TRA - MEDICAL SURGICAL NURSING (PERIOPERATIVE)

Ms. Jules Arceo I Comprehensive I August 4, 2024

● To maintain the body’s

OUTLINE function
● - ectomy surgeries
I. Categories of Surgery
II. Pre-operative Phase Palliative ● Focus: relied of sign and
A. Informed Consent Surgery symptoms
B. Diagnostics and Laboratories ● To relieve patient’s burden to
C. Preparation increase their comfort
III. Intra-operative Phase ● Example: for cancer > removal
A. The Surgical Team of pain nerve > such as
B. Principle of Sterility rhizotomy
C. Anesthesia
IV. Post-operative Phase
Cosmetic ● For normal parts of the body
V. Complication
● For enhancement of normally
A. Airway
functioning organs
B. Breathing
● Example: gender
1. Pneumonia, Atelectasis,
reassignment surgery,
Decreased Lung Expansion
rhinoplasty
C. Circulation
1. Bleeding or Shock
2. Orthostatic Hypotension Reconstruc- ● To restore function of a
3. Deep Vein Thromboembolism tive certain organ after trauma
4. Malignant Hyperthermia ● “Gagawin ulit”
D. Disability ● Example: skin grafting
1. Delirium
E. Wound Constructive ● To correct birth defects
1. Infection ● “Gagawin pa lang”
2. Dehiscerence and Eviscerence ● Example: cheiloplasty,
F. Nutrtion palatoplasty
1. Post-op Ileus
G. Elimination
Transplant ● Addition of an organ to
1. Bladder Incontinence
replace function
● Example: kidney transplant
● Nursing responsibilities for
PERIOPERATIVE NURSING
patients post-transplant
CATEGORIES OF SURGERY ● “Foreign object” yung
transplanted organ
● Promote therapy: Lifetime
According to Reason Immunotherapy treatment
- Usually
Diagnostics ● Removal of organ or tissue to corticosteroid right
make diagnosis after the surgery
● Example: Biopsy (hindi alam kailan o
magkakaroon ng
rejection sa
Exploratory ● Using scopes to manipulate
transplant) - Mahina
body organs towards each
immune system
other
para di i-attack ang
● Walang
transplanted organ
tatanggalin/kukunin/ilalagay
- Apply practices: Risk
● Example: Exploratory
for infection
Laparotomy
practices- Avoid
fresh flowers,
Curative ● Removal or replacement of a crowded places, raw
Surgery diseased tissue/organ foods, etc

TRANSCRIBED BY: DAISY 1

COMPREHENSIVE I FUNDAMENTALS OF NURSING

- WOF s/sx of Minor ● Less than 2 hours

transplant rejection ● Little to none blood loss
1. Elevated VS ● Lesser complications
2. Inflammati ● Local anesthesia
on on ● day/ambulatory post-op
post-op site care
3. s/sx of
nonfunction
ing PRE-OPERATIVE NURSING CARE
transplante
d organs
● From the time the patient decides to have the
surgery to the time the patient has been
According to Urgent
admitted to the OR suite

Emergent ● Requires immediate action

Checklist ● Informed consent forms
● Within 1-2 hours
before surgery ● Consultation request
● Condition if life-threatening
● Prescribed lab results
● Examples: rupture appendix
● ECG and chest PA results
(peritonitis; board-like
● Blood type, screen, and
abdomen)
cross-matched

Urgent ● Requires prompt action

● Within 24/48 hours
● If no action: will become life Informed Consent
threatening
● Examples: amputation, ● Proof of decision
appendectomy, stroke

When ● Blood products

Required ● Affects ADLs or quality of life needed? ● Radiation procedures (mri, xray,
● Within few weeks to few ct scan)
months ● Anesthesia
● Examples: cataract surgery, ● Invasive procedures
thyroid surgery, cesarean ● Non-invasive procedures but w/
section high risk to the life

