Surgical management

3. INTRODUCTION:
The traumatic and emergency surgery most
often results in prolonged hospital stay for a
patient.
Patient who are acutely ill or undergoing
minor or major surgery may require the
supportive supplementary care.
The main objective of the peri-operative
nursing management is an to success the
surgical procedure, prevent the post-
anesthesia and post-operative complication.

4. CONTI….
Before the understanding of the pre-
operative nursing management we should
know about the Peri-operative phase.
The Peri-operative phase it is an period of
time that consist the surgical experience,
including the pre-operative, intra-operative
and post-operative phase of nursing care.

5. CONTI….
The peri-operative nursing management are
classified into mainly 3 phases following are:
Pre-operative phase
Intra-operative phase
Post-operative phase
The pre-operative phase is begins when the
decision proceed with surgical intervention is
made and ends with the transfer of the patient
onto the operation room bed.

6. CONTI….
The intra-operative phase begins when the
patient is transferred onto the operation
room bed and ends with the admission to
the PACU.
The post-operative phase begins with the
admission of the patient to the PACU and
ends with a follow-up evaluation in the
clinical setting or home.

7. In the pre-operative nursing management we are
discuss about the which care we will provide the
patient before the surgical intervention.

8. A) PRE-ADMISSION TESTING
B) ADMISSION TO SURGICAL WARD
C) IN THE HOLDING AREA OF OR

9. 1. PRE-ADMISSION
TESTING
The nurse should be collect and analyze the
patients demographic, health history and other
essential information for surgical procedure.
The nurse should be initiates the initial physical
assessment and its should be documented.
Initiates the education appropriate to patients
need. For example psycho-emotional support.
The nurse should be involve the other family
member in education or interview.

10. CONTI….
 The nurse should be verified the completion of
pre-operative diagnostic testing and reported to
the surgeon.
 The nurse should be verified the pre-operative
surgeon orders and reported to the head of
surgeon.
 The nurse should be discuss and review the
evidence and advance directive documents. For
example intake output chart and cardio-
pulmonary data.
 The nurse should be educate the patients and their

11. 2. ADMISSION TO SURGICAL WARD
 The nurse should be initiates the pre-operative
assessment and its should be documented in good
manner.
 The nurse should be assesses of the risk for post-
operative complication.
 The nurse should be reported the unexpected
finding in the patient. for example sudden
increasing the temperature or abnormal vital signs.
 The nurse should be verified the operative consent
has been signed by patients or their family
members.

12. CONTI….
 The nurse should be co-ordinate the patients and
plan the intra and post operative care with the
other nursing staff and other health workers.
 The nurse should be explain the period of Peri-
operative phases and expectation.
 The nurse should be answers patient and family
questions.
 The nurse should be assess and analyze the mental
status of the patient and family member when she
educating to them.

13. 3. IN HOLDING AREA
 In a holding area of OT the nurse should be
identifies the patient.
 The nurse should be assess the patients health
status, baseline pain, and nutritional status.
 In a holding area the nurse should be review
the medical records and if there is any changes
immediately report the surgeon.
 The nurse should be verifies the surgical site
and that it has been marked as per institutional
policy.

14. CONTI….
 Before the surgery the nurse should be
established the I.V. line in a patient.
 The nurse should be administer the medication if
prescribed.
 The nurse should be always the measure patients
comfort.
 The nurse should be provide the psychological
support to the patients and their family
members.
 The nurse should be always communicate with
the patient during this all phases.

15. In the preoperative assessment we will discuss
the which information nurse should be collect
before the surgical procedure.

16. PRE-OPERATIVE ASSESSMENT
 The pre-operative assessment is an assessment
of patient in which the profession nurses or
other health workers collect the information of
patients health before the surgical procedure.
 The pre-operative assessment is generally
collect the 2-4 weeks before the date of
surgery.
 The pre-operative assessment is an opportunity
to identify co-morbidities that may lead to
patients complication during anesthetic,

17. CONTI….
The pre-operative assessment are
classified into the 3 categories
following are:
I. Pre-operative history
II. Pre-operative examination
III.Pre-operative investigation

18. 1. PRE-OPERATIVE
HISTORY
 In the pre-operative history involve the history of
presenting complaint.
 The nurse should be collect the past medical
history of the patient such as any type of cardiac,
respiratory, renal, and endocrine diseases.
 The nurse should be collect past surgical history
such as patient had anesthesia, any type of minor
or major surgeries such as coronary bypass
surgery etc.

