Академический Документы
Профессиональный Документы
Культура Документы
By
ZEANATH CARIENA JOSEPH
DECEMBER - 2014
I
II
III
ACKNOWLEDGEMENT
I am grateful to God Almighty for his guidance, strength,
would be incomplete.
IV
I am extremely thankful to the Medical Superintendent,
formed the core and basis for this study and for whole hearted
co-operation.
this endeavor.
Date: 02-12-2014
V
TABLE OF CONTENTS
Chapter Page
Content
No. No.
I INTRODUCTION 01 - 05
II REVIEW OF LITERATURE 06 – 51
III METHODOLOGY 52 – 70
SUMMARY, CONCLUSION,
V
IMPLICATIONS, AND 117 – 140
RECOMMENDATIONS.
ANNEXURES I - LXVIII
VI
LIST OF TABLES
Table Page
Title
No. No.
Frequency and Percentage distribution of sample according
1 74
to socio-demographic variables.
Distribution of Sample according to information specific to
2 76
surgical history in both Experimental and control group
Distribution of sample according to the overall level of
3 78
perioperative Knowledge before and after intervention.
Distribution of sample according to the overall level of
4 80
perioperative Practice before and after intervention.
Area wise Distribution of perioperative Knowledge of sample
5 82
before and after intervention
Area wise Distribution of perioperative Practice of sample
6 84
before and after intervention
Comparison of perioperative Knowledge level before and
7 86
after intervention among both Experimental and control group
Comparison of perioperative Practice before and after
8 87
intervention among both Experimental and control group.
Comparison of perioperative knowledge, practice and level of
9 satisfaction among Experimental and control groups after 88
intervention.
The distribution of the sample based on the occurrence of
10 89
complication in experimental and control group.
Distribution of sample according to the overall level of
11 satisfaction of Experimental and Control groups after 90
intervention
Area wise distribution of level of satisfaction of Experimental
12 91
and Control groups after intervention
Association of perioperative knowledge with selected socio
13 demographic variables in both experimental and control 92-93
groups after intervention
Association of perioperative Practice with selected socio
14 95
demographic variables after intervention
Association of level of satisfaction with selected socio -
15 demographic variables with level of satisfaction after 97
intervention
VII
LIST OF FIGURES
Figure Page
Title
No. No.
VIII
LIST OF ANNEXURES
ANNEXURE
CONTENTS
No.
IX
ABSTRACT
Perioperative nursing is a specialized area of nursing
implementation of intervention.
X
By using an Experimental Two Group before and after
using the lottery method to select the sample of the study. The
data were collected from patients who were admitted for surgical
checklist for practice along with a three point Likert scale for
XI
With regard to the overall perioperative practice level
P<.0001) was greater than the table value, hence the stated
XII
With regard to the findings on the association between
groups, as the obtained 2 value was less than the table value,
the study revealed that the obtained 2 value was greater than
H4 was accepted. As the obtained 2 value was less than the table
2 value was less than the table values, hence the stated
hypothesis H3 is rejected.
the obtained 2 value was greater than the table value only in
hypothesis H5 is accepted.
XIV
Whereas with regard to marital status, religion, and family
income the obtained 2 value was less than the table value, thus
surgical patients.
XV
CHAPTER - I
INTRODUCTION
medicine.
health care setting. More than ever today‟s nurses‟ need to think
1
Modern surgery helped to alleviate many diseases that have
activities.
2
Surgical patient has the right to know what to expect, and
transfusion related costs, length of the stay and case fatality rates.
3
The trend analysis was performed by a linear regression
4
Providing patients with the supportive preoperative teaching
5
CHAPTER - II
REVIEW OF LITERATURE
outcome.
on postoperative outcome.
6
1. Review of literature related to effectiveness of
supine to sitting over the edge of the bed, standing, walking on the
spot for one minute, sitting on the bed initially and sitting out of the
the tidal volume, respiratory rate and minute volume were largely
7
breathing and coughing group. Mobility duration, frequency and
8
operated. Thirty received conventional resection and 34 of them
program. The hospital diet was given to all the patients on the 1st
movements occurred in all cases on the 2nd day (range 2-3). The
abdominal surgery. The study was cohort used 754 persons under
the age of 70 years old were included, the investigator studied the
9
months. The results showed that habitual physical activity is
10
information from the DVD and only 12% believed that they were
undergone colonic surgery. The aim of the study was to evaluate the
group 1 (p < 0.05). The overall complication rate (35 patients) was
received less knowledge than they felt they expected on the bio-
12
education. The results highlighted the need for improved patient
13
The level of dependency in performing activities of daily
activities and as well as on the 4th and the 7th postoperative day.
The control group did not receive any preoperative teaching. Data
14
difference of pretest performance scores between the two groups.
for elective resection for colorectal cancer was offered trial entry.
oliguria, restricted oral intake until the return of bowel motility, and
15
weaning regimen epidural analgesia. Adherence to both regimens
16
had undergone upper abdominal surgery after receiving
median uptime was 3.0 (IQR 8.2), 7.6 (IQR 11.5), 13.2 (IQR 26.6)
and 34.4 (IQR 65.6) minutes for the first four postoperative days
0.17). The results show that the quality upright mobilization had a
review of the DVD, patients were surveyed for their knowledge and
17
perceived ability to participate in postoperative care activities.
=8), and 47% were male (n =7). Based on the Likert scale (1 =I do
for all areas of postoperative care. When asked about their ability
18
Kaur, Nirmal. (2007), conducted a study to assess the
3rd and the 5th postoperative day. The Control group did not
less pain, early wound healing and recovery than the patients who
19
A study conducted by Richard D. Kuylen,. Lallie
The intervention group had 13, patients who had watched a pre-
20
Lin JH, Whelan RL, Sakellarios NE, Cekic V, Forde K.A,
operative day 1 (P < .001), 290 and 752 feet on day 2 (P < .001),
and 495 and 965 feet on day 3 (P < .001). The average LOS in the
open group was 9.3 days compared with 5.9 days in the
21
The average LOS in the open group was 10 days compared
with 8.5 days in the hybrid group (P = .46). The average incision
the hybrid group (P < .001). When all 216 patients were
longer (average 16.9 cm, P < .001) ambulated 101, 334, and 521
<8-cm group was 6 days compared with 8.9 days in the> or =8-cm
22
stay. The methodological quality studies were independently
23
Chang, Chia Hue. (2011), conducted study on factors
influences the duration of the patient getting out of bed those who
entitled to interview the patients who get out of the bed at the first
data. The finding revealed that the period taken by the patient to
get out of the bed for the first time after surgery was 79.2 hours.
period of time to get out of the beds. However, after a surgery the
patients whose bodies had inserted some tubes than those who
first time to get out of bed after a surgery being encouraged by the
experienced by the patients who are at the moment of the first time
of getting out of the beds are pain, fainters and lower leg
trial. One hundred and six consecutive patients who underwent the
25
(13.2% Vs 26.9%, P<0.05). Also, the percentage of patients who
complications after major visceral surgery. The aim of the trial was
26
group received only the information brochure. Outcome measures
27
3888 (56%) of 6970 women received the questionnaire and were
made, and more than half of the patients were reassured by the
8.0; 95% CI, 2.4-27.4; P=.001) language and a poor rating of the
written description of the planned operation (OR, 3.1; 95% CI, 1.1-
mean age of the patients was 69 years (SD 9), and 43.8% were
the study concluded that changing the process of such care may
29
Jennie April Walker. (2007), conducted a literature review is
30
Jaime Ortiz, et.al. (2010), conducted a survey on pre-
All patients aged 18 years and older were given this survey upon
control, and instructions for the day of surgery. Future studies are
32
satisfaction includes the meeting of preoperative expectations and
good pain relief. The five-year study is the first to measure and
33
Satisfaction was assessed 6 weeks postoperatively with a 5-
but only about half achieved their expectations. Satisfaction did not
satisfaction.
34
Results showed that the average satisfaction score (scale
1-5) in the group receiving better information was 4.2 vs. 2.95 in
the original group. Further, only three patients from the well-
symptoms can foster anxiety and the need for medical attention to
levels”.
were males (61 percent), aged 35-64 years (70 percent), educated
0.001) than females. Patients with GCE (A/L) were less satisfied
36
The review of literature on effectiveness of planned
satisfaction.
37
NEED FOR THE STUDY
their experience.
