PURPOSE OF SURGICAL CHECKLIST AND ITS IMPORTANCE

 to monitor and improve patient safety, and to ensure that errors in health care do not
result in adverse events
 to identify, document, and communicate patient risk factors or vulnerabilities.
 Risk assessment anticipates the potential positive and negative consequences the patient
may experience related to anesthesia and the surgical procedure.
 to improve communication and teamwork by bringing together the surgeons, anaesthesia
providers and nurses involved in care to confirm that critical safety measures are
performed before, during and after an operation.
 to reminder for the whole surgical team to remember important items to be performed
before and after the surgical procedure to reduce complication
 contains critical elements that must be checked and analyzed such as laboratory records,
patients name, informed consent, history and physical assessment.

KAHALAGAHAN NG ASSESSMENT AND REVIEW NG RECORDS NG PATIENT

 it is the first part of the nursing process and helps to identify basis of care plan
 to identify their real needs
 to maintain safety and reduce accidents, injuries and identify faults.
 whether you have any medical problems that might need to be treated before surgery
 whether you might need special care during or after surgery
 the risk of anything going wrong, so that they can talk to you about these risks.
 To check for allergies of clients
 Records can be used as evidence in the event of a complaint or claim.
 opportunity to identify instances of harm to a patient and to undertake quality
improvement to improve patient safety.

IMPORTANCE NG CP CLEARANCE
 Includes:
1. CBC- including red blood cells (RBCs), white blood cells (WBCs), and platelets
(PLTs).
2. ABG - arterial blood gases (ABG) test measures the acidity (pH) and the levels of
oxygen and carbon dioxide in the blood from an artery
3. Serum electrolytes – help determine whether there's an electrolyte imbalance in the
body
 Sodium, which helps control the amount of fluid in the body.
 Chloride, which also helps control the amount of fluid in the body.
 Potassium, which helps your heart and muscles work properly.
4. ECG- check your heart's rhythm and electrical activity
 Importance:
 primary preoperative preparation in all undergoing surgical intervention on general
anesthesia.
 to evaluate and, if necessary, implement measures to prepare higher risk patients for
surgery
 The results of cardiac testing can affect the choice of anesthesia and help doctors plan for
surgery and make better postoperative recommendations. Cardiac events are a common
cause of complications during surgery. Therefore, a risk assessment is an important step
in preparing for surgery for good postoperative outcomes.
 to avoid complications during surgery as a result of an underlying cardiac condition

HEALTH TEACHING BEFORE SURGERY. EX. DEEP BREATHING, MOVING

 Stop drinking and eating for a certain period before the time of surgery. Not eating or
drinking also reduces the risk of complications from anesthesia.
 Bathe or clean, and possibly shave the area to be operated on.
 Undergo various blood tests, X-rays, electrocardiograms, or other procedures necessary
for surgery.
 Sometimes a patient may be asked to take an enema the evening before surgery, to
empty the bowels. Please check with your physician.
 Do not wear makeup the day of surgery as it can hinder the ability to monitor the
wellbeing of the patient.
 Do not wear nail polish for monitoring oxygen levels such as placing the pulse oximeter
to the finger and sometimes it does not work as well when there is nail polish.
 Do not wear your eye contacts because it can result in a corneal abrasion. Which is a
scratch on the eye cornea which can be painful.
 Leave valuables and jewelry at home as it can get lost or damaged during the operation
and it might also carry bacteria that could affect the surgical site.
 Advise the medical staff of dentures or other prosthetic devices you may be wearing
because it can be swallowed during the surgery or dislodged that may cause respiratory
obstruction that prevents air from getting into the lungs.
 Often, to make their experience more comfortable and efficient, patients are advised to
bring the following:
 Loose-fitting clothes to wear.
 Social Security card number, Insurance information, and Medicare or Medicaid card.
 A bracelet is also placed with the patient’s name and identification number on their wrist.
It can include allergies that the patient may have.
 Intravenous line (IV) will be started to give fluids and medication. The medication will
make the patient sleepy.
  The surgeon will perform the surgery and that a drain may be placed from the inside of
your incision out of your abdomen after surgery.
 After the operation expect that the patient would be moved to the recovery room.
 Change to operation room uniform before transferred to operating room.
 Empty bladder before surgery
 May need pre-medications and intravenous drip.
 The patient would also be catheterized during the procedure
Breathing

Do these exercises every hour when you’re awake.

1. Breathe in deeply and slowly through your nose, expanding your lower rib cage, and letting
your abdomen move forward.
2. Hold for a count of 3 to 5 or 5-10.
3. Breathe out slowly and completely through pursed lips. Don’t force your breath out.
4. Rest and repeat 10 times every hour. Rest longer if you become dizzy or lightheaded.

Coughing Exercises

It’s best to do coughing exercises when you’re feeling comfortable. Your healthcare provider
will tell you if you shouldn’t do the coughing exercises in this handout.

