Pre & Post Operative Nursing Care

8/4/2019 Pre & Post Operative Nursing Care

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PRE & POST OPERATIVE

COMPLICATION & NURSING

CARE

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PRE OPERATIVE CARE

Pre operative care begins at thetime of decision of surgery.

The purpose of care is to preparethe patient both physically &

psychologically.


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PSYCHOLOGICAL

PREPARATION

1) In psychological preparation surgeonshould explain to the patients & hisrelatives:

A. What is to be done?

B. The probable outcome

C. Expected duration of hospitalization

D. Cost of operationE. Duration of absence from work

F. Expected disabilities

G. About Anesthesia


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2) Help the patient to talk about his fear& give him every opportunity to askquestion.

3) Each procedure & examination shouldbe well explained to the patient &relatives.

4) Avoid too many visitors which may

interfere the patient from gettingadequate rest.

5) Take consent from patient ( if pt is able

to give) or relatives & make sure thatconsent paper is attached in the filebefore shifting the pt in OR


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PHYSIOLOGICAL

PREPARATION

The most important preparations are

a) Respiratory preparations

b) Cardiovascular preparationc) Renal preparation

d) Nutritional status

e) Deep breathing & coughing exercise

f) Leg exercise


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RESPIRATORY PREPARATION

Routine X-Ray of chest is mostimportant to detect any lung disease

Signs of upper respiratory tractinfection must be noted.


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CARDIOVASCULAR

PREPARATION

Routine ECG should be done for adult

patients to detect any cardiac problem


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RENAL PREPARATION

Routine Urine examination & renalfunction test is important to rule outany UTI or any other renal disease


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NUTRITIONAL STATUS

Malnourished persons are more likelyto develop complications.

Dehydration & poor nutrition adverselyinfluence the operative prognosis.


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DEEP BREATHING & COUGHINGEXERCISE

Following persons will have to do deepbreathing & coughing exercise in the postoperative period

a) smokers

b) any history of pulmonary disease

c) pts who are receiving thoracic or high

abdominal incision

d) any cardiovascular operation


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LEG EXERCISE

Following patients have increasedincidence of post operative thrombusformation who will have

a) Decreased mobility after surgeryb) previous history of decreased peripheral

circulation

These patients should carry out legexercise pre-operatively & post operativelyas much as possible


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IMPORTANT PREPARATIONS

FOR OPERATIONS

IMPORTANT PREPARATIONS FOROPERATIONS

1) Keep the patient NPO from midnight oradvise by surgeon

2) clean the operative area & shaving theskin to prevent infection

3) Provide calm & quite environment forsleep

4) when patient awake up in morning checkvital signs & record it in file.


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5) Allow the pt to take bath (if possible)

6) Give clean gown to pt to wear

7) Tie hair with clip or give cap to wear.

8) Wigs, lenses & dentures should beremoved from pt before shifting him to OT.

9) Jewellery must be removed


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10)The pt chart must be accurate &completed & should contain theinformation that may be needed during &after surgery

11)All consent forms, Lab reports, X-Ray ,ECG attached carefully with file.

12) Shift the pt to OR by stretcher.


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POST OPERAIVE CARE

When the patient received in the wardfollowing conditions should bechecked.

1)Comfortable bed for the patient.

2) Level of consciousness

3) Check respiratory tract whether the airwayis clear or not

4) Check respiratory status


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5) Check circulatory status:

Vital signs Color & Temp of skin

6) Check the wound for dressing ( any

bleeding) , presence of any drainage

7) Check IV cannula for any displacement &IV Fluid on flow


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8) Necessity of side rails:

Patients proper position

Presence of pain

Nausea or vomiting

9) Keep proper record of Intake/Output chart

10) Check patients chart & surgeons order &carry out the order properly.


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A. SHOCK

NURSING MANAGEMENT:

Assess level of consciousness.

Pulse quality & rate changes.

Fluid resuscitation.


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Nursing management:

Inspect the wound as a possible site of

bleeding.

Increase IV fluid infusion rate & administerblood if necessary as soon as possible.

Immobilize fractures to minimize blood

loss.
http://www.dicts.info/img/ud/bleeding.jpg


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Numerous, rapid blood transfusionsmay induce coagulopathy &

prolonged bleeding time .The patientshould be monitored closely forsigns of increased bleedingtendencies following such

transfusion.


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Nursing management :

Avoid rubbing or massaging calves andthighs.

Encourage leg exercises and ambulate thepatient as soon as permitted by thesurgeon.

Initiate anticoagulant therapy eitherintravenously, subcutaneously, or orally asprescribed.


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Nursing management:

Monitor the patients progress carefully on

a daily basis for the first postoperativeweek to detect early signs & symptoms ofrespiratory difficulties.

Promote full aeration of the lungs.

Initiate specific measures for particularpulmonary problems.


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Administer oxygen with the patient in anupright sitting position if possible.

Reassure and quiet the patient.

Monitor vital signs, ECG, and arterial blood

gases.
http://www.faqs.org/photo-dict/photofiles/list/6508/8579oxygen_mask.jpg


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Massive PE is life threatening andrequires immediate interventions to

maintain the patientscardiorespiratory status.


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Assist patient to sit or stand if permissiblebecause many patients are unable to voidwhile lying in bed.

Provide the patient with privacy.

Catheterize only when all other measuresare unsuccessful.


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recognize that when a patient voidssmall amounts ( 30-60 ml every 15-

30 minutes ), this may be a sign ofan overdistended bladder withoverflow of urine.


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relive abdominal distention by passing anasoenteric suction tube.

Replace fluid and electrolytes.

Assess bowel tones and degree ofabdominal distention (may need tomeasure abdominal girth) ;document thesefindings every shift.

Monitor and document characteristics ofemesis and nasogastric drainage.


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Nursing management:

Stay with the patient and have someonenotify the surgeon immediately.

If intestines are exposed , cover withsterile moist saline dressing .

Assure the patient that the wound will beproperly cared for ;attempt to keep patientquiet and relaxed.
http://www.epmonthly.com/whitecoat/wp-content/uploads/2009/06/Wound-dehiscence-.jpg


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a. Keep dressing intact

b. Use strict asepsis when dressing arechanged.

c. Monitor and document amount type and

location of drainage. Ensure that alldrains are working properly
http://drbloem.files.wordpress.com/2008/10/pk081011d.jpg


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No surgery is without risk. No matterhow short or small , every invasiveprocedure can potentially injure.

Just as there is no guarantee as tothe outcome of any operation , thereis never a guarantee that anoperation will be without

complications.


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THANKS

Documents

Pre & Post Operative Nursing Care