19. CONTI…
 The nurse should be assess the past and present drug
allergy history of patient.
 The patient had any type of drug allergy before. If
yes then which drugs? And why he consumed?
 The nurse should be assess the family history of
patient such an any genetic disorder, disease or co-
morbidity in family. Example diabetes, autoimmune
disorders like Rheumatoid arthritis.
 The nurse assess the social and personal history of
the patients such as smoking and alcohol intake
habits.

20. 2. PRE-OPERATIVE EXAMINATION
 The pre-operative examination is classified into 2
types first is General/physical examination and 2nd
is Airway examination (To predict the difficulty in
intubation)
 In the general examination nurse closely observe the
cardiovascular, respiratory or abnormal sign.
 The nurse should also observe the psychological
status of the patient to identify the any type of stress
related to surgical procedure.

21. 3. PRE-OPERATIVE INVESTIGATIONS
 In the phases of pre-operative assessment the
patients are undergoing lots of investigation and
its also mandatory in pre-operative phase.
 This investigations are help to identify any type of
diseases, abnormalities, and other co-morbidity in
patients
 This investigation is include complete blood count
for assess the anemia or thrombocytopenia and
other blood diseases
 It also include the urine and electrolytes
examination.

22. CONTI….
 The liver function test and kidney function test also
may performed to identify liver and kidney
disfunction.
 In the phase of pre-operative assessment the
electrocardiogram is very essential investigation. By
the ECG we are find out the any history of
cardiovascular diseases.
 The chest X-ray is also performed to identify the any
respiratory illness and significant history of
smoking.
 The Spirometry investigation is also useful the

24. PRE-OPERATIVE NURSING DIAGNOSIS
The nursing diagnosis is totally based on the
assessment of data and patients chief complaints :
Deficient knowledge related to unfamiliarity with
information recourses
Fear and anxiety related to the surgical incision
or situational crisis.
Risk for injury related to immobilization or
obesity
Risk for imbalance body temperature related to
exposure to cool environment or uses of

25. CONTI….
Risk for imbalance cardiac out put related
to fear and anxiety of surgical procedure.
Imbalance nutrition pattern less than body
requirement related to loss of appetite.
Disturbance in sleeping pattern related to
the excogitate of post-operative
expectation.
Activity intolerance related to loss of
appetite.

27. 2. INTRA-OPERATIVE PHASE
A) MAINTENANCE OF SAFETY
B) PHYSIOLOGICAL MONITORING
C) PSYCHOLOGICAL SUPPORT

28. 1. MAINTENANCE OF
SAFTETY
 The nurse should maintain and follow the aseptic
methods while doing any procedure.
 The nurse should be effectively manage the human
resources and surgical equipment.
 After the identifies patient the nurse should be
transfers patients to the operation room bed or table.
 After the transferring patient the nurse should be
provide the position to the patient according to
surgical site and exposure in well manner.
 The nurse should be applied the grounding devices to
patients. Eg. P.O.M., O2(if needed).

29. CONTI….
The nurse should be ensures that sponge,
needles, and other surgical equipment count are
correctly.
The nurse should complete the intra-operative
documents.
That all documents cross-check and report to
the head of surgeon.
The nurse should be always observe health
status during intra-operative phase and
compares with previous phase.

30. 2. PHYSIOLOGICAL MONITORING
 The nurse should be calculate the patients fluid
loss or out put. Intake also calculate if the I.V.
fluid administer.
 The nurse should be assess the cardio-pulmonary
data and compares with the previous data.
 If there is any changes in cardio-pulmonary data,
immediately report to the surgeon.
 The nurse should always assess the vital sign of
patient and documented in well manner.

31. 3. PSYCHOLOGICAL SUPPORT
The nurse should be provide the psycho-
emotional support to the patient before the
pre-anesthesia phase, post-anesthesia
phase.
The nurse should be stand near the patient
and touche to him during surgical
procedure.

