The document discusses different aspects of pre-operative patient care including: 1. The pre-operative period involves evaluating and preparing the patient prior to surgery through obtaining medical history, conducting examinations, reviewing lab results, assessing physical and psychological needs, obtaining informed consent, and providing patient education. 2. Key parts of pre-operative evaluation and preparation include developing a pre-operative plan, taking a thorough medical history, conducting a focused physical exam, ordering relevant tests and labs, addressing any comorbidities, and discussing the planned surgery and post-operative expectations with the patient to obtain informed consent. 3. The goals are to optimize the patient's condition for surgery, identify any issues that could impact the procedure,

1. Pre, Intra and Post
Operative Patient Care
MR AMMAR HUSSAIN
ASSISTANT PHYSICIAN
SIUT

2. PRE OPERATIVE CARE
 The pre operative period runs from the time the patient
is admitted to the hospital or surgical center to the time
that the surgery begins.
 Begins with the decision to perform surgery and
continues until the patient has reached the operating area.
2

3. 3

4. PRE OPERATIVE PLAN
 Gather and record all relevant information.
 Optimize patient condition.
 Choose surgery that offers minimal risk and maximum
benefits.
 Anticipate and plan for adverse events.
 Obtaining informed consent.
 Pre operative teaching.
 Physical preparation of patient.
 Psychological preparation of patient
4

5. PREOPERATIVE EVALUATION
5
•Aim: Not to screen broadly for undiagnosed disease but
rather to identify and quantify comorbidity that may impact
operative outcome.
Driven by findings on history and physical examination
suggestive of organ system dysfunction.
The goal is to uncover problems areas that may require
further investigation or be amenable to preoperative
optimization.
If significant comorbidity or evidence of poor control of an
underlying disease process, consultation with a specialist.

6. STEPS OF PRE OPERATIVE CARE
 History.
 Examination.
 investigations,.
 Preoperative treatments.
 Documentation.
 Communications – valid consent.
6

7. PREOPERATIVE PREPARATION FOR
SURGERY
7
History
Physical examination
Special investigation
Informed consent
Marking the site/side of operation
Antibiotic prophylaxis

8. PRINCIPLES OF HISTORY-TAKING 8
Listen:
What does the patient see as the problem? (Open questions)
Clarify:
What does the patient expect? (Closed questions) Narrow the
differential diagnosis. (Focused questions) Fitness: what other
comorbidities exist? (Fixed questions)

9. LAYOUT OF A STANDARD HISTORY
9
"SORE POPE”
Symptoms, including features not present
• Onset
• Relieving factors (food, which can relieve or precipitate pain, Defecation,
micturition, sitting forward, applying a warm / hot water bottle - eases
musculoskeletal pain)
• Exacerbating factors (include irritant dermatitis, food allergy in children,
sweating, and psychological stress in adults)
• Pain, nature of the pain, any radiation, etc. Other therapies
• Planned surgery
• Expectations

10. HISTORY 10
A complete history and physical should be obtained at least 1
week before the scheduled surgery for patients who have
significant medical conditions.
1) Presenting complaint
2) Systemic assessment
3) Past Medical and Surgical history
4) Drug and Allergic History
5) Family History
6) Social History

11. PHYSICAL EXAMINATION AND ITS
IMPORTANCE
11

12. 1) General: + findings even if not related to the proposed
procedure should be explored.
2) Surgery related: Type and site of surgery, complications which
have occurred due to underlying pathology.
3) Systemic: Comorbidities and their severity. For example,
suitability for positioning during surgery.
12

13. • General Physical Ex: To check fitness for anesthesia & surgery.
GPE Systemic: - CVS - CNS - GIT - Respiratory system
• Specific Surgical Ex: Its aim: to confirm previous findings &
diagnosis, to determine severity & to gauge extent. E.g. in
inguinal hernia confirm it’s inguinal not femoral, reducible or
not & whether there are any signs of bowel obstruction.
• Specific Medical Ex: Its aim: to evaluates the presence &
severity of other problems. E.g. Diabetic patient undergoing
surgery need careful examination for sepsis , neuropathy or
microvascular disease
13