38
and in reducing their duration of hospitalization, and to elevate
but also influences the attitudes and behaviors of the patients with
39
15 years, 5,125,000 in those between 14 and 44, 1,194,000 in
those between 45 and 64, and 950, 300 surgeries in those over
age of 65 respectively.
from October 2007 to March 2009 shows that with the use of a
40
When the patient develops the postoperative complications, it will
activities.
living, and it was also found that most of the surgical patients‟
42
STATEMENT OF THE PROBLEM
after intervention.
intervention
43
HYPOTHESES:
44
LIMITATIONS OF THE STUDY:
only.
OPERATIONAL DEFINATIONS:
45
3. Planned Perioperative Nursing Information refers to a
surgeries
46
CONCEPTUAL FRAMEWORK OF THE STUDY:
ideas, which utilizes and forms the conceptual framework for the
47
The HPM describes the multi-dimensional nature of persons
3) Behavioral outcomes.
post-operative outcomes.
48
In this study the Individual Characteristics and
49
CONCEPTUAL FRAMEWORK OF THE STUDY
P Increase in
P Knowledge
Experimental O Practice
Group INTERVENTION
Socio - R Satisfaction
S
Demographic Decreased post
E
Variables T operative
T Complication
Surgical
specific E
T
personal Control Group S
experience. E No change in,
NO INTERVENTION Knowledge
T
S Practice
Satisfaction
T
Minimal Post
operative
complication
Fig: 1 Modified Conceptual Framework Based on NOLA Health Promotion Model (2002- Revised).
50
SUMMARY
51
CHAPTER - III
METHODOLOGY
This chapter deals with the methodology selected for the study. It
the procedure of data collection and plan for data analysis. The
the procedure for empirical study together with the method of obtaining
RESEARCH APPROACH:
for this study is an evaluative approach. This helps to explain the effect
52
RESEARCH DESIGN:
postoperative outcome.
design
Pre-
Group Intervention Post -test
test
E O1 X O2
C O1 _ O2
Key:
E: Experimental group.
C: Control group.
X: Intervention
53
RESEARCH DESIGN
Research Design:
Experimental two groups before and after intervention design
Accessible Population:
Gastro-intestinal & genito urinary surgical patients who fulfilled the criteria.
1. Structured knowledge
Experimental group-200 questionnaire Control group.-200
2. Observational checklist.
3. Satisfaction scale.
Implementation of intervention No intervention
Post test
54
VARIABLES OF THE STUDY:
Independent variable:
Dependent variable:
variable and cannot exist by itself. In this study, knowledge and positive
variables.
Attribute Variable
55
history of hospitalization for any surgical procedure, duration of present
surgical risk factors and duration of present stay in the hospital after
surgery:
the community. Being 89-92%occupied, each day. Out of the total beds,
300-315 beds are exclusively allotted for surgical patients. The bed
56
The hospital has well equipped laboratories for early diagnosis
sixteen operating tables for major surgeries and two tables are allotted
The pre and post-operative units along with recovery room are
genitourinary system.
The number of both major and minor surgeries conducted per day
ranged between 46-50 out of which more than 30-35 number of surgical
the investigator felt the need to select this hospital because of the
proximity.
POPULATION:
57
SAMPLE AND SAMPLING TECHNIQUE:
technique was used by adopting the lottery method to select the sample
of the study.
The list of clients who attended surgical OPD was short listed by
respectively.
58
Exclusion Criteria; refers to the individuals who are;
of satisfaction.
tool.
59
The following steps are undertaken to prepare the final tool:
TOOL – 1
60
The Structured interview schedule on Knowledge Questionnaire
TOOL- II
TOOL –III
TOOL –IV
nursing.
61
SCORING OF THE TOOL:
<19 49 Inadequate
Practice score
<9 41 Poor
62
Development of Criteria Rating Scale.
agreement on all the items of each tool except for modification in certain
subject experts‟ suggestions and opinions the tool was modified with
items and time taken to complete the tool was assessed. All the items
The subjects have taken about 45-50 minutes to answer the questions.
63
Reliability of the Tool
method along with reliability for stability by using test re-test method by
Prophecy formula.
The reliability for internal consistency was 0.99 and for stability,
0.81 which is highly reliable. Hence the tool was found to be is reliable.
Information
teaching program is
given by the subject experts and research guide. The factors such as
The lesson plan was prepared after reviewing the literature. The
final content was organized with adequate Audio-Visual Aids as per the
criteria check list for the planned perioperative teaching program was
Remarks Columns.
65
Content Validity of teaching information
blue print and criteria raring scale designed for validation was submitted
to ten experts. The experts consisted of five Nursing and five Surgeons,
programme information.
purposes
66
Translation of planned perioperative teaching programme
Pilot study
authority prior to the study. The purpose of the study was explained to
Likert three point scale for satisfaction assessment. The data were
same day of pre-test. On the 5th or 7th day, i.e. on the day of discharge
post test was conducted with the same tool in order to assess the gain
67
in knowledge, skill on performance of post-operative exercises and level
the study could be achieved. Thus investigator felt the study could be
surgical wards. The purpose of the study was explained to the study
First phase deals with the selection of the sample based on specified
testing the reliability of the tool and teaching content along with the Pilot
study.
68
The second phase deals with administration of planned perioperative
study, which will be followed on the first day after the pre-test.
scale which was carried out on 5th or 7th day in both groups of
69
Ethical Considerations
Summary
research design, and variables under study, the setting of the study,
study instrument or tool, pilot study and method of data collection plan
70
CHAPTER – IV
RESULTS
This chapter presents the results of study conducted to find out
of 400 surgical patients (200 experimental and 200 control groups). The
Organization of Findings
The analyzed data is organized and presented under the following
sections:
71
Section II: Deals with the data pertaining to the first objective of the
Intervention
Intervention.
after intervention
Section III: Deals with the data pertaining to the second objective of the
study, that was to assess the Effectiveness of planned perioperative
nursing information on postoperative Outcome among experimental and
control groups.
72
3. Comparison of perioperative knowledge, practice and level of
intervention.
Section IV: Deals with the data pertaining to the third objective of the
Section V: Deals with the data pertaining to the fourth objective of the
study, which was to find out the association between the perioperative
after intervention
73
SECTION – I : Distribution of sample according to socio-
demographic variables
Table -1: Frequency and Percentage distribution of sample
according to socio-demographic variables.
N=400
Experimental Group Control Group
SI. (n1=200) (n2=200)
Demographic Variables
NO
f % f %
1 Age in years
a. 19-30 years 28 14.0 31 15.5
b. 31-40 years 63 31.5 79 39.5
c. 41-50 years 75 37.5 44 9.5
d. 51-60 years 24 12.0 26 13.0
e. >61 years 10 5.0 20 10.0
2 Gender
a. Male 136 68.0 134 67.0
b. Female 64 32.0 66 33.0
3 Educational Status
a. Illiterate 123 61.5 83 41.5
b. Primary education 53 26.5 65 32.5
c Others specify ------ 24 12.0 52 26.0
4 Type of occupation
a. Government employee 19 9.5 31 15.5
b. Self-employed 130 65.0 116 58.5
c. Unemployed 51 25.5 53 26.0
5 Marital status
a. Married 162 81.0 160 80.0
b. Unmarried 31 15.5 29 14.5
c. Divorced 7 3.5 11 5.5
6 Religion:
a. Hindu 150 75.0 153 76.5
b. Muslim 29 14.5 29 14.5
c. Christian 21 10.5 15 7.5
d. Any other------- - - 3 1.5
7 Family income per month
a. Rs.< 2000 35 17.5 13 6.5
b. Rs. 2001-5000 98 49.0 57 28.5
c. Rs. 5001-7000 36 1.0 81 40.5
d. Rs.7001 and above 31 15.5 49 24.5
8 Exposure to mass media
a. exposed 28 14.0 19 9.5
b. not expose 172 86.0 181 90.5
74
Table-1 reveals the Socio-demographic variables of the sample.
group were between the age of 41-50, years and only 5% (10) of them
were in the age group of 61 years and above, whereas in control group
majority 39 % (79) of the sample were between the age of 31-40 years.
