Care of Client During Preoperative Period

1. Phases of Surgery

3 Phases of Surgery

Pre-operative : Begins when the decisions for surgical intervention is made and ends when the patient is transferred to the operating room.

Intra-operative : Begins when the patient is transferred to the surgery and ends when transferred to the recovery room.

Post-operative : Begins when the patient is admitted to the recovery room and ends with follow up evaluation in the clinical setting or home.

2. Classification of Surgery

Classification of Surgery

There are different types of surgery and surgeries can be classified according to surgical urgency. The terms used by National Confidential Enquiry into Patient Outcome and Death (NCEPOD) to classify the types of surgery were Emergency, Urgent, Scheduled and Elective.

Two Main Classification of Surgery  

Invasive procedure A body cavity/ compartment is entered Peritoneal/ thoracic/ cranial cavity or muscles compartments to do orthopedic surgery Examples of major surgery include cardiac operations, any bowel cavity operations, reconstructive surgery, deep tissue procedures, any transplant procedures, as well as any surgeries in the abdomen, chest or cranium.	Minor surgery done in minor OT or Clinic under local anaesthesia. Minor surgeries are generally superficial and do not require penetration of a body cavity

Classification According to Purpose  

• Diagnostic
• Curative
• Palliative
• Reconstructive
• Preventive
• Exploratory
• Cosmetic

3. Types of Surgery

Types of Surgery

• Bariatric Surgery
• Breast Surgery
• Colon & Rectal Surgery
• Endocrine Surgery
• General Surgery
• Gynaecological Surgery
• Hand Surgery
• Head & Neck Surgery

4. Categories of Surgery

4 Major Categories of Surgery

1. Wound Treatment : Tehnical aspects of wound surgery, is on procuring good healing and the avoidance of infection.

2. Extirpative Surgery : Extirpative surgery involves the removal of diseased tissue or organs. Cancer surgery usually falls into this category, with mastectomy (removal of the breast), cholecystectomy (removal of the gallbladder), and hysterectomy (removal of the uterus).

3. Reconstructive Surgery 

4. Transplantation Surgery 

Other Categories of Surgery

The Surgical Setting : In the past, surgery may have meant a lengthy hospital stay to recover. Today, you now have several choices. Those choices depend on your diagnosis and type of surgery you need.

Inpatient Surgery : For some surgeries, you will need to stay overnight or longer in a hospital. This is so the staff can carefully watch your recovery. You can get medical attention right away in case of problems.

Outpatient Surgery : Many surgeries done today let you recover and go home on the same day. Or you may go home the next day. Outpatient surgery costs less, lowers stress, and speeds up your recovery. It also means you need to take less time off from work. Outpatient surgery may also be called same-day surgery, in-and-out surgery, or ambulatory surgery. And outpatient surgery is sometimes done in specialty surgical centers.

• Ambulatory Surgery : Ambulatory surgery is done without admitting you to the hospital. The surgery may be done in the outpatient section of the hospital. Or it may be done in an outpatient surgical center or in a healthcare provider's office.
• Specialty Surgery Centers. : Certain medical specialties such as ophthalmology may be in an office separate from the hospital. These specialty centers offer full care, including outpatient surgery. Most outpatient centers have ties to hospitals. That means you can be admitted there if needed after surgery

The surgery may be done in the outpatient section of the hospital, in an outpatient surgical center, or in a healthcare provider's office. Specialty surgery centers. Certain medical specialties, such as ophthalmology, may be located in their own office settings, away from the hospital.

5. The role of nurse in medical surgical settings

Medical-Surgical Nurse Roles

Medical-Surgical Nurse responsibilities include monitoring vital signs, administering medications, and maintaining patient records. Ultimately, you will work directly with patients before and after they complete a surgical procedure in our facility to ensure they receive necessary medical attention Surgical nurses are a critical part of the healthcare team and ensure that patients are well cared for before, during, and after their surgery. They need specialized skills and knowledge in order to be prepared for working in a surgical setting.

6. Patient Safety in the Surgical Environment

Improving Patient Safety in the Surgical Environment

Protocols and procedures to identify and manage stress and fatigue in surgical personnel may help to avoid surgical errors and patient injuries. The operating room is an appropriate educational environment, but the presence of observers at any level must not be allowed to compromise patient safety. Patient safety in surgery demands the full attention of skilled individuals using well-functioning equipment under adequate supervision.

All members of the operating room team also should postpone nonessential conversation until surgery is finished. Similarly, it may be preferable to ask nonessential personnel to remain outside the operating room while surgery is being performed. Everyone on the team is mutually accountable for minimizing distractions.

The education process in these environments presents special challenges in protecting patient safety. It is a fundamental principle that all trainees must be meticulously supervised and assisted when participating in surgery. Both the trainee and the supervisor should be alert, well rested, and well prepared in advance for the surgical procedure being performed. Because patient safety depends on effective communication.

Statement on the prevention of retained foreign objects after surgery, the American College of Surgeons recommends consistent application and adherence to standardized counting procedures and documentation of the surgical counts, instruments or items intentionally left as packing, and actions taken if count discrepancies occur.

6.1. World Health Organization Surgical Safety Checklist

Another useful tool to promote patient safety in the surgical setting is the surgical safety checklist published by the World Health Organization. The checklist is based on the successful international program “Safe Surgery Saves Lives,” which incorporates validated checklists to be reviewed by the surgical team before induction of anesthesia, before skin incision, and before the patient leaves the operating room. It is inappropriate to place total reliance on the surgeon to identify the correct surgical site or to assume that the surgeon should never be questioned. The risk of error may be reduced by involving the entire surgical team in the site verification process and encouraging any member of that team to point out a possible error without fear of ridicule or reprimand.

7. The Universal Protocol

Preprocedure Verification Process

• The health care team ensures that all relevant documents and related information or equipment are available before the start of the procedure;
• Correctly identified, labeled, and matched to the patient’s identifiers; and
• Reviewed and are consistent with the patient’s expectations and with the team’s understanding of the intended patient, procedure, and site.
• The team must address missing information or discrepancies before starting the procedure