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1. Preparing the person the evening
before surgery
Bathing or scrubbing a local skin
area with an antiseptic
The surgeon will usually specify
the site for a local skin scrub if
indicated
Restricting food and fluid: nothing
per mouth (NPO) after midnight

Perform enema for GIT surgeries
only
Promote rest and sleep through:
A well ventilated room
Comfortable, clean bed
Back rub
Warm fluid
Sleeping medication as doctor
order

 Make sure the patient has had no solid food for at least
6 hours and no water for at least 2 hours before
surgery.
 Make sure the chart contains all necessary information,
such as signed surgical consent, diagnostic test results,
health history, and physical examination.
 Tell the patient to remove jewelry , makeup, hairpins
and nail polish.
 Perform mouth care.
 Ask the patient void
 Put on a surgical cap and gown.
 Instruct patient to remove dentures or partial plates,
contact lenses, glasses, or prostheses (such as an
artificial eye)

Take and record vital signs.
Make sure the informed consent form is
signed by the patient or a responsible
family member
The site of surgery should be marked
with a permanent marker by the
surgeon.
Check for and carry out special orders
(administering enema, NGT insertion, IV
line)
Check the identification band
Administer preoperative medication as
ordered.


Types:-Opiates- Morphine, Demerol
 Anticholinergics: Atropine ,Robinul, scopolamine
(reduce respiratory tract secretions and prevent
severe reflex & bradycardia)
 Barbiturates-tranquilizers - Pentobarbital (Nembutal)
and other hypnotic - night before ensure rest
 Prophylactic antibiotics- just before or during surgery
- bacterial contamination is expected; given before
skin incision

 Anxiety related to results of surgery and post-
operative pain.
Goal: the patient will decrease level of anxiety
Nursing intervention:-
 Activities that decreasing anxiety are deep
breathing, relaxation exercises, music therapy,
massage and animal-assisted therapy.
 Administer medication to relieve anxiety as
doctor orders
 Explain the surgical procedures for patient
 Allow the patient to ask questions
 Reassessment

Knowledge deficit related to the preoperative
procedure
Goal: the patient will explain the preoperative
procedure
Nursing intervention:
Explain the surgical procedures for patient
Explain the preparation of operation for patient
Instruct the patient about type of anesthesia is
planned, such as general, regional, or balanced
Teach patient measure to decrease
postoperative pain
Teach patient postoperative care, including
diet, mobility, leg and deep breathing exercises,
Range of motion exercises and treatments.

 Anesthesia
It is an artificially induced state of partial or total
loss of sensation, occurring with or without
consciousness.
 There are three types of anesthesia:
 General
 Regional
 local

General
anesthesia
Regional
anesthesia
Produces
unconsciousness
body relaxation,
and loss of
sensation
administered by
inhalation or
I.V. infusion
Inhibits excitatory
processes in nerve
endings or fibers
Provides analgesia
over a specific
body area
Doesn’t produce
unconsciousness
administered
by topical
Blocks
transmutation of
nerve impulses at
the site of action,
analgesia over
limited tissue area
and doesn’t
produce
unconsciousness
Local
anesthesia
Blocks
awareness
centers in the
brain
administered by
spinal or epidural

Immediate ( post-anaesthetic )
phase (1): Intermediate ( hospital stay
)
phase (2): starts with complete
recovery from anesthesia and lasts for
the rest of the hospital stay.
Recovery ( after discharge to full
recovery )
Aim of phases 1 & 2
 Homeostasis
 Treatment of pain
 Prevention & early detection of
complications

1. Immediate postoperative care “recovery
room”- In this stage the patient is assessed
every 10 to 15 minutes initially
 level of consciousness; orientation,
sensation, ability to follow command,
pupillary response and ability to move
extremity following regional anesthesia
 Respiratory Status - patent airway and
ability to deep breath and cough

a. Assess patient for the following items:
 Cardiovascular: regular, strong heart rate and
stable BP ; peripheral pulses
 Position of patient
 Safety: need for side rails, draining tubes
unobstructed
 Assess patient’s pain
 Wound condition: including dressings and drains
 Presence of IV lines
 Drainage system such as nasogastric, chest,
urinary)Ability to void Urinary output > 30 ml/hr
 Fluid balance, including IV fluids, output from

B) Respiratory Care according to
patient condition:
O2 mask.
Ventilator.
Tracheal suction.
Chest physiotherapy.
C) Position in bed and mobilization:
Turning in bed usually every 30 min.
until full mobilization.
Special position required sometimes.

D) Diet:
NPO until return the bowel
movement then:
Liquids, Soft diet and finally Normal
or special diet.
E) Administration of I.V. fluids
according to Daily requirements.
F) Administration of Medication such
as Antibiotics, analgesic or sedatives.

