NURSING ACTIVITIES IN THE PRE, TRANS AND POST OPERATIVE

Preoperative

Nursing care in the preoperative area is the set of activities aimed at the physical and
psychological preparation of the patient, they also include those aimed at organizing the clinical
history. In addition, the aim is to identify conditions that may alter the results of the intervention
and the prevention of possible surgical complications.

We can divide the preoperative into two phases:

 Medium : From the moment the patient decides to undergo surgery until 12 hours
before the intervention.
 Immediate : From 2-4 hours before the intervention to the operating room.

Within the middle period, a series of interventions occur in the patient, among which we
must highlight:

 Receive the patient and authorization for surgery. At this point we must advise the
patient, informing him and resolving all doubts that may arise regarding surgery,
managing to control the fear and anxiety that may arise. Signing the consent to
perform the intervention is of great importance, as it allows the surgery to be carried
out.
 A physiological examination must be performed, controlling vital signs, to ensure
that the patient enters safely, avoiding risks that may appear in the postoperative
period or during surgery.
 We review the patient's medical history and verify that all the necessary tests are
found, blood test results, radiological tests...
 Ask the patient to clean himself, showing special interest in fold areas. In the case
of a bedridden patient, cleanse in bed.
 Inform the patient about the hours of fasting prior to surgery, indicating the limit
time after which they should not consume any food by mouth.

For the immediate period, the nursing interventions that must be carried out are the
following:

 Monitor vital signs.

 Check that the patient has maintained pre-surgical fasting.
 Administer pre-surgical medications according to medical indication: antibiotics,
sedatives, analgesics...
 Identify the patient with their full name, room and bed number, and service in which
they are located.
 Remove from the patient all metal objects, dental prostheses, ocular prostheses...
 Check that the surgical area is free of hair, and proceed to shave if necessary,
according to medical indications or according to the surgical operation.
 Check again that the patient's medical history is complete, with the necessary signed
surgical consents and the corresponding tests.
  Provide the patient with the necessary elements for the intervention, such as a
surgical cap, special gown. In addition to healing the wounds, putting clean
bandages.
 Make sure that the peripheral canalization is patent, paying special attention to
ensuring that it is of an adequate caliber for the surgery to be performed.

ACTIVITIES AFTER THE OPERATORY

It begins when the patient is taken to the operating room and ends with transfer to the
resuscitation room or PACU.
FUNCTIONS OF THE CIRCULATING NURSE

The activities of operating room nursing staff are very varied and must follow perfectly established
standards that require specific preparation. The main functions of the circulating nurse are:

1. Verify the operations plan and the type of interventions that will be carried out.

2. Verify that the operating room is prepared, assembled and checking the operation of the various
devices: aspiration systems, electric scalpel, lights, etc.

3. Gather and arrange where appropriate the elements that will be used in the operation, as well as
those required for hand washing and surgical clothing.

4. Receive the patient. Assist in positioning the patient on the operating table.

5. Collaborate with the anesthesiologist in anesthetic induction and preparation for monitoring (if
there is no anesthesia nurse).

6. Help the scrub nurse dress, giving her all the items necessary for the operation. Help surgeons
and assistants get dressed.

7. Collaborates with the instrumentation staff and surgeons during the intervention in everything
necessary, acting from outside the sterile field.

8. Check the operation of the suction systems, electric scalpel, lights, etc. during the intervention.

9. Keep the operating room tidy.

10. Take charge of collecting samples for analysis, labeling them and arranging their shipment to
the laboratory.

11. Collaborate with the scrub nurse in counting gauze, compresses and other elements in the last
part of the intervention.

12. Collaborate in the completion of the operation, placing external dressings, fixing drains and
catheters, etc.

13. Collaborate in placing the patient on the stretcher and transferring him to the resuscitation area.
14. You will fill out the data on the Circulating Nursing form. It will prepare the operating room for
subsequent operations.

FUNCTIONS OF THE INSTRUMENTAL NURSE IN THE TRANSOPERATIVE CARE:

1. Know in advance the operation to be carried out.
2. Prepare all the instruments and materials necessary for the operation, verifying that
no element is missing before the start of the intervention.
3. You will perform your surgical scrub, then dressing, with the help of the circulating
nurse, in sterile clothing and putting on gloves.
4. Dress the instrumentation tables, arranging in the corresponding order the elements
that will be used at each operating time.
5. Help surgeons put on gloves.
6. Help place the sterile field.
7. Deliver the items requested by the surgeons.
8. You will take intraoperative samples and pass them to the circulating nurse.
9. Control the elements used, keeping the table tidy and properly disposing of the
material used.
10.Control the use of gauze and compresses in the operating field, verifying that they
are radiopaque, and count them with the circulating nurse.
11. Collaborate in the final disinfection and placement of dressings.
12. Remove scalpel blades, needles and other sharp and sharp objects.
13. Help the patient on the stretcher.
14. Collect and review the instruments used, as well as arrange what is necessary for
their washing, disinfection and sterilization.
15. Will collaborate with the rest of the team to leave the room perfectly prepared.
POSTOPERATIVE

