Pre and Post Operative Carefor

Patients undergoingGeneral Anesthesia

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

Pre - Operative PhaseDecision for Surgical Intervention

toTransferring Patient to Operating

Room

Intra - Operative PhasePost - Operative Phase

Patient Received in Operating Roomto

Admitting to Post Anesthesia Care Unit (PACU)

Admitting to Post Anesthesia Care Unit (PACU)

toFollow up Evaluation

INTRODUCTION

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

Internal Fixationof Fracture

Elective :

Required :

Urgent :

Emergency :

Scheduled Time Example

At the Convenienceof the Patient

Within a Few Weeks

As soon as Possible

Immediate Surgicalattention required

without Delay

Superficial Cyst

Eye Cataract

IntestinalObstruction

Types ofSurgery

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

Pre – Operative CareVital Componentof the

Surgical Experience

Patient Education

General Instructions

Obtaining a DatabasePlan and Implement Teaching Program

Determining what the Patient knows or wants to know

Determine the Cultural or Religions Health Beliefs and PracticesProvide time & Encourage the Patient to Ask Questions

Begin at Patient’s Level of Understanding

Include Family Members & Significant Others in the Process

Encourage Patient’s Active Participation in their Care & Recovery

Plan and Implement Teaching Program

Assign the Patients Level of Interest in or Reaction to it Explain Details of Pre Operative Preparation & Provide a Tour of the Area & View Equipment when Possible

Offer General Information on SurgeryApprox. How long it will take, about PACU, etc.

Explain how a Test or Procedure may Feel,during or Afterwards

Describe PACU & what Personnel & Equipment the Patient may expect to See and Hear

Document what has been taught, discussed, Patient’s Reaction & Level of Understanding

Discuss with Patient the anticipated Post Operative Course

General InstructionsIncentive Spirometry

The Patient uses an Incentive

Spirometer to measure deep breathes while

exerting maximum effort

Coughing

Coughing promotes the removal of

Chest Secretions

TurningChanging Position from back to side-lying stimulates

circulation & encourages deep

breathing

Foot and Leg Exercises

Moving the Legs improves

Circulation and Muscle Tone

Evaluation of Teaching ProgramObserve the Point

for Correct Demonstration of

Expected Post Operative

behaviours

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

Gastrointestinal TractPREPARATION

OF OPERATIVE AREA

Skin AntisepsisHuman Skin Harbours Transient & Resident Bacterial Flora

Pre Operative Bathing with Chlorhexidine

Cleaning with a Bactericidal – Impregnated Sponge

Hair Removal should be done within 2 hrs at the Operative Site

Cathartics & Enemas remove Gross Collection of StoolOral Antimicrobial Agents

Provide Enemas until clear

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

PRE OPERATIVEMEDICATION

Administration of Systematic Prophylatic

Incrioperative Antibiotics is one of the most important

steps in preventing Surgical Site Infections

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

Admitting Patientto Surgery

Final ChecklistThe Pre Operative Checklist is the last Procedure before taking the Patient to Operating Room

Identification & VerificationVerbal identification – Checking Identification Band on Patient’s Wrist – Procedure to be Performed – Surgical Site marked by Surgeon – Surgeon & type of Anesthesia

Review of Patient RecordCheck for Allergies – History – Completed Pre Operative Checklist – Laboratory Values – Pregnancy Test – ECG – Pre Operative Medications

Consent FormObtaining Informed Consent is the Responsibility of the Surgeon performing the Specific Procedure

Patient Preparedness

NPO StatusProper Attire & Clean LinenSkin Preparation

IV Line Started with Gauge Needle

Dentures or Plates removedJewellery, Piercings, Contact Lenses and Glasses removed & Secured in a locked Area

Allow the Patients to Void

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

POST OPERATIVECARE

(PACU)

Initial Nursing Assessment

Verify the Patient’s Identity , Operative Procedure & the SurgeonObtain Vital SignsEvaluate Airway StatusEvaluate Respiratory Status and Auscultate Breath Sounds

Observe LOC and Orientation to Time & PlaceEvaluate conditions of Surgical Dressings & Drains and Check IV lines, Infusing Fluids or IV MedicationsDetermine Patient’s Pain level using a 1 to 10 scale

Review the Health Care Provider’s Orders

Initial Nursing Interventions

Maintaining a Patient Airway

• Closely monitor the Patient arriving with an Oral or Nasal Airway in place until awake

• Early initiation of CPAP (Continuous Positive Airway Pressure) in the PACU is Beneficial

Maintaining Adequate Respiratory Function• Encourage the Patient to take deep breath, use an Incentive Spirometer to aid this function• Assess lung fields through Auscultation•Periodically Evaluate the Patient’s LOC

Maintaining Glycenic Control

• Check Serum Glucose on arrival to PACU

• For Patients who are Diabetic, Administer Insulin and follow Protocols

Promoting Tissue Perfusion

• Monitor Vital Signs, normally every 15 mins• Monitor Intake and Output Closely•Recognize early Symptoms of Shock & hemoerrage

• Recognize factors that may alter circulating blood volume

Stabilizing Thermoregulatory Status

• Monitor temperature every 15 min & be alert• Provide warm Blankets for Patients feeling cold•Active warming with forced warm air

Maintaining Adequate Fluid Volume

• Administer IV, as Ordered• Evaluate mental status and Skin colour and Turgor•Recognizing signs of fluid Imbalance

Minimizing Complication of Skin Impairment

• Perform handwashing before and after contact with Patient• Inspect Dressing Routinely• Turn Patient Frequently & maintain good body alignment

Minimizing Sensory Deficits

• Avoid saying anything in Patient’s Presence that may be disturbing• Explain procedures at Patient’s of Understanding• Treat the Patient as a person who needs much attention

• Demonstrate concern for & an Understanding of the Patient & anticipates his/her needs & feelings• Tell the Patient repeatedly that the Surgery is over & that he/she is in the PACU

Introduction Types of Surgery Pre Operative Care Preparation of Operative Area Pre Operative Medication Admitting Patient to Surgery Post Operative Care

Lippincott Manual of Nursing Practice – 10th Edition (Pg. 102 – 115)

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