AE	Anti-embolism; anti-embolic
CBC	Complete blood count
ECG	Electrocardiogram
EKG	Electrocardiogram
ID	Identification
IV	Intravenous
NG	Naso-gastric
NPO	Non per os; nothing by mouth
OR	Operating room
PACU	Post-anesthesia care unit
post-op	Post-operative
pre-op	Pre-operative
SCD	Sequential compression device
TED	Thrombo-embolic disease

The many reasons for surgery include to:

• Remove, repair, or replace a diseased or injured body part.

• Remove a tumor.

• Make a diagnosis.

• Relieve symptoms.

• Restore or improve function or appearance.

Surgery may require a hospital stay. In-patients are admitted the morning of surgery or 1 or 2 days before surgery. Some patients go to surgery from the emergency room. Patients stay for 1 or more days after surgery.

Same-day surgery (out-patient, 1-day, or ambulatory surgery) is common. The surgeries are done in hospitals and surgi-centers (surgery centers). Surgi-centers are designed and equipped for certain surgical and diagnostic procedures. The person goes home the same day or the next day.

Surgeries are described as:

• Elective surgery—done by choice to improve life or well-being. It is not life-saving. Joint replacement surgery and cosmetic surgery are examples. The surgery is scheduled in advance.

• Urgent surgery—needed for the person’s health. It can be delayed for a few days. Sometimes cancer surgery and coronary artery bypass surgery can be delayed for a few days.

• Emergency surgery—done at once to save life or function. The need is sudden and not expected. Vehicle crashes, stabbings, and bullet wounds often require emergency surgery.

The person is prepared for what happens before, during, and after surgery. Pre-operative (pre-op) refers to before surgery. Post-operative (post-op) refers to after surgery. Some people recover in nursing centers or rehabilitation centers. Some need home care.

Psychological Care

Surgery causes many fears and concerns (Box 35-1). Past experiences affect feelings. Some persons had surgery before. Others have not. Patients are affected when family and friends talk about their own surgeries. Most people know about tragic events—surgery on the wrong person or body part, instruments left in the body, death during or after surgery. Some people do not share fears and concerns. They may cry, be quiet or withdrawn, or talk about other things. Some pace. Others are very cheerful.

Box 35-1

Surgery Fears and Concerns

The Fear of …

• Anesthesia and its effects

• Cancer

• Complications from surgery

• Disability

• Disfigurement and scarring

• Dying during or after surgery

• Exposure

• Not waking up after surgery

• Pain: during surgery, after surgery

• Prolonged recovery

• Separation from family and friends

• Surgery on the wrong body part

• Tubes, needles, and other care equipment

• Waking up during surgery

• What happens after surgery—more surgery, treatments, care, and so on

Concerns about …

• Caring for children and other family members

• Finances—monthly bills, loan payments, mortgages, hospital bills, doctor bills

• House, lawn, and garden

• Pets

• Plants

Mental preparation is important. Respect the person’s fears and concerns. Show warmth, sensitivity, and caring.

Patient Information

The doctor explains the need for surgery to the patient and family. They are told about:

• The surgery, risks, and possible complications

• The risks from not having surgery

• Who will do the surgery

• The date and time of the surgery

• How long the surgery will take

Questions are answered. Misunderstandings are cleared up. Care instructions are given.

After surgery, the doctor talks to the patient and family. Often the health team knows the results before the person.

See Focus on Communication: Patient Information.

Focus on Communication

Patient Information

Patients and families are eager to know the results. They may ask you about reports. Refer their questions to the nurse. Never tell any results or diagnoses. You can say:

• “The doctor will tell you about the surgery and the results. I’ll tell the nurse that you’re asking.”

• “I’ll get the nurse to answer your questions.”

Your Role

You can assist in the person’s psychological care before and after surgery.

• Listen. The person may talk about fears and concerns.

• Refer questions to the nurse.

• Explain the care you will give and its need.

• Follow communication rules (Chapters 7 and 9).

• Use verbal and nonverbal communication (Chapter 9).

• Provide care with skill and ease.

• Report signs of fear or anxiety (Chapter 48).

• Report a request to see a member of the clergy.

Pre-Operative Care

The pre-operative (pre-op) period may be many days or a few minutes. If time allows, the person is prepared mentally and physically for anesthesia and surgery. The goal is to prevent complications before, during, and after surgery.

See Teamwork and Time Management: Pre-Operative Care.

Teamwork and Time Management

Pre-Operative Care

The nurse has a limited amount of time for pre-op care. Assist as directed. You must understand what to do and when to complete care.

You may be delegated several tasks. Tell the nurse when you complete each task. For example, you provide personal care (p. 591). Tell the nurse about your progress.

Pre-Operative Teaching

The nurse explains what to expect before, during, and after surgery. Teaching includes:

• Pre-op care—includes tests and their purpose, skin preparation, personal care, and the purpose and effects of pre-op drugs.

• Deep breathing, coughing, and incentive spirometry—are practiced. Post-op, they are done every 1 to 2 hours when the person is awake. See Chapter 39.

• Post-anesthesia care unit (PACU)—commonly called the recovery room, this is where the person wakes up after surgery (Fig. 35-1). The care given is explained.

FIGURE 35-1 The post-anesthesia care unit (PACU).

• Vital signs—are taken often until they are stable.

• Food and fluids—post-op, the person is NPO (non per os; nothing by mouth) and has an IV (intravenous). Food and fluids are allowed when the person’s condition is stable.

• Turning and re-positioning—are done at least every 1 to 2 hours post-op.

• Early ambulation—is done as soon as possible post-op.

• Pain—relates to the type and amount of pain to expect and how pain-relief drugs are given.

