PRE AND POST-OPERATIVE CARE

OF GYNAE CONDITIONS
PRESENTED BY
MRS B. M. MALUTI
 GENERAL OBJECTIVE
• At the end of the Lecture/Discussion, Students
should be able to demonstrate an
understanding of pre and post operative care
of patients undergoing gynaecological
operations.
 SPECIFIC OBJECTIVES
• Define the following terms: Surgery, Pre
operative care and Post operative care.
• State the types of surgery.
• Describe the pre and post operative care of
patients undergoing gynaecological
operations.
• State the complications which may occur after
gynaecological operations.
 INTRODUCTION
• The preparation of women before and after
Gynaecological surgery is important to all
patients going for operation regardless of the
kind of operation because women who are
about to undergo some operation will have
various needs.
• Some conditions may require emergency
surgery and others require elective surgery.
 INTRODUCTION
• It is the role of nurses to prepare women undergoing
surgery adequately.
• This helps to prevent complications as well as helping
the client to cope with the outcome of the operation.
• Good pre-operative nursing management may
contribute much to having the patient achieve an
optimum condition that favours a satisfactory post-
operative progress and minimizes the possibility of
complications.
 DEFINITIONS OF TERMS
• Surgery is a branch of medicine concerned
with treatment of disease, injury or deformity
by manual or instrumental procedure (Lewis,
2004).
• Pre-operative care is the care provided for
surgical patients before surgery; it includes
physiologic and psychosocial assessment,
education, physical and psychosocial
preparation (Luckmann, 1997).
 DEFINITIONS OF TERMS
• Post-operative care is the care provided for
the surgical patient after surgery, it includes
conducting post operative assessment during
the immediate, intermediate and extended
stages of care (Luckmann, 1997).
 TYPES OF SURGERIES
• 1.Elective surgery
• Elective surgery is surgery done to correct a
non-life threatening condition and is carried
out at the patient’s request, subject to the
surgeon’s and the surgical facility’s availability.
 TYPES OF SURGERIES
• 2. Emergency surgery
• Emergency surgery is surgery which must be
done promptly to save life, limb, or functional
capacity.
• It is done with minimal delay in the interest of
the patient’s survival.
 PRE-OPERATIVE CARE

