Download Textbook For Nursing Assistants

Textbook For Nursing
Assistants
Chapter 39 – Caring for Surgical
Patients
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 1
Introduction to Caring for Surgical
Patients
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 2
Introduction to Caring for Surgical
Patients
A person may need surgery for many different
reasons
Exploratory surgery
May be performed when a person has a significant medical
problem but the doctors do not know exactly how bad the
problem is or exactly what is causing it
For example, doctors might want to do exploratory surgery
following an accident when the extent of the damage to the
person’s internal organs is unknown, or when cancer is
suspected but cannot be confirmed by other means
Often times, the problem is not only discovered but solved
during the same surgery
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 3
Introduction to Caring for Surgical
Patients
Definitive surgery
Is performed when the person’s medical problem is
known and the best way to address it is through
surgery
For example, surgeries are performed to repair organ
defects or injuries, as in a hernia repair or surgical
repair of a fractured bone
Surgeries are also performed to remove diseased
body parts, as when the cancerous part of the colon
is removed as treatment for colon cancer
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 4
Introduction to Caring for Surgical
Patients
Elective Surgery
Surgeries are performed on an elective basis
when the procedure is planned for and
scheduled ahead of time
An example of an elective procedure would
be cataract surgery or a plastic surgery
procedure, such as a face-lift
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 5
Introduction to Caring for Surgical
Patients
Urgent surgeries
Are planned and scheduled ahead of time, but
usually an effort is made to schedule the
procedure as soon as possible to prevent the
person’s condition from getting worse
Examples of urgent procedures would include
a mastectomy (in a person with breast
cancer) or cardiac bypass surgery (in a
person with coronary artery disease)
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 6
Introduction to Caring for Surgical
Patients
Emergent surgery
Is one that must be performed immediately to
prevent the person from dying or becoming
disabled
Emergent surgeries are unplanned and
unscheduled and are usually the result of an
acute illness or injury, such as a ruptured
appendix
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 7
Anesthesia
Most surgical procedures are done under
anesthesia
Anesthesia prevents the person from feeling
pain during the surgery, and is accomplished
through the use of medications
Based on the situation, the doctor may choose
to use a
General anesthetic
Regional anesthetic, or
Local anesthetic
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 8
Anesthesia
General anesthesia
Causes a loss of consciousness
Usually, a combination of inhaled drugs (in the form of
a gas) and injected drugs are given to cause general
anesthesia
The person is “put to sleep” for the duration of the
surgical procedure
When the procedure is completed, the drugs are
stopped and the person “wakes up”
The person will be sleepy for several hours after the
procedure and may experience some nausea or
vomiting during the recovery period
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 9
Anesthesia
Regional anesthesia
Causes a loss of sensation in part, but not all, of the body
The person remains conscious throughout the procedure
A sedative drug may be given in addition to the anesthetic to
help the person relax
The anesthetic drug is injected near a nerve pathway, causing
the part of the body beyond the injection site to become numb
After surgery, the sensation returns gradually
The person may experience temporary paralysis and weakness
of the anesthetized body part until the anesthetic has worn
completely off
An example of regional anesthesia is “an epidural block,” which
numbs the body from the waist down and is often given to
women during childbirth
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 10
Anesthesia
Local anesthesia
Causes a loss of sensation in only a very small part of
the body (the surgical site)
As with regional anesthesia, the drug is injected near
a nerve pathway, the person remains conscious
throughout the procedure, and a sedative may be
given to help the person relax
The surgical site remains without sensation until the
local anesthetic wears off
Eye surgeries, breast biopsies, and hernia repairs are
examples of surgeries that are often performed under
local anesthesia
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 11
Surgery in the Past
In the past, people who were having a planned surgical
procedure were admitted to the hospital the day before
the scheduled surgery
The tests required prior to surgery were done, the
surgical site was shaved and cleaned, the person and
his family members were told what to expect during and
after the surgery, and the person was given a sleeping
pill to ensure a restful night’s sleep
Following the surgery, the person usually stayed in the