1. If you’re lying on your back, bend your knees (if your surgeon says you can), and rest your
feet on the bed.
2. Hold a pillow against your stomach.
3. Take a slow, deep breath. Breathe in through your nose and concentrate on fully expanding
your chest.
4. Breathe out through your mouth and concentrate on feeling your chest sink downward and
inward.
5. Take a second breath in the same manner.
6. Take a third breath. This time hold your breath for a moment, then cough vigorously. As you
cough, concentrate on forcing all the air out of your chest.
7. Repeat this exercise two more times.
8. If you cough up some mucous, clear it into a tissue. Repeat the coughing until there isn’t any
more mucous. If you have a lot of mucous, you may need to take a break so you don’t get too
tired.

Foot and Leg Exercises

Foot and leg exercises, also help you to get better sooner and prevent problems like blood clots.
You may also have SCD stockings (Sequential Compression Devices) on your legs (the
stockings inflate and deflate to keep good blood flow in your legs).
 Do these exercises every hour while you’re awake.

A. Ankle Pump
1. Pump your ankles up and down for 1 minute.
2. Relax both feet.
3. Repeat 5 times then relax.

B. Ankle Circles
1. Circle both ankles; first to the right, and then to the left.
2. Repeat 5 times then relax.

If your surgeon says you can:

1. Bend each knee one at a time, sliding your foot up along the bed and then back down.
2. Repeat 5 times then relax.

Changing Positions
Change your position every hour while awake, or as directed by your nurse. It’s important to
move often to prevent problems like a lung infection, blood clots, and weak muscles.

Walking
 For your safety, it’s important to have a nurse or physical therapist with you the first time you
get up, and remember to wear proper footwear.
 At first you may need some help. As you become stronger, you’ll be able to move around more
on your own. You may need to take short rests in between walks.
 It’s normal to feel dizzy and uncomfortable when you first get up. Remember to move slowly. If
you have more pain or dizziness, please tell your nurse or physical therapist.
 The goal is to be able to walk in the hall several times a day.

DIFFERENCE BET. FIRST CALL AND SECOND CALL

1ST CALL
 Name of patient and surgeon
 Procedure to be done
 Exact date and time
 Contraptions
 Lab results
2ND CALL
 Patient name, gender, age
 surgeon
 Allergies
 Surgical procedure
 Length of time in OR
 Anesthesia given
 Blood transfusion done?
 Contraptions – IV gauge, site of insertion, IV solution
 VS
 Medical comorbities (diabetes, HTN)
-----
 Estimated blood loss/fluid loss/blood replacement
 Problems during procedure
 Any complications encountered (anesthetic or surgical)
 Considerations for immediate postoperative period (pain management, reversals,
ventilator settings)
 Language barrier
 Location of patient’s family

2nd CALL

Endorsing patient Almacen, 36 year old, born on February 7, 1985 patient room no. 201, with the
surgery team that will perform the surgery headed by surgeon Dr. Grey, anesthesiologist Dr.
Suarez, and nurse in charge of the patient with cardiologist cleared and ordered for exploratory
laparotomy appendectomy on July 28, 2021 at 3 pm. With contraptions of D5LR regulated at 20
gtts/min.

Laboratory works:
-CBC (WBC 12.4 x 10 E3/uL)
-Urinalysis (trace ketones, clear yellow)
-Electrolytes (Na: 138mmol/L; K:4.4mmol/L; Glucose:93mg/dl; BUN: 17mg/dl)
-ALT (SGPT) 45U/L
-AST (SGOT) 39 U/L
Prothrombin time – 12 seconds

Imaging Test:
-ECG – normal sinus rhythm
-Chest X-ray PA- Both normal lung fields
-Ultrasound result – Visualization of blind ending, non peristaltic, non compressible appendix. A
diameter of greater than 6mm; presence of an appendicolith, and distention of lumen; with peri-
appendiceal free fluid.

ATLEAST TWO LAB TESTS THAT IS NEEDED BEFORE SURGERY AND THE
IMPORTANCE
CHEST X-RAY:
Purpose:
To assist in the evaluation of cardiac, respiratory, and skeletal structure within the lung cavity
and diagnose multiple diseases such as pneumonia and heart failure.
Importance:
Chest radiography is reasonable for patients at risk of postoperative pulmonary complications if
the results would change perioperative management.

CBC relevance to surgery:

 a group of tests that evaluate the cells that circulate in blood, including red blood cells
(RBCs), white blood cells (WBCs), and platelets (PLTs).
 can evaluate your overall health and detect a variety of diseases and conditions, such as
infections, anemia and leukemia.
 may be done during a routine check-up or before surgery.
 make sure your blood can clot well enough before surgery or procedures.
 may be done to diagnose a medical condition. Acquired haematological disorders, and the
effects of other systemic diseases.
 to check if the body is fighting for infection or if the body has a high or low hemoglobin
which affects bleeding during surgery
 if the patient is anemic and needs blood transfusion during surgery.

URINALYSIS:
 the physical, chemical and microscopic analysis of urine. In the preoperative setting
 to detect urinary tract infections, renal diseases and poorly controlled diabetes. And other
kidney and bladder infections that if not diagnosed immediately after surgery it can cause
further complications.
  It is done to confirm any urinary tract infection or a kidney stone that may be causing the
pain.

