Ppre PRE OPERATIVE NURSING

CARE

FOR NURSING STUDENTS

By GETNET K.(, BSc, OTNS)

01/17/2025 PREPARED BY GETNETT 1

 Pre, Intra and Post Operative Nursing
Management
 Perioperative Period: The time that constitute the
surgical experience, include the preoperative,
intraoperative, postoperative phases.
 Preoperative Phase: The time from when decision
for surgical intervention is made to when the patient
is transferred to the operating room table.
 Intraoperative Phase: Period of time from when the patient
is transferred to the operating room table to when he or
she is admitted to the post anesthesia care unit.
 Postoperative Phase: Period of time that begins with the
admission of the patient to the post anesthesia care unit
and ends after follow-up evaluation in the clinical setting or
home.

01/17/2025 PREPARED BY GETNETT 3

 Purposes of surgery
 Diagnostic→e.g. Biopsy
 ­Exploratory→e.g. laparotomy

A type of major surgery that involves opening the abdomen with

a large incision in order to visualization the entire cavity .
 ­Curative →e.g. excision of a tumor or an inflamed appendix
 Reconstructive or cosmetic → e.g. mammoplasty
 Palliative→ relieve of symptoms as pain
 Categories of surgery
1- Emergency:
Must be performed immediately:
1)Maintain life
2)Maintain organ or limb function
3)Stop hemorrhage (Intestinal obstruction/Gunshot & stab wounds).
2- Urgent:

Must be performed within 24 to 48 hours(Bleeding of duodenal

ulcer)
3- Planned
Scheduled weeks or months ahead of the
proposed operation (cataract removal)
4- Elective
Not absolutely necessary (hernia)
5- Optional
Requested by the person (Mammoplasty)
 Risk factors for surgical
complications:
 Age, obesity, malnutrition, immobility , hypovolemia ,
infection, pregnant, diabetes mellitus, hepatic
disease, cardiovascular disease, renal disease and
pulmonary disease.
 Nature of condition (Malignant)
 Location of condition (Heart/Brain)
Potential Intraoperative complication:

Nausea and vomiting

Anaphylaxis

Hypoxia and other respiratory

complication
Hypothermia
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A. Caring for peri-operative clients
PATIENT PREPARATION

 Preparing the perioperative environment starts before the

patient arrives.

 The only information that may be available for the staff is

retrieved from the operating theatre list, which is written daily

and produced ideally 48 hours before the scheduled surgery.

 At a minimum, this should detail the patient’s name, age,

gender and procedure.

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 Day of Surgery:

 If the surgery is in the morning be sure the patient is

prepared early.
 Anything abnormal such as pain, fever cough rapid
pulse or elevated blood pressure must be reported
immediately.
 The surgery may have to be canceled or delayed until
the patient is well.
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 Check the cleanliness of body areas, umbilicus, nails
and hair.
 Shave the hair from the skin of the operative area
thoroughly.
 Someone should check to see if all the hair has been
removed.
 Wash the skin well with soap and water before and
after shaving.

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 Surgery and the post-operative period typically receive a lot
of attention but the pre-operative period is also important.
 Preparing a patient for surgery will help the patient recover
physically and psychologically while preventing post-
operative complications.
 Many of the pre-operative tasks are essential for physical
recovery and for preventing post-operative complications.
 Surgical consent

 Before surgery, the client must sign a surgical

consent form or operative permit.

 Clients must sign a consent form for any procedure

that requires anesthesia and has risks of
complications.

 If an adult client is confused, unconscious, a family

member or guardian must sign the consent form.

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If the client is younger than 18 years of age, a
parent or legal guardian must sign the consent form.
In an emergency, the surgeon may have to operate
without consent, health care personnel, however,
makes every effort to obtain consent by telephone,
or fax.

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 Informed Consent:

 One of the basic rights of all patients is the right to accept or refuse

 medical or surgical treatment.

 Surgery, invasive procedures, or any medical or surgical treatment

that is not considered to be routine may only be performed if a
health professional has obtained the patient’s informed consent.
 Patient consent is not typically required if a procedure is
considered to be routine, for example, a venipuncture for obtaining
a blood sample.
 Informed consent indicates that prior to surgery
the patient has been informed by the surgeon,
and that the patient understands, the following
factors related to surgery.
1) The primary diagnosis.
2) The nature of the surgery or procedure.
3) Why the surgery or procedure is being done.
4) The risks and benefits of the surgery or
procedure.
5) The risks and benefits of not having the surgery or
procedure performed.
6) What outcome he or she can expect.
7) What the post-operative period and the recovery period will
be like.
8) Alternatives to the surgery or procedure and their risks and
benefits.
All of the above factors should be discussed with the patient
and the patient must then sign a surgical consent form.
The surgical consent form is an agreement that is signed by the
physician and the patient or by the patient and a witness.
 2.INTR – OPERATIVE PHASE
Reception Nurse
1. Identified patient by asking him to
say his name and checks and
corresponds with his record and
reporting list.
2. Reassures patients , creates quiet ,
calm atmosphere to decrease patient
apprehensiveness .
3. Checks the preoperative assessment

01/17/2025 PREPARED BY GETNETT 26

 Risks to improve the quality of care delivered.