- The following are the criteria for patient discharge
from recovery room:
- Demonstrate quiet respirations
- Be awake or easily aroused to answer simple
questions
- Have stable vital signs with a patent airway and
spontaneous respirations
- Have a gag reflex
- Feel minimal pain

 Ongoing Assessment
 Respiratory function
 General condition
 Vital signs
 Cardiovascular function
 Fluid input and urine output and fluid balance
chart
 Pain level and characteristics
 Bowel and urinary elimination
 Surgical site and wound drainage systems
 Intravenous sites for patency and infusions for
correct rate and solution

Monitor vital signs including Blood
pressure, Respiration, Pulse rate ,
O2 saturation and Temperature :
15mins for first hour
30mins for next 2hours
Cont…Hourly for next 2hours
Then if stable every 4 hourly
 While monitoring these vital signs
it is also important to observe
(look, feel, listen)

1. Pain related to surgical incision and manipulation
of body structures.
2. Activity Intolerance related to decreased mobility
and weakness secondary to anesthesia and surgery.
3. Nausea /vomiting related to effects of anesthesia
or side effects of narcotics.
4. Risk for altered respiratory function related to
immobility, effects of anesthesia, analgesics and
pain.
5. Risk for Infection related to break in skin integrity
(surgical incision, wound drainage devices).

 Teach pain relieving measures such as relaxation
techniques and position changes
 Splinting the incision may help the patient reduce
pain when he coughs or moves especially following
chest or abdominal surgery.
 Instruct the patient to use the bed’s side rails for
support when he moves and turns.
 Should move slowly and smoothly, without sudden
jerks.
 Position patient in comfortable position
 Administer analgesic as ordered

 Promote activity Encourage leg exercises for the
bedridden patient.
 Encourage patient to carry out activity of daily life
 Encourage progressive ambulation as soon as
permitted
 Avoidance of heavy lifting, pushing or pulling for at
least 6 weeks after major surgery

 Provide IV fluids as ordered.
 NPO until peristalsis returns, it is usually takes
about 24hs.
 Gradual return of oral feeding from liquids to
normal diet.
 Provide diet as per likes and dislikes of patient.
 Teach patients to select foods high in protein
and vitamin C to enhance wound healing.
 Administer anti-emetic as per physicians order.
 Improve patient immunity through nutrition

 Encourage changing position at least every 2 to3
hours for bed patient
 Encourage deep breathing and coughing exercises
every hour while he’s awake
 Encourage warm fluid
 Encourage patient to use incentive spirometer for
person at high risk for pulmonary complications
 Monitor breath sounds until patient is ambulatory

 Dressing can be removed 3-4 days after operation
or according to hospital policy.
 Wet dressing should be removed earlier and
changed.
 Symptoms and signs of infection should be looked
 Good nutrition.
drains are used to drain fluids accumulating after
surgery, blood or pus.
 Should be removed as long as no function.
 Should come out throw separate incision to
minimize risk of wound infection.
 Inspection of drain’s contents and its amount.

 OPERATION THEATRE differs from other areas
of hospital and care should be taken to
prevent accidents by physical , chemical or
biological means.
 Accident is an unexplained, unexpected and
undesired event.
 Objective:
 To identify the hazards present in the
operating rooms
 To list actions that can be taken to minimize
these hazards.

They are of three types :
1)Physical Hazards
2)Chemical Hazards
3)Biological Hazards

 A physical hazard is a type of occupational
hazard that involves environmental hazards that
can cause harm with or without contact.
 A physical hazard is a Most common type of
hazard in an OT.
 The physical facility is designed to, decrease
contamination, facilitate handling of equipment's
and supplies and to provide a comfortable working
environment.
 Engineering controls are often used to mitigate
physical hazards

ENVIRONMENTAL HAZARDS
 TEMPERATURE control
 Ventilation
 Lighting
 Colour
 Noise
PREVENTIVE MEASURES
 Maintain adequate ventilation through AC
 Maintain adequate temperature through AC
 Lighting should be without shadow and glare
 Wall, ceiling and curtain should have light green or
light blue
 Provision for soft music which is relaxing for both
patient and OT personnel

IMPROPER BODY MECHANICS:
 Standing for prolonged period in an awkward
position cause low back pain.
 Weight bearing on particular body part cause
additional strain.
 Improper height cause back injury or low backache
PREVENTIVE MEASURES
 OT table should be adjusted to best working
height.
 Maintaining an erect posture & remain close to the
OT table.
 Surgical team member should stand with feet
apart.
 Surgical team member should wear soft leather
with back open APRON.

