Preoperative and postoperative periods. Preoperative period Preoperative period - interval
Preoperative period – the time from the moment of admission (application) of the patient to a medical institution until the start of the operation.
Purpose of preoperative preparation- studying impaired body functions, creating reserves of functional capabilities of organs and systems to reduce the risk of surgery and minimize the possibility of developing postoperative complications.
Stages of the preoperative period:
1) remote; 2) closest; 3) direct.
Depending on the urgency of the operation, the number of stages may be reduced.
Tasks of the preoperative period:
Establishing a diagnosis.
Carrying out additional and special diagnostic studies
dovaniya.
Determination of indications and contraindications for surgery.
4. Determining the urgency of the operation and its nature
and the choice of anesthesia method (assessment of surgical and anesthetic risk).
16. Preoperative preparation.
17. Prevention of endogenous and exogenous infection.
18. Psychological preparation of patients.
19. Carrying out mandatory and specific preoperative measures
acceptance.
20. Premedication.
10. Transporting the patient to the operating room.
Establishing a diagnosis:
The diagnosis is made based on the patient’s complaints, medical history and life history, clinical manifestations of the disease, laboratory and instrumental research methods.
Examination of the patient:
Depending on the timing of the operation (planned, emergency or urgent), a minimum diagnostic examination must be performed.
At emergency surgery in patients under 40 years of age
General blood analysis
General urine analysis
At emergency surgery in patients over 40 years of age The minimum examination required is:
General blood analysis
General urine analysis
Blood group and Rh factor
Electrocardiogram
Plain chest x-ray
Examination by an anesthesiologist-resuscitator
In addition, according to indications, individual biochemical indicators are taken (for example, blood sugar in a patient with diabetes) and consultations with specialized specialists are carried out (examination by a cardiologist for chronic heart failure). Additional examination according to indications is individual in nature and should be carried out in case of emergency surgical treatment within 2 hours.
At planned surgery for all patients The diagnostic minimum includes:
General blood analysis
General urine analysis
Blood group and Rh factor
Blood for markers of viral hepatitis “B” and “C”
Blood for markers of HIV infection
Blood chemistry
Coagulogram
Electrocardiogram
Plain chest x-ray (or fluorography)
Feces on worm eggs
Examination by a therapist
Examination by a gynecologist (for women)
Dentist examination
Patients admitted for planned hospitalization should be examined as much as possible at the prehospital stage for chronic, sluggish infection (gynecologist, dentist). The scope of instrumental research methods (ultrasound, rectoscopy, colonoscopy, etc.) is decided individually depending on the pathology.
The scope of the diagnostic minimum for urgent surgical intervention should not be less than for emergency surgery. A maximum examination is required in the department, based on medical and economic standards for this pathology.
Determination of indications for emergency, urgent and planned surgery. Vital indications before surgery arise when there is a direct threat to the patient’s life (bleeding, acute diseases of the abdominal organs, purulent-inflammatory diseases, etc.)
Absolute readings to surgery - when failure to perform an operation or its long delay can lead to a condition that threatens the patient’s life. When absolutely indicated, treatment of the disease is possible only surgically (malignant neoplasms, obstructive jaundice, etc.). Long-term delay of surgery in such cases can lead to the development of complications of the disease or irreversible changes in the affected organ and other systems.
Relative readings are prescribed for surgery for diseases that do not pose a threat to the patient’s life (varicose veins of the lower extremities, benign tumors, etc.) For relative indications, temporary refusal of surgery does not cause significant harm to the patient’s health.
In accordance with the given indications of the operation by urgency divided into:
- urgent, or emergency(performed immediately or in the first two hours from the moment the patient enters the surgical hospital),
- urgent(produced within 2 days from the moment of hospitalization),
- planned(performed after a detailed examination of the patient on an outpatient basis).
Preoperative period. Concepts about indications and contraindications for surgery. Preparation for emergency, urgent and planned operations.
Preoperative period– the period of time from the moment the patient is admitted to the surgical hospital until the surgical intervention is performed.
