Editing Medical-Surgical Nursing (section)

== Perioperative and Postoperative Nursing ==

=== Preoperative Care ===

Verify that informed consent is signed, that the patient understands the procedure, and that the surgeon, not the nurse, obtained the consent; the nurse witnesses the signature and confirms understanding. Confirm allergies, current medications including anticoagulants, herbal products, and diabetes agents, the nothing by mouth status, and the removal of jewelry, dentures, and prostheses per policy. Verify the site marking and participate in the surgical time-out.

Preoperative teaching that reduces complications includes coughing and deep breathing, incentive spirometry, splinting the incision with a pillow, leg exercises, early ambulation, and how to rate and report pain.

=== Postoperative Priorities ===

Immediate priorities are airway and breathing, then circulation, then level of consciousness, then pain, then surgical site and drains, then output.

Monitor for the classic complications by timing. Atelectasis and pneumonia often explain fever in the first forty-eight hours, and the response is pulmonary hygiene and ambulation, not antibiotics alone. Urinary retention appears in the first day. Wound infection typically appears after the third to fifth day with fever, purulent drainage, increasing pain, and erythema. Venous thromboembolism can occur at any point and is prevented by early ambulation, compression devices, and prophylactic anticoagulation. Paralytic ileus presents with absent bowel sounds, distention, and no passage of flatus.

Nursing application: wound dehiscence is separation of the wound layers, and evisceration is protrusion of viscera through the opening. If evisceration occurs, cover the organs with sterile gauze moistened with sterile normal saline, place the patient in low Fowler position with the knees slightly bent to reduce abdominal tension, keep the patient nothing by mouth, monitor for shock, stay with the patient, and notify the surgeon immediately. Do not attempt to reinsert the organs.