OPERATIVE MEASURES  Clients must sign a consent form for any

- Preoperative care refers to health care provided before procedure that requires anesthesia risks
a surgical operation. complications.
- The aim of preoperative care is to do whatever is right
to increase the success of the surgery.  If an adult client is confused, unconscious, a
- At some point before the operation the health care family member or guardian must sign the consent
provider will assess the fitness of the person to have form.
 If the client is younger than 18 years of age, a
surgery.
parent or legal guardian must sign the consent
- PREPARATION-SURGICAL AREA
form.
 In an emergency, the surgeon may have to
PRE-OPERATIVE PHASE
operate without consent, health care personnel,
- Preoperative: begins with the decision to perform
however, makes every effort to obtain consent by
surgery and continues until the client has reached the
telephone, or fax.
operating area.
 Each nurse must be familiar with agency policies
and state laws regarding surgical consent forms.’
ROLE OF NURSE IN THE PREOPERATIVE PHASE
1. Pre-operative Assessment
 Clients must sign the consent form before
2. Obtaining Informed Consent
receiving any preoperative sedatives.
3. Preoperative Teaching
4. Physical Preparation of Patient
 The nurse is responsible for ensuring that ALL
5. Psychological Preparation of Patient
NECESSARY PARTIES HAVE SIGNED THE
CONSENT FORM and that it is in the client's
1. Preoperative Assessment chart before the client goes to the operating room
I. Review preoperative laboratory and diagnostic studies (OR).
II. Review the client's health history o Secure any patients data w/c is attached
III. Assess physical needs
IV. Assess psychological needs 3. PREOPERATIVE TEACHING
V. Assess cultural needs
 Teaching clients about their surgical procedure
and expectations before and after surgery is
I. Review preoperative laboratory and diagnostic studies:
best done during the preoperative period.
 Complete blood count.
 Clients are more alert and freer of pain at this
 Blood type and cross match. time.
 Serum electrolytes.  Information in a preoperative teaching plan
 Urinalysis. varies with the type of surgery and the length of
 Chest X-rays. the hospitalization.
 Electrocardiogram.
 Other tests related to procedure or client's medical PREOPERATIVE TEACHING PLAN INCLUDES:
condition, such as: prothrombin time, partial (1) Preoperative medication.
thromboplastin time, blood urea nitrogen, creatinine, (2) Post-operative pain control.
and other radiographic studies. (3) Discussion of the frequency of assessing vital
signs and use of monitoring equipment.
II. Review the client's health history: (4) Explanation and demonstration
 History of present illness and reason for surgery (5) Deep breathing and coughing exercises,
 Past medical history (6) Use of incentive spirometry,
 Medical conditions (acute and chronic) (7) How to support the incision for breathing
 Previous hospitalization and surgeries exercises and moving,
 History of any past problem with anesthesia (8) Position changes
 Allergies (9) Feet and leg exercises.
 Present medications (10) Postoperative IV lines and tubing ex: NG tube
 Substance use: alcohol, tobacco, drugs
 Review of system 4. Physical preparation of patient
Preoperative preparation includes the following areas:
III. Assess physical needs: (1) Nutrition and fluids
 Ability to communicate (2) Elimination
 Vital signs (3) Hygiene
 Level of consciousness (4) Medications
 Confusion (5) Sleep
(6) Care of valuables
 Drowsiness
(7) Prostheses
 Unresponsiveness
(8) Special orders
 Weight and height (9) Surgical skin preparation
 Ability to move/ ambulate (10) Safety protocols
 Level of exercise (11) Vital signs
 Prostheses (12) Anti-embolic stockings
 Circulatory status
1. Nutrition and Fluids:
IV. Assess psychological needs:  Adequate hydration and nutrition promote healing.
 Emotional state  Usually "NPO after midnight" followed because Its
 Level of understanding of surgical procedure, anesthetics depress gastrointestinal functioning and
preoperative and postoperative instruction there was a danger the client would vomit and
 Coping strategies aspirate during the administration of a general
 Support system anesthetic.