14. INVESTIGATIONS
14

15. Preoperative Investigations
• Confirmation of diagnosis
• Exclusion of alternate diagnosis
• To know the extent of the disease
• Assessment of fitness for surgery
• Risk to others Medico legal
considerations
15

16. TYPES OF PATIENTS
 OUT PATIENT CARE :
 Usually seen 1-2weeks before surgery at preadmission
clinic.
 EMERGENCY CARE :
 Need initial assessment and immediate resuscitation.
16

17. PRE OPERATIVE PHASE
 Pre operative assessment.
 Obtaining informed consent.
 Pre operative teaching.
 Physical preparation of patient.
 Psychological preparation of patient.
17

18. 18

19. A. REVIEW PREOPERATIVE
LABORATORY AND DIAGNOSTIC
STUDIES:
 Complete blood count.
 Blood type and cross match.
 Serum electrolytes.
 Urinanalysis
 Electrocardiogram.
 Other tests related to procedure or patients medical
condition :
such as : Prothrombin time , partial thromboplastin time ,
blood urea nitrogen , creatinine, and other radiographic
studies.
19

20. BLOOD TESTS
20
1) Full blood count ( when to perform?)
• All emergency preoperative cases
• All elective preoperative cases over 60 years
• All elective preoperative cases in adult females
• If surgery is likely to result in significant blood loss
• Suspicion of blood loss, anemia, sepsis, CKD, coagulation
problems

21. BLOOD TESTS
21
2) Urea and electrolytes (when to perform?)
• All preoperative cases over 65 years
• All patients with cardiopulmonary disease or taking diuretics
or steroids
• All patients with h/o renal/liver disease or abnormal
nutritional state
• All patients with h/o diarrhea, vomiting other
metabolic/endocrine disease
• All patients with IVF for more than 24 hrs. Incident of
unexpected abnormality in apparently fit patient under 40
yrs is < 1%

22. 3) Amylase:
• Perform in all adult emergency admissions with abdominal pain,
prior to consideration of surgery
4) Random Blood Glucose:
• Acute abdomen
• Elective cases with DM, malnutrition, obesity
• Elective cases over 60
5) Coagulogram studies:
• h/o of bleeding disorder, liver disease or excessive alcohol use
• Patients receiving anticoagulants( PT/INR done on the morning of
surgery for patients instructed to discontinue warfarin)
• Cardiothoracic surgery
• Vascular surgery
• Angiographic procedures
22

23. 6) Liver function tests
• All patients with upper abdominal pain, jaundice, hepatic
disease
• Alcoholic
• Screening for Hepatitis B and Hepatitis C
• Blood group/ cross match
• Emergency preoperative case
• Suspicion of blood loss, anemia, coagulation defects
• Procedure on pregnant ladies
7) Chest X-ray:
• All elective preoperative cases over 60 years
• All cases of cervical, thoracic or abdominal trauma
• Acute respiratory symptoms or signs
• Previous CRD or no recent CXR
• Thoracic surgery
• Malignant disease
• Viscous perforation
• Recent h/o TB
• Thyroid enlargement
23

24. B. PATIENT’S HEALTH HISTORY
 History of patient illness and reason for surgery.
 Past medical history.
 Medical conditions (acute and chronic)
 Previous hospitalization and surgeries.
 History of any past problem with anesthesia.
 Allergies
 Present medications
 Substance use : Alcohol , tobacco, drugs.
 Review of system.
24

25. C. ASSESS PHYSICAL NEEDS :
 Ability to communicate.
 Vital signs.
 Level of consciousness.
 Confusion.
 Drowsiness
 Unresponsiveness.
 Weight and height.
 Ability to move / ambulate.
 Circulatory status.
25

26. D. ASSESS PSYCHOLOGICAL
NEEDS :
 Emotional state.
 Level of understanding of surgical procedure , pre and
post operative instruction.
26