33. INTRA-OPERATIVE NURSING DIAGNOSIS
The nursing diagnosis is totally based on the
assessment of data and patients chief complaints :
Fear and anxiety related to surgical incision.
Risk for latex allergy response related to possible
exposure to latex products in the operation room.
Risk for peri-operative injury related to positioning
to operation room.
Risk for infection related to anesthesia and surgical
procedure.
Risk for unconsciousness related to OR
environment.

35. 3. POST-OPERATIVE PHASE
A) TRANSFER THE PATIENTS TO P.A.C.U.
B) POST - OPERATIVE ASSESSMENT
RECOVERY AREA
C) SURGICAL NURSING UNIT
C) HOME AND CLINIC CARE

36. 1. TRANSFER THE PATIENTS TO
P.A.C.U.
In post-operative care the nurse should be
identify the patients by name.
The nurse should be observe the status of
operated area for example bleeding from the
incision.
The nurse should be identify the type and
amount of anesthesia
The nurse should be identify the analgesics
agents used.

37. CONTI….
 Report the post-operative assessment, vital sign
and it should be documented good manner.
 The nurse should be report the post-operative
cardio-pulmonary data and it should be also
documented.
 The nurse should be assess the intra-operative
factors for example insertion of drains, catheters,
administration of blood, medication during
surgery.
 The nurse should be describe the physical
limitation.

38. CONTI….
 Communicates the necessary equipments needs
for example dressing trolley
 Explain the all phases of surgical procedure to
family members.
 The nurses should be continually observe post-
anesthesia recovery of patients.
 The nurse should be check the how many fluids
loss during the surgical procedure & PACU ( If
patients with catheter)

39. 2. POST-OPERATIVE ASSESSMENT
RECOVERY AREA
 After the surgical procedure the nurse should be
determine the response to the patients.
 After the surgical procedure the nurse should be
monitor the cardio-pulmonary data, vital sign
and physiological status of patients and it should
be documented.
 The nurse should be assess the conscious level of
patient.

40. CONTI….
The nurse should be assess the pain level of
patient and administer the appropriate
analgesics agents.
The nurses should be determine the
ventilation of patient room, airway secretion,
blood circulation.
The nurse should be administer the
medication, electrolyte fluid, blood
component therapy as per physician orders.

41. CONTI….
The nurse should be provide the oral fluid
to ambulatory surgery patients.
The nurse should be assess the patients
readiness for a transferring into post-
operative surgical ward as per institutional
policy.
The nurse should be record all post
operative documents and reported to
surgeon.

42. 3. SURGICAL NURSING
UNIT
The nurses should be continuously monitor
the patients physical and psychological
response.
Assess the patients pain level and
administer the appropriate analgesics.
Provide the health education to patients
regarding immediate recovery period. For
example diet, medication.

43. CONTI….
Before the discharge planning the nurse
should cross-checked the patients physical
& psychological status.
The nurse should be assess the recovery of
patients and prepare the discharge
planning.

44. 4. HOME AND CLINIC
The nurse should be provide the follow up
care by office, clinic, visit and telephone.
The nurse should be answers the question of
family regarding follow up care.
The nurse should be explain the side-effects
of medication to patient and their family
members.

46. POST OPERATIVE NURSING
DIAGNOSIS
The nursing diagnosis is totally based on
the assessment of data and patients chief
complaints :
Risk for ineffective airway clearance related to
complete bed rest or sedation.
Acute pain related to the surgical incision.
Decreased cardiac out-put related to
hemorrhage or shock.
Risk for activity intolerance related to surgical
incision or weakness.

47. CONTI….
Impaired skin integrity related to surgical
incision or drainage equipment.
Risk for imbalance body temperature related to
post-operative medication.
Risk for imbalance nutrition pattern less than or
more than body requirement related to decreases
or increase food intake.
Risk for constipation related to effects of
medication, dietary changes and immobility.

49. 1. INTRODUCTION
The pre-operative, intra-operative and post-
operative patient subject to several risk for a
complications
The peri-operative complication is defined as it
is an unexpected problems or illness are arises
in patient before surgery, during surgery or
after the surgery.
This complication may interrupting in the
patients prognosis and it may also risk for death
to patients.