The postoperative period is defined as the period that follows the surgical intervention and during
which the controls and care installed during it are continued, in a decreasing manner, until the
patient's rehabilitation. If therapy fails, it may end in death.

The nursing staff in the recovery room is the primary caretaker of the patient after surgery. This
monitors them while they are still under the effects of anesthesia, providing constant care
immediately after surgery. This may be for a few hours or until the patient is stable enough to be
transported to their hospital room or discharged.

We can divide it into mediate and immediate

IMMEDIATE POST-OPERATIVE:

It includes the first 24 hours, a period during which reflexes and homeostatic responses must be
completely stabilized. Vital signs such as blood pressure, pulse, respiration, this involves assessing
the patency of the airways to rule out any type of obstruction.
Also in this period, attention will be paid to the appearance of both internal and external bleeding,
which will impact the pulse rate and blood pressure values.

MEDIUM POST-OPERATIVE:

It includes after 24 hours post-surgery, in most surgical interventions, the patient is definitively
discharged from the surgical consultation.

Attention will be paid to the control of imbalances, diuresis, fever, hydroelectrolyte alterations,
beginning of intestinal function.

POST-OPERATIVE NURSING ACTIVITIES

 Place the patient in a supine position with the head sideways and the neck
hyperextended until regaining consciousness.
 Upon regaining consciousness, place the patient in the appropriate position.
 Vacuum secretions frequently and if necessary.
 Cover the patient.
 Provide oxygen to the patient who needs it.
 Check vital signs and report relevant changes.
 Check skin condition (color, paleness, cyanosis)
 Assess level of consciousness, pupils, and movements.
 Identify presence or absence of catheters and drains, connect them to the collecting
device and quantify.
 Observe the incision site and report any excessive bleeding from the dressings.
 Check for nausea, vomiting, pain, location and administer the indicated analgesic
according to medical order.
 Make required position changes.
 Answer questions to the patient, guide him and explain to him about the place
where he is and the procedure to which he was subjected.
 Attach railing to the stretcher.
 Monitor drainage tubes for obstruction.
 Assess the correct fixation and patency of the venous accesses.
 Verify that the patient's equipment is working properly. (infusion pumps, SV
monitor)
 Review HC and follow medical orders immediately regarding analgesic and
antibiotic medication administrations.
 Comply with and respect the medication administration schedule by confirming
with Kardex and medication card.
 Strict control of fluids administered and eliminated.
 Monitor diuresis, reporting if it is less than 50ml/hour
 Apply physical means to stimulate elimination.
 Motivate the patient to perform breathing exercises (coughing and deep breathing)
 Transfer the patient to the hospitalization area when indicated
 Monitor for signs and symptoms of dehydration observed oral mucosa, shedding,
and skin folds.
NURSING ACTIVITIES IN THE IMMEDIATE POST-OPERATIVE

Patient reception:

Verify and Monitor Vital Signs

Operative Site, incision and dressings in search of hemorrhage.

Inquire about relevant data during surgery.

Administer oxygen if required.

Start ordered pharmacological treatment.

Carrying out the aldrete or Bromage test according to times.

Assessment of anesthetic recovery.

Monitor the presence of reflexes (pharyngeal and laryngeal)

Sensitivity to pain, touch and temperature.

Recovery of voluntary movement

Evaluate the presence of any type of complication due to the anesthetic medication administered.

START OF DRUG TREATMENT

The nursing professional who receives the patient must review the pharmacological treatment
that has been ordered and initiate it, taking into account the route, dosage, frequency indicated,
and also administer the medications they had before the intervention.

Record the medications administered on the respective sheet

Medications commonly administered to post-surgical patients are:

o Sedatives and narcotics to relieve pain.

o Antibiotics to prevent infection.

o Antihemetics to prevent nausea and vomiting.

The post-surgical patient is in danger of presenting fluid and electrolyte imbalance, which is why it
is necessary to monitor the appearance of signs and symptoms of an imminent imbalance.

The normal fluid intake of an adult during the 24 hours a day is approximately 2,500 ml, normally
compensating for daily fluid loss.

