Pre-Intra Operative Care

‫بسم اهلل الرحمن الرحيم‬
:Providing Preoperative Patient Care

The patient proceeds to
surgery physically and
psychologically prepared
Preoperative Phase
extendsfromthetimetheclientisadmittedinthe
surgicalunit,tothetimehe/sheispreparedforth
esurgicalprocedure,untilheistransportedintot
heoperatingroom
INFORMED CONSENT
Pre Operative Care
Physical Preparation Before Surgery
Correct any dietary deficiencies
Reduce an obese person’s weight
Correct fluid and electrolyte imbalances
Restore adequate blood volume with BT
Treat chronic diseases
treat any infectious process
Treat an alcoholic person with vit.
supplementation, IVF or fluids if dehydrated
Pre Operative Teaching
Incentive Spirometer
Diaphragmatic Breathing
Coughing Splinting
Turning Foot and Leg Exercise
Early Ambulation
Preparing the Patient in the Evening Before
Surgery
Preparing the Skin-
have a full bath to reduce microorganisms in the skin.
-hair should be removed within 1-2mm of the skin to avoid skin
breakdown,
Preparing the G.Itract -NPO, cleansing enema as required
preparing for Anesthesia
-Avoid alcohol and cigarette Smoking For at least 24 hours before
surgery.
promoting rest and sleep
-Administer sedatives as ordered
Providing Preoperative Patient
Care: (Day of Surgery)
NO Steps of the procedure
1 Check the patient’s chart for the type of surgery and

.review the medical orders
2
Review the nursing database, history, and physical
examination. Check that the baseline data are recorded;
.report those that are abnormal
3
Gather the necessary supplies and bring to the bedside
.stand or over bed table
4
Perform hand hygiene and put on PPE, if indicated.
5
Identify the patient
6 .Close curtains around bed and close the door to the room, if possible
7 .Explain what you are going to do and why you are going to do it to the patient
8 Check vital signs. Notify primary care provider and surgeon of any pertinent changes
(e.g., rise or drop in blood pressure, elevated temperature, cough, symptoms of
infection).
9 Provide hygiene and oral care. Assess for loose teeth and caps. Remind patient of food
and fluid restrictions before surgery
10 Instruct the patient to remove all personal clothing, including underwear,and put on a
hospital gown.
11 Ask patient to remove cosmetics, jewelry including body piercing, nail polish, and prostheses (e.g.,
.contact lenses, false eyelashes, dentures, and so forth)
12 Some facilities allow wedding band to be left in place depending on the type of surgery, provided
it is secured to the finger with tape
13
If possible, give valuables to family member or place valuables
.in appropriate area, such as the hospital safe
14
Have patient empty bladder and bowel before surgery
15
Attend to any special preoperative orders, such as starting an IV
.line
16
Complete preoperative checklist and record of patient’s
preoperative preparation
17
Question patient regarding the location of the operative site.
18
Document the location in the medical record according to facility
policy.
19
Administer preoperative medication as prescribed by
physician/anesthesia provider
20
Help move the patient from the bed to the transport stretcher,
.if necessary
21
Reconfirm patient identification and ensure that all preoperative
events and measures are documented
22
Tell the patient’s family where the patient will be taken after
surgery and the location of the waiting area where the surgeon
will come to explain the outcome of the surgery
23
After the patient leaves for the operating room, prepare the room
.and make a postoperative bed for the patient
24
Anticipate any necessary equipment based on the type of surgery
and the patient’s history.
25
Remove PPE, if used. Perform hand hygiene
The sterile field is created without
Goal: contamination and the patient
remains free of exposure to
potential infection causing
microorganisms
Intraoperative Phase
extends from the time the client is admitted
to the OR, to the time of administration of
anesthesia, surgical procedure is done, until
he/she is transported to the RR/PACU
NO Procedure steps
1 .Perform hand hygiene and put on PPE, if indicated
2 .Identify the patient. Explain the procedure to the patient
3 Check that packaged sterile drape is dry and UN opened.
Also, note expiration date, making sure that the date is

still valid
4 .Select a work area that is waist level or higher
5 Open the outer covering of the drape. Remove sterile
.drape, lifting it carefully by its corners

