PRE & POST OPERATIVE NURSING MANAGEMENT

r PREOPERATIVE &
POSTOPERATIVE NURSING

MANAGEMENT FOR
THORACIC SURGERY

RABIATUL ADAWIAH ABD RAZAK
GUIDED BY: ROS IDAYU MAT NAWI (MNSC UM)



PREOPERATIVE

 This phase begins when the decision is made for surgical
intervention

 The pre-op nurse is responsible for assessing the patient ‘s
physical, psychological and social states and implementing
nursing interventions

Baseline evaluation
Preparatory education
 The pre-op phase ends when the patient is transport to the

operating room and care is transferred to the OR nurse.

“ What to do before surgery “
 Smoking Cessation

- Smoking irritates the lungs and may prolong the recovery

- If a smoker will increase the lung function and efficiency each
day that you are smoke free before sugery

- Recommended to stop smoking immediately or atleast 3
weeks before surgery

- Smoking cessation before surgery is recommended to avoid
the copius bronchorrhea

- Could improve clearance and decrease of secretions, lower
incidents of pulmonary complications

Cont...

 Patient Education

- Teach patient deep breathing exercise and coughing exercises
- Explaining about pain management
- Increase patient familiarity with the procedures to decrease
anxiety
- Assess and adress individual learning needs
- Involve patients in decision making concerning their care
- Teaching coping strategies

Cont...

 Physiotherapy Function

- Breathing exercise very important to prevent chest complication
after surgery such as chest infection, pneumania, effusions,
empyema or more worst lung collapse

- Deep breathing and coughing will help to clear secretions after
surgery and can help to relax before and after surgery

- Breathing exercise with or without use devices and respiratory
muscle training in preoperative period of cardiac surgery in
reducing postoperative pulmonary complications

Cont...

 Respiratory Function
- To assess the severity of known pulmonary disease, diagnose causes
of respiratory symptoms and may help identify patients who are at risk
for postoperative pulmonary complications

Maintain / Increase Physical Activity
- General exercise/rehabilitation
- daily activity will help condition your muscles and make it easier to
move after the operation.
- Walking is generally easy and effective way to maintain physical
conditioning before the admission to the hospital

Cont...

 Post discharge issues
- Teach about postoperative pain control
- Give instruction on activities that will promote healing and
prevent postoperative complications

Cont...

 Diet instruction

- Eat a balanced diet prior to surgery
- You will be permitted to eat and drink up until midnight before the
surgery date, do not eat and drink after midnight
- The major purpose of witholding food and fluid before surgery to
prevent aspiration
- A fasting period of 8Hours or more is recommended

 Bowel preparation

- For some patients will be required to complete a bowel
preparation prior to the day of surgery

Cont...

 Preparing the skin
- The goal of preoperative skin preparation is to decrease
bacteria without injuring the skin

Relaxation
- As much as possible relax the day before surgery
- Spent time with family and get a good night’s sleep

Cont...

“ What NOT to do fefore surgery “
 Any medication that may cause bleeding will be stopped

before surgery
 Please be sure to stop taking these medications as

directed by the surgeon or anesthesiologist
 1 week before surgery
- NO all medicines containing Aspirin, Plavix, Ticlid, Anacin,
Excedrin,Fiorinol and Alka-Seltzer

Cont...

 5 days before surgery

- NO Coumadin (Warfarin )

 2 days before surgery

- NO all non-steroidal anti-inflammatory ( NSAIDS ) medications
which includes:- Celebrex, Diclofenac, Ibuprofen ( Motrin, Advil ),
Meloxicam ( Mobic ), Nabumetone ( Relafen ), Naproxe(
Aleve,Naprosyn,Anaprox ) Piroxicam ( Feldene )
- Discontinue all supplements atleast 48H before surgery
- If not dissolved properly,it can make surgeon’s job more difficult

Cont...

