DAY 1: ADMISSION

1. IDENTIFICATION AND VERIFICATION OF THE PATIENT:

- identify the ff (full name of the patient, address, age, birthdate)
- obtain VS
- verify if alam ng patient mga susunod na procedure, name ng surgeon

2. PATIENT HX/REVIEW OF RECORDS

- obtain present hx of patient and past health hx
- medications
- Social hx
- Medication hx
- any surgical hx

3. HEALTH TEACHING AND INFORMED CONSENT (BASED ON PATIENT’S

KNOWLEDGE) This may include the ff:
- About the informed consent
- Health teaching about both pre-op and post-op
- Deep breathing exercises
- Exercise after surgery

4. 1ST CALL POLICY

- schedule for exploratory laparotomy (exact date and time)
- name of surgeon
- anesthesia to be given
- include kung ano mga nakakabit sa patient such as (IV [pati type ng IV], catheter)
- Laboratory results
LIST OF QUESTIONS FOR DAY 1:
- Type of IV and its use
- Tramadol: administration, SE, pedeng buong drug study
- Abnormal lab values
- Blood typing, cross matching, blood transfusion (kasama SE)
- Patient rights
- What is tramadol?
- Is it really necessary? (the procedures and rationale)
NOTE:
1. Focus sila sa way ng pagaadminister ng medications
2. Communication sa patient
3. Dapat may ice breaker at wag masyado serious
4. Pag confused, always ask the head nurse or physician
 DAY 2: PREOPERATIVE EXAMINATION
1. Laboratory Test
 CBC (rbc, wbc, platelets, electrolytes) phrothrombin time, clotting factor
 relevance of liver function test to surgery
 cardiac investigation □ respiratory investigation
 blood typing & crossmatching
2. Requirements for donating blood
 complication ng iv insertion= phlebitis □nursing intervention for phlebitis
 requirements for CP clearance
 ceftriaxone administration, side effects, skin testing muna, gauze, color
 18 gauge for blood transfusion
3. 2nd call policy
 size and color of cannula for IVF infusion and blood transfusion
QUESTIONS
1. Bakit bawal sagutin ng nurse ang tungkol sa dignosis sa pasyente
2. Ano ang basic requirements of a potential blood donor
3. Ilang beses kinukuhanan ng dugo for blood typing at crossmatching
4. Explain to the patient the purpose of blood and urine specimen collection
5. Discussion of the lab. findings and imaging studies results with another nurse in the
nurse's station
NOTE:
1. Importance of verification of pt. name
2. Skin testing for antiobitics
3. Doctors order maybe written, verbal or through text or message
4. Standard practice, papakinggan lang pasyente, pero kailangan ung tama pa din ang
masusunod
5. documentation ng mga ginagawa (after referral, nursing intervention, whatever we do
must be documented)
6. Verbal orders must be sign by the Dr. w/in 24 hrs
 DAY 3 PREPARATION OF PATIENT THE
DAY BEFORE OF SURGERY
 Shaving procedure
 Deeper understanding of enema
 Purpose of NPO, how long NPO, when to resume diet after surgery
 Heath teaching on what to expect after the surgery (catheter, NGT, stockings)
 Health teaching on expectation to pain after the surgery.
QUESTIONS:
1. Equipment for catheterization.
2. Equipment for NGT insertion.
3. What to assess in patient before the surgery?
4. What part of the body should be shaved for exlap procedure?
5. Is burping a sign of peristalsis?
NOTE:
1. Assess the presence of accessories, nail polish, make up, and presence of denture.
2. You can draw or cut out pictures if the client and SO are not able to read and remember
the instructions regarding the recommended diet.
3. Shave from below the chest to above the knee.
4. Doctor will perform the NGT insertion.
5. Flatus and burping are sign of peristalsis
6. Encourage deep breathing during catheter insertion
7. Always give special consideration to patients with accordance to the physician.
8. Always include in the endorsement all considerations and remarks given to the patient.
9. Ask patient about what usual foods he eats and resources in their community so it can
have used as a basis for the foods that the nurse can recommend for the patient's diet
 DAY 4 COMPLETION OF THE
SURGICAL CHECKLIST

 Introduction about the procedure

 Goals and objectives
 Family orientation
o Waiting room
o SO’s participation
o Patient’s belongings
 Surgical Checklist
o Identity
o Is the site marked and shaved
o Did the patient know the procedure
o Consent and signatures
o Gowned
o Known allergies
o Airway/aspiration risk
o Is the patient risk for blood loss
o Confirmed the team about the site, patient and procedure
o Laboratories are complete
o Medications
 Health Teaching
o Deep Breathing Exercise
o Leg and Arm Exercise
o Importance of Turning Patient
 Endorsement to the OR (from day 1 to operation day)
o Name and situation of the patient
o Background: History of the patient, allergies, medications, contraptions, diet,
special considerations, blood transfusion
o Assessment: Latest vital signs, laboratories
o Recommendation: nursing concerns, (surgical checklist is done and patient is
ready for surgery)

Questions
1. How to carry out order? (Dr's order, color of med card, time)
2. What if the patient didn't want to undergo blood transfusion what will you do?
3. There is no packed red blood cell available is it okay to use a fresh whole blood as
alternative?
 a. ff question:
i. why is it okay to use?
ii. where to bring the blood for checking if it can be used?
iii. what is needed to do to make it compatible for the patient?
4. Why do we need different type of vicryl?
5. What type of IV is needed while the patient is under blood transfusion?
6. What are included in surgical checklist in surgery ward?
7. Surgical checklist in OR
8. What is needed to do to the patient before proceeding to OR
9. Endorsement
10. Health teaching (deep breathing, leg and arm exercise)
11. How many hours it will take for the patient to wake up after the surgery? Is it okay to
do exercises immediately?

Note:
1. Always ask the patient his/her name for verification
2. Color of cannula and IVs
3. Layers of the skin have corresponding vicryl
4. There is a surgical checklist in the ward and in the OR
5. Whole blood can be put in the laboratory to separate the packed rbc for blood transfusion
6. Consider the culture of the client regarding blood transfusion, give client respect
7. Always be sure of what you are going to say to the client.
8. Do not let the client think that you know nothing.
9. If not sure, recheck the doctors order or talk to the head nurse