PRE-OPERATIVE CARE

 

Pre Operative Care

Aims

1.     To prepare the client physically for surgery

2.     To provide psychological care

3.     To allay anxiety

PSYCHOLOGICAL CARE

I will explain to the patient the nature of the operation in simple terms that will be done in order to allay anxiety.

I will explain the condition to the patient and the relatives in simple terms in order to allay anxiety.

I will explain to the patient about the theater environment and the equipment that will be used in order to allay anxiety and to promote compliance.

I will explain to the patient and the relatives about the theater team that will conduct the surgery in order to allay anxiety.

I will allow the patient to ask questions about their condition and the nature of surgery and I will answer the questions appropriately and refer some to the physician in order to allay anxiety and to promote cooperation.

I will involve the patient and the relative in the care of the patient preoperatively in order to promote cooperation.

I will provide postoperative information which will include the following;

v The location of the incision

v Mobility restrictions

v The length of  the hospital stay

v The location where the patient will be nursed post operatively

I will explain the appropriate medications, the extent of treatment, management of side effects, possible reactions after treatment, frequency and duration of treatment in order to allay anxiety and to promote cooperation.

CONSENT FORM

I will explain what a consent form is in simple terms that it is a legal document which allows or permits the surgeon to conduct an operation and it protects both the surgeon and the patient.

I will obtain a signed consent form by the patient or her next of kin as soon as enough information has been given to the patient about the condition, nature of the operation and the available treatment options.

INVESTIGATIONS

I will ensure that I collect blood samples for grouping and x-match in order to know the blood group of the patient in case there is any need for blood transfusion.

I will ensure that all the investigations that were done I collect the results and the file of the patient and have them put in order for correct documentation.

I will ensure that I do an X-ray to rule out lung metastasis or chest abnormalities.

I will collect blood for full blood count in order to rule out anaemia.

NUTRITION

I will ensure the patient is not malnourished during surgery by encouraging the patient to take a balanced diet as well as enough fluids some days before the day of surgery.

I will ensure the patient is nil orally for 6 to 8 hours prior to surgery in order to avoid aspiration during surgery.

OBSERVATIONS

I will observe the general condition of the patient and response to diagnosis and impending treatment options in order that ill take right interventions to allay anxiety.

I will observe the mental status of the patient to rule out any mental disorder.

I will observe for any signs of infection such as cough and fever in order to prevent the spread of infection.

I observe the vital signs which include temperature, pulse, respiration and blood pressure to rule out infection and shock.

I will observe whether the patient is experiencing any discomfort before surgery and I will deal with the cause.

PRE-MEDICATION

I will give the patient any prescribed medications prior to surgery.

ELIMINATION

I will monitor bowel and bladder emptying prior to surgery to rule out renal disorder and constipation.

SKIN PREPARATION

I will clean the operation site to prevent infection.

I will shave the operation site to prevent infection.

I will label the operation site to avoid the surgeon from conducting an operation on a wrong site.

PHYSICAL PREPARATIONS

IDENTIFICATION

I will write the patient’s details on all the files for easy identification.

I will write the right information on the consent form and the nature of operation for easy identification.

I will write patient’s name, sex, age, ward, date and the type of operation on the identity band for easy identification of the patient.

I will label of operation site for identification of the operation site.

BOWEL CARE AND BLADDER CARE

I will do an enema if patient is not able to pass stool to prevent fecal impaction and constipation.

I will catheterize the patient prior to surgery to prevent urinary incontinence during surgery.

REMOVAL OF DENTURES

I will remove any artificial nails for easy monitoring of pallor on the nail beds

I will remove any nail polish for easy monitoring of pallor and cyanosis.

I will remove any ear, nose and finger rings to prevent electrocution during surgery.

TRANSFER OF PATIENT TO THEATRE

I will escort the patient to theatre and hand over to the theater team.

I will give hand over to the theater team telling them the name, age, sex and nature of operation the patient is due for corresponding to what is on the identity band for easy identification of the patient and documentation.

POAT OPERATIVE PREPARATION

I will prepare the post operative bed in a clean environment near the nurses’ bay to prevent infection and for close monitoring of the patient.

I will ensure that all resuscitative equipment such oxygen machine and suction machine are all in good working condition before the patient is brought to theater for easy and proper management of the patient post operatively.

I will ensure the vital signs tray is readily available for use for monitoring of the patient post operatively.

 

 

POST OPERATIVE MANAGEMENT

Aims

·       To maintaining normal respiratory functioning

·       To relieving pain and discomfort

·       To prevention of complications

·       To promote healing.

I will get the patient from theater from the theater nurse with the appropriate information and the type of anesthesia which was used in order to manage the patient appropriately.

