For nursing instructions

1. Preparation of surgical
patients

2. Surgery

3. Anaesthesia

4. Deals with specific problem
Results into some common problems
• Pain
• Bleeding
• Immobility
Requires the utmost care

5. Care
Preoperative
Intraoperative
Post operative

6. Preop
Well before
• Consultation
• Investigations
• Co-existing diseases
• Preanesthetic check up
Just before
• Consent
• Booking
• Shave and clean
• Medications

7. Consultation
 Tuning of the patient
 An overview of the peri op management

8. Investigations
 Routine
 CBC with ESR
 S creatinine
 RBS
 HBsAg
 AntiHCV
 Urine RME
 ECG
 Chest x-ray
 Additional
 S electrolytes
 TSH
 HIV
 Liver function test
 Spirometry
 Echo

9. Co-existing Disease
DM
HTN
BA
Thyroid disease
Kidney disease
CLD

10. Intra operative
Sterilization
Check Preop
Tourniquet
Diathermy
Ot room
Hypothermia
Implants
Day care surgery
High risk population

11. Histopathology
•Purpose
•Medium to send

12. Postoperative care
Immediate postoperative care (the recovery phase)
Care on the ward until discharge from hospital
Continuing care after discharge

13. Immediate postoperative care (the
recovery phase)
close monitoring
•Airway
•Breathing
•Circulation

14. Airway and Breathing
all secretions must be cleared by suction
The artificial airway left until the patient can maintain his or her own airway
Breathing may be depressed and a patient hypoxic due to three factors:
• Airway obstruction
• Residual anaesthetic gases
• The depressant effects of opioids
Oxygen is given, ideally by mask, and
The oxygen saturation monitored by a pulse oximeter
Special care is needed for patients with a new tracheostomy
If there is concern about vomiting and the risk of aspiration, patients can be sat up or nursed head-up rather than supine

15. Blood pressure is recorded
• quarter-hourly or,
• after major surgery, continuously
• via a radial artery cannula.
The pulse rate is recorded regularly and continuously monitored by a
pulse oximeter.
The wound and any drains are monitored for signs of reactionary
bleeding.

16. FLUID BALANCE
 Before patients are returned to the ward their calculated fluid losses should be
replaced
 Monitoring of
 central venous pressure (CVP)
 Urine output measurement

17. CORE TEMPERATURE
36.5 and 37.4°C
 Corrected before the patient leaves
the recovery room (e.g. with a space
blanket).
 As the temperature rises, peripheral
vasodilatation may occur; if not
anticipated this can lead to
hypotension after the patient has
returned to the ward

18. SPECIAL FACTORS
Diabetes mellitus - blood sugar monitoring
Cardiac disease - electrocardiogram (ECG) monitor
Orthopaedic surgery –
•monitoring of distal perfusion in a treated limb,
•position of limb,
•maintenance of fracture reduction,
•examination for peripheral nerve injury
Neurosurgery –
•quarter-hourly neurological observations,
•intracranial pressure monitoring (intraventricular catheter or a transducer in the subarachnoid space)
Urology –
•catheter output
Vascular surgery - distal limb perfusion.

19.  Relief of pain and anxiety
Sedation
 Administering mouthwashes (a dry mouth
is common after general anaesthesia)
 Only after getting alert
 The patient's position, including care of
pressure points
 Recovery position
 Prophylactic measures against:
 atelectasis by encouraging deep breathing
 venous stasis by passive leg exercises.

20. Care in the ward
 A fresh assessment of each patient is required
 at each meet
 Introduce
 Look at the patient
 Look at the charts
 Look at the drug chart
 Communicate

21. Enquire
 • General comfort
 • Pain control
 • Thirst
 • Specific symptoms

22. EXAMINE
 General condition
 Respiration and chest (oxygen saturation if appropriate)
 Surgical wound
 Drains and tubes (content, kinks or blockage, loss of vacuum)
 Peripheral circulation/nerves (vascular/limb surgery)
 Pressure areas
 Drip sites

23. CHARTS
 Pulse
 blood pressure
 Temperature
 Urine output
 Fluid balance (assess insensible loss, e.g. sweating, diarrhoea)
 Special monitoring (e.g. diabetics - blood sugars)
 Results of investigations

24. REVIEW DRUG CHART
 Nutrition/oral fluid and dietary intake
 Intravenous fluid prescription (volume, sodium and potassium need)
 Antibiotic prescription
 Analgesia management
 Other postoperative drugs
 Regular prescription medicines (when to start oral medication)

25. Fluid balance
 Visible fluid losses are recorded on a fluid balance chart at regular intervals (e.g.
 hourly for urine output,
 4-hourly for nasogastric aspirations, and
 12- or 24-hourly for output into drains) and
 totalled every 24 h

26.  Inform your doctor
 Communicate with other staffs
 Write in nurses notes

27. Drains
Pain
PONV
Resp
Cardiac
Kidney
Confusional state
Pyrexia

28. Mobilization
 Importance
 Initial difficulty
 Process
 Fall risk

29. CARE AFTER HOSPITAL DISCHARGE
 The key is good communication.
 The patient should understand
 what treatment he or she has had,
 its effect,
 the likely time period required to complete recovery and
 special restrictions on normal activity

30. Thank you