 Within the intraoperative phase, the patient is

vulnerable and totally dependent on perioperative

nurses and other members of the team to ensure

that they come to no harm.

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 Pre-Operative Checklist

 The pre-operative checklist is the final document that must

be
 completed before a patient is transferred to the operating
room.
 It indicates that all necessary preparations for surgery have
been completed.
 This document must accompany the patient when being
transported for surgery.
 Table 1: Pre-Operative Checklist

 Patient name

 Date of birth

 Positive patient identification by two

witnesses
 Verification patient identity band
 Allergies

 Name of the surgery

 Vital signs

 Last time of urination

 Contact lenses, dentures, and hearing aids removed (if

applicable)
 Jewelry removed
 Pre-operative medications (names, doses, times
administered)
 Verification of patient fasting (as ordered by the
physician)
 Laboratory test results

 X-ray test results

 Electrocardiogram result
 Preoperative Teaching

 Teaching clients about their surgical procedure

and expectations before and after surgery is best
done during the preoperative period.

 Clients and family members can better participate

in recovery if they know what to expect..

 Information in a preoperative teaching plan varies

with the type of surgery and the length of the
hospitalization.
01/17/2025 PREPARED BY GETNETT 33
 Preoperative Preparation:

Physical Preparation.
Skin preparation

Elimination

Food and fluids

clothing/ grooming

Prostheses

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 Psychological Preparation and Support

 Surgery is a stressful experience and it can be frightening.

 The patient often having surgery due to a serious illness.

 Surgery involves risks, complications, pain, and

discomfort, before and after the operation.
 There is the possibility that the patient's life will be
drastically changed, and not all surgeries are completed
successfully
Psychosocial Preparation.
Careful preoperative teaching can
reduce fear and anxiety of the clients.

01/17/2025 PREPARED BY GETNETT 36

 Anesthetic Nurse
 Prepares safe environment for induction of
anesthesia.
 Checks suction apparatus , gas supply , gas
cylinder machine to be well prepared for use.
 Checks O2 supply and emergency tray in
position.
 Checks and records all drugs required by the
anesthetist .
01/17/2025 PREPARED BY GETNETT 37
 Arranges for the scrub nurse to see the signed
consent.
 Prepares inhalation trolley
 Assist in the transfer patient to recovery room
 Cleans used equipment

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 Skin Preparation

 An intact skin is the body’s first line of defense against

infection.
 However, surgery involves breaking that line of defense with
an incision.
 The surface of the skin is home to countless numbers of
bacteria, the so-called normal flora of the skin.
 These bacteria are the source of most surgical wound
infections.
 Although surgery involves sterile technique, even the most
conscientious use of sterile technique cannot prevent all surgical
wound infections.
 Because of these risk factors, preparation of the skin by a thorough
cleaning before surgery is often performed.
 This decreases the risk of infection and it is a vital part of the pre-
operative procedure.
 There are too many pre-operative skin preparation techniques to
discuss them here in detail.
 Additionally, body hair harbors bacteria and that bacteria cannot be

removed if the hair is not removed.

 Removing body hair by shaving was once standard procedure.

 Now, for many procedures, body hair is not removed.

 If it is removed, clippers or a depilatory cream are the preferred methods.

 The depilatory creams can also be used for areas that are difficult to shave.

 Shaving can damage the skin by creating small cuts and this increases the

chances that an infection will develop.

 Coughing:
 Patients are lying completely immobile during surgery and in

many cases, they have been on bed rest before the operation.
 Because a patient has been immobile for an extended time,

secretions can pool in the lungs, bacteria can grow, and a

pulmonary infection can happen.
 For example, if the surgery lasts between 2-3 hours, the

patient is 5 times as likely to develop post-operative lung

complications.
 In addition, patients who have abdominal or chest surgery are less likely to

cough normally, as a forceful cough can be quite painful to a surgical incision in

those areas

 Coughing exercises are an effective way to prevent post-operative lung

infections.