Record the amount of fluids administered orally or parenterally.

Record the date and time on the corresponding sheet, taking into account the amount and type of
fluids being administered.

COMPLICATIONS IN THE IMMEDIATE POST-OPERATIVE

It is any alteration in the expected course of the local and systemic response of the surgical patient
during the first hours after surgery.

MALIGNANT HYPERTERMIA. - Malignant hyperthermia (MH) is also known as malignant fever,

malignant hyperpyrexia and/or anesthetic fever.

It is a hereditary disease that causes a rapid rise in body temperature (fever) and intense muscle
contractions when the affected person receives general anesthesia.

With a mortality rate greater than 50%, it is essential to identify patients at risk.

Signs and symptoms

Tachycardia >150 bpm

Muscle tension and rigidity.

Muscle pain without obvious cause.

Bleeding.

Dark brown urine.

Rapid temperature rise to 40.5ºC or higher

ACUTE PAIN

Postoperative pain is acute pain that appears as a consequence of the surgical act. From the
pathophysiological point of view, it is generated by the manipulations inherent to the surgical act
such as tissue sections and the release of substances capable of activating and/or sensitizing the
receptors responsible for processing the nociceptive sensation.

 The administration of analgesics ordered by medical personnel in an effective and

timely manner helps to reduce pain.
 To a large extent, the patient's comfort will help us manage pain, comfort, above all.
 Psychological support will greatly help reduce fears, worries and anxiety of patients
regarding their health status.
 When your condition allows it, a family member can support this process in the
recovery room, thus reducing anxiety.

POST-OPERATIVE HEMORRHAGE

The excessive blood loss of an individual after an operation or surgery.

SYMPTOMS

 Active hemorrhage
 Paleness and decreased hemoglobin.
 Nausea
 Abdominal pain
 Vomiting
  Confusion
 Pulse rate increases and temperature decreases.

COMPLICATIONS

 Eat
 Syncope
 Arterial Hypotension
 Hypovolemic Shock

ARTERIAL HYPOTENSION

It happens when blood pressure is much lower than normal. This means that the heart, brain, and
other parts of the body do not receive enough blood.

CAUSES

It is due to blood loss , hypoventilation, changes in the normal position of the body or side effects
of the medications and anesthetics applied.

COMPLICATIONS

Shock, one of the most serious complications, is characterized by a drop in venous pressure,
increased peripheral resistance, and tachycardia.

SYMPTOMS

Blurry vision

Confusion

Vertigo

Fainting (syncope)

Dizziness

Nausea or vomiting

Drowsiness

Weakness

TREATMENT

Timely administration of intravenous fluids, blood, and medications that increase blood pressure.

Administer oxygen by nasal cannula, mask or mechanical ventilation.

Monitor RR, HR, BP, SpO2, urinary output, level of consciousness and report changes to medical
staff.

POST-OPERATIVE VOMITING

Nausea and vomiting are common problems in the post-anesthesia care unit. Nausea and vomiting
can postpone discharge from the post-operative ward, above and beyond material and human
efforts, and if severe enough, it may require medical attention. admission to Hospitalization if it is
Outpatient Surgery.

TREATMENT

Generally, the anesthesiologist administers some type of antiemetic such as Metoclopramide in

pre-anesthetic medication or during surgery.

In the post-operative period, be attentive if it has been indicated to be administered with

opportunity.

URINARY RETENTION

This postoperative urinary retention (PUR) is defined as the inability to urinate in the presence of a
full bladder.

Urinary retention after anesthesia and surgery has an incidence of 3.8% in the general surgical
population, although it can be as high as 80%.

SIGNS AND SYMPTOMS

 The discomfort

 Pain in the lower abdomen.

 Palpation and percussion of the suprapubic area witnessing bladder balloon.

 patient anxiety.

CAUSES

The causes of postoperative urinary retention can be diverse:

 Obstruction of the lower urinary tract precipitated by immobility, fecal impaction, or

surgery.

 Bladder hypocontractility related to the drugs used (anesthetics, analgesics, narcotics,

anticholinergics, calcium antagonists) with electrolyte alterations (hypokalemia,
hyponatremia)

 Pelvic parasympathetic nerve injury, in some types of pelvic surgery.

TREATMENT

When this complication appears, we will have to try to discover the precipitating factor and not
exclusively consider obstruction as the only possible mechanism. We will have to try to avoid the
placement of a permanent bladder catheter, resorting to scheduled urination, through
intermittent catheterizations, while the precipitating factors are corrected and the general
situation and mobility are recovered.

