Preoperative,Post operative,

1. Pre and Post
operative care
Zaid Rasheed
Noradeen hussan
University of Duhok
College of Medicine

2. objectives
Pre operative in general
Pre operative assessment
Pre operative preparation
Post operative care in general
Post c/s care
Complications after c/s
Post cerclage care
 post gynecological operations care

3. Preoperative care
• Preoperative care is the preparation and
management of a patient prior to surgery.
• It includes both physical and psychological
preparation.
• Many postoperative problems can be anticipated
preoperatively, and eliminated or minimized.

4. Preoperative care
• Patient education and consent Selection of the appropriate
procedure for the appropriate patient should have already occurred
in the gynaecology outpatient clinic.
• The Royal College of Obstetricians and Gynaecologists (RCOG)
guidance on consent advises that explanation of the procedure
should include: 1-how it will be performed 2-the site and size of
incision 3- length of hospital stay 4- anaesthesia 5- pain 6- recovery
7- impact on lifestyle (e.g. work, sexual intercourse, eating, driving)
8- its potential risks and benefits

5. Preoperative assessment
• 1-complete detailed history should be taken from patient
• 2-examination:
- The patients undergoing minor surgery can be examined by their
surgeon and anesthesiologist on the operation day during preoperative
preparation
- those with more serious conditions should be examined at least a
week before surgery, allowing the time for risk assessment, specialist
consultations, and preparation.
• 3-Investigations: CBC,RFT,virology profile,LFT,Blood group,coagulation
screen(PT,bleeding time)

6. • 4-Medications Evaluation :
- to decrease risk of venous thromboembolism (VTE), the
combined oral contraceptive pill should be stopped 4–6 weeks
prior to major surgery.
-Anticoagulants Patients on oral anticoagulants will need to
be converted to preparations whose anticoagulant effect can
be more easily predicted and controlled, such as with low
molecular weight heparin (LMWH)

7. Preoperative preparation :
1-Correction of anemia:
1-Iron supplementation
2- Medical treatment of abnormal uterine bleeding
3- Erythropoiesis-stimulating agents
4-Blood transfusion
2- Smoking cessation: stop smoking at least eight weeks before
surgery.
3- control comorbid disease: HTN,DM,hypo or hyperthyroidism

8. 4-Bowel preparation:
1- Modify the diet
2- Take a laxative or bowel preparation medication
2- Increase fluid intake
5- preoperative antibiotics: A single dose of antibiotic immediately
before the operation is sufficient for most surgical procedures

9. • 6-Thromboprophylaxis: reduces the incidence of symptomatic DVT
and pulmonary embolism.
• Mechanichal:
• 1-using stockings and correctly worn at all times
• 2-avoid dehydration
• 3-encourage early mobilisation
• 4-ensure leg exercises during prolonged immobility
• 5-use intermittent pneumatic compression where appropriate for as
long as possible.

10. • Pharmacologic prophylaxis
• 1-Low-dose unfractionated heparin (LDUH) — 5000 units
subcutaneously (SC) every 8 to 12 hours.
• 2-Low molecular weight heparin (LMWH) — Dalteparin 2500 units or
enoxaparin 40 mg SC daily. NB:
• The use of aspirin for prophylaxis is NOT recommended, as other
measures are more efficacious.

11. post operative
 The post operative period begins from the time
patient leaves the operating room and ends with
the follow up visit by surgeon.
The type of post operative care you need depends
on the type of surgery u have, as well as your
health history .

12. Purposes
To enable a successful and faster recovery of the
patient post operatively .
To reduce post operative mortality rate .
To reduce the length of hospital stay of the
patient.
To provide quality care service .
To reduce hospital and patient cost during post
operative period .

13. Phases
Immediate
Post
_anesthetic
Intermediate
Hospital stay
Convalescent
After discharge
to full recovery

14. Immediate post operative period
What’s needed ?
Receive a complete patient record from the operating room to plan post
operative care .
 Detect early signs of complication .  patient’s name
 Age
 Surgical procedure
 Existing medical problem
 Allergies
 Anesthetic and analgesics given
 Fluid replacement
 Blood loss
 Urine output
 Any surgical / anesthetic
problems encounted

15. Immediate post operative period
 Admitting the patient to the post anesthesia care unit
(PACU)
The basic responsibilities of PACU staff include :
• Airway mangment and O2 administration for patients
who have undergone general anesthesia .
• Monitoring vital signs .
• Managing post operative pain .
• Treating post operative nausea and vomiting .
• Treating post anesthetic shivering .
• Monitoring surgical site

16. Discharge from the PACU depend on Aldrete score
• A patient remains in the PACU, until the patient has fully recoverd from
anesthesia.
• Following measures are used to determine the patient ready for
discharge from PACU :
 Stable vital signs
 Orientation to person
place
time or events
 Adequate O2 saturation level
 Urin out put at least 30ml/hr
 Minimal pain
 Adequate respiratory function
 Aldret score more than 9

18. The intermediate post
operative period
Start with complete recovery from
anaesthesia until we discharge the patient to
home.

