1. MR. ABHIJIT BHOYAR
Lecturer
M. sc. nursing

2. SURGERY
DEFINITION
surgery can be defined as the art and
science Of treating diseases, injuries
and deformities by operation and
instrumentation

3. SURGICAL PROCEDURE COMMONLY GROUPED
ACCORDING TO THE:
A) PURPOSES
• Diagnostic
• Palliative
• Ablative
• Reconstructive or
cosmetic
• Transplant or corrective
• Curative
• Repairative
• Restorative

4. B) DEEGRY OF URGENCY
• EMERGENCY SURGERY
• IMMEDIATE
• URGENT
• ELECTIVE SURGERY
• REQUIRED
• RECOMMENDED
• OPTIONAL
C) DEEGRY OF RISK
INVOLVED
• MAJOR SURGERY
• MNOR SURGERY

5. PREOPERATIVE CARE OF PATIENT
1. PSYCHOLOGICAL PREPARATION OF THE PATIENT
Discuss with the patient to give full information about the surgery, such
as .
 Type of surgery
 Consequence of surgery (if it is done and if it is not done)
 The problems to be faced (disabilities expected)
 Expected duration of hospitalization
 Expected time of resuming duty (if employed)
PREOPERATIVE CARE OF THE PATIENT BEGINS AS SOON AS THE SURGEON MAKES A
DIAGNOSIS AND DECIDES THAT AS OPERATION IS NECESSARY
FOR THE PATIENT

6. 2. ERADICATE FEAR OF OPERATION FROM THE PATIENT
 Allow patient to ask the questions.
 Introduce patient to some other patient who recover from that same
diagnosis.
 Explain about surgery, anesthesia
 Explain regarding meal.
Cost of surgery
Treatment/investigations done before surgery and its purposes
Necessary arrangements to be made about the family, financial
matters, work, hospitalization, etc

7. 3. MEET THE SPIRITUAL; NEEDS OF THE PATIENT
• Help the patient to meet the ministers of his religion, if requested by
the patient

8. 4. OBTAIN INFORMED CONSENT
• Obtain the consent from the patient/ guardian for each operation
after explaining the nature of the operation and anaesthesia.
• Never compel the patient/ guardian to give their consent
• Explain the complications that may occur when they is under
anaesthesia.
• The language used in the consent form should be by the patient/
guardian, who gives the signature
• Obtain consent for major diagnostic procedure

9. 5. BUILD UP THE GENERAL HEALTH OF THE PATIENT
& CORRECTION OF DISEASE PROCESS FOR SPEEDY
RECOVERY
• Assist doctor for examination.
• Carry out the all the examination by the doctors ordered
• Collect all the baseline date which is required
• arranged for the blood donor
• Maintained diet

10. 6. PREOPERATIVE TEACHING
• Stop smoking (if the patient is a smoker)
• Maintain personal hygiene
• Deep breathing and coughing exercises to prevent chest
complications.
• Active and passive exercises of the limbs to prevent postoperative
thrombus (blood clot)
• Control of visitors to prevent cross infection

11. 7. SURGICAL PREPARATION OF THE SKIN
• Shaving
• Maintained personal hygiene
• Paint the area of the surgical site

12. 8. PREPARATION OF THE PATIENT ON THE
EVENING BEFORE OPERATION
• Remove all jewellary
• Get the order from the physician for immediate
preoperative care
• Medication given by doctors order if necessary
• Shave the surgical area
• Give enema at evening

13. 9. PREPARATION OF THE PATIENT ON THE
DAY OF SURGERY
• Help the patient to go to the toilet
• Remind the patient and relative about fasting.
• Check the doctors order
• Check the operation site preparation
• Introduce nasogastric tube, urinary catheter, etc if ordered
• Stop all medication unless special ordered by the doctor

14. 10. SENDING THE PATIENT TO OPERATING
ROOM
• Administered the premedication to the patient
• Check the vitals
• Changed the patient dress
• Ask the patient to void.
• Transfer the patient on the trolley
• Never leave the patient alone
• Send all the charts with the patient
• Send the patient with attendant.