27. E. ASSESS CULTURAL NEEDS :
 Language need for interpreter.
27

28. 2. OBTAINING INFORMED
CONSENT
 Before surgery, the patient must sign a surgical consent form or operative permit ; for
any procedure that requires anesthesia and has risks of complications.
 If an adult patient is confused , unconscious ; a family member or guardian must
sign the consent form.
 If the patient is younger than 18years of age , a parent or legal guardian must sign
the consent form.
 In an emergency , the surgeon may have to operate without consent, healthcare
personnel, however , makes every effort to obtain consent by telephone , or fax.
28

29.  Each nurse must be familiar with agency policies and
state laws regarding surgical consent form.
 Patient must sign consent form before receiving any pre
operative sedatives.
 The healthcare person is responsible for ensuring that all
necessary parties have signed the consent form and that
it is in the patient’s chart before the patient goes to the
operating room.
29

30. RISKASSESSMENTAND
CONSENT
• Risks: Related to the co-morbidities, anesthesia and
surgery
• Explain: Advantages, side effects, prognosis
• Language: Simple, use daily life comparisons to explain risks
• Consents: Valid consent is necessary except in life-saving
circumstances
30

31. 31

32. SURGICAL CONSENT
• Valid consent implies that it is given voluntarily by a
competent and informed person who is not under duress.
• In emergency situations or in an unconscious patient,
consent may not be obtained and the procedure carried out
‘in the best interests of the patient’.
32

33. Informed consent serves to identify and respect a patient’s best
interest by giving each patient the opportunity to decide
autonomously what his/her best interest are in light of the
planned procedure.
Important because:
1) Right of the patient
2) Patient education
3) Prevent misunderstanding
4) Prevent medico-legal cases
33

34. IN GENERAL
• Should presented clearly as possible.
• Include discussion of the diagnosis.
• Should include explanation of the procedure
• Explanation of risks.
• Benefits.
• Potential consequences of the procedure
• Treatment options.
• Alternatives to treatment (including
nonsurgical management or non
intervention).
34

35. Who Signs the Consent?
• Adult patients. (≥ 18)
• Any emancipated minor
• Legal Surrogate or Conservator
• Family (spouse, children, parent, sibling, etc)
• DOCTOR
Withdrawing Of Consent
• Right to withdraw consent at any time.
• Doctor must stop treatment once consent withdrawn unless
life- threatening or immediate serious problems to health of
patient to stop.
• If unclear whether consent being withdrawn, doctor must stop
to ascertain.
35

36. 36

37. 3. PREOPERATIVE TEACHINGS
 Teaching patient about their surgical procedure and
expectations before and after surgery is best done during
the preoperative period.
 Patients are more alert and free of pain at this time.
 Information in a preoperative teaching plan varies with
the type of surgery and the length of the hospitalization.
37

38. PREOPERATIVE PLANNING
IMPORTANCE
38
The aim of assessment of surgical patients is to establish
the patients normal pre- operative function to assist in
prevention and recognizing possible post operative
complications.

39. MANAGEMENT PLAN
39
1) Provide all information necessary for the patient to make an
informed decision.
2) Use common language.
3) Discuss the options rather than telling the patient what will be
done.
4) Give the patient time to think things over.
5) Encourage to discuss things ( trusted person).
6) Suggest to write down a list of points that to be discussed.

40. ARRANGING THE THEATRE
LIST
40
• The date, place and time of operation should be matched with
availability of personnel.
• Appropriate equipment and instruments should be made available.
• The operating list should be distributed as early as possible to all staff
who are involved in making the list run smoothly.
• Prioritize patients, e.g. children and diabetic patients should be placed
at the beginning of the list; life- and limb-threatening surgery should
take priority; cancer patients need to be treated early.

41. 41

42. PREOPERATIVE PATIENT EDUCATION
42
• Nil by mouth and regular medications
• Patients are advised not to take solids within 6 hours and clear
fluids (isotonic drinks and water) within 2 hours before
anaesthetic to avoid the risk of acid aspiration syndrome.
• Infants are allowed a clear drink up to 2 hours, mother's milk
up to 3 hours and cow or formula milk up to 6 hours before
anaesthetic.
• Patients can continue to take their specified routine medications
with sips of water in the nil by mouth period.

