NURSING PRACTICE II

Preparing patient for surgery

Perioperative nursing
This refers to the management and treatment of the patient during the
three phases of surgery that is
Preoperative
Intraoperative
postoperative.
Preop. phase
This phase begins when the patients, or someone acting on
the patient’s behalf, is informed of the need for surgery and
made the decision to have the procedure.
The phase ends when the patient is transferred to the
operating room (OR) bed.
It can also be refers to the time interval that begins when
the decision is made for surgery until the patient is
transferred to the operating room (OR).
Cont.
The preop phase is the period that is used to
physically and psychologically prepare the patient for
the surgery.
The duration of the preop period varies.
For example, in elective surgery, the period may be
long whiles that of emergency, the period is brief; the
patient may have no awareness of this period.
Cont.
The nursing activities associated with this phase
includes assessing the patient, identifying potential or
actual health problems, planning specific care based
on the individual’s needs, and providing preoperative
teaching for the patient and family.
Psychological preparation/Support
Psychological care before surgery is aim at reducing patient and
relatives’ anxiety/fear.
Explain the need for surgery as well as pre and post-operative care
activities and assure him/her of support from the staff
Explain procedure to patient and give reason(s) for each nursing
activity
Inform patient what to expect during and after the surgery
Allow questions from patient and family about the procedure and
clarified any
Cont.
Allow patient to ventilate feelings about the procedure
Orientate patient to his new home including theatre, surgical
equipment
Introduce patient to other patients or pictures of persons who have
undergone the same/similar operations and are responding well
Religious leaders such as pastors, Imams, Rev. Fathers are call to pray
for patient before the surgery if s/he wishes.
Cont.
Ensure the surgeon explain to the patient and family of the
procedure, its expected outcomes, benefits, potential risks and
alternatives
Reinforce surgeon explanation ensure that patient sign the consent
form
No sedation should be given before patient sign the consent form
Minors (children below 18 years by Ghana law) need a
parent/relative to sign
In consultation with the anaesthetist and the surgeon, sedation may
be given the night before the surgery if the patient is still anxious
Physiological Preparation
The purpose is to correct physiological imbalances, identify any
abnormalities, and get base line data ensure that the patient is fit for
the surgery.
Ensuring that investigations such as urinalysis, full blood count,
grouping and cross matching, stool R/E or C/S, FBS/RBS and x-rays etc,
are explained to patient and carried out.
Ensure that patient is well hydrated by administering prescribed
intravenous fluids.
Administer blood to correct anaemia if needed and ordered
Cont.
Monitor and record vital signs such as temperature,
blood pressure (B/P), weight and pulse
Observe the general condition of the patient for any
co-morbidity
Observe to ensure that the IV line is flowing correctly
and record the type and amount of intravenous fluids
given in the intake and output chart.
 Pass a urinary catheter if needed and observe to be
sure that is draining well and notes the colour amount
Cont.
Improve the nutritional state of the patient by giving
high protein and calorie diets on admission depending
on his condition.
Give light non residue diet a day before operation.
Give nothing by mouth after supper and in the
morning of operation
If it is an emergency case, nothing should be given by
mouth (NPO)
Physical preparation
Ensure patient maintain good personal hygiene
Naso-gastric (NG) tube may be passed to empty the
stomach and possibly reduce the pressure within the
abdomen before surgery
Encourage patient to bath if s/he can or bed bath
him/her if not able
Cont.
Clean the incision site with mild antiseptic soap
the night before the surgery
Shaving should be done according to hospital
protocol
Carry out doctor’s orders on bowel preparation.
The bowel may be emptied in some cases
Evacuate enema is given the night before
surgery and this may be repeated on the
How to do skin prep
Requirement
1. Gauze
2. Antiseptic lotion
3. Plaster
4. Bowl of water
5. Soap
6. Operation gown
7. Operation towel
8. Dressing mackintosh
Procedure
Establish rapport, explain procedure and reassure
patient
Prepare and send trolley to patient bed side and
provide privacy
Place patient into the desired position
Expose the area to be prepared and protect the bed
cloths
Cont.
Wash hand, wear glove and washes the area with
soap and water
Dries and cleanse with antiseptic lotion
Cover area with operating towel and secure it in
position with adhesive strapping.
Thank patient, discard trolley and wash hands
Document procedure
Immediate-Preoperative Preparation (day
of operation)
Stress on NPO
Encourage patient to move bowel if bowel
preparation was not required and empty his/her
bladder if not catheterized
Assist patient to bath
Cont.
Check patients’ vital signs and record findings in the nursing record
and report any abnormalities.
Ensure that NG tube if ordered is in situ and draining well.
Empty drainage before sending patient theatre
Remove all jewellery, beads, rings, hairpins etc and labelled, recorded
and kept them safe.
 A ring that could not be removed because of religious, cultural
reasons should be covered with a tape/plaster.
cont.
Serve pre-medication e.g. diazepam, atropine, morphine,
pethidine, phenergan etc, 30 minutes or an hour prior to
surgery or as instructed by the surgeon.
Reasons for pre-op medications include; diminish bronchial
and salivary secretion, alley patient anxiety and make the
induction and maintenance of anaesthesia easy.
Help patient to put on theatre gown
Cont.
Put an identity named tag on the patient's arm
Ensure that an IV line is maintained and prescribed IV fluids running
Send patient to theatre on a stretcher with patient’s case notes,
charts, x-ray, lab results drugs ordered for the procedure, signed
consent form and preoperative checklist
Hand over patient to the theater staff.
Preoperative teaching
Deep breathing exercise
Splinting and coughing exercise
Leg exercise
Intraoperative (during surgery) phase
Intraoperative begins when the patient is transferred to the
operating room bed and ends with patient transfer to
recovery ward.
During this period the patient is monitored, anaesthetized,
prepped, draped and the procedure is carried out.
Nursing activities in the intraoperative period is center on
patient safety, facilitation of the procedure, prevention of
infection, satisfactory physiologic response to anaesthesia
and surgical intervention.
Postoperative phase (after surgery)
It begins with the patient’s transfer to the recovery unit and
ends with patient recovery from the anaesthesia.
Nursing activities in the immediate postoperative period
center on support of the patient’s physiologic systems
(assessing the patient’s response to surgery, and perform
interventions to facilitate healing and prevent
complications).
In the later stages of recovery, much of the focus is on
reinforcing the essential that patients and caregivers require
in preparation for discharge.