The goal of the preoperative period is to improve the quality of patient treatment by reducing the risk of surgical intervention and the development of complications.
The preoperative period is divided into two stages:
Stage 1 – diagnostic;
Stage 2 – the actual preoperative preparation.
Tasks of the diagnostic stage.
Make an accurate diagnosis (you can limit yourself to determining surgical tactics).
Determine the presence of indications or contraindications for surgery.
Assess the condition of the main body systems.
To identify the presence of complications of the disease and concomitant damage to the patient’s organs and systems, determining the degree of impairment of their function.
Correctly choose the method of surgical intervention and method of anesthesia.
Objectives of preoperative preparation
Conduct psychological preparation.
Correct dysfunctions of organs and systems, if possible, eliminate complications of the disease and cure concomitant diseases.
To create in the body the necessary reserve of functional capabilities of organs and systems, to increase the immunobiological strength of the patient’s body.
Carry out general measures to reduce the risk of developing a surgical infection.
The results of the work carried out by the surgeon in the preoperative period are summarized in the medical record in the form of an operational epicrisis, which includes: 1) justification for the diagnosis; 2) indications for surgery; 3) operation plan; 4) type of anesthesia and expected degree of surgical risk.
The intensity of activities carried out in the preoperative period depends on a number of reasons, primarily on the type of operation and the urgency of its implementation.
During emergency operations, the preoperative period is extremely limited. In this situation, the preoperative period includes either only one stage - diagnostic, when the required minimum of preoperative measures is carried out already in the operating room (vascular catheterization, transfusion therapy, administration of blood products and blood substitutes, etc.) or both stages are carried out in parallel, while the duration of the preoperative the period for emergency operations does not exceed 2 hours (acute intestinal obstruction), widespread peritonitis - no more than 4-6 hours.
For urgent operations, the duration of the preoperative period can vary from 1 to 2 days. The diagnostic stage may include the use of all diagnostic capabilities of the hospital. There is enough time for intensive care.
For planned operations, the preoperative period will depend mainly on the volume of the upcoming operation and on the characteristics of the organization of the surgical hospital. In some cases, patients may be admitted to the hospital having already been fully examined in other medical and diagnostic institutions, which minimizes the duration of the patient’s preoperative hospital stay; in others, the entire diagnostic stage is carried out in the same hospital where the surgical intervention will subsequently be performed.
The diagnostic stage may include all known research methods, on the basis of which the diagnosis is clarified and indications and contraindications for surgery are determined.
Standard minimum examination: general blood test, biochemical blood test - total protein, transaminases, urea, creatinine, glucose, amylase, etc., blood group and Rh factor, general urinalysis, ECG, chest x-ray, etc.
Indications for operations.
Absolute – (emergency and planned surgery) treatment of this disease or condition is life-threatening and is only possible through surgery; (acute appendicitis, acute destructive cholecystitis, pancreatic necrosis, perforated ulcer of the stomach and duodenum, acute intestinal obstruction, strangulated hernia, acute aortic dissection, pulmonary embolism).
Relative – (planned surgery):
the disease can only be treated surgically, but does not pose an immediate threat to life (cholelithiasis, varicose veins of the lower extremities, benign tumors, Hirschsprung's disease);
the disease can be treated both surgically and conservatively (coronary heart disease; obliterating vascular diseases of the lower extremities).
Contraindications for surgery.
Absolute – shock (serious condition of the body, close to terminal), except hemorrhagic with ongoing bleeding; acute stage of myocardial infarction or cerebrovascular accident (stroke), except for methods of surgical correction of these conditions, and the presence of absolute indications (perforating duodenal ulcer, acute appendicitis, strangulated hernia)
Relative - the presence of concomitant diseases, primarily the cardiovascular system, respiratory, kidney, liver, blood system, obesity, diabetes.
Possible components of preoperative preparation.
