SUBJECT: ADVANCED NURSING

PRACTICE
TOPIC: TREATMENT ASPECTS:
PHARMACOLOGICAL AND PRE AND
POST OPERATIVE CARE ASPECTS

PREPARED BY:
PATEL JANVI D
F.Y.MSc.NSg
 INTRODUCTION:
 The development of Pharmacological science in early 20 century,
coupled with the technological advance of organic chemistry. The
eruption into therapeutics of thousand of new drugs, as well as a
general information explosion in medicine.  
 The drugs are chemical or biological substances used in the prevention
or disease, or to alter bodily functions in a beneficial way.
 Drugs can come from many different sources. Some drugs are
obtained from plants. Such as the roots, leaves -md fruit, example of
digitalis (from the foxglove plant) and antibiotics such as penicillin
and streptomycin (from lower plant called molds).Drugs can also be
obtained from animals for e.g. Hormones are secretion from glands
from animals. Drugs can be made as chemical substances that are
synthesized in the laboratory.
 The field of medicine that studies drugs their nature origin and
effect on the body is called pharmacology. Pharmacology is a
broad medical specialty and contains many subdivision of study,
including medical chemistry pharmacodynamics,
pharmacokinetics, molecular pharmacology, chemotherapy and
toxicology. 
 TERMINOLOGY:
 Pharmacology
 Pharmacokinetics
 Therapeutics
 Toxicology
 Adverse Reaction
DRUGS NAMES, STANDARD AND
REFERANCE NAMES
 A drug can have three different names. The chemical
formula for the drug. "This name often long and
complicated is useful for the chemist, because its show the
structure of the drugs.
 The generic or official name is a shorter, less complicated
name that is recognized a identifying the drugs for legal and
scientific purpose. There is only one generic name for each
drug.
 The brand (trade or proprietary) name is the private
property for the individual drugs manufacture and no
competitor may use it .Most drugs have several brands
name because each manufacturer producing the drugs give
a different name. It must be dispersed by the pharmacist.
 EXAMPLE:
The following lists give the chemical, generic and brand names of
the antibiotic drug ampicillin; note that the drug can have several
brands but only one generic, or official name:

Chemical name Generic name Brand name

Derivative of Ampicillin Ammpicilline
6¬Aminopr.nic. capsules
illinic acid Omnipen
  Polycillin
Princi ren
REASONS FOR MEDICATION ADMINISTRATION
 Treatment: - examples Acetylsalicylic acid ( Aspirin) for
fever, Digoxin, Lanoxin, for heart failure
 Cure:-example, Antibiotic for infection
 Maintenance:- example; Insulin for Diabetes
 Support: examples, IV - administered fluid, Potassium
supplements.
THE STUDY OF PHARMACOLOGY INCLUDES
THREE AREAS
 Pharmacodynamics
 Pharmecotherapeutic
 Pharmacokinetics

1. Absorption
2. Distribution
3. Metabolism and Excretion
 ADMINISTRATION OF DRUGS:
 Drugs are given in many ways
 Orally
 By Injection
 Intravenously
 Intramuscularly
 Subcutaneously
 Intradermally
 Into various body cavities such as the pleura peritoneum, or into the spinal theca.
 Rectally
 By Inhalation
 Local Application (Lotion, Ointment, Cream ..... etc.)
 Intra Articular (drugs administered directly into a joint for the treatment of local
condition, e.g. Hydrocortisone Acetate in the Rheumatoid Arthritis.)
 