With regard to sex, the majority of the sample were males in both
experimental 136 (68%) control 67 % (134) groups and 32% (64) were
them were unemployed and only 9.5 % (19) them were government
employees. In the control group majority 58% (116) of them were self
(150) and control 76.5% (153) groups were Hindus. With regard to
group majority 41.5% (81) of them belonged to the income of Rs. 5001-
76
Regarding, duration of illness, the majority of the sample in both
experimental 79% (158) and control 71% (142) groups presented illness
and control 79% (158) groups had undergone surgeries related to the
and 21% (42) in the control group had surgeries related to Genitourinary
system.
of pre-surgical risk factor and only 28.5% (57) of them presented with
risk prior to surgery. In control group majority 56% (113) of the sample
had preexisting risk factors and only 43.5%) (87) of them did not have
77
With regard to hospitalization after surgery, majority of the sample
Control groups.
N=400
Experimental group Control group
(n1=200) (n2=200)
Variables Grade
Before After Before After
No. % No % No % No %
Inadequate
176 88.5 2 1.0 147 73.5 83 41.5
(<49%)
Perioperative Moderate
24 12 173 86.5 52 26.5 115 57.5
Knowledge (50-70% )
Adequate-
- - 25 12.5 1 0.5 2 1.0
(71-100%)
78
After intervention the perioperative knowledge of the
(173) and 12.5% (25) of them had adequate knowledge, and only
group majority 57.5% (115) of them had moderate knowledge with only
100
88.5
90
80 73.5
70
Percentage
60
50 41.5
40
30
20
10
1
0
% % % %
Knowledge level
79
Table - 4 Distribution of sample according to the overall level
of perioperative Practice before and after
Intervention.
N=400
Experimental Control group
group(n1=200) (n2=200)
No. % No % No % No %
Poor
192 96 - - 200 100 189 94.5
(<41%)
Moderate
Perioperative 8 4 20 10 - - 10 5.0
Practice (42-72% )
Adequate
- - 180 90 - - 1 0.5
(73-100%)
80
In the control group the entire sample belonged to 100% (200) poor
the sample had showed some change in performance level, i.e. 5% (10)
120
96 100
100 94.5
PERCENTAGE
80
Practice score
60 Poor
40
20 10
4 5
0 0 Practice score
0 Moderate
% % % %
PRACTICE LEVEL
81
Table 5- Area-wise Distribution of perioperative Knowledge
of sample before and after intervention.
N=400
(1.85 ± 1.028) and (2.41 ± .696), pre-operative area (12.70 ± 2.878) and
82
Findings highlight that after an intervention, the mean perioperative
Area-wise knowledge
Experimental group Control group
16.33
12.7 13.26
11.13
Knowledge
83
Table 6 – Area-wise Distribution perioperative Practice of
sample before and after intervention
N=400
exercise, (1.77 ± .757), (3.61 ± 838) coughing with splinting, (1.68 ± .757)
(4.18 ± .986) leg exercise with splinting (1.32 ± .656) and turning
coughing with splinting, (1.66 ± .689) (1.93 ± 1.044) leg exercise with
84
splinting (1.21 ± .706) and turning exercise with ambulation (.93 ± .712),
(Figure-6).
Experimental Group
Ряд1
Area-wise practice
Control Group
Ряд2
4.18
3.61
3.29 3.24
2.04 1.93
1.771.74 1.681.66
1.53
1.321.21 1.34
1.17
0.93
0 0
Practice
85
Section - III Effectiveness of planned perioperative nursing information
on Post-operative Outcome among experimental and
control groups.
N=400
Experimental Group Control Group
(n1=200) (n2=200)
Variable
„t‟ „t‟ value
Mean SD Mean SD
value (Unpaired)
Before-
16.16 2.634 18.33 3.054
intervention
37.511 13.777
Perioperative
After- *S *S
Knowledge 25.92 2.576 20.33 2.989
intervention
was greater than the table value. Hence the stated hypothesis H1 is
accepted.
86
Table-8 Comparison of perioperative Practice before and after
intervention among both Experimental and control group.
N=400
mean practice level (5.93) before intervention. The calculated „t‟ value
(„t‟ 199=49.935, P<.0001) was greater than the table value. Hence the
87
Table - 9 : Comparison of perioperative knowledge, practice and
Level of satisfaction among Experimental and control
groups after intervention.
N=400
Experimental Group Control Group
t‟ Value
Variable (n1=200) (n2=200)
(Unpaired)
Mean SD Mean SD
Perioperative
18.33 3.606 16.16 2.628 7.602 *S
Knowledge
Perioperative
14.32 1.616 6.84 1.919 42.167 *S
Practice
Satisfaction
95.70 7.747 57.65 6.836 52.083 *S
*S = Significant P< 0.0001 df=399 t- table value at 399 =3.290
P<.0001) was greater than the table value. Hence the stated hypothesis
88
Table 10: Distribution of the sample based on occurrence of
Complication in experimental and control group.
N=400
89
Section IV: Level of satisfaction among Experimental and Control
and 15.5% (31) they were fully satisfied, whereas in the control group
96.5
100 84.5
80
60
40 15.5
20 0 3.5 0
0
Not satisfied Moderately Fully
satisfied satisfied
Intraoperative
20 5-20 13.44 2.149 3-16 7.27 2.540
information
Postoperative
20 7-13 13.62 2.342 3-17 9.24 2.632
information
91
Section V: Association between the perioperative knowledge, practice and level of satisfaction with
Selected socio-demographic Variables in both Experimental and Control group.
Table: 13 Association of perioperative knowledge with selected socio demographic variables in both
experimental and control groups after intervention
N=400
Experimental group (n1=200) Control group(n2=200)
Level of knowledge Level of knowledge
Inference
Variable Mod. Inference Mod.
Inadequate Adequate Inadequate Adequate
Adequate Adequate
No. % No. % No. % No. % No % No. %
1. Age in years
a. 19-30 23 11.5 5 2.5 - - 2 20 10 11 5.5 0 2
8.608 10.926
b. 31-40 60 30 3 1.5 - - df =4 66 33 12 6 1 0.5 df=8
c. 41-50 67 33.5 8 4 - - p=.069 28 14 16 8 0 p=.209
d. 51-60 18 9 6 3 - - NS 20 10 6 3 0 NS
e. 61and above 8 4 2 1 - - 13 6.5 7 3.5 0
2. Gender 2 2
2.398 3.090
a. Male 123 61.5 13 6.5 - - df =1 96 48 38 19 0 0 df =1
b. Female 53 26.5 11 5.5 - - p=.056 51 25.5 14 7 1 0.5 p=.215
NS NS
3 Educational Status 2 2
.447 6.197
a. Illiterate 107 53.5 16 8 - - df =2 66 33 16 8 1 0.5 df =2
b. Primary education 47 23.5 6 3 - - p=.800 48 24 17 8.5 0 0 p=.185
c higher than primary 22 11 2 1 - - NS 33 16.5 19 9.5 0 0 *S
92
4 Type of occupation 2 2
3.013 1.173
a. Govt. employee 19 9.5 18 9 - - df =2 24 12 7 3.5 0 0 df =4
b. Self employee 112 56 60 30 - - p=.010 83 41.5 32 16 1 0.5 p=.903
c Unemployed 45 22.5 NS 40 20 13 6.5 0 0 NS
5 Marital status 2 2
10.623 6.291
a. Married 147 73.5 15 7.5 - - df =2 117 58.5 43 21.5 0 0 df=4
b. Unmarried 22 11 9 4.5 - - p=.010 22 11 6 3 1 0.5 p=.222
c. Divorced 7 3.5 0 - - - *S 8 4 3 1.5 0 0 *S
2
6 Religion 2.179 .799
a. Hindu 132 66 18 9 - - df =2 111 55.5 41 20.5 1 0.5 df=6
b. Muslim 26 13 3 1.5 - - p=1.000 22 11 7 3.5 0 0 p=.962
c. Christian 18 9 3 1.5 - - NS 12 6 3 1.5 0 0 NS
d. others - - - - - - 2 1 1 0.5 0 0
7. Family income per
month 2 2
.067 16.160
a. Rs< 2000 27 13.5 4 2 - - df =3 36 18 13 6.5 0 0 df =6
b. Rs 2001-5000 32 16 4 2 - - 62 31 19 9.5 0 0
p=.0001 p=.047
c. Rs.5001-7000 86 43 12 6 - - 39 19.5 18 9 0 0
NS NS
d. Rs 7000 & above
31 15.5 4 2 - - 10 5 2 1 1 0.5
2 2
8 Exposure to mass .051 2.895
media df=1 11 5.5 8 4 0 0 df =2
a. Yes 25 12.5 3 1.5 - - p=.247 136 68 44 22 1 0.5 p=.193
b. No 151 75.5 21 10.5 - - NS NS
NS= Non Significant *S- Significant
93
Table 13 shows that there was a significant association between
was higher than the table value in both experimental (210.623, df =2,
and control groups, as the obtained 2 value was less than the table
94
Table 14: Association of perioperative Practice with selected socio
N=400
Experimental group Control group
(n1=200) Inferenc (n2=200)
Variable Inference
Practice e Practice
Poor Moderate adequate Poor Moderate adequate
1. Age in years
a. <30 - 25 2 2 2.122 30 1 0 2 4.188
b. 31-40 - 56 5 df =4 75 4 0 df =8
c. 41-50 - 70 5 p=.713 40 3 1 p=.840
d. 51-60 - 21 2 NS 25 1 0 NS
e. 61and above - 8 2 19 1 0
2. Gender 23.908 2 0.543
a. Male - 121 12 df =1 126 7 1 df =2