Psychological preparation. Should be carried out in all cases where the patient is adequate. The patient has the right to receive the necessary information about the nature of the upcoming surgical intervention. In addition to communication between the doctor and the patient, you can use pharmacological agents - sedatives, tranquilizers, antidepressants, etc. It is necessary to obtain the patient’s consent to the operation with documentary evidence. If the patient is incapacitated, the operation is performed with the consent of the guardian, and if absolutely necessary, it can be performed in the presence of a medical consultation. Information can be provided to the patient's relatives only with the consent of the patient.
Preparing the stomach. For planned surgery, fast 12 hours before surgery. In case of emergency surgery, gastric probing is performed.
Bladder catheterization (if indicated).
Cleansing enema (according to indications) – for planned operations
Preparation of the surgical field. During a planned operation, complete sanitary and hygienic treatment is carried out. In case of emergency surgery, shaving the hair.
Premedication. (sedatives, hypnotics and narcotic analgesics). The purpose of premedication is to reduce emotional arousal and reactions to external stimuli; creating optimal conditions for the action of antiseptics; decreased secretion of glands; neurovegetative stabilization; prevention of allergic reactions to agents used for anesthesia.
When performing urgent, and especially planned operations, the scope of preoperative preparation can be significantly expanded.
General somatic preparation – treatment of concomitant pathologies, correction of disorders of the internal environment of the body, sanitation of endogenous foci of infection, etc. Particular attention should be paid to eliminating anemia and correcting dysproteinemia.
Special preparation - for example, preparation of the large intestine (slag-free diet, intestinal lavage), sanitation of the bronchial tree in case of purulent lung diseases.
Local preparation – sanitation and shaving of the surgical field
Preventive antibiotic therapy.
Prevention of thromboembolic complications.
As soon as the patient crosses the border of the operating block, the operating period begins, which consists of the following stages:
placing the patient on the operating table in a position appropriate for each surgical intervention;
putting the patient under anesthesia or performing local anesthesia;
preparation of the surgical field;
performing surgery;
bringing the patient out of anesthesia
1. from the moment of illness;
2. from the moment of diagnosis;
3. from the moment of admission to the surgical hospital;
4. -from the moment the indications for surgery are established;
5. from the moment of setting the day of the operation.
Select the main factors that determine the duration of the preoperative period:
1. - the patient’s condition;
2. -severity of concomitant diseases;
3. - the nature of the pathological process;
4. - volume and traumatic nature of the upcoming operation;
5. none of the above.
The stage of immediate preparation for surgery includes?
1. examination of life support systems;
2. -psychological preparation;
3. rehabilitation of chronic foci of infection;
4. -preparation of the gastrointestinal tract and catheterization of the bladder;
5. -premedication.
On the day of surgery for planned surgical intervention, you should perform:
1. the patient must take a hygienic bath or shower as indicated;
2. change underwear and bed linen;
3. transfuse fresh frozen plasma;
4. - shave the hair in the area of the surgical field;
5. rinse the stomach.
What are the goals of the preliminary stage of preoperative preparation?
1. ensure portability of the operation;
2. reduce the likelihood of developing intra- and postoperative complications;
3. speed up the healing process;
4. stabilization of the main parameters of homeostasis;
5. -all of the above.
Operations performed for life-saving reasons are:
1. stomach cancer;
2. lipomatosis;
3. -perforated gastric ulcer;
4. acute cholecystitis;
5. -strangulated ventral postoperative hernia.
The principles of increasing the body’s resistance to surgical trauma are to:
1. standard preoperative preparation;
2. biostimulation of the metabolic functions of the body;
3. adaptation to operational stress;
4. reducing the reactivity of adaptive-regulatory mechanisms by introducing metabolites of stress-releasing and stress-releasing systems;
5. -all of the above.
The early postoperative period begins:
1. after removing the sutures from the surgical wound;
2. after discharge from the hospital;
3. after restoration of working capacity;
4. -the first 2-3 days after surgery;
5. after eliminating early postoperative complications.
The use of an ice pack on a wound in the postoperative period serves the following purposes:
1. preventing the development of infection;
2. prevention of thrombosis and embolism;
3. prevention of divergence of wound edges;
4. -prevention of bleeding from a wound;
5. -reduction of pain.