V. Assess cultural needs:

 Language-need for interpreter
2. OBTAINING INFORMED CONSENT
 Before surgery, the client must sign a surgical
consent form or operative permit.
THE CURRENT QUIDELINES ALLOW FOR:
I. The consumption of clear liquids up to 2 hours
II. The consumption of breast milk 4 hours before
surgery
III. A light breakfast (e.g., formula, milk, light meal
 IV. such as tea and toast) 6 hours before the procedure
V. A heavier meal 8 hours before surgery.
2. Bowel and bladder Elimination:
 Enemas may be ordered if bowel surgery is planned.
 The enemas help prevent contamination of the
surgical area (during surgery) by feces.
 Prior to surgery an indwelling Foley catheter may
be ordered to ensure that the bladder remains empty.
 This helps prevent injury to the bladder, particularly
during pelvic surgery.
3. Hygiene:
 In some settings, clients are asked to bathe or
shower the evening or morning of surgery (or both).
 The purpose of hygienic measures is to reduce the
risk of wound infection by reducing the amount of
bacteria on the client's skin.
 The client's nails should be trimmed and free of
polish, and all cosmetics should be removed so that
the nail beds, skin, and lips are VISIBLE when
circulation is assessed during the perioperative phases
4. Pre-operative Medications:
 Preoperative medications are given to the client prior
to going to the operating room.
 Commonly used preoperative medications includes:
o Antiemetics
o Anticholinergics
o Sedatives
o Antibiotics
5. Sleep:
 Nurses should do everything to help the client sleep
the night before surgery. Often a SEDATIVE is
ordered. EG: ALPRAZOLAM
 Adequate sleep helps the client manage the stress of
surgery and helps healing.
6. Care of valuables:
 Valuables such as jewelry and money should be sent
home with the client's family or significant other.
 If valuables/money cannot be sent home, they need to
be labeled and placed in a locked storage area per
the agency's policy.
7.Care of Prostheses:
 All prostheses (artificial body parts) such as partial or
complete dentures, contact lenses, artificial eyes,
and artificial limbs and eyeglasses, wigs, and false
eyelashes must be removed before surgery.
8. Special Orders.
 The nurse checks the surgeon's orders for special
requirements (e.g., the insertion of a nasogastric tube
prior to surgery, the administration of medications,
such as insulin, or the application of antiemboli
stockings).
9. Skin Preparation.
 The surgical site is cleansed with an antimicrobial to
remove soil and reduce the resident microbial count
to sub pathogenic levels
 REMOVE THE HAIR at the site of surgery
Nursing Consideration
 Determine the area to be shaved and its extent; know
the operation to be done; the organ involved and its
location and the proposed incision.
Nursing Consideration
 Examine the area to be shaved for any signs of
irritation or any abnormal condition.
 Report this to your head nurse
 Do not cut the patient's skin.
 In abdominal operations, pay particular attention to
the umbilicus.
 In shaving, follow the direction of the growth of the
hair while the free hand exerts an opposite force by
pulling the skin to the opposite direction.
 If a Wound Is present on the area to be shaved, start
from the clean area to the dirty area
10. Safety Protocols:
 Identifying the patient and surgery to be performed
 Surgical site marking
11. Vital Signs:
 In the preoperative phase the nurse assesses and
documents vital signs for baseline data.
 The nurse reports any abnormal findings, such as
elevated blood pressure or elevated temperature
12. Antiemboli Stockings:
 Antiemboli (elastic) stockings are firm elastic hose
that compress the veins of the legs and thereby
facilitate the return of venous blood to the heart.
5. Psychological Preparation.
- Careful preoperative teaching can reduce fear and
anxiety of the clients.
Nursing Diagnosis
- Anxiety related to results of surgery and postoperative
pain.
- Knowledge deficit related to preoperative procedures
and postoperative expectations.
INTRA OPERATIVE MEASURES
- Intraoperative prophylactic measures should not only
include the routine use of antibiotic administered
within 60 min of the incision, but should also include
copious intraoperative irrigation [normal saline (NS)
and/or NS with an antibiotic].
- OPERATING ROOM – RECOVERY ROOM
The intra-operative phase extends from the time the client is
admitted to the operating room, to the time of anesthesia
administration, performance of the surgical procedure and
until the client is transported to the recovery room or
PostAnesthetic Care Unit (PACU)
PRINCIPLES OF ASEPTIC TECHNIQUE
1. All items used within the sterile field must be sterile.
2. A sterile barrier that has been permeated must be
considered contaminated.
3. The edges of a sterile wrapper or container are
considered unsterile once the package S opened.
4. Gowns are considered STERILE from chest to the level
of the sterile field, and the sleeves to 2inches above the
elbows.
5. Tables are sterile at table level only.
6. Sterile persons and items touch only STERILE areas;
unsterile persons and items touch only UNSTERILE
areas.
7. Movement around the sterile field must not contaminate
the field.
8. All items and areas of doubtful sterility are considered
contaminated.
ELEMENTS OF ASEPTIC TECHNIQUE
*Sterile gowns and gloves.
*Sterile drapes used to create sterile field.
*Sterilization of items used in sterile field.
SURGICAL ASEPSIS
- The absence of pathogenic microorganisms.
- Ensure sterility
- Alert for breaks
- The practice of aseptic technique requires the
development of sterile conscience, an individual's
personal honesty and integrity with regard to
adherence to the principles of aseptic technique.

