Al-Ghad International Colleges for Applied Medical Sciences

Pre-& post-operative care

 Preoperative care refers to health care provided before a surgical operation.

 The aim of preoperative care is to do whatever is right to increase the success of the surgery.

 The perioperative period consists of three phases that begin and end at a particular point in
the sequence of events in the surgical experience.

1. The preoperative phase: begins when the decision to proceed with surgical intervention
is made and ends with the transfer of the patient into the operating room table.
2. The intraoperative phase: begins when the patient is transferred onto the OR table and
ends with admission to the PACU (post-anesthesia care unit).
3. The post-operative phase begins with the admission of the patient to the PACU and ends
with a follow-up evaluation in the clinical setting or home.
 Surgical classification‫التصنيف الجراحى‬

Classification Indications for surgery Examples

Emergent - patient requires
immediate attention; disorder
maybe life-threating
‫تدخل فورى لجراحه عاجله‬
Urgent - patient requires
prompt attention
‫المريض يتطلب اهتماما فوريا‬
Required – patient needs to
have a surgery
‫المريض محتاج عمليه جراحه‬
Without delay Severe bleeding.
‫بدون تاخير‬ Bladder or intestinal
obstruction.
Fractured skull
Gunshot or stab wounds. ‫طلق‬
‫نارى والجرح الطعنى‬
Extensive burns
With 24-30 hours Acute gallbladder infection.
Kidney or ureteral stones
Plan within a few weeks or Prostatic hyperplasia without
months bladder obstruction.
Thyroid disorders.
Cataracts.

Elective – patient should Failure to have surgery not Repair of scars

have surgery catastrophic Simple hernia
‫لعدم حدوث مضاعفات‬ Vaginal repair

Optional – decision rests Personal preference Cosmetic surgery

with patient
 Ambulatory surgery: includes out-patient, same-day, or short stay surgery that does not
require an overnight hospital stay but may entail an admission to an inpatient hospital
setting for less than 24 hours.

 Emergency surgery: are unplanned and occur with little time for preparation for the
patient or the perioperative team.

 Informed consent: is the patient’s autonomous decision about whether to undergo a

surgical procedure

 Informed consent is necessary in the following circumstances: ‫موافقه المريض مهمه فى حاالت‬
‫معينه‬

1. Invasive procedures, such as a surgical incision, a biopsy, a cystoscopy, or

paracentesis
2. Procedures requiring sedation and / or anesthesia
3. A non-surgical procedure, such as an ‫تصوير لشرايين القلب‬arteriography, that carries
more than a slight risk to the patient
4. Procedures involving radiation

 Steps to preoperative care:

1. Introduce yourself, confirm the patient’s identity, explain the procedure, and
obtain consent.
2. Undertake baseline observations of pulse, BP, respiratory rate, oxygen saturation,
and temperature. Identify and report any abnormalities.
3. Ensure investigations have been completed and reported upon requested, e.g.
chest x-ray, ECG, ECHO, exercise stress test, ultrasound/ CT scan, etc.
communicate any abnormal reports to medical staff.
4. Ensure patient consent form has been signed. Check patient’s understanding of
the procedure.
5. Ensure pre-op checklist is completed.
6. Check patient identification details are correct on wristband and that wrist band is
secure.
7. Ensure the patient is nil by mouth for 4-6 hours prior the operation (according to
the local policy).
8. Ensure hygiene needs are met, e.g. shower, theatre gown, clean bed and linen.
Remove nail polish. Hair removal at operation site.
9. Remove wedding ring and any prosthesis.
10. Explain to patient why each action is required, encourage patient to ask questions,
offer information at a level the patient understands.
11. Administer pre-medication if prescribed.
12. Assess pre- operative risk of DVT using recommended VTE (venous
thromboembolism) risk assessment score. Administer antiembolic stockings/
subcutaneous heparin according to risk score/ local protocol.
13. Ensure pre-operative marking is performed.
 Preoperative instructions to prevent postoperative complication:

- Diaphragmatic breathing refers to a flattening of the dome of the diaphragm during

inspiration, with resultant enlargement of the upper abdomen as air rushes in. During
expiration the abdominal muscles contract.