• Pre operative care begins when the decision

for the operation is made and may extend
from an hour to several days or weeks.
 PRE-OPERATIVE CARE
• 1.Admission
• Admission depends on the type of the case.
Elective cases can be admitted 48 hours prior
to the operation.
• This gives the medical personnel on the ward
adequate preparation of the patient for the
operation which includes physical,
psychological and spiritual care.
 PRE-OPERATIVE CARE
• 2.Psychological preparation
• Any period spend in hospital is stressful, so
measures to reduce stress should be instituted.
• Giving information to the patient and explaining
is the measure of reducing stress.
• This could be done by orienting the client to his
surroundings, the regime and the possible
outcomes.
 PRE-OPERATIVE CARE
• It is important that you provide an
opportunity to discuss long term effects of
patient’s condition and treatment.
• Gynaecological surgery has important bearing
on woman’s self image, sexuality etc.
• Potential problems common to the patient
preoperatively are anxiety and lack of
knowledge.
 PRE-OPERATIVE CARE
• Patient teaching
• Assess the patient’s understanding of the
operation and events that will occur pre and post
operatively.
• Repeat necessary information and answer the
patient’s questions.
• Inform the patient about the surgical procedure
and the pre- and postoperative procedures and
activities.
 PRE-OPERATIVE CARE
• Teach the patient to perform deep-breathing,
coughing and leg exercises, explaining the
purpose of each.
• Provide information relating to the
expectations of the patient post-operatively
such as pain.
 PRE-OPERATIVE CARE
• 3. Nutrition
• Adequate hydration for patient to ensure
normal body reactions and avoid
complications like shock and thrombosis.
• Encourage a high nutritious diet rich in
Vitamin C for tissue repair thus promoting
wound healing.
 PRE-OPERATIVE CARE
• High protein diet like beans, kapenta to aid
tissue repair.
• If anaemic, provide diet rich in iron.
• In vaginal operation encourage a low residual
diet to avoid constipation.
 PRE-OPERATIVE CARE
• 4.Bowel preparation
• Avoid constipation by good ambulation and
diet rich in fibre.
• If constipated, provide suppositories prior to
operation.
 PRE-OPERATIVE CARE
• 5. Examination and investigations
• Physical examination: Head to toe
examination
• Urine examination: Mid-stream urine for
culture and sensitivity to rule out any
abnormalities.
• High vaginal swab to detect any infections.
• Ultra sound scan to view abdominal organs
 PRE-OPERATIVE CARE
• If there are any abnormalities detected,
patient is treated before the surgery.
• Blood examination: Haemoglobin, grouping
and cross match to detect any anaemia and
prepare for blood transfusion in case of need
during surgery.
• Chest x-ray to rule out chest infections.
 PRE-OPERATIVE CARE
• 6.Explanation and signing of consent
• The patient must be provided with sufficient
details and information about the operation to
be done and all concerns and questions by the
patient should be addressed and answered.
• A consent form signed by the patient is
necessary for surgery as it implies that consent
is given freely and that the patient has not been
put under undue pressure.
 PRE-OPERATIVE CARE
• 7.Observations
• -These are Temperature, Pulse Respiration and
Blood Pressure (Vital signs). These are done
either 4 hourly, 6 hourly or 12 hourly depending
on the condition prior to surgery.
• General condition of the patient is assessed to
rule out malnutrition.
• Reaction to the environment and treatment and
counseling given accordingly.
IMMEDIATE PREOPERATIVE PREPARATION

• Day of Operation
• Food and drinks are with held for 4-6 hours prior to
surgery.
• Patient is kept nil orally and an explanation should be
given to the patient.
• Remove dentures and cosmetics to prevent
electrocution in theatre.
• Jewelry and other valuables should be taken home or
can be recorded and kept for safety by the ward in-
charge.  
IMMEDIATE PREOPERATIVE PREPARATION

• Patient’s stomach should be empty when going

for the surgery to prevent the possibility of
aspiration or vomiting.
• Essential oral medication, such as, ARVs may be
given during this time.
• Nasogastric tube may be inserted to aspirate
stomach contents if patient is not starved.
• Intravenous line is accessed and kept open for
anaesthetic drugs and intravenous fluids
IMMEDIATE PREOPERATIVE PREPARATION

• Elimination
• An evacuation enema the evening before
surgery is done to empty the bowels and
prevent constipation following surgery, when
diet and activity are restricted.
• The bladder should be empty when the patient
goes to the operating theatre in order to
prevent incontinence during the anaesthetic
induction and operation.
IMMEDIATE PREOPERATIVE PREPARATION

• In lower abdominal or pelvic surgery, a full

bladder may interfere with surgical
procedures by making the site less accessible,
and may also increase the risk of accidental
injury to the bladder wall.
• The patient is catheterized to empty the
bladder and allow free flow of urine during
and after operation.
IMMEDIATE PREOPERATIVE PREPARATION

• Local site preparation/skin care

• Preparation of the site of operation depends on
the Surgeon’s preference and the hospital policy.
• Preoperative skin care is to have the skin as free
as possible of dirt particles, hair, desquamated
cells, secretions and organisms.
• Prior to surgery, the patient takes a warm bath
or shower
IMMEDIATE PREOPERATIVE PREPARATION

• Shaving may be done but abrasions and

lacerations in the skin caused by the razor
blade serve as entry for microorganisms.
• If the hospital policy allows shaving of hair, it
should be done 1-2 hours prior to surgery.
• Trimming of hair or not shaving reduces the
risk of infection post operatively.
IMMEDIATE PREOPERATIVE PREPARATION