hospital for several days to recover under the watchful
eyes of the hospital staff
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 12
Surgery Today
Now, changes in how we pay for health care have led to changes in
the lengths of hospital stays
People are discharged from the hospital “quicker and sicker”
For the surgical patient who is having elective or urgent surgery, this
means that most of the tasks that used to be done in the hospital the
day before surgery are now done in the surgeon’s office or on an
outpatient basis in the days leading up to the surgery
The person remains home until the morning of surgery and goes to
the hospital or surgical center an hour or two before the surgery is
scheduled
After the surgery, the person is often discharged from the hospital
within a few hours to recover at home, in an extended care facility,
or in a long-term care facility
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 13
The Peri-Operative Period
There are three phases of care for the person
having surgery
These phases are:
The pre-operative phase, or before surgery
The intra-operative phase, or during surgery
The post-operative phase, or after surgery
The term peri-operative period is used to
describe all three phases of the surgical process
as a whole
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 14
Care of the Pre-operative Patient
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 15
Care of the Pre-operative Patient
Emotional preparation
A person facing surgery usually has many fears,
concerns, and worries
The person may be afraid of not waking up from the
anesthesia, dying as a result of the surgery, or experiencing
pain during or after the procedure
He may worry that the doctor will make a mistake, and
remove the wrong organ or limb
If the person is having exploratory surgery, the person may
be very worried about what the doctor will find (for example,
a malignant tumor)
Many people worry about how long it will take to recover from
the surgery, and what this will mean in terms of time missed
from work and lost income needed to support a family
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 16
Care of the Pre-operative Patient
To help reduce a person’s anxiety about
the upcoming surgery
The health care team spends time talking with
the person and his family members about the
procedure, its benefits and possible risks, and
what can be expected during the postoperative recovery period
These conversations, which occur during the
pre-operative phase, are commonly called
pre-operative teaching
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 17
Care of the Pre-operative Patient
Pre-operative teaching begins with the
doctor’s explanation of why she feels the
procedure is the best treatment option for
the person
The doctor tells the person what
complications can occur as a result of the
procedure, what will actually occur during
the procedure, and what other treatment
options, if any, are available
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 18
Care of the Pre-operative Patient
Informed consent must be given by the person
and documented in the person’s medical record.
If the person is not able to make an informed
decision on his own, informed consent must be
obtained from the person’s family members.
The nurse is responsible for making sure that
informed consent has been obtained and that
the person signs a form giving permission for the
procedure to take place.
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 19
Care of the Pre-operative Patient
Once informed consent for the procedure is obtained,
the nurse continues the pre-operative teaching by
explaining what will need to be done both before and
after the surgery
The nurse explains the pre-operative procedures that are
done to physically prepare the person for surgery, as
well as the purpose of any medications or tests that are
required during the pre-operative period
The nurse also explains what will happen during the
post-operative period, and teaches the person how to do
any exercises that may be necessary to prevent
complications following the surgery
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 20
Care of the Pre-operative Patient
Nursing assistants reinforce what the nurse has
told the person, and keep the nurse informed of
any questions the person may have about the
procedure
If the person asks you a question about an aspect of pre- or
post-operative care that you are directly involved with, such as
the reason for the NPO status prior to the procedure or the
purpose of taking vital signs frequently after the procedure, you
can answer the question yourself
But if you do not know the answer to the person’s question, or if
the question is about the surgical procedure itself, please tell the
nurse immediately that the person has a question
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 21
Care of the Pre-operative Patient
Nursing assistants can:
Recognize the person’s fears
Listen to the person’s questions and concerns
Take action to get those questions or
concerns addressed
These are all very important things that
nursing assistants do to help a person to
prepare emotionally for the upcoming
surgery.
