Nursing Procedures & Protocols for Pre- and Post-Operative Care

Lesson Transcript
Instructor: Rachel Torrens

Rachel obtained a Bachelor of Science in Biology from Grove City College. She then earned her Bachelor's and Master's Degree in Nursing from Thomas Jefferson University. For over 8 years, Rachel has practiced as a Board Certified Family Nurse Practitioner, and taught science to elementary aged students.

Nurses are a vital part of surgical success, particularly in the pre-operative and post-operative care steps. Explore the nursing procedures and protocols related to pre-operative and post-operative care, assessing patients, and patient education. Updated: 01/21/2022

Essentials of Preoperative Care

You ran a mile and your time was 8 minutes 23 seconds. So is this a crushing defeat or awesome news? Well, without knowing the baseline it would be impossible to say! If you're a trained runner, normally averaging a 5-minute mile, then this time would be a humiliation. But if you're a new runner, who normally takes 10 minutes to finish a mile, then this time would be a success. Knowing the baseline is critical for you to interpret the result properly.

The goal of preoperative care, or care given leading up to an operation, is to establish a baseline for the patient. Once the baseline is defined, noticing deviations from this baseline during and after surgery becomes easier. Thoroughly examining the patient allows the healthcare team to establish this baseline.

Preoperative goals include:

  • Assessing pre-existing health problems
  • Identifying any new medical issues
  • Assuring the patient is ready physically and psychologically for surgery

But, how exactly are these pre-operative goals accomplished? Through obtaining and performing:

  1. Detailed patient history
  2. Complete physical exam, including necessary imaging and blood work
  3. Patient education

Detailed Patient History

The first step is a detailed patient history. Interviewing the patient will provide loads of information, such as allergies, current medications, past medical history, and past surgical experiences. Special attention should be paid to current medical issues, especially those that could adversely affect the outcome of the surgery, like heart disease, chronic respiratory disease, diabetes, or renal dysfunction.

Also, certain lifestyle factors can adversely affect surgical success, like obesity or smoking. Making note of these factors helps better prepare the surgical team for possible complications.

Complete Physical Exam

Next comes the preoperative physical examination, including a brief overview of all systems, but with a special focus on cardiac, respiratory, and renal systems.

Common tests to assess these systems are:

  • Electrocardiogram
  • Chest X-ray
  • Complete blood count
  • Chemical metabolic panel
  • Coagulation screening

A nurse should be familiar with a patient's history, examination, and test results. Knowing this information allows a nurse to be aware of a patient's vulnerabilities and anticipate which complications are more likely to arise.

Patient Education

Lastly, preoperative care includes patient education. The nurse must make sure the patient feels well informed about the entire operative procedure.

The preoperative education includes:

  • Giving instruction related to preoperative preparations, such as bowel evacuation or the need to be fasting
  • Providing realistic expectations regarding the pre-, intra-, and postoperative periods

For example, if a patient is accustomed to having a cup of tea every morning to steady her nerves, and she may not have that cup of tea on the morning of surgery, then this may lead to increased anxiety. The nurse needs to coach the patient in alternative ways to decrease anxiety. Otherwise, the patient will have high anxiety before even entering the operating room!

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Coming up next: Common Medical Emergencies for Nurses: Types & Strategies

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Essentials of Postoperative Care

The surgery is successfully completed! Now, the nurse enters postoperative care, or the care given after the operation is completed until the time of discharge to home. Depending on the surgery, the length of postoperative care can vary from hours to days, but no matter the length, the nurse is responsible for observing the patient.

After surgery, the cardiac and respiratory systems are closely observed. In fact, respiratory complications are the most common postoperative cause of morbidity. The cardiac and respiratory systems are commonly monitored through observing a patient's:

  • Pulse
  • Systolic blood pressure
  • Respiratory rate
  • Oxygen saturation

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