Health talk

On
Pre-operative and post-operative care

Submitted by:
Submitted to:
Riny Khurshid
Mrs.Sarita Ahwal
M.Sc. Nursing 2nd year
lecturer
CON, ILBS Hospital
CON, ILBS Hospital

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 College of Nursing, Institute of Liver and Biliary Sciences
M.Sc. Nursing 2nd year

Subject: Clinical Specialty Ⅱ

Class group: pre-operative patients and their relatives
Date/Time:
Duration:20 minutes
Venue: General ward ,GB PANT hospital
Method of teaching: Lecture cum discussion
Medium of teaching: Charts and Flashcards
Name of student Teacher: Ms. Riny Khurshid
Name of the moderator: Mrs. Sarita Ahwal
Previous knowledge: Patients have some knowledge aboutpre-operative and post operative phase.

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 Objectives
General Objectives:
At the end of the topic, the patients will be able to gain knowledge about pre-operative and post operative care ,can able to adapt with the
changes after surgery and prevent post operative infection

Specific Objectives:
At the end of the teaching, the patients will be able to -
1.Define preoperative phase
2.To patient will able to enlist the goals of pre-operative care
3.To list down pre-operative checklist
4To explain the post-operative exercises
5.To enlist the importance of personal hygiene
6. To identify changes that may occurs after surgical procedure
7.To explain the important steps for wound care

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S.No Time Specific Content Teaching AV-aids Evaluation
. Objective Learning
activity
1. 1min To introduce myself Good morning everyone present here. I am The student
to the group and to Riny Khurshid students of M.Sc. Nursing 2 nd teacher
announce the topic. introduces the
year of ILBS College of Nursing. I will be
topic to the
presenting my Healthtalk on the topic “Pre- group.
phase phase”.
2. 1 min To introduce pre- Introduction Lecture cum
operative and post Surgery whether elective or emergent, is a discussion.
operative care stressful, complex event. The special field
knownas peri-operative and peri
-anesthesianursing includes a wide variety of
nursing functions. It is the phase when the
patient had decided for surgical intervention up
to thetime of transfer to the operating
room.There is 3 phases of surgery that is pre-
operative,intra-operativeand
postoperative.Preoperative care is the
preparation and management of a patient prior
to surgery.
It includes both physical
andpsychological preparation. During the pre
–operative phase, assessment is done in terms
of age of the patient, by which young children
and olderadults are the most vulnerable to
complications; the patient’s nutritional status,
wherein post op recovery usually relies; fluid
andelectrolyte status, because hydration is

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 important to prevent hypovolemia during
surgery; presence of infection and other
health problems.
3. 1min The patient will be Preoperative careis the time period between Lecture cum Define pre-
able to define pre- operative and post-
thedecision to have surgery and the beginning discussion.
operative and post- operative care
of the surgical procedure
operative care
Post -operative care is the care that the patient
receives after surgical procedure till the
discharge of the patient .
4. 2 min To patient will able GOALS OF PREOPERATIVE CARE Lecture cum Enlist the goals of
to enlist the goals of discussion. pre-operative care.
Although the physician is responsible for
pre-operative care.
explaining thesurgical procedure to the patient,
the patient may ask the nursequestions about
the surgery. There may be specific
learningneeds about the surgery that the patient
and support personsshould know. A nursing
care plan and a teaching plan should becarried
out.
During this phase, emphasis is placed on
 Assessing and correcting physiological and
psychological problems that may increase
surgical risk.
 Giving the patient and significant others
complete learningand teaching guidelines

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 regarding the surgery.
 Instructing and demonstrating exercises
that will benefit the patient postoperatively.
 Planning for discharge and any projected
changes inlifestyle due to the surgery

5. 2min To list down pre-  Consent form Lecture cum List down pre-
operative checklist  Bath/Shower/Scrub Make up removed discussion. operative checklist