43. 43

44. MEDICATIONS
44
1) Continue medication over the perioperative period, especially drugs
for hypertension, ischaemic heart disease and bronchodilators.
2) Give patients on oral steroid therapy intravenous hydrocortisone.
3) Stop oral warfarin anticoagulation 3-4 days preoperatively and check
the prothrombin time prior to surgery. If the prothrombin time
remains unacceptably high, the patient may require an infusion of
fresh frozen plasma.
4) Those on warfarin who have had a life-threatening thrombotic
episode (e.g. pulmonary embolus) within the previous 3 months
should be switched to heparin intravenously until 6h before surgery;
the heparin can usually be recommenced 4h after surgery.

45. PHYSICAL PREPARATION OF PATIENTS 45

46. 4. PHYSICAL PREPARATION OF
PATIENT:
 Pre operative preparation includes:
1. Nutrition and fluids.
2. Elimination.
3. Hygiene.
4. Medications.
5. Care of valuables.
6. Special orders.
7. Surgical skin preparation. (shaving)
8. Shower or body wash.
9. Vital signs.
10. Safety protocols.
11. Anti embolic stocking.
12. Sleep
13. Care of valuables.
14. Prosthesis.
46

47. 1. NUTRITION AND FLUIDS
 Adequate hydration and nutrition promotes
healing.
 Usually “ NPO AFTER MIDNIGH T “
followed because if anesthetic depress
gastro0intestinal functioning and there is a
danger that the patient could vomit and aspirate
during the administration of a general
anesthetic.
47

48. THE CURRENT GUIDELINES ALLOW FOR NPO
:
 The consumption of clear fluids up to 2hours.
 The consumption of breast milk 4 hours before surgery.
 A light breakfast ( e.g. ; milk , light meal such as: tea and toast)
6hours before the procedure .
 A heavier meal 8hours before the surgery.
48

49. 2. BOWELAND BLADDER
ELIMINATION
 Enemas may be ordered if bowel surgery is
planned.
 The enemas help prevent contamination of the
surgical area ( during surgery) by feces.
 Prior to surgery and indwelling Folley catheter
may be ordered to ensure that the bladder
remains empty.
 This helps prevent injury to the bladder.
49

50. 3. HYGIENE
 In some setting the patient are asked to bathe or
shower the evening or morning of surgery (or both)
 The purpose of hygienic measure is to reduce the
risk of wound infection by reducing the amount of
bacteria on the patient’s skin.
 Nails should be trimmed and free of polish , all
cosmetic should be removed so that the nail beds ,
skin , and lips are visible when circulation is
assessed during the perioperative phases.
50

51. 4. PRE OPERATIVE MEDICATIONS
 Pre operative medications are given to the
client prior to going to the operating room.
 Commonly used medication include :
 Anti emetic drugs
 Antibiotic
 Sedatives.
51

52. 5. CARE OF VALUABLES
 Valuables such as jewelry and money should be sent
home with the patients family or significant others.
 If valuables / money cannot be sent home, they need to
be labeled and placed in a locked storage area per the
agency’s policy.
52

53. 6. CARE OF PROSTHESIS
 All prosthesis (artificial body parts) such as
: partial or complete dentures , contact
lenses , artificial eyes , and artificial limbs
and eyeglasses , wigs , and false eyelashes
must be removed before surgery.
53

54. 7. SPECIAL ORDERS
 The nurse checks the surgeons orders for
special requirements ( e.g the insertion of a
nasogastric tube prior to surgery , the
administration of medications , such as: insulin
, or the application of antiembolic stockings).
54

55. 9. SKIN PREPARATION
55

56. 10. SAFETY PROTOCOLS
56

57. 11. VITAL SIGNS
57

58. 12. ANTIEMBOLIC STOCKINGS
58

59. INTRA OPERATIVE CARE
 The intra-operative phase extend from the time the
patient is admitted to the operating room, to the time of
anesthesia administration, performance of the surgical
procedure and until the patient is transported to the
recovery room or post anesthesia care unit (PACU).
59

60. Intraoperative care
 Definition
 The term "intraoperative" refers to the time during surgery.
Intraoperative care is patient care during an operation and
ancillary to that operation.
 Activities such as monitoring the patient's vital
signs , blood oxygenation levels, fluid therapy, medication
transfusion, anesthesia, radiography, and retrieving samples
for laboratory tests, are examples of intraoperative care.
 Intraoperative care is provided by nurses, anesthetists,
surgical technologtist, surgeons, and residents, all working as
a team.