• Treatments and equipment—may involve a urine catheter, NG (naso-gastric) tube, oxygen, wound suction, a cast, or traction.

• Position restrictions—are common after some surgeries. For example, the hip is abducted after hip replacement surgery (Chapter 44).

See Focus on Children and Older Persons: Pre-Operative Care.

Focus on Children and Older Persons

Pre-Operative Care

Children

The child and parents are prepared for the surgery. Often play can help the child understand what will happen. For example, a doll is used to show the surgery site. A tour is given of the operating room (OR) and PACU. The child and parents meet the OR and PACU nursing staff.

Special Tests

Pre-op, the doctor evaluates the person’s health status. These tests are common.

• Chest x-ray.

• Complete blood count (CBC).

• Urinalysis (U/A).

• Electrocardiogram (ECG, EKG). See Figure 35-2.

FIGURE 35-2 An electrocardiogram is taken.

Other tests depend on the person’s condition and surgery. For expected blood loss, the person’s blood is tested for blood type and compatible blood. This is called type and crossmatch.

The person is prepared for the tests as needed. Test results must be on the chart before surgery.

Nutrition and Fluids

A light meal usually is allowed. Then the person is NPO for 6 to 8 hours before surgery. These measures reduce the risk of vomiting and aspiration during anesthesia and after surgery. An NPO sign is placed in the person’s room. The water mug is removed.

Bowel Elimination

Bowel surgeries may require a bowel prep—cleansing the bowel of feces. Feces contain microbes. When the intestine is opened, feces can spill into the sterile abdominal cavity. The bowel prep prevents this contamination.

For the bowel prep, the doctor orders special fluids for the person to drink. Or the doctor orders what enemas to give and when.

Urinary Elimination

The person voids before the nurse gives pre-op drugs. If the person has a catheter, the drainage bag is emptied. The output is measured and recorded.

Often catheters are inserted in the OR. For pelvic and abdominal surgeries, the bladder must be empty. A full bladder is easily injured during surgery. Catheters also allow accurate output measurements during and after surgery.

Personal Care

Personal care before surgery involves:

• A complete bath, shower, or tub bath and shampoo. A special soap or cleanser and shampoo may be ordered. The bath and shampoo reduce the number of microbes present. This reduces the risk of a wound infection. A patient gown is worn after bathing.

• Make-up, nail polish, and fake nail removal. The skin, lips, and nail beds are observed for color and circulation during and after surgery.

• Hair care. All hairpins, clips, combs, and other items are removed. So are wigs and hairpieces. A surgical cap keeps hair out of the face and the operative site.

• Oral hygiene. Being NPO causes thirst and a dry mouth. The person must not swallow any water during oral hygiene.

• Dentures. Provide denture care and store dentures following agency policy. Some people do not like to be without their dentures. Let them wear dentures as long as possible. This promotes dignity and self-esteem.

• Prostheses. Eyeglasses, contact lenses, hearing aids, artificial eyes, and artificial limbs are removed. Hearing aids may be left in if the surgeon needs to talk to or instruct the patient during surgery. Follow agency policy for storage and safe-keeping.

• Other. Often elastic stockings (p. 598) are put on before transport to the OR. So are sequential compression devices (p. 601).

See Promoting Safety and Comfort: Personal Care.

Promoting Safety and Comfort

Personal Care

Safety

Check for loose teeth. Loose teeth are common in children. Adults may have loose teeth from periodontal disease (Chapter 22). Report loose teeth to the nurse. The nurse notes this on the pre-op checklist and tells the surgery staff. A loose tooth can fall out during anesthesia. The person can aspirate the tooth.

Jewelry

Jewelry is easily lost or broken in the OR and PACU. Transfers to and from the OR, PACU, and the person’s room also present safety risks. And jewelry can cause pressure injuries (Chapter 37). Therefore all jewelry is removed and stored for safe-keeping. This includes body-piercing jewelry. Record jewelry removal and storage according to agency policy.

The person may want to wear a wedding ring or religious medal. Secure the item in place with gauze and tape according to agency policy. Hand, arm, shoulder, and breast surgeries can cause swelling of the fingers. Wedding rings are removed for such surgeries.

Skin Preparation

Microbes from skin and hair can enter the body through the surgical incision. To reduce the risk of infection, a skin prep is done. For the skin prep, the doctor orders 1 or more of the following.

• Cleansing with an anti-microbial soap. Anti means against.

• Clipping the hair at and around the site.

• Removing hair at and around the site.

The incision site and a large area around it are prepped (Fig. 35-3, p. 592). The prep is done in the person’s room or in the OR. To remove hair, a hair cream remover is used. Or the skin is shaved.

FIGURE 35-3 Skin prep sites. The shaded area shows the area to prep for the type of surgery.

A skin prep kit is used for shaving. The kit has a razor, a sponge filled with soap, a basin (tray), a drape, and a towel (Fig. 35-4, p. 593). Lather the skin with soap. Then shave in the direction of hair growth (Fig. 35-5, p. 593).

FIGURE 35-5 Shave in the direction of hair growth.

See Delegation Guidelines: Skin Preparation, p. 593.

See Promoting Safety and Comfort: Skin Preparation, p. 593.

See procedure: The Surgical Skin Prep—Shaving the Skin, p. 593.

Delegation Guidelines

Skin Preparation

When reviewing the skin prep procedure with the nurse, you need this information.

Promoting Safety and Comfort

Skin Preparation

Safety

Any break in the skin is a possible infection site. Be very careful not to cut, scratch, or nick the skin. Follow Standard Precautions and the Bloodborne Pathogen Standard.