 Coughing will help expand the lungs and bring up secretions.

 Coughing exercises are simple to teach and easy to do.

 The patient should be sitting upright and it is recommended that a towel or a

small pillow be held firmly over the surgical incision.

 Instruct the patient to take a deep breath, hold the breath
for a second or two and then give a forceful cough.
 Cough from the belly, not the throat.

 Press down on the towel that is covering the incision

during the cough. This is called splinting.
 It will stabilize the area, help prevent pain, and allow the
patient to perform the exercises.
 Deep breathing can be performed by itself but it is usually done along
with the coughing exercise.
 Like coughing, it expands the lungs and prevents lung infections.
 The patient should be instructed to take a very deep breath, hold the
breath for a second or two, and then slowly exhale.
 Splinting may be helpful and, in many cases, it will be necessary in
order for the patient to perform deep breathing.
 The importance of post-operative deep breathing should be
emphasized.
 Deep breathing exercises can also be done using an incentive
spirometer.
 Assessment

 Client assessment varies depending on the urgency of the

surgery.

 Time for preoperative assessment, nursing diagnosis, and

evaluation of the nursing management may be limited when a
client is admitted for ambulatory surgery or admitted shortly
01/17/2025 PREPARED BY GETNETT 49
before surgery.
 Preoperative Assessment

I. Review preoperative laboratory and

diagnostic studies

II. Review the client’s health history and

preparation for surgery
:

III. Assess physical needs

IV. Assess psychological needs

V. Assess cultural needs

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I. Review preoperative laboratory and diagnostic
studies:
• Complete blood count.
• Blood type and cross match.
• Serum electrolytes.
• Urinalysis.
• Chest X-rays.
• Electrocardiogram.

01/17/2025 PREPARED BY GETNETT 51

II. Review the client’s health history and preparation for
surgery:
• History of present illness and reason for surgery
• Past medical history
• Medical conditions (acute and chronic)
• Previous hospitalization and surgeries
• History of any past problem with anesthesia
• Allergies
• Present medications
• Substance use: alcohol, tobacco, street drugs
• Review of system

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III. Assess physical needs:
• Ability to communicate
• Vital signs
• Level of consciousness
Confusion
Lethargy
Unresponsiveness
• Weight and height
• Skin integrity
• Ability to move/ ambulate
• Level of exercise
• Prostheses
• Circulatory status
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IV. Assess psychological needs:
• Emotional state
• Level of understanding of surgical procedure, preoperative and
postoperative instruction
• Coping strategies
• Support system
• Roles and responsibilities

V. Assess cultural needs:

• Language-need for interpreter

01/17/2025 PREPARED BY GETNETT 54

 Cheek the orders for preoperative treatment,
such as enema, catheterization of folly catheter.
 The patient’s temperature, pulse, respirations
and blood pressure should be taken and
recorded on the chart just before surgery.
 Give the premeditation as ordered.
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Preparing the person the evening before
surgery.
 Hygienic care ( bathing or scrubbing )
 Skin preparation( shaving)
 Document observation of the surgical site. (note cuts
or breaks)
 Restricting food & fluid eight to ten hours preop.
 NPO after midnight.
 intravenous infusions may receive for
debilitated or malnourished patient.
 Enemas not routinely ordered except for G.I.T s
 NG tube sometimes is inserted the evening
before or the morning of surgery.
 Remove colored nail polish
 Assist the person in donning a hospital gown,
cap
 Check for laboratory record
 Blood available
 Pre-anesthetic medication given

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Pre-operative teaching:
 Deep breathing and coughing exercises To prevent pneumonia
 Incentive spirometer
 Turning & moving, leg exercise to prevent DVT
 Getting out of bed
 Pain management
Preoperative Preparations
 Intraoperative Phase
 Begins when patient is transferred to operating room
table
 Provide for patient safety
 Maintain aseptic environment
 Provide surgeon with supplies and instruments
 Documentation
Surgical Team
 Cheek the orders for preoperative treatment,
such as enema, catheterization of folly catheter.
 The patient’s temperature, pulse, respirations
and blood pressure should be taken and
recorded on the chart just before surgery.
 Give the premeditation as ordered.
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 Inserting a Nasogastric Tube

Purposes
 To administer tube feedings and medications to clients unable to eat

by mouth or swallow a sufficient diet without aspirating food or fluid into

the lungs
 To establish a means for suctioning stomach contents to prevent gastric

distention, and vomiting.