Elective ● Failure to push through with Surgeon or Surgeon

the surgery will not affects the Healthcare ● obtains consent
patient’s life but surgeon Professio- ● Mag pa-oo ng patient
recommends nals ● Explains nature and reason of
● Examples: tonsillectomy, surgery
uncomplicated hernia ● Answers q’s from patient about
the surgery
Optional ● Decision for the surgery to ● Give available options
push through rests on the ● Provide information about risks
patient’s autonomy and benefits
● Examples: cosmetic surgeries ● Right to refuse > Allows the
patient to refuse treatment
>Autonomy
According to Risk
● Provide name and qualifications
of surgical team
Major ● More than 2 hours
● More than 500 ml of blood
Nurse ● Witness signing of informed
loss
Responsibi- consent
● Major organs are affected→
lities ● Confirm
more complication to WOF
- Competence of the
● General anesthesia
patient > dapat fully
● “Dine in” or needs in hospital
aware si patient
stay post-op care

TRANSCRIBED BY: DAISY 2

COMPREHENSIVE I FUNDAMENTALS OF NURSING

- Signature of patient is Urinalysis , ● Kidney Function Test

authentic > nakita na BUN, and
nag sign si patient Creatinine
- Voluntarily sign/agree
● Discuss and review the informed AST, ALT, LDH, ● Liver Function Test
consent form and Bilirubin
● Place the informed consent at
the prominent area in the
ABG ● Check oxygenatuib status
patients records (front of chart)

Who can ● At least 18 y/o and 1 day old Pregnancy ● Since madaming medication
give Test ang ibibigay - teratogenic
● LOC: oriented to time, place, and
consent? person
● Consents voluntarily Essential to ● X-ray
preop ● ECG
checklist
Who cannot ● Age - 17 y/o and below
give ● Partial consciousness / fully
consent? DIET PREPARATION
unconscious
● Disorders: mentally ill - but
Check dr’s ● Risk for aspiration d/t
pwede if may medical clearance
order for NPO anesthesia
- spouse > children >
status
parents > siblings > kin

Usual diet ERAS Protocol - Enhanced Recovery

Consent can be waived during these situations: progression After Surgery - maikling NPO
● No heavy meals 8 hours prior
Level of ● Immediate to life - 1-2 hrs surgery
threat
● No light meals 6 hours prior
surgery
Experts ● They should agree that it is an ● No breastmilk 4 hours prioro
emergency sugery
● No liquids 2 hours prior
Client ● Is unconscious surgery
● Start D5W since NPO -para di
A legally ● Csannot be reached magutom
authorized - Obtain consent from
person surgeon > paternalism Glucose ● If (-) diabetes - once
Monitoring ● If (+) diabeter - q4 to q8 - inc.
prior risk for unstable blood
Diagnostics and Laboratories glucose status

RBC/Hgb ● If decreased - needs blood Insertion of: ● Two large bone IV access
transfusion e.g., PRBC - 14g to 16g
- For D5W infusion and
WBC ● if increased - positive for emergency BT
infection - PNSS compatible for
blood transfusion

Platelets and ● Risk for bleeding

Coagulation Elimination ● Routine enema prior surgery -
Parameter not practiced
● Required use of enema -
FBS and HbA1C ● If increased - check diabetes bowel surgery
status - Colonosccopy