61. Purpose
 The purpose of intraoperative care is to maintain patient
safety and comfort during surgical procedures.
 Some of the goals of intraoperative care include
maintaining homeostasis during the procedure,
maintaining strict sterile techniques to decrease the
chance of cross-infection, ensuring that the patient is
secure on the operating table, and taking measures to
prevent hematomas from safety strips or from positioning

62. Purpose of Intra Operative Care
 During a surgical procedure many instruments, drapes,
and sponges are used.
 It is the responsibility of the surgical technologist working
in the operating room to maintain an accurate count of
all sponges, instruments, and sharps that may
become foreign bodies upon incision closure.
Technologist who fail to make accurate counts can be
held legally liable.
62

63. Description
 Intraoperative care includes the activities performed by
the health care team during surgery that ensure the
patient's safety and comfort, implement the surgical
procedure, monitor and maintain vital functions, and
document care given.
 The intraoperative time period can vary greatly from less
than one hour to 12 hours or more, depending on the
complexity of the surgery being performed.

64. Preparation
 Prior to surgery the patient or legal guardian must have the surgical
procedure explained to them in great detail, including the expected
outcomes and all possible complications, in order to give informed
consent .
 The explanation should be given to the patient at a time when he or
she is relaxed, but when judgment is not clouded by the use of
any pain medication or anesthesia, which would invalidate the
consent.
 A consent form must be signed by the patient or guardian and
witnessed by a staff member as well as the surgeon performing the
procedure. It is the duty of the RN admitting the patient to the
surgical suite to check the patient's ID band and ensure that all
records are intact and accounted for.

65. Preparation
 After consent is given the patient may be taken to a holding
area where a large-bore intravenous catheter is inserted into
the patient's arm for use in fluid replacement and to infuse
medications during the procedure.
 The area of the body where the incision will be made is
meticulously prepared using drapes, and a skin preparation
that is antiseptic and may include the use of alcohol
solutions.
 Monitoring devices such as continuous ECG nodes, pulse
oximetry probes, and a blood pressure cuff are usually
applied prior to skin preparation. Anesthesia, also, is begun
before skin prep. Surgery is then ready to begin.

66. Complications
 Intraoperative complications are surgery related, anesthesia
related, or position related.
 One complication occurring during the intraoperative period
that is not common but can be life threatening is an
anaphylactic (allergic) reaction to anesthesia.
 The intraoperative staff is trained extensively for the
treatment of such reactions
 Another anesthesia-related complication is called "awareness
under anesthesia." This occurs when the patient receives
sufficient muscle relaxant (paralytic agent) to prohibit
voluntary motor function but insufficient sedation and
analgesia to block pain and the sense of hearing .

67. Health care team roles
 Health care team of operation theater consist of scrub person (
technologist or physician assistant, surgeon, anesthetist, circulator
,anesthesia technician etc.
 The scrub person is responsible for providing instruments and
supplies to the surgeon and maintaining the sterile field.
 The circulator is first the patient's advocate, with primary concern
and responsibility for the patient's safety and welfare.
 In addition, the circulator is responsible for anything related to the
patient that is not directly contingent to the sterile field. That means
all activities necessary to prepare the patient and the operative site
for surgery, and assistance required by anesthesia personnel.
 Of crucial import is that the circulator must be certified to give
intravenous medication to the patient in case of an emergency.
Finally, circulator must document and process tissue specimens for
pathology.

68. Intra operative patient monitoring

69. purpose
 To maintain the patients physiology and homeostasis
through out the anesthesia and surgery.
 During surgery, blood loss, anemia, hypotension is
common complication so it is necessary to recognize
when patient is need of transfusion

70. Basic monitoring
 There are four basic intraoperative monitoring system we
use,
 ECG
 SPO2
 Blood pressure( invasive and non-invasive)
 Capnography

71. ECG
 An ECG test monitors your heart's electrical activity and
displays it on monitor screen as moving line of peaks and
dips. It measures the electrical current that runs through
your heart. Everybody has a unique ECG trace but there
are patterns of an ECG that indicate
various heart problems such as arrhythmias.