• Personal care/hygiene
• Patient has a bath prior to surgery or morning of
surgery and given a clean hospital gown.
• Oral care/ toilet is done to remove any food
particles.
• Remove dentures because they may become
displaced and block the airway. Any prosthesis,
such as, limb or artificial eye is removed and
safely stored.
IMMEDIATE PREOPERATIVE PREPARATION

• Hair should be neatly combed and tied and secured

under a cap to prevent infection.
• Remove coloured nail polish and make-up in order
to allow checking the colour of the lips and nail beds
for cyanosis.
• All Jewelry removed are kept safely.
• Put the identification band on the patient’s forehead
or wrist indicating the name of patient and
procedure to be done to prevent surgical mistakes..
IMMEDIATE PREOPERATIVE PREPARATION

• Medication
• A sedative is given a night prior operation to
ensure a good sleep for the patient.
• Patient is given preoperative medications, such
as, atropine to reduce salivary and respiratory
secretions.
• Finally check the vital signs after the
preoperative drugs have been given to act as
baseline data.
IMMEDIATE PREOPERATIVE PREPARATION

• Patient’s Chart
• The patient’s file, diagnostic reports,
investigation and laboratory results and the
signed consent form are collected and taken
to the operating theatre together with the
patient
IMMEDIATE PREOPERATIVE PREPARATION