TRANSCRIBED BY: DAISY 3

COMPREHENSIVE I FUNDAMENTALS OF NURSING

- Colostomy insertion atropine sulfate > prophylaxis

- Hemorrhoidectomy for aspiration
● Urine - insert foley catheter 1 ● Analgesics - for pain since
hr prior surgery inc. pain threshold > dec.
- empty the foley post-op pain
catheter bag and ● Sedatives - encourag
document the verbalzation muna but if di na
findings immediately kaya use sedatives as a last
before endorsing the resort > dec. pre-op anxiety
patient. ● Antihistamines - dec. allergy
response
Skin ● Full body wash - with ● Antibiotics - reduce bacterial
Preparation antibiotic soap - the night load > dec. post-op infection
before the morning ● Antiemetics - dec. effects of
- additional body PONV (Post-Operative
cleansing: with Nausea and Vomting)
chlorhexidine wipes ● H2 receptor antagonists/
in the site of surgery PPIs - dec. HCL > dec. ulcer
● If indicated: trimming / risk
clipping of the hair
- do not shave: risk for Smoking ● Includes two problems
bleeding and History 1. interfere with
infection recovery - inc. risk
● Remove all make-up, for respiratory
accessories, jewelries, complication
assistive devices (dentures, 2. Vasoconstriction >
eyeglasses, aids, prosthetics) dec. blood supply to
- can stay: braces, wound > poor wound
venners - if loose healing
braces tatanggaln ● Stop - 4 to 8 weels before
- put identification ● At least withhold 24-48 hours
band before surgery

Medications ● OTC and herbal medications Medical ● Bleeding disorder (liver

being taken (if unprescribed) - stop 7 History disease) - dec. platelets give
days before surgery platelet concentrate, (-)
- gingko biluba and coagulation factors give
fish oil - inc risk for Fresh frozen plasma or
bleeding cryoprecipitate
● Assess for allergies ● Diabetes melitus - inc. cbg
- my be allergic to 1. inc. HCT > poor
latex (KABB) - kiwi, wound healing
avocados, bananas, 2. Dec. Igs > risk for
blowing balloons infection
- may be alllergics to ● Heart disease - inc. stress
iodice dye - (d/t surgery) > damaged
shellfish/ seafoods heart > inc. risk for cardiac
arrest > ECart in OR
Medications ● Anticholinergics - anti-PNS > ● URTI - consticted airways >
given SNS > dec. secretions e.g., delay surgery

TRANSCRIBED BY: DAISY 4

COMPREHENSIVE I FUNDAMENTALS OF NURSING

● Chronic respiratory disease - Final ● Nutrition: verify NPO status

higher risk for respiratory documentatio ● Elimination: drain foley
complication n catheter bag
● Immmunological disorders - ● PE: complete PE and history
myelouppression (inatake ● Valuables: properly label and
and sinira ang bone marrow) give to significant other
> dec. blood cells
● Renal disorders - impaired Checklist ● Informed consent forms
elimination of meds > inc. risk ● Consultation requests
for medication overdose/ ● Prescribed laboratory results
toxicity (kasi di nalalabas ang ● ECG and chest PA results
gamot) ● Blood type, screen, and
cross-matched
Health ● Focus of mental preparation
Teaching - patient has mild
anxiety - inc. focus
INTRA-OPERATIVE NURSING CARE
attention, retention
● Procedures taught
The Surgical Team
- DBE, coughing with
splinting, incentive
Surgeon ● Leader of the surgical team
spirometer -
● In charge
promote lung
● Captain of the ship - kapag
expansion (dec. risk
may nagkamali sa surgery
for atelectasis) , dec.
madadamay si surgeon
sputum (dec. risk for
pneumonia)
Assistant ● Some level and some
● Medications for pain - inform
Surgeon expertise of the surgeon
the patient that pain is
● Takes over when surgeon is
normal after surgey and also
not around
inform that medications will
be given prior pain.
Anesthesiolo- ● Prior: assess patient, select
- to inc. pain threshold
gist anesthesia, intubate if
● The complete surgical team/
necessary
Operating room - inform the
● During: monitors all
patient about the OR to dec.
hemdynamics of patients/
anxiety
circulatory parameteres

Procedures ● Extremity exercises - bed

Taught Circulating BEFORE SURGERY
exercises before early
Nurse ● Verify informed consent and
ambulation > dec. immobility
patient (DOB and name)
complications such as
during endorsement from
pressure ulcers, muscle
ward nurse
atrophy, renal calculi,
● Ensures all equipment are
deformities
working properly
- extension and flexion
● Guarantees sterility of
of the knee and hip
instruments and supplies
joints
● Assisting anesthesia
- great toe rotation
personnel - during intubation
- elbow and shoulder
of the patient
ROM exercises
● Positioning the patient