ELECTRICAL HAZARDS
• Short circuit
• Improper electrical devices cause risk for both
patients and personnel.
• Inadequate knowledge of handling electrical
devices.
PREVENTIVE MEASURES
 Periodical checking and checking before using
of electrical sockets, equipment's and devices
 All electrical equipment's should be properly
insulated.
 Equipment's should be turned off when not in
use.
 Surgical team should use cotton gowns.
 Cotton blankets should be used for patients.

Fire Hazards:
 Fire is caused by short circuit, anesthesia
machines, oxygen cylinders and other
inflammable items.
Preventive measures
 Periodic checking of electrical sockets, lines.
 Anesthesia machines should be kept away from
source of heat.
 OT should be strictly no smoking zone.
 OT should have fire extinguisher ,fire alarm.

RADIATION HAZARDS:
 When x-ray is taken.
 When fluoroscopy and image intensifying apparatus
are used.
 Implantation or removal of radioactive elements.
 Patient Safety
a) Time b) Distance c) Shielding
Preventive measures
 Prevent exposure to fluoroscope , image intensifier
and x-ray machine.
 Unsterile members should leave OT during
procedures.
 Sterile team members should keep atleast 2meter
distance.
 Lead aprons should be worn inside sterile gown by

 Health care providers are exposed to many
chemical hazardous daily.
 A)Anesthetic gases
Health hazards include risk for spontaneous
abortion , cancer, hepatic and renal diseases. •
.Chronic exposure to nitrous oxide leads to
neurologic problems.
 B) Sterilizing agents
The chemicals agents which are used to sterilize
heat sensitive items which are toxic and also
irritating to eyes and nasal passages, even at low
levels of exposure >Ethylene Oxide >Formaldehyde
> Glutaraldehyde

C)DISINFECTANTS
Some of the disinfectants that are used to clean the
equipment’s can be irritating to the skin and eyes.
 Gloves and goggles should be worn while using these
chemicals.
D) Methyl Methacrylate
 Commonly known as bone cement .
 It is a carcinogen and is toxic to liver.
 A scavenging system should be used to collect the
vapours.
PREVENTIVE MEASURES
 Ventilation through AC
 Proper dilution
 Mask ,goggles and gloves for protection
 Handwashing

 Transmission of infection and disease is a concern
for personnel.
a)Infectious Waste
 Waste having enough virulence and are capable
of causing infectious diseases.
 Presence of pathogenic organism in sufficient
number and are capable of causing infection.
 Presence of portal of entry into a susceptible
host.

 B) BLOOD-BORNE DISEASES
 A . Penetrating injury(needle stick ,cut) or a
splash(into the eye ,onto mucous membranes)
with fluid contaminated with blood must not be
ignored.
If exposure to blood or body fluid occurs.
The following procedures to be performed:
 Stop the activity immediately and step back from
the point of contamination.
 Squeeze skin around the needle stick or cut to
expel blood and contaminants
 Cleanse puncture site
 Report the incident and seek medical attention
promptly
 Follow the protocol established for follow up

 C)LATEX ALLERGY
 • Allergy to latex items.
 • Lead to anaphylactic shock and even death.
MANAGEMENT OF HAZARDS
 Administration
 Prevention
 Correction
 Education
 Documentation
 A) ADMINISTRATION
 Regulation, recommendations, guidelines and laws should
be enforced to prevent disastrous consequences of
occupational hazards.
 Policies and procedures should be written reviewed and
updated periodically.
 Protective attire and safety equipment’s should be made
available to the employees
 Employee health services should be provided for
immunisation

B) PREVENTION
 Routine preventive maintenance should be
provided for all potentially hazardous equipment
C) CORRECTION
 Faulty or malfunctioning equipment should be
taken out of serve immediately
 Unsafe conditions should be reported.
D) EDUCATION
 Orientation
 Use of emergency equipments
 Protective garments
E) DOCUMENTATION Incident reports regarding
injuries to personnel and patients should be filed
with the administration of facility.

 i. PROLIFERATION OF RODENTS
 ii. BREEDING OF FLIES AND INSECTS
 iii. AIR POLLUTION
 iv. LAND POLLUTION
 v. WATER POLLUTION
 vi. TRANSMISSION OF INFECTIONS LIKE HIV,
HEPATITIS-B, OTHER MICROBES
 vii. BAD ODOUR

 1. INCINERATION
 High temperature and dry oxidation process
that reduces organic and combustible waste to
inorganic and incombustible matter and results
in significant reduction in waste volume and
weights
 Double-chamber pyro lytic incinerators
specially designed to burn infectious health-
care waste
 Single-chamber furnaces with static grate,
used only if pyro lytic incinerators are not
affordable
 Rotary kilns operating at high temperature,
capable of causing decomposition of geno
toxic substances and heat-resistant chemicals.