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 22
Care of the Pre-operative Patient - Physical Preparation
- In the Days Leading up to the Surgery
Typically, a person who is having surgery
will need to have several tests done before
the surgery to assess her level of health
Tests to assess the functioning of the
person’s cardiovascular, respiratory, and
urinary systems are typically done
In addition, the doctor may request blood
work
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 23
Care of the Pre-operative Patient - Physical Preparation The Evening Before Surgery
A person who is scheduled for surgery
will usually be on NPO status for 6 to 8
hours before surgery
A Person on NPO status
This is necessary to ensure that the
person’s stomach is empty during and
after the procedure
It is common for a person who has had
general anesthesia to vomit as the
anesthesia is given or starts to wear off
Vomiting while in a semi-conscious state
puts the person at risk for aspiration (the
inhalation of foreign material into the
lungs)
Aspiration puts the person at risk for
developing pneumonia
Going into the procedure with an empty
stomach helps to reduce the risk of
aspiration and pneumonia
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 24
Care of the Pre-operative Patient - Physical Preparation The Evening Before Surgery
Helping a person who is on NPO status
Tell the person, as well as any visitors, that NPO means that the
person may not have anything by mouth, including water, ice,
gum, and mints
Show visitors to an area outside of the person’s room where they
can enjoy their snacks and beverages, away from the person
who is on NPO status
Remember to remove the water pitcher and the drinking glass
from the bedside table
Frequent mouth care helps to keep the person on NPO status
comfortable
The person is usually allowed to brush her own teeth as long as
no water is swallowed
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 25
Care of the Pre-operative Patient - Physical Preparation The Morning of Surgery
Many things are done the day of surgery
to prepare the person
Tasks that you may be involved with
include the following:
Administering an enema or vaginal douche
Bathing
Grooming
Dressing
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 26
Care of the Pre-operative Patient - Physical Preparation
- The Morning of Surgery
Administering an enema or vaginal douche
A cleansing enema is given before many procedures
to empty the bowel
For example, an enema may be given if the person is
scheduled for intestinal surgery, to prevent feces from
contaminating the abdominal cavity during the
surgery
If a woman is having a vaginal procedure, the doctor
may order vaginal irrigation (a douche) prior to the
surgery to clean the vagina
When vaginal irrigation is ordered, a special solution
is placed in the vagina and then allowed to drain out
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 27
Care of the Pre-operative Patient - Physical Preparation
- The Morning of Surgery
Bathing
You may need to help the person to bathe and
wash his hair prior to the surgery
Bathing and shampooing reduces the number
of microbes on the skin
In some cases, the doctor may order a special
anti-microbial soap to be used
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 28
Care of the Pre-operative Patient - Physical Preparation
- The Morning of Surgery
Grooming
Make-up, including nail polish, is not permitted during
surgery
Prosthetic devices, glasses, contact lenses, hearing
aids, dentures, wigs, jewelry, and hair ornaments may
also be removed prior to the surgery
Although the person may want or need to wear some
of these items up until the very last minute, you
should let the person know about these restrictions
and encourage him to leave all but the most
necessary items at home
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 29
Care of the Pre-operative Patient - Physical Preparation
- The Morning of Surgery
Dressing
If the person will be going to the hospital or surgical
center the day of the surgery, have him wear clothing
that is loose and comfortable
This will make changing into a hospital gown before
the procedure easier, and it will also ensure that when
the person goes home, the clothing will fit over any
bulky dressings or casts that may have been applied
during the procedure
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 30
Care of the Pre-operative Patient - Physical Preparation
- Immediately Before the Surgery - Outpatients
Once the person arrives at the hospital or surgical center, she will go
to a preparation area next to the operating room
The person will be shown to a private area and asked to undress
and put on a clean hospital gown and surgical cap
A nurse will check that all paperwork has been properly completed,
and will answer any questions that the person has
The person will then be asked to void, and may be given an antiemetic drug (to prevent nausea) and a sedative (to help relieve
anxiety)
After these drugs have been given, the side rails must remain up on the
bed or stretcher and the person must not get up without assistance,
because the sedative may make the person drowsy and weak
Make sure the call light control is within easy reach, and that the person
is comfortable and warm
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 31
Care of the Pre-operative Patient - Physical Preparation
- Immediately Before the Surgery - Outpatients
If the surgery will be performed under general
anesthesia, the person’s glasses or contact lenses,
hearing aids, dentures, prosthetic devices, jewelry, and
hair ornaments may be removed at this time
If the surgery will be performed under regional or local
anesthesia, the doctor may request that the person wear
hearing aids or dentures during the surgery, to make
communication easier
Items that are removed from the person are
documented and given to the person’s family or placed
in the facility safe