To prevent thromboembolic complications in the postoperative period, the following should be done:
1. after surgery, examine the state of the blood coagulation system;
2. 2 hours before surgery, administer heparin to patients in the thrombotic group.
5000 units intramuscularly;
3. elastic bandaging of the lower extremities before surgery;
4. active behavior of the patient in bed;
5. -all of the above.
For the prevention of postoperative pneumonia, the following is used:
1. intravenous administration of large quantities of solutions;
2. introduction of proserin;
3. - breathing exercises;
4. -introduction of painkillers;
5. none of the above.
If you experience urinary retention in the postoperative period, you should do the following:
1. cleansing enema;
2. prescribe diuretics;
3. administer 10 ml of 40% methenamine intravenously;
4. - a warm heating pad on the hypogastric area;
5. -catheterization of the bladder.
Which of the noted complications always develop during surgical interventions on the gastrointestinal tract?
1. peritonitis;
2. -paresis of the gastrointestinal tract;
3. -flatulence;
4. oliguria;
5. pneumonia.
In case of paresis of the gastrointestinal tract, the following should be done:
1. blockade according to Roman;
2. hypertensive enema;
3. prescribe the administration of cerucal;
4. administer intravenously a hypertonic sodium chloride solution;
5. -all of the above.
Identify early complications that may develop in a postoperative wound:
1. pain and burning in the wound area;
2. - bleeding from the wound;
3. infiltrate in the wound area;
4. ligature fistula;
5. suppuration of the wound.
An uncomplicated course of the postoperative period is characterized by:
1. duration 1-6 days;
2. positive nitrogen balance;
3. decreased activity of the sympathoadrenal system;
4. restoration of intestinal function;
5. -all of the above.
Description of the presentation Preoperative period Preoperative period - interval on slides
The preoperative period is the period of time from the moment of diagnosis and indications for surgery to the start of its implementation. It begins from the moment the decision to undergo surgery is made. It ends with the patient being taken to the operating room.
The preoperative period is divided into a diagnostic period ((establishing the main diagnosis, identifying concomitant diseases - in the case when the diagnosis is clarified) - in this case, the condition of organs and systems is determined, indications for surgery are set, and the period of preoperative preparation is determined. Preparatory (Psychological, general simulatory, special, direct training). The duration of the preoperative period depends on the degree of urgency of the surgical intervention.
Preoperative period Stages Contents Long-term (weeks, months, years) Medical examination, health education work Immediate (weeks) Assessment of risk and contraindications Immediate (hours, days) Preoperative preparation (general and special)
Objectives of preoperative preparation: 1. 1. Normalization of mental state. 2. 2. Normalization of general somatic condition: - cardiovascular system; — respiratory systems; - liver and kidney functions; - blood systems. 3. 3. Normalization of metabolism: - protein metabolism; - carbohydrate metabolism; — KSH and VEB. 4. 4. Prevention of surgical infection: - sanitation of foci of infection; — immunocorrection; 1. 1. antibiotic prophylaxis. 5. 5. Preparation of the operation area: - general; - special.
The main task of the preoperative period. . The main task of P. p. is to minimize the risk of developing various complications associated with pain relief and surgical intervention both during surgery and in the immediate postoperative period. P. p. is necessary for a comprehensive examination of the patient, an in-depth assessment of the function of the main organs and systems, as well as carrying out the most complete corrective therapy for identified disorders in order to increase the reserve capabilities of the body.
The patient's needs are violated. There is a risk of complications. Drinking is a risk of developing complications. Discharge – constipation, pain. Breathing is a pain. Sleep. Resting is a pain syndrome. Moving – increased pain. Dressing, undressing - the severity of the condition. Risk of complications. Maintain the condition – pain syndrome. To be clean means the severity of the condition, the pain syndrome. Avoid danger - risk of complications. Communication - isolation in a hospital, severity of condition. Self-realization – severity of condition, limitation of ability to work.
