on.
  • Teach client how to perform simple exercises such as deep breathing, coughing…
  • Advice the patient to avoid the following;
    • Makeup on the day of surgery
    • Spectacles
    • Nail polish
    • Prosthetics and dentures
    • Jewelries – ask patient to leave these valuable with someone they trust or the nurses.
  • If NG tube or Catheter is required for the surgery, pass them under aseptic technique.

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PRE-OPERATIVE CARE – CONT.

  • Assist patient to dawn theatre gown (if available).

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As part of the final steps, document the state of your patient before surgery, wheel your patient to the theatre on a stretcher, keep reassuring your patient/care taker until you have handed them over to the theatre staff.

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POST-OPERATIVE CARE – CONT.

RECEIVING A CLIENT FROM SURGERY

So you’ve received a call from the theatre to receive a client from surgery. What do you do?

  • Make a comfortable bed suitable for condition, which should be free from creases and wrinkles.
  • Assemble bed accessories and equipment such as oxygen apparatus, suction machine, infusion stand, vitals tray etc. – simply put, prepare the emergency bed.
  • When you arrive at the theatre, assess to confirm client is alive by checking rise and fall of chest, feeling pulse and passing finger around nostrils to perceive breathes, accept patient if alive.
  • Check for any special instruction from the case notes but if empty, obtain the instruction from the anesthetic nurse.

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POST-OPERATIVE CARE – CONT.

POSITIONING OF CLIENT

  • Ensure the appropriate lifting technique, supporting the client’s head and limbs in order to ensure airway patency.
  • Place client in an appropriate position

suitable for the condition or as per the

surgeon‘s order.

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POST-OPERATIVE CARE – CONT.

OBSERVATION

  • Assess level of consciousness using the Glasgow coma scale to subsequent nursing care.

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POST-OPERATIVE CARE – CONT.

  • Assess airway patency by observing for rise and fall of the chest – especially on NG tube.
  • When gurgling sound is heard, extend client’s neck and turn head to one side. If it’s still heard, prepare to suction the airway to drain retained fluid.
  • Monitor vital signs every 15 minutes for the first hour, 30 minutes for the next 2 hours, then hourly when condition is stable.
  • Observe wound site for soaked dressing which may indicate bleeding. Re-inforce dressing if bleeding occurs.
  • Monitor IV fluids to ensure it’s running at the appropriate rate.
  • If spinal anesthesia was used, assess for return of sensations and mobility of limbs.

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POST-OPERATIVE CARE – CONT.

  • Begin wound dressing as per hospital protocol or surgeon’s instruction. The first is usually done on the third day after surgery with dressing changed.
  • Assess pain using a pain scale, e.g. Wong-Baker Faces Pain Scale.

OTHER MANAGEMENT

  • Administer pain medication as prescribe, Provide diversional therapy – Our TV.
  • When bowel sounds return, encourage sips of water or plain tea and graduate into light soup, and then heavier feeds.
  • Change diapers as soon as client fills them and change dirty linen to avoid pressure sores.
  • If client is bed ridden, turn them regularly.

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THANK YOU

Ask

Simple

Questions.

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PHOTO CREDIT

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