Pre- and Post-Operative Care
Lesson Objectives
By the end of this topic, learners should be able to:
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Describe pre-operative assessment and preparation.
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Understand informed consent and ethical considerations.
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Identify perioperative prophylaxis measures.
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Monitor patients post-operatively and recognize complications.
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Apply nursing and medical perspectives for optimal surgical outcomes.
Key Glossary Terms
1. Pre-Operative Assessment
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Definition: Evaluation of patient before surgery to determine fitness and optimize outcomes.
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Components:
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Medical history (comorbidities, previous surgeries)
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Medications and allergies
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Physical exam
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Laboratory tests and imaging
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Anesthesia assessment
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2. Informed Consent
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Definition: Voluntary agreement by patient after understanding procedure, risks, benefits, and alternatives.
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Nursing Relevance: Ensure patient comprehension, witness signature.
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Medical Student Relevance: Legal and ethical responsibility; patient-centered care principle.
3. Pre-Operative Prophylaxis
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Antibiotic Prophylaxis: Prevents surgical site infections (SSI).
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DVT Prophylaxis:
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Mechanical: Compression stockings, pneumatic devices
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Pharmacologic: Low molecular weight heparin (LMWH)
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Fasting Guidelines: Reduce aspiration risk (6–8 hrs for solids, 2 hrs for clear fluids).
4. Post-Operative Monitoring
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Vital Signs: Monitor BP, pulse, respiratory rate, temperature, oxygen saturation.
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Fluid Balance: Intake/output, IV fluids.
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Wound Care: Check for bleeding, infection, or dehiscence.
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Pain Management: Analgesics (opioid and non-opioid) tailored to patient needs.
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Early Mobilization: Reduce risk of DVT, pneumonia, and ileus.
5. Common Post-Operative Complications
| Complication | Clinical Features | Nursing/Medical Management |
|---|---|---|
| Bleeding/Hemorrhage | Hypotension, tachycardia, swelling, pallor | Monitor vitals, wound inspection, surgical intervention if severe |
| Infection | Fever, erythema, pus, tenderness | Culture, antibiotics, wound care |
| Deep Vein Thrombosis (DVT) | Leg swelling, pain, erythema | Anticoagulation, compression devices, early ambulation |
| Pulmonary Complications | Atelectasis, pneumonia | Incentive spirometry, oxygen therapy, mobilization |
| Ileus | Abdominal distension, absent bowel sounds | Nasogastric decompression, fluids, mobilization |
| Urinary Retention | Difficulty voiding | Catheterization, bladder scan |
| Wound Dehiscence | Separation of wound edges | Wound care, possible re-suturing |
6. Nursing & Medical Student Focus
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Nursing: Monitor vitals, wound care, patient education, early mobilization, and infection prevention.
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Medical Students: Recognize complications, understand physiology, plan interventions, document findings, communicate with surgical team.
7. Pre-Op and Post-Op Mnemonics
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ABCDE for Pre-Op Checks: Allergies, Blood work, Consent, Diet restrictions, Equipment readiness
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POST-OP Care Mnemonic: Pain, Oxygen, Surgical site, Temperature, Output, Position
Tables
Table 1: Fasting Guidelines Pre-Op
| Type of Intake | Minimum Fasting Time |
|---|---|
| Solids | 6–8 hours |
| Breast milk | 4 hours |
| Clear fluids | 2 hours |
Table 2: Early Post-Operative Interventions
| Complication | Nursing Intervention | Medical Intervention |
|---|---|---|
| Bleeding | Monitor vitals, pressure dressing | Re-explore wound if severe |
| Infection | Dressing changes, asepsis | Antibiotics, culture-guided therapy |
| DVT | Compression stockings, mobilization | Anticoagulants |
| Pulmonary | Incentive spirometry | Oxygen therapy, antibiotics if pneumonia |
| Ileus | NPO, NG tube if needed | Fluid/electrolyte correction |
| Pain | Analgesics, repositioning | Opioid titration, multimodal pain therapy |