1. Practice in the same position you would assume in bed after surgery: a semi-
fowler’s position, propped in bed with the back and shoulders well supported with
pillows.
2. With your hands resting lightly on the front of the lower ribs, and fingertips
against lower chest to the feel the movement.
3. Breathe out gently and fully as the ribs sink down and inward toward midline.
4. Then take a deep breath through your nose and mouth, letting the abdomen rise as
the lungs fill with air.
5. Hold this breath for a count of five.
6. Exhale and let out all the air through your nose and mouth.
7. Repeat this exercise 15 times with a short rest after each group of five.
8. Practice this twice a day preoperatively.
- Coughing

1. Lean forward slightly from a sitting position in bed, interlace your fingers together, and
place your hands across the incisional site to act as a splintlike support when coughing.
2. Breath “diaphragmatic breathing”.
3. With your mouth slightly open, breathe in fully.
4. “Hack” out sharply for 3 short breaths.
5. Then, keeping your mouth open, take in a quick deep breath and immediately give a
strong cough once or twice. This helps clear secretions from your chest. It may cause
some discomfort but will not harm your incision.
- Leg exercises

1. Lie in semi-fowler’s position and perform the following simple exercises.

2. Bend your knee and raise your foot – hold it a few seconds, then extend the leg and lower
it to the bed
3. Do this five times with one leg, then repeat with the other leg.
4. Then trace circles with the feet by bending them down, in toward each other, up and then
out.
5. Repeat these movements 5 times.

Turning to the side

1. Turn on your side with uppermost leg flexed most and supported on a pillow.
2. Grasp the side rail as an aid maneuver to the side.
3. Practice diaphragmatic breathing and coughing while on your side.

- Getting out of bed

1. Turn on your side.

2. Push your self up with one hand as you swing your legs out of bed.
 Postoperative care is the care you receive after a surgical procedure.

 Postoperative care begins immediately after surgery. It lasts for the duration of your
hospital stay and may continue after you’ve been discharged.

 Steps to post-operative care:

1. Handover information from the theatre/recovery nurse and review relevant

documentation of the procedure performed and any special instructions regarding
nursing care.
2. Check patient color, respiratory rate and depth, and oxygen saturation. Check the
patient is conscious or responding appropriately to verbal stimuli or light touch.
Observe for confusion or altered neurological status, e.g. anxiety. Administer
oxygen as prescribed. Report to medical staff if the patient condition deteriorates.
3. Initiate early warning for VTE scoring if required.
4. Check pulse and BP every 15 mins for first hour. Then every 30 mins for 2 hours.
Observe skin for paleness, sweating, and peripheral vasoconstriction (cold
extremities). Observe wound site for bleeding; report if bleeding exudes through
dressing.
5. Administer intravenous fluids as prescribed. Undertake observations if blood
transfusion in progress. Monitor urine output (report if patient has not passed for
over 4 hours). If catharized, report if urine output is less than 5ml/kg. Observe and
record drainage, e.g. wound/ nasogastric drainage. Report if excessive. Check
bloods for hematology and biochemistry; report abnormal results to medical staff.
6. Assess pain levels using pain scale when performing other observations. Advise
patient to let nurse know if pain develops or worsens. Administer analgesics and
antiemetic as prescribed. Note effect and report to doctor if ineffective.
7. Assess oozing from wound through dressing each time observations are
performed, and report.
8. Change dressings as per recommendations. Assess wound site for heat, redness,
swelling, pain and purulent discharge. If wound exudate present, send swab for
microbiology, culture and sensitivity. Remove sutures as instructed by medical
staff. Use appropriate dressing according to exudate level.
9. Administer medication as prescribed. Antibiotic prophylaxis/ VTE prophylaxis.
10. Observe and record temperature, reporting pyrexia. Identify possible sources of
infection. Send appropriate swab/specimens to microbiology for culture and
sensitivity.
11. Use strict hand hygiene technique between patient contacts. Use of gloves and
another PPE when attending to patient.
12. Assist the patient with personal hygiene as required. Ensure mouth is clean and
moist.
13. Assess pressure sore risk using Barden score. Assist patient to change position
regularly, use of pressure- relieving mattress as required.
14. Assess nutritional requirements, involve dietician is required.

Thank you 