Patient problems in the preoperative period. Physiological: Cessation of life activity; Pain syndrome; Violation of movement (forced position); Breathing disorders Thirst, dry mouth; Violation of physiological needs (eat, drink, excrete).
The duration of the preoperative period depends on the degree of urgency of the operation, the condition of the patient, his age and the severity of the upcoming surgical intervention. .
Only emergency, emergency operations performed for life-saving reasons (severe injuries, injury to large vessels, acute appendicitis, strangulated hernia, ectopic pregnancy, perforated gastric ulcer, acute intestinal obstruction, etc.) are allowed with minimal preparation (from a few minutes to 1-2 hour), since a delay in surgery in such cases threatens the patient’s life.
Classification of surgical operations 1. 1. According to the purpose of the intervention: - diagnostic (exploratory, trial); — radical therapeutic (combined, extended); palliative; optional (cosmetic, aesthetic, gender correction). 2. 2. By deadlines: - urgent/emergency (in the first hours); — urgent/delayed (on the first day); - planned (in weeks, months, years). 3. 3. By order of execution: - primary; — repeated (re-) early; late.
Classification by urgency of implementation Planned (in the department, in the morning, with tests). Postponement of the scheduled operation does not affect the forecast. Urgent (in the morning, in the department, with tests). Such an operation cannot be postponed, as this will lead to a deterioration in the patient’s condition. Emergency – performed within the first 2 hours from the moment the patient is admitted to the hospital. And in case of life-threatening conditions (bleeding, asphyxia, etc.), intervention is carried out in the shortest possible time.
Preparation for the operation is carried out strictly individually and includes a number of general and special measures: general - - mandatory for each operation; ; special - - are necessary only in preparation for certain operations.
In patients with acute appendicitis, strangulated hernia, and ectopic pregnancy, after examination and obtaining consent for surgery, preoperative preparation is limited to the administration of morphine and cardiac drugs; ; patients with severe trauma or injury to large vessels are treated with anti-shock therapy; ; in case of intestinal obstruction, saline solution and 5% glucose solution are infused before surgery; patients with perforation of the abdominal organs are administered serum, plasma or protein blood substitutes.
Direct preparation of the patient for surgery General principles. Planned operations Emergency operations Preparation of the surgical field. Full sanitary and hygienic treatment. Dry shaving of hair. "Empty Stomach". Fast 12 hours before surgery. Probing of the stomach according to indications. Bowel movement. Cleansing enema. Not produced. Emptying the bladder. Independent urination. Bladder catheterization according to indications. Premedication. Various means according to a certain scheme. Atropine and narcotic analgesics.
Premedication is the administration of medications before surgery in order to reduce the incidence of intra- and postoperative complications. Objectives of premedication: Reducing emotional stress; Neurovegetative stabilization; Decreased reactions to external stimuli; Creation of optimal conditions for the action of anesthesia; Prevention of allergic reactions to agents used in anesthesia; Decreased secretion of glands;
Before operations performed under anesthesia, gastric emptying with a probe is often required, and in case of acute intestinal obstruction, a siphon enema is also required. . In so-called planned (non-urgent) operations, the main task of the preoperative period is to minimize the risk of the upcoming operation.
The preoperative period for non-urgent operations (appendectomy in the “cold” period, hernia repair, etc.) usually takes 2-3 days. It takes from 10 to 30 days to prepare a patient for pneumonectomy due to a suppurative process of the lung with symptoms of severe intoxication or a patient with exhaustion due to cancer of the esophagus, lung, etc.
General measures are aimed at improving the neurosomatic condition of the patient, increasing the immunobiological strength of the body, combating secondary anemia, dehydration, intoxication, loss of nutrition, etc. A number of patients undergo special preparation for surgery in specialized departments ((clinics, hospitals))
TASKS OF THE NURSE: removal and preservation of dentures, rings and other jewelry Submission of an application for premedication control of diuresis. To reduce the risk of aspiration of vomit during anesthesia, patients usually have a light dinner the night before surgery and do not receive any food or liquid until after 11:00 pm on the day before surgery.