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 32
Care of the Pre-operative Patient - Physical Preparation
- Immediately Before the Surgery - Outpatients
The surgical site (the area of the body being operated
on) may be prepared at this time, or this may be done in
the operating room
Preparation of the surgical site may or may not involve
removal of the body hair
If hair removal is ordered, there are several ways to remove hair
from the surgical site
The hair may be shaved, clipped with an electric clipper, or
removed with a chemical depilatory (hair-removing) lotion
If one of your duties is to perform pre-operative hair removal,
make sure you have been instructed in the proper technique
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 33
Care of the Pre-operative Patient - Physical Preparation
- Immediately Before the Surgery - Outpatients
Lastly, a pre-operative checklist is
completed
The checklist is used to confirm that all
pre-operative tests and procedures have
been completed
The nursing assistant is often responsible
for completing and recording many of the
tasks on the checklist
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 34
Care of the Pre-operative Patient - Physical Preparation
- Immediately Before the Surgery – Inpatients
If the person was admitted to the hospital prior to the
surgery, the tasks that are completed immediately before
the surgery may be completed in the person’s room,
before taking her to the operating room
In addition, you may need to help your patient from the
bed onto the stretcher when it is time to go to the
operating room
Let the person’s family members know where they can
wait while the person is in surgery
Please remember that family members are often anxious and
nervous about the surgery
Refer any questions family members may have about the
procedure or the person’s condition to the nurse
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 35
Care of the Post-operative
Patient
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 36
Care of the Post-operative Patient
Immediately after surgery, the
person is taken to the postanesthesia care unit (PACU),
also known as the recovery
room
While in the PACU, the person
is closely monitored by the
health care team to make sure
that he is recovering without
complications from the surgery
or the anesthesia
While the person is in surgery,
you will most likely be
responsible for preparing the
person’s room for his arrival
post-operatively
Preparing a surgical bed to
receive the patient after
surgery
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 37
Care of the Post-operative Patient
Equipment for taking vital signs and a flow sheet
for recording the vital signs
An intravenous (IV) pole
A towel and washcloth
An emesis basin
A bed protector
Suction to connect to drainage devices
Supplemental oxygen
Pillows or other positioning aids to elevate the
extremities
Warmed blankets
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 38
Care of the Post-operative Patient
When the person is returned to his room, you
will need to assist in transferring the person from
the stretcher to the bed
The nurse assesses the person’s overall
condition, checks for blood on the dressing and
for the presence of drains and catheters, and
adjusts the IV flow rate
While the nurse is doing this, you may be asked
to measure and record the person’s vital signs
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 39
Care of the Post-operative Patient
Post-operatively, routine vital sign
measurements, including temperature, are
usually taken every 15 minutes for the first
hour, every 30 minutes for the next 1 to 2
hours, every hour for the next 4 hours, and
then every 4 hours as ordered
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 40
Care of the Post-operative Patient Preventing Complications
People who have had surgery are at risk for developing
complications, especially related to breathing and
circulation
In addition, the surgical site may become infected or the
wound may not stay closed
As a nursing assistant, there are several things that you
will do to prevent complications from developing
Also, if one of your patients develops a complication
from surgery, you may be the first one to notice
Reporting your observations to the nurse promptly helps
to ensure that action will be taken quickly to prevent the
person’s condition from getting worse
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 41
Care of the Post-operative Patient Preventing Complications
Respiratory complications
The combined effects of general anesthesia, the
drugs given to relieve post-operative pain, and a
painful incision make it difficult for a person who is
recovering from surgery to clear the lungs and
airways of fluid and mucus
If the person also has a chronic respiratory disorder,
such as asthma or chronic obstructive pulmonary
disease (COPD), or if the person smokes, then her
risk of developing a respiratory complication
increases even more
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 42
Care of the Post-operative Patient Preventing Complications
Common respiratory complications of
surgery include pneumonia (fluid fills the
alveoli) and atelectasis (the alveoli
collapse)
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 43
Care of the Post-operative Patient Preventing Complications
To prevent fluid and mucus from collecting
in the person’s lungs, you may need to
assist the person with frequent
repositioning and with performing
respiratory exercises
Commonly used respiratory exercises
include coughing and deep breathing and
incentive spirometry
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 44
Care of the Post-operative Patient Preventing Complications
Coughing and deep breathing
The person is helped into a
comfortable position and then
instructed to take a few deep
breaths and cough forcefully
If the person has had abdominal or
chest surgery, you may need to
support the incision site with a
small pillow or folded towel while