TRANSCRIBED BY: DAISY 5

COMPREHENSIVE I FUNDAMENTALS OF NURSING

1. With assistant Unrestricted ● Can wear street clothes

surgeon (accrdg to Zone ● Reception area
the book)
2. With Semi- ● Hallway in between the OR
anesthesiologist restricted theaters
(accrdg to WHO) Zone ● Wear: scrubs and hair caps
● Positioning the patient
- most common Restricted ● Inside the OR
position: dorsal Zone ● Wear semi-restricted + gown,
reumbent gloves, shoe caps, face mask
- for lower abdominal
surgeries:
The OR Attire
trendelenburg
- for renal surgeries:
OR Attire ● Fit - close fitting
side-lying/ lateral
● Material: cotton scrubs
- for vaginal, perineal,
● Shirt and waist drawstings:
and rectal surgeries:
tucked in > avoid
lithotomy
contamination
DURING SURGERY
● Change if soiled or wwet
● Coordinates all personnel in
the OR - traffic inside the OR
Face mask ● Fits tightly - covers the nose
(dapat walang taong
and mouth
magkakabanggan)
● Prevents venting from both
● Handling all specimes - e.g.,
sides
to the medtech
● Does not interfere with (BSV) -
● Monitors the room and team
breathing, speech, vision
members for breaks in the
● Changed when new patient is
sterile technique
for OR
AFTER SURGERY
- 1:1 ration
● Documents care provided tot
● Warm in this manner: either on
the patient
or off

Scrub Nurse ● Gathers all surgical supplies

Headgear ● Face mask, surgical cap
● Prepares all supplies and
● Covers the hair, including beard
instruments using sterile
technique
● Maintains sterility during Shoe covers ● Worn when these are

surgery anticipated - splashes

● Handles all equipments sterile ● Changed when wet, torn, soiled

and materials during surgery

● Keep accurate count of Floor and Horizontal Surfaces
sponges, sharps, and
instruments during surgery - Cleaned with ● Detergent germicide or soap
in-charge and water
● Performs aftercare of surgical
instruments The Operating Room

Temperature ● 20-24 degree celsius

PRINCIPLE OF STERILITY
Airflow ● Laminar

Zoning

TRANSCRIBED BY: DAISY 6

COMPREHENSIVE I FUNDAMENTALS OF NURSING

Humidity ● 30%-60% Analgesia ● Loss of pain reflexes

Ventilation ● Positive pressure Amnesia ● Loss of memory -

anterograde amnesi, unuable
Principles of Sterility to form new memories

Only sterile ● Can touch the sterile filed Unconscious

persons nes

For the ● For unsterile field,, whoever Loss of reflexes ● At risk for aspiration
sterile field prepares uses it and muscle
- unsterile part: 2-3 inch tone

away from the edge

Stages of Anesthesia

Operating ● Mayo table - 100% sterile - all

Room Tables Stage 1: Onset ● From administration to loss of
instruments used during
or Induction consciousness
surgery
● Patient s/sx
- edge of the mayo
- LOC: dizzy, drowsy,
table is not sterile
inabiliy to move
● Back table - back-up
extremities
instruments
- Ears: tinnitus -
- distance from sterile
ringing/ buzzing
field - 1 to 2 inches
● Nursing intervention
away from the sterile
- Priority: safety
field
- Appliication of soft
- in the ⅓ portion the
restraints
unsterile part - wet
(abdominal binder)
such aas sterile
- Environment: quiet or
solutions are placed
calm d/t tinnitus
- In the ⅔ dry and sterile

