MEETING NEEDS OF

PREOPERATIVE
PATIENT
 PreperationOf the patient

BEFORE A N Y TREATMENT IS INITI ATED, A HEALTH HISTORY IS OBTAI NED A N D A PHYSI C A L EXAMINATION IS PERFORMED DURING
W H I C H VITAL SIGNS ARE NOTED A N D A DATA BASE IS ESTABLI SH FOR FUTURE COMPARISONS.
THE FOLLOWING ARE THE PHYSI O L O G I C ASSESSMENTS NECESSARY D U R I N G THE PREOPERATI VE PHASE:
• AGE
•OBTAI N A HEALTH HISTORY A N D PERFORM A PHYSI C A L EXAMINATI O N TO ESTABLI SH VI TAL SIGNS A N D A DATABASE FOR FUTURE
COMPARISO NS.
• ASSESS PATI ENT’S USUAL LEVEL OF FUNCTI O N I N G A N D TYPI C A L DAILY ACTI VI TIES TO ASSIST IN PATI ENT’S C A R E A N D RECOVERY
O R REHA BI LITA TI O N PLA N S.
• ASSESS MOUTH FOR DENTAL CARI ES, DENTURES, A N D PARTI AL PLATES. DECAYED TEETH O R DENTAL PROSTHESES M A Y B E C O M E
DISLODG ED DURING INTUBATION FOR ANESTHETI C DELIVERYAND O C C L U D E THE A I R W A Y
▶ Nutritional status and needs – determined by measuring the patient’s height and weight, triceps skinfold, upper arm
circumference, serum protein levels and nitrogen balance. Obesity greatly increases the risk and severity of complicat ions
associated with surgery.

▶ Fluid and Electrolyte Imbalance – Dehydration, hypovolemia and electrolyte imbalances should be carefully assessed and
documented.

▶ Infection

▶ Drug and alcohol use – the acutely intoxicated person is susceptible to injury.

▶ Adrenal corticosteroids – not to be discontinued abruptly before the surgery. Once discontinued suddenly, cardiovascular
collapse may result for patients who ar e taking steroids for a long time. A bolus of steroid is then administered IV
immediately before and after surgery.

▶ Diuretics – thiazide diuretics may cause excessive respiratory depression during the anesthesia administration.

▶ Phenothiazines – these medications may increase the hypotensive action of anesthetics.

▶ Antidepressants – MAOIs increase the hypotensive effects of anesthetics.

▶ Tranquilizers – medications such as barbiturates, diazepam and chlordiazepoxide may cause an increase anxiety, tension
and even seizures if withdrawn suddenly.
▶ Insulin –when a diabet ic person is undergoing surgery, interaction between anesthetics and insulin must be considered.

▶ Antibiotics – “Mycin” drugs such as neomycin, kanamycin, and less frequently streptomycin may present problems when
combined with curariform muscle relaxant. As a result nerve transmission is interrupted and apnea due to respiratory
paraly sis develops.
Gerontologic
Considerations
▶ M o nito r o ld e r p a tie nts und e rg o ing surg e ry fo r
subtle clues that indicate underlying problems
since elder patients ha v e less physiologic reserve
tha n yo ung e r p a tie nts.
▶ M o nito r a lso e ld e rly p a tie nts fo r d e hyd ra tio n,
hyp o v o lemia ,a nd e le c tro lyte imb a la nc e s.
Nursing Diagnosis

▶ The following are possible nursing diagnosis during the preoperative

phase:
▶ Anxiety related to the surgical experience (anesthesia, pain) a n d
the out come of surgery
▶ Risk for Ineffective Therapeutic M a n a ge me nt Regiment related to
deficient know ledge of preoperative procedures a n d protocols
a n d postoperative expectations
▶ Fear related to per ceiv ed threat of the surgical pr ocedure a n d
separation from support system
▶ Deficient Know ledge related to the surgical process
Diagnostic Tests

▶ These d ia g nostic tests m a y b e c a rrie d out d urin g the

p erio p erative p h a se:
▶ Blo o d a n a lyses suc h a s c om p lete b lo o d c ount,
sedimentation rate, c-reactive protein, serum protein
electrophoresis with immunofixation, calcium, alkaline
phosphatase, a n d chemistry profile
▶ X-ray stud ies
▶ MRI a n d CT scans (with or without myelography)
▶ Ele c trodia g nostic studies
▶ Bone scan
▶ Endoscopies
▶ Tissue b iop sie s
▶ Sto o l stud ies
▶ Urine stud ies
Psychological Assessment

▶ Psychological nursing assessmentduring the

preoperative period:
▶ Fear of the unknown
▶ Fear of d ea t h
▶ Fear of anesthesia
▶ C o nc e rns a b o ut lo ss o f w o rk, tim e , jo b a nd
support from the family
▶ C o nc e rns o n thre a t o f p e rm a ne nt inc a p a c ity
▶ Sp iritua l b e lie fs
▶ C u ltura l v a lue s a nd b e lie fs
▶ Fear of pain
Continued...

