Management of patients undergoing surgery

Preoperative care

Preoperative care refers to the preparation and management before surgery.

A patient is admitted to the hospital with various physical conditions and the condition requires surgical intervention to treat the physical condition. Nurses are responsible for completing pre-operative care and implementing doctors’ orders, recording all care.

Preoperative care consists of many components that are performed in the hospital before surgery.Many surgical procedures do not require admission.

To try and correct the physiological and psychological problem, if not corrected, during surgery it will have its effect.

Giving all the surgery related information to the patient.

Demonstrating and instructing the patient in some post-operative exercises

Physical preparation

Psychological preparation

Physiological preparation

Premedication

Operative preparation

The preparations mentioned above are done in pre-operative care.

Physical preparation

Conducting physical assessment in physical preparation

Medical History

Taking history of any past medical conditions like diabetes, hypertension, asthma, TB, myocardial infection, etc.

If any surgery has been done before, get information about it.

In case of allergy to any drug, take detailed information about it.

General Examination

Performing a physical examination including checking and recording vital signs.

Drug and alcohol use

Know if there is a history of alcoholism with pleasure. To know if he uses any drug or not.

Nutritional and fluid status

Assessing the nutritional status of the patient, checking obesity, weight loss, my nutrition etc. If any nutritional deficiency is present, it should be corrected before surgery.

Respiratory status

Assessing respiratory status as ventilation is potentially compromised during surgical treatment

Surgery is postponed if the patient has a respiratory infection.

If the patient has a history of smoking, it should be stopped one month before the surgery as it affects during the surgery.

Cardio vascular status

When preparing a patient for surgery, the goal is that the cardio vascular system should be functioning properly so that the whole body gets oxygen, fluid, nutrition.

Surgery is postponed if blood pressure is uncontrolled.

Hepatic and renal function

Before surgery, check that the liver and urinary system are functioning well or not because medication, an aesthetic agent, body waste and toxins are removed through adequate processes. So if this system works properly, it can remove the waste.

Endocrine function

If the patient has diabetes, then there is a risk of hypoglycemia during the surgery and the glucose level has to be checked frequently before surgery, during surgery and after surgery.

Before surgery check whether there are any diseases related to endocrine system or not.

Checking for latex allergy If the patient has a recent fancy, use all care and surgical procedures latex free gloves.

Bowel clearance if lower gastrointestinal track surgery.

Giving some patients sleeping in the night before surgery.

Skin preparation the night before surgery S on folder, clubbing by special shop and surgical area 60 hair removal. Saving hair is not highly recommended as some studies show that it increases the chances of infection.

To carry out pre-operative laboratory and diagnostic investigations.

Laboratory and Diagnostic Tests

CBC
Blood type and cross match

Serum electrolytes
Urine analysis

Chest x-ray

ECG

Other test related to procedure

Psychological preparation

Surgery related patients have anxiety and fear

The patient should express his emotions with the nurse so that he feels good and his anxiety is removed.

Providing psychological support to patients and their family members.

Surgery is sometimes postponed if the patient feels more secure.

Explaining all surgical procedures to the patient so as to reduce hi fear.

Spiritual belief plays an important role in coping with that anxiety

Premedication

Anesthesia is administered in pre-operative care, so it is administered through safety techniques.

NTMAT Drug

NTMAT drugs are given to prevent aspirating eg ondansetron.

Sedative drug

A sedative drug such as Dije Palm is given the night before surgery to prevent muscle hyperactivity.

Intra-venous fluid is given on doctor’s order.

Prophylactic antibiotics are given.

An anti-hypertensive drug like propanolol is given if needed.

Also providing other prescribed drugs like diuretic, cardia drug, as well as current meditation of the patient.

To record the medicines given.

Preoperative preparation

When the patient is ready for the operation, the surgeon gives the pre-operative preparation order. If there is an elective operation, the pre-operative order should be given one day before.

Identifying the patient and removing his hair on the surgery side, before the operation, giving a complete bath with antiseptic soap and Savlon on the day before the surgery.

Eliminate anxiety

Enema for bowel care

Do a pre anesthetic checkup

Taking a pre-operative approach

Legal and Ethical

Informed concert

A return concert from the patient or his guardian is a vital part of pre-operative care for surgery. According to Law, the physician who performs the procedure explains to the patient the risk factors and benefits of the surgery, other treatment options.

The nurse stands as a witness while the patient signs the concert form. It is important that the patient understands what is explained by the surgeon. Sometimes asking the patient what was explained can tell how much the patient understood.

A patient who is mentally impaired, heavily sedated, or in critical condition is not legally able to give a concert, in such a situation his spouse, adult child, adult sibling signs the concert form.

If the patient is below 18 years, his/her parents should sign the consent form.