the person coughs
Incentive spirometry
The person forcefully inhales
through a special device called an
incentive spirometer
If your patient has orders to
perform respiratory exercises,
these exercises will need to be
done every few hours, or as
directed
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 45
Care of the Post-operative Patient Preventing Complications
Cardiovascular complications
Anesthetic agents, pain medications, and
general immobility after surgery can cause the
body’s circulation to slow down, leading to
pooling of the blood in the legs
When blood flow slows and blood pools, a
thrombus, or blood clot, may form
Surgical patients who are elderly or have a
history of circulatory problems are at the most
risk for developing thrombi
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 46
Care of the Post-operative Patient Preventing Complications
Preventing embolism
Sequential compression device (SCD)
Anti-embolism (TED) stockings
Leg exercises
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 47
Care of the Post-operative Patient Preventing Complications
Sequential compression device (SCD)
A sequential compression device (SCD) is a device
that is applied to the calves to help prevent pooling of
blood in the lower legs
Disposable plastic sleeves are wrapped around the
person’s lower legs
The sleeves, which have several different
compartments, are connected to an air pump via
tubing
Air is pumped into the first compartment (the one
closest to the foot) to inflate it
Then the next compartment inflates, then the next,
helping to move the blood from the lower legs toward
the heart
When the top-most compartment has been inflated, all
the compartments deflate and the cycle begins again
at the bottom
The inflating and deflating action massages the veins,
pushing the blood through the veins and back to the
heart
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 48
Care of the Post-operative Patient Preventing Complications
Anti-embolism (TED) stockings
Anti-embolism (TED) stockings are made of a tightfitting elastic fabric
The stockings, which may be knee-high or thighhigh, are specially fitted for the person by the nurse
or the physical therapist
The elastic fabric applies pressure, compressing
the veins and helping to return blood to the heart
This helps to prevent pooling of blood in the legs
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 49
Care of the Post-operative Patient - Other
Tasks
Assisting with positioning
Assisting with nutrition
Assisting with elimination
Assisting with hygiene
Assisting with walking (ambulation)
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 50
Care of the Post-operative Patient - Other
Tasks
Assisting with positioning
During the post-operative period, most people will
need assistance with repositioning themselves every
1 to 2 hours
Frequent repositioning is necessary for the person’s
comfort
In addition, it helps to prevent the post-operative
complications of pneumonia and embolism
Depending on where the incision is, moving may be
very painful for the person
Use a lift sheet to help reposition the person, and
move him gently and slowly
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 51
Care of the Post-operative Patient - Other
Tasks
Assisting with nutrition
A person who is recovering from surgery usually
needs intravenous (IV) therapy until she is able to
take fluids orally and is no longer nauseated
If the person has had surgery involving the digestive
system, then she may have a nasogastric tube
The nasogastric tube is connected to suction to keep the
stomach empty
These patients may need to remain on IV fluids for several
days
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 52
Care of the Post-operative Patient - Other
Tasks
Assisting with elimination
Following surgery, the person may have difficulties related to
elimination
 Some people may need to use a bedpan or a urinal after surgery
 The person’s NPO status, pain medications, and immobility can
lead to constipation
 A full bladder can increase pain from an abdominal incision, making
voiding difficult and necessitating catheterization
Your responsibilities will include reporting the person’s first
voiding after surgery
Often, you will also need to measure and record the person’s
intake and output (I&O) for a period of time following surgery as
well
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 53
Care of the Post-operative Patient - Other
Tasks
Assisting with hygiene
People who are recovering from surgery may need
help with personal hygiene.
Assisting with frequent oral care, helping the person
to wash his face and hands, and changing soiled
gowns promptly are all things you can do to help
promote comfort.
Many people will not be able to take a bath or a
shower for a few days following surgery, because the
incision cannot get wet. These people will need your
help in the form of either partial or complete bed
baths.
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 54
Care of the Post-operative Patient - Other
Tasks
Assisting with walking (ambulation)
Early and frequent ambulation is helpful in preventing many of the
complications that can result from surgery
Many times, a person who has had surgery is able to get out of bed
within a few hours of returning to his room
Because the person will be weak and unsteady, he will need your help
when ambulating
Allow the person time to sit on the edge of the bed (“dangle”) before
getting out of bed
If the person complains of feeling dizzy or lightheaded while he is
dangling, help the person to lie back down and call the nurse
Otherwise, check the person’s pulse and blood pressure and then help
the person to stand
Usually, you and the person will walk only a short distance to begin with
As the person’s strength returns, you can go for longer walks
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 55
End of Presentation
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 56