- Some nutritional supplements and foods can interfere with
anesthesia and healing and should be avoided 1 week
before surgery
- The most common ( but not all ) include:- No Vitamin E,
Gingko bilboa, fish oils, Couramin, White willow bark, Garlic
and onion extract, Ginger root, Ginseng
 1 day before surgery
- NO Lovenox ( anti-coagulant )

Pre-verification checklist

 A checklist that is required to be asked and assessed as
part of your safe care before going for surgery

 Nurse will make sure that all requirements are done
before surgery such as :-

- identification of the patient such as name & date of birth
- mental & physiological status of the patient
- functional status ( patient’s ability to perform ADL’s )
- cardiovascular & respiratory status

Cont...

- skin condition
- nutritional status
- sensory impairments, language barrier, cultural or spiritual needs
- allergies history

- the surgeon will completely document patient medical
history , allergic history and physical examination

Cont...

- the nurse may withness patient signature on patient written
surgical consent
- patient are encouraged to ask question about the surgery
- patient need to be well informed by the surgeon
- Surgeon must provide the patient with sufficient information of
risks and benefits of the surgery

- correct patient identify, correct procedure, correct surgical site

Cont...

- as a baseline data before underwent surgery
- may helpful in certain health conditions
- preparation from bleeding issue
- to determine how spesific organ is functioning

- Anesthesiologist will interview patient before surgey for identify any
possible risk before receive anesthesia
- to determine types of anesthesia is best for patient
- patient can ask about the anesthesia during operation session
- ask how pain will be managed postoperative

POST OPERATIVE
MANAGEMENT AND COMPLICATION

POST OPERATIVE

 This phase begins with the admission of the patient to
the postanesthesia care unit and ends after follow up
evaluation in the clinical setting or home

 The aim of post operative care is to provide the patient
with as quick, painless and safe recovery from surgery as
possible

Nursing management in the postoperative

1-Assessing the patient:

- Close observation such as taken blood pressure, pulse and respiration should
be taken frequently for the first 24 Hours post operative.
-Frequent assessment of the patient oxygen saturation, pulse volume and
regularity, depth and nature of respiration, skin color,depth of consciousness.

2- Maintaining a patent airway:

− The primary objectives are to maintain pulmonary ventilation and prevent
hypoxia and hypercapenia.
− The nurse applies oxygen, and assesses respiratory rate and depth, oxygen
saturation.

Cont...

3 - Maintain cardiovascular stability:

- Assess the patient’s mental status, vital signs, cardiac rythym, skin
temperature, color and urine output
- Central venous pressure, arterial lines and pulmonary artery
pressure
- The primary cardiovascular complications include hypotension,
shock, hemorrhage, hypertension and dysarrythmias.

Cont...

4- Relieving pain and anxiety: − Opioid analgesic.

5- Assessing and managing the surgical site:
− The surgical site is observed for bleeding, type and integrity of
dressing and drains.

6- Assessing and managing gastrointestinal function:
− Nausea and vomiting are common post anesthesia.
− Check of peristalsis movement.

Cont...

7- Assessing and managing voluntary voiding:

− Urine retention after surgery can occur for a verity of reasons.
Opioids and anesthesia interfere with the perception of bladder
fullness.
- Abdominal, pelvic,hip may increase the like hood of retention
secondary to pain.

8- Encourage activity:

− Most surgical are encouraged to be out of bed as soon as
possible. Early ambulation reduces the incidence of post operative
complication as,atelectasis,pneumonia, gastrointestinal discomfort
and circulatory problem.

Cont...

9- Physiotherapy
- Teach patient in deep breathing exercise
- Teach patient post cardiac surgery exercise such as leg
exercise, arm and shoulder extension.

Postoperative complication

1- Shock:
Is the response of the body to a decrease in the circulating volume of
blood, tissue perfusion impaired, cellular hypoxia and death.

2- Hemorrhage:
Is the escape of blood from a blood vessel.

3- Deep vein thrombosis. (DVT).
Occur in pelvic vein or in lower extremities, and it’s common after hip
surgery.

Cont...

4- Pulmonary embolism.
It’s the obstruction of one or more pulmonary arterioles by an
embolus originating some where in the venous system or in the
right side of heart.

5- Urinary Retention.

6- Intestinal obstruction.
Result in partial or complete impairment to the forward flow of
intestinal content.

Potential intraoperative complication

– Nausea and vomiting
– Anaphylaxis
– Hypoxia and other respiratory complication
– Hypothermia