Pri operative teaching

Pre-operative teaching involves explaining the pre-operative period, surgery time and post-operative to the patient. Preparing for surgery in the pre-operative period.

Explain to the patient how to prepare the day before the surgery eg giving it to the patient before the surgery.

Explain to the patient why eating and drinking should not be done eight to 12 hours before surgery, as it increases the chance of aspirating vomit due to its stabilizing effect.

Ask the patient to take a bath in the morning, ask to remove all jewelry makeup, eye glasses, dentures etc. before going to the operation room.

Explaining the operation theater and recovery room setup to the patient. Asking his staff members to wear scrubs and masks.

Instruct the patient to be transferred to the recovery room after surgery and be closely monitored. Oxygen masks, blood pressure cuffs and other monitoring equipment are attached there.

Instructing the patient on how much activity can prevent complications such as deep breathing exercises.

Pain management is a primary concern after surgery. Telling the patient to inform the medical staff when he has pain, checking his pain level with a pain scale and using pain control methods accordingly. Like comfort position, mind diversional therapy, music therapy etc.

2) Intra operative care

Intraoperative means during surgery, the care given during surgery like patient’s vital sign, blood oxygen level, fluid therapy, medication, transfusion, radiography, and retrieving laboratory sample, etc. are done intra operative care.

The purpose of intraoperative care is to maintain patient safety during surgery. Some of the goals are hemostasis during the procedure, maintaining strict sterile technique during the procedure to minimize cross infection, checking that the patient is secure on the operating table.

Intraoperative time can range from less than one hour to more than 12 hours, depending on the complex CT scan performed during surgery.

Surgical team

and responsibility

Creation

A surgeon is the leader of the surgical team. The surgeon is ultimately responsible for safe and effective surgery.

The surgeon depends on other team members to monitor the patient’s emotional well-being and psychological well-being.

Anesthesiologist

An anesthesiologist is a physician trained to administer anesthetics.

Responsibility

Provides smooth anesthesia to prevent pain.

Static Factory maintains patient relaxation during surgical procedures.

Continuous monitoring of patient’s physiological status including oxygen exchange, systemic circulation, neurological status, vital signs during surgical procedure.

Scrubbers

Paper _1

Circulating nurse

Circulating nurses are registered nurses who work between the person and outside of the operating room.

Circulate team nurses respond to requests from surgeons and anesthesiologists.

Delivers and obtains sterile items from the sterile field as needed.
Carry out nursing care plan.

Circulating nurses do not wear sterile gloves, gowns or scrubs.

Other responsibilities such as assessment of patients from admission to operation room

Helps in monitoring the patient

Assists surgeons and scrub nurses in donning sterile gowns and gloves.

Provide necessary equipment instruments, medication, and blood components

Opening the package so the scrub nurse can remove the sterile object.

Prepare the label

Spacey transfers the man to the laboratory for analysis.

Count the used gauze

Count all instruments, used needles, and sponges at the end of surgery to prevent accidental loss of wood.

Anesthetic agent and role of nurse in anesthesia

Paper no.__2
Post operative management

(1) Immediate care

monitor

To monitor vital signs

Temperature
blood pressure
pulse
Respiration

In case of neuro surgery, check the level of consciousness.

Electrocardiogram monitoring

Respi retry Care

Clear the airway

Checking the oxygen level.

Start oxygen if necessary.

If the patient cannot take oxygen on his own, keep on ventilation.

Apply suction in a regular manner to prevent airway obstruction.

If necessary, do chest physiotherapy.

Position and Mobilization

The patient’s position depends on the type of surgery he is having.

If the patient does not want to undergo Mo B Liageson, then Mo B Liageson should not be done as it may cause surgical side bleeding.

If the patient can mobilize, change position at 30 minute intervals to prevent bed sore.

If the patient cannot mobilize for a long time, compression of the intermediate calf muscles can be used to prevent deep vein thrombosis.

Diet

Keep oral on the neel for 24 hours after surgery.

Start liquid diet when peristalsis movement is audible.

Start semi-liquid diet after liquid diet and then regular normal diet if there is no precaution.

Intake of nutritional diet to prevent imbalance nutrition.

Administration of IV Fluid

Administer IV fluid as per patient’s requirement.

It is IV fluid crystalloid or colloid

Blood transfusion if needed.

Maintain patient’s intake and output chart.

Strictly monitor IV fluid in case of renal surgery or cardiac surgery so that fluid overload can be reduced.

We can prevent hypo volemia by administering timely eye fluid.

Medication

Administer prophylactic antibiotics to prevent infection.

Administer sedative drugs.

Administering an antacid drug to reduce the production of HCl can prevent acidity.

Pain killer drugs are given so that the level of pain can be reduced.