50. CONTI….
This complication may result in failure of
the surgery which is life threatening
condition for patient.
The patients undergoing sedation or
anesthesia may result in loss of cognitive
function and self protection mechanism.
Approximately one third of surgical
patients are 65 year of age.

51. CONTI….
Pre-operative complication is very
uncommon. Most often it is occurs due to
pre-operative medications.
Older and adult patients are at higher risk for
complication from anesthesia and surgery
compared with younger peoples.
As a responsible nurse we should be predict
this all factors to prevent the complication.

52. 2. CLASSIFICATION OF PERI-
OPERATIVE COMPLICATION
 The peri-operative complications are classified
into mainly 2 categories following are:
A. Potential Adverse effects of surgery
and Anesthesia
B. Systemic complication of surgery

54. 1. ALLERGIC RE-ACTION OF
SURGERY AND ANESTHESIA
The allergic reaction of surgery and anesthesia
can happen, but its not very common. It’s
estimated that 1 out of every 10,000 cases.
The symptoms of allergic reaction to
anesthesia are similar to those of other allergic
reaction. The symptoms of mild and moderate
allergic reactions including following are

55. CONTI….
Skin rash, hives, itchy skin, swelling
especially around the eyes, lips or entire
face ( called as Angiodema).
Mild reduction of Blood pressure.
Mid shortness of breath.
Cough and sneeze.
Acute chest pain due to breathlessness.

56. 2. SEVERE ANAPHYLAXIS
Anaphylaxis is an severe, potentially life-
threatening allergic reaction.
It is an occur within seconds or minutes of
exposure to allergic drugs substance.
The symptoms of anaphylaxis may include
severe shortness of breath due to extreme
secretion of mucus.

57. CONTI….
Severe hypotension.
Arrhythmia ( abnormal heart rhythm) fast
or slow
Cardiac arrest or heart failure.
Nausea, vomiting.
Dizziness or sudden unconsciousness.

58. 3. MYOCARDIAL DEPRESSION
The cardiovascular system is play a key role
in human body. Collapse of Circulatory
system is life threatening condition for a
human.
Myocardial depression is not clearly defined,
but it is related to the dysfunction of the both
left- right atriums & ventricles.
The myocardial depression is a common
finding associated with increase mortality.

59. 4. SEIZURES & CONVULSIONS
 Due to the preoperative medication and anesthesia
patient having a risk of the seizures and
convulsions.
 A convulsion is an general term that describe the
uncontrolled muscles contractions due to
medication or anesthesia
 Seizures is defined as it is an disturbance of
electrical impulses in brain, that is also lead to
medication or anesthesia

60. 5. OVER SEDATION & UNDER
SEDATION
The over sedation is refer to extreme loss of
consciousness with respiratory depression
due to high amount of anesthesia.
There is high risk for collapse of cardio-
circulatory and respiratory system due to
over sedation.
It is also very severe and life threatening
condition for patients.

61. CONTI….
Under sedation is refer to small amount of
anesthesia administer in long term
surgical procedures.
Under sedation create very painful
situation for patient during intra-operative
phase.

62. 6. HYPOXEMIA
Hypoxemia it is an very common
complication happen in patient.
Hypoxemia is refer to abnormally
decrease of oxygen level in blood.
The hypoxemia is commonly occurs
due to hypoventilation or inadequate
respiratory support.

63. 7. THROMBOSIS
The thrombosis is defined as it is an
process of blood clot in a blood vessels due
to compression of the blood vessels.
Compression of blood vessels are arise due
to effects of pre- and intra operative
medication and that’s leads to thrombosis
which is very fatal factor for patient health.

64. CONTI….
If the patient with thrombosis the
physician usually administer the
anticoagulant drugs to dissolve the blood
clot.

65. 8. ORAL & LARYNGEAL
TRAUMA
Oral and laryngeal trauma is an common
complication in peri-operative phase
which is happen due to seizures &
convulsions.
If patient with oral & laryngeal trauma
due to anesthetic agent, the surgeon
should take design regarding postponed of
surgery immediately.