72. SPO2
 This indicates percentage of oxygen in blood.
 It is the most important monitor use through out the
procedure.

73. Blood pressure
 Blood pressure is the force of the blood pushing against the
artery walls during contraction and relaxation of the heart.
Each time the heart beats, it pumps blood into the arteries,
resulting in the highest blood pressure as the heart
contracts. When the heart relaxes, the blood pressure falls.
 Two numbers are recorded when measuring blood pressure.
The higher number, or systolic pressure, refers to the
pressure inside the artery when the heart contracts and
pumps blood through the body. The lower number, or
diastolic pressure, refers to the pressure inside the artery
when the heart is at rest and is filling with blood. Both the
systolic and diastolic pressures are recorded as "mm Hg"
(millimeters of mercury).

74. Blood pressure
 Blood pressure is categorized as normal, elevated, or
stage 1 or stage 2 high blood pressure:
 Normal blood pressure is systolic of less than 120 and
diastolic of less than 80 (120/80)
 Elevated blood pressure is systolic of 120 to
129 and diastolic less than 80
 Stage 1 high blood pressure is systolic is 130 to
139 or diastolic between 80 to 89
 Stage 2 high blood pressure is when systolic is 140 or
higher or the diastolic is 90 or higher

75. Capnography
 Capnography is a non-invasive measurement during
inspiration and expiration of the partial pressure of CO2
from the airway. It provides physiologic information on
ventilation, perfusion, and metabolism, which is
important for airway management.

76. Capnography
 The amount of CO2 at the end of exhalation is normally
35-45 mm HG. The height of the capnography waveform
accompanies this number on the monitor, as well as the
respiratory rate.

77. POST OPERATIVE CARE
 The patient’s recovery from the anesthesia is monitored in
the post anesthesia care unit (PACU). His ongoing
recovery is managed on either an intensive care unit (ICU)
or medical-surgical unit. The postoperative period
extends from the time the patient leaves the operating
room until the last follow-up visit with the surgeon.
77

78. Purpose
 The goal of postoperative care is to prevent such
complications as infection , to promote healing of the
surgical incision, and to return the patient to a state of
original health.

79. Precautions
 Thorough postoperative care is crucial to ensuring
positive outcomes for patients who have had surgery.
There are no contraindications to providing postoperative
care. However, skill and careful monitoring are needed to
prevent complications and to restore the patient to health
as soon as possible.

80. Description
 Postoperative care involves assessment, diagnosis, planning,
intervention and outcome evaluation.
 The extent of postoperative care required by each patient depends
on the original health status of the patient, type of surgery, and
whether the surgery was performed in a day-surgery setting or in
the hospital.
 Patients who have procedures done in a day-surgery center usually
require only a few hours of care by health care professionals before
they are discharged to go home.
 If postanesthesia or postoperative complications occur within these
hours, the patient must be admitted to the hospital.
 Patients who are admitted to the hospital may require days or weeks
of postoperative care by hospital staff before they are discharged.

81. Postanesthesia care unit (PACU)
 After the surgical procedure, and anesthesia reversal and
extubation if necessary, the patient is transferred to the
PACU.
 The length of time, the patient spends there depends on the
length of surgery; the type of surgery; the status of regional
anesthesia (for example, spinal anesthesia); and the patient's
level of consciousness.
 Rather than being sent to the PACU, some patients may be
transferred directly to the critical care unit instead. For
example, patients who have had coronary artery bypass
grafting (CABG) are sent directly to the critical care unit.

82. Monitoring in Recovery
 In the recovery, the anesthesiologist or the nurse reports on
the patient's condition; the type of surgery performed; the
type of anesthesia given; estimated blood loss; and total
input and output during the surgery.
 The receiving nurse should also be made aware of any
complications during the surgery, including any variations in
hemodynamic stability.
 Assessment of the patient's airway patency, vital signs , and
level of consciousness are the first priorities upon admission
to the PACU.

