Preoperative stay refers to the processes that involve the preparation of a patient before surgery. In broad understanding, it involves both the physical and psychological preparation of the patient. Research reveals that patients who are adequately prepared both physically and psychologically have better surgical results and achieve faster rates of recovery. This is because the preoperative teaching adequately equips the patient with much-needed information on the experience during the operation which in turn lowers down the fears of the patient. Preoperative care remains fundamentally important before any type of surgical procedure. This process is best provided individually due to the fact that the demands of the patients differ. Some patients would demand as much information as possible to reduce their levels of fear while others would want as little as possible to lower their levels of anxiety.
A number of preoperative issues always come into focus before surgery. One fundamental issue is the physical preparation of the patient. According to Edwards & Brown (2008), “physical preparation may consist of a complete medical history and physical exam, including the patient’s surgical and anesthesia background and the patient should inform the physician and hospital staff if he or she has ever had an adverse reaction to anesthesia (such as anaphylactic shock), or if there is a family history of malignant hyperthermia”.
This process also entails “an undertaking of the laboratory tests to determine the complete blood count, electrolytes, activated partial thromboplastin time, and urinalysis” (Edwards & Brown, 2008). In the physical preparation of the patient, he or she is likely to have an electrocardiogram (EKG) if there is a medical history of cardiac disease. This process is also suitable for patients who are 50 years of age. The next process to be undertaken on the patient is an analysthe is of history of respiratory complications through a chest x-ray.
There exist more sub-issues that must also be considered in the physical preparation. Fowler (2010) succinctly illustrates that “part of the preparation includes assessment for risk factors that might impair healing, such as nutritional deficiencies, steroid use, radiation or chemotherapy, drug or alcohol abuse, or metabolic diseases such as diabetes; and the patient should also provide a list of all medications, vitamins, and herbal or food supplements that he or she uses”. It must be noted in this issue that even though the use of supplements is always ignored; they may result in very diverse effects in instances where they have been used in conjunction with anesthetics.
The second issue that also remains important in preoperative care is psychological preparation. “Patients are often fearful or anxious about having surgery and as such, it is often helpful for them to express their concerns to health care workers (Crisp & Taylor, 2009). This procedure is critically important to patients who are critically ill or are undergoing very high-risk surgical procedures. The age of the patient is also an issue for consideration in that children are often very fearful and should be close to their parents as much as possible to avoid a feeling of loneliness.
The third issue in preoperative care is the practice teaching. This issue involves the provision of information as regards instructions about the preoperative period, issues of the surgery itself, and any relevant piece of information that may be important during pre and post-operativ periods. “Knowledge about what to expect during the postoperative period is one of the best ways to improve the patient’s outcome and instruction about expected activities can also increase compliance and help prevent complications”(Tollefson, 2010).
The understanding on how to deal with the issue of pain management in preoperative patient care remains very central to reducing the patient’s level of anxiety. This is due to that fact that pain remains the primary concern of most surgery patients. Tollefson (2010) demonstrates the importance of pain management by stating that “Preoperative instruction should include information about the pain management method that they will utilize postoperatively”. Patients should be encouraged to take their medications incase of acute pain conditions. Alternative methods of pain control such as music therapy, imagery, distraction, positioning and mindfulness are best presented in controlling pain (Tollefson, 2010).
The last issue in this paper on preoperative care is the informed consent. The role of a guardian or a parent in this process is very important in that a formal consent must be given before surgery is done. In most instances, the nurse plays the role of a witness during the signing of the consent form.
The postoperative care begins at the end of the surgery procedure and the patient is taken to a special ward to recover from anesthesia and comes to an end when the patient if fully recovered and discharged from the nursing facility. The intensive monitoring takes place in the postanethesia care unit (PACU) that is also known as postanethesia reacting (PAR). During the period in PACU, the nurses ensure that the patient returns safely to the general unit. The focus of nursing in PACU remains different from that in the general unit because in the latter, the patient is in a more stable condition.
Problem Identification in pre and postoperative care
Problem based learning in the nursing profession demands that there are adequate problems that are readily available for nurses to handle (Barrows and Tamblyn, 1980). Surgical procedures come along with a variety of complications and health problems that are best detected and handled swiftly and appropriately to avoid further multiple complications. The application of problem based approach in the detection of these problems to effectively come up with intervention or actions to address them is suitable in surgical complications. The early detection of these complications on admission through a review of preoperative instructions such as diet and fluid restrictions, the important step of bowel and skin preparations, and the temporary withdrawal of self-administration of medications. The identification of the patient’s potential risks is swiftly done to avoid the instances of preoperative complications.
In the problem based analysis and detection, there are a number of indicators that can be effectively put to use for the detection of these complications. These indicators are referred to as variable factors of a patient and constitute age, nutritional status, substance abuse and medical problems. Age factor constitute a very important pointer to the detection of preoperative and post operative complications. Very young and immature organs and regulatory systems complicate the surgical procedure and is commonly a product of various potential complications. These include respiratory obstruction, fluid overload, dehydration, hypothermia and infection. In the elder people, the multiple organ degeneration due to their slow responses results to the potential risks of decreased metabolism, fluid overload and renal failure.
According to Schuster (2008), “Postoperative nausea and vomiting (PONV) are among the most common adverse events after surgery and anesthesia in comparison to other postoperative complications like wound infection, deep vein thrombosis, PONV is of minor medical importance; it almost never kills”. This complication is often very distressful to patients and thus requires agent attention or an effective preventive measure.
