Preoperative And

Postoperative
Management
M.Khan

Surgery
Special Preparations
 Impairment of respiratory functions
 Stop smoking for two weeks, encourage the patient to exercise
deep breathing and cough to increase ventilation and drainage.
 If sputum is thick, aerosol inhalation
 coughing pus sputum, antibiotics
 asthma , Dexamethasone 0.75mg
 Medication before anesthesia should be small Dolantin is better
than morphine because it is capable of bronchial dilation. The
amount of atropine should be adequate to avoid increment of
viscosity of sputum
Special Preparations

Diseases of the liver

 Liver function tests preoperatively
 impairment is found, therapy should be given to protect liver function.
 Improve the general condition and increase storage of liver glycogen, use
mixture of glucose, insulin and potassium salts (10% glucose 1000ml,
insulin 20u, 10% KCl 20ml).
 Repeated transfusion of fresh blood can correct anemia and increase
coagulating factors. Vitamins B, C, K may be given.
 Ascites: salt-limited, diuretics and albumin or plasma
Special Preparations
Diseases of the kidney
 Renal function tests
 Water-electrolyte imbalance and acid-base imbalance should be
corrected.
 Restore blood volume to avoid hypotension and renal ischemia.
 Avoid using renal impairing drugs, avoid vascular contracting agents
in order not to reduce the renal blood flow
 oliguria occurs, mannitol can be used to increase the renal blood
flow and glomerular filtration rate.
Special Preparations
Diabetes mellitus
 blood sugar level controlled before operation,
 water-electrolyte imbalance and acidosis should be corrected,
nutritional state should be improved.
 suspected infection, antibiotics
 Before a major operation is performed, the blood sugar should be at
steady mild elevating states (5.6-11.3mmol/L), urine sugar. This is
not only harmless to health, but also avoiding hypoglycemia due to
overdose of insulin or acidosis due to little insulin.
 POSTOPERATIVE CARE
OBJECTIVE
 The purpose of postoperative management is to facilitate the early
recovery by assuming various measures, reducing patient suffering and
discomfort, preventing and managing various complications timely
General nursing care

 After the patient is sent to the operating room,

preparations of bedding and appliance should be made
in the ward, such as GI depressing apparatus, infusing
stand and oxygen etc.
 When the patients sent back, keep warm and connect
the drainage tube. Hot water bag should not be put to
the skin directly before the patient awakes in order to
prevent scald.
 General nursing care
 Pulse, respiration and blood pressure should be observed repeatedly every
2-4hrs on the day of operation.
 major operation or internal hemorrhage and tracheal depression possibly
occur, intensive care, above measurement records every 30-60 min,
 pay special attention to early manifestations of respiratory obstruction,
suffocation, bleeding and shock,for the reason and make timely
management.
Lying position

 Unawakened from the anesthesia, attention should be paid to

preventing vomiting and inspiration, removal of pillow, head turning
to one side, to facilitate flow of oral secretion and vomitus out.
 awake, lying according to the requirement of operation.
 subarachnoid anesthesia, remove pillow and take flat lying for 12
hours to prevent headache
 receiving subdural, local or acupuncture anesthesia, lying is
determined by the operational requirements.
 Lying position
 Cerebral operations without shock or coma, leaning position with upper body
elevating 15-30 degree.
 Operation on neck and chest, leaning position with the upper body elevating
higher to help respiration
 Abdominal operation, lower loin to reduce tension.
 Spinal column and buttocks, prone or supine position.
 Any lying make patients comfort, considering the physiological activites of
the visceral organs and facilitate patient's appropraite activites.
 For patients with shock, lower limbs elevate 20 degree with the head and
trunk elevating 5 degree.
 Lateral position is more suitable for obese patients because it can facilitate
respiration and venous return.
Activities and getting out of bed

 Leave bed early to increase forced expiratory volume, reduce

complications in the lung, improve systemic blood circulation, reduce
incidence of thrombosis caused by venous congestion of lower limbs
 Ease the restoration of intestinal and cystic functions, reduce
incidence of abdominal and urine retention.
 Activities increased to suit patient's tolerance
Activities and getting out of bed

 Certain activities can be done in bed, such as deep

breathing, flexion and extension of the toes and ankles,
alternate relaxation and contraction of muscles in the
lower limbs, intermittent turning over of the body etc.
 much sputum, cough regularly is required,
 leaving bed and doing activity is permitted 1-2 days
after operation.
Diet and infusions
Non-abdominal operations:
 Beginning diet is determined by extent of operation, method of
anesthesia and patient's reactions.
 For minor operation, diet can be taken immediately after operation.
 For local anesthesia, if no discomfort or reactions, patients can eat
according to their requirements.
 For subarachnoid or subdural anesthesia, patients can take meal 3-
4hrs after operation and
 For general anesthesia, meal can be taken after patients wake up,
nausea and vomiting reflex has disappeared.
Diet and infusions
Abdominal operations
 For gastrointestinal operations fasting is needed in the first 24-48hrs.
 Little by little, liquid diet can be given 3-4 days later when GI
function restored and patient has flatus.
 5-6 days later, semi-fluid diet.
 7-9 days later common diet can be given.
 During the fasting stage, water, electrolytes and nutrition are
maintained by infusion.
Suture removal
 The time of suture removal is determined by the location of
incision, blood supply of the incision and the age of patient.
 Head, face or neck is removed 4-5 days later,
 Lower abdomen and perineum, 6-7 days later.
 Chest, upper abdomen, back and buttocks, removal is done 7-9 days
later.
 For extremities, 10-12 days (for incision on the joints,
the time should be longer).
 For tension sutures, 14 days is required.
 Remove sutures disconnectedly.
 Adolescence, the time shortened, while for aged and
malnutrition patients, it should be prolonged.
 Recording of incision healing
Incisions classified into 3 categories.
1.1 Clean incisions, signified by “Ⅰ”,
indicating sterile incisions, subtotal
thyroidectomy.
2.2 Probably contaminated incision,
signified by“Ⅱ”, indicating that
incisions may be contaminated, such as
subtotal gastrectomy.
1.3 Contaminated incision,
signified by “Ⅲ”, indicating
those that are near the
infection areas or exposed to
infections substances
directly, such as resection of
perforated appendix or
operation of necrosis of
intestinal obstruction.
Recording of incision healing
 Healing is also classified into 3 categories
1. 1 Primary, signified by“A”, which
means healing well, no without toward
reactions.
2. 2 Secondary, signified by “B”, which
means poor healing, there are
inflammatory reaction at the healing
areas such as red, swelling, nodules
hematomas or effusions, but no pus
formation.,
 3 Third, signified by“C”, which means
pus formation at the incision and drainage
must be done.