*SURGICAL NURSING PRo*

*PERI OPERATIVE NURSING CARE*

Pre-operative care consists of all the nursing care rendered to a surgical patient before surgery (pre-
operative nursing care), during surgery (intra operative nursing care) and after surgery (post-operative
nursing care).

*PRE OPERATIVE NURSING CARE*

Pre-operative care is the preparation and management of a patient prior to surgery. The perioperative
phase begins when the decision to proceed with surgical intervention is done.

*GOALS DURING THE PREOPERATIVE PHASE*

📚Assessing and correcting physiological and psychological problems that may come up as a result of
surgical risk.

📚Giving the patient and significant others completing learning and teaching guidelines regarding the
surgery

Instructing and demonstrating exercise that will benefit the patient post operatively.

📚Planning for discharge and projected changes in lifestyle due to the surgery.

▪The pre-operative phase includes; physiological, psychological, physical, spiritual and socioeconomic
preparation.
📦 *PSYCHOLOGICAL PREPARATION*

📚Once the decision is made for a surgery, there’s anxiety. The nurse must give words of mouth to clear
or reduce the level of anxiety in the patient.

📚Establish rapport by giving patient warm reception followed by exchange of greetings and preliminary
conversation. This is done to create a good inter-personal relationship.

📚Maintain patient integrity by addressing patient with respect and giving him the correct title. This is
done in order to build trust and confidentiality.

📚Reassurance. Reassure patient that there is a competent surgical team and equipment to ensure a
successful surgery. The will help to allay fear and anxiety.

📚Allow patient to ask questions about the impending surgery and the nurse must answer him/her
tactfully in a language the patient understands in order to clear all misconceptions.

📚The nurse explains the surgical procedure to the patient in order to gain his/her cooperation.

📚Inform patient that, even though there are other treatment options, chemotherapy but surgery is the
best choice. This is to gain patients cooperation.

If available, introduce patient to other patients who have undergone similar surgery and have recovered
successfully in order to boost patient confidence. If there are no such patients on the ward, show
pictures or videos of patients who have undergone same surgery and recovered successfully to boost
patient confidence.

📚Introduce patient to the surgical team and orientate patient to the theatre environment by showing
him/her some of the equipment that will be used during surgery. In order to familiarize him/herself with
the theatre environment.
📚Inform patient about any extra gadgets such as catheters, monitory devices, turbines that may be
found on him/her after surgery in order to accept the outcome of treatment

📚Regarding pain, inform patient that anaesthesia will be given before to reduce pain and after the
surgery analgesics will be given to combat pain in order to allay fear and anxiety.

📚Ensure that the patient has signed the consent form to protect the hospital and the surgical team
against legal issue

📦 *SPIRITUAL PREPARATION*

📚If the patient desires for prayers, invite the spiritual leader to come and have a word of prayer with
him/her before surgery in order to boost his/her spiritual confidence.

📚If the spiritual leader is not available, the nurse arranges for the hospital chaplain to have a prayer with
him/her before surgery.

📚If all these people are not available, the nurse assists the patient in offering prayers before the surgery
to boost his/her spiritual confidence.

📦 *SOCIOECONOMIC PREPARATION*

📚Find out if the patient has a valid NHIS card that may cater for his/her bills after surgery.

📚If patient has a valid health insurance card, inform him/her that there are some medication and
procedures that the insurance doesn’t cover which he/she has to buy them his/her own money in order
to accept any cost that may be given during discharge.
📚Find out the occupation of the patient in order to determine if the patient can afford his/her bills.

📚Allow friends and relatives to visit patient in order to feel a form of belongingness which will speed up
recovery process.

Find out the effect surgery will have on the patient’s role in the society and help him/her find solutions
to them.

*PHYSICAL PREAPARTION*

📚📚📚 *(RONIDEPEP)* 📚📚

📦 *R- REST AND SLEEP*

Rest and sleep as needed before surgery in order for patient to conserve enough energy to face the
impending surgery

📚Make a warm comfortable bed free from cruises and cramps to promote enough rest and sleep.