Stage 2: ● From loss of consciousness to

The Team and Traffic
Excitement loss of reflexes
Phase ● Patient s/sx: loss of
Front ● Unsterile - below the waist and
- reflexes (GSCP) -
above the shoulders
gag, cough, swallow,
● Back - whole back is unsterile
pain reflexes
- when moving - front to
- vital (HR, RR)- inc hr,
front or back to back
inc. rr, irregular rr
● Nursing interventions
OR Light ● Distance - 1 to 2 feet above
- Initaite seizure
sterile field
(priority)
● Who handles - circulating nurse
precautions
and anesthesiologist
- Environemnt dec.
stimulation

ANESTHESIA environment

General Anesthesia

● All parts of the body

TRANSCRIBED BY: DAISY 7

COMPREHENSIVE I FUNDAMENTALS OF NURSING

Stage 3; ● From loss of reflexes to Spinal ● Brain, blood, csf (30 ml) + 10 ml
Surgical respiratory paralysis Headache in = 40 ml > inc. csf > monro-kelle
Anesthesia ● Patient s/sx: Regional hypothesis > inc. icp
Stages Anesthesia
- LOC; Coma state - ● Cause: rapid inc. in icp d/t
patient lies quietly anesthesia administration
- Vitas: normal HR and ● Nursing intervention
rr - prevention: lie flat on
● Nursing Intervention: bed fr 4-6 hours
- Priority airway > use - administer: (+) spinal
mechanical headache > severe
ventilator pain > administer
- Indication: start of analgesics thru IV > to
the surgery follow
non-pharmacologic
Stage 4: ● From respiratory paralysis to pain mngt
Medullary medullary paralysis
Stage ● Cause: too much effect of Hypotension ● Cause
anesthesia in the patient in Regional 1. vasomotor nerve
● Patient manifestations: Anesthesia paralysis
- (-) rr, (-) hr, 2. too much bleeding
unconscious > s/sx Nursing intervention
of cardiac arrest ● Initial action
● Nursing interventions - if mild - wait for it to go
- CPR > circulation away
(priortiy) - in cases - if significant
of cardiac arrest 1. give 02 (1-2
lpm)
2. position:

Regional Anesthesia modified

trendelenbur

● Blocking of transmission of nerve impulses to a g

region of the body 3. fluid
● Numb pain in the lower extremities from the challenger
abdominal area below (PNSS/Lr)
● Patient LOC: conscious ● Administer
● Either epidural or spinal anesthesia
- if severe hypotension -
norepinephrine -
Epidural ● Site of injection: epidural space
constict blood veseels
● Indication: labor and delivery
● Complications: hypotensions,
paralysis

Spinal ● Site of injection - subarachnid

space between L3 and L5
● Indication: abdominal or lower
extremity surgeries
● Complications: hypotension,
paralysis, spinal headache

TRANSCRIBED BY: DAISY 8

COMPREHENSIVE I FUNDAMENTALS OF NURSING

COMPLICATION
Local Anesthesia

Topical ● indicated for skin and mucous Airway

Anesthesia membrane procedures
● Usually used in stitching and Manifestatio ● Noise: choking
neonatal circumcision n ● Respirations: irregular
● Nursing intervention ● O2 sat: hypoxia
- spread adequate ● Skin color: cyanosis
amount and wait for
15-30 mins Intervention To remove tongue obstruction
- reasses skin after prior ● head-tilt/chin lift
- For no suspected SCI
procedure
● Jaw thrust
- Indicated with
Local ● Inject to a specific area suspected spinal cord
Infiltration ● Usd for minor surgical injury
procedures such as adult
circumcision or AVF creation Too much ● If patient complained of nausea
secretions of - Interventions: turn
PONV patient completely to
Nerve Block ● Injected to a group of nerves
side-lying
(plexuses)
● If patient vomited
● e.g., facial nerve block (bunot - Head of bed: 15-10
ngipin; paralyzed buong degree HOB elevation
cheeks) (low-fowler’s)
● eg.., pudental nerve block (for - Position: side lying
● If (+) retained vomitus or
kiffy)
increased secretions
- suctioning equipment
at bedside
POST-OPERATIVE NURSING CARE

Breathing
● From the transport of the patient to the PACU
until discharge ● Complication post-op: Pneumonia, atelectasis,
decreased lung expansion