TYPES OF DRUGS REFERRING TO MODE OF
ACTION:
 Anesthetics: Generally anesthetics drugs
 Analgesics: depress CNS Relive pain
 Antipyretics: Reduce body temperature
 Antiseptic: Kill Bacteria
 Antibiotics: Kill / prevent multiplications of Bacteria in
the body
 Carminative: promote belching
 Diaphoretic: Induce sweating
 Diuretics: Increase the secretion of the urine
 Anti -Emetics: Prevent vomiting
 Expectorant: Expelled bronchial secretion
 Hypnotics: Produce sleep
 Mydriatics: Dilate the Pupil
 Myotics: Constricts the Pupil
 Tranquilizers: So the Without Causing drowsiness
DRUG THERAPY AND THE NURSING PROCESS
 Assessment :
 6-R
 Obtain a drugs history:-Include each of the following:
 Prescription drugs
 OTC drugs
 Habits
 Medical History
 Allergies
 Drug specifics Name
 Amount of dose
 Route of administration;
 Frequency how often administration
 Identify diseases in the body system that may affect the following
 Drug absorption through the GI tract, lungs, mucus membrane.
 Distribution by the circulatory system
 Metabolism by the hepatic system
 Excretion by the renal system  
 Assess the use of illegal drugs.
 Identify special consideration for the older adult, pediatrics & others.
 Know the FDA pregnancy categories of the drugs
 Identify client's ability to explain why each medication prescribed or
prescribed being taken
 Identify cultural consideration released to drug therapy.
  Diagnosis
 Identify nursing diagnosis related to the medication currently in use
 Begin a plan of care related to the client's drug regimen: consider side effect,
dietary factors & compliance level.
 Apply nursing diagnosis
 Knowledge deficit related to drug treatment regimen
 Noncompliance related to side effects of medication
 Risk for injury related to side effects of medication
 Constipation related to slowing of peristalsis due to narcotic use for pain
management
 Diarrhea related to side effects of medication.
 Risk for infection related to specific drug's effect of compromising immune
system.
 Ineffective management of individual therapeutics regimen related to limited
financial resources
 Health- seeking behaviors such as help for physical dependence related to chronic
& abusive use of cocaine.
  Planning
 Identify outcome criteria for documenting client responses to drug therapy.
 Determine the best schedule for administering the prescribed drugs
 Consider drugs to be administered with & without meals
 Plan diuretics & laxatives early in the morning to avoid unnecessary
interruption in sleep during the night for elimination
 Identify potential drug interaction & schedule accordingly
 Establish nursing observations & interventions needed for safe drug therapy
 Recognize safety factors for drugs that interfere with level of consciousness
 Develop guidelines for reporting abnormal side effects
 Identify necessary client teaching for safe drug administration at home
 Implementation:-
 Provide drug therapy as directed on the plan of care
 Prepare the medication with consideration to the proper technique
 for the ordered route & correct drug calculation
 Consider the five rights of drug administration: right drug, dose,
route, time,& client
 Monitor for the effectiveness of l he drug & for adverse side effects
 Teach appropriate information for home drug therapy
 Accurately document the medication prescribed
 
 Evaluation:-
 Document the effectiveness of the drug
 Document any side effects & the actions taken to
relieve them
 Determine the client's knowledge of the drug regimen
 Evaluate laboratory work necessary for safe drug
administration
 PRE AND POST OPERATIVE CARE

 CATEGORIES OF SURGERY BASED ON

URGENCY:
 Emergent
 Urgent
 Required
 Elective
 Optional
 TYPES OF SURGERY & THEIR MAIN FEATURES:
 Emergency surgery: pre operative period is very short, because of the
life threatening situation. E.g. acute appendicitis
 Planned surgery: time of surgery is fixed with the mutual consent of
the doctor & the patient .there is enough he time left for the pre
operative care to be given to the patient.
 Major surgery: the operation involving large surface area of the body.
 Minor surgery: the operation involving a small area of the body.
 Diagnostic surgery: this is an operation in which the diagnosis is
unknown. e.g exploratory laparotomy, in which abdomen is opened for
to seek the cause of symptoms.
 Curative surgery: this is an operation in which diseased part or organ
is removed to to relieve symptoms. e.g. cholecystectomy
 Restorative surgery: this is an operation involving
strengthening of weakened area. E.g. herniorrhaphy
 Corrective surgery: this is an operation in which deformities
are corrected. E.g. replacement of mitral valve.
 Palliative surgery : this is an operation in which symptoms are
relieved, but the basic cause remains e.g. gastro jejunostomy
 Cosmetic surgery: this is an operation done to improve the
appearance e.g. cleft lip & palate
PRE & POST OPERATIVE CARE ASPECT
 The success of every surgery depends on the type of nursing care given to the
patient before, during & after period of surgery. The preparation of the surgery
depends upon the type of surgery, age of the patient, general health of the patient
& the organ involved:
 Pre operative phase: period of time from when the decision for surgery
intervention is made to when the patient is transferred to the operation room
table.
 Intra operative phase: period of time from when the patient is transferred to the
operation room table to when he/she admitted to the post anesthesia care unit.
 Post operative phase: period of time that begins with the admission of the
patient to the post anesthesia care unit & ends after a follow up evaluation in the
clinical setting or home.
 Peri operative phase : period of the time that constitute the surgical experience
in clued the pre operative .intra operative & post operative phase of nursing care.
 PRE OPERATIVE CARE OF THE PATIENTS
  Psychological preparation: Discuss with the patient to give full
information about the surgery such as
 Type of surgery
 Consequences of surgery (if it is done & if it not done)
 The problems to be faced.(disabilities expected}
 Expected duration of hospitalization
 Expected time of resuming duty (if employed)
 Cost of surgery
 Treatment / investigations done before surgery & its purpose
 Necessary arrangement to be made about the family, financial
matters, work, hospitalization.
 Eradicate fear of operation from the patient
 Allow the patient to ask questions & clear all his doubts
 Introduce to the patient someone who had similar surgeries & successfully
recovered from the symptoms
 Explain what happens during anesthesia
 Explain how to get rid of pain after surgery ~ Tell the patient when he can
have meals
 Answer all questions asked by the patient in language he can understand, so
that the patient will have confidence to undergo surgery
 Let the patient see the persons, place & equipment involved in his operation
 Always start the procedure with an explanation, so that it will inspire
confidence in the medical team. The patient has to feel that he will be safe
in the hands of the competent people during surgery
 For many patients, their admission to the hospital is a first experience in their lives.
In such situation the nurses should take them feel at home by eradicating their fear
 Meet the spirituals needs of the patients : Let the patient meet the ministers of his
religion .if requested by the patient
 Obtain informed consent: obtain the consent from the patient for each operation
after explaining the nature of the operation & anesthesia.
 Never compel to give their consent
 Explain the complication that may occurs when the patient is under anesthesia
 The language used in the consent form should be understood by the patient who
gives the signature.
 Obtain consent for the major diagnostic procedure, also.
 Criteria for valid informed consent
 voluntary consent :valid consent must be given freely
 Incompetent patient: legal defining: individual who is not autonomous & cannot
give or withhold consent .e.g., mentally retarded, mentally ii or comatose
 Informed consent: it should be in writing .it should contain the following:
 explanation of procedure & its risk
 Description of benefits & alternatives
 An offer to answer questions about procedure
 Instruction that the patient may withdraw the consent
  