📚Switch off bright light and put on dim light during the night to promote sleep.

📚Ensure adequate ventilations by opening nearby windows to allow in fresh air.

📚Reduce noise on the ward by tuning down the volumes of TV and radio sets in order to promote rest
and sleep.

📚Assist patient to have a warm bath in the evening to stimulate rest and sleep.
Restrict visitors especially when patient is sleeping to prevent interruption of sleep pattern.

📚Administer prescribed analgesics to combat pain to stimulate rest and sleep.

📚Serve warm beverages such as milo drinks in order to stimulate rest and sleep.

Administer prescribed hypnotics such as diazepam to induce sleep.

📦 *O- OBSERVATION*

📚Check vital signs (TPR, BP) to serve as a baseline data to detect any deviation from normal.

📚Observe the IV infusions flow rate in order to prevent cardiac overload or dehydration.

📚Observe intake and output and record on the intake and output chart in order to promote fluid and
electrolyte balance.

📚Observe the patient’s pain by using the pain rating scale and provide appropriate intervention.

📚Observe the sight such as swelling, blockage or infiltrate and intervene appropriately.

📚Observe for desired and side effects of the medications and report of if side effect is detected.

📦 *N- NUTRITION*

📚Ensure NPO 6 to 8hours before surgery to prevent aspiration during surgery.

📚If the patient has already eaten before arrival (in emergency), then an NG tube is inserted to
decompress the stomach.

📚Administer prescribed IV fluids to hydrate the patient.

Monitor the flow rate of the infusion to prevent over hydration or under hydration.

📚Monitor intake and output and record on the intake and output chart to prevent fluid and electrolyte
imbalance or to promote fluid and electrolyte balance.

📚Administer easily digestible diets high in calories to provide energy before surgery.

📚Educate the patient about the need for NPO in order for him/her to comply.

*D- DRUGS/MEDICATION*

📚Administer prescribed IV infusion fluids to hydrate the patient.

📚Monitor the flow rate of the infusion to prevent cardiac overload or dehydration.

📚Observe for desired and side effects of the medication and report if any side effect is detected.

Document all medications served on the drug administration chart in order to prevent drug overdose.

📚Monitor intake and output and record on the intake and output chart to ensure

📚Administer prescribed antibiotics to combat infections

📚Administer prescribed analgesics to combat pain.

📦 *E- ELIMINATION*

📚Assist patient to empty his/her bladder by offering bed pan to ensure clear visualization of the
abdominal organs during surgery.

📚Assist patient to empty the bowel by offering bedpan before surgery to ensure clear visualization of the
abdominal organs during surgery.

📚Serve food high in fibre to prevent constipation

Serve prescribed laxatives or stool softeners to prevent constipation.

📚In case if difficulty in passing urine, a prescribed urethra catheter is inserted to promote continuous
drainage of urine.

📚Maintain proper perinea care to prevent infections.

📦 *P- PERSONAL HYGIENE*

📚Assist patient to perform oral care using paste and toothbrush, chewing stick in order to prevent
abnormalities such as halitosis.

📚Help patient bath and groom him/herself using antimicrobial soap/antiseptic soap to prevent
microorganisms on the skin as well as patient to feel refresh.

📚The nurse should care for the patient wound aseptically to prevent infections.
📚Care for patient’s hands and feet by cleaning them and trimming the nails to prevent infections.

📚Educate the patient on the important of maintaining good personal hygiene especially paying particular
attention to the skin folds such as axilla and perineum to prevent infections.

📚Change soiled linens to prevent infections

📚Care for the patient’s hair and report any abnormalities such as lice infestations, furuculosis (a multiple
boils).

*E- EXERCISE /EDUCATION*

📚Educate patient on how to perform deep breathing and coughing exercise to be performed post
operatively in order to prevent complications such as collapse of the lungs (atelectasis).