 Hair Clipped
 Date Time Polish/Artificial Nails removed
 Personal Clothing andunderwear removed
 Dentures/Partial/Retainer removed
 Glasses/contacts removed Hearing aid Lt
removed
 Pins/Hairclips removed Hearing aid Rt
removed
 Tampon removed Prosthesis removed
 Bowel Prep done Voided at
 NG Tube inserted
 Catheter inserted
 NPO - Solids at Medications taken this
am
 NPO Clear Fluids at Pre-Op medications

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 given
 IV Site checked Medications to OR
 Blood Products arranged Antiembolic
Stockings

6. 4 min To explain the post- The postoperative exercises include turning, Lecture cum To explain the
operative exercises deep breathing, coughing, and extremity discussion . post-operative
exercises?
movement.
(1) Turning. Turning in bed and early
ambulation helps patients maintain blood
circulation, stimulate respiratory functions, and
decrease the stasis of gas in the intestines and
resulting discomfort. Practice before surgery
usually makes it easier for the patient to do it
postoperatively. In some instances, the patient
may need special aids, such as a pillow
between the legs, to help maintain body
alignment.

a. Patient turned away from the nurse with

arms and legs crossed.
b. Patient turned toward the nurse with arms
and legs crossed.

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c. Patient on side in middle of bed with a
pillow in front of the bottom leg with the top
leg on the pillow in flexed position, a pillow
against the back, a small pillow supports the
arm and hand, pillow under head and shoulder

2) Deep breathing. Deep breathing helps

prevent postoperative pneumonia and
atelectasis (incomplete expansion of the lung or
a portion of the lung). In deep breathing, the
patient should inhale and exhale as much air as
possible. You are to explain the procedure and
its purpose to the patient. Instruct the patient to:
a) Inhale slowly through the nose, distending
the abdomen and exhaling slowly through
pursed lips .

(b) Deep breathe as often as possible,

preferably 5 to 10 times every hour during the
postoperative, immobilized period.
(3) Coughing. Coughing is done to mobilize
and expelrespiratory system secretions which,
because of the effects of anesthesia, tend to

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pool in the lungs and may cause pneumonia.
The patient should be in a sitting or lying
position. Instruct the patient to:
(a) Lean forward slightly while sitting in bed.
(b) Take a deep breath.
(c) Inhale fully with the mouth slightly open.
(d) Let out three to four sharp "hacks."
(e) With mouth open, take in a deep breath and
give one or two strong coughs.
(f) Repeat steps (a) through (e) ten times, as
tolerated.
NOTE: The above steps should be repeated
every two hours during the postoperative phase
or as prescribed.
(g) The patient may lace his fingers and hold
them tightly across the incision before
coughing. This is used as a splint to minimize
pressure and helps to control pain when the
patient is coughing. A small pillow or folded
towel may be used in place of laced fingers.

NOTE: Encourage the patient to perform deep

breathing exercises before coughing. This
stimulates cough reflex.
(4) Extremity exercises. These exercises help to
prevent circulatory problems, such as
thrombophlebitis, by facilitating venous return
to the heart. It also decreases postoperative "gas
pains

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 (a) Flex and extend each joint, particularity the
hip, knee, and ankle joints, keeping the lower
back flat as the leg is lowered and straightened.
Move each foot in a circular motion.
b. Time of Instruction. The best time to teach
patients is relatively close to the time of
surgery, which is usually the afternoon or
evening before the surgery.
(1) If instruction is given several days in
advance, the patient may forget.
(2) If instruction is given just before surgery,
the patient may be too apprehensive to listen or
too heavily sedated to comprehend.

7. 3 min To enlist the Lecture cum Charts Enlist the

importance of a) Bathe or shower. This is done to remove discussion and importance of
personal hygiene excess body dirt andoils. It gives the patient a personal hygiene?
sense of relaxation. Depending upon the extent
of surgery, it may be several days before a
patient may take a "real bath."

(b) Shampoo hair. This is also done for the

same reasons as in the previous paragraph.

(c) Remove nail polish and make-up. During

surgery, numerous areas must be observed
carefully for evidence of cyanosis to include
the face, lips, and nail beds. Make-up and nail
polish hide true coloration.

(3) Mouth care:All preoperative patients

should have thorough mouth care before

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surgery. A clean mouth makes the patient more
comfortable and prevents accidental aspiration
of food particles. Chewing gum must be
removed before the patient goes to the
operating room.

