Pre&post op care

• Surgery


  Invasive medical procedures performed to diagnose and treat disease, repair injury, or correct deformity
• Purposes of surgery


  • Diagnosis: determines presence/ extent of pathological condition (ex. Biopsy)
  • Cure: Elimination/Repair
  • Palliation: Focus on alleviation of symptoms without care & improve quality
  • Prevention: Removal of before malignancy (removing a mole before malignant)
  • Cosmetic: Reconstruction
  • Exploration: Determine nature/ Extent of disease (ex. Exploratory laparoscopy)
• Elective surgery


  Time to plan and prepare
• Emergency surgery


  Can't wait (ex. E.D.)
• Other names for outpatient surgery


  • Ambulatory care
  • Same day and inpatient surgeries
• Contrast between inpatient and outpatient care


  Physical care is provided in the same way
• Compare inpatient and outpatient care


  • Outpatient needs more teaching and emotional support for outpatient
  • Family and patient will be caring for postoperative care
• Factors that determine inpatient or outpatient surgery


  • Complexity of Surgery
  • Recovery
  • Expected needed level of post op care
• Benefits of outpatient surgeries


  • Decreased cost
  • Reduced risk of Healthcare Associated Infections (HIA)
  • Less interruption in patient's and family's routine
  • Possible reduction in time loss from work
  • Less physiologic stress to patient and family
• Consent form


  Needed before surgery; Delayed or canceled if not
• Phases of perioperative nursing


  • Preoperative: Decision for surgery made, Patient transferred to operating room
  • Intraoperative: Entry into operating room, Transfer to Recovery room
  • Postoperative: Admittance to recovery room, Complete recovery
• Informed consent


  An active, shared decision-making process between the provider and patient
• Conditions for informed consent


  • Adequate disclosure
  • Diagnosis, Nature & purpose of the treatment, Probability of successful outcome, Availability, benefits, and risks of alternative treatment, Prognosis if treatment not implemented
  • The patient must demonstrate clear understanding of the information provided before receiving sedating preoperative drugs
  • The patient must give voluntary consent
• Nurse's role in informed consent


  • Ensure signature
  • Ensure 1st and 2nd condition is met
  • Verify patient
• Past health history


  • Medication, previous hospitalization(s), surgeries, and/or complications
• Medications that can impact preoperative assessments


  • Opioids
  • Antihypertensives
  • Diabetic medications
  • Antiplatelets
  • Immunosuppressive drugs
  • Herbal supplements
• Allergies that can impact care


  • Medications
  • Food
  • Latex
• Type & cross


  Necessary before surgery in case of emergency blood transfusion
• Diagnostic studies needed


  • CBC
  • Coagulation
  • Kidney & liver function
  • Electrolytes
  • EKG
  • Chest X-ray
• Main systems reviewed for preoperative care


  • Respiratory
  • Cardiovascular
• A patient who is underweight has a higher likelihood of surgical risk than an overweight person
• Medications for preoperative surgeries and their functions


  • Antibiotics: prevent bacterial infection
  • Anticholinergics: decrease oral & secretions and prevent nausea and vomiting
  • Antidiabetics: Stabilize blood glucose
  • Antiemetics: Increase gastric emptying & prevent nausea and vomiting
  • Benzodiazepines: decrease anxiety
  • Beta Blockers: manage hypertension
  • Histamine Receptor Antagonists: Decrease gastric volume & secretion and increase pH
  • Opioids: Pain control
• Examples of preoperative teaching


  • NPO status (diet)
  • Medication
  • Postoperative care
  • Explanations of nursing care
  • Physical prep (special bathing/removal of fake nails)
• Patient preparation for male patients


  • Shaving
  • Removal of: jewelry, contacts, glasses, piercings, dentures, and hearing aids
• Recommendation if voiding could be an issue

  Use the bathroom before surgery
• Common priority NANDAS in preoperative care


  • Fear
  • Anxiety
  • Knowledge Deficit
• Surgical suite


  A controlled environment designed to minimize the spread of pathogens and allow a smooth flow of patients, staff, and equipment needed to provide safe patient care
• Permitted in surgical suite


  • Family members: unrestricted
  • Nurse preparing you for surgery: Semirestricted
  • Surgeon: Restricted
• Nurses on surgical team and their functions


  • Perioperative nurse: RN implements the patient's plan of care
  • Scrub nurse: Involved with sterile activities
  • Circulating nurse: Involved with non sterile activities
• Surgical hand antisepsis


  Washing fingers and hands first to elbow/foreman with hands up
• Aseptic technique


  Protective to prevent infection
• Safety precautions for intraoperative care


  • Prevention of wrong site surgery retained foreign objects
  • Accurate labeling and handling of specimens
  • Prevent electrical, chemical, and thermal burns
  • Safe blood, fluid, medication administration
  • Prevention of positioning injuries
• Complications linked to hypothermia


  • Impaired wound healing
  • Adverse cardiac events
  • Altered drug metabolism
  • Altered blood clotting (increased bleeding)
• Reason for unintended hypothermia


  Decrease temp. Level in OR to prevent infection and increased risk with anesthesia
• Surgical site cleaning


  Start at the surgical site in an outward circular motion (clean to dirty)
• Anesthesia techniques


  • Moderate to deep sedation: doesn't require an anesthesiologist or CRNA; administered by a trained RN outside the OR
  • Monitored Anesthesia Care: Requires anesthesiologist/ CRNA in or out OR
  • General Anesthesia: Patients will be intubated and require IV or Inhalation
  • Local Anesthesia: Interrupt nerve impulses by altering sodium into nerve cells; can be administered topical, nebulizer, or ophthalmic
  • Regional Anesthesia: always injected & involves central/cluster nerves supply area remote to injected
• Top priority for general anesthesia

  Airway management
• For local anesthesia the patient doesn't need to be out
• Intraoperative surgical risks


  • Thromboembolism
  • Anaphylactic reactions
  • Adverse Cardiac Events: especially in older adults r/t to stress on the circulatory system
  • Myocardial infarction
  • Cardiac Ischemia
  • Malignant hyperthermia (MH): Genetic disease passed from 1 parent that causes a rapid increase in temperature resulting in possible death
• How pulmonary embolism occurs


  Thromboembolism and DVT