Nursing Responsibilities Onset ● Pneumonia: 2-3 days after

surgery
● Atelectasis: 1-2 days after
To the Family ● explain post-op care (frequent
surgery
observations)
● explain the contraptions of the
patient Perform the ● Deep breathing exercises,
ff for coughing exercises, incentive
prevention spirometer
To the Patient ● Priority of the nurse: prevent
development of complication
● Monitoring frequency: Initially Monitor ● RR, 02 sat, (+) mucus
q15 mins until stable ● Mucus color as an indication of
● Goals infxn: yellow/yellow
- Clear airway green/green
- Stable VS
- Will recover to Circulation (Bleeding or Shock)
baseline cognitive
function
● Complication post-op: Bleeding or shock
- Control N and V
(hypovolemic shock)

TRANSCRIBED BY: DAISY 9

COMPREHENSIVE I FUNDAMENTALS OF NURSING

Assessment ● SBP ● Indications a patient can safely

- <90 mmHg ambulate before going home
- downward trend of 5 - Distance: can walk a
mmHg/reading functional distance
(decreasing SBP kada - Bed mobility: go in and
BP) out of bed
● Blood loss independently
- >500 ml - Toileting:
● Hgb and Hct independently
- Sharp drop
Circulation (Deep Vein Thromboembolism)
Intervention ● Administer
- O2 (1-2 liters via nasal ● Increased risk due to immobility
cannula)
● Position
Prevention ● Fluids: inc. OFI
- modified
of Embolus - Para lumabnaw ang
trendelenburg
dugo
● Apply
● Movement: early ambulation
- Sterile gauze at the
(bed exercises)
wound
● Device: anti-embolic stockings
● Anticipate
- Worn at morning;
- Fluid challenge (PNSS)
before going out of the
or blood product
bed
- Di nag suot ng stcking
Circulation (Orthostatic Hypotension) pero nag CR > wait for
20-30 mins before
● Risk for injury/falls wearing stocking and
after going to the CR
Assessment ● SBP - Check for skin integrity
- Dec. of 20 mmHg when TID
sudden changing ● Medications: low molecular
positions weight heparin
● DBP
- Dec. of 10 mmHg when Avoid Avoid activities that increases pressure
sudden changing activities in popliteal artery (behind the knees)
positions ● (+) pressure behind the knees >
blood stasis > inc. blood clot >
Intervention ● Perform gradual changing of wear thigh compression
position (check bp every stockings
change of position) ● Avoid: dangling of legs
● From lying > sitting by raising ● Devices: avoid knee high socks
HOB > upright > turned to edge
of bed with legs dangling > Circulation (Malignant Hyperthermia)
helping to stand + safety
precaution ● Medical emergency
● Safety precaution: adequate - Give medication first
lighting, up side rails, risk for fall
sign in the room door
At risk ● Females
● General anesthetics
● Autosomal dominant (only 1
parent passess the genetic do)

TRANSCRIBED BY: DAISY 10

COMPREHENSIVE I FUNDAMENTALS OF NURSING

S/sx ● HR: >150 bpm (tachycardic; Dx Test get sample for culturing
early sign) ● Wound
● Upper chest/jaw rigidity (early - Through swab
sign) - Perform wound care
● Temperature of more than or first (irrigate; no
equal to 40 c (late sign) betadine)
● Cardiac arrhythmias (late sign) ● UTI
- Through urine
Intervention ● Immediate: Acquire order and specimen
administer Dantrolene N2 ● Meningitis
After - Through CSF
● Tepid sponge bath and inc. OFI ● TB
● Cooled IV fluids to dec body - Through sputum
temp
● Give hyperthermia blanket Prophylaxis ● (+) antibiotics even before
confirmation of infection cause
Disability (Delirium/ Acute Confusional State) - Broad-spectrum
antibiotic