6 Hold away from body and above the waist and work
.surface
7 Continue to hold only by the corners. Allow the drape to unfold,
.away from your body and any other surface

8 Position the drape on the work surface with the moisture proof
side down. This would be the shiny or blue side.

9 .Avoid touching any other surface or object with the drape
10 If any portion of the drape hangs off the work surface, that part
of the drape is considered contaminated

11 .Place additional sterile items on field as needed
12 Continue with the procedure as indicated.
13 When procedure is completed, remove PPE, if used. Perform
Goal:
The sterile field is created without
contamination, the sterile supplies
are not contaminated, and the
patient remains free of exposure to
potential infection-causing
microorganisms
No Procedure steps
1 .Perform hand hygiene and put on PPE, if indicated
2 .Identify the patient. Explain the procedure to the patient
3 Check that the sterile, packaged drape and supplies are
dry and unopened.

4 Also note expiration date, making sure that the date is still
.valid
5 .Select a work area that is waist level or higher
6 Prepare sterile field
7
A-To Add an Agency-Wrapped and Sterilized Item
8
Hold agency-wrapped item in the dominant hand, with top flap
opening away from the body.
9
With other hand, reach around the package and unfold top flap
.and both sides
10
Keep a secure hold on the item through the wrapper with the
dominant hand. Grasp the remaining flap of the wrapper closest to
the body, taking care not to touch the inner surface of the wrapper
or the item.
11
Hold the item 6 inches above the surface of the sterile field and
drop onto the field. Be careful to avoid touching the surface or
other items or dropping onto the 1-inch border.
B-To Add a Commercially Wrapped and Sterilized Item
12 Hold package in one hand. Pull back top cover with other hand. Alternately, carefully
.peel the edges apart using both hands

13 After top cover or edges are partially separated, hold the item 6 inches above the
surface of the sterile field.

14 .Continue opening the package and drop the item onto the field
15 Be careful to avoid touching the surface or other items or dropping onto the 1-inch
border
C-To Add a Sterile Solution
16 .Obtain appropriate solution and check expiration date
17 Open solution container per directions and place cap on table away from the field with
edges up
18 Hold bottle outside the edge of the sterile field with the label side facing the palm of
.your hand and prepare to pour from a height of 4 to 6 inches (10 to 15 cm)
19 The tip of the bottle should never touch a sterile container or field
20 Pour required amount of solution steadily into sterile
container previously added to the sterile field and
.positioned at side of sterile field or onto dressings
21 .Avoid splashing any liquid
22 Continue with procedure as indicated.
23 When procedure is completed, remove PPE, if used.

Perform hand hygiene
Putting on Sterile Gloves and
Removing Soiled Gloves
As before
Members of the Surgical Team
Surgeon
Surgical assistant
Anesthesiologist
Certified registered nurse anesthetist
Holding area nurse
Circulating nurse
Scrub nurse
Surgical technician/ Operating room technician
Environment of the Operating
Room
Preparation of the surgical suite and team safety

Layout
Health and hygiene of the surgical team
Surgical attire
Surgical scrub
Surgical Scrub, Gowning, and
Gloving
Any questions

Pre-Intra Operative Care

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‫بسم اهلل الرحمن الرحيم‬

:Providing Preoperative Patient Care

Turning Foot and Leg Exercise

1 Check the patient’s chart for the type of surgery and

1 .Perform hand hygiene and put on PPE, if indicated

2 .Identify the patient. Explain the procedure to the patient

3 Check that packaged sterile drape is dry and UN opened.

Also, note expiration date, making sure that the date is

5 Open the outer covering of the drape. Remove sterile

.drape, lifting it carefully by its corners

.away from your body and any other surface

side down. This would be the shiny or blue side.

of the drape is considered contaminated

3 Check that the sterile, packaged drape and supplies are

dry and unopened.

.peel the edges apart using both hands

surface of the sterile ﬁeld.

22 Continue with procedure as indicated.

23 When procedure is completed, remove PPE, if used.

Preparation of the surgical suite and team safety

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