PRE & POST OPERATIVE COMPLICATION & NURSING CARE

PRE OPERATIVE CARE

Pre operative care begins at the time of decision of surgery.

The purpose of care is to prepare the patient both physically & psychologically.

PSYCHOLOGICAL PREPARATION
1) In psychological preparation surgeon should explain to the patients & his relatives:
A. B. C. D. E. F. G. What is to be done? The probable outcome Expected duration of hospitalization Cost of operation Duration of absence from work Expected disabilities About Anesthesia

2) Help the patient to talk about his fear & give him every opportunity to ask question. 3) Each procedure & examination should be well explained to the patient & relatives. 4) Avoid too many visitors which may interfere the patient from getting adequate rest. 5) Take consent from patient ( if pt is able to give) or relatives & make sure that consent paper is attached in the file before shifting the pt in OR

PHYSIOLOGICAL PREPARATION
The most important preparations are a) Respiratory preparations b) Cardiovascular preparation c) Renal preparation d) Nutritional status e) Deep breathing & coughing exercise f) Leg exercise

RESPIRATORY PREPARATION
Routine X-Ray of chest is most important to detect any lung disease
Signs of upper respiratory tract infection must be noted.

CARDIOVASCULAR PREPARATION

Routine ECG should be done for adult patients to detect any cardiac problem

RENAL PREPARATION

Routine Urine examination & renal function test is important to rule out any UTI or any other renal disease

NUTRITIONAL STATUS

Malnourished persons are more likely to develop complications.

Dehydration & poor nutrition adversely influence the operative prognosis.

 DEEP BREATHING & COUGHING EXERCISE

Following persons will have to do deep breathing & coughing exercise in the post operative period

a) smokers b) any history of pulmonary disease c) pts who are receiving thoracic or high abdominal incision d) any cardiovascular operation

 LEG EXERCISE
Following patients have increased incidence of post operative thrombus formation who will have a) Decreased mobility after surgery b) previous history of decreased peripheral circulation These patients should carry out leg exercise pre-operatively & post operatively as much as possible

IMPORTANT PREPARATIONS FOR OPERATIONS

IMPORTANT PREPARATIONS FOR OPERATIONS 1) Keep the patient NPO from midnight or advise by surgeon 2) clean the operative area & shaving the skin to prevent infection 3) Provide calm & quite environment for sleep 4) when patient awake up in morning check vital signs & record it in file.

5) Allow the pt to take bath (if possible) 6) Give clean gown to pt to wear 7) Tie hair with clip or give cap to wear.

8) Wigs, lenses & dentures should be removed from pt before shifting him to OT.
9) Jewellery must be removed

10)The pt chart must be accurate & completed & should contain the information that may be needed during & after surgery 11)All consent forms, Lab reports, X-Ray , ECG attached carefully with file. 12) Shift the pt to OR by stretcher.

POST OPERAIVE CARE

When the patient received in the ward following conditions should be checked.
1) Comfortable bed for the patient. 2) Level of consciousness 3) Check respiratory tract whether the airway is clear or not 4) Check respiratory status

5) Check circulatory status: Vital signs Color & Temp of skin 6) Check the wound for dressing ( any bleeding) , presence of any drainage 7) Check IV cannula for any displacement & IV Fluid on flow

8) Necessity of side rails: Patients proper position Presence of pain Nausea or vomiting 9) Keep proper record of Intake/Output chart 10) Check patients chart & surgeons order & carry out the order properly.

A. SHOCK
NURSING MANAGEMENT: Assess level of consciousness. Pulse quality & rate changes. Fluid resuscitation.

 Nursing management:
Inspect the wound as a possible site of bleeding. Increase IV fluid infusion rate & administer blood if necessary as soon as possible. Immobilize fractures to minimize blood loss.

 Numerous, rapid blood transfusions may induce coagulopathy & prolonged bleeding time .The patient should be monitored closely for signs of increased bleeding tendencies following such transfusion.

 Nursing management :
Avoid rubbing or massaging calves and thighs. Encourage leg exercises and ambulate the patient as soon as permitted by the surgeon. Initiate anticoagulant therapy either intravenously, subcutaneously, or orally as prescribed.

 Nursing management:
Monitor the patients progress carefully on a daily basis for the first postoperative week to detect early signs & symptoms of respiratory difficulties. Promote full aeration of the lungs. Initiate specific measures for particular pulmonary problems.

 Nursing management : Administer oxygen with the patient in an upright sitting position if possible. Reassure and quiet the patient. Monitor vital signs, ECG, and arterial blood gases.

 Massive PE is life threatening and requires immediate interventions to maintain the patients cardiorespiratory status.

 Nursing management :
Assist patient to sit or stand if permissible because many patients are unable to void while lying in bed. Provide the patient with privacy. Catheterize only when all other measures are unsuccessful.

 recognize that when a patient voids small amounts ( 30-60 ml every 1530 minutes ), this may be a sign of an overdistended bladder with overflow of urine.

 Nursing management : relive abdominal distention by passing a nasoenteric suction tube. Replace fluid and electrolytes. Assess bowel tones and degree of abdominal distention (may need to measure abdominal girth) ;document these findings every shift. Monitor and document characteristics of emesis and nasogastric drainage.

 Nursing management: Stay with the patient and have someone notify the surgeon immediately. If intestines are exposed , cover with sterile moist saline dressing . Assure the patient that the wound will be properly cared for ;attempt to keep patient quiet and relaxed.

a. Keep dressing intact

b. Use strict asepsis when dressing are changed. c. Monitor and document amount type and location of drainage. Ensure that all drains are working properly

 No surgery is without risk. No matter how short or small , every invasive procedure can potentially injure. Just as there is no guarantee as to the outcome of any operation , there is never a guarantee that an operation will be without complications.

THANKS