Pre-Operative and Post-Operative Care Chapter 29 Pre-Operative and Post-Operative Care

Patient-Centered Care Patients are often unsure what to expect and have concerns regarding pain, possible disfigurement, and length of recovery. Families can be unsure about their role in the patient’s recovery. Teach the patient and family what to expect and how to assist in the recovery process. Assess the impact of cultural practices and religious beliefs. Communicate information to the health care team.

Safety A thorough preoperative assessment is the basis for the plan of care during and after surgery. Verify the following safety measures: Correct patient, surgery, and site Signed consent and relevant documentation Availability of required devices or products Surgical site preparation and timing/duration of antibiotics “Time Out” procedures

Safety (cont’d) Monitor airway, breathing, and circulation. Assess the wound and drainage. Implement prophylactic venous thromboembolism (VTE) measures. Identify patients with special risk factors.

Skill 29.1 Preoperative Assessment A thorough preoperative assessment includes: Laboratory and other diagnostic tests. Assessment for changes in medical condition. Completion of a preprocedure checklist. Assessment of communication impairment. Assessment of patient’s understanding of procedure. Include emotional status, anxiety, coping, and support. Nursing history and identification of risk factors. A physical examination for baseline data. Identification of last intake of food or drink.

Skill 29.2 Preoperative Teaching Assist in preparation for the surgical experience. Ensure privacy. Select the best learning method for the patient. Include family members who will provide care. Discuss bowel or skin preparations. Instruct on food, fluid, and medication restrictions. Describe perioperative routines and sensations. Teach turning, deep breathing, coughing, and use of incentive spirometer. Teach leg exercises. Allow time for return demonstration and questions.

Skill 29.3 Physical Preparation for Surgery Physical preparation minimizes surgical risks. Assist patient into hospital gown and place cap on head. Remove and secure personal items. Allow sensory aids to remain with patient as long as possible. Confirm food, fluid, and medication restrictions. Verify that appropriate preparations have been completed. Confirm presence of surgical consent and paperwork. Ensure that preoperative diagnostics are completed. Perform interventions specific to surgery (e.g., intravenous [IV] line). Administer preoperative medications as ordered. Assist onto stretcher for transport.

Skill 29.4 Managing the Patient Receiving Moderate Sedation Monitor patients undergoing moderate sedation closely to minimize risks. Confirm food, fluid, and medication restrictions. Determine patient allergy status. Gather baseline physical assessment data. Establish or confirm intravenous (IV) access. Perform universal protocol per agency policy. Monitor vital signs and oxygen saturation continuously. Observe for verbal or nonverbal evidence of pain. Assess level of sedation using approved scale. Discharge according to approved score or criteria.

Skill 29.5 Providing Immediate Anesthesia Recovery in the Postanesthesia Care Unit Know common complications associated with specific type of anesthesia. Assess airway and cardiovascular and neurological status. Attach monitoring devices; connect drainage tubes. Compare vital signs with preoperative baseline. Maintain intravenous (IV) infusion.

Skill 29.5 Providing Immediate Anesthesia Recovery in the Postanesthesia Care Unit (cont’d) Suction oral airway; assess for return of gag reflex. Encourage to cough and deep breathe. Promote warmth. Assist with position changes. Transfer according to approved score or criteria.

Skill 29.6 Providing Early Postoperative and Convalescent Phase Recovery Attach tubing and drains. Maintain airway by placing in side-lying position. Compare vital signs with recovery and baseline. Encourage coughing and deep breathing. Assess surgical dressing.

Skill 29.6 Providing Early Postoperative and Convalescent Phase Recovery (cont’d) Measure all sources of intake and output (I&O). Position patient for comfort; assess pain status. Promote early ambulation and activity. Progress diet as tolerated and as ordered. Discuss discharge with patient and family.