▶ Psychological Nursing Interventions

▶ Explo re the c lie nt’s fe a rs, w o rrie s a nd c o nc e rns.
▶ Encourage patient verbalization of feelings.
▶ Pro v id e info rm a tio n tha t he lp s to a lla y fe a rs a nd
concerns of the patient.
▶ G iv e e m p a the tic sup p o rt.
Informed consent

▶ Reinforce informa tion p rovide d b y surgeon.

▶ Notify p hysicia n if p a tient needs a d d itiona l informa tion to
m a ke his or her d e c ision.
▶ Ascertain that the consent form ha s b e e n signed before
administering psychoactive premedication. Informed
consent is required for invasive procedures, such as
incisional, biopsy, cystoscopy, or paracentesis; procedures
req uiring sed a tion a nd /or a nesthesia ; nonsurgic a l
procedures that pose more t han slight risk to the patient
(arteriography); a n d procedures involving radiation.
▶ Arrange for a responsible family member or legal guardian
to b e a v a ila ble to g iv e c onsent w hen the p a tient is a
minor or is unconscious or incompetent (an emancipat ed
minor [married or independently earning o wn living] m a y
sign his or her o w n surgical consent form).
▶ Place the signed consent form in a prominent p l a c e on
the p a tient’s c h a rt.
Continued....

▶ A n informed consent is necessary to b e signed by

the patient before the surgery. The following are
the p urp o se s o f a n info rm e d c o nse nt:
▶ Pro te c ts the p a tie nt a g a inst unsa nc tio ne d
surgery.
▶ Pro te c ts the surg e o n a nd ho sp ita l a g a inst le g a l
a c tio n b y a c lie nt w ho c la im s tha t a n
una utho rize d p ro c e d ure w a s p e rfo rm e d .
▶ To e nsure tha t the c lie nt und e rsta nd s the na ture
of his or her treatment including the possible
c o m p lic a tio ns a nd d isfig ure m e nt.
▶ To ind ic a te tha t the c lie nt’s d e c isio n w a s m a d e
w itho ut fo rc e o r p re ssure .
Criteria for a Valid
Informed Consent
▶ Consent voluntarily given. Valid consent must b e freely g iven without
coercion.
▶ For incompetent subjects, those w ho are NOT autonom ous a n d ca nnot
g ive or withhold consent, permission is required from a responsible
family member w ho could either b e a p p a rent or a legal guardian.
Minors (below 18 years of age), unconscious, mentally retarded,
psychologically incapacitat ed fall under the incompetent subjects.
▶ The consent should b e in writing a n d should contain the following:
▶ Proc ed ure expla n ation a n d the risks inv olv ed
▶ Description of benefits a n d alternatives
▶ A n offer to a n sw er q uestions a b out the proc ed ure
▶ Statement that emphasizes that the client m a y withdraw the consent
▶ The information in the consent must b e written a n d b e deliv ered in
la n g ua g e that a c lient c a n c omprehend.
▶ Should b e obtained b efore sed a t ion.
Nursing Interventions