Laboratory test
Post-operative complications can be prevented through laboratory tests.
E.g
Hb

Assessment of the surgical site

Assess the surgical site for bleeding.

If mild bleeding is observed at the surgical site, apply gentle compression to stop the bleeding.

In case of concealed bleeding, immediate shift to operation theater and emergency exposure.

Keep the patient left

Because of its anesthesia, anesthesia affects the hypothalamus due to which there is a chance of hypothermia.

Therefore, by using a warmer blanket or a light, keep the patient awake so that hypothermia can be prevented.

Relieving Pen

Administering Opoid Anaesthesia on a Doctor’s Order

Order on making NSA Id Ed Minister.

Providing psychological support.

Provide calm and comfort environment.

Providing Mind Diversional Therapy.

Nausea and vomiting

Nausea and vomiting are commonly seen after surgery so NT Amity Drug Ad minister.

E.g
Injection Metoc Loparamite
Injection on the centrone

Isolation

Keeping the patient in isolation after surgery to prevent cross infection.

If the patient has communicable diseases, we can prevent infection to others due to separation.

Prevent visitors

Keep the isolation room clean and ventilated.

Check drainage tube

Continue to check the drainage tube so that excessive bleeding can be identified early.

Patient in recovery room and recovery from anesthesia

A post anesthetic care unit also called a post anesthesia recovery room is located near the operation room.

The PACU should be quiet, clean, and free of accessories.

PA CU is divided into two phases.

Phase 1 –– This is the immediate recovery phase requiring intensive nursing care in which the nurse monitors the patient’s pulse receptivity, blood pressure, pulse oximetry, and ECG for 15 minutes.

Phase 2–Phase Two provides post-anesthesia care that requires less observation and nursing care as compared to Phase One.

Admin team patient to PACU

The patient is transferred from the operation theater to the PSCU after the surgical procedure.
A highly skilled area in which care and close monitoring is provided to all anesthetically emerging patients.

He has the stegiologist responsibility for transfer from operation theater to PACU.

In PACU, he reports the patient’s condition, type of surgery performed, type of anesthesia given, and blood loss, input output, etc. to the anesthesiologist or nurse anesthetist.

Recovery from anesthesia is uneventful but its complications are rare and life threatening.

The Process What to Do

(1) Hand over

In which the name of the patient
The same
History__Medical, Surgical

Type of anesthetic and what type of drug provided

Vital sign
Specific order
Blood loss
Other than significant events, assays are performed.

(2) Initial assessment

In which the patient’s airway is checked.

The patient’s spo2 should be checked.
To check whether the patient can do self-breathing or not. If self-breeding is not possible, provide artificial breeding.

Checking rate and def of patient’s recipe ration including assessing chest movement and work of breath.

To check the color of the patient’s lips, nails, and distant parts of the body

If there is an artificial airway, remove it when the patient is conscious and self-breathing.

Do not leave the patient alone after removing the artificial airway.

Start oxygen mask if needed.

Continuous oxygen level and airway observation

(3) Cardiovascular assessment

To continuously monitor the patient’s heart rate and blood pressure at 10 minute intervals.

If patient, keep checking at five minute intervals.

(4)Neurological assessment

Neurological assessment by four components.

Glass Go Coma Scale

Upil size and its reaction to light.

Limb response

Vital sign

(5)Assess pain level

Checking the level of pain by pain scale.

Pain management is a big challenge for PACU nurses

Doctor orders on s to provide pain killers.

(6)Reinsurance of patient

Explain to the patient where you are, how long you have to stay and what procedures have to be done during that time.

(7) Observe wound site and drainage.

(8) Status of fluid.

(9) Maintain patient privacy and encourage continuity of care.

(10) To work with the safety and comfort of the patient in mind.

Documentation

Documentation is an important factor in nursing care

If not documented then the order is considered not completed.

Hence ensuring that all documentation is completed and signed by the patient prior to discharge.

Post operative record in documentation

Anesthetic record

Treatment seat

Fluid orders and drug charts

Specific Observation Chart

Post operative check list etc. are recorded.

Discharge

The following criteria must be fulfilled before the patient is discharged

The patient should be conscious and cooperative

Eddy cavitation ventilation and airway should be maintained.

Confol table should be eg
Pain should be under control
Nozia should be absent or minimal

The dressing should be dry and secure.

Should be hemodynamically stable.

Many complications in PSCU can be prevented by proper care and monitoring.

Post operative order

The surgeon who gives the order is solely responsible for making the appropriate order for the patient.

Post-operative care requires detailed treatment orders.

The surgeon orders the patient to be transferred from the operation theater to the recovery room.

Keeping the patient oral on Nile for 6 hours after surgery

To monitor vital signs regularly

To mo b lice the patient.

Administering eye vs. fluid based on fluid lost in intra-operative surgery

Providing medical scene.

