PRE-OPERATIVE NURSING CARE

APSHARA GHIMIRE
BSN 2 YEAR
ROLL 1
 CONTENT
• Definition
• Purpose
• Equipments
• Steps
 Definition

It begins where the decision for surgical

intervention is made and ends with the
transfer of client to the operating room. The
care is provided to the patient from time of
admission or from the time of the decision
for surgery to the time the patient are shifted
onto the operation theatre. It covers the care
of patient before surgery.
 PURPOSE
1. To prepare the patient psychologically and
physically for anesthesia and surgery.
2. To help the patient feel comfortable and
relaxed about surgery.
3. To prevent post operative complication
4. To teach the patient about health exercise
they may need to do after surgery.
 EQUIPMENTS
• Shaving set
• Soap and water
• Clear cotton gown
• Thermometer
• Tray
• Bp instrument
• Pre operative check list
• Kidney tray
• Brush or comb
• Medicine with medication cardex
• Pre operative admission form and other
admission form
 STEPS
A. History and physical assessment
1. Health history include present past health history,
personal history. Allergic history, history of
medication used, previous operation and
hospitalization should be obtained before
initiating any surgical procedure.
2. Physical examination including assessment of
nutritional status, fluid and electrolyte balance,
pulmonary function, cardiovascular status, hepatic
and renal function, and endocrine function
hematological function should be performed.
 B. Routine Pre-operative investigation
• Complete blood count, haematocrit
• Hemoglobin
• Blood glucose
• Serum electrolyte
• Renal function test
• Liver function test
• Blood grouping and cross matching
• Clotting profile (BT,CT, PT, APTT)
• Chest x-ray
• Electrocardiogram
• Urine RE/ME
• Serological test (HIV, HBs, AG)
 C. Psychological assessment and
preparation
• Assess the patients level of anxiety, causes of
anxiety like fear of unknown procedure, fear of
death/ disability, fear of losing his/her social and
family roles
• Admit the patient with warm welcome and keep
good relation with the patient
• Help the patient take about his fear and give him
every opportunity to ask question
• Correct the patient if he may have any
misunderstanding and continue to support the
patient emotionally
• Explain routine preparation measures and
operation procedure
• Show and allow the patient to talk with other
patients who have successfully recovered from
similar surgery
• Avoid too many visitors which may interfere with
the patient getting adequate rest
• Respect the patients religion culture, custom,
belief if needed allow visiting
 D. Pre-operative teaching
• Preoperative teaching should be given during the pre
admission visit when diagnostic test are performed not
on the day of surgery. This will allow patient to gain
information and ask question if they have any queries
• Preoperative teaching should be given on
– Deep breathing and coughing exercise
– Use of incentive spirometry
– Active and passive exercise
– Early ambulation
– Side effect of anesthesia
– Diet
– Pain management
Incentive spirometry
• Passive exercise
Active exercise
 E. Consent
Voluntary and written informed consent from the
patient is necessary before surgery, its complication
and possible modes of treatment should be
informed before taking consent. Get the consent
signed by the patient or responsible relatives for
children and unconscious patient. If the patients
relatives are unable to read the consent from, read
it to them and get it signed. Do not force them if
the patient and relatives are unable to write , they
should give the consent by putting the finger prints.
The person giving consent should be mentally
normal and client personally signing the
consent should be at the legal age. i.e. 18
years or above. In the absence of relatives the
hospital authority could give consent for
emergency surgery.
 F. Physical preparation
• Nutritional therapy
1. Optimal nutrition is an essential factor in
promoting healing and resisting infection and
other surgical complication
2. Assessment of a patients nutritional status
identifies factors that can affect the patient
surgical course , such as obesity nutrients,
metabolic abnormalities and the effects of
medication on nutrition
3. Any nutritional deficiency such as malnutrition
should be corrected before surgery to provide
adequate protein for tissue repair
• Preparation of skin
1. Prepare the operating part by shaving area or
trimming hair. Give through bathing including
hair care on the day of surgery.

• Preparation of gastrointestinal tract

1. The gastrointestinal preparation should be
performed on the evening before surgery
2. Patient should be kept on NPO 8-10 hours in
case of general anesthesia and minimum 6
hours if spinal anesthesia is indicated
3. Stomach should be empty 4-8 hours before
operation
4. Enema should be given as prescribed
5. Carry out special order like insertion of Ryle's
tube
• Preparation of urinary bladder
1. Ensure patient voids before shifted to
operation theater
2. Insertion of indwelling catheter should be
performed if indicated
 • Provide pre-operative medication
1. Drying and vagolytic agent; Atropine
2. Sedative and tranquilizers; Lorazepam
3. Analgesics: morphine, pethidine
4. Prophylactic antibiotics
 OTHERS
• Remove the jewelleries from the patient and
handover to the visitors
• Provide oral care and remove artificial
denture if present
• Ask patient to remove nail polish to observe
nail bed for sign of hypoxia
• Carry out special order such as inserting
Ryle's tube, catheterization, I/v line etc
• Check patients vital sign and report to the
doctors if any changes found
• Give appropriate pre-medication according to the
order of anesthetic
• Put the adhesive on nose ring or phuli if not able to
remove
• Put on identification card around the chest of the
patient
• Fill out the pre- operative check list and mark the
task performed for the patient
• Put the identification slip that includes the name,
diagnosis , operative procedure , age and sex , date of
admission, wars and name of the attending doctors
• change the patient dress and help to put on OT gown
• Ask the patient to void and sent the patient
to the operation theater along with the
patient chart, checklist , x- ray , ECG,
investigation report, drugs and needed items
blood etc and handover to the OT staff
• Record and report departure of the patient
medication given. Note if the patient
belongings are handover to the patients
relatives.