Reducing Anxiety and Fear

• Provide p syc hosocia l supp o rt.
• Be a g o o d listener, b e empathetic, a n d provide information
th a t help s a llevia te c o n ce rns.
•During preliminary contacts, give the patient opportunities
to ask questions a n d to b e c om e acquaint ed with those who
might b e providing ca re during a n d after surgery.
• Acknowledge patient concerns or worries about impending
surgery by listening a n d communicating therapeutically.
• Explo re a ny fe a rs w ith p a tient, a n d a rra n ge fo r the
a ssista nc e of other h e a lth p rofessiona ls if re q uire d.
•Tea ch patient cognitive strategies that m a y b e useful for
relieving tension, overcoming anxiety, a n d achieving
relaxation, including imagery, distraction, or optimistic
affirmations.
Managing Nutritionand Fluids
Provide nutritional support as ordered to correct a ny nutrient deficiency
before surgery to prov ide enoug h protein for tissue repair.
Instruct patient that oral intake of food or water should b e withheld 8 to 10
hours before the operation (most common), unless physician allows clear
fluids up to 3 to 4 hours before surgery.
Inform patient that a light meal m a y b e permitted on the preced ing
evening when surgery is scheduled in the morning, or prov ide a soft
breakfast, if prescribed, w hen surgery is scheduled to take p l a ce after noon
a n d does not involve a ny part of the G I tract.
In d ehyd ra t ed patients, a n d especially in older patients, encoura g e fluids
b y mouth, as ordered, before surgery, a n d administer fluids intravenously as
ordered.
Monitor the patient with a history of chronic alcoholism for malnutrition a n d
other systemic problems that increase the surgical risk as well as for alcohol
withdrawal (delirium tremens up to 72 hours after alcohol withdrawal).
Respecting Spiritual and Cultural Beliefs
• Help patient obt ain spiritual help if he or she requests it;
respe c t a n d supp o rt the b eliefs o f e a c h p a tient.
• Ask if the p a tient’s spiritu al a d v iserknow s a b o ut the
im p e n din g surg ery.
•When assessing pain, remember that some cultural groups
are una ccust omed to expressing feelings openly. Individuals
from som e c ultural g roups m a y not m a ke d irec t ey e c o nta c t
with others; this la ck of eye cont act is not avoidance or a la ck
o f interest b ut a sig n o f respe c t.
•Listen c a refully to p a tient, esp e c ia lly w hen o b ta inin g the
history. Correct use of communication a n d interviewing skills
c a n help the nurse a cquire invaluable information a n d insight.
Remain unhurried, understanding, a n d caring.
Providing Preoperative Patient Education
• Teach ea ch patient a s a n individual, with cons ideration for a n y unique
concerns or learning needs .
•Begin teachi ng as s oon as possible, s tarting in the phys ician’s office a n d
continuing during the pre admis s ion visit, when diagnos tic tes ts are being
p e rfo rme d , thro ug h a rriv a l in the o p e ra ting ro o m.
• S pa ce instruction over a period of time to allow patient to assimilate
information a nd as k ques tions .
•C o m bi n e t ea chi ng sessions with various pre parati o n pro ce- dures t o allow for a n
e as y flow of information. I n cl ude des criptions of the pr o cedur es a n d ex planatio ns
of the s ens ations the patient will experience.
• During the preadmis s ion visit, arrange for the patient to meet a nd as k ques tions
of the perianes thes ia nurse, view audiovis uals, a nd review written materials.
Provide a telephon e number for patient to call if ques tions arise clos er to the
da t e of surgerinf•
• Reinforce information a bo ut the pos s ible need for a ventilator a n d the pres ence
of drainage tubes or other types of equipment to help the patient adjust during
the p o sto p era tiv e p erio d .
• Inform the patient when family a nd friends will be able to visit after surgery a n d
that a spiritual advis or will be available if des ired.
Teaching Deep Breathing and Coughing Exercises
•Teach the patient ho w to promote optimal lung
expansion a nd consequent b lo o d oxygenation after
anesthesia by assuming a sitting position, taking
d e e p a nd slo w b re a ths (ma xim a l susta ine d
inspiration), a nd exhaling slowly.
•D e m o nstra te ho w p a tie nt c a n sp lint the inc isio n
line to minimize pressure a nd control pain (if there will
b e a tho ra c ic o r a b d o m ina l inc isio n).
•Inform patient that medications are available to
re liev e p a in a nd tha t the y sho uld b e ta ke n re g ula rly
for pain relief to enable effective deepbreathing
a nd c o ug hi ng exercises.
Explaining Pain Management
•Instruct patient to take medications as frequently
as prescribed during the initial postoperative period
for pain relief.
•Disc uss the use o f o ra l a na lg e sic a g e nts w ith
p a tie nt b e fo re surg e ry, a nd a sse ss p a tie nt’s inte re st
a nd willingness to participate in pain relief methods.
• Instruct patient in the use of a pain rating scale to
promote postoperative pain ma na gement.
Preparing Patientfor Surgery
•Instruct patient to use detergent–germ icid e for several d a ys at hom e (if the
surgery is not a n emergency).
• If hair is to b e removed , rem ove it immediately before the operation using
electric clippers.
• Dress patient in a hospital g ow n that is left untied a n d op en in the back.
Cover patient’s hair completely with a disposable p a p er ca p ; if patient ha s long
hair, it ma y b e braid ed; hairpins are remov ed.
Inspect patient’s mouth a n d rem ove dentures or plates.
Transporting Patient to Operating Room
•Send the completed chart with patient to operating
room; attach surgical consent form a n d all laboratory
reports a n d nurses’ records, noting any unusual last minute
observations that m a y h a v e a bearing on the anesthesia or
surgery at the front of the chart in a prominent place.
•Take the patient to the preoperative holding area, a n d
keep the area quiet, avoiding unpleasant sounds or
conversation.
Attending to Special Needs of Older Patients
• Assess the older patient for dehydration, constipation, a n d malnutrition;
rep ort if present.
• Maintain a safe environment for the older patient with sensory limitations
such as impaired vision or hearing a n d red uced tactile sensitivity.
•Initiate protective measures for the older patient with arthritis, which m a y
affect mobility a n d comfort. Use a d eq ua t e p a d d ing for tender areas. M ove
p a t ient slow ly a n d protec t b ony prominenc es from prolong ed pressure.
Provide gentle m a s s a g e to promote circulation.
• Take a d d e d precautions w hen m oving a n elderly patient b eca us e
d ecrea s ed perspiration leads to dry, itchy, fragile skin that is easily a b ra d ed .
•Apply a lightweight cotton blanket as a cover w hen the elderly patient is
m oved to a n d from the operating room, b eca us e d ecrea s ed
subcuta neous fat makes older people more susceptible to temperature
cha ng es .
•Provide the elderly patient with a n opportunity to express fears; this
enables patient to gain some p e a c e of mind a n d a sense of being
understood
POSTOPERATIVE
EXERCISES