66. 9. HYPOTHERMIA & HYPERTHERMIA
The hypothermia is indicate reduction of
body temperature below the 36.6*C.
Due to the anesthetic agents, cool
temperature of OR room, infusion of cold I.V.
fluid patient body temperature may fall.
The metabolic acidosis may occurs due to
reduction of glucose metabolism, that’s
chemical reaction may result in hypothermia.

67. CONTI….
The hyperthermia is indicate the increased the
body temperature more than normal range
(37*C).
The hyperthermia is occur due to anesthetic
agents and as well as post operative infection.
The mortality of malignant hyperthermia had
been reported 70% last 10 year.
The symptoms of malignant hyperthermia are
increased the temperature with cardiovascular
and respiratory changes.

68. 10. HYPOTENSION & HYPERTENSION
The hypotension & hypertension may also
arise due to pre-operative medication and as
well as anesthetic agents but its rare in
normal patient.
Its is an very common complication when a
patient with any cardiovascular diseases.
Mostly patient having a risk for hypotension
due loss of blood during the intra-operative
phase.

69. 11. INFECTION AND GANGRENE
TO OPERATED SITE
The infection on surgical site is very
common during intra-operative and post
operative phase.
Its occurs due to unsterile surgical
procedure, unsterile dressing procedure &
unsterile intra-operative factors
equipments.

70. CONTI….
Gangrene it is an necrosis of tissue and its
occurs due to chronic infection on surgical
site.
It is an very rare condition, but it is happen
if patient with blood coagulation disorders
such as hemophilia & endocrine disorders
such diabetes mellitus.

71. 12. REGURGITATION OF GASTRIC
FLUID
Regurgitation of gastric fluid is an very
common complication in intra-operative
phase which is occurs due to food intake in
pre-operative phase.
But some time nausea occurs even patient
with empty stomach due to situational crisis.
If patient having major symptoms of nausea,
then physician may administer the antacid
immediately.

72. CONTI….
This complication mostly occur due to lack of
knowledge in patient. Hence, as responsible
nurse we should provide the knowledge to
patient regarding pre-operative phase.

74. The nursing diagnosis is totally based on the
assessment of data and patients chief
complaints :
Decreases cardiac out put related to loss of
blood during surgical procedures.
Imbalance body temperature related to peri-
operative medication & post operative infection.
Risk for infection related to anesthesia and
surgical procedure.
NURSING DIANOSIS IS FOLLOWING
ARE:

75. CONTI….
Fluid volume deficit related to excessive
loss of blood, hemorrhage.
Impaired skin integrity related to chronic
infection on surgical site.
Fear and anxiety related to situational crisis.

77. SYSTEMIC
COMPLICATIONS
The systemic complication is classified in
mainly 6 categories following are :
Respiratory complications
Cardiovascular complications
Neurological complications
Integumentrical complications
Gastro-intestinal complication
Excretory complications

79. 1. ATELECTASIS
Atelectasis is defined as it is an complete or
partial collapse of lungs called as atelectasis.
Atelectasis is also called as respiratory failure.
Due to the anesthetic agent and surgical
incision patient have high risk of atelectasis.
It is an common complication when patient
with lobectomy surgery. (Removal of lungs
lobe).

80. 2. PNEUMONIA
The pneumonia is defined as it is an
infection on the lung tissue with
accumulation of fluid in air sac called
as pneumonia.
This complication is commonly seen in
post-operative phase when patient with
respiratory surgery.

81. 3. PULMONARY EMBOLISM
Embolism is defined as it is an occurs
obstruction in artery due to blood clot
or air bubble.
Pulmonary embolism is a blockage in
one of the pulmonary arteries in your
lungs. In most cases, pulmonary
embolism is caused by blood clots.

82. CONTI….
Surgery is one of the leading causes of
blood clots. For this reason,
anticoagulation medication has been
prescribed to dissolve clots may be
given before and after major surgery,
such as joint replacement.

84. 1. THROMBOPHLEBITIS
Thrombophlebitis is defined as it is an
process of inflammation that occurs in veins
due to thrombosis (blood clot).
It is evidence of located pain especially in
legs.
The main symptoms of thrombophlebitis is
an swelling among the path of infected vein,
immobility of lower extremities because of
pain and swelling.