Activities before the operation On the eve of the operation, the patient is prescribed a general bath or shower and the underwear is changed. When washing, pay attention again to the skin of the entire body - whether there are pustules, rashes, diaper rash, etc. On the day of surgery, the surgical field is shaved; 30-40 minutes before surgery, morphine with atropine and other medications are administered as prescribed by the anesthesiologist. Before the operation, the patient is asked to urinate. The patient is always taken to the operating room on a gurney, accompanied by a ward nurse.
The most important element of P. p. is the psychological preparation of the patient. As a rule, patients want to receive comprehensive answers to questions related to the nature of the disease, the validity of the operation and its features, danger to health or ability to work, etc. The patient must be confident in the high professional competence of the surgeon and in the successful outcome of the operation.
Test-reference control Preoperative preparation begins from the moment of: a) making a diagnosis requiring surgery and deciding on its implementation; b) the patient’s admission to the surgical department for surgery; c) both answers are correct;
Test-reference control In the preoperative period, stages are distinguished: a) one: b) two; at three o'clok;
Test-reference control Psychological problem of the patient before the operation: a) pain: b) fear: c) inability to pay for the operation:
Test-reference control The needs during preparation for gastric resection surgery are violated: a) the need to move is violated; b) the need to eat is violated; c) the need to sleep is disrupted;
Test-reference control Premedication on the day of surgery includes the administration of: a) promedol solution 2% - 1 ml, atropine solution 0.15, diphenhydramine solution - 1% - 1 ml. b) analgin solution 50% - 2 ml, phenobarbital - 0.1 ml, aspirin - 0.5 ml; c) aspirin – 0.5, diphenhydramine solution 1% – 1.0.
Test-reference control Premedication is prescribed before surgery: a) 2 hours; b) 4 hours; c) 30 -45 minutes;
Test-reference control A cleansing enema is carried out before surgery: a) emergency: b) planned: c) does not matter;
Situational tasks Task No. 1 There is a patient in the surgical department with a diagnosis of stomach disease. The patient is bothered by pain in the epigastrium that is not associated with food intake. Over the past 3 months I have lost 8 kg. Notes decreased appetite, aversion to meat foods, feeling of fullness in the stomach after eating. Sometimes he induces vomiting for relief. The examination revealed that the tumor was located in the pyloric region of the stomach. During the round, the doctor told the patient that he was about to have an operation, after which the patient began to worry, in a conversation with his sister he expressed fears that he was unlikely to undergo the operation, since his friend allegedly died from a similar operation.
Situational tasks Tasks: 1. What special and additional research methods were performed on the patient to confirm the diagnosis. 2. List the satisfaction of which needs is impaired in the patient. 3. Identify the patient’s problems, prioritize them, and formulate goals. 4. Create a motivational nursing intervention plan. 5. Make a plan to prepare the patient for surgery.
Situational tasks 1. What special and additional research methods were performed on the patient to confirm the diagnosis. When examining a patient, an R-graph of the stomach with barium, an FGDS with a biopsy, and an ultrasound of the liver and pancreas are performed.
Situational tasks 2. List the satisfaction of which needs is impaired in the patient. Violation of need satisfaction - to be healthy, to eat, to excrete, to avoid danger, to work.
Situational tasks 3. Identify the patient’s problems, highlight the priority, formulate goals. Patient problems. Present: weight loss; decreased appetite; vomit; fear of the upcoming operation; Priority problem: - fear of the upcoming operation. The goal is that by the time of surgery, the patient will feel safe during and after surgery.