In most instances, it ends within the next 24 hrs after the surgery. The most disturbing statistics is that most surgical patients suffer from Postoperative nausea and vomiting (PONV). The preventive measure for this complication is the administration of proper nutrition. Spinasanta and Rodts (1999) illustrates that effective approaches towards the handling of this complication is that “patients may only be allowed ice chips, sips of water or clear liquids the first day or two and their nutritional needs are met through IV fluids” this process is then progressed as the patient advances to balanced diet. Fever is another common complication of surgical procedure. A large number of surgical clients experience high levels of fever that occurs during the next 48 hours or more. This calls for necessary post operative clinical measures to protect then patients from adverse body temperature fluctuations.
According to Jawaid, Masood and Iqba (2004), “the most frequent complication observed was postoperative fever in 75 (18.2%) patients”. In addition to the above, fever experienced by most postoperative patients is as a result of inflammatory stimulus. Furthermore, pyrexia that affects these patients has been documented to occur as a result of pulmonary atelectasis. Jawaid, Masood and Iqba (2004) assert in their study that “pyrexia may be the result of thrombophlebitis or infection of the urinary tract or the chest, and, more than five days after surgery, a wound infection or anastomotic breakdown should be suspected.” This complication is best approached by frequent monitoring by the nurses and placing the client in an area that provides adequate air circulation.
Preoperative pulmonary complications remain common and distressing complication of surgical procedures. This is due to the development of respiratory tract infection that is also a product of gastrointestinal tract that resume normal operation after different time intervals. The bowel is affected to a lower degree because of its small size; the stomach can take approximately 24-48 hours while the colon takes the longest time interval to resume operation. This is always between 48-72 hours. “If postoperative ileus lasts longer than 3 days, it is thought to be complicated, and may be termed postoperative paralytic ileus” ref. According to Timby (2008), “surgical clients ambutate with assistance as soon as possible to reduce the potential for pulmonary and vascular complications”.
The appropriate nursing actions or intervention for this complication is the application of pneumatic compression device that promotes the overall circulation and release of excess fluids into the lymphatic vessels. Other simpler nursing interventions include the provision of a lot of fluids to the client as a measure to prevent the occurrence of thrombi. The avoidance of long periods of sitting and keeping the legs stretched, ambulating and frequently changing positions aids in the reduction of thrombi occurrence.
Wound infection is a common surgical complication that affects many clients because of a number of reasons. Referred to as wound dehiscence, it begins with the discharge of serosanguinous from the wound during the fists seven days after the surgery. The clinical nursing intervention is the close monitoring of the wound and its mode of discharge once in every shift. In the case the charge dressings become loose, it is adequately fastened.
“Venous thromboembolism (VTE) is considered to be a significant cause of morbidity and mortality in hospitalized patients, especially in those undergoing major surgical procedure” (Lemone &Burke, 2008). This is more pronounced in the absence of adequate prophylaxis that may lead to the worst from of complication referred to as the deep vein thrombosis (DVT).
Complications have the ability to occur once or multiple times after an operation. While some of these complications are complicated and require further surgical procedures, most of them can be effectively prevented or controlled through the evaluation of preoperative processes. Furthermore, the application of sound surgical techniques and an effective and closely monitored postoperative care contribute significantly to controlling and preventing the effects of surgical complications.
Other applicable intervention techniques towards the achievement of faster return to normal health status include the effective communication and evaluation of the client improvement indicators. In addition to these, patients can only remain safe if they are properly advised on what is expected of them in their postoperative life. The timely education on the adverse effects of some activities after the surgery is effective in enhancing a faster return to normal life. Lastly, prompt detection and interventions of these complications remain the fundamental steps in the reduction of the overall effects of these surgical complications.
Barrows, H, S. and Tamblyn, R, M. (1980). Problem-based learning: an approach to medical education. Springer Publishing Company.
Crisp, J. & Taylor, C. (2009). Potter & Perry’s Fundamentals of Nursing. (3rd Ed) Marrickville, N.S.W.: Mosby Harcourt Australia.
Edwards, D. & Brown, D. (2008). Lewis’s Medical – Surgical Nursing: Assessment and Management of Clinical Problems. Sydney: Elsevier Mosby.
Fowler, J. (2010). Staff Nurse Survival Guide: Essential questions and answers for the practising staff nurse (2nd Ed) Quay Books London.
Jawaid,M., Masood, Z. and Iqbal, S.A. (2004). Post-operative Complications in a General Surgical Ward of a Teaching Hospital. Web.
Lemone, P. & Burke, K. (2008). Medical – surgical nursing: Critical thinking in client care. 4th Edition, New Jersey, Pearson Prentice Hall.
Schuster, P. (2008). Concept Mapping: A critical-thinking approach to care planning. (2nd Ed) Philadelphia: F. A. Davis.
Spinasata, S. and Rodts, M. (1999). Post-Operative Care: Activity, Incision Care, Rehab and Recovery. Web.
Timby, B.K. (2008). Fundamental Nursing Skills and Concepts. Lippincott Williams & Wilkins.
Tollefson, J. (2010). Clinical Motor Skills: Assessment tools for nursing students.(4th Ed.). Tuggerah, N.S.W.: Social Science.