Throughout the surgical experience the nurse functions as

the patient's ADVOCATE
Goals of care:
1. Safe administration of anesthesia, right patient,
right procedure, correct site
2. Homeostasis
3. Promote the principle of asepsis
4. Hemostasis

SURGICAL TEAM
SURGEON
- responsible for determining the preoperative
diagnosis,
- the choice and execution of the surgical procedure,
- the explanation of the risks and benefits,
- obtaining inform consent and the postoperative
management of the patient's care.

SCRUB NURSE - (RN OR SCRUB TECH)

- preparation of supplies and equipment on the sterile
field
- maintenance of pt.’s safety and integrity POST OPERATIVE MEASURES
- observation of the scrubbed team for breaks in the OPERATING ROOM – PACU
sterile fields Postoperative
- provision of appropriate sterile instrumentation, - Begins with transfer to PACU and ends with the
sutures, and supplies discharge of the patients from the surgical facility
- sharps count or the hospital.
CIRCULATING NURSE Nursing Interventions
- responsible for creating a safe environment, - Communicating pertinent information about surgery
- managing the activities outside the sterile field, to the PACU staff.
- providing nursing care to the patient. - Postoperative evaluation in clinic or home.
- Documenting intraoperative nursing care and
ensuring surgical specimens are identified and place Nursing assessment in the Recovery Room
in the right media. (0R nurse-PACU nurse)
- In charge of the instrument and sharps count and  Vital signs- presence of artificial airway, 02 sat, BP,
communicating relevant information to individual pulse, temperature.
outside of the OR, such as family members.  Ability to follow command, pupillary response>
the patient follows commands although there’s
ANESTHESIOLOGIST AND ANESTHETIST drowsiness, we need to consider that.
- Anesthetizing the pt.  Urinary output
- providing appropriate levels of pain relief,  Skin integrity
- monitoring the pt's physiologic status and providing  Pain
the best operative conditions for the surgeons.  Condition of surgical wound
- Other personnel- PATHOLOGIST,  Presence of IV lines
RADIOLOGIST, PERFUSIONIST, EVS  Position of patient > transition from sedated to the
PERSONNEL. period of gigisingin yung pt.
Nursing Roles:
1. Staff education
2. Client/family teaching
3. Support and reassurance
4. Advocacy
5. Control of the environment
6. Provision of resources
7. Maintenance of asepsis
8. Monitoring of physiologic and psychological status
 - Avoiding Venous Stasis
o Avoidance of positions leading to venous
stasis
o In Bed Exercises
o Antiembolism stockings
o Sequential Compression Device
o When all is said & done, AMBULATION is
the best!

NEUROLOGIC Assessment
- Assess cerebral function = after several hours, the
patient is conscious, uses Glasgow coma scale
CS= numbness is on the lower extremities is awake.
General anesthesia= are most nonconscious.
- As soon as pt. is transferred to recovery room. Every o Think elderly
15 mins so the v/s is stable. - Assess motor/sensory function