85. CONTI….
If the patient with major surgery like lower
extremities surgery there is high risk for
thrombophlebitis.
If patient with thrombophlebitis, the I.V.
fluid should be immediately stop.
If the patient with symptoms of
thrombophlebitis the physician may
administer the injection heparin to dissolve
the clots.

87. 2. HEART FAILURE
The hear failure is very common
complication when patient with heart
surgeries (for example Coronary artery
bypass grafting & heart valve replacement)
as well as anesthetic agent.
Heart failure is defined as it is an very
serious condition in which heart muscles
unable to pump enough blood to meet
body.

88. CONTI….
If the patient undergone cardiac surgery
may have a continues supervision to
evaluate the patient condition. If any
negligence is there then patient may risk
for a death.

90. 1. POST OPERATIVE DELIRIUM
Older patients recover more slowly and high
risk for development of post operative
complications. The post operative delirium is
one of them.
Post-operative delirium is defined condition
in which patient having a confusion, deficit
of cognitive functions, imbalance attention
level and disturbance in sleeping pattern due
to post-operative medication.

91. CONTI….
 The post operative delirium is most common
complication in older patient in post operative
phase.

92. 2. CEREBRO-VASCULAR-
ACCIDENT
The cerebro-vescular accident is also
known as stroke, ischemic brain stroke and
brain attack.
The CVA is defined as it is an sudden loss
of brain function due to disturbance of
blood supply in brain.
The severe haemorrhage may result in CVA
during intra-operative and post operative
phase.

94. 1. DEHISCENCE
Dehiscence is defined it is an severe
condition in which separation of surgical
sutures and occurs severe infection on
surgical part.
The cause of dehiscence is an infection,
obesity, malnutrition and increased the
abdominal pressure.

95. DEHISCENCE

96. 2. SURGICAL HEMATOMA
Hematoma is generally defined as a
accumulation of blood outside of blood
vessels.
The most commonly, hematoma are causes
by the injury to the wall of blood vessel. It
is an very common problems which is
occurs during surgery and after surgery.

97. SURGICAL HEMATOMA

99. 1. CONSTIPATION AND
DIARRHEA
The constipation & diarrhea is very
common in post operative phase due to
medication, dietary changes.
The constipation and diarrhea is very
common due to pre-operative and post
operative medication and dietary changes.
Constipation it is an infrequent bowel
movements or difficult passing stool.

100. CONTI….
The constipation may cure with
maintaining the I.V. fluid and enema to
patient in post operative phase but severe
diarrhea requires the antibiotics
medication with proper maintaining of I.V.
fluids.

101. 2. INTESTINAL OBSTRUCTION
The intestinal obstruction is defined as it is
an blockage of the intestine & obstruction the
digestive material.
Intestinal obstruction complication happen in
patient but cases are very rare. Mostly this
complication occur in post operative phase. It
is an very severe complication when patient
with gastro-intestinal surgeries.

102. 3. ABDOMINAL HERNIA
Hernia is defined as it is an condition in
which the organ is displaced from his
normal place.
In other concept, abnormal protrusion of
the organ called as hernia.
This complication is also very common
when patient with gastro-intestinal
surgeries.

104. 1. URINARY RETENTION
Urinary retention is defied as it is an inability
to pass of urine due to obstruction in urinary
track.
The urinary retention is common
complication if patient with renal calculi
surgery, bladder surgery & renal
transplantation.
This complication is very serious for the
patient health and occurs in post operative

105. 2. URINARY TRACK INFECTION
A urinary track infection (UTI) is defined
as it is an inflammation on urinary system
including kidney, ureters, urinary bladder
and urethra.
The most of UTI occurs when patient
with catheterization. This condition is also
called as catheter associated urinary track
infection.

107. The nursing diagnosis is totally based on the
assessment of data and patients chief
complaints:
Decreased cardiac output related to impaired
contractibility of heart muscles.
Impaired gas exchange related to loss of
respiratory function.
Hyperthermia related to infection. (eg. UTI,
Pneumonia)
NURSING DIANOSIS IS FOLLOWING
ARE:

108. CONTI….
Excess fluid volume related to unable to
pass of urine. (Urinary retention)
Impaired skin integrity related to
separation of sutures or infection on
surgical site.
Fear and anxiety related to decreased the
prognosis of patient health.

