SEMINAR ON PRE AND POST OPERATIVE CARE

1. SEMINAR ON
PRE-POST OPERATIVE
CARE

2. • INTRODUCTION:
Surgery can be defined as the art and science of treating
diseases, injuries, and deformities by operation and
instrumentation.

3. PREOPERATIVE CARE/PHASE:
The preoperative phase begins when the decision to
proceed with surgical intervention is made and ends with
the transfer of the patient onto the operating room table.

4. DEFINITION:
The preoperative period runs from the time the patient is
admitted to the hospital or surgi center to the time that the
surgery begins.

5. 1.INFORMED CONSENT:
CRITERIA FOR VALID INFORMED CONSENT:
(av aids)

6. INFORMED CONSENT IS NECESSARY IN THE
FOLLOWING CIRCUMSTANCES:
• Invasive procedures
• Procedures requiring sedation and/or anesthesia.
• A nonsurgical procedure, such as an arteriography
• Procedures involving radiation

7. 2.ASSESSEMENT OF HEALTH FACTORS THAT
AFFECT PATIENTS PREOPERATEVELY:
(chain chart)

8. 3.PREOPERATIVE NURSING INTERVENTION:
Nurses have long recognized the value of preoperative
instruction. Each patient is taught as an individual, with
consideration for any unique concerns or needs; the
program of instruction should be based on the individual's
learning needs.

9.  When and What to Teach-
• give information and ask questions as they arise.
• Frequently, teaching sessions
• The nurse should guide the patient
–

10. • reduce the anxiety level of pt.
• Most institutions provide written instructions about many
types of surgery

11.  Deep-Breathing, Coughing, and Incentive
Spirometers :
• to teach the patient how to promote optimal lung
expansion
• The patient assumes a sitting position to enhance lung
expansion.
• addition to enhancing respiration, these exercises may
help the patient to relax.

12. • inform regarding medications are available to relieve pain
• The goal in promoting coughing is to mobilize secretions
so they can be removed.
• Deep breathing before coughing stimulates the cough
reflex. If the patient does not cough effectively,
atelectasis(lung collapse), pneumonia, and other lung
complications may occur.

14. COUGHING EXERCISE-

15.  Mobility and Active Body Movement
• to promote mobility improves circulation
• Exercises of the extremities include extension and flexion
of the knee and hip joints
• Exercises of the extremities include extension and flexion

17.  Pain Management
• determination between acute and chronic pain so that the
patient may differentiate postoperative pain from a chronic
condition.
• It is at this point that a pain scale should be introduced
and its use explained to the patient.

18. • The patient is instructed to take the medication as
frequently as prescribed during the initial postoperative
period for pain relief.

19.  Cognitive Coping Strategies-
• Cognitive strategies may be useful for relieving tension,
overcoming anxiety, decreasing fear, and achieving
relaxation.

20. Examples of such strategies include the following:
• Imagery
• Distraction Optimistic self-recitation-The patient recites
• optimistic thoughts ("I know all will go well").

21. 4.PREOPERATIVE PSYCHOSOCIAL
INTERVENTION:
• Reducing Preoperative Anxiety
• Decreasing Fear
• Respecting Cultural, Spiritual, and Religious Beliefs

22. 5.GENERAL PREOPERATIVE NURSING
INTERVENTIONS
• Managing Nutrition and Fluids
• Preparing the Bowel for Surgery
• Preparing the Skin

23. 6.IMMEDIATE PREOPERATIVE NURSING
INTERVENTIONS
• removal of jwellery
• Administering Preanesthetic Medication
• Maintaining the Preoperative Record
• Transporting the Patient to the Presurgical Area
• Attending the family needs:

24. 7.NURSING PROCESS-
Assessment
• Physical condition- including respiratory, cardiac, and
other major body systems.Results of blood tests, x-ray
studies, and other diagnostic tests
• Nutritional and fluid status
• Medication use, as previously described Psychological
preparedness for surgery (anxiety, fear, spiritual and cultural
beliefs)

25. Nursing dagnosis-
• Anxiety related to the surgical experience (anesthesia,
pain) and the outcome of surgery
• Fear related to perceived threat of the surgical procedure
and separation from support system • Knowledge deficit of
preoperative procedures and protocols and postoperative
expectations

26. Planning and Goals
The major goals for the preoperative surgical patient may
include relief of preoperative anxiety, decreased fear,
increased knowledge of perioperative expectations, and
absence of preoperative complications.

