Pre-Op and Post-Op Nursing Assessment and Management

Assessment Identification: Use admission history and surgical-related questions to identify factors affecting surgery.
Pre-Op Checklist: Complete the assessment as outlined in the Canvas Module; verify previous surgical history, such as a CABG requiring a cardiology consult.
Latex Allergy: Screen regularly as surgeons use latex products; medications or alternative products are used to limit risk.
Pre-Operative Teaching: * Pre-Op: Focus on deep breathing, coughing, Incentive Spirometer, early mobilization (preventing DVT and constipation), pain management, and splinting incisions. * Intra-Op: Explain IV placement, skin preparation, and equipment. * Post-Op: Inform patient they will be in recovery for approximately $1\,hour$ . Vital signs occur $q15\,mins$ for the first $1\,hour$ , then $q30\,mins \times 2\,hr$ , then $q1\,h \times 4\,hr$ . Progress diet as tolerated.

Core Assessment: Focus on AIRWAY, VITALS, PAIN, and INCISION.
Neurological: Assess LOC using GCS; perform focused neuro exams for brain surgery or spinal anesthesia.
Cardiac/Perfusion: Monitor BP (fluctuations due to pain, fluid loss, or narcotics), Temperature (risk of Malignant Hyperthermia or infection), and EKG/Telemetry for Normal Sinus Rhythm.
Respiratory: * Observe for airway obstruction (Secretions, Spasms, Edema, Tongue, Snoring, Stridor). * Stridor is an emergency requiring possible reintubation. * Depressed rates from anesthesia/narcotics require rescue breaths and NARCAN!.
GI/GU: Assess bowel sounds, passing gas, and diet status. Monitor fluid status via Ins and Outs, weights, and wound drainage.
Skin and Drains: Evaluate wound size, dressing, and drains (JP DRAIN, HEMOVAC, PENROSE, WOUND VAC).
Drainage Types: SEROUS, SERO-SANGUINEOUS, SANGUINEOUS, and PURULENT.
Specific Orders: May include CSM (Circulation, Sensation, Movement) checks $q1\,h$ , laying flat for $4\,hrs$ , or utilizing a back brace.

Hemorrhage/Shock: * Symptoms: Low BP, High HR, cool/pale skin, weak pulses, ALOC, saturated dressing. * Interventions: Call "Code Shock", apply pressure, head of bed flat, and obtain stat CBC, INR, PT, PTT. Anticipate fluid boluses or blood products.
Blood Clots (DVT/PE): * DVT Symptoms: Weak/absent pulses, swelling, calf pain. Prevent with compression devices, early ambulation, and subcutaneous low dose heparin. * Pulmonary Embolism (PE): Respiratory distress or deterioration.
Atelectasis/Pneumonia: Prevent via Incentive Spirometer, Deep Breathing and Coughing (DB+C), and maintaining head of bed at $30^\circ$ .
Compromised Airway: Indicated by snoring, stridor, or $o2$ desaturation. Interventions include Oral Pharyngeal Airway, intubation, or Narcan.

Informed Consent: Practitioner must explain the procedure, underlying disease, risks/benefits, right to refuse, and recovery plans. Students cannot witness informed consent.
Advanced Directive: Legal document regarding treatment and Code Status: * DNR: Do not resuscitate. * Modified Code: Specific requests (e.g., no CPR, no Defib, ventilations only). * FULL CODE: Includes CPR, Defib, emergency meds, and intubation.