Prevention ● Fluids: give adequate hydration

● Orientation: reorient to time, Therapy ● Empiric: shorten length of
place, and person infection (general antibiotic)
- Talk to patient even ● Therapeutic: guide antibiotic
when unconcious dosage (specific antibiotic)
● Environment: non-stimulating,
calm and quite Wound (Dehiscence and Evisceration)
● Pain: adequate pain control
● Activity: early ambulation
● Dehiscence: partial or total separation of wound
● Others: safety precautions
edges
● Evisceration: uncontrolled exteriorization of
During ● Intervention: stay with the intra-abdominal contents
Agitated patient and calmly reorient to
State time, place, and person
Onset ● 5th-8th day of post-op
● Medication or restraints?
(commonly)
- Physical restraints
worsen delirium
- Give chemical Common ● Surgical team: inadequate
restraints (diazepam) Cause surgical closure
● Patient’s activity: inc. pressure in
the wound (coughing, vomiting,
Wound (Infection)
valsalva or umire, bend down)

Onset 48-72 hours after admission

S/sx ● Serosanguinous drainage
● Hospital acquired infxn: 48 hrs
(pink)
after hospital admission
- Sanguineous - bloody
● Nasomical: nakuha sa hospital
- sero/serous - clear
● Iatrogenic: infxn related to
- Red + white/clear =
hospital procedure
pink
● Sensation of “something let go/
Common ● streptococcus aureus may bumigay”
Cause

Initial MNGT ● Dehiscence: assist px to go

S/sx ● fever, purulent drainage, back to bed
inflammation ● Evisceration: lie down wherever
they are - put sterile moist
(PNSS) gauze

TRANSCRIBED BY: DAISY 11

COMPREHENSIVE I FUNDAMENTALS OF NURSING

Position ● Dorsal recumbent to dec. Nursing ● Bowel decompression - insert

pressure in the abdomen Intervention NGT (lavage)
- if air - NGT alone
Subsequent ● WOF Hypo Tachy Tachy (shock) - if food - with suction
MNGT ● Anticipate return to OR (to ● Normal paralysis - 24 to 48 hrs
perform closure of wound) after
● Prevention of abdominal
distention
Prevention ● When coughing, use splinting
- position: turn patient
(pillow)
frequently
● Antiemetics (prevent vomiting)
- activity: early
● Inc. OFI and fiber
ambulation
● If stool is hard
- do not feed PO
- Give stool softener
(instead of laxative
because laxatives Elimination (Bladder Incontinence/Retention)
requires you to
“umire”) ● Intervention for bladder or urinary retention:
foley catheter
Wound Changing and Dressing ● Expected time patient will void after surgery:
within 8 hrs
● Expected amount of urine voided after surgery:
● Optimal times 200 ml
- Never perform during meal times (may
cause appetite loss
Bladder ● If without the urge to urinate: -
- Do it without visitors to promote privacy
Training clamp for 2 1/2hs ; release from
● Never touch dressing with ungloved hands
Start 30 mins
● During
● if with urge - remove clamp (30
- Wear sterile gloves during cleaning and
mins) > reclamp until next urge
application or new dressing
- advice the patient to
● After
do kegel’s exercise
- Use clean gloves when removing old
dressing
- In removing tapes, moisten the tapes Indication ● # of urges: 4 to 5 consistent
with sterile water for removal urges - dapat within 2 ½ hrs
● WOF of foley ● If the FC is removed - within 4
- Too much red drainage (sanguineous) catheter hrs after dapat nag-urinate na
> inc. bleeding
- Purulent drainage (yellow/green/yellow Intervention ● Fluids - inc. oral fluid intake
green) > nc. infxn s to ● Sounds - whooshing sound
stimulate ● Faucet - running water
Nutrition ( Post-operative ileus) urination ● Environment - comfort room, as
much as possible
● Bedpan or commode - warm
● No GI movement
environment

Symptoms If patient has eaten

● Abdominal distension
● Nausea and vomiting
● No bowel sounds

TRANSCRIBED BY: DAISY 12