 A statement informing the patient if the protocol differs from customer procedure
 Patient able to comprehend: information must be written & delivered in language
understandable to the patient .question must be answered to facilitate
comprehension, if material is confusing .
 PREPARATION OF THE PATIENT EVENING BEFORE
OPERATION.
 Remove the jewelry & hand over them to relative ~ Remove the lip stick &
nail police
 If the patient was taking some drugs such as insulin, steroids, hormones,
digitalis preparation. Ask the physician how to administer them.
 Enema is ordered in the evening when the surgery involved the GI Tract
 A light diet In the evening before the day of the surgery & fasting after
midnights advice to prevent vomiting& aspiration of food material into the
lungs during general anesthesia
 A tranquilizer like diazepam may be ordered by the doctor & it is given at bed
time to the patient to ensure good sleep at night before the day of surgery.
 The preparation of the patient for the surgery varies according to the type of
operation& the surgeon's preference. There for ask the surgeon for the
specific orders.
 Sending the patient to the operation room
 Assessment of the factors that affect the patient pre operatively:
 Nutritional & fluid status
 Drug or alcohol use
 Respiratory status
 Cardiovascular status
 Hepatic & renal function .
 Immune function
 Previous medication use
 Psycho social factors
 Spiritual & cultural beliefs
 Special considerations given are
The ambulatory surgery patient
Elderly patients
Obese patient
Patients with disabilities
Patients with diabetes
Patients undergoing emergency surgery
PRE OPERATIVE NURSING INTERVENTION:
 Pre operative teaching:
 Deep breathing ,coughing & incentive spirometers
 Mobility & active body movement
 Pain management
 Cognitive coping strategies
 Instructions for ambulatory surgical patient
 Pre operatively psychological intervention

 Reducing the pre operative anxiety

 Decreasing fear
 Respecting cultural, spiritual ,& religious beliefs
  General pre operative nursing interventions
 Managing nutrition & fluids
 Preparing bowel for surgery
 Preparing the skin
 Immediate pre operative nursing interventions:

 Administering pre operative pre anesthetic medication

 Maintaining the pre operative records
 Transporting the patient to the pre surgical area
 Attending to family needs.
  sending the patient to operation room
 Administer the pre operative medicine to the patient 1 hour before surgery
 Before giving the medicine check the vital sign & record it.
 Change the patient's dress & put on hospital gown.
 Ask the patient to void just before the operation
 Transfer the patient on to a patient trolley & cover him with a green sheet
to prevent draught.
 Never leave the patient alone on to the patient trolley to prevent any
accidental fall
 Always send the patient chart along with him such as; all the laboratory
reports ,consent form for anesthesia & consent for the operation.
POST OPERATIVE CARE:
 Preparation of post anesthetic bed & reception of the
patient:
 Prepare a bed for the patient undergone for the surgery
 There should be adequate number of the people to transfer the patient
without disturbing the functioning devices attached with the patient,
e.g. iv set ,drainage tubing, oxygen tube, urinary catheter ,or traction
etc.
 Ask the staff who had accompanied with the patient about the
complication that has occurred in the operation room during surgery.
 Before the theatre staff return to the operation theatre check the base
line value of the patient vital signs, check for cyanosis
 Check the operative site for bleeding ,discharge ,& the drainage
tunings
 Keep the patient well covered to prevent draught.
 Never leave the patient alone.
 Observe the patient for swallowing reflex. if not present ,keep
the patient side lying position to prevent tongue falling back &
obstructing the airway. The patient who had spinal anesthesia
,the foot end may be raised on the bed blocks.
 Check the doctor's order for further treatment & special
instruction.
 