📚Educate patient on the importance of early ambulation post operatively to prevent complications such
as deep vein thrombosis. ( DVT)

📚Inform patient on the importance of performing the exercises post operatively in order to ensure
compliance.

*IMMEDIATE NURSING CARE*

These are the nursing measures that are done just before patient enters theatre;

📔Administer prescribed IV infusion to hydrate the patient

📔Inspect and remove external gadget or structures such as dentures plate to prevent blockage of the
airway or aspiration

📔Remove jewelleries including necklaces, bangles. Earing to prevent electrocutions.

📔Assist patient to change into theatre gown which has an opening at the back for easy access to the
operation site will also help to reduce number of microorganisms.

📔Administer prescribed premedication about 30-40mins before surgery in order to achieve the full effect
of the medications.

📔Hand over valuables to patient’s relatives or keep them in the ward’s locker and let the patient sign
together with the nurse and a witness (relative or nurse).

📔Ensure that all examination results are ready and fixed in the patient’s folder in order to guide the
surgeon during surgery.

📔Ensure that the consent form has been signed before administration of premedication to protect the
hospital from any illegal issues.

📔Assist the patient to empty his/her bladder and bowel before been sent to theatre to prevent
perforation of internal organs during surgery.

📔Put on an identification on the wrist bearing patient’s name, sex, age, ward, type of surgery to ensure
that the right patient undergo right surgery.

Observe the urine output in the urine bag. A urine less than 30mls is an indication of renal insufficiency
and report to the surgeon.
📔Use checklist to ensure that all the necessary pre-op. Preparations are done before patient is sent to
the theatre.

*POST OPERATIVE NURSING CARE*

📮RONIDEPEP

Immediate post-operative management (1st -24hours).

After surgery patient is transferred from the post anaesthesia care unit (PACU) and later transferred to
the surgical ward.

📔Receive patient into already prepared operation bed with it accessories to ensure comfort of the
patient and manage postoperative complications respectively.

📔Check whether you are receiving an alive patient by observing for rise and fall movement of the chest.

📔Place patient in recovery position or the position stated by the surgeon in the patient’s folder or put
patient in a position that is not contraindicated in order to prevent swallowing back secretions.

📔Ensure that all turbines such as urethra catheter, infusion giving set, drainage tubes are all patent to
prevent blockage and also well connected.

📔Check v/s (TPR BP) every 25mins for the first 1hour, 30mins for next 1hour, hourly, 2hourly and 4hourly
as patient’s conditions improves in order to avoid post op. complications or in order to detect early
onset of complications.

📔Observe the incisional for bleeding, if slight bleeding occurs re-enforce dressing. On the hand, bleeding
is profuse notify surgeon.
📔Administer prescribed IV infusion to hydrate the patient.

📔Monitor the flow rate or the drop rate of IV infusion in order to avoid cardiac overload or dehydration.

📔Record and report intake and output chat to prevent fluid and electrolyte imbalance.

📔Observe patient for pain using pain assessment scale.

📔Serve prescribed analgesics to combat pain

Instruct patient to perform deep breathing and coughing exercises to prevent complication such as
atelectasis.

📔If the patient has a drainage tube such as chest tube, check the drainage container for an amount,
colour, and consistence and report any abnormalities.

📔Mount padded side rails to prevent patient from falling when recovery from anaesthesia or nurse
patient on a low bed to prevent falling.

📔Assist patient to make his/her personal hygiene (oral care, bathing and grooming) in order to prevent
infection to the mouth and skin respectively.

📔Ensure NPO until bowel sounds are heard (passing of flatus using stethoscope) to prevent abdominal
complications.

*SUBSEQUENT CARE*
REST AND SLEEP 📦

📚Place patient in already prepared operation with its accessories to ensure comfort of the patient and
management post-operative complication respectively.