111. INTRODUCTION
The rehabilitation is a goal oriented process
which help to patient for increased self care
activity and daily living activity.
The rehabilitation is not only integral part of
nursing but it also main specialty of advance
nursing care.
The rehabilitation is an main specialty of
nursing care because of every major illness,
surgeries, disorders & injury carries the risk of
disability for patients.

112. CONTI….
The rehabilitation nursing is an specialty that
focus on returning patient to daily life activity
through a holistic approaches.
The rehabilitation approach is basic care
which is apply to all patients.
The ultimately goal of rehabilitation nursing
is to assist (help) patient to maintain optimum
level of health.

113. CONTI….
The scope of rehabilitation services is an –
If the patient with difficulty in taking,
hearing, walking, climbing stairs, lifting
and carrying object, performing daily living
activity & working at job.
The main objective of rehabilitation
nursing is an improve the capabilities in
patient to eliminate the physical, mental &
social disabilities.

114. CONTI….
The ideal rehabilitative nursing care
provided when all physician, health
workers, nurses and patient family members
are participate in rehabilitative services.
This all persons are provide education to
patient for cope up from the disabilities.
Before the providing the rehabilitative
services we should know the basic
principles of rehabilitation which is given
following are:

115. CONTI….
 The rehabilitation services encompasses all
domain of personhood for example domain of
physical, psychological, emotional, cultural,
spiritual and cognitive.
 The rehabilitation services is an continues
process.
 Rehabilitation services requires the active
participation of professional personnel's
including patient and their family.
 This professional personnel’s have a good

117. INTRODUCTION
The rehabilitation is a creative &
dynamic process that requires a team of
professionals working together with
patients and their family members.
The interdisciplinary team members
include health professionals who make a
unique contribution in rehabilitation
process.

118. CONTI….
The communication, co-ordination,
understanding of role & responsibility
and educational level of team members
are important aspect in build up
effective interdisciplinary
rehabilitation team. The members of
rehabilitation may include following
are:

119. CONTI….
The physician
Neuropsychologist
Physiotherapist
Trained nurses
Speech/ language therapist
Occupational therapist
Re-creational therapist
Counsellor

120. 1. THE PHYSICIAN
The physician is the leader of the
rehabilitation team. The physician assess the
patient carefully and monitor the patients
progress.
The physician decides which medical
services requires patient and design the
programme as per patient’s need.
The physician need to be an specialist in
rehabilitation services.

121. 2. NEUROPSYCHOLOGIST
 Often after the serious illness or major surgery a patient
may not able to behave or think as he use to before
illness or surgery. Especially this problems seen in
older peoples.
 Therefore, the neuropsychologist monitor this changes
and then design the effective programme to recover the
patient quickly. A neuropsychologist will educate the
family members of patient to accept this changes in
patient and way to deal with it.

122. 3. THE PHYSIOTHERAPIST
 After the traumatic injury or major surgeries a person
may suffer from the musculoskeletal problems and
issues. Therefore, such cases require the
physiotherapist.
 The role of physiotherapist is an improve the body
activity of patient. The physiotherapist focus on the
development of posture, strength of patient, physical
independence and proper body balance.

123.  The nurses who deal with rehabilitation patients
are trained to take care of the every needs of
patients.
 Often after the major surgeries or any injury a
person may difficult to take care of oneself.
Therefore the nurse are trained to take care of
patients.
 If the patients undergoing major surgeries or any
injuries, then nurses are responsible for
providing basic and daily needs of patients in
rehabilitative services.
4. THE NURSES

124. A patient suffering from any type of the post
operative delirium (loss of cognitive function)
there is require the speech language therapist to
motivate the patients for speaking.
Some time patient may also frustrated when he
is not able to communicate properly, so the
main objective of speech therapist is reduce the
frustration of patient and motivate the patient to
communicate to peoples.
5. SPEECH LANGUAGE THERAPIST

125. 6. OCCUPATIONAL THERAPIST
The work of an occupational therapist
is to make a patient learn advanced
independence skill that will help him
in various ways in his personal life
The occupational therapist teach
patient about the laundering, cooking
and shopping etc.