 Care of the patient who I under the effect of anesthesia
 The patient needs close & diligent observation until the patient fully
recovers from anesthesia.
 A noisy breathing is indicative of airway obstruction that can occur
due tongue fall back & obstructing the pharynx.
 Keep the patient in a suitable position that will helpful to drain out
the vomit us, blood & secretion collected in the mouth & preventing
them to aspirate into the lungs.
 Suctioning should be done with the use of sterile technique
 if the patient is cyanosed, administer oxygen inhalation.
 A weak and thready pulse indicative of blood loss & circulatory
failure, so immediately inform the anesthetist or the doctor.
 Keep the side rails to prevent accidental fall
 While awakening from anesthesia , patient need frequent orientation as
where they are, what has been done to them .they also need to now that
the operation Is over
 Patient recover from anesthesia may ask for drinking water .unless the
patient has fully regained the swallowing reflex, drinking water may
choke the patient.
 As the patient recovering from the effects of anesthesia, the patient may
become restless due to the discomfort caused by the presence of those
devices attached to the patient
 Keep the family informed of the successive surgery .these information
will reduce the anxiety.
 Observation of the patient post operatively:
 Close observation is necessary to detect any complication in its early
state
 The main points that should be observed are:
 Vital signs :blood pressure ,respiratory rate, pulse rate .skin color & skin
temperature
 Intake & output chart: iv fluids ,oral fluids if permitted ,nasogastric
aspiration, wound drainage & blood loss
 Urinary output
 Abdominal girth
 Bowel movement
 Signs of hypo or hyper volemia
 Any breathing difficulties
 Pain over calf muscles
 Operation site for bleeding & pain
 Any specific observation told by the surgeon  
 Care of the wound
 Diet of the patient:
 All patient except those with abdominal surgery may start the diet as per the doctor's
permission
 Gradually the patient is put on liquid ,then soft diet & then full diet as per their disease
condition .like ADD ,SRD,HPD ,ETC
 Remember the patient undergone any type of surgery need a diet rich in vitamin & minerals.
 Post operative health teaching:
 All patient need health education as per their knowledge
 Maintenance of personal hygiene
 Diet allotted to them & any control over it
 Ambulation: activities that are permitted as well as restricted
 Any drugs to be taken post operatively
 Date on which the patient may resume all activities
 Learning of any activities to be carried out post operatively, e.g. care of colostomy
 Complication & its prevention:
 Respiratory complication:
 Atelactesis
 Pneumonia
 Respiratory depression ./ Pulmonary embolism ./ Emphysema
 Bronchitis
 Bronchiactes
 Preventive measures:
 Proper preparation of patient for surgery & anesthesia .
 Treatment of all infection before surgery
 prevent pooling of secretion in the respiratory tract
 Adequate fluid intake
 Pre operative teaching of coughing & deep breathing exercise
 Active passive exercise
 Post operatively control of visitors
 Prevention of cross infection
 Frequent change of position
 Early ambulation
 Use of humidifier with oxygen
 Circulatory complication:
 Phlebothrombosis & thrombo phlebitis
 Cardiogenic shock
 Cardiac arrest
 Cardiac failure
 Pulmonary edema
 Hypothermia
 Preventive measures
 Avoid constrictive restrain
 Application of bandages with even pressure .
 Close observation
 Checking calf muscles for redness, pain ,etc ./ Early ambulation
 Active & passive exercise ./ Use of foot board
 Oxygen inhalation in cyanosis ./ Psychological support
 Prevention of chills by keeping the patient covered & warm
 Fluid & electrolyte imbalance ./ Dehydration
 Over hydration
 Pulmonary edema
 Hypo/ hyper natraemia .
 Hypo/ hyper kalaemia
 Respiratory acidosis /alkalosis
 Metabolic acidosis / alkalosis
 Preventive measures
 Fluid administration before ,during & after surgery
 Continuous monitoring of vital signs & urine output
 Continuous patient monitoring for hypo /hyper volemia, fluid loss,&
replacement
 Detection of behavior changes
SUMMARY
THANK YOU