PREOPERATIVE NURSING

The total surgical episode is called preoperative period. This period in the health care continuum include the time before surgery or the pre operative period, the time spent during the actual surgical procedure or intraoperative period. The period after the surgery is completed is postoperative period. Pre operative period: Each client responds differently to surgery. Therefore for each client

having surgery, a care plan based on the nursing process is developed. It is vital to identify potential risks and complications that may arise during the perioperative period. Pre operative nursing care is implemented by registered nurses who strives to assist the client by functioning in various roles. Medications with possible effects on the surgical client: Antibiotics; i. ii. entamicin Penicillin

Effects: Produces mild respiratory depression may mask infection and affect metabolic of muscles rela!ants. Anti dysthythmic agents: i. ii. iii. Propranalol "#l $ffects tolerance of anesthesia interacts with Epinepheine use in local anesthesia. %uinidine gluconate & depresses cardiac function Procainamide "cl & potentiates anesthetic agents that are

neuromuscular blockers.

Antihypertensi e Agents i' ii' Methyldopa & May alter response to muscle rela!ants and narcotics. #aptopril & May cause intraoperative or post operative hypertensive crisis. !ortico steroids: i. ii. iii. (e!amethasone & (elays would healing "ydrocortisone sodium & asks infection Prednisone & Increases serum glucose, decreases stress responses

Anticoag"#ants: i. ii. iii. E$$ects: Increases risk of hemorrhage intra operatively and post operatively because of clotting abnormalities. Tricyc#ic Antidepressants+ i' $mitriptyline , amo!apine & -owers blood pressure, thus increasing risk of shock. %eta Adrenergic %#oc&es: i' ii' E$$ects: $ntidysrhythmic and antihypertension which can cause adverse effects when combined with anesthetic agents. $trenalol Propranalol "eparin sodium) *arfacin sodium $spirin

Anesthesia ' Anesthetic Ris&: The anesthesia care provider visits the client before surgery to perform a complete respiratory. #ardiovascular and neurologic e!amination. The client)s general surgical risk is e!pressed according to the $merican society of $nesthesia .$/$' grading system. enerally, the topics discussed with the client

during their e!amination include the type of anesthesia planned and the sensations the client may e!perience when undergoing anesthesia. 0ear about anesthesia are also addressed. The pharmacologic preoperation for anesthesia is based on many variable including the client)s age and physical and psychological condition. The type of surgery anesthesia to be used. Preoperative anesthetic medications are also given for the clients. Pre OP Preparation: The nurse who is to accompany the patient to the theatre must ensure that 1. The patient is correctly identified, by verbal communication, by checking the arm band and by confirming the nature and si2e of operation. 3. The consent form has been signed and is taken to theatre with the case notes and ! rays. 4. 5eep the patient in 6P7 previous 8 hours and bladder to be voided. 9. The patient is correctly attend+ appropriate skin preparation has been carried out if and when necessary and warm blankets are available for transport. :. 0alse teeth should be removed, hair clips, rings and other ;ewelry are removed, to avoid the risk of burns if diathermy used.

Pre operati e (edications: Pre operative Medications are given to allay an!iety, to decrease pharyngeal decretions, to reduce side effects of anesthetic agent sand to induce amnesia. Pre operative medications may be given in the pre operative holding area or on the nursing unit. <efore administering pre operative medications, ensure that the operative permit is correctly signed because legal consent cannot be given by a medicated adult. $fter administering pre operative medication, make sure the bed is in the lowest position and the side rils of the lbed are raised to prevent in advertent falls. 7bserve the clients) foreside effects .e.g.= hypotension and respiratory distress. #7MM76-> ?/E( P@E 7PE@$TIAE ME(I#$TI76/ Medications (esired effect TranBuili2ers (ecreases an!iety (i2epam .Aacum' Produce an (roperidol .Inaspine' antiemetic effect /edattives: Mida2olam "# Prometha2ine "#-.phenorgan' $nalgesies Morphinesulfate Meperidine "# .(emerol' Introduces desired sleepiness (ecreases an!iety /ame as per droperiodol @elieves pain (ecreases an!iety sedation /ame asmorphinesulphate ?ndesired effects May cause di22iness, clumsiness or confusionC an!ietyChypertension during and after surgery "ypo tension, undesired respiratory depression

@espiratory depression, "ypertension, circulatory depression /ame as morphine

INTRA OPERATIVE PERIO)

The nurse remains the client)s advocate during this period. $nticipating and guarding against potential complications. The anesthesia provider

concentrates on the clients breathing and on maintenance of the client)s physiologic stability. Anesthesia: $nesthesia is an artificial induced state of partial or total loss of sensation with or without loss of consciousness. $nesthesia agents produe

muscle rela!ation, block transmission of pain nerve impulses and suppress refle!es. The depth and effects of anesthesia are monitored by observing changes in respiration. 7!ygen saturation and end tidal carbon dio!ide .#o 3' leds, heart rate, urine output and blood pressure. Administration o$ genera# anesthesia: eneral anesthesia can be administered in a variety of ways. The most common method of administering anesthesia is to use a combination of type of surgery. This type is Dneuro lepticE or Dbalanced anesthesiaE Ne"ro m"sc"#ar b#oc&ing Agention: 6euro muscles blocking agents are classified as Ddepolari2ingE and non depolari2ingE. These agents block the transmission of nerve impulses to the muscle fibres common muscle rela!ants are sucunylcholine, tubocurasine, pancuronium and vecuronium.