126. 7. RE-CREATIONAL THERAPIST
The re-creational therapist is to make a
patient include in all those activities
that the patient enjoys for example
brain game and puzzles games.
The re-creational therapist brings a
positive attitude in patient by the
learning of re-creational activities.

127. 8. COUNSELOR
 Health mind is very important in patients
because healthy mind will lead to a faster
healing any illness or injury.
 After the any kind of major surgery, traumatic
injury accident and major illness patient way
goes through depression and other negative
feelings.
 There is an important role of the counselor to
reduce the negative feelings by the counseling.

129. REHABILITATIVE NURSING CARE
The patient with self care deficit in activity of
daily living 1
The patient with impaired physical mobility
2
The patient with impaired skin integrity 3
The patient with altered eliminatory pattern 4

131. ASSESSMENT OF PATIENT
 The nurse must observe and assess the patient’s
ability to performed the ADLs to determine the
level of independence e.g. bathing and required
items (soap, washcloth, water), drying the body
after bathing, dressing and clothing activity.
 The nurse assess and observe the self-feeding
activity such as bring food into the mouth,
chewing and swallowing of food.

132. CONTI….
 The nurse assess the toilet and bowel pattern of
patient including removal of cloths and
readjusting the cloths.
 The nurse should assess the grooming pattern of
the patient including hair combing, brushing of
teeth and shaving and applying makeup.
 During the assessment of patient, the nurse
aware about the medical condition of patient
and health problems of patients.

134. The nursing diagnosis is totally based on the
assessment of data and patients chief complaints:
 Self care deficit related to unable to bathing.
 Self care deficit related to unable to dressing.
 Self care deficit related to unable to self food
feeding.
 Self care deficit related to unable to toilet and
bowel activities.

136. ASSESSMENT OF PATIENT
 The mobility is restricted due to localized pain, major
surgeries, paralysis, loss of muscles strength, systemic
diseases and immobilizing devises such as cast and
brace.
 The nurse should assess the mobility including patient
positioning, ability to moving, muscles strength,
muscle tone and joint movements.
 The nurse should observe and assess the orthostatic
hypotension, skin pallor and skin discoloration and
diaphoresis.

138. CONTI….
 The nurse motivate and assess the patients ability to use
various assistive and adaptive devises that promote to
mobility.
 If the patient cannot ambulate without assistants, the
nurse recommended and advice to use of assistive and
adaptive devises such as crutches, pick up & rolling
walker, wheelchair, C-cane, functional cane and quad
canes.
 Before the advising assistive and adaptive devises the
nurse should identify the patients need of devises.

140. CRUTCH
WALKER

143. The nursing diagnosis is totally based on the
assessment of data and patients chief complaints:
 Impaired physical mobility related to wearing of
assistive and adaptive devises. (wheelchair,
walkers and canes)
 Risk for activity intolerance related to
immobilized of body.
 Risk for injury related to assistive and adaptive
devises.
 Impaired walking related to immobilized devises.
(Cast and Brace)

144. CONTI….
Fear and anxiety related to during use of
assistive and adaptive devises.

146. ASSESSMENT OF PATIENT
 Pressure ulcers or bed sore are localized areas of
necrotic soft tissue that occurs when pressure applied to
the skin.
 Lack of blood supply is occurs due to pressure on
prominent site.
 The nurse should assess the susceptible areas in patient.
(prominent site of bed sore)
 The nurse also assess the sensory perceptions of patient
skin especially prominent and susceptible areas of bed
sore.

147. AREAS OF SUSCEPTIBLE FOR PRESSURE
SORE
FRONT SIDE OF BODY
 Ear
 Shoulders
 Ribs cage
 Hip joint
 Knee joint
 Ankles joint
BACK SIDE OF BODY
 Occiput
 Scapula
 Elbows
 Spine
 Buttocks
 Ischial tuberosity
 Heels

148. BACK SIDE OF
BODY
FRONT SIDE OF
BODY