The document discusses preoperative, intraoperative, and postoperative nursing care. It outlines the three phases of operative nursing care which include preoperative, intraoperative, and postoperative phases. In the preoperative phase, nurses provide education to patients, assess patients' knowledge, and prepare patients physically and psychologically for surgery. Key aspects of preoperative nursing care are also discussed such as preoperative assessment, tests, and medications. The roles and responsibilities of nurses in the intraoperative phase are summarized as monitoring patients, ensuring sterility, documenting care, and safely positioning patients for surgery.

1. PREOPERATIVE &
INTRAOPERATIVE
NURSING CARE
MS. DEEPA BIJU
SISTER IN-CHARGE,
OT, SVBCH, SILVASSA

2. Patient education is a vital component
of a surgical experiences pre-operative
patient education may be offered through
conversation , discussion.
The pre-operative nurse can assess
the patient knowledge and use this
information in developing a plan for an
event full pre-operative course.

3. SURGERY
 Surgery is any procedure performed on the
human body that uses instruments to alter
tissue or organ integrity.
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4. PHASES OF OPERATIVE NURSING CARE
1. Pre operative nursing care
2. Intraoperative Nursing care
3. Post operative Nursing care
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5. Cont. . .
 Preoperative phase – begins when the
decision to have surgery is made and ends
when the client is transferred to the OT table.
 Intraoperative phase – begins when the client
is transferred to the OT table and ends when
the client is admitted to the PACU.
Postoperative phase - begins with the
admission of the client to the PACU and ends
when the healing is complete.
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6. PRE OPERATIVE NURSING
CARE
 Preoperative Nursing care is the preparation
and management of a patient prior to surgery.
It includes both physical and psychological
preparation.
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7. Diagnostic :-
Determination of the presence and or extent of
the pathology.
Eg: Laparatomy.
Therapeutic :-
Elimination or repair of the pathology.
Eg: Removal of the appendix when it's inflammed,
removal of a localized cancer tissues / organs.
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Types of Surgeries

8. Cont . . .
Palliative:-
Alleviation of symptoms without curing the underlying
disease.
Eg: Rhizotomy (cutting of a nerve root) to decrease pain.
Preventative:-
Surgery to remove tissue that has the potential to become
pathologic .
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9.  Cosmetic :-
The surgery is preformed for aesthetic reasons.
Eg: Repair of scars from burns or injuries, minor
cleft palate . repairs, face lifts, breast
augmentation
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11. PRE OPERATIVE ASSESSMENT
Assessment differs from those
performed on the patient in a medical-
surgical unit

12. o Current health status.
o Allergies.
o Medications- list all current medications.
o Previous surgeries.
o Understanding of the surgical procedure
and anesthesia.
o Smoking.
o Alcohol and other-altering substances.
o Social resources.
o Cultural considerations.

13.  Cardiovascular system
 Respiratory system
 Renal system
 Neurological system
 Musculoskeletal system
 Nutritional status

14. PSYCHOSOCIAL ASSESSMENT
 Level of anxiety
 Coping ability
 Support systems

15. In emergency surgery, the principles of
preoperative assessment is the same
as in elective surgery.

16.  Nature and intention of the surgery.
 Risks, including tissue damage, disfigurement, or even death.
 Possible alternative measures.
 The right of the client to refuse consent or later withdraw
consent.
 No relatives (MS, Self declaration & group of doctors concern)
 If pt not willing & life saving inform to MS & police & surgery
can be done
 Written informed consent in case of organ removal such as
nephrectomy, orchidectomy & amputation

17. CBC, Blood grouping and X-match,
Fasting blood glucose
RFT & LFT
Urinalysis
Chest X-ray
ECG
Serum electrolytes
COVID -19 test
2 D ECHO (above 60 yrs & if necessary)
As per Hospital policy & Consultant suggestions

