PSYCHOLOGICAL & PHYSICAL PREPARATION OF THE CLIENT FOR

SURGERY

Psychological Preparation of the Client

 therapeutic communication
 patient and family teaching

Communicating
 Establish and maintain a therapeutic relationship allowing the client to verbalize
fears and concerns
 Use active listening skills
 Use touch, as appropriate, to demonstrate genuine empathy and caring
 Be prepared to respond to common client questions about surgery
Do not give false reassurance like “everything will be alright” or “don’t worry, you’ll be
fine.”
 Inform that patient will be taken to the PACU to recover from anesthesia
 Inform that patient may have devices in place eg. foley cathethers, NGT, oxygen
lines, blood transfusion, etc.

Teaching
 postoperative activities taught in preoperative phase
 Must not be done too far in advance of surgery or when client is anxious

Physical activities:
a.) Deep breathing
During surgery, the cough reflex is suppressed, mucous accumulates in the tracheo-
bronchial passages and the lungs do not fully ventilate. After surgery, respirations are
often less effective as a result of the anesthesia, pain medications, and pain from the
incision. As a result, alveoli do not inflate and may collapse, and secretions retained
increasing the potential for atelectasis and pulmonary infection. Deep breathing
exercises hyperventilate the alveoli and prevent their recollapse, improve lung
expansion and volume

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 Guidelines:
 Place patient in semi-Fowler’s position, with support for the neck and shoulders
 Ask the client to place his hands over his rib cage, so he can feel the chest rise as
the lungs expand
 Have the client - exhale gently and completely
- inhale through the nose gently and completely
- hold his breath and mentally count to three
- exhale as completely as possible through the mouth with lips pursed (as if whistling)
- repeat three times
This exercise should be done every 1 to 2 hours, while awake, for the first 24 to 48 hours after
surgery.

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2. Coughing
Coughing facilitates the removal of retained mucus from the respiratory tract and is
usually taught in conjunction with deep breathing. Coughing is painful; the client should
be taught how to splint the incision (splint incision with a pillow or folded blanket) and to
use the time period after pain medications to best advantage.

Guidelines:
 pace the client in a semi-Fowler’s position leaning forward
 provide a pillow or folded blanket to use in splinting the incision
 Have the client
- inhale and exhale deeply and slowly through the nose three times
- take deep breath and hold it for 3 seconds
- “hack out for three short breaths
- with mouth open, take a quick breath
- cough deeply once or twice
- take another deep breath
Repeat the exercise every two hours while awake.

3. Incentive Spirometry
The use of this should be practiced preoperatively. This device produces increased lung
volume and inflation of the alveoli; it also facilitates venous return.
Guidelines:
- sit upright or elevate the head of the bed 45 degrees
- take 2 or 3 normal breaths, then insert the spirometer’s mouthpiece into the mouth
- inhale through the mouth and hold the breath for 3-5 seconds
- exhale slowly and fully
- repeat the sequence ten times during each waking hour for the first 5 days after surgery
(except immediately or after meals)

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 4. Leg Exercises
During surgery, venous blood return from the legs slows; some surgical positions may
also decrease venous return. With circulatory stasis of the lower extremities,
thrombophlebitis and resultant emboli are potential complications.
Guidelines:
- alternately point toes toward chin (dorsiflex) and toward the foot of the bed (plantar flex);
then make a circle with toes
- flex and extend the knees , pressing the knees down toward the mattress on extension
- raise and lower each leg with the leg straight
- repeat the exercises every 1-2 hours
Leg exercises must be individualized to client needs and physical condition, physician’s
preference, and the protocol of the agency.

5. Turning in Bed
This improves venous return, respiratory function, and gastrointestinal peristalsis.
Although it may seem like a simple procedure, incision pain will make it more difficult,
and should be practiced before surgery.

Guidelines:
- Ask client to raise one knee
- reach across to grasp the side rail and roll over while pushing with the bent leg and pulling
on the side rail
- A small pillow is useful in splinting the incision while turning. The client should turn
from side to side every two hours.

Physical Preparation of the Client

The physical preparation may vary depending on the client’s physical status and special
needs, the type of surgery to be done, and the physician’s orders. However, certain
nursing interventions are appropriate for all.

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Hygiene and Skin Preparation. Goal: to decrease bacteria without injury to the skin.
Operative site is shaved before surgery because hair serves as a reservoir for bacteria.
This is usually done immediately before the operation.

Elimination. The nurse should determine the need for an order for bowel elimination. If
the patient is scheduled for surgery of the GI tract, cleansing enema are usually ordered.
An empty bowel also prevents contamination of the surgical area during surgery. A Foley
catheter may be ordered for clients having pelvic surgery to prevent bladder distention or
accidental injury. If the client does not have a Foley catheter, they should void
immediately before receiving preoperative medications to ensure empty bladder during
surgery.

Nutrition and Fluids

Clients having general anesthesia or major regional anesthesia are made NPO 8 hours to
12 hours before the surgery (often at midnight prior to next morning surgery) to prevent
aspiration of gastric contents if the patient should vomit while anesthetized. The nurse
should explain the reason to the client and remove all food and fluid from the bedside and
places a sign over the bed so that all health team members and visitors will know about
the restriction. If the client should eat or drink, the physician should be notified at once.
To maintain hydration, IV fluids will be ordered.