COMPLICATIONS IN THE MEDIUM POST-OPERATIVE

It is any alteration in the expected course of the local and systemic response of the surgical patient
after 24 hours after surgery.

PARALYTIC ILEUS

It is an intestinal motility disorder, a complicated medical condition that is characterized by partial

or total obstruction , NOT mechanical but functional, of the small or large intestine. This blockage
occurs when the intestinal muscles are paralyzed for more than 3 days after surgery.

SIGNS AND SYMPTOMS

 Functional bowel obstruction

 Nausea

 The inability to defecate.

 Abdominal distention

 Vomiting

 Excess burping

 Fast breathing

 Absence of bowel sounds

PULMONARY ATELECTASIA

It is the partial or total collapse of the lung, they are present in the majority of patients during
general anesthesia and are the main cause of perioperative hypoxemia. The post-surgical patient is
at high risk due to the major respiratory changes during surgery.

SYMPTOMATOLOGY

Difficulty breathing

Chest pain

Cough
Sputum production

Low grade fever

Tachycardia

tachypnea

Cyanosis

CAUSES

 Poor Alveolar Ventilation or any type of blockage that prevents the passage of air to and
from the alveoli.

 Altered breathing patterns

 Retained secretions

 Pain

 Prolonged dorsal recumbency

 Increased abdominal pressure

 Specific surgical procedures (upper abdominal Cx or open heart)

TREATMENT

 The goal in treating the patient is to improve ventilation and eliminate secretions.

 Prevention strategies such as frequent position changes, early ambulation, lung expansion
maneuvers (deep breathing exercises, expansive spirometry) and coughing.

SURGICAL SITE INFECTION

It is the second frequently reported cause of nosocomial infection.

It is the infection that develops within the first 30 days after the surgical intervention or up to a
year later in the case of prosthetic material.

WOUND CARE
  Protect the wound with a sterile dressing for at least 24 to 48 hours.

 Wash hands before and after changing dressings and with any contact with the operative
site.

 Use sterile technique to change dressings.

PHLEBITIS

It is defined as inflammation of a vein related to chemical or mechanical irritation or both. It is

characterized by erythema and increased temperature around the insertion site or in the vein path
in addition to inflammation. Your risk increases with the amount of time the venous access is
present, the composition of the solution or medication (pH and tonicity), caliber and site of
insertion, fixation, and asepsis.

THROMBOPHLEBITIS

It denotes the presence of clots and inflammation in the vein, manifested by localized pain,
erythema, increased temperature and edema around the insertion or in the vein's path, slow fluid
flow, fever, malaise and leukocytosis.

PREVENTION

Have an aseptic technique during the insertion of the venous catheter, use an appropriate caliber
depending on the type of TTO (Composition and type of TTO).

Fix appropriately to avoid trauma and change or maintain insertion site according to institution
policies.

Avoid trauma at the time of insertion to avoid thrombus formation.

TREATMENT

 Discontinue TTO IV and restart it at the other site, preferably the opposite limb.

 Apply a warm, wet compress to the affected part.

 For thrombophlebitis, the limb must be elevated.

NOSOCOMIAL PNEUMONIA

It is an inflammation of the lung parenchyma caused by a lung infection that occurs during
hospitalization. This type of pneumonia can be very serious and can sometimes be fatal.

CAUSES

 Nosocomial pneumonia tends to be more serious than other lung infections, because:

o Hospitalized people are often sicker and unable to fight off germs.
 o The types of germs present in a hospital are often more dangerous and more
resistant to treatment than those found in the community.

 Greater frequency in people with a respirator (Artificial ventilator).

 It can be spread by health workers, who do not comply with Biosafety standards.

URINARY TRACT INFECTIONS

 A urinary tract infection or UTI is an infection of the urinary tract, it occurs more in women
than in men. The infection can occur at different points in the urinary tract, including:

o The bladder: An infection in the bladder is also called cystitis or bladder infection.

o Kidneys: An infection of one or both kidneys is called pyelonephritis or kidney

infection.

o The ureters: The tubes that carry urine from each kidney to the bladder are rarely
the only site of an infection.

o Urethra: An infection of the tube that carries urine from the bladder to the outside
is called urethritis.

CAUSES

 Diabetes

 Older age and illnesses that affect self-care habits (such as Alzheimer's and delirium)

 Have a urinary catheter

 Enlarged prostate, narrow urethra, or any other factor that blocks urine flow

 kidney stones

 Staying still (still) for a long period of time (for example, while recovering from a hip
fracture)

 Pregnancy

 Surgery or other procedure on the urinary tract