Role of Nurse in Preoperative and Intraoperative nursing care. Practical aspects of Nursing care

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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SHRI VINOBA BHAVE CIVIL HOSPITAL,
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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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SHRI VINOBA BHAVE CIVIL HOSPITAL,
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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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SILVASSA
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