Pre-operative phase-from the time the decision is made

for surgical intervention to the operating room.

Pre-op care- is to reduce the infection rate and to make
pt. fit to undergo anesthesia and surgery.
1. Informed consent-signed by the pt. granting
permission to have the operation performed as described
by the surgeon. This is medicolegal requirement.The
consent form should be written using short words and
brief, simple sentences.
Purpose:
a. To ensure that the patient understands the nature of
the treatment, including potential complications.
b. To indicate that the pt. decision was made without
pressure.
c. To protect the pt. against unauthorized procedures.
d. To protect the surgeon and hospital against legal
actions by a patient who claims that an unauthorized
procedure was performed.
2. Baseline V/S- determine in initial assessment, bld.
Pressure problems, medication being taken (aspirin)(anti
depressant MAOs-Increase hypotensive effects of
anesthesia, (diuretics particularly thiazides cause
electrolyte imbalance and respiratory depression during
anesthesia. smoker, condition of teeth(dentures, crowns)
other surgeries.
3. Baseline lab and diagnostic test-electrolyte imbalances
can have adverse effects in terms of general anesthesia
this can cause cardiac dysrhythmias. Bld.requirements.
4. IV access- dehydration can have an adverse effect in
general anesthesia and the anticipated volume losses
associated with surgery this can cause shock.
5. NPO- from MN before surgery (to prevent aspiration)
6. Pre-op antibiotics- serve as prophylaxis.
7. Skin Prep-human skin normally harbor transient and
resident bacterial flora, some of which are pathogenic. It
is ideal for the pt to bathe or shower, using a
bacteriostatic soap (povidone-iodine) on the day of
surgery.
SHAVING should be performed as close to the operative
time as possible. The longer the interval between the
shave and operation, the higher the incidence of post
operative wound infection.
8. Bowel preparation-is imperative for intestinal surgery
because escaping bacteria can envade adjacent tissues
and cause sepsis.
Enemas- remove gross collection of stool.
9. Pre-op checklist.

POST OP PHASE- from the time of admission to

recovery room to the follow-up clinic evaluation.
a. LOC-assess level of consciousness, (VS q15min in 4h)
( 30min 4h) then 4h.
b. Pain medication- we are required to do the pain scale
ratings and document that when making pain control
decisions, take into consideration where the pt is in
the post op time line.
c. Dressing- check for intactness; watch for drainage,
outline visible drainage on the dressing(time, date,
initial) so you can assess whether or not its
increasing when you recheck it.
d. Incision looks like.
e. Nasogastric tube- use to decompress the stomach
and decrease secretion. DO NOT irrigate w/o specific
order to do so b/c there could be so much pressure
with instillation of the irrigant that u can disrupt the
suture line. DO NOT insert the NG automatically who
has gastric surgery if accidentally removed, CALL
THE DR.
f. NG tube in 24h- for the first 24h or so, usually start of
blood, then turn to a brownish color then will turn to
a yellow green, which is normal.
g. Bowel Sound will be absent initially 24-48hr post op
b/c the intestines have been manipulated.
h. Abdominal girth-(monitor this for distention, measure
at the same level every time, marking the skin is
helpful).
i. I/O (urine, emesis,drainage. Anything that comes out
is output).
j. Encourage early and progressive ambulation( as
quickly as possible, helps restore peristalsis.) prevent
thromboembolus, ! abdominal distention, ! flatus.
k. About 3-5 day post op, the pt will start to feel the gas
pains, if this is what they are feeling, its
recommended that they not receive narcotics for the
pain b/c these will slow peristalsis down.
l. Coughing and Deep breathing- with splinting of the
surgical site to prevent complication such as
atelectasis, Pneumonia. Incentive spirometry.