2. Surgery
Surgery is any procedure performed on
the human body that uses instruments to
alter tissue or organ integrity.
3. Reasons for surgery
Diagnostic
Curative
Palliative
Preventive
Explorative
Cosmetic
4. 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
5. A.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.
6. B.Intra operative phase.
This is from the time the patient is
received in the operating room
until transferred to the recovery
room.
8. A. PREOPERATIVE NURSING
CARE
Welcome and greet the patient to alley anxiety
and gain cooperation.
Introduce yourself to the patient to aid
understanding and allay anxiety.
Explain the procedure to the patient and
significant others.
Patient should sign consent form
9. Perform preoperative assessment.
Ask about patient’s current heath, allergies,
current medication, previous surgeries
understanding of surgical procedure and
anesthesia, smoking, alcohol and substance
abuse, social support, religious and cultural
considerations, mental status and activities of
living.
Check vital signs: temperature, pulse,
respirations and blood pressure.
Commence intravenous fluids
11. 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.
12. Carry out all investigation/interventions
ordered i.e. Full blood count + Grouping and
X- match.
Give patient nothing in the mouth for 6-8
hours before surgery depending on the type
of surgery and hospital protocol to prevent
vomiting and aspiration of stomach contents.
Ask patient to open bowels before or
administer enema if necessary.
Give a bath in the morning of surgery for
hygienic purposes.
13. Allow patient to pass urine or catheterize to
prevent bladder trauma during the procedure
Check vital signs and record to serve as
baseline data in order to detect any deviation
from normal during surgery.
Remove jewelry and dentures to prevent trauma.
Put identification band on the patient to ensure
that the procedure will be done on the right
patient and right part of the body.
14. CONTD………………..
Give pre-medication an hour before surgery as
prescribed to meet requirement.
Preoperative teaching
Give the patient information about what will
happen to them and when, and what they will
experience such as expected sensations and
discomfort
Teach about ways of improving their recovery
such as:
How to move postoperatively.
Deep breathing and coughing exercises
15. How to splint incisions to ease pain when
moving or coughing
Leg exercises to reduce the risk of clots
forming in the veins in the legs
Teach the possible complications.
Dress patient in a theatre attire to reduce cross
infection
When theatre staff calls for the patient put
patient on a trolley
16. Take the patient’s notes, x-ray films,
laboratory investigation results and blood with
the patient. These may be needed before,
during and after surgery.
Take the patient to theatre and give full
handover to theatre staff for continuity of
care.
17. Pre op check list.
Exercise
Discuss each item on the checklist,
and provide a rationale for its
importance.
Feedback to group.
18. 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.
19. Final check
Ensure checklist is with patients notes, along
with consent form, x-rays, laboratory results,
nurses records.
Patient is transferred to theatre.
20. POST OPERATIVE CARE
Handover from recovery nurse to determine
post op instruction from surgeon/anaesthetist
Note patient’s time of arrival in the ward.
Assess airway for patency
Position the patient in recovery position
Assess breathing
Respiratory rate, rhythm and depth
Use of accessory muscles
Assess breath sounds
21. Assess circulation
Check the incision wound for bleeding.
Assess the patient’s skin colour
Heart rate, rhythm and strength
Capillary refill if necessary (OPTIONAL).
Assesses the level of consciousness
using Glasgow Coma Scale.
22. MAKES INITIAL OBSERVATION
Checks the theater notes to establish operation
performed, presence and location of any drains,
anesthesia used, estimated blood loss,
medications received in recovery room and post-
operative diagnosis.
Monitor vital signs such as Temperature, pulse,
respirations and Blood pressure ¼ hourly for the
first hour then ½ hourly for the next hour then 4
hourly if stable.
23. • Observe type and integrity of dressing and
drains
• Checks and secure , urinary catheter or any
drainages for patency
• Checks fluid status
- Checks, records and interprets intake and
output
24. Assess activity and ability to move extremities.
RELIEVING PAIN AND ANXIETY:
Administer Opioid analgesia such as
Pethidine 50- 100mg intramuscularly when
the patient has regained consciousness
Make sure the patient is safe(raise side
rails)