Pre & Post Operative Care

8/9/2019 Pre & Post Operative Care

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Pre & Post operative care

Syaiful Mukhtar


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Preoperative care

• Preoperative care involves manycomponents, and may be done theday before surgery in the hospital, orduring the weeks before surgery onan outpatient basis. Many surgicalprocedures are now performed in a

day surgery setting, and the patientis never admitted to the hospital


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Preoperative care

• Physical preparation may consist of acomplete medical history andphysical exam, including the

patient's surgical and anesthesiabackground

• lood exam, urinalysis, chest x rays,

!"#.• $llergy history


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Preoperative care

• Psychological preparation

• Patients are often fearful or anxious about having

surgery. %t is often helpful for them to express theirconcerns to health care workers. his can be

especially benecial for patients who are criticallyill, or who are having a high(risk procedure. he

family needs to be included in psychologicalpreoperative care. Pastoral care is usually o)ered in

the hospital. %f the patient has a fear of dying duringsurgery, this concern should be expressed, and thesurgeon notied. %n some cases, the procedure may

be postponed until the patient feels more secure.


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Preoperative care

• Informed consent

• he patient's or guardian's written consent for thesurgery is a vital portion of preoperative care. y law,the physician who will perform the procedure must

explain the risks and benets of the surgery, alongwith other treatment options. *owever, the nurse isoften the person who actually witnesses the patient'ssignature on the consent form. %t is important that thepatient understands everything he or she has beentold. Sometimes, patients are asked to explain whatthey were told so that the health care professionalcan determine how much is understood.


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Preoperative care

• Preoperative teaching

• Preoperative teaching includesinstruction about the preoperativeperiod, the surgery itself, and thepostoperative period.


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Post operative care

• Postoperative care begins in the recovery roomand continues throughout the recovery period."ritical concerns are airway clearance, paincontrol, mental status, and wound healing. +therimportant concerns are preventing urinaryretention, constipation, deep venous thrombosis,and P variability high or low-. or patients withdiabetes, plasma glucose levels are monitored

closely by ngerstick testing every / to 0 h untilpatients are awake and eating because betterglycemic control improves outcome.


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Post operative care

• Airway: Most patients are extubatedbefore leaving the operating roomand soon become able to clear

secretions from their airway. Patientsshould not leave the recovery roomuntil they can clear and protect their

airway unless they are going to an%"1-.


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Post operative care

• Pain: Pain control may be necessaryas soon as patients are conscioussee Pain3 reatment of Pain-.

http://www.merckmanuals.com/professional/neurologic_disorders/pain/treatment_of_pain.htmlhttp://www.merckmanuals.com/professional/neurologic_disorders/pain/treatment_of_pain.html


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Post operative care

• Mental status: $ll patients arebrie4y confused when they come outof anesthesia. he elderly, especially

those with dementia, are at risk ofpostoperative delirium, which candelay discharge and increase risk of

death


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Post operative care

• Wound care: he surgeon mustindividuali5e care of each wound, butthe sterile dressing placed in the

operating room is generally leftintact for 60 h unless signs ofinfection eg, increasing pain,

erythema, drainage- develop.


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Post operative care

• $fter 60 h, the site should be checked twice7day, ifpossible, for signs of infection. %f they occur, woundexploration and drainage of abscesses, systemicantibiotics, or both may be re8uired. opical

antibiotics are usually not helpful. $ drain tube, ifpresent, must be monitored for 8uantity and8uality of the 4uid collected. Sutures, skin staples,and other closures are usually left in place 9 days

or longer depending on the site and the patient.ace and neck wounds may be supercially healedin : days; wounds on the lower extremities may

take weeks to heal to a similar degree.


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Post operative care

• Deep venous thrombosis (D!" prophyla#is: after surgery is small,but because conse8uences can be severe and riskis still higher than that in the general population,

prophylaxis is often warranted. Surgery itselfincreases coagulability and often re8uiresprolonged immobility, another risk factor for =>see Pulmonary !mbolism and seePeripheral

>enous =isorders-. Prophylaxis for => usuallybegins in the operating room see able ?3Pulmonary !mbolism3 enous hrombosis and Pulmonary !mbolism in Surgical Patients

http://www.merckmanuals.com/professional/pulmonary_disorders/pulmonary_embolism/pulmonary_embolism.htmlhttp://www.merckmanuals.com/professional/cardiovascular_disorders/peripheral_venous_disorders/deep_venous_thrombosis_dvt.htmlhttp://www.merckmanuals.com/professional/cardiovascular_disorders/peripheral_venous_disorders/deep_venous_thrombosis_dvt.htmlhttp://www.merckmanuals.com/professional/pulmonary_disorders/pulmonary_embolism/pulmonary_embolism.htmlhttp://www.merckmanuals.com/professional/pulmonary_disorders/pulmonary_embolism/pulmonary_embolism.htmlhttp://www.merckmanuals.com/professional/pulmonary_disorders/pulmonary_embolism/pulmonary_embolism.htmlhttp://www.merckmanuals.com/professional/pulmonary_disorders/pulmonary_embolism/pulmonary_embolism.htmlhttp://www.merckmanuals.com/professional/cardiovascular_disorders/peripheral_venous_disorders/deep_venous_thrombosis_dvt.htmlhttp://www.merckmanuals.com/professional/cardiovascular_disorders/peripheral_venous_disorders/deep_venous_thrombosis_dvt.htmlhttp://www.merckmanuals.com/professional/pulmonary_disorders/pulmonary_embolism/pulmonary_embolism.html


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Post operative care

• $ever: $ common cause of fever is ahigh metabolic rate that occurs withthe stress of an operation. +ther

causes include pneumonia, 1%s, andwound infections. %ncentivespirometry and periodic coughing

can help decrease risk of pneumonia


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Post operative care

• Urinary retention andconstipation are common aftersurgery. "auses include use of

anticholinergics or opioids,immobility, and decreased oralintake. Patients must be monitored

for urinary retention. Straightcatheteri5ation is typically necessaryfor patients who have a distended

bladder and are uncomfortable or


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Post operative care

• Loss of muscle mass(sarcopenia) and strength occur inall patients who re8uire prolonged

bed rest. Bith complete bed rest,young adults lose about /C ofmuscle mass7day, but the elderly

lose up to ?C7day because growthhormone levels decrease with aging.$voiding sarcopenia is essential to

recovery.


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Postoperative care protocol

• Post operative note and orders

• he patient should be discharged to the ward with comprehensive ordersfor

• the following3

• D >ital signs

• D Pain control • D


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• $ftercare3 Prevention of complications

• D !ncourage early mobili5ation3

• o =eep breathing and coughing

• o $ctive daily exercise

• o Goint range of motion

• o Muscular strengthening

• o Make walking aids such as canes, crutches and walkers available

• and provide instructions for their use

• D !nsure ade8uate nutrition

•

D Prevent skin breakdown and pressure sores3• o urn the patient fre8uently

• o Heep urine and faeces o) skin

• D Provide ade8uate pain control


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• =ischarge note

• +n discharging the patient from the ward,

record in the notes3

• D =iagnosis on admission and discharge• D Summary of course in hospital

• D %nstructions about further management,including drugs prescribed.

• !nsure that a copy of this information is givento the patient, together with

• details of any follow(up appointment


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hanks u

Pre & Post Operative Care

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