Preoperative and Postoperative care

Preoperative Care A. Purposes
1. Ensure that the client is in complete physical and psychological condition for surgery 2. Eliminate or reduce postoperative discomfort and complications 3. Pre-op teaching
a. Enhances client's participation b. Decreases anxiety c. Helps to ensure good postop recovery

B.General Preoperative Care
1. Psychological support : stress experience, consider the effects here 2. Client teaching related to specific scheduled procedure
a. coughing and deep breathing b. Supporting the wound :use of pillow and splinting c. Leg exercise d. Turning, positioning, early ambulation e. Analgesics and pain control : discuss the option of patient controlled analgesia (PCA) f. Recovery from procedures g. Other postoperative expectations: type of dressing, nasogastric tube (NGT), drains, IV

Postoperative drugs a. Purpose
1. Reduce anxiety 2. Decrease secretions 3. Reduce amount of anesthesia required 4. Control nausea and vomiting

b. Common preoperative drugs: Medication is rarely given IM ,usually IV when the patient gets to the OR
1. Meperidine (Demerol), mophine sulfate 2. Hydroxyzine (Vistaril),promethazine (Phenergam) synergistic to narcotics

3. Atropine , scopolamine to dry oral secretions during anesthesia 4. Pentobarbital sodium (Nembutal), secobarbital sodium(Seconal)night before to help sleep 5. Midazolam (Versed) causes conscious sedation and is very popular , client will get amnesia postoperatively so pt will not remember what happened

Anesthetics 1. General : Causes the most effects postoperatively
a. inhalation b. intravenous

2. Local
a. topical b. spinal
1. side effects: hypotension, nausea, vomiting, headache 2. Nursing Interventions
a. increase fluids per order b. Increase cafffeine per order c. Flat for 6- 8 hours post op

Postoperative Care A. Nursing Interventions 1. Assess for complications
a. take vital signs routinely according to policy b. NPO until alert & gag reflex returns c. Suction oral cavity PRN d. Monitor intake and output

2. Positioning
a. head to side, chin forward if unconcious b. Lateral sims, semi prone c. Turn and position the client , have the client cough and deep breathe

3. Immediate “Head to Toe” Assessment
1. Pulmonary
a. Airway (check gag reflex) b. Bilateral breath sounds c. Encourage coughing, deep breathing

2. Neurological
a. Level of consciousness b. Reflexes, patterns of movement

3. Circulatory
a. Vital signs b. Peripheral perfusion

4. Gastrointestinal
a. Bowel sounds b. Distention

.

COMMON POSTOP COMPLICATIONS

Atelect asis Hypost atic pneum onia Hypoxi a Shock

Common Postop Complictations
Cough and deep breathe Shallow repirations After 48 hours

Cough and deep breathe

Shallow repirations

First 48 hours

Fever, increased pulse and respiration Fever, increased pulse and respiration,crackles and ronchi

Cough and deep breathe,ambulation and turning Assess routinely for signs of shockidentify populations at risk,monitor for bleeding

Anesthesia causing depressed respirations Loss of fluids and electrolytes, bleeding from wound or surgical site

48 hours

Confusion , increased BP and pulse,SOB Decreased BP, pulses, cold clammy pale skin

48 hours

Throm boplebi tis

-Leg exercises, elastic stocking,,identify at risk populations for intervention

Venous stasis, Iv irritation, pressure to legs

7-14 days

Redness, warmth, pain and swelling at the side

COMPLICATI ON Urinary retention Wound hemorrhage

PREVENTION

COMMON CAUSES

OCCURANCE

MANIFESTATIONS

.

Upright to Medications 2-3 Days void(male) (narcotic) -monitor I and O -Local edema Monitor site for bleeding Slipping of suture, wound evisceration Poor aseptic technique, debilitated, obesity

-Inability to void -restlessness -bladder distention

Immediately or -signs of shock later bleeding(sanguinous drainage) from tubes or site of surgery 3-5 days Wound area red and edematous, increased pain in the incisioanal area, increase in the amount and/or change in the character of the drainage to be purulent

Wound infection

Maintain nutritional status -Maintain aseptic technique with manipulations of dressings

.
COMPLICATION PREVENTION COMMON CAUSES OCCURANC E 4-15 days MANIFESTATIONS

Identify those ate Debilitated, Wound risk obese, dehiscence elderly andevisceration -Maintain nutritional status in high risk populations

Wound opens and contents may come out onto abdominal area Intervention: place sterile saline soaked gauze over site and place in recumbent positon Dysuria, hematuria, urgency, frequency,

Urinary tract infection

Maintain sterility of catheter, increase fluids -remove catheter as soon as possible

Indwelling catheter, urinary post anesthesia

5-8 days

4. Pain interventions
a. Pharmacologic intervention
1. PRN scheduling: pain medication is given as ordered to the client on demand basis when pain occurs; Is lease effective strategy 2. Fixed scheduling: pain medication is given round the clock (usualy q 4 hors ).Not only treats but prevents pain 3. Patient controlled analgesia (PCA): pain medication is self administered by client via an infusion system. Client must be able to participate in this intervention 4. Most pharmacologic ingterventions use narcotic drugs , therefore client must be carefully assessed for the complication of respiratory depression.

The end....
Courtesy to Sunrise learning

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