To carry out laboratory investigations.

Discharge the patient as per doctors order

Post operative complications and preventive management

Paper no. 3

Postoperative nursing management

Nurses have an important role in post-operative care.

The nurse is responsible for the patient’s recovery.

Control post operative pay e no
Checking the patient’s pain level and location. Follow the pain relief orders given by the doctors.

Helping the patient feel relaxed through back rubs and other comfort measures.

Make sure fluid intake is adequate

It is necessary to have enough fluid in the patient. Check the patient for signs of dehydration and fluid overload.

Signs of dehydration such as
Mucus membrane drying.

Elasticity of the scheme should be poor.
Thirst and small amount of urine

Like signs of fluid overload
Bridging Difficulty

Distension of the neck vein

Crackle sound in lunks

Swelling.

After surgery the patient is administered intravenous fluids depending on the fluid loss during the surgery.

Listen to the patient’s borewell sound with a stethoscope before starting liquid fluids, a gurgling sound that is a sign of Paris stalsis movement.

Then stop the intra-venous fluid and start the amount of water and then give another fluid. Check the patient’s intravenous fluid level. To prevent dehydration and constipation.

Check urine output

Checking urine output is an important factor

A patient’s catheter is placed after surgery to help increase urine output.

Urinary infection due to continuous catheter and low intake of fluid.

Retention of urine can cause kidney problems, so inform the doctor if the patient does not pass urine within 8 hours of surgery.

Carefully record fluid intake and urine output.

ton and exercise the patient

The patient needs to tone every two hours. Usually the patient starts walking in the evening on the first day of surgery so ensure that the patient is comfortable and under pain control.

Helping the patient to walk If the patient is pale and clammy skin is seen, keep the patient standing, check blood pressure, pulse.

Leg exercises, early walking, and elastic stockings if available are the best ways to prevent clots from forming in the veins.

If there is a clot in the patient’s vein, flex the patient’s leg to fill the patient with discomfort.

So to prevent clots, exercise the legs every hour from the time the patient wakes up.

Anchorage cuff and dip bridging

How to have the patient perform cuff and deep breathing every two hours on the first day of surgery.

Do this exercise till the patient starts walking regularly. Explain this exercise to the patient before surgery so that he can perform it easily after surgery.

Succumbing if the patient is unable to cough

Provide Adequate Diet

Patient is transitioned from fluid to soft diet and then regular diet.

Early walking and good fluid intake can prevent urinary tract infection, constipation, abdominal distention, gas.

If the patient consumes healthy food, it will provide protein, calories and vitamins, which will help in the healing of the surgical wound.

Check bowel function

Checking that the patient has passed stool.

Signs of constipation such as

Abdominal swallowing, pain

Hard stool

To check vital sign of regular patient.

Observation

Observing that signs of complications are present.

Checking the patient’s self-care activities.

Observing the patient’s skin condition.

Transferring station from theater of operations
Transfer means moving a patient from one place to another.
After surgery patient is transferred from OT to recovery room. For recovery from the effects of anesthesia and for post-operative care.

Before transferring the patient to the recovery room, it is important to know the patient’s physiological status.

Level of Consciousness

Checking that the patient responds to verbal instructions and is oriented to the surrounding area?

activity

Checking whether the patient moves his limb according to the instructions.

Respiration

Check if the patient’s respirations are 10-20 breaths/min without extra airway.

SPO level two should be above 95.

Circulation

Blood pressure, urine output, heart rate to check whether all the organs are getting adequate blood supply or not.

Pei no

Check the level of pain

Surgical site bleeding

Observing that surgical site bleeding occurs

Nozia and Vo meeting
Checking whether the patient has nosia, vomiting or not.

Things to keep in mind before transfer

Use correct form

A health care person can prevent injury to the lower back by correct body position when transferring the patient.

Keeping the body and lower back in a straight line, knees bent.
Fit it a little wider than the width of the solder.

A health care person should stand closer to a patient before I do.

Move the person safely

Safe handling of the patient. Do not wrap the neck and back of the patient in this way because it may cause injury to the neck and back. Do not drag the patient through.

Ask for help if needed

If it is necessary to take the help of someone to move the patient, so that more weight is carried by one person.
We can prevent bearing.

Move the person smoothly without sudden movement

If we move the patient quickly, fall, injury, pain may occur. The skin can also be tarred.

Use the right device to help you transfer the person safely

Patient is transferred by equipment like transfer belt, slide seat, slide board etc.

A health care person uses a device that is appropriate for that patient.

Ensure that all investigations and procedures are completed before transfer

The patient should receive the medicine prescribed by the doctor.

All procedures and orders placed should be documented

Before transferring the patient from the operation theater to check whether the patient is stable or not.