15. NURSING DIAGNOSIS OF THE PRE-
OPERATIVE CLIENT
1. Anxiety related to lack of knowledge about pre-operative routines
and post-operative care.
2. Fear related to effect of surgery and ability to function in usual
roles.
3. Fear related to the risk of death.
4. Anxiety related to the outcome of exploratory surgery for
malignancy.

16. 5. Fear related to loss of control during anaesthesia or up during
anaesthesia.
6. Anxiety related to the perceived inadequate post operative
analgesia.
7. Sleep pattern disturbance related to hospital routine and
psychological stress.

17. 8. potential for risk of aspiration related to the position used for
surgery and anaesthesia.
9. potential for risk of perioperative positioning injury related
improper positioning and inadequate support
10. Potential for impaired skin integrity related to surp.cal incision and
infection.
11. Potential for altered tissue perfusion related to anaesthetic drugs.

18. INTRAOPERATIVE CARE
When the client arrives in the operating room three groups of personnel
are involved in the care:
1. THE ANESTHETIC TEAM
2. THE SURGICAL TEAMS
3. THE OPERATING ROOM NURSES
• These team have the role that is in the circulating and scrubbing.

19. INTRAOPERATIVE NURSING FUNCTION
• CIRCULATING ACTIVITIES
INCLUDE
 Assuring for the cleanliness,
 Proper temperature,
 Humidity and lighting,
 The safe functioning of the
equipment
 The availability of the supplies.
• THE SCRUB ACTIVITIES
INCLUDING
 Scrubbing for the surgery,
 Setting up the sterile table,
 Preparing suture,
 Special equipment necessary for
the surgery.

20. POST OPERATIVE CARE
1. PREPARATION OF POST ANESTHETIC BED &
RECEPTION OF THE PATIENT
• Prepare bed for the patient
• There should be adequate number of people to transfer the
patient
• Received patient without disturbing the devices attached to
the patient

21. • Check operation site for the bleeding or any discharge.
• Keep the patient well covered and comfortable
• Never leave the patient alone
• Observe the patient for swallowing reflex. If not present
keep the patient in a sideling position to prevent the
tongue falling back and obstructing the airway
• Check the doctors order

22. 2. CARE OF THE PATIENT WHO IS UNDER THE
EFFECTS OF ANAESTHESIA
• Patient needs close and diligent observation until the patient fully
recover from anaesthesia. This will help to detect the early signs of
complications after surgery and the nurse will be able to respond
immediately.
• A noisy breathing is indicative of airway obstruction that can occur
due to the tongue falling back and obstructing the pharynx, or fluid
collected in the airway passages or fluids aspirated into the lungs.
Apply suction immediately, send call the surgeon and the
anaesthetist.

23. • Keep the patient in a suitable position that will be helpful to drain
out the vomitus, blood and secretions collected in the mouth and will
prevent them aspirating into the lungs. This position is maintained
until protective reflexes are returned.
• The oro-pharyngeal airway left in the mouth of the patient should be
removed as soon as the patient has regained the cough and
swallowing reflexes
• Excessive secretions in the mouth or anywhere in the respiratory
passage can lead to airway obstruction. It should be sucked out. If
intra-tracheal suctioning is necessary, always use sterile technique.

24. • If the patient is cyanosed, administer oxygen inhalation. At the same
time, find out the cause and remove the cause. prolonged oxygen
therapy should be guided by arterial blood as determinations
• A weak thready pulse with a significant fall in blood pressure may
indicate circulatory failure. It may also indicate loss from the body.
The surgeon and the anaesthetist should informed.
• In order to prevent injury from falls from bed, put the rails on the
bed. Till the patient recover from the effects of anaesthesia, the
nurse should not leave the patient Alone

25. • Patient recovering from anaesthesia may ask for drinking water
Unless the patient has fully regained the swallowing reflex, drinking
water may choke the patient; it should not be given.
• As the patient is recovering from the effects of anaesthesia, the
patient may become restless due to the discomfort caused by the
presence of those devices attached to the patient, such as i.v. sets,
urinary catheters, drainage tubes etc.
• The nurse should help the patient by giving adequate explanations

26. • Keep the family informed of the successful completion of
surgery, transfer of the patient from the operating room to
recovery room etc. These information will reduce their
anxiety.
• If possible, allow the relatives to meet surgeon to clear their
doubts.

