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1. Pre and Post Operative Care
for
Patients undergoing
General Anesthesia

2.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

3. Pre - Operative Phase
Decision for Surgical Intervention
to
Transferring Patient to Operating Room
Intra - Operative PhasePost - Operative Phase
Patient Received in Operating Room
to
Admitting to Post Anesthesia Care Unit
(PACU)
Admitting to Post Anesthesia Care Unit
(PACU)
to
Follow up Evaluation
INTRODUCTION

4.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

5. Internal Fixation
of Fracture
Elective :
Required :
Urgent :
Emergency :
Scheduled Time Example
At the Convenience
of the Patient
Within a Few Weeks
As soon as Possible
Immediate Surgical
attention required
without Delay
Superficial Cyst
Eye Cataract
Intestinal
Obstruction
Types of
Surgery

6.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

7. Pre – Operative CareVital Component
of the
Surgical Experience
Patient Education
General Instructions


Obtaining a Database
Plan and Implement Teaching
Program


Determining
what the
Patient knows
or wants to
know
Determine the
Cultural or
Religions
Health Beliefs
and Practices
Provide time & Encourage the Patient to Ask Questions
Begin at Patient’s Level of Understanding
Include Family Members & Significant Others in the Process
Encourage Patient’s Active Participation in their Care
& Recovery
Plan and Implement Teaching Progra




Assign the Patients Level of Interest in or Reaction to it
Explain Details of Pre
Operative Preparation &
Provide a Tour of the Area
& View Equipment when
Possible
Offer General Information
on Surgery
Approx. How long it will
take, about PACU, etc.
Explain how a Test
or Procedure may
Feel,
during or
Afterwards
Describe PACU & what
Personnel & Equipment
the Patient may expect to
See and Hear
Document what has been taught, discussed, Patient’s
Reaction & Level of Understanding

Discuss with Patient the anticipated Post Operative Course

8. General Instructions
Incentive Spirometry
The Patient uses an
Incentive Spirometer to
measure deep breathes
while exerting
maximum effort
Coughing
Coughing promotes the
removal of Chest
Secretions
Turning
Changing Position from
back to side-lying
stimulates circulation &
encourages deep
breathing
Foot and Leg Exercises
Moving the Legs
improves Circulation
and Muscle Tone
Evaluation of Teaching Program
Observe the Point for
Correct Demonstration
of Expected Post
Operative behaviours

9.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

10. Gastrointestinal Tract
PREPARATION
OF
OPERATIVE AREA
Skin Antisepsis
Human Skin
Harbours
Transient &
Resident
Bacterial
Flora
Pre
Operative
Bathing with
Chlorhexidin
e
Cleaning with
a Bactericidal
–
Impregnated
Sponge
Hair Removal
should be
done within 2
hrs at the
Operative
Site
Cathartics & Enemas remove Gross
Collection of Stool
Oral Antimicrobial Agents
Provide Enemas until clear




11.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

12. PRE OPERATIVE
MEDICATION
Administration of Systematic
Prophylatic Incrioperative
Antibiotics is one of the most
important steps in preventing
Surgical Site Infections

13.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

14. Admitting Patient
to Surgery
Final Checklist
The Pre Operative Checklist
is the last Procedure before
taking the Patient to
Operating Room
Identification & Verification
Verbal identification – Checking
Identification Band on Patient’s
Wrist – Procedure to be Performed –
Surgical Site marked by Surgeon –
Surgeon & type of Anesthesia
Review of Patient Record
Check for Allergies – History –
Completed Pre Operative Checklist
– Laboratory Values – Pregnancy
Test – ECG – Pre Operative
Medications
Consent Form
Obtaining Informed Consent
is the Responsibility of the
Surgeon performing the
Specific Procedure
Patient Preparedness




NPO Status
Proper Attire & Clean Linen
Skin Preparation
IV Line Started with Gauge Needle
Dentures or Plates removed
Jewellery, Piercings, Contact Lens
and Glasses removed & Secured in
locked Area
Allow the Patients to Void

15.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

16. POST OPERATIVE
CARE
(PACU)
Initial Nursing Assessment




Verify the Patient’s Identity , Operative
Procedure & the Surgeon
Obtain Vital Signs
Evaluate Airway Status
Evaluate Respiratory Status and
Auscultate Breath Sounds
Observe LOC and Orientation to Time
& Place
Evaluate conditions of Surgical
Dressings & Drains and Check IV
lines, Infusing Fluids or IV Medications
Determine Patient’s Pain level using a
1 to 10 scale
Review the Health Care Provider’s
Orders

17. Initial Nursing Interventions
Maintaining a Patient Airway
• Closely monitor the Patient arriving with
an Oral or Nasal Airway in place until
awake
• Early initiation of CPAP (Continuous
Positive Airway Pressure) in the PACU is
Beneficial
Maintaining Adequate Respiratory Function
• Encourage the Patient to take deep
breath, use an Incentive Spirometer to aid
this function
• Assess lung fields through Auscultation
•Periodically Evaluate the Patient’s LOC
Maintaining Glycenic Control
• Check Serum Glucose on arrival to
PACU
• For Patients who are Diabetic, Administer
Insulin and follow Protocols
Promoting Tissue Perfusion
• Monitor Vital Signs, normally every 15
mins
• Monitor Intake and Output Closely
•Recognize early Symptoms of Shock &
hemoerrage
• Recognize factors that may alter
circulating blood volume
Stabilizing Thermoregulatory Status
• Monitor temperature every 15 min & be
alert
• Provide warm Blankets for Patients
feeling cold
•Active warming with forced warm air
Maintaining Adequate Fluid Volume
• Administer IV, as Ordered
• Evaluate mental status and Skin colour
and Turgor
•Recognizing signs of fluid Imbalance
Minimizing Complication of Skin Impairment
• Perform handwashing before and after
contact with Patient
• Inspect Dressing Routinely
• Turn Patient Frequently & maintain good
body alignment
Minimizing Sensory Deficits
• Avoid saying anything in Patient’s Presence
that may be disturbing
• Explain procedures at Patient’s of
Understanding
• Treat the Patient as a person who needs much
attention
• Demonstrate concern for & an Understanding
of the Patient & anticipates his/her needs &
feelings
• Tell the Patient repeatedly that the Surgery is
over & that he/she is in the PACU

18.  Introduction
 Types of Surgery
 Pre Operative Care
 Preparation of Operative Area
 Pre Operative Medication
 Admitting Patient to Surgery
 Post Operative Care

19.  Lippincott Manual of Nursing
Practice – 10th Edition (Pg. 102
– 115)
 Internet: www.wikipedia.com
BIBLIOGRAPHY
THANK
YOU