Chemical disinfection:
used for treating liquid waste by
adding chemicals. Thermal
disinfection: generally used for
treating solid waste

3. STERILIZATION
 Steam sterilization: autoclave used to disinfect
waste. Microwave irradiation: (2450 MH3 wave
length 12.24 m ) water is heated with waste and
then infectious component is destroyed by heat
conduction.
4. LANDFILL OR LAND DISPOSAL
Open dumps: not recommended. Sanitary landfills:
Disposing of certain types of health-care waste
(infectious waste and small quantities of
pharmaceutical waste) in sanitary landfills is
acceptable.
5. INERTIZATION:Mixing wastewith cement and other
substances before disposal. 65% pharmaceutical work

 The International Association for the Study of Pain
(IASP) defines pain as a "sensory and emotional
experience associated with tissue damage or
described in terms of such damage."
 The American Pain Society goes further by stating
that it is "not the responsibility of clients to prove
they are in pain; it is the nurse's responsibility to
accept the clients report of pain (2005).
TYPES OF PAIN
 ACUTE PAIN
 CHRONIC PAIN
 PHYSIOLOGIC PAIN

 Acute pain – Short duration , healing process in 30
days.
 Chronic pain – Its persist for the more than 3-6
month.
 Physiological pain- it leads to potential tissue
damage.
 Nociceptive pain -arises from tissues damaged by
physical or chemical agents such as trauma,
surgery, or chemical burns,.
 Somatic pain – It involves superficial tissues (skin,
bone, muscle, joints)
 Visceral pain- It involves organs (heart, stomach
& liver)
 Neuropathic pain – arises from diseases or
damage mediated directly to sensory nerves, such
as diabetic neuropathy.

Four process of nociceptive (normal) pain:
 Transduction
 Transmission
 Perception
 Modulation

 Visual analogue scale (vas)

 Who 3 step ladder for pain management

 Types of analgesic medications Analgesic drugs
can be divided into two groups:
 Non-opioid - also referred to as non- narcotic,
peripheral, mild & antipyretic agents
 Opioids - also called narcotic, central or strong
agents

 Increased Heart Rate
 Diaphoresis
 Increased Blood Glucose Levels
 Dilatation Of Pupils
 Decreased GI Motility
 Increased Musle Tension
 Increased respiratory rate

 IDENTIFYING GOALS FOR PAIN MANAGEMENT
 ESTABLISHING THE NURSE-PATIENT
RELATIONSHIP AND TEACHING
 PROVIDING PHYSICAL CARE
 MANAGING ANXIETY RELATED TO PAIN

 Pain management strategies include both
pharmacologic and non-pharmacologic
approaches.
 PHARMACOLOGIC INTERVENTIONS
 NON-PHARMACOLOGIC INTERVENTIONS
 Non-pharmacological
 pain management is the management of pain
without medications. This method utilizes ways to
alter thoughts and focus concentration to better
manage and reduce pain. Methods of non-
pharmacological pain include

 Superficial Heat
Thermogenic agent which induces a temperature
increase and subsequent physiologic changes to the
superficial layer(s) of the skin, fat, tissues, blood
vessels, muscles, nerves (usually less than 1 cm)
 Cryotherapy
 Exercise (Correction of posture)
 ACUPUNCTURE
 ACUPRESSURE
 Placebo therapy
 CUTANEOUS STIMULATION AND MASSAGE
(Transcutaneous Electrical Nerve Stimulation
(TENS) and Percutaneous Electical Nerve
Stimulation (PENS)
 DISTRACTION

 Ethics
 The word ethics is derived from the Greek word
ethos which means character.
 It is the branch of philosophy that defines what is
good for the individual and for society and
establishes the nature of obligation or duties that
people owe themselves and one another.
 Surgical Ethics
Ethics is an essential discipline in the practice of
surgery.

 Autonomy
 Informed consent and difficulties
 Confidentiality
 Excellent standards

 AUTONOMY
 Respect autonomy of patient and their ability to make
choice about their treatment .
 Attention
 Information accurate and reasonably complete
 Avoidance of technical language (medical terms)
 Provision of translator
 Clarification of doubts
 Practical Difficulties
 Temporary unconsciousness
 patients Children less than 18 year are minors
CONFIDENTIALITY
The principle of confidentiality is that the information a
patient reveals to practitioner is private and has
 GOOD STANDARED
To optimize success in protecting life and health to an
acceptable standard Practitioner must offer specialized
treatment in which they have been properly trained

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