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
edition)

6th

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.
optional
Required

Day
Surgery

Urgent

Elective
Emergency

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?


1.
2.

Bowel evacuation is carried out :To prevent defaecation during surgery

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 care
Answers
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 !