SKIN Assessment F & E Assessment

"Altered Skin Integrity"  Fluid Status
 Day 3 or so to Day 14 (or 21 or more) o Intake
- Proliferation: fibrin strands form scaffold o Output
o Collagen with blood = granulation tissue  Why would a postop client need an IV??
o Protect from damage or stress o To replace blood volume loss
o No lifting, heavy exercise, driving etc. o For medication and nutrition
o At risk for dehiscence or evisceration
 Day 15 (or weeks, months, years) URINARY Assessment
- Scar is organized, less red, stronger  Anuria (define)
- Max strength = 70 - 80%  Urinary Retention – because of anesthesia, then the
bladder need to adapt. If not relaxed, need to
RESPIRATORY Assessment stimulate.
 Impaired gas exchange or impaired airway o Or Urinary retention with overflow
clearance o Differentiate
 Risks: pneumonia, atelectasis  Intervention:
 Assessment: - Fluids – baka kulang pa yung binigay
- Open airway - AMBULATION
- Pulse oximetry (what is normal?) 99-100% - Careful monitoring
- Check opioid use (why?)
- Monitor quality & quantity of respirations GI Assessment
 Nausea & vomiting – maaamoy gamot
Interventions:  Assessment of peristalsis/paralytic ileus
 Turn (also relates to cardiovascular risk – any  Interventions:
ideas?) = positioning of bed, (8hrs flat on bed = CS, - N/G tube, GI rest (NPO), AMBULATION
after 8hrs to prevent atelectasis)  Postop Diets
 Deep breathe & cough - Why are clear liquids usually the first diet? -
 Incentive spirometry = for impending pneumonia given 8 hrs. after surgery, ex. Laparotomy, after
and atelectasis 8hrs the pt. give clear liquids. Additional
 In-bed exercises = dangle foot to promote irritation if not clear liquid thus it vomits the
circulation food.
o AMBULATION!!> if it is permitted - What does "advance as tolerated" mean? –
process, advance full liquid diet, if there’s
SKIN Assessment BOWEL SOUND from clear liquid to full
"Altered Skin Integrity" liquid (milk, tea) Kapag umutot na, pt. will
 Wound healing advance to soft diet (lugaw, sopas, mamon, rice
- How is the face healing time-line different from w/ sabaw). If tolerated soft diet with positive
the foot? bowel movement, regular diet is given.
- Irritation if not followed diet restrictions w/c
 OR to Day 2 (may 3-5)
lead to ileus
- Inflammation vs. infection
o redness, pain, swelling, warmth - What are nursing responsibilities??
o skin held together by blood clots & tiny
SKIN Assessment
new blood vessels= assess if the site is
"Altered Skin Integrity"
bleeding.
Redness
- Avoid pressure/ be sure to splint > Edema
- CS= wound of CS they applied MATERNAL Ecchymosis
BINDER to support wound to prevent pagbuka Drainage
ng sugat. Approximation
**Diabetic pt. has poor wound healing** Is a scar as strong as the original skin?
CARDIOVASCULAR The Ultimate in "Altered Skin Integrity"
Assessment: Potential for hypoxemia Risk factors:
 Think (hypovolemic) shock (hemorrhage) -Dehiscence
- Assessment: close monitoring, v/s, i&o, -Evisceration
- DEC BP No single assessment, need to repeat, 3-
4 report. Prevention:
-Wound Splinting
 Prevention of VENOUS STASIS -Abdominal binder
- Who is at risk? Clotting factor problems, -Diet
bleeder,
- What should be done? Nursing Diagnosis
  Ineffective airway clearance- increased secretions 2 o All post op should be free from pain
to anesthesia, ineffective cough, pain  What is the key reason to control postoperative pain?
 Ineffective breathing pattern- anesthetic and drug
effects, incisional pain Skills - THU cover-to-cover pic one procedure or topic
 Acute pain Urinary retention (wound care for 3 questions)
 Risk for infection Rle - FRI
Pedia – WED
Postoperative Management OB –
• Maintain a patent airway
• Stabilize vital signs Heat and cold therapy
• Ensure patient safety
• Provide pain Phototherapy
• Recognize & manage complications https://www.slideshare.net/pateldharmendra4/phototherapy-
for-nursing-student
When caring for post-surgical patient, think of
the "4 W's" consideration
 Wind: prevent respiratory complications collecting specimen (guidelines)
 Wound: prevent infection operative measures
 Water: monitor | & 0
 Walk: prevent thrombophlebitis

Complications
 Respiratory- atelectasis, pulm. Embolus
 Cardiovascular- venous thrombosis
 Gastrointestinal-Hiccoughs, N/V,abd.
 Distention, paralytic ileus, stress ulcer.
 GU- urinary retention
 Hemorrhage-slipping of a ligature(suture)
 Wound infection-
 Wound dehiscence and evisceration-

PERINEAL CARE POST PARTUM DRAPING

- After 24hrs
- Cleaning of the perineum
- Expose only the areas
- Proper position of bed pan
- Simple moving of legs

If patient is male and you are the only female nurse, how
will you help the male pt. to the urinals?
- Offer the urinals but let the pt. hold his penis
then start to urinate.

WOUND CARE
- use cotton-soaked w/ betadine
- paint the site
- if post CS, give attention to opening lines coz
there’s excess secretions on the line.
- after the site is painted, cover w/ sterile gauze.

ABDOMINAL BINDER
- Should be placed w/ cloth under the wound to
prevent infection from sweatiness.
- Cover below the symphysis pubis
- Then adjust the bell craw depending on the waist
line.

Postoperative Pain Control

 What is the definition of Pain?
- Past experience, cognitive development,
knowledge,
 As nurses, what do we need to remember about the
pain experience?