learning Objectives - Demonstrate skill in preparing the client for surgery. Recognise and perform the role of nurse during surgery. Demonstrate skill in giving care to clients after surgery (post-operative care)
Hours - 8
Teaching and Learning Activities - Lecture cum discussion Demonstration Videos
Assessment Methods - Short answer Objective type Essay type Return demonstration
Content of the chapter
Management of patient undergoing surgery
a) Pre operative preparation and care
– Physical
– Psychological,
– Pre-medications
– Legal and ethical
b) Intra operative management
– Surgical Team
– Nursing activities and responsibilities
– Anesthetic agents
– Role of nurse in anesthesia
c) Post operative Management
– Immediate care
– Transferring patient from operation theatre
– Patient in recovery room
– Recovery from Anesthesia
– Post operative observation and nursing
management
– Carryout the post operative orders.
– Postoperative complication observation,
prevention & management.
Management of Patient Undergoing Surgery
Surgical management involves pre-operative, intra-operative and post-operative care to ensure patient safety, reduce complications and promote early recovery.
a) Pre-operative Preparation and Care
Pre-operative care begins from the decision for surgery until the patient is shifted to the operation theatre.
1. Physical Preparation
- Complete history taking and physical examination
- Baseline investigations:
- Blood tests, urine examination
- ECG, chest X-ray (if indicated)
- Vital signs assessment
- Ensure nil per oral (NPO) status (6–8 hours before surgery)
- Bowel preparation if required
- Skin preparation:
- Bath with antiseptic soap
- Hair removal (clipping, not shaving)
- Bladder care (voiding or catheterization)
- Removal of:
- Jewelry, dentures, nail polish, contact lenses
- Maintain IV access
- Identification band and surgical site marking
2. Psychological Preparation
- Explain:
- Type of surgery
- Expected outcome
- Post-operative pain and care
- Reduce anxiety by:
- Encouraging expression of fears
- Providing emotional support
- Teach:
- Deep breathing exercises
- Coughing and splinting
- Leg exercises and early ambulation
- Involve family members when appropriate
3. Pre-medications
Purpose:
- Reduce anxiety
- Decrease secretions
- Prevent nausea and vomiting
- Induce sleep
Common pre-medications:
- Sedatives (Midazolam, Diazepam)
- Anticholinergics (Atropine, Glycopyrrolate)
- Analgesics (Morphine)
- Anti-emetics (Ondansetron)
- Antibiotics (prophylactic)
4. Legal and Ethical Aspects
- Informed consent obtained and documented
- Verify:
- Correct patient
- Correct procedure
- Correct site
- Respect:
- Patient dignity and privacy
- Cultural and religious beliefs
- Maintain confidentiality
- Follow hospital policies and ethical principles
b) Intra-operative Management
Intra-operative care begins when the patient enters the operation theatre and ends when shifted to recovery room.
1. Surgical Team
- Surgeon
- Assistant surgeon
- Anesthesiologist
- Scrub nurse
- Circulating nurse
- OT technician
2. Nursing Activities and Responsibilities
Before Surgery
- Check consent and investigation reports
- Ensure NPO status
- Count instruments, sponges and needles
During Surgery
- Maintain sterile field
- Assist surgeon
- Monitor patient position
- Prevent pressure injuries
- Maintain accurate counts
- Monitor vital signs (with anesthetist)
After Surgery
- Ensure correct sponge and instrument count
- Apply sterile dressing
- Prepare patient for transfer
3. Anesthetic Agents
Types of Anesthesia
- General anesthesia
- Regional anesthesia (spinal, epidural)
- Local anesthesia
- Sedation / Conscious anesthesia
Common agents
- Inhalational: Nitrous oxide, Halothane, Isoflurane
- IV agents: Propofol, Ketamine
- Muscle relaxants: Succinylcholine
4. Role of Nurse in Anesthesia
- Prepare anesthesia equipment
- Assist anesthetist
- Monitor:
- Airway
- Oxygen saturation
- Vital signs
- Observe for adverse reactions
- Ensure patient safety and positioning
c) Post-operative Management
Post-operative care starts after surgery and continues until full recovery.
1. Immediate Post-operative Care
- Maintain airway patency
- Position patient:
- Lateral or semi-Fowler’s
- Monitor:
- Vital signs
- Oxygen saturation
- Observe for bleeding
- Manage pain
- Maintain IV fluids
2. Transferring Patient from Operation Theatre
- Ensure:
- Stable vital signs
- Patent airway
- Transfer with:
- Oxygen
- IV fluids
- Drain tubes and catheters secured
- Proper handover to recovery nurse
3. Patient in Recovery Room
- Continuous monitoring:
- Respiratory status
- Cardiovascular status
- Level of consciousness
- Check:
- Surgical site
- Drain output
- Urine output
- Maintain warmth
- Prevent aspiration
4. Recovery from Anesthesia
Signs of recovery:
- Stable vital signs
- Adequate respiration
- Responsive to commands
- Protective reflexes return
Nursing care:
- Airway support
- Oxygen therapy
- Monitor nausea and vomiting
5. Post-operative Observation and Nursing Management
- Vital signs monitoring
- Intake and output charting
- Wound care and dressing
- Pain assessment and management
- Early ambulation
- Deep breathing and coughing exercises
- Prevent complications
6. Carrying Out Post-operative Orders
- Administer prescribed:
- Antibiotics
- Analgesics
- IV fluids
- Monitor laboratory results
- Maintain drains and catheters
- Dietary progression:
- NPO → liquids → soft diet
7. Post-operative Complications: Observation, Prevention & Management
Common Complications
Respiratory
- Atelectasis, pneumonia
- Prevention: Deep breathing, incentive spirometry
Cardiovascular
- Shock, DVT
- Prevention: Early ambulation, leg exercises
Wound
- Infection, dehiscence
- Prevention: Aseptic technique
Gastrointestinal
- Nausea, vomiting, paralytic ileus
Urinary
- Retention, infection
Conclusion
Effective surgical patient management requires systematic nursing care before, during and after surgery. Proper preparation, vigilant monitoring and early intervention play a key role in preventing complications and promoting safe recovery.