b. Female - 59 4 p=0.052 63 3 0 p=.762
SS NS
3. Educational Status
a. Illiterate - 111 26.193 77 5 1 2 1.788
b. Primary - 48 9 df =2 62 3 0 df =4
c. Higher primary - 21 5 p=0.008 50 2 0 p=.775
2 SS NS
4.Type of occupation
a. Unemployed 26.088 2 1.759
b. Govt employee - 45 5 df =2 49 4 0 df =4
c..Private employee - 16 3 p=0.031 30 1 0 p=.780
- 119 8 SS 110 5 1 NS
5. Marital status 22.003 2 1.050
a. Married - 143 15 df =2 151 8 1 df =4
b. Unmarried - 30 1 p=.367 27 2 0 p=.902
c. Divorced - 7 0 NS 11 0 0 NS
6. Religion 2 0.723
a. Hindu - 133 14 21.490 144 8 1 df =6
b. Muslim - 28 1 df =2 28 1 0 p=.994
c. Christian - 19 1 p=.475 14 1 0 NS
d. others - - - NS 3 0 0
7. Family income per
month
a .Rs.>2000 - 30 1 23.508 46 3 0 2 5.852
b.Rs 2001-5000 - 32 4 df =3 79 1 1 df =6
c. Rs.5001-7000 - 84 10 p=.320 52 5 0 p=.440
d. Rs,7000 & above - 34 1 NS 12 1 0 NS
95
Table 14 presents on association of perioperative practice with
study revealed that the obtained 2 value was greater than the table
As the obtained 2 value was less than the table value in age
was greater than the table value only in exposure to mass media (2
With regard to age (2 4.188, ,df =8, p=.840), gender (2 0.543,
p=.902), religion (2 0.723, df =6, p=.994) and family income (2 5.852,
df =6, p=.440) the obtained 2 value was less than the table value,
96
Table- 15 Association of level of satisfaction with selected socio
N=400
NS= Non Significant S*= significant df =1 ( 3.84), df=2 (5.99), df=3 (7.82), df=4 (9.49),
97
Table 15 indicated that the obtained 2 value was greater than
the table value only in sample of experimental group with regard to age
family income (χ21.551, df- 3, p=.694), the obtained 2 value was less
less than the table value, thus the stated H5 was rejected.
98
DISCUSSION
based care in health care setting. More than ever, today‟s nurse‟s
99
This chapter discusses on the major findings of the study
Organization of Findings
sections:
Control groups.
Control group.
100
Section I - Socio-demographic variables and information
groups
were between the age of 41-50, years and only 5% (10) of them
31-40 years. With regard to sex, the majority of them were males
101
In terms of Marital status, the majority of the sample in both
than 6 months.
102
in both experimental 73.5% (147) and control 70% (140) groups
risk factors and only 43.5%) (87) of them did not have any pre-
control 78.5% (157) groups sample were hospitalized for less than
8 days.
103
The above findings are consistent with the findings of the
not. The results showed that the experimental group had a mean
experimental group.
104
for poor prognosis. These findings are consistent with present
study findings.
105
± 708) and postoperative care(1.71+ .853 ), (3.20 + .697)
perioperative practice.
106
adequate perioperative practice level, and majority 94.5% (189) of
107
Watt-Watson J, Stevens B, Katz J, Costello J, Reid GJ,
confused.
experienced by patients.
108
The mean perioperative knowledge (25.92) was higher in the
P<.0001) was greater than the table value. Hence the stated
accepted.
value (t‟ 399=3.290, P<.0001) was greater than the table value,
109
Stern and Lockwood (2005) conducted a systematic review
110
surgical exposure strongly influences the knowledge and practice
they were fully satisfied, whereas in the control group majority, 193
(96.5%) of the sample were not satisfied. This finding reveals that
111
preoperative information was higher in both experimental (30.87 ±
anxiety and improves patient satisfaction and has benefits for the
112
Section V- Association between the knowledge, practice and
as the obtained 2 value was higher than the table value in both
hypothesis H3 is accepted
and control groups, as the obtained 2 value was less than the
113
experimental group, hence the stated H4 was accepted. As the
obtained 2 value was less than the table value with regard to
value was greater than the table value only in exposure to mass
media (2 11.462, df =2, p=.003), thus the stated H4 was accepted.
2 value was less than the table value, hence the stated H3 was
rejected.
the obtained 2 value was less than the table value, thus the
114
In control group none of the variables as age, gender, and
present study:
SUMMARY
to prove that the findings were true and the planned perioperative
116
CHAPTER - V
AND RECOMMENDATIONS
SUMMARY
study, and to plan analysis of the data, in the most meaningful and
117
The study was conducted at R. L. Jalappa Hospital and
method to select the sample of the study. The data were collected
the age group of 19-75 years. The data was collected by using a
items and time taken to complete the tool was assessed. All the
the questions.
118
Reliability of the tool was inferred by administering the
tool to ten subjects. The reliability for internal consistency was 0.99
and for stability it was 0.81 which is highly reliable. Hence the
119
t-test. The association between knowledge, practice and level of
were between the age of 41-50 years and in the control group
majority 39% of the sample were between the age of 31-40 years.
groups.
of general anesthesia.
majority (56%) of the sample had preexisting risk factors and only
(43.5%) of them did not have any system related risk factors.
respectively.
123
In control group the mean practice score before and after
group.
greater than the table value, hence the stated hypothesis H1 & H2
is accepted
124
Findings related to level of Satisfaction among surgical
patients
This finding revealed that the planned teaching program was found
125
Findings in association between the knowledge, practice and
126
educational status (26.193, df =2, p=0.008 ) type of occupation
the obtained 2 value was less than the table value in age, marital
value was greater than the table value only in exposure to mass
was less than the table values hence the stated H3 is rejected.
127
income the obtained 2 value was less than the table value, thus
128
CONCLUSION:
130
4. With regard to the third objective of the study, the findings of the
than the table value in age, marital status, religion, and family
rejected.
131
In control group, findings revealed that the obtained 2
value was greater than the table value only in exposure to mass
and family income the obtained 2 value was less than the
was less than the table value, thus the stated H5 i is rejected.
132
majority (84.5%) of the sample in the experimental group was
patient care.
133
IMPLICATIONS:
Nursing Practice:
clients.
134
Perioperative planned teaching program also helps the
Nursing Education:
135
The study emphasizes on the significance of short term in-
developing curriculum.
The study findings will also help the staff nurses and patients
Nursing Administration:
subordinates.
136
A nursing administrator has a significant role in encouraging
procedures.
137
The nursing administrator should plan and organize
Nursing Research:
complications.
investigation.
138
RECOMMENDATIONS:
quality care.
surgical patients.
139
7. An Interventional study among staff nurses can be done to
SUMMARY:
140
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157
ANNEXURE – 1
I
ANEXXURE - 2
NURSING INFORMATION
Code No:
1.2 Gender :
a. Male ( ) b. Female ( )
II
1.3 Educational Status : a. Illiterate ( )
b. Self employee ( )
a. Married ( ) b. Unmarried ( )
c. Divorced ( )
1.6 Religion:
a. Hindu ( ) b. Muslim ( )
a .Rs.6750-13499 ( ) b. Rs 5050-6749 ( )
1.8 Exposure to mass media about surgery and its care within 6
months period
a. Television ( ) b. Newspaper ( )
c. Magazine ( ) d. Radio ( )
d. Others specify ( )
III
Tool I-SEC- B Information Specific to Surgical History
Date of Interview:
Date of Discharge:
procedure:
a. Yes ( ) b. No ( )
c. Elective surgery ( )
a. General anesthesia ( )
IV
2.7 History of pre existing surgical risk factors
V
TOOL - I SEC-C
Information.
