Preoperative and Postoperative

care
Preoperative Care
A. Purposes
1. Ensure that the client is in complete physical
and psychological condition for surgery
2. Eliminate or reduce postoperative
discomfort and complications
3. Pre-op teaching
a. Enhances client's participation
b. Decreases anxiety
c. Helps to ensure good postop recovery
B.General Preoperative Care
1. Psychological support : stress experience,
consider the effects here
2. Client teaching related to specific scheduled
procedure
a. coughing and deep breathing
b. Supporting the wound :use of pillow and
splinting
c. Leg exercise
d. Turning, positioning, early ambulation
e. Analgesics and pain control : discuss the option
of patient controlled analgesia (PCA)
f. Recovery from procedures
g. Other postoperative expectations: type of
dressing, nasogastric tube (NGT), drains, IV
Postoperative drugs

a. Purpose
1. Reduce anxiety
2. Decrease secretions
3. Reduce amount of anesthesia required
4. Control nausea and vomiting
b. Common preoperative drugs: Medication
is rarely given IM ,usually IV when the
patient gets to the OR
1. Meperidine (Demerol), mophine sulfate
2. Hydroxyzine (Vistaril),promethazine
(Phenergam) synergistic to narcotics
3. Atropine , scopolamine to dry oral secretions
during anesthesia
4. Pentobarbital sodium (Nembutal),
secobarbital sodium(Seconal)night before to
help sleep
5. Midazolam (Versed) causes conscious
sedation and is very popular , client will get
amnesia postoperatively so pt will not
remember what happened
Anesthetics
1. General : Causes the most effects
postoperatively
a. inhalation
b. intravenous
2. Local
a. topical
b. spinal
1. side effects: hypotension, nausea, vomiting,
headache
2. Nursing Interventions
a. increase fluids per order
b. Increase cafffeine per order
c. Flat for 6- 8 hours post op
Postoperative Care
A. Nursing Interventions
1. Assess for complications
a. take vital signs routinely according to policy
b. NPO until alert & gag reflex returns
c. Suction oral cavity PRN
d. Monitor intake and output
2. Positioning
a. head to side, chin forward if unconcious
b. Lateral sims, semi prone
c. Turn and position the client , have the client
cough and deep breathe
3. Immediate “Head to Toe” Assessment
1. Pulmonary
a. Airway (check gag reflex)
b. Bilateral breath sounds
c. Encourage coughing, deep breathing
2. Neurological
a. Level of consciousness
b. Reflexes, patterns of movement
3. Circulatory
a. Vital signs
b. Peripheral perfusion
4. Gastrointestinal
a. Bowel sounds
b. Distention
.
COMMON POSTOP
COMPLICATIONS
Atelect Cough and deep Shallow repirations First 48 Fever, increased

Common Postop Complictations

asis
breathe hours pulse and respi-
ration
Hypost Cough and deep Shallow repirations After 48 Fever, increased
breathe hours pulse and respi-
atic ration,crackles
pneum and ronchi

onia
Hypoxi Cough and deep Anesthesia causing 48 hours Confusion ,
breathe,ambulation depressed increased BP and
a and turning respirations pulse,SOB
Shock Assess routinely for Loss of fluids and 48 hours Decreased BP,
signs of shock- electrolytes, pulses, cold
identify populations bleeding from clammy pale skin
at risk,monitor for wound or surgical
bleeding site
Throm -Leg exercises, Venous stasis, Iv 7-14 Redness,
elastic irritation, pressure warmth, pain
boplebi stocking,,identify to legs
days and swelling at
tis at risk populations the side
for intervention
COMPLICATI PREVENTION COMMON OCCURANCE MANIFESTATIONS
ON CAUSES

.
Urinary
retention
Upright to
void(male)
Medications
(narcotic)
2-3 Days -Inability to void
-restlessness
-monitor I and O -Local edema -bladder distention

Wound Monitor site for Slipping of Immediately or -signs of shock

hemorrhage bleeding suture, later -
wound bleeding(sanguinous
evisceration drainage) from tubes
or site of surgery
Wound Maintain Poor aseptic 3-5 days Wound area red and
infection nutritional status technique, edematous,
-Maintain debilitated, increased pain in the
aseptic obesity incisioanal area,
technique with increase in the
manipulations of amount and/or
dressings change in the
character of the
drainage to be
purulent
.
COMPLI- PREVENTION COMMON OCCURANC MANIFESTATIONS
CATION CAUSES E

Wound Identify those ate Debilitated, 4-15 days Wound opens and
dehiscence risk obese, contents may come
andevisceration -Maintain elderly out onto abdominal
nutritional status in area
high risk Intervention: place
populations sterile saline
soaked gauze over
site and place in
recumbent positon
Urinary tract Maintain sterility of Indwelling 5-8 days Dysuria, hematuria,
infection catheter, increase catheter, urgency, frequency,
fluids urinary post
-remove catheter anesthesia
as soon as
possible
4. Pain interventions
a. Pharmacologic intervention
1. PRN scheduling: pain medication is given as
ordered to the client on demand basis when pain
occurs; Is lease effective strategy
2. Fixed scheduling: pain medication is given round
the clock (usualy q 4 hors ).Not only treats but
prevents pain
3. Patient controlled analgesia (PCA): pain
medication is self administered by client via an
infusion system. Client must be able to participate
in this intervention
4. Most pharmacologic ingterventions use narcotic
drugs , therefore client must be carefully
assessed for the complication of respiratory
depression.
 The end....

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