- KANGAN
ROLL NO. 29
POSTOPERATIVE PHASE

▶ THE C A RE O F THE PATIENT AFTER SURG ERY:

▶ THIS INCLUDES C A RE GIVEN DURING THE
IMMEDIATE POST OPERATIVE PERIOD, BOTH IN THE
OPERATIVE R O O M A N D POST ANESTHESIA C A RE
UNIT.
▶ WHETHER O R NOT THE PATIENT C A N AMBULATE
EARLY IN THE POSTOPERATIVE PERIOD, BED
EXERCISES ARE E N C O U RA G E D TO IM PROVE
CIRCULATION
QUADRICEPS SETS

▶ TIGHTEN THE THIGH M USCLE

▶ TRY TO STRA IG HTEN THE KNEE
▶ HOLD FOR 5 TO 10 SE C O N D S
▶ REPEAT APPROXIMATELY 10 TIMES DURING A N D 2
MINUTE PERIOD
▶ C O NTINUE TILL THIG H STA RTS FEELIN G FATIG UED
STRAIGHT LEG RAISES

▶ TIGHTEN THIGH M USCLE WITH KNEE FULLY

STRAIGHTENED O N BED
▶ LIFT LEG SEVERA L IN C HES
▶ HO LD FO R 5 O R 10 SEC O N DS . SLO WLY LO WER
▶ REPEAT UNTIL THIGH FEELS FATIGUED
ANKLE PUMPS

▶ M O V E THE FOOT UP A N D D O W N BY
CONTRACTING CALF A N D SHIN M USCLES
▶ PERFORM THIS PERIODICALLY FOR 2 TO 3 MINUTES
▶ C O NTINUE TILL O NE IS FULLY REC O VERED
EARLY ACTIVITY

▶ WALK AS RHYTHMICALLY A N D SM OOTH AS THEY

CAN
▶ DON’T HURRY
▶ ADJUST THE LENGTH OF STEP A N D SPEED AS
NECESSARYTO WALK WITH A N EVEN PATTERN
▶ WITH TIME PATIENT M AY SPEND M O RE TIME
WALKING
STAIR CLIMBING AN D
DESCENDING
▶ THE ABILITY TO G O UP A N D D O W N STAIRS
REQUIRES STRENGTH A N D FLEXIBILITY
▶ PATIENT M AY NEED SUPPORT /HANDRAILS A N D
WILL BE ABLE TO G O O N E STEP AT A TIME
BREATHING EXERCISE

▶ RELAX SHOULDER A N D UPPER CHEST

▶ TA KE A DEEP BREATH A N D HO LD IT FO R 5 SEC O N DS
▶ BREATHE OUT SLOWLY THROUGH MOUTH
A R M EXERCISES

▶ WRIST STRETCH
▶ PRONATION A N D SUPINATION OF THE FOREARM
▶ GRIP STRENGTHENING
▶ WA RM UP SHRUG/SHOULDER SHRUG
INTRAOPERATIVE PERIOD
Intraoperative period

▶ The intraoperative period starts as soon a s the patient

enters the OT from the p re-o p era tive a rea . The nurse
should m a k e preparation a n d h a v e knowledge of the
ev ents th a t w ill b e o c c urrin g d urin g the surgery.
▶ There a re tw o typ es of nurses inv olve d in a surgery: a scrub
nurse a n d a c ircula tory nurse.
1. The scrub nurse is responsible for maintaining sterile field
d urin g the surgery, a ssist in sterile d rap in g, a sep tic h a nd ling
of instrum ents a n d other sup p lies to the surgeon a nd
ke e p ing the spong e a n d instrum ent c ounts.
2. Whereas the circulatory nurse is responsible for reviewing
the p a tient’s file a n d d o c um ents a n d to p rovide the extra
supplies to the scrub nurse. The circulatory nurse a lso assists
in the procedures like intubation, intravenous (IV)
cannulation, blood transfusion,catheterization, assisting
equipment a n d a ccura t e completion of records.
Anesthesia

▶ A ne sthe sia is d e riv e d fro m G re e k w o rd m e a ns

“w itho ut se nsa tio n”.
▶ DEFINITION:
It is defined as a state of controlled, temporary loss
of sensation that is induced for medical purposes. It
m a y inc lud e so m e o r a ll o f a na lg e sia , p a ra lysis
a m ne sia a nd unc o nsc io usne ss.
Types of Anesthesia

▶ Anesthesia is categorized into generap or regional.