3.1. The care received from the time of admission till discharge
is called as
a) Pre-operative care ( ) b) Intra-operative care ( )
c) Peri-operative care ( ) d) Post-op.care ( )
VI
3.5. The Perioperative (surgical) team includes all the following
members except:
a) Anesthesiologist and nurse anesthetist ( )
b) The surgeon and his assistance ( )
c) Nurse surgeon and his assistance anesthesiologist ( )
d) Causality &ICU nurse. ( )
3.9 The pre surgical health history and diagnostic tests are
needed to estimate the,
a) Risk associated with cost of surgery ( )
b) Risk associated with surgery ( )
c) Risk associated with instruments ( )
d) Risk associated with operative team mem ( )
VII
3.10 The common preoperative investigations include the
investigation of
a). Gastrointestinal system ( ) b). All body systems ( )
c). Respiratory system ( ) d). Urinary system ( )
VIII
3.15 The precaution that should be followed post operatively
while performing breathing and coughing exercise is
a). hold fingers loosely over the surgical site ( )
b). splint the surgical site with the pillow or folded bed sheet ( )
c) cover the surgical site with plain bed sheet ( )
d) cover the surgical site with plain dressing ( )
IX
3.20 The advantage of turning exercise after surgery is to,
a). Promote comfort ( )
b). Promote normal bowel elimination ( )
c).Prevent pooling of secretion ( )
d). Prevent respiratory distress. ( )
X
3.25. The preparation of surgical site (operation area) aims to;
a). reduce surgical site wound infection ( )
b). Reduce the risk of surgical site infection ( )
c). decrease the wound healing process ( )
d). Maintain skin integrity. ( )
3.28. For early wound healing the surgical patient should take
food which is rich in
a. Carbohydrate and vitamin C ( ) b. Protein and vitamin C ( )
c. Fat and vitamin C ( ) d. Minerals and vitamin ( )
XI
3. 30 The most suitable position that you should assume after
spinal anesthesia is
a). sitting position with head turned to one side ( )
b). Flat on back for 6-8 hours with head turned to one side ( )
c). Side lying position with head turned to one side ( )
d) Sleeping on abdomen with head turned to one side ( )
XII
3.34. The main cause of post operative hemorrhage is due to;
a). use of unsterile instruments ( )
b). Slipping or dislodging of sutures ( )
c). improper wound dressing ( )
d). Excessive IV fluid infusion. ( )
XIII
Tool –II Sec. A
Observational Checklist on Re-demonstration of Post-operative
Exercises Pre-operatively
XIV
Coughs deeply once or twice and brings out the
g
secretions.
c Keeps the right leg straight and flexes left knee up.
d Holds the right side rail of bed with left hand and
rolls to right.
XV
TOOL II : Sec. - B
PRESENCE OF CIOMPLICATION
ASSESSMENT Pre &
PARAMETERS post D1 D2 D3 D4 D5 D6 D7
SYSTEM
Y N Y N Y N Y N Y N Y N Y N Y N
1. CVS
2. RS
3. CNS
4. GIS
5. GUS
6. MSS
7 INTEG. S
8 PSY
XVI
TOOL III Sec- A Modified Aldert‟ scale.
1
Ad 30. 45 60
Area of assessment Point 5
m m m m
m
Activity- (Able to move spontaneously
2
or an command)
Ability to move two extremities 1
Unable to control any extremities 0
Respiration –
2
Ability to breathe deeply and cough
Limited respiratory efforts(Dyspnea or
1
splinting)
No spontaneous effort 0
Circulation BP _+ 20% pre anesthetic
2
level
BP +_ 20%-49% of Pre anesthetic level 1
BP +_ 50%of Pre anesthetic level 0
Area of assessment P
Consciousness Fully awake 2
Arousal on calling 1
Not responding 0
O2saturation Able to maintain oxygen
2
saturation>92% on room air
Needs oxygen inhalation to maintain
1
oxygen saturation>90%
Oxygen saturation<90% even with
0
oxygen supplement
Note: Required for discharge from post anesthesia care unit: 7-8
points
XVII
TOOL III- Sec. C- Observational Checklist on Assessment of Post Operative Outcome
1 Temperature
2 Pulse
3 Respiration
4 Blood pressure
Level of
5
consciousness
ASSESSMENT ON
D N D N D N D N D N D N R D N D N D N R D N D N R D N D N R D N D N R D N D N R D N D N R
EXERCISE
Deep breathing
1
exercise
2 Coughing exercise
3 Leg exercises
4 Turning exercise
Splinting of surgical
5
site
xviii
TOOL-III Sec. B
Patient Satisfaction Scale on Peri-operative Nursing
Information.
Sl. Satisfaction parameter on Peri-operative surgical
F MN
No events
1 Satisfaction related to general information
11 Information provided on need for surgery and its purpose
1.2 Information provided on types of surgery
1.3 Information provided on phases of surgical procedure
1.4 Information provided on different positions used for surgery
Information provided on common risk factors and its
1.5
prevention
2 Satisfaction related to pre-operative preparation
Information provided on need for legal consent/operation
2.1
permits
Information provided on psychological stress reduction and
2.2
its techs.
Information provided on need for history coll. & and all body
2.3
sys. asst.
Information provided on need for physiological system
2.4
review
Information provided on preparation of surgical site, bowel
2.5
and bladder along with NPO status
Information provided on need for deep breathing, coughing
2.6 exercise, splinting technique, leg and turning exercise and
pain control measures
Information provided on control of post operative nausea
2.7
and vomiting
Information provided on post operative drains and its
2.8
purpose
Information provided on post operative diet and its purpose
2.9
was
Information provided on immediate and late post operative
2.10
complication
Information provided on use of anesthesia and its purpose
2.11
was
Information provided on need for preoperative medication
2.12
and its purpose.
XIX
3 Satisfaction Related to Information on Intra-operative
Preparation
Information provided on pre surgical waiting room and
3.1
maintaining vital signs stability its purposes
Information provided on common safety measures on infection
3.2
control and operation room set up was
Information provided on measures followed in safe anesthesia
3.3
administration
3.4 Information provided on surgical site and its closure
3.5 Information provided on PACU and its purpose s
4 Satisfaction Related to Postoperative Care
Information provided on post anesthesia related complications
4.1
and its prevention
Information provided on wound healing process, factors
4.2
favoring and hindering wound healing
Information provided on need for monitoring symptoms and
4.3
prevention of post operative complication
Information provided on expected outcome of the surgical
4.5
procedure upon my future health was
Information provided on home care aspects and need for
4.6
regular follow up and its benefit
5 Satisfaction Related to General Peri-operative Care Aspects
The means to approach and clarify the doubts from Peri-
5.1
operative health care team members
The facilities available and information in utilization of
5.2
emergency services
5.3 The overall privacy provided throughout the surgical events was
The overall confidentiality maintained throughout the
5.4
hospitalization care provided from admission to discharge
The overall medico-technical competencies of the
5.5
Peri-operative team
The overall spiritual support provided from admission to
5.6
discharge was
The overall method of recording maintained throughout the
5.7
Peri-operative surgical events
The overall information on Peri-operative nursing information
5.8
and care provided throughout
XX
ANEXXURE - 4
Lesson Plan
on
Peri-operative Nursing care Information on
Post-operative Outcome
Guided by Prepared by
Dr. B.A. Pataliah Mrs. Zeanath Cariena J.
M.A. M.Sc (N). Ph. D.(N), Prof. SDUCON -KOLAR
Principal Ph.D. Nursing Scholar
Shushruthi CON, V M URF Salem
Bagalore- 91
XXI
LESSON PLAN
Name of the Instructor : Mrs. Zeanath Cariena J.
Topic : Perioperative Nursing care Information on Post operative Outcomes
Group : Patients undergoing Selected Surgical Procedure
(Gastro-intestinal and Genitourinary system)
Method of Teaching : Discussion cum Video Assisted Teaching
Audio Visual aids : PPT
Duration : 50 minutes .
Place : OPDs and Wards of Selected Hospital at Kolar.
Previous Knowledge : The surgical clients have some knowledge regarding common surgical related
procedure and their purposes
General Objectives : At the end of Video Assisted Teaching on Perioperative Nursing care
Information the surgical client will gain in-depth knowledge regarding common
surgical related procedures and their purposes and appreciate their importance by
applying the knowledge throughout perioperative phases to attain
positive postoperative outcomes.