• Handover the patient

• Patient is handed over to the theater staff
together with the file and all the reports and
results.
 EMERGENY PREOPERATIVE CARE
• Preoperative preparation in emergency
surgery is limited to basic essential.
• Psychological Care
• Psychological care is given to the patient.
•  The condition is explained to the patient.
• All her concerns and questions should be
addressed and answered.
 EMERGENY PREOPERATIVE CARE
• Patient is reassured that everything possible is
being done to help her.
• This will help relieve her anxiety.
• The patient is informed of her condition and
the reason for surgery after which a consent
form for operation is signed.
 EMERGENY PREOPERATIVE CARE
• Investigations
• When the patient is in shock or bleeding,
haemoglobin is checked and blood grouping
and cross matching is done and patient can be
transfused.
•  Intravenous line is accessed and intravenous
infusion with normal saline is started in
readiness for blood transfusion.
 EMERGENY PREOPERATIVE CARE
•  Vital signs are checked to assess the level of
consciousness and shock.
•  Check the amount of haemorrhage e.g. per
vagina.
 EMERGENY PREOPERATIVE CARE
• Elimination
• If the patient took some food and fluid within
the last 6-8 hours, a nasogastric tube is
inserted to evacuate the stomach contents.
•  Catheterization is done to empty the bladder
at the same time urine specimen for urinalysis
is taken to detect any abnormalities.
 EMERGENY PREOPERATIVE CARE
• Skin Care
• Depending on the hospital policy, the patient
may be shaved or hair trimmed from nipple
line to mid thigh.
 EMERGENY PREOPERATIVE CARE
• Personal Care
• Remove any dentures or prostheses and Jewelry.
•  Hair may be tied and capped.
•  The patient is given a clean hospital gown.
• When all the preparations are done the patient
is handed over to theatre and the nurse gets
back to ward to making preparations for
receiving the patient.
 POST-OPERATIVE CARE
• NOTE: Postoperative care starts from collection of a
patient from theatre.
• Ensure that you carry a tray with spatula, airway and
Bp machine where necessary
• Get a full handover from the theatre nurse with the
necessary handover notes.
• Do the vitals to ensure that you are receiving a living
being
• Wheel the patient to the ward while observing the
respirations on the way
 POST-OPERATIVE CARE
• Environment/ Rest
• Patient is nursed in a quiet room, preferably
near the nurse’s bay for easy observation.
• Patient should be nursed in semi-prone
position to allow free drainage of secretions
until when fully conscious.
 POST-OPERATIVE CARE
• Observation
• Monitor the vital signs, temperature, pulse, respirations
and blood pressure are done quarter hourly, half
hourly, 2 hourly and then 4 hourly as condition dictates.
• Observe the wound site for bleeding, skin colour for
signs of shock such as cyanosis.
• Observe the facial reactions to assess if the patient is in
pain.
• Any change in patient’s condition should be noted and
reported for prompt action.
 POST-OPERATIVE CARE
• Psychological care
• Reinforce the information given pre-operatively after
gynaecological operation like tubal ligation and
hysterectomy where a woman may feel less woman.
• The woman has to be encouraged to see the wound
in order to move the woman towards accepting her
new condition.
• Advise her to focus her thoughts on the normal
structures like she has all her body parts.
 POST-OPERATIVE CARE
• Pain relief
• Assess the patient for pain.
• Facial expressions may help to determine pain.
• Provide a quiet environment and comfortable bed.
• Administer prescribed analgesic once patient is fully
awake.
• Preferably pethidine 100mg intramuscularly stat
• Care must be taken when dressing the wound to
ensure minimal pain is caused.
 POST-OPERATIVE CARE
• Wound care
• Dressing should be done according to the doctor’s
orders.
• Maintain the aseptic technique.
• When dressing, observe the bandage to see if it is soaked
with blood or pus.
• If soaked reinforce it with more absorbent sterile
dressing and inform the doctor.
• Check the drains regularly.
• Note the kind of drainage coming out and report.
 POST-OPERATIVE CARE
• Diet and fluids
• An intravenous infusion will be in progress
after major operation.
• Oral fluids are commenced after the bowel
movements are heard.
• Sometimes, blood transfusion will be
commenced in theatre, if so continue to do
observations.
 POST-OPERATIVE CARE
• Intake and output chart is maintained to guard
against renal failure and over hydration.
• Gradual introduction of solid diet is done as
condition permits.
 POST-OPERATIVE CARE
• Elimination
• Patient may come with an indwelling catheter
(urethral or suprapubic catheter).
• Catheter allows for proper measuring of the
output on the fluid balance chart.
• Any haematoma is reported.
• Constipation and straining should be avoided.
• Strain puts pressure on suture line.
 POST-OPERATIVE CARE
• Hygiene
• Encourage daily baths to provide sense of well
being and refreshment.
• Special attention should be made to vulva
hygiene (vulva toilet) when doing a bed bath.
• Soiled pads should be changed frequently to
prevent ascending infections.
 POST-OPERATIVE CARE
• Ambulation
• Early ambulation is important to avoid the risk of
deep vein thrombosis.
• The patient is helped to the toilet as soon as she
feels able to.
• Encourage short walks in the ward.
• For bed ridden patients, deep breathing exercises
and leg exercises should be encouraged.
 POST-OPERATIVE CARE
• Exercises
• The patient should be kept well ambulated
during hospitalisation in order to improve blood
circulation and aid in bowel movements.
• Post-operative exercises should be taught to the
patient like the breathing exercises to prevent
chest complications like hypostatic pneumonia.
• Leg and arm exercises are encouraged to improve
muscle tone of the pelvic floor.
 POST-OPERATIVE CARE
• Drugs
• Antibiotics to treat infections of the genital
tract.
• Analgesics given to relieve pain.
• Any other drugs ordered by the doctor should
be given, recorded and signed for to prevent
overdose.
 COMPLICATIONS POST-OPERATIVELY

• Shock due to excessive bleeding.

• Infection due to presence of microorganisms
in the body.
• Hypostatic pneumonia due to late ambulation.
• Renal failure due to dehydration
• Wound gapping due to poor suturing
 SUMMARY
• Pre operative and post operative care is very
important to all patients going for operation
regardless of the kind of operation.
• This helps to prevent complications as well as
helping the client to cope with the outcome of
the operation.
• Relatives should be involved in the planning of
the care especially the discharge plan.