27. 3. OBSERVATION OF THE PATIENT IN THE POST
OPERATIVE PERIOD
• Close and diligent observation by the nurses are important to detect
complications in the early stages, and thus, save the patient.
• On the first post operative day the patient needs close and frequent
observations : e.g., the vital signs are checked every 15 minutes or
more frequently
The main points that should be observed are :
• Vital signs—blood pressure, pulse rate, respiratory rate, skin colour,
skin temperature.
• Intake and output — I.V. fluids, oral fluids taken by the patient, naso-
gastric aspiration, wound drainage, blood loss.
• Abdominal girth in patients with abdominal distension.

28. • Urinary output - time and amount.
• Bowel movements.
• Signs of hypo/ hypervolaemia.
• Any breathing difficulties.
• Pain over the calf muscles.
• Operation site for bleeding, drainage
• Any specific observation as told by the surgeon and according to the
operation done.

29. 4. CARE OF WOUND
• Check Dressing
• Dressing should be regular
• Skin care
• Infection control
• Proper diet

30. 5. DIET OF THE PATIENT
• All patients, except patients who had abdominal surgery, may start
the normal diet, if desired so, on the first day. Remember to exclude
nausea and vomiting due to the effect of anaesthesia.
• patient who had abdominal surgery, but did not involved the
intestine or stomach, can have the clear fluids on the day after the
surgery.
• Gradually, it can change into soft diet and then normal diet.

31. • Patients who are with specific diseases, for which they scare
taking special diets, should continue to observe the control of
their diet as ordered by the doctor (e.g., a diabetic patient)
• Remember, the patients who had undergone any type of
surgery need a diet rich in vitamins and minerals.

32. 6. POST OPERATIVE HEALTH TEACHING
All patients need health teaching according to the education at
background of the patient. Teach the patient following points
• Maintenance of personal hygiene.
• Diet that is allowed for the patient; any control on the diet.
• Ambulation; activities that are permitted, as well as restricted.
• Any adjustments to be made in the occupation of the patient.

33. • Any drugs to be taken post operatively; the side effects and
precautions.
• Date on which the patient may resume duty.
• Learning of any particular procedure to be carried out
postoperatively, e.g., care of the colostomy. When the patient is
unable to perform the procedure, teach the patient's relatives.
• Future treatment that may be needed for the patient in any other
hospital e.g., radiation therapy for cancer patients.

34. NURSING DIAGNOSIS OF POST OPERATIVE
CLIENTS
 Ineffective airway clearance related to effects of medications and
anaesthetic agents.
 Ineffective breathing pattern related to pain, surgical incision and
medications.
 Risk for altered body temperature, hypothermia — related to the
use of drugs, infusion of cold fluids, inhalation of cold gases etc.
 Risk for injury related to post anaesthetic status.
 Pain related to surgical incision and reflex muscle spasm.

35.  Altered nutrition, less than body requirements.
 Risk for fluid volume deficit related to loss of fluid during surgery
and inadequate intake of fluid after surgery.
 Nausea and vomiting related to gastrointestinal distension
medication, anaesthetic effect and stimulation of vomiting centre or
chemoreceptor's trigger zone.
 Risk for infection related to surgical incision, inadequate nutrition
and fluid intake, presence of environmental pathogens, invasive
catheter and immobility.
 Altered urinary elimination related to decreased activity, effects of
medication and reduced intake of fluid.