XXII
SPECIFIC OBJECTIVES:
At the end of Video Assisted Teaching on Perioperative Nursing care Information the surgical Client
2. Discuss on categories of surgical procedure with common positions used during selected surgeries
3. Explain on Factors that affect the estimation of Surgical Risk with their effect on anesthesia and
surgery
4. List the common diagnostic measures used during surgical procedure along with their purposes
XXIII
Specific
Time Content Teaching Learning Activity Visual Aids Evaluation
Objectives
XXIV
Specific Teaching Visual
Time Content Evaluation
Objectives Learning Activity Aids
Benefits of Peri-operative Education
XXV
Specific Time Content Teaching Visual Evaluation
Objectives Learning Activity Aids
States the 2 min II: Information on peri-operative phases with goal
meaning, A. Meaning and Definition of Peri-operative Nursing Care:
goal and List the
phases of The Nursing care provided for the patient Before, During and After phases of
perioperative surgery is called as Perioperative Nursing. peri-
nursing care PPT operative
A. The Goal of Peri-operative Nursing are: &Video nursing?
The peri-operative nursing practice goal is to promote and assist the Assisted
patient and family to achieve a level of wellness equal to or greater than Teaching
XXVI
Specific Teaching Visual
Time Content Evaluation
Objectives Learning Activity Aids
ii. Post operative phase:
The postoperative phase lasting from admission to the recovery area to
complete recovery from surgery.
III Categories of Surgical Procedures:
According to Purpose:
a. Diagnostic: to verify suspected diagnosis, e.g. biopsy
b. Exploratory: to estimate the extent of the disease, e.g. exploratory
laparotomy
c. Curative: to remove or repair damaged or diseased organs or
tissues
d. Palliative: to relieve pain, relieve distressing Signs and symptoms
Urgency: reason for procedure:
Elective-Performed on the basis of client‟s choice; not essential and may
not necessary for health.
Urgent- Necessary for client‟ health, may prevent additional problem
from developing (e.g. tissue destruction); not necessarily emergency.
XXVII
Specific Teaching Visual
Time Content Evaluation
Objectives Learning Activity Aids
XXVIII
Specific Teaching Visual
Time Content Evaluation
Objectives Learning Activity Aids
c. The Extent of the Disease
d. The Magnitude of the Required Operation
Discusses on
peri- e. Resources and Preparation of the Surgeon, Nurses, and the Observing and
operative Hospital learning
team V- THE PERIOPERATIVE TEAM AND THEIR ROLES
members i. The Surgeon
and their Responsible for conducting surgical procedure by following all the
roles 1min safety precautions
ii. An Anesthesiologist or Nurse Anesthetist
Makes the preoperative assessment to plan for the type of
anesthesia to be administered and to evaluate the client‟s status PPT
iii. The Professional Registered OR Nurse &Video
Makes preoperative assessment and documents the peri-operative client Assisted
care plan (Scrub, Circulating, PACU Nurse) Teaching
a. The Circulating Nurse
Manages the OR and protects the safety and health needs of the client
by monitoring the activities of the members of the surgical team and
monitoring the conditions in the OR.
b.The Scrub Nurse
Responsible for scrubbing for surgery, including setting up sterile tables
and equipment and assisting the surgeon and surgical technicians
during the surgical procedure
c. The PACU Nurse
Responsible for caring for the client until the client has recovered from
the effects of anesthesia, is oriented, has stable vital signs, and shows
no evidence of hemorrhage.
XXIX
Specific Teaching Visual
Time Content Evaluation
Objectives Learning Activity Aids
12 VI- PREOPERATIVE PHASE : The preoperative period begins at the time of
Describes min decision for surgery and ends when the client is transferred to the OR.
on Goals:
preoperative a. Assessing and correcting physiologic and psychological problems that PPT
phase with might increase surgical risk &Video
its related b. Instructing and demonstrating exercises that will benefits Assisted
preparations the person during post-op period Teaching
and C. Planning for discharge and any projected changes in lifestyle due to
procedures surgery.
The preoperative phase consists of the following preparations: Observing and
1. Psychological preparation.
learning
2. legal preparation,
3. Physiological preparation,
4. Preoperative instructional preparation,
5. Physical preparation;
a). On the Night of the Surgery b). On the Day of Operation.
1. Psychological preparation :
Psychological preparation aims to reduce the anxiety of the patient. The
anxiety related to surgery is reduced by
1. Explaining the reason for hospital admission
Explains on 2. Explanation of the procedures that will be carried out routinely,
the 3. Discussing on the probable outcome, expected duration of hospitalization,
psychologica cost, length of absence from work, and residual effects.
l preparation Causes of Fears related to surgery are:
a. Fear of the unknown, b. Fear of anesthesia, vulnerability while
unconscious c. Fear of pain, d. Fear of death, e. Fear of disturbance of
body image f. Worries: loss of finances, employment, and family role.
XXX
Specific Teaching Visual
Time Content Evaluation
Objectives Learning Activity Aids
Manifestations of Fears:
1. Anxiousness
2. Confusion
3. Anger
4. Tendency to exaggerate
5. Sad, evasive, tearful, clinging
6. Inability to concentrate
7. Short attention span
8. Failure to carry out simple directions
9. Dazed PPT
Interventions to Minimize Anxiety:
&Video
1) Assessing client‟s fears, anxieties, support systems, and patterns of
Assisted
coping
Teaching
2) Establishing trusting relationship with client and significant others
3) Explaining routine procedures, encourage verbalization of fears, and
allow client to ask questions
4) Demonstrating confidence in surgeon and staff Observing and
5) Providing for spiritual care if appropriate learning
Highlights on 6) Divert tonal and music therapy.
legal permit 2. Legal Preparation: “Informed Consent”, operative permit, surgical
and its consent
importance a. This is to protect the surgeon and the hospital against claims that
unauthorized surgery has been performed and that the patient was
unaware of the potential risks of complications involved
Explains on b. Protects the client from undergoing unauthorized surgery.
need for 3. Physiologic preparation
physiological a. History collection: Medical History, Previous surgeries, Medication
preparation History, Client Expectations, Occupation, Cultural and Spiritual Factors and
Body image.
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B. Physical Examination Through System Review
1. Cardiovascular system: History of preexisting or existing disease
Explains on
need for 2. Respiratory System: Patient t who smokes should quit 6 weeks
reviewing the before surgery
systems for 3. Nervous System: Ability to pay attention, concentrate, and respond
analysis of appropriately pre-op are extremely important for post–operative
risk factors outcomes
PPT
4. Urinary System: Many drugs are metabolized and excreted by the &Video
kidneys Assisted
5. Hepatic System: The patient with hepatic dysfunction may have Observing and Teaching
problems with glucose control, clotting abnormalities and adverse learning
response to drugs
6. Musculoskeletal System: Frequently, postoperative pain is due to
chronic musculoskeletal pain and positioning during surgery, rather
than acute pain of the surgery
7. Endocrine System: The diabetic patient is at risk for the
development of hypoglycemia, hyperglycemia, cardiovascular
alterations, delayed wound healing and infection
8. Immune system: Patients with active infection will frequently have
elective surgeries cancelled
XXXII
Specific Teaching Learning Visual Evaluati
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Objectives Activity Aids on
10. Nutritional status: Obesity stresses both the cardiac and pulmonary
system
and makes access to the surgical site and anesthesia more difficult.
