Perioperative care and common conditions
Surgery is a major event for patients. Nurses prepare them, keep them safe during surgery, and help them recover. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
Preoperative care
Before surgery, nurses check informed consent is signed, verify identity and procedure, review allergies and medications (such as anticoagulants that may need stopping), confirm fasting status as ordered, and teach about pain control, coughing, deep breathing, and early mobilisation. Anxiety is common; clear information helps.
Surgical safety
The WHO Surgical Safety Checklist, introduced in 2008, includes checks before anaesthesia, before incision (a 'time-out' confirming patient, procedure, and site), and before the patient leaves the operating room. Studies found it reduced complications and deaths in diverse hospitals.
Postoperative monitoring
After surgery, nurses monitor airway, breathing, circulation, vital signs, level of consciousness, pain, wound and drains, urine output, and nausea. Early warning signs of complications include rising heart rate, falling blood pressure, fever, low oxygen saturation, and new confusion.
Postoperative complications
Common complications include atelectasis (collapsed alveoli, prevented by deep breathing, incentive spirometry, and mobilisation), pneumonia, deep vein thrombosis and pulmonary embolism (prevented with mobilisation, compression devices, and anticoagulants as ordered), wound infection, bleeding, urinary retention, and ileus (slowed bowel movement).
Wound care
Surgical wounds usually heal by primary intention (edges closed). Monitor for infection: redness, warmth, swelling, increasing pain, discharge, and fever. Use aseptic technique for dressing changes. Wound dehiscence (separation) and evisceration (organs protruding) are emergencies; cover with sterile saline-moistened dressing and call for help.
Diabetes care
Hospitalised patients with diabetes need regular glucose monitoring, coordinated insulin and meal timing, and attention to hypoglycaemia and hyperglycaemia. Diabetic ketoacidosis (more common in type 1) causes high glucose, ketones, acidosis, deep rapid breathing, and dehydration, and requires urgent fluids, insulin, and electrolyte management.
Stroke
A stroke occurs when blood flow to part of the brain is blocked (ischaemic) or a vessel bleeds (haemorrhagic). The BE FAST mnemonic aids recognition: Balance, Eyes, Face drooping, Arm weakness, Speech difficulty, Time to call emergency services. Clot-busting treatment for ischaemic stroke must be given within hours, so noting the time symptoms began is vital.
Worked example
On the second day after abdominal surgery, a patient's temperature is 38.1 C, breathing is shallow, and breath sounds are reduced at the lung bases. The nurse suspects atelectasis, encourages incentive spirometry and deep breathing, helps the patient walk as allowed, and reports the findings, since fever and reduced breath sounds can also signal pneumonia.
Key takeaways
Preoperative care confirms consent, identity, allergies, medications, and fasting, and teaches recovery techniques. The WHO checklist and time-out prevent errors. Postoperative nurses monitor ABCs, vital signs, pain, wounds, and output. Prevent atelectasis, DVT, infection, and ileus with breathing exercises, mobilisation, and prophylaxis. Dehiscence and evisceration are emergencies. DKA needs urgent treatment. Recognise stroke with BE FAST and record symptom onset time.
Flashcard
Consent, identity, allergies, medications, fasting
Check your understanding
Why is recording the exact time stroke symptoms began so important?