CAAR OF PATIENT BEFORE AND AFTER SURGERY

1. BHARATI VIDYAPEETH DEEMED
UNIVERSITY COLLEGE OF
NURSING SANGLI
SEMINAR
SUBMITTED BY :
MR.MAHESH CHAND
MSC.NURSING

2. PREOPERATIVE
PREPARATION AND
POSTOPERATIVE
CARE

3. INTRODUCTION
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.
The use of audio-visual aids
demonstration and return demonstration.

4. Definitions.
 Preoperative 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
(Lipincott Manual of Nursing
Practice 6th
edition)

5. CLASSIFICATION OF SURGERY:
The type of surgical procedure are classified
according to
1] Seriousness
2] Urgency
3] Purpose

6. 1] Seriousness:
I] Major
II] Minor
I] Major surgery
Involves expensive reconstruction or
alternation in body parts . Poses great risk
to well-being .
II] Minor
Involves minimal alternative in body
parts often designed to correct deformities
involves minimal risk compared with major
procedure.
e.g. Cataract extraction, facial plastic
surgery, tooth extraction

7. 2) URGENCY:
1) ELECTIVE
2)URGENT
3)EMERGENCY
1)ELECTIVE:-
It performed on basis of Clients choice,
is not essential and may not be necessary
for health .
e.g.-facial plastic surgery , breast
reconstruction

8. 2)URGENT:
Is necessary for client health, may
prevent additional problem from developing
(e.g. tissue destruction or impaired organ
function
e.g.:- excision of cancerous famour, removal
of gall bladder for stone
3}EMERGENCY:-
Must be done immediately for save life or
preserve function of body part.
e.g. Repair of perforated appendix, Repair of
traumatic amputation, Control of internal
hemorrhaging.

9. Purpose:
1)Diagnostic :- Is surgical exploration that
allow physician to confirm diagnosis. May involve
removal of tissue for further diagnostic testing
e.g. Breast mass biopsy
2)Cosmetic :- Perform to improve personal
appearances
e.g.Rhinoplasty to reshape nose
3)Constructive :- Restore function lost or
reduced as result congenital abnormalities
e.g. Repair of cleft palate , closure of arterial
septal defect in heart
4)Palliative:- Relieves or reduces intensity of
arterial symptoms will not produce care.
e.g. colostomy, debridement of necrotic tissue

10. The nursing process in the pre
operative surgical phase:
The surgical client may undergo test of
procedures to confirm or rule out alteration
requiring surgery.
The client meets many health care personal
including surgeons, nurse, anesthesiologist, therapist
all play a role in the client care and recovery.
The nurse must effectively communication with
the client and family because the nurse client
ralationship is the foundation of care.
The nurse assess the client physical, emotional
and spiritual well being and cultural heritage,
recognizes the degree of surgical risk, coordinates
diagnostic test, identifies nursing diagnosis and
nursing interventions and establishes outcome in
collaboration with the client and with family.

11. ASSESSMENT
 The aim of assessment of surgical client is
to establish the clients normal pre-
operative function to assist the nurse in
prevention and recognizing possible post
operative complications.

12.  MEDICAL HISTORY
 NUTRITION
 PAST HISTORY
 ALLERGIES
 HABITS
 FAMILY HISTORY
 AGE
 OBESITY
 FLUID AND ELECTROLYTE IMBALANCE
 PREGANACY

13. PHYSICAL EXAMINATION
 General assessment
 head to toe examination

14. DIAGNOSTIC SCREENING
 BLOOD INVESTIGATION
 RADIOLOGICAL INVESTIGATION
 ECG


15. Implementation :
Pre-operative nursing intervention provide
the client with a complete understanding of the
surgical intervention.
1) Informed consent:
Surgery cannot be legally or ethically
performed until client understand the need for a
procedure the steps involving, risk, expected
resources and alternative treatment.
It is surgeons responsible to explain the
procedure and obtain the informed content.
After the consent form has been completed
the nurse ensure that the form is placed in the
client medical record.

16. 2)Health Promotion:-
Health problem activity during the
pre-operative phase focus on health
maintenance, prevention or complication
and support of possible rehabilitation need
post operatively.

17. 3)Pre –operative teaching
The client education is an important
aspect of the client surgical experiences.
The nurse should provide client with
information about sensation typically
experienced after surgery.

18. 4)Deep breathing:
One goal of pre – operative nursing
care is to teach the patient how to promote
optimal lung expansion and resulting blood
oxygen after anesthesia.
Asset client to comfortable sitting
position on side of bed or in chair standing
position.
The nurse then demonstrates how to
take a deep slow breath and now exhale
slowly.

19. 5. INCENTIVE SPIRMETER
 Pre – operative the patient was a spirometer to
measure deep breath expiring maximum effort.
 The pre-operative measurement because the goal of
be achieve as soon as possible after the operation
Post operatively the patient is encouraged to use
the incentive spirometer about 10 to 12 time per
hours.
6. COUGHING:-
 If thoracic or abdominal incision is anticipated
nurse demonstrate now to splint the incision to
minimize pressure and control pain.
 The patient should put the palm of both hand
across the incision site acts as an effective
splint when coughing.

