Pre and Post op Care

By

Elaine Jones + Anne Wright.

Definitions.

Perioperative nursing is a term used to describe the nursing functions in the total surgical experience of the patient, pre operative, intra operative, and post operative

(Lipincott Manual of Nursing Practice 6th edition)

Pre operative phase.

This is from the time the decision is made for surgical intervention to the transfer of the patient to the operating room.

Intra operative phase.

This is from the time the patient is received in the operating room until transferred to the recovery room.

Post operative phase.

From the time of transfer to the recovery room to transfer back to ward.

Types of surgery.

Day

Elective

Emergency

Urgent

Required

optional

Surgery

Criteria for day surgery selection.

Surgery for short duration ( up to 60 minutes). Type of operation in which post operative complications

are predictably low. Age (based on biological/physiological age rather than

chronological). BMI. Support at home for 24 hrs within 1 hours journey from hospital access to telephone Adequate toilet facilities (inside)

Exercise 1.

On admission for surgery patients undergo an assessment, what factors need to be considered

Answers. Reason for admission Biographical information Current health status/illness Medications Symptoms/complaints/disabilities Previous medical problems Chronic illness Family medical history Nutritional status Integrated Care Pathway

Continued>>>>

Baseline observations. Specimen collection. Mobility Assessment. Nutritional assessment. Cardiovascular assessment Respiratory assessment. Urinary assessment. Social assessment Risk assessment

Psychological Assessment.

Patient may be anxious for numerous reasons……..

Suggestions….

Fear of the unknown Anaesthetic + side effects / not waking up Unrelieved pain Restricted in bed post op. Use of bed pan Body image /effect on relationship, family Dependant relatives. Financial problems if sole provider for family.

In what ways can the nurse alleviate anxiety in the pre op patient?

Pre operative education:-

Patient information leaflets, diagrams, posters

Pre op visit from recovery nurses.

Specialist nurses- pain control team, surgical nurse specialist.

Consent.>Legal requirement.

>Informed consent

Written consent should be obtained identifying that the subject has received and understood:-

The procedure offered Reasonable alternatives to the procedure Possible benefits of the procedure to the patient. Risks, inconveniences, and discomforts of the

procedure. Answers to all patient's questions.

(DOH 2001)

Immediate pre operative preparation.

What are the fasting requirements for a patient pre operatively?

It is routine to fast patients for a minimum of four hours before a general anaesthetic, to empty the stomach and avoid peri-or post operative vomiting, or regurgitation, which increases the risk of aspiration.

2hrs Preop for water (tap not fizzy)

Gastrointestinal preparation.

Is this required for all types of surgery?

Bowel evacuation is carried out :-

1. To prevent defaecation during surgery

2. To reduce the risks of accidental damage to the colon during abdominal surgery.

It is not required for all types of surgery, and should not be seen as routine.

Skin preparation.

Why is skin preparation necessary pre op?

It is necessary to remove dirt and transient micro organisms from the area.

Local procedures should be followed.

Hair removal.

Is this necessary pre op?

Controversial area of discussion!! Against Pre operative shaving increases risk of post

operative wound infection. In favour of shaving:- Avoidance of hairs trapping in the incision A clear field of vision.

Pre op check list.Exercise

Discuss each item on the checklist, and provide a rationale for its importance.

Feedback to group.

Premedication.

Prior to any pre medication being given, the nurse must :-

Ensure identity bands are worn and labelled correctly.

Consent form is signed by patient and doctor. Patient has voided urine. Check all other items on the checklist. Premedication to be given as prescribed at

appropriate time, with explanation to the patient.

Final check

Ensure checklist is with patients notes, along with consent form, x-rays, laboratory results, nurses records.

Patient is transferred to theatre.

POST OPERATIVE CARE

What factors should you consider when caring for a patient post operatively

(this starts from accepting the patient from the recovery room)

Post op careAnswers

Handover from recovery nurse to determine post op instruction from surgeon/anaesthetist

Observations ( Airway patency, level of consciousness,BP, pulse, respirations)

Temperature Wound check ( e.g per vagina, per rectum) Fluid balance (catheter, IVI, naso gastric tube,

catheter, wound drain) Pain (pain score, positioning, analgesia) General appearance (colour, pallor, sweating,

shivering)

Common post operative complications

Respiratory complications

Airway obstruction, chest infection

Cardiovascular complications

shock, haemorrhage, DVT, PE

Gastrointestinal

vomiting, constipation, paralytic ileus, retention of urine

Wound infection

ANY QUESTIONS !