Anesthetic agents generally are administered by a n
anesthesiologist. General anesthesia is the loss of all
snesation a n d consciousness. While the patient is
under a n influence of general anesthesia, the
protective reflexes of the patient such as c o u g h a n d
g a g reflexes are absent. A general anesthetic acts
by blocking alertness centers in the brain such that it
causes amnesia ( loss of memory), analgesia (
insensibility to pain), hypnosis ( artificial sleep), a n d
relaxation (rendering a part of the bo dy less tense).
General anesthetics are administered either by
intravenous infusion or by inhalation of gases
through a mask or through a n endotracheal tube.
▶ GENERAL ANESTHESIA:
It makes the patient lie in a n unconscious state; there
by vital signs n e e d to be monitored readily. Also, the
anesthesia is beneficial as it c a n be adjusted as per the
length of the surgery a n d the patient’s a g e a n d
physical status. Its major weakness of general
anesthesia is that it depresses the respiratory a n d
circulatory systems. Some patients tend to be c o m e
anxious as they lose the capability to control their o w n
bodies.
▶ REGIONAL ANESTHESIA:
It is a short-term disruption of the transmission of nerve
impulses to a n d from a specific area or region of the
body. The patient loses sensation in a particular area of
the bo dy but remains conscious.
Various techniques used to deliver anesthesia.
The g eneral objec tiv es of c are in the intra op erativ e period are to maintain the
p a t ient’s safety a n d to maintain homeostasis.
Nursing interv ention p erformed to a c c omplish
g oals inc lud es the follow ing .
Surgical skin preparation

Surgical skin preparation includes cleaning of the

surgical site by applying a n d antimicrobial agent a n d
removing hair. The purpose of a surgical skin
preparation is to decrease the risk of surgical site of SSIs.
It inc lude s the fo llo w ing :
▶ Cleaning of the surgical site a n d surrounding area
by having the patient shower a n d s h a m poo or wash
the surgical site before the surgery, with the help of
a n antimicrobial agent.
▶ Removal of hair from the surgical site if it impedes
with the surgical procedure. Electric clippers, razors
a n d skin removal creams are used for removing the
hair. Skin trauma also increases the risk of infection at
surgical site. Chlorhexidine gluconate a n d
povidone-iodine are frequently used solutions for skin
preparation.
Positioning
The p osition of the p a tient
d uring a surg ic al
proc ed ure is essential for
maintaining the p a t ient’s
safety. A ll the healthc are
professionals in O T are
resp onsible for prev ention
of p eriop erativ e
complications related to
positioning. The patient’s
position ca n affect
v entilation a n d c irc ulation
a n d imp a ir p erip heral
nerv e func tion.
Nursing Implication

Positioning is performed after anesthesia is induced a n d

b efo re surg ic a l d rap in g o f the p a tient. The p a tient is lifte d into
position to prevent shearing forces on the skin from sliding or
rolling. The exact position for the patient depends on the
operation, that is, the surgical a pproa ch. For exa mple, a
lithotomy position is usually used for va ginal surgery. Straps
maintain positions on the operating table, a n d b o d y
prominences are frequently p a d d e d . The position should
c o nsid er norma l jo int ran ge o f m o tio n a n d g o o d b o d y
alignment, thereby a voiding strain or injury to muscles, bones,
a n d ligaments. Nursing care during the postoperative phase is
especially important for the patient’s recovery b e c a use
anesthesia impairs the ability of patients to respond to
environmental stimuli a n d to help themselves, alt hough the
degrer of consciousness of patients will vary. Moreover,
surgery itself traumatizes the b o d y by disrupting protective
m e c h a nisms a n d hom eosta sis.
C o m m o m Surgical
Position
Postoperative period

PRESENTED BY
K.LUXMI
BSC NURSING 1ST YEAR
Postoperative period

Defination
▶ Po st-o p e ra tive c a re is the c a re tha t the
p a tie nt re c e iv es a fte r a surg ic a l
procedure. The type of post-operative
care that the patient need d ep end s o n
the typ e o f surg e ry a s w e ll a s the
p a tie nt’s histo ry. It o fte n d e p e nd s up o n
pain ma na g ement a nd w o und care.
 Phases
▶ Im m e d ia te (Post-a ne sthe tic ) Pha se (1)

• Inte rm e d ia te (Ho sp ita l Sta y) Pha se (2)

• C o nv a lesc e nt (Afte r Disc ha rg e To Full Re c o v ery)

 Purposes

▶ To enable a successful a nd faster recovery of the patient

post operatively.
▶ To reduce post-operative mortality rate.
▶ To reduce the length of hospital stay of the patient. To
p ro v id e q ua lity c a re se rv ic e.
▶ To reduce hospital a nd patent cost during post operative
period.
Nursing management in post
operative care unit
▶ I-Assessing the patient:
▶ Fre q ue nt a sse ssm e nt o f the p a tie nt fo r o xyg e n
sa tura tio n. Pulse v o lume a nd re g ula rity, d e p th
a nd nature of respiration, skin color depth of
consciousness.
▶ II- M a inta ining a p a te nt a irw a y:
▶ -The p rim a ry o b je c tiv e s a re to m a inta in
pulmonary ventilation a nd prevent hypoxia a nd
hypercapenia. –Provide oxygen, a nd assesses
re sp ira to ry ra te a nd d e p th. O xyg e n sa tura tio n.
Cont…