📚Assist patient to assume into a position that is not contraindicated to his/her condition or a position
prescribed by the surgeon to promote comfort.

📚Ensure adequate ventilation by opening nearby windows to promote fresh air in to order to induce
sleep.

📚Restrict visitors especially when the patient is asleep to prevent interruption of sleep.

📚If possible, group and perform all nursing activities at a go to prevent interference and disturbance
during sleeping.

📚Serve warm beverage such as milo tea after bowel sound is heard in order to induce sleep.

📚Reduce noise on the ward by tuning down the volume of gadgets such as TV, radio sets in order to
promote good sleep and rest.

*HYGIENE*

📚Educate the patient on the important of maintaining good personal hygiene especially paying particular
attention to the skin folds such as axilla and perineum to ensure compliance.
📚Assist patient in caring for his/her overgrown nails to prevent microorganisms from harbouring under
them to cause diseases.

📚Assist patient to care for the hair in order to prevent abnormality such as lice infestations

*WOUND CARE*

📚Observe the incisional for bleeding, if slight bleeding occurs re-enforce dressing. On the hand, if
bleeding is profuse notify surgeon.

📚Nurse must use aseptic technique such as wearing of gloves and nose mask to prevent introducing
microorganisms into the wound.

📚Use sterile items such as prescribed lotions in dressing wound to prevent infection

📚Educate patient not to be touching wound with his/her bare hands to prevent introducing
microorganisms into the wound.

📚Inform patient not to soak dressing with water when bathing to prevent build-up of microorganisms.

📚Observe the wound for the signs of infections such as pussy discharge, swelling, high body temperature
and intervene appropriately.

Serve food rich in proteins and vitamins to help in the build-up of worn-out tissues and promote of
wound healing respectively.

📚Serve prescribed antibiotics to combat infections.

Serve prescribed analgesics to combat pain.

📚Assist patient to manage his/her personal hygiene to prevent spread of infections to the wound site.

📚Observe patient for pain such as swelling, loss of function to combat pain.

*EXERCISE*

📚Encourage patient to early amputation in order to prevent proper blood circulation to wound to aid in
healing process.

📚Allow patient to demonstrate deep and coughing exercise that were taught pre-op. To prevent
complication such as deep vein thrombosis.

📚Assist patient to practices range of motion (ROM) active and passive exercise to promote proper
circulation and prevention of contractures.

📚Teach patient how to splint both hands and small pillow over the incisional site especially when
coughing to prevent disruption of the suture line.

📚Exercises are performed base on the patient’s strength and state.

*ELIMINATION*

📚Assist patient to empty his/her bladder by providing bedpan or urinal on request.

📚Encourage intake of copious fluid to aid in free bowel movement and flushing of the system.
📚Serve patient with food high in fibre to aid in the formation

*MEDICATION*

📚Administer prescribed IV infusion fluids to hydrate the patient.

📚Check for the flow rate of the infusion to prevent cardiac overload or dehydration.

📚Observe for desired and side effects of the medication and report if any side effect is detected.

📚Document all medications served on the drug administration chart in order to prevent drug overdose.

📚 Monitor intake and output and record on the intake and output chart to ensure

📚Administer prescribed antibiotics to combat infections

📚Administer prescribed analgesics to combat pain.

*MAINTAINING ADEQUATE FLUID VOLUME*

📚Observe for signs of dehydration such as sunken eyes, dry mucus membrane, poor skin turgor and treat
accordingly.
📚Weigh patient daily with the same materials on every day and almost at the same time.

📚Administer prescribed IV infusion fluids to hydrate the patient.

📚Check for the flow rate of the infusion to prevent cardiac overload or dehydration.

📚Monitor intake and output and record on the intake and output chart to ensure

📚Encourage intake of copious fluid to aid in free bowel movement and flushing of the system.

📚Observe the urine output in the urine bag. A urine less than 30mls is an indication of renal insufficiency.