ENVIRONMENT

I will nurse the patient near the nurse’s bay for close monitoring and observations.

I will nurse the patient on the post op bed for the comfort of the patient.

I will ensure that the post operative tray is available in case there is need for an emergency action.

I will ensure all resuscitative equipment are readily available in working condition such as a suction machine, oxygen apparatus for used when need arises.

I will nurse the patient in the surgical ward for close monitoring and observation.

I will ensure there enough light in the room for close monitoring and observation.

I will ensure a clean environment in order to prevent infection.

I will ensure a well ventilated room to prevent cross infection.

POSITIONING

I will nurse the patient in fowler’s position in order to maintain a clear airway.

I will elevate the head of the bed when patient is fully conscious to promote lung expansion.

I will turn the patient 2 hourly to prevent development of pressure sore formation.

PAIN MANAGEMENT

I will ensure proper positioning in order to relieve pain.

I will administer prescribed analgesics intravenous or intramuscularly such pethedine 50-100 milli-grams when pain is severe in order to block pain receptors.

I will provide psychological support in order to deviate the pain form the mind.

I will provide deviational therapy such encouraging the patient to read a book or watch a movie in order to deviate the mind from the pain.

I will ensure that the patient has enough rest in order to relieve pain.

WOUND CARE

I will leave the dressing undisturbed unless there are signs of fresh bleeding in order to prevent any infection.

I will clean the wound daily with antiseptic solution such povidone in order to prevent infection

I will ensure that sutures are removed on the 7^th to 9^th day after surgery in order to prevent infection.

I will monitor the wound for any bleeding in order to rule out any bleeding disorder.

OBSERVATIONS

I will observe and maintain the breathing pattern of the patient to prevent any chest complications post operatively.

I will observe any active bleeding from the dressing post operatively in order to prevent anaemia and any bleeding disorder.

I will observe temperature 4 hourly to rule out infection when temperature raises.

I will monitor the pulse in order to rule out shock such as haemorrhagic shock.

I will monitor and observe respirations and blood pressure 2 hourly in intensive phase then 4 hourly as the condition improves to prevent respiratory post operative complication.

I will observe the general signs of discomfort which may indicate pain and then I will offer appropriate interventions to manage the pain.

I will observe the hydration status of the in order to rule out dehydration.

I will observe the mental status of the patient in order to allay anxiety and to rule out psychosis and depression.

I will observe any allergic reaction to medication and take appropriate interventions.

I will observe any smell that is offensive in order to rule out infection.

MEDICATION

I will give prescribed analgesics such as pethedine 50-100mg or paracetamol 1g for pain management.

I will administer prescribed antibiotics such amoxicillin 500mg to prevent infection

I will monitor the side effects of the drugs and take appropriate nursing intervention.

EXERCISES AND REST

After recovery from anaesthesia, I will encourage the patient to turn and take deep breathing exercise in order to avoid chest complications.

I will encourage early ambulation in order to prevent hypostatic pneumonia and deep vain thrombosis.

I will ensure the patient has enough rest in order to promote healing and to relieve pain.

I will oil the doors and trolley in order to promote rest by reducing noise

I will control traffic in the ward in order to promote rest for the patient.

I will do all relevant procedures collectively in order to promote rest

I will administer prescribed medication at the appropriate time in order to promote rest

NUTRITION AND FLUIDS

I will a high protein diet for the patient in order to promote healing.

I will encourage eight to 10 glasses of water and non-caffeinated beverages to prevent constipation.

I will promote a carbohydrate diet to prevent constipation

I will monitor the hydration status of the patient to prevent dehydration.

HYGIENE

I will do bed bath in the acute phase to remove dead epithelial cells and to prevent infection

I will clean the wound daily to prevent infection and to promote healing.

I will change soiled linen and clothes to prevent infection and to promote self hygiene and esteem for the patient.

I will do and encourage self oral care to prevent halitosis and stimulate appetite.

I will nail care to promote appetite and prevent infection.

ELIMINATION

I will monitor and record the urine output on the fluid balance chart to prevent fluid overload and dehydration.

I will observe for bowel sounds to rule out constipation.

I will observe the input and output of food and fluids to prevent dehydration and malnutrition.

INFORMATION, EDUCATION AND COMMUNICATION (I.E.C)

I will teach the patient about wound care and bathing in order to remove dead epithelial cells and to prevent infection.

I will encourage exercising regularly but no strenuous exercises to promote blood circulation.

I will encourage the patient the importance of attending review schedules and appointments with care givers to prevent post operative complications.

I will encourage the patient on drug compliance to prevent drug resistance.

I will encourage the patient on having a well mixed diet to promote healing and tissue repair.