Types of general $nesthesia: i. ii. Intravenous $nesthesia Inhalation $nesthesia

GENERA* ANEST+ETI! AGENTS Inha#ation agents: 6itrous 7!ide: Gas has very low anesthetic potency, so it must be used with other agents. 6o muscle rela!ant properties. "alothane: .0luothane' & Aolatile liBuid with high anesthetic potency.

/o it could be used alone. *eak anesthetic effect moderate decrease in <P and -arge decrease in respirations. Enflerane: .Ethane' Volatile liBuid with fairly high anesthetic potential has weak analgesic effect causes moderate decrease in <P and large decrease in the respirations and also a moderate muscle rela!ant too. Intra eno"s dr"gs: Thiopental sodium .Pentothal': /hort acting barbitant that produce

rapid unconsciousness, a weak analgesic and muscle rela!ant. 0entanyl litrate droperidol .Innovar' $ potent opiroid .fentanyl' combines with a neuroleptic produces indifference to surroundings and intensity to pain .6/ depression'

6euro muscular blocking $gents Pancuronium bromide .pavulon' 6on depolari2ing agent prevents

acetylcholorine from binding to the receptors on muscle end plate blocking depolari2ation. Aecuronium bromide .6orcum' 6on depolari2ing agents prevents

accetylcholorine from binding to receptors on muscle end plate, blocking depolari2ation. /$uccinylcholrine chloride .anectine' & 6on depolari2ing agent that

prolongs depolari2ation of the muscles and end plate These are all the main neuro muscular blocking agents. *hen genial

anesthetics are given with these agents and then latter can be given in smaller and thus safer closes. OT care $or patient d"ring s"rgery: Room preparation: The 7T should be fully sterili2ed and also septic techniBues are practical as each surgical item is opened systematically on the instrument table. /crubbing, growing and gloving procedures to be carried out before starting the surgery. Positioning the patient: In various positions the patients have to be placed before surgery such as, supine, pione, trend elenburg, lateral, kidney, lithotomy. *hatever position is reBuired for the procedure, great care is taken to prevent in;ury to the patient.

Sa$ety considerations: -aser of electro surgical units can cause in;ury to the patient and staff. The nurse must be familiar with fire safety issues to protect the patient and staff against burns. @ole of 7T 6urse+ 6ursing role isn the intra operative setting change and evolve as technology and health care changes. 7ne of these change in the use of @60$ .@egistered nurse first assistant' The nurse must have formal education for this role and works collaboratively with the surgeon patient and surgical team by handling tissue, using instruments, providing e!posure to the surgical site, assiting with homeostasis and suturing.

POST OPERATIVE PERIO) The post operative period of surgery is the third and final stage of the preoperative period. 6ursing care continues to be a critical element in returning the client to an optimum level of function. POST ANEST+ESIA !ARE UNIT+ The goal of post anesthesia nursing is to assist an uncomplicated return to safe physiologic function after an anesthetic produce by providing safe, knowledgeable, individuali2ed nursing care for clients and their family members in the immediate postFanesthesia phase.

Promote com$ort $ll clients who have ;ust had surgery will e!perience pain. Pain

medication should be given when needed and before the pain becomes severe. *hen pain becomes too severe, more medications and a large time are needed for the medication to tae effect. Post operati e N"rses responsibi#ities The nurse must always accompany the patient back to the ward. 7n return to bed, patients should continue to be nursed on their side without a pillow. conscious. The operated site should be inspected regularly for bleeding. If the patients having airway problems means it will developcynosis. /o o!ygen should be administered $nd also the nurse must take cae of all these aspects after receiving the patient from surgery. o Post operative pain o Post operative vomiting o The care of mouth o Maintenance of nutrition o (eep breathing e!ercise $ nurse must stay with them until they are fully

Red"ce Na"sea and Vomiting + Aomiting is a refle! and it is stimulated in many ways. /timuli arise from gastrointestinal tract distention or irritation. /everal medications stimulate the #TG, .chemoreceptor trigger 2one' .which is located in the floor of 9th ventricle in the brain' including morphine, reperidine, cardiac glycoside and amphetamines. 0or control of P76? and include i. ii. iii. $nticholingergics and histamine type 1 ."1' receptor antagonists. $ntidopaminergic drugs which depresses the #TG. astrointestinal antispasmodics, which promote forward penstalic movement. !onc#"sion: The nurse plays a critical role in the preoperative care of thelcient. 6o matter what type of surgery is performed. "owever the client needs e!pert

nursing care. The Buality of nursing care can determine whether the client has a successful preoperative e!perience. %I%*IOGRAP+,: 1. 3. 4. Hoyce M. <lack, Hane "okanson "awks DTe!tbook of Medical surgical 6ursingE seventh edition volumeFI -ewis "eitkemper DTe!tbook of Medical surgical 6ursingE si!th edition, Mosby publishers P.6o.48=F4I4. <runner , /uddarth)s DTe!t book of Medical /urgical 6ursingE eleventh edition, volume J I, -ippincott publishers P.6.9KLF:34.