CARING FOR THE PERIOPERATIVE PATIENT.POSTOPERATIVE PATIENT CARE.
SURGICAL CARE
Care of the surgical patient (perioperative) can be divided into three parts:

Preoperative(before surgery)

Operative(in the operating room)

Postoperative(after surgery)
During the Operative Period

While the patient is in the operating room, prepare the room for his or her return

Prepare the surgical bed.

Remove everything from the top of the bed side stand except anemesis basin, tissues,
tongue depressors, equipment to check vital signs, and a pen and paper.

Obtain needed equipment, such as oxygen, IV poles, or suction.
Watch for the return of your patient from
surgery.Video:https://www.youtube.com/watch?v=B_hPK-QYP8I
Postoperative Care
During the immediate postoperative period, the patient recovers from anesthesia. For this
period, the patient is placed in a special area called the recovery room. The recovery room is
located next to the operating room and is sometimes called the post anesthesia care unit
(PACU).
When the patient’s condition is stabilized, the patient is returned to the unit. Upon the
patient’s return from the recovery room, you should:

Identify the patient

Assist in the transfer from stretcher to bed

Inform the nurse if you can not arouse the patient

Check with the nurse for special instructions


Notify the nurse if the patient’s temperature is
below 97F.

Have an extra blanket available patient soften feel cold upon return
Patients receive many drugs before and during surgery. Some can alter
the patient’s mental status. They are excreted from the body
slowly. The patient may sleep soundly upon return to the unit. Keep the side rails up and follow
all safety precautions until the patient is fully awake and the nurse instructs you that side rails
are no longer necessary. Do not leave liquids at the bed- side until the nurse instructs you that
it is safe to do so. Check on the patient regularly. Anesthesia reduces body temperature. Keep
the patient warm. If the patient’s temperature is below 97 F, inform the nurse promptly.
Nursing assistant observations related to the care of post-operative patients that require
immediate reporting.
Observe the patient carefully, especially during the first 24 hours, for complications. You will
assist with postoperative exercises, such as:

Deep breathing and coughing

Leg exercises
Preventing Complications
A physician’s order is needed to apply special hosiery. The ordering
physician will specify if knee-high or thigh-high hose should be used.
The size is based on each patient’s leg measurements. Make sure you
apply the correct hosiery and the correct size.
The risk of complications from anti-embolism hosiery is low. However, they are not totally riskfree. Ill-fitting hosiery is the most common cause of complications. The greatest risk is a
reduction in blood flow from pressure, which increases the potential for blood clots. Other
complications are pressure ulcers, gangrene, and arterial occlusion. These usually occur when
the patient sits for a prolonged period without moving. In one reported case, the tourniquet
effect created by bunched-up hosiery, combined with swelling of the leg, caused serious skin
break- down that led to amputation.
Applying Anti Embolism Stockings
The care plan will specify the wearing schedule for the stockings.
For most patients, hosiery is removed at bedtime.
If the patient has a latex sensitivity , be sure the hosiery used is latex free.
Apply the stockings before the patient gets out of bed in the morning, because this is when the
edema is least.
Make sure the legs are dry before applying the hosiery.
Never apply the hosiery over open areas, fractures, o deformities.
Make sure the stockings are smooth and wrinkle free.
Every 8 hours (or as specified on the car e plan), monitor circulation in the toes and be sure the
hosiery tops have not rolled down. Note color, sensation, swelling, temperature, and ability to
move.
Avoid contact with lotions, ointments, or oils containing lanolin or petroleum products. These
products deteriorate the elastic in the hosiery .
video:
https://www.youtube.com/watch?v=3cecmBcoORE
APPLYING ELASTICIZE STOCKINGS
1. Carry out initial procedure actions.
2. Assemble equipment:
Elasticized stockings of proper length and size
3. Apply stockings with the patient lying down. Expose one leg at a
time.
4. Grasp the stocking with both hands at the top and roll it toward the toe end.
5. Adjust the stocking, positioning the opening at the top or base of the toes (unless the toes
are to be covered).
6. Continue rolling the stocking upward toward the body.
7. Be sure the stocking is smooth, even, and wrinkle free.
8. Repeat the procedure on the opposite leg.9. Carry out ending procedure actions.
HEAT AND COLD
APPLICATIONS
Heat and cold applications are used for many different purposes. A localized application is used
to apply heat or cold to a specific area of the body. An example of this type of application is an
ice bag applied to a swollen ankle. A generalized application is used to apply heat or
cold to the patient’s entire body.
Heat applications dilate or enlarge the blood vessels, bringing oxygen and nutrients to the area,
relieving pain and
speeding healing. They are commonly used when IV fluid has accidentally entered the tissue.
Local cold applications are used to control bleeding, relieve pain, and prevent or relieve edema,
which is common after an injury. Cooling causes blood vessels to constrict, making them
smaller. Generalized cooling is used to reduce temperature. Blankets may also be used for
eating, but this is less common.
Dry or moist treatments may be ordered. Moist treatments (those in which water touches the
skin) penetrate more deeply than dry. Some dry applications have water inside them, but the
outer surface remains dry. Dry applications may be used to maintain the temperature of moist
applications. Common types of heat and cold treatments are:
Ice bags , ice collars ,hot water bottles.
Aquamatic K-Pads. K-Pads come in many shapes and sizes.
Distilled water circulates through the pad continuously.
The temperature can be set by the user. They are commonly used to apply heat. With a special
attachment, they can also be used for cooling.
Pre packaged , single use chemical packs for the application of heat or cold.
Follow safety rules to prevent spills and falls.
Apply the principles of standard precautions.
Always check the temperature of the treatment with a thermometer.
Cover the application with a protective cover. Covers may be flannel or foam. Towels and
pillowcases are also used.
Assist the patient into a comfortable position that he or she can maintain during the treatment.
Cover the patient with a bath blanket.
Expose only the part of the body that you will be treating.
A metal cap conducts heat and cold. Face it away from the person.
Remove or reposition metal zippers, buttons, jewelry, or other materials that may conduct heat
or cold.
Check the skin under the application every 10 minutes or more often.
If the skin under a heat application is very red, or if a dark are appears, stop the application and
inform the nurse.
If the skin under a cold application is blue, pale, white, or bright red, or if the person
is shivering, stop the application and notify the nurse.
Treatments are usually applied for 20 minutes. Check the care plan or with the nurse to learn
the length of time the application is to be applied.