 To remove laboratory contents for laboratory analysis

 To lavage (wash) the stomach in case of poisoning or overdose of

medication
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 Gastric Lavage

Definition- This is the irrigation or washing out of

the stomach.
Purpose
1.To remove alcoholic, narcotic or any other
poisoning, which has been swallowed.
2. To clean the stomach before operation
3.To relive congestion, there by stimulating
peristalsis e.g. Pyloric stenosis
4.For diagnostic purposes
01/17/2025 PREPARED BY GETNETT 66
 Gastric gabage

To administer tube feedings and

medications to clients unable to eat by
mouth or swallow a sufficient diet
without aspirating food or fluid into the
lungs

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 GASTRIC ASPIRATION

Aspiration is to withdrawal of fluid or gas from a cavity

by suction
Purpose
 To prevent or relieve distention following abdominal
operation
 In case of gastrointestinal obstruction, to remove the
stomach or gastric contents
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To keep the stomach empty before on

emergency Abdominal operation is done

To aspirate the stomach contents for

diagnostic purposes
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 There are two type of gastric Aspiration

 Intermittent method: - In this case, Aspiration is done as condition

requires and as ordered.

 Continues method: - Attached to a drainage bag

 There are 2 ways of supplying suction

 Simple suction by the use of a syringe

  An electric suction machine

 The continues method is indicated when it is absolutely necessary

and desirable to keep the stomach

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 Enema

Enema: is the introduction of fluid into rectum and sigmoid

colon for cleansing, therapeutic or diagnostic purposes.

Purpose
 For emptying – soap solution enema

 For diagnostic purpose (Barium enema)

 For introducing drug/substance (retention enema)

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 Solution used
Normal saline
Soap solution – sol. Soap 1gm in 20 ml of H2O
Epsum salt 15 gm – 120 gm in 1,000 ml of H2O .

Classified into:
• Cleansing (evacuation)
• Retention
• Return flow enema
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 CATHETRAZATION AND
PREVALANCE OF CAUTI

8/25/2022 PREPARED BY GETINET K.(OTNS) 73

 Outline

 Introduction of catheterization
 Importance ofcatheterazation
 List types of catheter
 Prevention strategies for health care-associated UTIs
and CAUTIs
 Summary
 Learning objectives
At the end of this presentation, the particepant should able
to :-

 Explain the Definition of catheterization

 List types of catheter

 Prevention strategies for health care-associated

UTIs and CAUTIs

75
 Urinary Catheterization

Definition of catheterization: Is the introduction of a

tube (catheter) through the urethra into the urinary
bladder .
 Is performed only when absolutely necessary for fear
of infection and trauma
 Note. Strictly a sterile procedure, i.e. the nurse
should always follow aseptic technique
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Catheter: is a tube with a hole at the tip
Types of Catheter
 Straight (plain or Robinson)
 Retention (Foleys, indwelling)
 Condom catheter

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 Group exercise

Be in pair and discusion with in 1 minute

 What is the purpose of Using a straight
catheter
 What is the purpose of Inserting a Retention
Indwelling Catheter

8/25/2022 PREPARED BY GETINET K.(OTNS) 78

 Catheterization Using a straight catheter

Purpose
 To relieve discomfort due to bladder
distention .
 To assess the residual urine

 To obtain a urine specimen

 To empty the bladder prior to surgery

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 Inserting a Retention Indwelling Catheter

Purpose
 To manage incontinence

 To provide for intermittent or continuous bladder

drainage and irrigation
 To prevent urine from contacting an incision after
perineal surgery (prevent infection)
 To measure urine out put needs to be monitored hourly
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 Epidemiology
 In low- and middle-income countries (LMICs), the rate is estimated

at 8.8 per 1,000 urinary catheter-days.

 where patients have at least twice the risk of acquiring UTIs than

in high-income countries, based on indwelling urinary catheter

use (WHO 2011).

 In LMICs, the available data show that CAUTIs are the second most

frequent type of HAI (24% of all HAIs)

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 Urinary tract infection is one of the most
common HAIs.
 Urinary tract infection (UTI) is an infection involving any part of the

urinary system, including the urethra, bladder, ureter, and kidney.

 The majority (70–97%) of health careassociated UTIs are caused by

indwelling urinary catheters, known as catheter-associated

urinary tract infection (CAUTI).

 It has been estimated that 12–16% of adult patients will have an

indwelling urinary catheter inserted during their hospitalization

8/25/2022 PREPARED BY GETINET K.(OTNS) 82

 Complications associated with CAUTIs

 discomfort to the patient

 longer hospital stay,

 increased cost

 increased morbidity and mortality rates.

