SURGERY WARD  goal in the preoperative period is for
the patient to be as healthy as possible.
Informed consent
o Patients autonomous decision about
whether to undergo a surgical
procedure
o Helps patient to prepare
psychologically, ensuring that the
patient understands the surgery to be
performed.
Informed consent is necessary in the following
circumstance:
o Invasive procedure such as surgical
incision, a biopsy, a cystoscopy or
paracentesis
o Procedures requiring sedation and/or
anethesia
o A nonsurgical procedure such as
arteriography, that carries more than a
slight risk to the patient
o Procedures involving radiation
o Blood product administration
The patient personally signs the consent if of
legal age and mentally capable. Permission is
otherwise obtained from a surrogate, who most
often is a responsible family member or legal
guardian.
Pre-operative Phase
o includes the establishment of the
patient’s baseline assessment in the
clinical setting or at home, carrying out
preoperative interview and preparing
the patient for the anesthetic to be
given and the surgery
Preoperative Assessment
Every attempt is made to assess for and
address risk factors that may contribute
to postoperative complications and
delay recovery.
 Before any surgical treatment is
initiated, a health history is obtained, a
physical examination is performed
during which vital signs are noted, and a
baseline is established for future
comparisons.
 The nurse should ask about any:
o allergies and comorbid conditions
o joint mobility
o Genetic considerations
o prescription and over-the-counter
(OTC)medications
o Activity and functional levels
Nutritional and Fluid Status
Assessment of a patient’s nutritional status
identifies factors that can affect the
patient’s surgical course, such as obesity,
weight loss, malnutrition, deficiencies in
specific nutrients, metabolic abnormalities,
and the effects of medications on nutrition.
 Nutritional deficiency should be
corrected before surgery
 Assessment of a patient’s hydration
status
Dentition
 decayed teeth or dental prostheses
may become dislodged during
intubation and occlude the airway.
  bodily infection, even in the mouth,
can be a source of postoperative
infection.
Drug or Alcohol Use
 Ingesting even moderate amounts of
alcohol prior to surgery can weaken
a patient’s immune system and
increase the likelihood of developing
postoperative complications
 use of illicit drugs and alcohol may
impede the effectiveness of some
medications
Respiratory Status
 The patient is educated about
breathing exercises and the use of
an incentive spirometer, if indicated,
to achieve optimal respiratory
function prior to surgery
 Patients with underlying respiratory
disease are assessed carefully for
current threats to their pulmonary
status. Patients also need to be
assessed for comorbid conditions
and age-related changes that may
affect respiratory function
Cardiovascular Status
 Patient preparation for surgical
intervention includes ensuring
that the cardiovascular system
can support the oxygen, fluid,
and nutritional needs of the
perioperative period.
Hepatic and Renal Function
 The liver is important in the
biotransformation of anesthetic
compounds. Disorders of the liver
may substantially affect how
anesthetic agents are metabolized.
The kidneys are involved in excreting
anesthetic medications and their
metabolites
Immune Function
 important function of the
preoperative assessment is to
determine the presence of infection
or allergies. Routine laboratory tests
used to detect infection include the
white blood count (WBC) and the
urinalysis
Preoperative Nursing Interventions
 Providing Patient Education
-Each patient’s education is individualized,
with consideration for any unique concerns
or learning needs. Multipl education
strategies should be used, depending on
the patient’s needs and abilities
- Preoperative education is initiated as soon
as possible, beginning in the physician’s
office, in the clinic, or at the time of PAT
when diagnostic tests are performed.
- Education should go beyond descriptions
of the procedure and should include
explanations of the sensations the patient
will experience. Knowing what to expect
will help the patient anticipate these
reactions and attain a superior degree of
relaxation.
Deep Breathing, Coughing, and Incentive as frequently as prescribed during the initial
Spirometry postoperative period for pain relief.

- educate the patient how to promote Immediate Preoperative Nursing

optimal lung expansion and resulting blood
oxygenation after anesthesia. Nurse then
demonstrates effective breathing and
coughing techniques.
- The patient is informed that medications
are available to relieve pain and should be
taken regularly for pain relief so that
effective deep-breathing and coughing
exercises can be performed comfortably.
Interventions
-Preparing the patient
- Administering Preanesthetic Medication
- Maintaining the Preoperative Record
- Transporting the Patient to the Presurgical
Area

- Deep breathing before coughing

stimulates the cough reflex. If the patient
does not cough effectively, atelectasis,
pneumonia, or other lung complications
may occur.

Mobility and Active Body Movement

- promoting mobility postoperatively are to
improve circulation, prevent venous stasis,
and promote optimal respiratory function.
The patient should be taught that early and
frequent ambulation Postoperatively, as
tolerated, will help prevent complications
Pain Management
- pain assessment should include
differentiation between acute and chronic
pain.
- Postoperatively, medications are given to
relieve pain and maintain comfort without
suppressing respiratory function. The
patient is instructed to take the medication
Postoperative Nursing Management
The postoperative period extends from the
time the patient leaves the operating room
(OR) until the last follow-up visit with the
surgeon. Nursing care focuses on
reestablishing the patient’s physiologic
equilibrium, alleviating pain, preventing
complications, and educating the patient
about self-care.
Postanesthesia Care Unit (PACU)
- Patients still under anesthesia or
recovering from anesthesia are placed in
this unit.
Phases of Postanesthesia Care
phase I PACU- usedduring the immediate
recovery phase, intensive nursing care is provides psychological support in an effort
provided to relieve the patient’s fears and concerns

phase II PACU- the patient is prepared for
self-care or an extended care setting
phaseIII PACU- the patient is prepared for
discharge
- When the patient’s condition permits, a
close member of the family maynvisit in the
PACU to decrease the family’s anxiety and
make the patient feel more secure.

Nursing Management in the

Postanesthesia Care Unit
 Assessing the Patient
- Frequent, skilled assessments of the patient’s
airway, respiratory function, cardiovascular
function, skin color, level of consciousness, and
ability to respond to commands
-Vital signs are observed and recorded, as well
as level of consciousness, checks the surgical
site for drainage or hemorrhage,checks any
intravenous (IV) fluids, Medications currently
infusing are checked.
- Administration of the patient’s postoperative
analgesic medications is a top priority in order
to provide pain relief before it becomes severe.
Preparing the Postoperative Patient for
Direct Discharge
 Discharge Preparation
- The patient and caregiver are informed about
expected outcomes and immediate
postoperative changes anticipated, before
discharging the patient, the nurse provides
written instructions covering each of those
points. Prescriptions are given to the patient.
The nursing unit or surgeon’s telephone
number is provided, and the patient and
caregiver are encouraged to call with questions
and to schedule follow-up appointments

 Maintaining a Patent Airway

- nurse assesses respiratory rate and depth,

ease of respirations, oxygen saturation, and
breath sounds.

- primary objective in the immediate

postoperative period is to maintain ventilation
and thus prevent hypoxemia and hypercapnia

 Relieving Pain and Anxiety

- nurse in the PACU monitors the patient’s

physiologic status, manages pain, and