III- M a inta ining c a rd io v a sc ula r sta b ility:

•-Assess the patient’s mental status, vital signs,
cardiac rhythm, skin temperature, color a nd unine
output. Central venous pressure, arterial lines a nd
p ulm o na ry a rte ry p re ssure .
•The p rim a ry c a rd io v a sc ula r c o m p lic a tio ns inc lud e
hyp o te nsio n, sho c k, he m o rrha g e , hyp e rte nsio n a nd
dysarrythmias.
Cont..
▶ IV- Relieving pain a nd anxiety: - Opioid analgesic
▶ V-A sse ssing a nd m a na g ing the surg ic a l site : -The
surg ic a l site is o b se rv e d fo r b le e d ing ,typ e a nd
inte g rity o f d re ssing a nd d ra ins.
▶ VI- Assessing a nd ma na g i ng gastrointestinal
func tio n: N a use a a nd v o m iting a re c o m m o n a fte r
anesthesia.
▶ -C he c k o f p e rista lsis m o v ement.
Cont..

▶ VII- A sse ssing a nd m a na g ing v o lunta ry v o id ing : -

Urine retention after surgery c a n occur for a verity
o f re lio ns. O p io id s a nd a ne sthe sia inte rfe re w ith
the p e rc e p tio n o f b la d d e r fullne ss.
▶ VIII- Encourage activity:
▶ M ost surgical are enc o ur a g ed to b e out of b e d as
soon as possible. Early ambulation reduces the
incidence of postoperative complication as
atelectasis pneumonia, gastrointestinal discomfort
a nd c irc ula to ry p ro b le m .
Nursing
interventions
 WOUND
•
A wound is a breakdown in integrity of
small cut to full thickness
the skin. This breakdown may vary from a
 TYPES OF WOUND
According to status of skin integrity
• Open wound
• Closed wound
According to duration
• Acute wound
• Chronic wound

Open wound Clos e wound

Acute wound Chronic wound

ACCORDING TO PURPOSE OF WOUND
• Intentional wounds
• Unintentional wounds

ACCORDING TO THE DEPTH OF THE WOUND

• Partial thickness
• Full thickness

Partial thickness
ACCORDING TO DEGREE OF CONTAMINATION
• Clean wounds
• Clean - contaminated wounds
• Contaminated wounds
• Dirty or inflected wounds

Infected wound
FACTOR AFFECTING WOUND HEALING
 CARE OF

DRAINAGE SYSTEM
Pre se nte d b y
MD.Hashim
B.Sc N URSIN G 1 st Ye a r
 ▶ CARE OF DRAINAGE SYSTEM

 ▶A drain is inserted into or close to

a surgical wound, where large
amount of drainage is expected
a n d when keeping wound layers
closed is especially important
.accumulation of fluid under tissue
prevents closing of wound e dg es
 ▶NURSES RESPONSIBILITIES
▶ Always h a n g the drainag e system freely at the e d g e
of the b e d below the chest or abdominal level.
▶ N e ve r kee p it on g round.
▶ A lw a ys w a tc h for outp ut a nd re c ord it in the inta l
output chart, less than 30 ml in last 24 hours indicate
re mov a l of dra ina g e in a d d ition in c onsulta tion w ith
surgeon
▶ We a r g lov e s w hile ha ndling .
▶ Aseptic surgical dressing at site of insertion.
 TYPES
OF
D RA INS
C O RRUG ATED RUBBER T TUBES
DRAINS TUBES
ID ENTIFIC ATIO N O F INFEC TIO N

 TYPES OF W O U N D CULTURE
 ▶ Swab culture: A swab culture is the most common
technique used
 because it is non-invasive, and most cost-effective.
 Deep-tissue biopsy: A deep-tissue or punch biopsy for a
quantitative culture is the gold standard for identifying
wound bioburden and diagnosing infection
 Aspiration culture: Insertion of a needle into the tissue
adjacent to
 the wound to aspirate the fluid.
 WOUND CLEANING