18. PRE OPERATIVE NURSING
ROLE
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 NBM (Depends on the surgery & age)
 Educating the patient about the reason for NPO status
may help with adherence .
 Patient will likely need to be there 1 to 2 hours prior to
scheduled procedure.(OPD Base case)
 Skin Preparation (depends on surgery)
 Catheterization
 Bowel preparation if needed
 RT insertion if needed
 Nebulization should be given in case of pediatric surgeries

19. CONT . .
 Instruct to take bath and prepare the patient with
cap, mask, Hospital dress & Identification tag
 All investigation reports to be attached
 Payment should be done prior surgery according
to hospital policy
 Ornament & artificial dentures should be removed
 Relative must accompany the client
 Blood should be arranged for major surgeries
priorly
 Weight should be mentioned in case of pediatric
 Physician / Pediatric and Anesthetic fitness
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20. PREOPERATIVE MEDICATIONS
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 Medications
 Sedatives/hypnotics- (As per surgeon / anesthetic
instruction)
 Anticholinergics-Atropine sulfate (if needed)
 H2o blockers- Zantac
 HT, DM & Thyroid disorder should be given morning
dose of tablet with sip of water with NBM
 IV Fluids should be initiated as per doctors order while
NBM
 If patient takes Tablet Aspirin should be stopped 5 days
prior to surgery
 Inj. TT (0.5 ml, IM), Test dose of Inj Xylocaine(0.1ml,

21. PREOPERATIVE TEACHING
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 Deep breathing (incentive spirometer),
coughing, leg exercises, ambulation.
 Recovery room orientation.
 Probable postoperative therapies.

23. SUMMARY
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 All personal belongings are identified and secured.
 Jewelry & nail polish to be removed.
 Dentures are removed, labeled and placed in a denture cup.
 Pt. to verbally confirm the surgical procedures and the
surgical site. This verification process is documented in the
medical record on the pre operative checklist.
 Complete skin preparation in case of GA (Face)
 One day priorly OT List to be sent to OT Incharge
 Skin preparation to be done the night before the surgery
 Catheterization to be done just before taking the client to
OT
 Atleast over the phone to be informed in case of acute
emergency

24. INTRAOPERATIV
E NURSING
CARE
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27. Nursing Roles:
 Staff education.
 Client/family teaching.
 Support and reassurance.
 Advocacy.
 Control of the environment.
 Provision of resources.

28.  Maintenance of asepsis.
 Monitoring of physiologic and
psychological status.
 Ensure sterility.
 Alert for breaks.

29. Patient Positioning
Supine
Prone
Lateral
Sitting

30. POSITION DURING INDUCTION
OF ANAESTHESIA

31. POSITIONING THE CLIENT FOR SURGERY
The choices or position is usually determine by
surgical approach
Ideally the client position provide good asses to
the operative site and sustain adequate
circulatory respiratory function
The client comfort and safety must be consider
DOCUMENTATION OF INTRA OPERATIVE
CARE
During intra operative face the nursing staff
countinues pre operative plan e.g. strict asepsis
must be follow minimize the risk surgical wound
infection.
Full fluid infusion and monitoring of urinary
output are action the nurse takes to maintain fluid
balance.
ROLE OF NURSE IN INTRAOPERATIVE CARE

32. Role of intra operative nurse
 Identification of client
 Identification of operative site
 Wide bore IV canalization should be checked
 Investigations & reports to be collected and
verified
 All equipment to be checked for its
functionality
 Trolley to be prepared and instruments to be
counted
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33. Cont. .
 Assist anesthetist for induction (Position, Sterility,
Medications and assist surgeon)
 Post operative counting of instruments
 Checklist to be filled before and after the surgery
(instruments, gauze, mops etc.)
 Continuous client monitoring (Vitals)
 Documentation of case file with intraoperative notes
 Shifting client to PACU (Recovery room)
 Depends on the condition and anaesthetist order shift
the client to post operative unit (Before shifting inform
to concerned staff)
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34.  Specimen, file, reports to be handed over to
ward Nursing officer and get signature in the
register
 Cleaning of all instruments and sending to
CSSD for autoclaving
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35. THANK
YOU
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