Elective C Section- IV fluids started at midnight. In emergency cases, with patient in

semi-Fowler’s position and (L) lateral position, infusion of 1- 1.5 liters Hartmann’s or
Normal Saline should be given in 20- 30 mins. prior to spinal block to reduce
hypotension.

Rest and Sleep

Rest and sleep are important components in reducing stress before surgery and in healing
and recovery after surgery. The nurse can facilitate rest and sleep in the immediate
preoperative period by meeting psychological needs, carrying out teaching, providing a
quiet environment, and administering the ordered bedtime sedative medication.

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Consent Form
This is a medico-legal form signed by the patient granting permission to have the
operation performed as described by the patient’s physician. Consent form should only be
signed after the patient has been well informed.
Consent has three components to make it valid.
1. Adequate disclosure: of diagnosis, nature, and purpose of the proposed
treatment, probability of successful outcome, risks and consequences of
moving forward with treatment or alternatives; prognosis if treatment is not
instituted and if treatment is deviating from standard for their condition.
2. Understanding and comprehension of above. This has to be assessed before
sedating medications can be given. Minors, severe mentally ill or
developmentally challenged cannot give consent.
3. Voluntary Consent: can’t be coerced into going through with a procedure. The
consent can be revoked up to any time leading to a procedure.

 The physician has the legal responsibility to obtain consent. The nurse must make
sure the consent was signed. The nurse has the primary role as patient advocate.
The nurse can witness the consent and sign as such. If the patient continues to
have questions, the doctor must be called to come and speak with the patient
again,
 Consent formed should be signed only by persons 18 years and over. A nurse or a
doctor can witness the signature. If the patient cannot write, an X along with the
witness signature is acceptable. Consent forms should never be signed by
confused, mentally ill patients, patients under sedation or mentally unstable
patients. All individual has the right to refuse surgery even after giving informed
consent.

Lab and X-ray Procedures

All necessary blood works and x-rays must be done upon admission. All results must be
ready (available) in patients docket before he leaves for operating theatre. One unit of
blood for C section pt.

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PHYSICAL PREPARATION- DAY OF SURGERY
1. Take and record vital signs
2. Prepare client physically for intra-operative phase.
 Remove patients personal clothing and put on a gown
 Remove all pins and hairpieces
 Leave on hearing aid, inform nurses at OT and recovery room
 Remove prosthesis- denture, eyeglasses, contact lens, artificial limbs, etc.
 Remove makeup and fingernail polish
 Remove jewelry
 Apply identification bracelet
 Neonate- pampers, cap, socks, sheet, towels
 Mother – large pampers
3. Carry out special procedures that are ordered such as IV infusions, NGT, etc.
4. Give preoperative medications that are ordered at the scheduled time or “on call”
5. Maintain client safety by elevating siderails, lowering bed positions, and
instructing client to stay in bed.
6. Meet family needs.
7. Document nursing interventions carried out.
8. Ensure preoperative checklist is completed.
9. Assist in moving client from bed to operating room stretcher when it is time to
transport the client to surgery.
10. Prepare the client’s bed and room for postoperative care. Make a surgical bed.
Have equipment and supplies in room such as IV stands, equipment to measure
vital signs, kidney dish, etc.

 Show family to waiting room

 Surgeon will meet family after surgery to discuss outcome

After C section, the patient is taken to Recovery Unit. Patient transfer to Maternity Unit
will occur after the anesthesiologist evaluation. Once the mother is recovering well, the
neonate is taken to the Recovery Unit to breastfeed.

Receiving Patient in the Maternity Unit

- Prepare room- IV pole, drainage receptacle, oxygen, emesis basin, tissues,
disposable pads, blanket, V/S equipment
- Recovery Unit nurse makes a verbal report to the unit nurse about the assessments
and interventions during the intraoperative and immediate postoperative phases.

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The nurse from the unit assists Recovery Unit Nurse in transferring the client to the bed
in his room. Conduct initial assessment.
 Colour and temperature of skin
 Level of consciousness
 Intravenous fluids- type, amount, rate, tubing and infusion site
 Wound
 Lochia
 Other tubes: foley catheter, NGT
 Altered comfort level: assess for pain (location, duration, intensity),
nausea/vomiting
 Position and safety: If not fully conscious, place side-lying position, elevate
bedrails, place in flat position after spinal anesthesia.
 Comfort: cover with blanket, reorient to room as necessary, and allow family
members to remain with client after initial assessment is completed

Following assessment, document time of arrival and all assessments. Time frame for
assessments are every 15 minutes for 2 hour, every 30 minutes for 2 hours, every
hour for 4 hours, and finally every 4 hours. This begins in the Recovery Unit.

If mother and neonate is stable, baby assisted to the breast at the Maternity Unit.

Postpartum patient and Surgical patient nursing care.

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K. H. (2010). Brunner and
Suddarth’s textbook of medical/surgical nursing. (12th ed.). Philadelphia, PA:
Lippincott Company.

MOH (2020) Obstetric care protocols: A guide for nurses and

Doctors.

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