▶ Wash the wounds with sterile water, normal saline, help in remov al of
w o u n d contaminants. Cleaning should b e performed from the least
contaminated area to a more contaminated area, i.e., from the w o u n d
to the surrounding skin. The wounds are usually c l e a n e d in linear strokes
or with a circular approach.
▶ The whirlpool is another form of w o u n d irrigation that should only b e
used for wounds that contain slough a n d necrotic tissue O n c e the
necrotic tissue is debrided, the whirlpool should b e discontinued as it
c a n d a m a g e granulation tissue
▶ Excessive use of antiseptics such as pov idine todine, hydrogen peroxide,
chlorhexidine, has b e e n shown to b e harmful for the fibroblasts.
The re fo re , ro utine use is no t re c o m m e nd e d .
W O U N D IRRIGATION A N D PACKING
Wound irrigation and packing refer to the
application of fluid to a wound to remove
exudate, slough, necrotic debris, bacterial
contaminants, and dressing residue
without adversely impacting cellular
activity vital to the wound healing process
AFTER CARE(WOUND IRRIGATION)
▶ Re m o v e M a c into sh a nd tre a tm e nt to w el.
▶ ta ke a ll a rtic le s to the tre a tm e nt ro o m .
▶ Discard soiled dressings in cov ered container a n d
se nd it fo r inc ine ra tio n.
▶ Instruments should b e p l a c e d in the disinfectant
so lutio n a nd sho uld b e c le a ne d tho ro ug hly.
▶ Re p la c e a ll a rtic le s a t p ro p e r p la c e .
▶ Help the patient to m a k e him comfortable.
▶ Wash hands.
 GAUZE PACKING
▶ G a uz e pa ck i n g us ed to pa ck wounds that require debridement a nd
involves da m p- t o - da m p technique. In this technique, moist 4 x 4
noncott o n filled gauzes are pa ck e d in the w o u n d to abs orb exudate. The
pa ck s s hould not get dry before removal.
▶ However, newer a d v a n c e d dres s ing materials h a v e significant
a d v a nta g es o v er the use o f g a uze.
▶ N e g a t i v e pres s ure w o u n d therapy, als o termed vacuum-as s is te d clos ure
(VA C), w o u n d VA C v a cuum sealing, a nd topical negativ e pressure, is a n
example of s uch newer interventions. It us es s uction equipment that
applies negative pres s ure the wound. This therapy provides a moist a n d
p ro tect ed e nv iro nme nt to the w o und a nd ha s p ro v e n to ha ste n tissue
generation, reduce swelling around the wound, a nd enha nce w o und
healing.
▶ Sterile foam sponges are p l a c e d into clean w o u n d
a n d c o v e r ed with a transparent adhesiv e drape a n d
the n a v a c uum tub ing is inse rte d thro ug h a ho le
m a d e in the d ra p e . M a xim um e ffe c tive ness o f the
v a c u u m c a n b e achiev ed, if applied for almost 24
ho urs e v e ry d a y a nd p o rta b le syste m s a re e xisting fo r
a m b ula to ry c lie nts.
M a d e b y: M eg hna
Ra na
BSc. Nursing (1st year)
Roll no. 36
 Introduction:
A suture is a thread used to stitch body
tissues together. Sutures that are used to
attach tissues under the skin are
ofte n m a d e of an a b sorb a ble m ate rial
that vanishes in several days.
In c ontrasts to suture s, the skin suture s are
m a d e of a ran g e of nona b sorb a ble
materials,
suc h as silk, line n, w ire , nylon an d d a c ron
(polye ste r fib e r). Skin suture s are usually
re m ove d 7-10 d a ys afte r surg e ry.
Categories of skin sutures:
1) Interrupted: Ea ch stitch is tied a nd knotted
separately.

2) Continuous: O ne thread runs in a series of

stitches
a nd is tied only a t the b eg inning a nd a t the end
of
the run.

3)Blanket suture: It is c ontinuous loc k-stitc h used to

approximate the skin of a wound. Such stitches are
often used to finish a n ed g e. The stitc h c rea tes a n
interlocked thread that runs on the ed g e of the
fabric.
4) Retention sutures: Hug e sutures used in addition to skin
sutures for s om e incisions. They a t t a ch underlying tissues of
fat a nd muscle as well as skin a nd are used to support
incisions in individuals who are ob es e a nd suffer from
d el a yed w ound healing They are commonly left in place
longer than skin sutures (14-21 days) but sometimes are
rem oved at the s a m e time as the skin sutures. These large
sutures tends to irritate the incision, the surgeon m a y
place rubber tubing over them or a roll of g a uz e under
them extending d own the incision line.
SutureRemoval:
Sterile technique a nd special suture scissors are used in
suture removal. The scissors ha ve a short, curved cutting tip
that readily glides under the suture. Wire clips or staples are
rem oved with a special instrument that squeezes the center
of the clip to remove it from the skin, it is known as clip
remover.

Careof suture:
• Keep wound a rea d ry for th e first 24 h ours.

• Apply antibiotic ointment a nd dressing daily for 48 hours.

• After 48-72 hours, sut ures c a n b e left uncovered. Ma y

c lea n g ently wit h mild soa p a nd wa ter or 1/2 strength
hyd rog en p eroxid e, a fter 48 h ours to p revent c rust ing
over sut ure knot s.
Check for signs of infection:
❖ Increasing redness, tenderness or warmth around the suture
site.

❖ Infla m m a tion a round the site.

