This document discusses pre-operative and post-operative nursing care. It covers goals of care including assessing risks, educating patients, and planning for discharge. Pre-operatively, it describes teaching patients about deep breathing, coughing, exercises and the surgery. Post-operatively, it divides care into immediate, intermediate and extended stages. The immediate stage focuses on monitoring vitals, airway and pain. The intermediate stage adds ambulation instructions. The extended stage monitors for infection and encourages exercises and diet.

1. Pre-post operative
Nursing Care
MS.c. Ayoub Abid
College of Nursing, University of Duhok

2. Preoperative period : begins with the decision to perform surgery and
continues until the client has reached the operating area.
Post operative period : is extends from the time of admission to the PACU
(post anesthesia care unit) to the time the patient is transported back to
surgical unit, discharged from the hospital until follow up care.

3. Goals:
1. Assessing and correcting physiologic and psychological problems
that might increase surgical risk.
2. Giving the person complete learning / teaching guidelines regarding
surgery.
3. Instructing and demonstrating exercises that will benefit the person during
postoperative period.
4. Planning for discharge and any projected changes in lifestyle due to surgery.
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Preoperative phase

4. Routine Preoperative ( Screening Tests)
CBC X matching Serum Electrolytes
ALT, AST S.Albumin
U/AU/S
C-XR PT, PTT FBS
BUN, Crea ECG
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5. Informed Consent
permission obtained from a patient to perform a specific test or procedure.
Purposes:
1. To ensure that the client understands the nature of the treatment.
2. Indicate that the client’s decision was made without pressure.
3. To protect the client against unauthorized procedure.
4. To protect the surgeon and hospital against legal.
5. Actions by a client who claims that unauthorized procedure was performed.
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PREOPERATIVE Teachings:

7. preoperative learning needs
1. Deep breathing (incentive spirometer), coughing, leg exercises, ambulation
2. Pain control and medications
3. Cognitive control to decrease anxiety and enhance relaxation (deep
breathing)
4. Recovery room orientation
5. Probable postoperative therapies.

8. PreoperativeTeaching:
Perioperative Nursing
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INCENTIVE SPIROMETRY

9. Preoperative Teaching:
Diaphragmatic breathing
Procedure:
1.Position in Semi-Fowler’s.
2.Breathe out gently and fully.
3.Take a deep breath through nose and mouth.
4.Hold breath.
5.Exhale through your nose and mouth.
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10. 10

11. Preoperative Teaching:
• Coughing exercises
Procedure:
1.Interlace fingers and place hands over the proposed
incision site.
2.Lean forward slightly while sitting in bed.
3.Breath with mouth slightly open.
4.Let out 3-4 sharp hacks.
5.Take in deep breath with mouth open and quickly give 1-2
strong coughs.
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12. Preoperative Teaching:
TURNING
Procedure:
1. Place the uppermost leg in amore flexed position than lower
leg.
Place a pillow in between the legs.
1. Make sure that the patient is turned from one side to back
every 2 hours.
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13. Preoperative Teaching:
Foot and leg exercises
Procedure:
1.Ask the patient to lie supine.
2.Instruct the patient to bend a knee and raise a foot.
3.Repeat 5 times with one leg and the other
every 3-5 hours.
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15. PREOPERATIVE Preparations:

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Preparing the Patient the Evening Before Surgery
Skin Preparation:
- FULL Bath
- Hair removal: within 1-2 mm of skin, use electric clipper.
GIT Preparation:
- NPO
- Cleansing enema

17. Perioperative Nursing
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Goals:
 Maintain adequate body system functions.
 Restore homeostasis.
 Alleviate pain and discomfort.
 Prevent postoperative complication
 Ensure adequate discharge planning and teaching.
Postoperative phase

18. - period of 1 to 4 hours after
surgery.
- period of 4 to 24 hours after
surgery.
- period of 1 to 4 days after
surgery.
Immediate Stage
Extended Stage
Intermediate Stage

19. Immediate stage:
Nursing Interventions:
1. Monitor vital signs
2. Monitor airway patency and adequate ventilation.
3. Encourage coughing & deep breathing each 1-2h.
4. Watch out for s/sx of shock
POSTOPERATIVE
PHASE

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5. Assess for Homan’s sign
(also called dorsiflexon sign test )
6. Proper positioning
7. Monitor for return of gag reflex/ bowel sounds.
8. Provide comfort measures to relieve pain.
Immediate stage:POSTOPERATIVE
PHASE

21. Perioperative Nursing
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Intermediate stage:
Nursing Interventions
1. Monitor vital signs
2. Before ambulation, instruct the client to sit at the edge of the bed
with the feet supported.
3. Avoid wound infection.
4. Maintain NPO status until gag reflex and peristalsis return.
5. Monitoring input and output
POSTOPERATIVE
PHASE

22. Perioperative Nursing
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Extended stage:
Nursing Interventions:
1. Monitor for signs of infection.
2. Encourage ROM exercises.
( Performing passive range-of-motion exercises)
3. Continue to encourage ambulation.
4. Encourage rich food.
POSTOPERATIVE
PHASE

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Device to prevent deep vein thrombosis

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Device to control pain

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