83. Monitoring
The following is a list of other assessment categories:
 surgical site (check that dressings are intact and there are no signs of
overt bleeding)
 patency of drainage tubes/drains
 body temperature (hypothermia/hyperthermia)
 rate of IV fluids
 circulation/sensation in extremities after vascular or orthopedic
surgery
 level of sensation after regional anesthesia
 pain status
 nausea/vomiting

84. Monitoring
 The patient is discharged from the PACU when they meet established criteria for
discharge, as determined by use of a scale.
 An example is the Aldrete scale, which scores the patient on mobility,
respiratory status, circulation, consciousness, and pulse oximetry.
 Depending on the type of surgery and the patient's condition, the patient may
be admitted to either a general surgical floor or the intensive care unit.
 Since the patient may still be sedated from anesthesia, safety is a primary goal.
 The patient's call light (a gadget use to call health care provider) should be in
their hand and all side rails ( the sides of bed) should be up.
 Patients in a day-surgery setting are either discharged from the PACU to the
unit to their home, or are directly discharged home after they have voided,
ambulated, and tolerated a small amount of oral intake.

85. Monitoring in First 24 hours
 Vital signs, respiratory status, pain status, the incision, and
any drainage tubes should be monitored every one to two
hours for at least the first eight hours.
 Body temperature must be monitored, since patients are
often hypothermic after surgery and may need a warming
blanket or warmed IV fluids.
 Respiratory status should be assessed frequently, including
auscultation of lung sounds, assessment of chest excursion
(movement of thoracic and diaphragm during breathing),
and presence of adequate cough.
 Fluid intake and urine output should be monitored every one
to two hours.

86. Monitoring in First 24 hours
 If the patient doesn't have a urinary catheter, the bladder
should be assessed for distension and the patient
monitored for inability to void.
 If they have not voided six to eight hours after surgery,
the physician should be notified.
 If the patient had a vascular or neurological procedure
performed, circulatory status or neurological status
should be assessed as ordered by the surgeon, usually
every one to two hours.
 The patient may require medication for nausea and/or
vomiting, as well as for pain.

87. POST OPERATIVE CARE UNIT
 The post operative care unit should be located near the operating
rooms and off -site invasive procedure areas.
 A central location in the operating room area itself is desirable, as it
ensures that the patient can be rushed back to surgery, if needed, or
that members of the operating room team can quickly respond to
urgent or emergent patient care issues.
 Proximity to radiographic, laboratory, and other intensive care
facilities on the same floor is also advantageous.
 The patient is left in the PACU until the major effects of anesthesia
have worn off . This period is characterized by a relatively high
incidence of potentially life-threatening respiratory and circulatory
complications.
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88. PACU NURSE
 The PACU nurse’s main goal is to meet the patient’s
physical and emotional needs, thereby minimizing the
development of postoperative complications. Such
factors as pain, lack of oxygen, and sudden movement
may threaten his physiologic equilibrium. Thanks to the
use of short-acting anesthetics, the average PACU stay
lasts less than 1 hour. The patient is assessed every 10 to
15 minutes initially and then as his condition warrants.
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89. DISCHARGE
Whether the patient is discharged from the PACU to the medical-surgical unit,
the ICU, or to the short-procedure unit, safety remains the major
consideration. The patient should:
 demonstrate quiet and unlabored respirations
 be awake or easily aroused to answer simple questions
 have stable vital signs with a patent airway and spontaneous respirations
 have a gag reflex
 feel minimal pain
 have return of movement and partial return of sensation to all anesthetized
areas if a regional anesthetic was administered.
 If the patient had major surgery or has a concurrent serious illness or if
complications occurred during or immediately after surgery, he may be
discharged to the ICU. Appropriate documentation should accompany the
patient on discharge, according to facility policy.
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90. CONCLUSION 90
The anticipated outcome of preoperative preparation is a
patient who is informed about the surgical course, and copes
with it successfully. The goal is to decrease complications and
promote recovery.
When patients are adequately prepared psychologically and
physically, and policies and guidelines have been followed, the
risk of postoperative complications should be low, leading to a
quick recovery.

91. THANK YOU
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