(4) Attire. Give the patient a clean hospital

gown. The wearing of his own gown or
pajamas to surgery is not permitted because of
Attire. Give the patient a clean hospital gown.
The wearing of his own gown or pajamas to
surgery is not permitted because of potential
loss or damage.

(5) Prostheses. Ask the patient to remove his

dentures, contact lenses, and artificial limbs. Be
sure to place all items in a container labeled
with the patient's name and room number. Take
extra care not to break or loose patient's
prostheses. If possible, send the prostheses
home with a relative.

(6) Jewelry. Jewelry should be removed for

safekeeping. Do NOT store in bedside stand
give the jewelry to a relative. The patient may
wear a wedding band to surgery secured with
tape or gauze wrapping. Do not secure it so
tightly as to impair circulation.

(7) Food and fluids. Follow the doctor's orders

for type of diet preoperatively. Usually, the

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 patient will be NPO from midnight on. Remove
the patient's water pitcher. Place an NPO sign
outside patient's room (see Figure 1-8). Mark
the diet roster.

(8) Offer emotional support. Answer

questions concerning surgery. Provide
explanation of each preoperative nursing
measure. Ask the patient about spiritual needs.
Provide family members with information
concerning their role the morning of surgery,
waiting room location, postoperative visit by
surgeon, rational for stay in recovery room, and
presence of any special tubes or machines
attached to their loved one.

(9)Communication: Good communication

between all members of the health care team
will ensure that the patient is well prepared and
ready to undergo surgery. All shifts and nursing
personnel must be an active participant in the
preoperative phase of the surgical patient.

8. 3 min To identify changes Appetite loss:Poor appetite after surgery is Lecture cum Flashchart Identify changes
that may occurs after very common, especially when general discussion and that may occurs
surgical procedure anesthesia was used. It may be associated with after surgical
temporary weight loss. Most patients regain
procedure?
their appetite and return to their normal weight
as the effects of the surgery wear off.

Swelling: Around the site of surgery. It is

natural to experience some swelling after any

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surgical procedure. A surgical cut in the skin,
also called an incision, is a form of injury to the
body. The body's natural response to injury is
the inflammatory process, which causes
swelling. As the healing occurs after the
surgical procedure, the swelling usually goes
away.

Drainage from the site of surgery. Sometimes

the fluid that builds up at the surgery site drains
through the surgical wound. Drainage that
smells bad along with a fever and redness
around the wound are signs of infection. If you
develop signs of infectionyou should contact
your surgeon's office.
Bruising :Around the site of surgery. After any
surgical incision, some blood may leak from
small blood vessels under the skin. This can
cause bruising, which is a common occurrence
after a surgical procedure. However, if you
have significant swelling along with bruising,
contact your surgeon's office.
Numbness: It is common to experience some
numbness in the incision site since skin nerves
are cut during surgery. Though it usually does
not cause patients any problems, it often lasts a
long time.
Bleeding:Patients usually lose some blood
during surgery. But, it is usually very little and
does not affect the normal functions of the
body. Sometimes, patients can lose a larger
amount of blood depending on the surgery. In
these situations, the surgical team will have
blood available for a transfusion if it is needed.

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After surgery you may experience some
bleeding from the wound Ifthis occurs, cover it
with a clean, dry bandage, and contact your
surgeon's office. If there is a lot of blood, apply
pressure until you can get to your surgeon's
office or the local emergency room.
Infection:An infection may occur at the site of
the incision, but it can also occur elsewhere in
the body. Surgeons take great care to lower the
risk of infection during the operation. After
surgery, your health care team will teach you
how to prevent infection during recovery. Signs
of infection in a surgical incision include
redness, warmth, increased pain, and
sometimes, drainage from the wound. If you
have any of these signs, contact your surgical
care team. Antibiotics generally work well to
treat most infections. However, some infections
form an abscess. This is a closed skin cavity
filled with fluid and/or pus. This usually needs
to be drained in a doctor's office. Antibiotics do
not work as well for an abscess because they
may not beable to reach the infection.
Organ dysfunction. Surgery in certain areas of
the body, such as the abdomen or chest, may
cause temporary problems with the surrounding
organs. For example, when surgery is
performed in the abdomen, the intestine may
become paralyzed for a short time. This means
that it won't allow food, fluid, and gas to pass
through the bowels. This is called an ileus or
bowel obstruction. It can cause nausea and
vomiting, stomach cramps, and bloating until
the bowels begin to function again. Organ