GIVE ATLEAST 3 HEALTH TEACHING AFTER SURGERY

After operation:
Incision should be kept dry for 24 hours after the operation.
Activity:
 need to walk around the same day of surgery, or the day after
 Movement will help prevent blood clots. (basic leg pumps and lifts to help improve
blood flow and circulation in the lower portions of your body)
 Do not get out of bed on your own until your healthcare provider says you can. Talk to
healthcare providers before you get up the first time. They may need to help you stand
up safely.
 When you are able to get up on your own, sit or lie down right away if you feel weak or
dizzy.
Diet:
 Be able to drink liquids and eat certain foods once your stomach function returns after
surgery.
 You may be given ice chips at first to prevent nausea and vomiting.
 Liquids such as water, broth, juice, and clear drinks.
 If your stomach does not become upset, you may then be given soft foods, such as ice
cream, yogurt, mashed potato, banana, tofu.
 Once you can eat soft foods easily, you may slowly begin to eat solid foods.

Please avoid the following foods the first 7 days after surgery:
 Spicy Foods (may trigger upset stomach)
 Foods that are difficult to chew, Popcorn & Chips (avoid for a month; can become lodged
in surgical sites causing pain and infection)
 Alcoholic Beverages (an affect thinking and slow breathing to potentially dangerous
levels. Alcohol is also dehydrating, and your body needs plenty of healthy fluids to heal)

Discharge:
1. It will take from 6-8 weeks to feel completely recovered. This is normal.
2. As you resume your usual activities, expect to tire easily. It is okay to become tired, but
avoid becoming exhausted.
3. It is normal to have a light pink discharge for up to 2 weeks.
4. Limit your activities for 4-6 weeks:
a) No lifting of more than 5 to 10 lbs.
b) No vacuuming
c) No strenuous activities or exercises
 d) No driving for 2 weeks (you may ride in a car for a short trip)
e) Walk up and down steps one step at a time.
5. Regular walks are encouraged
6. Showers are OK. It is fine to get water on your incision. Blot your incision dry with a
towel afterwards.
7. Wear loose clothing and cotton underwear for comfort.
8. A hard ridge should form along the incision. As it heals, the ridge will recede gradually.
9. You may use an electric heating pad, a heat lamp or a warm compress to relieve
incisional pain.
10. You may do light housework as tolerated: washing dishes help with cooking, light
cleaning such as dusting.
11. Resume your medications as ordered.
12. Report any of the following:
a) Foul smelling drainage from the vagina, or an increase in vaginal bleeding
b) Fever by thermometer over 101 degrees F within 24-48 hours
c) New symptoms such as nausea, vomiting, constipation, abdominal swelling or
severe pain
d) Inability to urinate e. Redness, pus, swelling, or more than usual tenderness from
incision

IMPORTANT REMARKS TO REMEMBER BEFORE AND AFTER SURGERY ATA DI

KO MATANDAAN YUNG SPECIFIC QUESTION

What are the 4 infection control measures and infection control in contraptions such as IV
catheter and NGT?
 hand hygiene and cough etiquette.
 the use of personal protective equipment (PPE)
 the safe use and disposal of sharps.
 routine environmental cleaning.
 incorporation of safe practices for handling blood, body fluids and secretions as well as
excretions
 Sterile Technique

TYPES OF SURGERY BASED ON URGENCY

Roles of Nurses in Peri-op
1. Initiates initial preoperative assessment
2. Initiates education appropriate to patient’s needs
3. Involves family in interview
4. Verifies completion of preoperative diagnostic testing
5. Verifies understanding of surgeon-specific preoperative orders (e.g., bowel
preparation, preoperative shower)
6. Discusses and reviews advance directive document
7. Begins discharge planning by assessing patient’s need for postoperative transportation
and care

1. Completes preoperative assessment

2. Assesses for risks for postoperative complications
3. Reports unexpected findings or any deviations from normal
4. Verifies that operative consent has been signed
5. Coordinates patient education and plan of care with nursing staff and other health team
members
6. Reinforces previous education
7. Explains phases in perioperative period and expectations
8. Answers patient’s and family’s questions In the Holding Area

1. Identifies patient
2. Assesses patient’s status, baseline pain, and nutritional status
3. Reviews medical record
4. Verifies surgical site and that it has been marked per institutional policy
5. Establishes IV line
6. Administers medications if prescribed
7. Takes measures to ensure patient’s comfort
 8. Provides psychological support
9. Communicates patient’s emotional status to other appropriate members of the health
care team

Importance of Written Consent

 necessary before non-emergent surgery can be performed to protect the patient from
unsanctioned surgery and protect the surgeon from claims of an unauthorized operation
or battery.
 a legal mandate, but it also helps the patient to prepare psychologically, because it helps
to ensure that the patient understands the surgery to be performed.
 The nurse clarifies the information provided, and if the patient requests additional
information, the nurse notifies the physician.
 The nurse ascertains that the consent form has been signed before administering
psychoactive premedication, because consent is not valid if it is obtained while the
patient is under the influence of medications that can affect judgment and decision-
making capacity