Obesity predisposes the patient to wound dehiscence, wound infection
and herniation.The patient has a slower recovery from anesthesia
because inhaled anesthetic is absorbed and stored in adipose tissue,
thus
leaving the body more slowly
Explains on
need for C-Common Preoperative Investigations
common
investigation Urinalysis…………..Renal status, hydration, infection, disease
s for analysis Chest X-ray………...Pulmonary disorders, cardiac enlargement Observing and
of risk factors CBC with dif……....Anemia, immune status, infection learning
Electrolytes..……….Metabolic status, renal function, diuretic PPT
effects &Video
ABG‟s, oximetry…..Pulmonary and Metabolic function Assiste
PT/PTT (INR)……..Bleeding tendencies d
. Blood glucose…….Metabolic status, diabetes mellitus Teachin
BUN/Creatinine………Renal function g
EKG…………………Cardiac disease,
electrolyte abnormalities
Pulmonary function …Pulmonary status studies
SGOT/SGPT, albumin…………Liver function
Type and Cross match………….Blood availability for
replacement
Pregnancy……………………...Reproductive status
XXXIII
Specific Teaching Learning Visual Evaluati
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Objectives Activity Aids on
4. Pre operative Instructional Preparation : PPT
Discusses on Preoperative information highlights on: Three types of information: &Video
importance – Sensory information Assiste
of Pre » Hear, see, smell, feel d
operative – Process information Observing and Teachin
» General flow
Instructional – Procedural Information or skill training learning g
Preparation » More specific
on post 1. Breathing exercise
operative 2. coughing exercise,
outcomes. 3. splinting techniques
4. Leg, ankle and foot exercises
5. Turning in bed
6. Early Ambulation
7. Surgical drains
Breathing and Coughing Exercises
1. The sitting position gives the best lung expansion for coughing and
deep breathing exercises. Inhale through the nose and exhale
through the mouth with pursed lips
2. Hold breath for three seconds and cough
Describes on 3. Cough and deep breathe q 2 h while awake
deep Quadriceps (thigh) setting
breathing press the back of the knees against the bed, and then
and Straight leg raises
coughing Have the patient tighten the thigh muscle and lift the leg several
inches off the bed
exercises Hold this position for 5 to 10 seconds
along with Repeat several times
splinting Note: Do not use for patients having abdominal surgery or patients with
technique back problems
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Objectives Learning Activity Aids
Observing
And
learning
Leg Exercises
Explains on Ankle Pumps
leg exercise Slowly push the foot up and down.
and its Do this exercise as often as every 5 to 10 minutes.
purpose This exercise can begin immediately after surgery and continue
until fully recovered to relax the knee
This contracts and relaxes the thigh and calf muscles to prevent
thrombus formation
Repeat this exercise 10 times in a ten minute period
Foot Circles
rotate each foot in a circle
Repeat 5 times in each direction 3 to 4 times a day
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Objectives Learning Activity Aids
Surgical drains;
The surgical drains are used to enhance wound healing process .
Discuss on PPT
common Types: open and closed drains. &Video
surgical The drains are removed on the third or fourth day as soon as the Assisted
drains discharge ceases, as it serves as a source of infection. Teaching
Observing and
learning
XXXVI
Specific Teaching Visual Evalua
Time Content
Objectives Learning Activity Aids tion
Explains on Physical Preparation
the need for On the Night of the Surgery:
physical a. Preparing the skin: shaving the part of the skin against the grain of
preparation. the hair shaft to ensure clean and close shave
b. Preparing the GIT:
NPO after midnight
Administration of enema may be necessary
Insertion of gastric or intestinal tubes Observing and
Preparing for Anesthesia learning PPT
Promoting rest and sleep: use of drugs &Video
∞ Barbiturates: Secobarbital Na, Pentobarbital Na Assisted
∞ Non barbiturates: chloral hydrate, Flurazepam Teaching
Note: preoperative medications are given after all pre-op treatments have
been completed.
On the Day of Operation:
a. Early morning care: about 1 hour before the pre-operative medication
schedule
Vital signs taken and recorded
changes into hospital gown that is left untied and open at the back
Braid long hair and remove hair pin
Provide oral hygiene
Prosthetic devices, eyeglasses, dentures removed
Remove jewelries
Remove nail polish
Void immediately before going to the OR
Make sure that the patient has not taken food for the last 10 hours
by asking the client
catheterization may be performed in the OR pr in the preoperative
ward
XXXVII
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Objectives Learning Activity Aids on
b). Pre-Operative Medications:
Generally administered 60-90 min before induction of anesthesia
Lists the Purpose:
purposes i. To relieve anxiety: the primary reason for pre-operative medications
medication ii. To decrease the flow of pharyngeal secretions
and its uses. iii. To reduce the amount of anesthesia to be given
iv. To create amnesia for the events that precedes surgery
VII INTRAOPERATIVE PHASE
Begins the moment the patient is anesthetized and ends when the last
5 min stitch or dressing is in place. Observing and PPT
Anesthesia –
Explains on learning &Video
A state analgesia, relaxation and reflex loss (severe central nervous
intraoperativ Assisted
system [CNS] depression produced by pharmacologic agent).
e phase Teaching
Four Stages of Anesthesia:
along with Stage I: Onset [Beginning of Anesthesia]
anesthesia The common symptoms that you experience during this stage is
and its Warmth, dizziness, & feeling of detachment may be experienced, Ringing,
stages roaring, or buzzing in the ears, Inability to move extremities, Surrounding
noise is exaggerated and Still conscious
Stage II: Excitement
Struggling, shouting, singing, laughing or crying may be experienced,
Pupils dilate rapid PR, irregular RR, Patient restrain might be necessary
Stage III: Surgical Anesthesia
Continued administration of anesthetic agent, RR, PR normal, skin pink
and flushed and Patient is unconscious
Stage IV: Danger Stage [Medullary Depression]
Reached when too much anesthesia has been administered, Respiration
shallow, pulse weak, pupils dilate, Cyanosis develops, without prompt
intervention death may ensue.
XXXVIII
Specific Teaching Visual Evalua
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Types of Anesthesia:
Discusses
on types of 1. General
anesthesia
2. Regional or local
and its effect
1. General Anesthesia causes:
i. Loss of all sensation and consciousness
ii. Loss of protective reflexes Observing and
iii. Block awareness centers in brain learning
XXXIX
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Objectives Learning Activity Aids on
VIII: Positioning the Client:
Commonly Used Operative Positions in gastrointestinal and
Lists on genitourinary surgeries are :
common
surgical 2. Patient positioning in the Operating room
positions. Four basic surgical
positions include:
1. Supine
2. Prone Observing and
3. Lateral learning
4. Lithotomy
Goals of Proper Positioning is to:
1. Maintain airway and avoid pressure on the chest cavity
2. Maintain circulation
3. Prevent nerve damage
4. Provide adequate exposure of the operative site
5. Provide comfort and safety to the patient
1. Supine position:
PPT
&Video
Assisted
Teaching
XL
Specific Teaching Visual Evaluati
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Objectives Learning Activity Aids on
Most common with the least amount of harm
1. Placed on back with legs extended and uncrossed at the ankles
12 2. Arms either on arm boards with palms up or tucked PPT
min 3. Head in line with the spine and the face is upward &Video
5. Padding is placed under the head, arms, and heels with a pillow Assisted
placed under the knees Teaching
6. Safety belt placed 2” above the knees while not impeding
Lists post circulation Eg; hernia repair, explore lap, cholecystectomy, mastectomy Observing and
operative learning
complication Lithotomy position
s along with 1. With the supine position, the legs are raised and abducted to expose
its preventive the perineal region
measures. 2. The buttocks are even with the lower break in the OR bed
3. The arms are placed on padded arm boards, tucked at the sides, or
placed across the abdomen
4. The legs and feet are placed in stirrups that support the lower
extremities
5. Stirrups should be placed at an even height
6. The legs are raised, positioned, and lowered slowly and
simultaneously, with the permission of the anesthesia care provider
XLI
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IX: POSTOPERATIVE PHASE
Postoperative Care
Begins when the client returns from the recovery room or surgical
suite to the nursing unit and ends when the client is discharged
It is directed toward prevention of complication and post-operative
discomfort
Post-Operative Complications
a. Respiratory Complications: atelectasis and pneumonia
Suspected whenever there is a sudden rise of temperature 24-48
hours after surgery
Collapse of the alveoli is highly susceptible to infection:
pneumonia Occurs usually in high abdominal surgery when
prolonged
*Inhalation anesthesia has been necessary and vomiting has occurred
during the operation or while the patient is recovered from anesthesia.
Measures to prevent pooling of secretions:
Frequent changing of position
High fowler‟s position
Moving out of bed
Measures to liquefy and remove secretions:
Increase oral fluid intake
Breathing moist air
Deep breathing followed by coughing
Administer analgesics before coughing is attempted after thoracic
and abdominal surgery
Splint operative area with draw sheet or towel to promote comfort
while coughing.
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Other measures to increase pulmonary ventilation PPT
Blow bottle exercise &Video
Rebreathing tubes: increase CO2 stimulates the respiratory center Assisted
to increase the depth of breathing thus increasing the amount of Teaching
inspired air
IPPB: intermittent positive pressure breathing apparatus.
b. Circulatory Complication: Observing and
venous stasis learning
Causes of venous stasis
» Muscular inactivity
» Respiratory and circulatory depression
» Increased pressure on blood vessels due to tight dressing
» Intestinal distention Prolonged maintenance of sitting.