Situational tasks 4. Create a plan for nursing interventions with motivation. 4. Planning: Motivation of M/s daily for 5 -10 minutes. will discuss with the patient his fears and worries. — provide moral support; The doctor, answering the patient’s questions, will familiarize him with the methods of pain relief, the preoperative preparation plan, and the course of the postoperative period. - instill confidence in the patient that all actions of health workers are aimed at preventing complications during anesthesia and the postoperative period; M/s will introduce the patient to a patient who has successfully undergone a similar operation. support your words with the lips of someone who has undergone surgery; M/s will provide moral support to relatives. - provide moral support from loved ones; M/s organizes the patient's leisure time. - distract the patient from thoughts about an unfavorable outcome; By the time of the operation, the m/s will be convinced that the patient has overcome his fear. - evaluate your actions;
Situational tasks 5. Make a plan for preparing the patient for surgery. Preoperative preparation plan: On the eve of the operation, feed a light dinner in the evening, warn the patient not to eat or drink in the morning. At night, do a cleansing enema. As prescribed by your doctor, take sleeping pills at night. In the evening, carry out a complete sanitization. On the morning of the operation: take the temperature; cleansing enema; shave the surgical field; as prescribed by the doctor, rinse the stomach through a tube; Before premedication, ask the patient to urinate; administer premedication; transport the patient on a gurney to the operating room; .
Situational tasks Task No. 2. The patient was operated on for mechanical obstruction. After surgery, a tumor of the sigmoid colon was discovered and a colostomy was performed. On the 2nd day after the operation, the bandage began to become abundantly wet with intestinal contents. The patient is upset, depressed, and is worried about the attitude of her relatives towards her. She believes that she will be a burden to the family of her daughter, with whom she lives. What worries her most is the presence of an intestinal fistula. She doubts that she will be able to provide skin care in the fistula area herself.
Situational tasks Tasks: 1. What skin changes in the fistula area can occur with poor care? 2. List the satisfaction of which needs is impaired in the patient. 3. Formulate the patient's problems, determine the priority problem and goals. 4. Create a motivational nursing intervention plan. 5. Select medications to protect the skin around the fistula. 6. Assemble a set of instruments for abdominal surgery.
The preoperative period is the period from the moment the patient is admitted to the hospital until the start of the operation.
PREOPERATIVE PREPARATION OF PATIENTS
LECTURE No. 9
Most patients who are admitted to the surgical department undergo surgery. From the moment of admission to the hospital, the preoperative period begins, during which efforts are aimed at reducing the risk of surgery and preventing complications that may arise during and after it.
Goals of preoperative preparation:
o Ensure tolerance of surgical trauma;
o Reduce the likelihood of developing intra- and postoperative complications;
o Speed up the healing process.
Objectives of preoperative preparation:
· Psychological preparation;
· Stabilization of the basic parameters of homeostasis, if necessary, primary preoperative detoxification;
· Preparation of the respiratory tract and gastrointestinal tract;
· Preparation of the surgical field;
· Emptying the bladder;
· Premedication.
There are two stages in the preoperative period:
Ø Diagnostic or stage of preliminary preparation for surgery (from the moment the patient is admitted to the hospital until the day of surgery is scheduled);
Ø Stage of immediate preparation (from the moment of setting the day of the operation to the start of the operation).
The preliminary preparation stage includes:
· Establishment/clarification of diagnosis;
· Examination of the body's life support systems;
· Determination of concomitant diseases;
· Risk assessment of surgical intervention;
· Correction of identified dysfunctions of organs and systems, sanitation of chronic foci of infection, stimulation of the body's resistance mechanisms are carried out.
The moral state of patients admitted for surgery differs significantly from the state of patients hospitalized for conservative treatment, since surgery is a major physical and mental trauma. It is important that from the first minutes of admission, from the emergency department to the operating room, the patient feels the precise work of the medical staff. He looks closely and listens to everything around him, is constantly in a state of tension, turns primarily to middle and junior medical personnel, and seeks their support. Calm behavior, gentle treatment, and a calming word spoken at the right time are extremely important. The indifferent attitude of the nurse, the staff’s negotiations about personal, irrelevant things in the presence of the patient, the inattentive attitude to requests and complaints give the patient a reason to doubt all further activities and put him on guard. Talk by medical personnel about the poor outcome of an operation, death, etc. has a negative effect. Medical personnel, with all their behavior, must inspire the patient’s favor and trust. The patient’s recovery depends not only on a well-technically performed operation, but no less on carefully conducted preoperative preparation; in some cases, caring for a surgical patient decides his fate. Nursing staff not only must know how to carry out the doctor’s prescription, but must understand why this prescription was made, how it is useful for the patient, and what harm can be caused to the patient by failure to comply with certain doctor’s instructions. Only one can prepare a patient well for surgery who will carry out the doctor’s orders not automatically, but consciously, and understand the essence of the activities being carried out.