❖ A p p ea ra nce of p us a round ea c h suture or a ny red strea ks.

❖ Fever

Removal of sutures:
Suture removal d ep end s on how well the w ound is healing a nd
w ound location. Sutures are usually rem oved from the eyelids
in 3 days; the f a ce in 3-5 days; the torso in 7-10 days; the hands
a nd feet in 7-10 d a ys, a nd sca lp 7 d a ys.
BANDAGES
AND BINDERS
 Bandage
A bandage is a type of dressing material , available
in variable length width and materials .
Usually light , weight,and low priced , they are
made up of material like cotton gauze flannel ,
elastic knit,elastin webbing and muslin.
Uses of Bandage
Bandages are used for following purposes:
▶ To prevent contamination of wound by holding dressings
in position.
▶ To provide support to the part that is injured, sprained or
dislocated joint.
▶ To provide rest to the part that is injured.
▶ To prevent & control hemorrhage.
 Types of bandages

According to the shape and size of the bandage they are

categorised as:
▶ Triangular Bandage.
▶ Roller Bandage
▶ Gauze bandage
▶ Crepe bandage
▶ Adhesive
 PRINCIPLES OF BANDAGING

▶ Always sit opposite to the pateint.

▶ Support the limb or Area where bandaging or area .
▶ Hold the tail of the roller bandage in non dominant hand and head of bandage in
dominant hand.
▶ Unroll the bandage with inner surface facing towards you.
▶ Always secure the bandage with two Circular turn while starting and ending the
bandage.
▶ Bandage should not be too tight or loose.
▶ While applying figure of edge bandage on joint keep the joint in 90°angle .
▶ Always cover 2/3 of previous turn while appy bandage.
▶ Bandage is always appleid from down to up and inner to outer.
▶ Securing knot shall be applied.
Basic applicationsof roller bandage
Spiral Bandage
Used to apply an elastic bandage to an arm or leg Spiral.

Reverse spiral Bandage

Used to wrap an extremity that has vary thickness.
Provides a means to secure,smooth,even-fitting bandage on extremity.
Recurrent Bandag e
Recurrent Bandage Applied to hold pressure dressings in place over the
tip end of a finger, toe, fist or on the head.

Circular Bandag e
used to adhere the b a nd a g e to the w ound a nd to terminate them.
Circular turns commonly are not appleid directly over a w ound
b ec a use it c a uses d iscom fort to the wound
Figure-8 Bandage
▶ Arm Sling Used whenever a joint is included in
wrapping.
▶ It protects dressings and keeps them in place,
supports and limits the movement of the joint and
promotes the venous blood return, which reduces
swelling or edema.
 BINDERS

While a dressing is simply not e n o u g h in providing support to w o u n d

Binde rs are purpo se ly m a de to fit a pa rtic ula r bo dy pa rt .
They are ba n da g e s prepared from large piece of material such as
e la stic , c o tto n ,muslin o r fla nne l .

Binder application
Binders are special ba n da g e s used to support a specific part of bo dy .
Binders are usually well fitted a n d m a d e in such shapes that it solved the
purpose of its use.
 TYPES OF BINDERS

▶ Breast binder
▶ They are used to support the breast after surgery a n d
also provide pressure on the breast to r educe
la c ta tion in w o m e n a fter c hild b irth.
▶ Abdominal binders
▶ It is a kind of wide compression belt that cov ers the
w hole of a bdominal a r ea .
▶ Abdominal binders are available a ccording to size
a n d width .
▶ S ome a bdominal binders also offers secondary lumbar
support .
▶ They are used to a cceler ate recovery rates after a n
a bdominal surgery.
▶ T-binders
▶ The y a re use d to ho ld the d re ssing o n the re c tum
a nd p e rine um a nd in the g rio n .
▶ The single T-binders is used in female patient a nd
the d o ub le .

Sling
A sling is use d a s a sup p o rt to a rm .
Sling are used as a first -aid
THANKYOU
SUBMITTED TO – MS. JYOTI MAM
SUBMITTED BY – ROLL NO .37- MEHAK
KUNDAL
ROLL NO.38 - MOHINI SHARMA
COLD APPLICATION
❑ Therapy effec ts of c old
❑ Contraindic ations to c old applic ations
❑ Methods
COLD APPLIC ATION
Students........

Je va np re e t kaur(27)-p re o p e ra tive p ha se
Jessica gill(28)-preoperative phase
Kangan(29)-postoperative exercise
Kashish(30)-m erg ing a ll p p t
Ko m al(31)-intra o p e ra tive p e riod
Kumari Laxmi(32)-postoperative
Laxmi (33)-wound
Lovely(34)
M d Ha shim(35)-c a re of dra ina g e syste m
M e g hna ra na (36)-suture s
Mehak kundal(37)-bandages
M ohini sha rm a (38)-a n d b ind e r
M ohit(39)-he a t a nd c old the ra p y