Contributing factors for venous stasis:
Obesity
CV disease
Debility
Malnutrition
Old age
Most common circulatory complications:
Phlebothrombosis (clotting in the veins)
Thrombophlebitis ( clotting of blood)
MEASURES FOR PREVENTION:
− Limbs must never be massaged for a post-op client
− If possible, client should lie on his abdomen for 30 min several time
a day to prevent pooling of blood in the pelvic cavity
− Do not allow the client to stand unless pulse has returned close to
baseline to prevent orthostatic hypotension
− Wear elastic bandages or stockings when in bed and when walking
for the first time.
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c. Fluids and Electrolytes Imbalance:
Causes:
− Blood loss PPT
− Increased insensible fluid loss through the skin; &Video
After surgery through vomiting, from copious wound drainage, and
Assisted
from the tube drainage as in NGT
− Since surgery is a stressor, there is an increased production of ADH Teaching
for the first 12-24 hours following surgery resulting to fluid retention
by the kidney
- The potential for over hydration therefore exists since fluids being given Observing and
IV may exceed fluid output by the kidney learning
Electrolyte Imbalance:
Particularly Na and K imbalance as a result of blood loss
Stress of surgery increases adrenal hormonal activity resulting to
increased aldosterone and glucocorticoids, resulting in sodium
reabsorption by the kidney
And as Na is reabsorbed, K coming from tissue breakdown is
excreted
Action: IV of D5W alternate with D5NSS or half strength NSS to prevent
Na excess
d. GIT complications:
a. Paralytic ileus: Cessation of peristalsis due to excessive handling
of GI organs
Nursing management:
NPO until peristalsis has returned as evidenced by auscultation of bowel
sounds or by passing out of flatus.
b. Vomiting: usually the effect of certain anesthetics on the stomach,
or eating food or drinking water before peristalsis returns.
Psychological factors also contribute to vomiting.
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NURSING MANAGEMENT:
Position the client on the side to prevent aspiration
When vomiting has subsided, give ice chips, sips of ginger ale or hot
tea, or eating small frequent amounts of dry foods thus relieving
nausea
Administer anti-emetic drugs as ordered: Trimethobenzamide Hcl
(Tigan); Prochiorperasine dimaleate (Compazine)
c. Abdominal distention: results from the accumulation of non-
absorbable gas in the intestine.
Causes:
o Reaction to the handling of the bowel during surgery
o Swallowing of air during recovery from anesthesia
o Passage of gases from the blood stream to the atonic portion of the
bowel Observing and
d. Gas pains: results from contraction of the unaffected portion of the learning
bowel in order to move accumulated gas in the intestinal tract
Management:
Aspiration of fluid or gas: with the insertion of an NGT
Ambulation: stimulates the return of peristalsis and the expulsion of
flatus
Enema: Rectal tube insertion: inserted just passed the anal sphincter
and removal after approximately 20 minutes Adult: 2-4 inches,
children: 1-3 inches. Prolonged stimulation of the anal sphincter may
cause loss of neuromuscular response, and pressure necrosis of the
mucous surface.
e. Constipation: due to decreased food intake and inactivity
Regular bowel movement will return 3-4 days after surgery when
resumption of regular diet and adequate fluid intake and
ambulation.
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Specific Teaching Visual
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Objectives Learning Activity Aids
e. GUT Complications
Return of urinary function: usually after 6-8 hours
- First voiding may not be more than 200 ml, and total out put
may not be more than 1500ml
-Due to the loss of fluids during surgery, perspiration,
hyperventilation, vomiting, and increased secretion of ADH
Complication: urinary retention PPT
Causes: &Video
Prolonged recumbent position Observing and Assisted
Nervous tension learning Teaching
Effect of anesthetics interfering with bladder sensation and the
ability to void
Use of narcotics that reduce the sensation of bladder distention
Pain at the surgical site and on movement
Urinary tract infection Management:
» Instruct the client to empty the bladder completely during voiding
» Catheterize if needed, done by sterile technique
f. Post-operative Discomforts
a. Post-operative pain
Narcotics can be given every 3-4 hours during the first 48 hours post-
operatively for severe pain without danger of addiction
b. Singultus
Brought about by the distention of the stomach, irritation of the
diaphragm, peritonitis and uremia causing a reflex or stimulation of the
phrenic nerve.
Management:
» Paper bag blowing; CO2 inhalation: 5% CO2 and 95% O2 x 5
minutes every hour.
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g. Wound Complications:
Sutures are usually removed about 5th-7th day post-op with the
exception of wire retention sutures placed deep in the muscles
and removed 14-21 days after surgery
h. Hemorrhage from the wound PPT
Most likely to occur within the first 48 hours post-op or as late &Video
as 6th-7th post-op day Assisted
Causes: Teaching
2. Hemorrhage occurring soon after operation: mechanical dislodging of
a blood clot or caused by the reestablished
blood flow through the vessel
2.Hemorrhage after few days: Sloughing off of blood clot or
of a tissue
3.Infection Observing and
Assessment reveals : learning
Bright red blood
Decreased BP
Increased PR and RR
Restlessness
Pallor
Weakness
Cold, moist skin
ii. Infection
Cause: streptococcus and staphylococcus
Assessment: 3-6 days after surgery, low grade fever, and the
wound becomes painful and swollen. There maybe purulent
drainage on the dressing
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i. Dehiscence and Evisceration
Dehiscence or wound disruption: Refers to a partial-to-complete
separation of the wound edges
PPT
Evisceration: Refers to protrusion of the abdominal viscera t &Video
through the incision and onto the abdominal wall Assisted
Assessment: Teaching
Complain of a “giving” sensation in the incision
Sudden, profuse leakage of fluid from the incision Observing and
The dressing is saturated with clear, pink drainage learning
Management:
Position the client to low Fowler‟s position
Instruct the client not to cough, sneeze, eat or drink, and remain
quiet until the surgeon arrives
Protruding viscera should be covered warm, sterile, saline
Explains on dressing
important X: Discharge Instructions:
points of Early discharge, which has become common, typically increases
home care client teaching needs
consideration Information about
s 1. Wound care,
2.Actiity restrictions, driving, lifting weight, bending
3.Dietary management, and hygienic practices-bathing, clothing,
4. Medication administration,
5.Symptoms to report
6. Rest sleep and bladder and bowel monitoring,
7. Follow-up care and resuming back to work.
XLVIII
Specific Teaching Visual
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Objectives Learning Activity Aids
Promoting Good Health by following the common Do‟s
5 min 1. Do take Adequate Rest
PPT
&Video
Observing and Assisted
learning Teaching
XLIX
Specific Teaching Visual
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Objectives Learning Activity Aids
3. Do Regular Exercise
PPT
&Video
Assisted
Teaching
Observing and
learning
L
Specific Teaching Visual
Time Content Evaluation
Objectives Learning Activity Aids
5. Do Limit Alcohol Intake
PPT
&Video
Assisted
Teaching
Observing and
learning
6. Do quit (stop) smoking
LI
Teaching
Specific Visual
Time Content Learning Evaluation
Objectives Aids
Activity
Observing
and
2. Proper use of medications learning
a. Do not change dosage
b. Do not mix medications
c. Report unusual reactions
d. Tell doctor about any OTC
medications
LII
Teaching
Specific Visual
Time Content Learning Evaluation
Objectives Aids
Activity
4min. Conclusion
Concludes the Perioperative nursing is a specialized area of nursing practice which
topic provides care before, during and after the surgery. As a fundamental member of
health care team, nurse works in collaboration with other health care
professional to provide quality care to obtain positive post operative outcomes.
Summary
Summarizes the topic by asking the following questions : Observing
1. What is the main purpose of surgical procedure? and
2. What are the common phases of surgical experience care? learning
3. What exercises will help to prevent post operative complications?
4. What are the common post operative complications and the ways to
prevent them?
Reference:
Textbook of Medical Surgical Nursing 7th Edition by Joyce Black
Brunner and Suddarth’s Textbook of Medical Surgical Nursing 11th
Edition by Suzanne Smeltzer
Berry & Kohn’s Operating Room Technique 10th edition by Nancymarie
Philips
The Lippincott Manual of Nursing Practice 7th Edition by Sandra Nettina
Mastering Medical-Surgical Nursing 2nd edition by Josie Udan
NCLEX-RN Review Materials
LIII