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 dysfunction after surgery generally goes away
as you heal.
8. 2 min To explain the  Taking Care of Your Wound Lecture cum Explain the
important steps for  Wash Your Hands: discussion. important steps for
wound care  Rub hands with soap and water for 15 to wound care?
30 seconds.
 Be sure to wash between fingers and under
your nails.
 Rinse well and dry thoroughly.
GET YOUR SUPPLIES:

• Have everything you need ready before you

begin.
aking Care of Your Wound

Wash Your Hands:

• Rub hands with soap and water for 15 to 30

seconds. • Be sure to wash between fingers and
under your nails.

• Rinse well and dry thoroughly.

GET YOUR SUPPLIES:

• Have everything you need ready before you

begin.
REMOVE OLD DRESSING:

Step 1. Loosen old dressing.

Step 2. Place your hand into a small plastic

bag.
Step 3. Gently take off the old dressing with
bag covered han

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Step 4. Turn bag inside-out over the old
dressing.

Step 5. Close the bag tightly before throwing it

in the garbage.

Wash/Irrigate the Wound:

• ALWAYS follow your doctor's instructions

for your wound care.

• To clean the open wound, pour enough

solution to dampen the gauze, then wipe your
wound using circular motions from the center
of the wound outward. Be sure to clean at least
1" beyond the wound margins.

• Make sure you use a new gauze each time you

wipe and discard the soiled one in a plastic bag.

• Dry surrounding skin by patting with new

gauze.

REMEMBER TO:
Use dressings only once.
•Keep dressings in a clean, dry place.
•Throw out the entire dressing if it gets dirty.
•CLEAN UP:
•Put all your dirty supplies in a double (two)
plastic bag.
Wash your hands
•Check that you have enough supplies for a
couple of days.

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 •Do not let your supplies run low.
•Tell Your Doctor or Nurse if The wound (sore)
gets larger or deeper.
• More fluid drains from the wound.
•The wound does not begin to show signs of
healing in 2 to 4 weeks.
• You see signs of infection.

9. 1min To summarize the The pre-op phase and post-operative is an important phase of peri-
topic operative nursing. The preoperative phase is used to perform tests, attempt
tolimit preoperational anxietyand may include the fasting. The patient
who consents to have surgery, particularly surgery that requires
ageneralanesthetic, renders himself dependent on the knowledge, skill,
and integrity of the health care team. In accepting this trust, thehealth care
team members have an obligation to make the patient's welfare their first
consideration during the surgical experience. Thescope of activities during
the preoperative phaseincludes the establishment of the patient’s baseline
assessment in the clinical setting. Post operative care help to prevent other
further complication

Reference:

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 Smeltzer, S. C. O., Hinkle, J. L.., Cheever, K. H., & Bare, B. G.. (2010). Brunner & Suddarth's textbook of medical-surgical nursing
(12th, North American Edition,
 Combined Volume edition.). Preoperative Nursing Management (pp. 399-414) Philadelphia: Wolters Kluwer Health/Lippincott Williams
& Wilkins
 Ignatavicius, D. D., Workman, M. L., & Henderson, L. (2015). Medical-surgical nursing: Critical thinking for collaborative care (7th
ed.). Care of Preoperative Patients (pp.239-259). Toronto: Elsevier Saunders. (ISBN 978-1-4377-2801-9.
 Kozier, B., Erb, G., Berman, A., Snyder, S. J., Bouchal, D. S. R. et al. (2014). Fundamentals of Canadian nursing: Concepts, process, and
practice (3rd ed.). Toronto: Pearson. (ISBN 978-0133249781)

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