For these reasons and because a high percentage of

hospitalized patients are catheterized, prevention of CAUTIs
is an Important aspect of reducing HAIs.
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 Urinary Retention
 Urinary retention is defined as a failure to void and a documented

 bladder volume of > 600 mL.

 Post operative urinary retention (POUR) is common following anesthesia and has
a varied incidence, ranging from 5 to 70 percent. Unless the patient has a
diagnosed urology condition, postoperative inability to void is usually transient
however can take longer to resolve in some patients.
 The POUR risk factors are patient-specific, procedure-specific, and anesthetic-

specific.
 People who are older, males, and with a history of urinary retention or

aneurological condition, such as cerebral palsy or multiple sclerosis, are at higher

risk of having post-operative urinary retention.
 Patients undergoing pelvic surgery, joint surgery, hernia

repair or incontinence surgery are at higher risk of POUR.

 During anesthesia, an excessive IV fluid administration,

certain medications or types of anesthesia administered

may lead to patients experiencing more difficulty when

needing to void post-operatively.

 The nurse should be aware that types of anesthesia and

analgesics can cause urinary retention, pain, and anxiety.

 Also, when the patient tries to void while in a supine position

this can contribute to POUR.

 Urinary retention can result in a prolonged hospital stay,

bladder infections, an infection from urinary catheterization,

and bladder dysfunction.

PREVENTING CATHETER-ASSOCIATED URINARY TRACT INFECTIONS (CAUTIS) STRATEGIES

 Use Infection prevention and control (IPC)

principles during insertion and maintenance of
indwelling urinary catheters
 Monitoring and surveillance of CAUTIs
 Quality improvement for prevention of CAUTI

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 2.3 Mechanism
Organisms gain access to bladder in one of two ways

 From the outside of the catheter (Extra-luminal)

microorganisms migrate to the bladder along the outside

of the catheter via the mucosa of the urethra.

 From the inside of the catheter (intraluminal)

microorganisms gain access to the bladder via

movement along the inside (lumen) of the catheter.

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 CAUTI risk factors can be divided into two groups

1.Catheter-related factors include Duration of catheterization, poor

insertion technique, poor catheter care and Failure to maintain a closed

drainage system

2.Patient-related factors:

 Compromised immune system,

 Diabetes mellitus

 Renal dysfunction

 Fecal incontinence, Female sex and Elderly age

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 Key strategies for prevention of CAUTIs include the following:

 Insert a catheter only when indicated

 Remove the catheter as soon as possible.

 Use recommended IPC practices for insertion.

 Keep the catheter secured to minimize bladder trauma.

 Ensure recommended catheter maintenance practices.

 Educate patients and families about preventing CAUTI.

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 Recommended Catheter Maintenance Practices

 Educate HCWs on the insertion, care, and maintenance of urinary

catheters and prevention of CAUTIs.
 Always follow Standard Precautions to protect
 Perform hand hygiene
 Check the flow of urine through the catheter several times a day to ensure
that the catheter is not blocked.
 Cleanse the perineal area daily with soap and water during routine
bathing while the catheter is in place .
 Keep the catheter and collecting tube free from kinks and dependent
loops
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 2.6 Monitoring and Surveillance of CAUTI
 Surveillance can be used to identify areas in which IPC
practices can be improved to decrease CAUTIs.
 It can, however, be labor-intensive and consume precious
resources. However, because CAUTI is one the most common
HAI in low resource settings, CAUTI surveillance in areas with
 high use of indwelling urinary catheter should be considered.
 A facility IPC risk assessment can help guide these decisions

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 Quality Improvement for CAUTI
 Once CAUTI rates are known, efforts should be made to
reducing CAUTI, which can improve patient out comes and
reduce facilities‘ cost of providing care.
 Multidisciplinary teams with representatives from the various
disciplines can help prevent CAUTI,
 The multidisciplinary team should work together to plan, do,
and sustain quality improvement efforts, guided by
surveillance data and evidence-based practices.

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 The multidisciplinary team should work together to plan,

do, and sustain quality improvement efforts, guided by

surveillance data and evidence-based practices.

 Based upon the team‘s consensus, the improvement

process should include ongoing quantitative measurement

of improvements and timely feedback of results and

successes.
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 Summary

 Health care workers can prevent CAUTIs by limiting use of

indwelling urinary catheters, daily reviews of indications for
continuation of indwelling catheters, and stringently applying
the IPC.
 practices recommended in this chapter for insertion,
maintenance, and removal.
 Applying recommendations of the CAUTI prevention bundle
will also help avoid infections.
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 THANK YOU

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