Preoperative preparation of patients consists of a set of measures. In some cases, they are reduced to a minimum (for emergency and urgent operations), and for planned operations they must be carried out more carefully.
Activities carried out to prepare patients for surgery can be divided into - - are common, i.e. mandatory before each operation,
· Hygienic bath or shower;
· Change of underwear and bed linen,
· Shaving hair in the surgical area (strictly on the day of surgery, but no more than 6 hours between shaving and surgery),
Cleansing enema
· Emptying the bladder.
- special, special ones that need to be carried out only in preparation for certain operations.
Specific events include:
o Gastric lavage (operations of the upper gastrointestinal tract)
o Siphon enema (colon surgery, etc.)
TO basic research planned patients include:
· measuring the patient's height and weight,
determination of blood pressure,
· clinical analysis of blood and urine,
· blood chemistry,
· coagulogram,
· blood test for hepatitis markers, RW, HIV.
determination of blood group and Rh factor,
X-ray/fluorography of the chest organs,
Ultrasound of the abdominal organs,
· Examination by an ENT doctor or dentist – sanitation of foci of chronic infection.
· examination of stool for worm eggs.
At emergency operations Premedication (injection of a solution of morphine or promedol), shaving the surgical field and emptying the stomach of its contents are sufficient. In patients with severe injuries, it is necessary to immediately begin anti-shock measures (pain relief, blockades, blood transfusions and anti-shock fluids). Before surgery for peritonitis or intestinal obstruction, emergency measures should be taken to combat dehydration, detoxification therapy, and correction of salt and electrolyte balance. These measures should begin from the moment the patient is admitted and should not cause a delay in the operation.
When preparing a patient for a planned operation, the diagnosis must be clarified and concomitant diseases identified that can complicate and sometimes make the operation impossible. It is necessary to identify foci of endogenous infection and, if possible, sanitize them. In the preoperative period, the function of the lungs and heart is examined, especially in elderly patients. Weakened patients require preoperative transfusions of protein drugs and blood, as well as combating dehydration. Much attention should be paid to preparing the patient's nervous system before surgery.
The risk of surgical intervention is based on taking into account:
ü Age;
ü Functional state of vital systems of the body;
ü The severity of the underlying and concomitant diseases;
ü Urgency and volume of the operation.
Operational risk criteria:
q Risk I degree– a somatically healthy patient undergoing a minor planned surgical intervention (opening of abscesses, diagnostic procedures).
q Risk II A degree– somatically healthy patients undergoing more complex planned surgical interventions (appendectomy, cholecystectomy, operations to remove benign tumors, etc.)
q Risk III B degree– patients with relative compensation of life support systems and functions of internal organs undergoing minor planned operations indicated in the category “risk of the first degree”.
q Risk III A degree– patients with full compensation of life support systems and functions of internal organs, undergoing complex, extensive interventions (gastric resection, gastrectomy, operations on the colon and rectum, etc.)
q Risk III B degree– patients with subcompensation of life support systems and functions of internal organs, undergoing minor surgical interventions.
q Risk IV degree– Patients with a combination of deep, general somatic disorders (acute or chronic, caused, for example, by myocardial infarction, trauma, shock, massive bleeding, diffuse peritonitis, endogenous intoxication, renal and liver failure, etc.), undergoing major or extensive surgical interventions, which in In most cases with the listed pathology, they are performed on an emergency basis or even for vital reasons.
q Risk V degree(recognized as a separate category by some clinics, but not accepted into the mandatory classification) – patients with decompensation of vital support organs and functions of internal organs, during surgical intervention in which there is a high risk of death on the operating table, and in the early postoperative period.