19. intermediate post operative period
Vital monitoring
Fluid and electrolytes
Pain mangment
Antimicrobial prophylaxis
Urine output
Ambulation

20. Discharge
 Ensure that a patient is sufficiently recovered .
 A written policy establishing specific discharge criteria is a sound
basis for a legally sufficient discharge decision .
Discharge notes:
On discharging the patient from the ward,record in the notes:
• Diagnosis on admission and discharge
• Summary of course in hospital
• Instructions about further mangment, including drugs
prescribed.
Ensure that a copy of this information is given to the patient,
with details of any follow_up appointment .

21. Follow up
To assume responsibility for the
patient’s after_care until all
possibility of post_operative
complications is past .
Long term follow_up .

22. Post c/s care
Routine post operative assessment:
• Monitoring of vital signs, level of consciousness, urine output,
and amount of vaginal bleeding
• Palpation of the fundus
• NPO
• IV fluids
• IV or IM analgesia
• Antimicrobial prophylaxis
• Care of wound
• Ambulation
• Prophylaxis for thrombo_embolism
• Encourage early breast feeding

23. IV fluids
Goal of fluid therapy :
Maintain blood pressure > 100 /70 mmHg
Pulse rate < 120 beat/min
Urine out put between 30_50 ml/hr
Normal temperature, warm skin & normal
respiration

24. Post operative complications
Early
 haemorrhage
 Paralytic ileus .
 Venous Thromboembolism .
 infection
Late
 Incisional hernia .
 Placenta praevia and Placenta accrete
 Scar rupture in the next pregnancy

25. Mangment of primary post
partum haemorrhage
Call for help
Resusitation
Put folys catheter
Uterine massage
Uterotonic agents
Insertion of baloon catheter into the uterus
Surgical approach

26. Mangment of secondary post
partum haemorrhahe
Call for help
Resusitation
put folys catheter
Antibiotic
Uterotonics
Surgical measures

27. Mangment of paralytic ileus
Hx , Ex , Ix
Placing the patient on NPO
status .
NG tube .
Administering IV fluids and
electrolytes .

28. Mangment of venous
Thromboembolism(VTE)
Hx , Ex , Ix
General measures .
Anticoagulation therapy .
Thrombolytic therapy .
Surgical intervention .

29. General measures
O2 therapy : is administered to correct the
hypoxemia, relieve the pulmonary vascular
vasoconstriction, and reduce the pulmonary
hypertension .
Using elastic compression stockings
Elevating the leg

30. Anticoagulation therapy
 Anticoagulant therapy prevents further
clot deposition and allows the patient’s
natural fibrinolytic mechanisms to lyse
the existing clot.
 Heparin is administered as an intravenous
bolus of 5,000 to 10,000 units followed by
a 18 U/kg/hr n’t to exceed 1,600 U/hr

31. Patients with acute massive pulmonary
embolism causing hemodynamic instability may
be treated initially with a thrombolytic agent eg
(streptokinase or tissue plasminogen activator
[t_PA]
Surgical intervention for venous
thromboembolic disorders include
thrombectomy and venous interruption

32. Mangment of wound
infection
 Sutures in the infected part are removed for free drainage
of pus, expressed
 Wound swab is taken for culture and sensitivity
 Placed on broad spectrum antibiotics pending the result of
culture and sensitivity
 Wound dressing (depends on degree of infection ) and
depridment of necrotic tissues
 Correction of anemia if present

33. Post Cerclage operation
care
Bed rest for 2-3 days
Weekly injection of 17 a-hydroxyprogesteron caproate
500mg IV
Isoxsuprine 10mg thrice daily _avoid uterine irritability
Advice on discgarge _usual antenatal advise, avoid
intercourse, avoid rough journey
Removal of stitch _ 37th week or if labor pain starts /
features of abortion appears

34. Post gynecological
operations care
The first 48 _72 hrs after surgery are when the patient is
most at risk of immediate surgical complications .
Nursing and medical care is focused on identifying early
signs of sepsis, and the source of any infection,
haemorrhage or thromboembolic disease .
The patient will have regular (usually 4 hourly )
observations of vital signs in the first 24 hrs to identify the
clinical signs of infection or hypovolemic collapse
Most patients will be given IV fluids for the first 12_24 hrs
after surgery until they can resume eating and drinking

35. The post operative ward round is a daily or twice daily
opportunity to review the patient’s progress
The patient should be asked about the presence and site
of any pain
Vital signs should be checked, and signs of conjunctival
pallor or a thready pulse should be sought
For all cases of either abdominal or vaginal surgery, the
abdomen should be palpated for localized tenderness and
bowel sounds should be checked
The abdominal wound should be checked for
inflammation, bruising or discharge .

36. If drains are present, these should be checked
If there are any concerns about bleeding or infection after
vaginal surgery, a gentle pelvic examination is appropriate
to exclode a hematoma or collection
Routine blood sampling for Hb concentration can be done
on the 2nd post operative day
Urea and electrolytes will need to be checked for those
patients who remain on IV fluids .

37. Thank you