27. Nursing Interventions
• REDUCING PREOPERATIVE ANXIETY
• DECREASING FEAR
• PROVIDING PATIENT EDUCATION
• MONITORING AND MANAGING POTENTIAL
COMPLICATION

28. Evaluation-
• 1. Reports relief of anxiety
• 2.Reports that fear is decreased
• 3.Voices understanding of surgical intervention

29. POST OPERATIVE CARE/PHASE:
• extends from the time the patient leaves the operating
room until the last follow-up visit with the surgeon.
• This period - 1 week to several months.
• During the postoperative period, nursing care focuses on
reestablishing the patient's physiologic equilibrium,
alleviating pain, preventing complications, and teaching
the patient self-care.

30. • IMMEDIATE POST OPERATIVE STAGE :
It is described as the period of 1 - 4 hours after surgery.
• INTEMEDIATE POST OPERATIVE CARE:
It is the period of 4-24hour after surgery
• EXTENDED POST-OPERATIVE STAGE
This is the period of at least 1 to 4 days post operatively.

31. IMMEDIATE POST OPERATIVE STAGE :It is
described as the period of 1 - 4 hours after
surgery.

32. • Respiratory system-
monitor airway potency
• Observe chest movement for symmetry
• Monitor pulse oxymetry.
• Encourage deep breathing and coughing exercises
• Note the rate, depth, and quality of respirations
• Assess breath sounds

33. CARDIOVASCULAR SYSTEM-
• Assess skin and check capillary refill.
• Assess peripheral pulses.
• Assess for peripheral edema.
• Monitor for bleeding.

34. • Assess pulse for rate and rhythm.
• Monitor for cardiac dysrrhythmias.
• Assess for homan's sign.

35. MUSCULOSKELETAL SYSTEM-
• Assess for the movement of the extremities.
• client positioning and restrictions.
• Fowler's position after surgery to increase the size of
thorax for lung expansion

36. • Avoid positioning the client in a supine position until
pharyngeal reflexes have returned.
• If the client is comatose or semicomatose, position on
side and keep an oral airway in place.

37. NEUROLOGICAL SYSTEM
• Assess the level of consciousness.
• Orient the client to the environment.
• Speak in a soft tone.
• Maintain body temperature and prevent heat loss by
providing the client with warm blankets and raising the
room temperature as necessary.

38. TEMPERATURE CONTROL
• Monitor temperature.
• Monitor for signs of hypothermia that may result from
anesthesia.
• Apply warm blankets and continue oxygen as prescribed if
the client is shivering.

39. INTEGUMENTARY SYSTEM
• Assess surgical site, drains and wounds dressings.
Monitor for and document any drainage or bleeding from
the surgical site.
• Assess the skin for redness, abrasions or breakdown
that may have resulted from surgical positioning.

40. GASTRO INTESTINAL SYSTEM
• Monitor for nausea and vomiting.
• Maintain patency of the nasogastric tube if present.
• Monitor for abdominal distension.
• Monitor for return of bowel sounds.

41. RENAL SYSTEM
• Assess the bladder for distension.
• Monitor colour, quality and quantity of urine Foley's
catheter is present. Expect the client to void 6-8 hours after
the surgery, depending on the anesthesia used.

42. PAIN MANAGEMENT
• Assess for pain
• Enquire about the type and location of pain.
• Enquire about the effectiveness of the last pain medicat
• Administer pain medication,
• Use non invasive measures to relief pain including
distraction, comfort measures, positioning, back rub

43. INTEMEDIATE POST OPERATIVE CARE:
• It is the period of 4-24hour after surgery

44. • Respiratory system
• Cardiovascular system
• Musculoskeletal system
• Neurological system
• Integumentary system
• Renal system
• Pain management

45. EXTENDED POST-OPERATIVE STAGE
• This is the period of at least 1 to 4 days post operatively.
• Continue to assess and observe the client's body systems
during this stage.
• Monitor for signs of infection, such as redness,swelling and
tenderness at the surgical site, fever and leukocytosis.

46. • Encourage active range of motion exercises every two hours.
• Continue to encourage ambulation to promote the peristalsis
and the passage of flatus.
• Increase ambulation every day to increase muscle strength.
• Encourage the client to perform as many as activities of daily
living as possible.
• Instruct the client to have foods that are high in protein and
vitamin C content to promote wound healing.

47. POST OPERATIVE COMPLICATIONS & ITS
MANAGEMENT-
(flash cards)

48. CONCLUSION

49. ANY QUESTIONS?

50. THANK YOU