This document discusses pre and post-operative nursing care. It defines perioperative nursing as caring for patients before, during, and after surgery. The pre-operative phase involves preparing patients for surgery through assessments, tests, education and more. The intra-operative phase is when patients are in the operating room. The post-operative phase focuses on monitoring patients as they recover from anesthesia and assessing their condition including vitals, wounds and pain level. The document provides detailed guidelines and considerations for nurses in each phase of the surgical experience.

1. Pre and Post op Care
By
P. MASINDA

2. Surgery
 Surgery is any procedure performed on
the human body that uses instruments to
alter tissue or organ integrity.

3. Reasons for surgery
 Diagnostic
 Curative
 Palliative
 Preventive
 Explorative
 Cosmetic

4. Definitions.
 Perioperative nursing is a term used
to describe the nursing functions in
the total surgical experience of the
patient, pre operative, intra operative,
and post operative

5. A.Pre operative phase.
 This is from the time the decision
is made for surgical intervention
to the transfer of the patient to the
operating room.

6. B.Intra operative phase.
 This is from the time the patient is
received in the operating room
until transferred to the recovery
room.

7. C.Post operative phase.
 From the time of transfer to the
recovery room to transfer back to
ward.

8. A. PREOPERATIVE NURSING
CARE
 Welcome and greet the patient to alley anxiety
and gain cooperation.
 Introduce yourself to the patient to aid
understanding and allay anxiety.
 Explain the procedure to the patient and
significant others.
 Patient should sign consent form

9.  Perform preoperative assessment.
 Ask about patient’s current heath, allergies,
current medication, previous surgeries
understanding of surgical procedure and
anesthesia, smoking, alcohol and substance
abuse, social support, religious and cultural
considerations, mental status and activities of
living.
 Check vital signs: temperature, pulse,
respirations and blood pressure.
 Commence intravenous fluids

10. Psychological Assessment.
Patient may be anxious
for numerous
reasons……..

11. Suggestions….
 Fear of the unknown
 Anaesthetic + side effects / not waking up
 Unrelieved pain
 Restricted in bed post op.
 Use of bed pan
 Body image /effect on relationship, family
 Dependant relatives.
 Financial problems if sole provider for family.

12.  Carry out all investigation/interventions
ordered i.e. Full blood count + Grouping and
X- match.
 Give patient nothing in the mouth for 6-8
hours before surgery depending on the type
of surgery and hospital protocol to prevent
vomiting and aspiration of stomach contents.
 Ask patient to open bowels before or
administer enema if necessary.
 Give a bath in the morning of surgery for
hygienic purposes.

13.  Allow patient to pass urine or catheterize to
prevent bladder trauma during the procedure
 Check vital signs and record to serve as
baseline data in order to detect any deviation
from normal during surgery.
 Remove jewelry and dentures to prevent trauma.
 Put identification band on the patient to ensure
that the procedure will be done on the right
patient and right part of the body.

14. CONTD………………..
 Give pre-medication an hour before surgery as
prescribed to meet requirement.
Preoperative teaching
 Give the patient information about what will
happen to them and when, and what they will
experience such as expected sensations and
discomfort
 Teach about ways of improving their recovery
such as:
 How to move postoperatively.
 Deep breathing and coughing exercises

15.  How to splint incisions to ease pain when
moving or coughing
 Leg exercises to reduce the risk of clots
forming in the veins in the legs
 Teach the possible complications.
 Dress patient in a theatre attire to reduce cross
infection
 When theatre staff calls for the patient put
patient on a trolley

16.  Take the patient’s notes, x-ray films,
laboratory investigation results and blood with
the patient. These may be needed before,
during and after surgery.
 Take the patient to theatre and give full
handover to theatre staff for continuity of
care.

17. Pre op check list.
Exercise
 Discuss each item on the checklist,
and provide a rationale for its
importance.
 Feedback to group.

18. Premedication.
 Prior to any pre medication being given, the nurse
must :-
 Ensure identity bands are worn and labelled
correctly.
 Consent form is signed by patient and doctor.
 Patient has voided urine.
 Check all other items on the checklist.
 Premedication to be given as prescribed at
appropriate time, with explanation to the patient.

19. Final check
 Ensure checklist is with patients notes, along
with consent form, x-rays, laboratory results,
nurses records.
 Patient is transferred to theatre.

20. POST OPERATIVE CARE
 Handover from recovery nurse to determine
post op instruction from surgeon/anaesthetist
 Note patient’s time of arrival in the ward.
 Assess airway for patency
 Position the patient in recovery position
 Assess breathing
 Respiratory rate, rhythm and depth
 Use of accessory muscles
 Assess breath sounds

21.  Assess circulation
 Check the incision wound for bleeding.
 Assess the patient’s skin colour
 Heart rate, rhythm and strength
 Capillary refill if necessary (OPTIONAL).
Assesses the level of consciousness
using Glasgow Coma Scale.

22. MAKES INITIAL OBSERVATION
 Checks the theater notes to establish operation
performed, presence and location of any drains,
anesthesia used, estimated blood loss,
medications received in recovery room and post-
operative diagnosis.
 Monitor vital signs such as Temperature, pulse,
respirations and Blood pressure ¼ hourly for the
first hour then ½ hourly for the next hour then 4
hourly if stable.

23. • Observe type and integrity of dressing and
drains
• Checks and secure , urinary catheter or any
drainages for patency
• Checks fluid status
- Checks, records and interprets intake and
output

24.  Assess activity and ability to move extremities.
RELIEVING PAIN AND ANXIETY:
 Administer Opioid analgesia such as
Pethidine 50- 100mg intramuscularly when
the patient has regained consciousness
 Make sure the patient is safe(raise side
rails)

25. ANY QUESTIONS !