20. THE FOLLOWING STANDARDS HAVE BEEN
ESTABLISHMENT BY ANA TO
DEMONSTRATE CLIENT UNDERSTANDING
OF THE SURGICAL EXPERIENCE

21. PHYSICAL PREPARATION
1) Maintenances of normal fluid and
electrolyte balance
 The surgical client is vulnerable to fluid and
electrolyte imbalance as a result or in
adequate pre operative intake or excessive
fluids losses during surgery.
 A client traditionally took nothing by mouth
(NBM) after midnight on the morning of
surgery of keep stomach empty and thus
reduce the risk of vomiting and aspiration.
 The physician assess serum electrolyte level
to determine the type of full fluid electrolyte
additives to administer.

22. 2)Promotional of rest and comfort :-
 Rest is essential for normal healing.
 Anxiety about the impending surgery can
easily interfere with ability to relax or
sleep.
 The nurse should attempts to make the
client environment quite and comfortable.

23. PRE PARATHION ON THE DAY OF SURGERY
The nurse complete a number of routine procedures
before releasing the client for surgery .
 Hygiene:- basic hygiene measure provide additional
comfort before surgery e.g. bath, provide clean hospital
gown
 Removal of prostheses: the client must remorse all
presence. Including denture artificial limb raring aids or
contact lens
 Safeguarding valuables :-
If client has any valuables the nurse should give them to
family members of secure them for safekeeping
 Preparing the bowel and bladder :-
The client may required an enema or catheter the
morning of surgery to ensure that the colon is empty.

24.  Vital signs:-
The nurse measure a final pre operative
vital signs
If pre operative vital signs are abnormal
surgery need to be pond
 Documentation:
Before the client goes to surgery the nurse
choice the contents of the medical record
laboratory reports and consent from cy choice
list
 Administering preoperative medication
Typically the physician order operative
medication to be administered when the client
values for the operating room or at an earlier
prescribe time

25. INTRA OPERATIVE SURGICAL
PHASE
 The nurse conduct a focused pre
operative assessment to verify client is
ready for surgery and plan.

26. ACUTE CARE :-
 Physical preparation :
After safety securing the client on the
orating room table the nurse applies
monitoring devices to the client before
surgery
Client reducing general and regional
anesthesia under go continues ECG
monitoring during surgery
Pulse oximetry will be used to monitor
oxygen saturation

27.  INTRODUCTION OF ANESTHESIA:-
Client undergoing surgical procedure
reduces one of four type or anesthesia,
general, regional local or conscious sedation
1) General anesthesia
It result in an immobile, acute, client
does not recall the surgical procedure
The client amnesia acts as a protective
measure from the unpleasant client of the
procedure
Surgical requiring general anesthesia
involve major procedure

28. 2)REGIONAL ANESTHESIA
 Regional anesthesia resulting of sensation
in an area of the body
 The method of induction influences the
potion of sensory path way that are
anesthetized
 No loss of sensation of conciseness
occures with regional anesthesia
 Administration technique include nerve
block and spinal or epidural
3)LOCAL ANESTHESIA
 Local anesthesia involve loss of sensatinal
at desired site E.g. (growth on skin or the
cornea of the eyes )

29.  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.

30. THE NURSING PROCESSING IN
POST OPERATIVE CARE :
 The nurse thoroughly documents
the assessment including vital
sciences, level consciousness,
condition of dressing and drain,
comfort level all fluids status,
and urinary output measurement
 Client data can be enter flow
sheet and compute raised client
record and written progress notes

31. 1. Respiration
 Certain anesthetic agent may cause
respiratory dispersion
 The nurse a specially alert for shallow,
slow breathing and weak cough
 The nurse asses air patency, respiratory
rate rhythm breath sound
 The acute care area nurse continues to
asses respiratory status and breath sound
old clients smokes and client with history
respiratory diseases are prone to
developing complication such as
atelectasis or pneumonia

32. 2) CIRCULATION
 The client is risk for cardio vascular complication
resulting of actual or potential blood loss form surgical
site. Side effect of anesthesia, electrolyte imbalance
and depression of normal circulatory regulating
mechanism
 Carefully assessment of heart rate and rhythm along
with blood pressure reveal’s the client cardio vascular
status
 A common early circulatory problem is haemorrhage.
 Blood loss may occur externally through a drain or
incision or internally.
 Either type of haemorrhage resulting a fall in blood
pressure elevate heart and respiratory rate cool clubby
pale skin and restlessness
 The nurse maintain IV fluid infusion and many need to
increase IV replacement fluid vital sciences every 15
minutes oxygen need to be continued medication may
be consider
 Blood counts and coagulation studies are drawn send to
laboratory.

33. 3)TEMPERATURE CONTROL
 Temperature regulation is important in the
post operative period
 Client are offend cool after surgery the
nurse proved warmed blanket in the
immediate post operative period

34. 4)MAINTAIN NEUROLOGICAL
FUNCTION
 Orientation to environment is important in
maintain the clients mental status the nurse
reorient the clients experience that surgery is
completed and describe procedure by nursing
measure
5)MAINTAIN FLUIDS AND
ELECTROLYTE BALANCE :-
 And important nursing responsibility is maintain
patency of IV infusion in the post operative
period

35. 6)PROMOTING WOUND HEALING
7) ACHIEVING REST AND COMFORT

36. THANK
YOU