SAINT LOUIS UNIVERSITY

SCHOOL OF NURSING
BAGUIO CITY, PHILIPPINES

TEACHING CARE PLAN

PRE & POST-OPERATIVE CARE
Submitted by:
LARA, Kit B.
BSN III-A1

Submitted to:
Kathleen Gail C. Guevarra, RN
(Clinical Instructor)

DESCRIPTION OF THE LEARNER: The learners are the patients who may undergo surgical procedure in the institutions of Saint Louis University Hospital of the
Sacred Heart and needs health teaching about pre-operative care
LEARNING NEEDS: Pre and Post-Operative Care Management
-LEARNING DIAGNOSIS: Risk for injury related to lack of knowledge of pre-operative management related to inadequate information on pre-op care
GENERAL OBJECTIVE: After 30 minutes of health teaching, the client will be able to identify pre and post-management in surgical procedure
TIME ALLOTMENT: 20-30 mins
TEACHING CARE PLAN PROPER:
Time allotment
Learning
Learning Objective
Learning Content
and resources
Evaluation
Strategies
needed
The patient will be able to :
One-on-one Time resource
Instant oral feedback: the
a medical procedure involving an incision with
instruments; performed to repair damage or arrest
1. Define using her own
-lecture
(1-min),
patient will be able to
disease in a living body; "they will schedule
words:
pamphlet,
define in his/her own
theoperation as soon as an operating room is available"
SURGICAL
brochure
words surgical operation
OPERATION.
2. Identify pre-op check
list

Consent form
Bath/Shower/Scrub Make up removed
Hair Clipped
Date Time Polish/Artificial Nails removed
Personal Clothing and
underwear removed
Dentures/Partial/Retainer
removed
Glasses/contacts removed Hearing aid Lt removed
Pins/Hairclips removed Hearing aid Rt removed
Tampon removed Prosthesis removed
Bowel Prep done Voided at
NG Tube inserted
Size
Catheter inserted
Type Size
NPO Solids at Medications taken this am
NPO Clear Fluids at Pre-Op medications given
IV Site checked Medications to OR
Blood Products arranged Antiembolic Stockings
Pre-Op Teaching done

One-on-one
-lecture

Time resource
(2-3 mins)
Brochure,
pamphlet

Instant oral feedback:

The patient will be able to
enumerate important pre
op check list

3. Explain how to
manage his/her preoperative fears

3. Enumerate postoperative exercise

Providing an opportunity for the patient to describe his

reactions and feelings in the stressful situation.
Providing or reinforcing patient teaching.
Arranging for a clergy to visit if the patient desires.
(Religious faith can be a strong source of strength.)
Being truthful and honest when answering patient
questions. If there are questions that you should not or
are unable to answer, refer them to the Charge Nurse or
physician.
The postoperative exercises include turning, deep breathing,
coughing, and extremity movement.
(1) Turning. Turning in bed and early ambulation helps
patients maintain blood circulation, stimulate respiratory
functions, and decrease the stasis of gas in the
intestines and resulting discomfort. Practice before
surgery usually makes it easier for the patient to do it
postoperatively. In some instances, the patient may need
special aids, such as a pillow between the legs, to help
maintain body alignment.
(2) A. Patient turned away from the nurse with arms and
legs crossed.
(3) B. Patient turned toward the nurse with arms and legs
crossed.
(4) C. Patient on side in middle of bed with a pillow in front
of the bottom leg with the top leg on the pillow in flexed
position, a pillow against the back, a small pillow
supports the arm and hand, pillow under head and
shoulder

2) Deep breathing. Deep breathing helps prevent postoperative

pneumonia and atelectasis (incomplete expansion of the lung or
a portion of the lung). In deep breathing, the patient should
inhale and exhale as much air as possible. You are to explain
the procedure and its purpose to the patient. Instruct the patient
to:
a) Inhale slowly through the nose, distending the abdomen and
exhaling slowly through pursed lips (see Figure 1-3).
(b) Deep breathe as often as possible, preferably 5 to 10 times
every hour during the postoperative, immobilized period.
(3) Coughing. Coughing is done to mobilize and expel

One-onone-lecture

Time resource
(1-2 mins)
Brochure,
pamphlet

Instant oral feedback: the

patient will be able to
identify ways to manage
pre-operative fears

One-onone-lecture

Time resource
(5 mins)
Brochure,
pamphlet

Instant oral feedback: the

patient will be able to
enumerate at least 5
important operative postexercise

respiratory
system secretions which, because of the effects of anesthesia,
tend to pool in the lungs and may cause pneumonia. The patient
should be in a sitting or lying position. Instruct the patient to:
(a) Lean forward slightly while sitting in bed.
(b) Take a deep breath.
(c) Inhale fully with the mouth slightly open.
(d) Let out three to four sharp "hacks."
(e) With mouth open, take in a deep breath and give one or two
strong coughs.
(f) Repeat steps (a) through (e) ten times, as tolerated.
NOTE: The above steps should be repeated every two hours
during the postoperative phase or as prescribed.
(g) The patient may lace his fingers and hold them tightly across
the incision before coughing. This is used as a splint to minimize
pressure and helps to control pain when the patient is coughing.
A small pillow or folded towel may be used in place of laced
fingers. See Figure 1-4. NOTE: Encourage the patient to
perform deep breathing exercises before coughing. This
stimulates cough reflex.
(4) Extremity exercises. These exercises help to prevent
circulatory problems, such as thrombophlebitis, by facilitating
venous return to the heart. It also decreases postoperative "gas
pains
(a) Flex and extend each joint, particularity the hip, knee, and
ankle joints, keeping the lower back flat as the leg is lowered
and straightened.
(b) Move each foot in a circular motion.
b. Time of Instruction. The best time to teach patients is
relatively close to the time of surgery, which is usually the
afternoon or evening before the surgery.
(1) If instruction is given several days in advance, the patient
may forget.
(2) If instruction is given just before surgery, the patient may be
too apprehensive to listen or too heavily sedated to
comprehend.
(3) If the patient is undergoing minor surgery (one-day or sameday surgery), the patient may receive preoperative instructions
several hours before surgery.
4. Identify importance of
Personal Hygiene

a) Bathe or shower. This is done to remove excess body dirt and

One-onone-lecture

Time resource
(2 mins)
Brochure,

Instant oral feedback: the

patient will be able to
identify at least 5 important

pamphlet
oils. It gives the patient a sense of relaxation. Depending upon
the extent of surgery, it may be several days before a patient
may take a "real bath."
(b) Shampoo hair. This is also done for the same reasons as in
the previous paragraph.
(c) Remove nail polish and make-up. During surgery, numerous
areas must be observed carefully for evidence of cyanosis to
include the face, lips, and nail beds. Make-up and nail polish
hide true coloration.
(3) Mouth care. All preoperative patients should have thorough
mouth care before surgery. A clean mouth makes the patient
more comfortable and prevents accidental aspiration of food
particles. Chewing gum must be removed before the patient
goes to the operating room.
(4) Attire. Give the patient a clean hospital gown. The wearing of
his own gown or pajamas to surgery is not permitted because of
potential loss or damage.
(5) Prostheses. Ask the patient to remove his dentures, contact
lenses, and artificial limbs. Be sure to place all items in a
container labeled with the patient's name and room number.
Take extra care not to break or loose patient's prostheses. If
possible, send the prostheses home with a relative.
(6) Jewelry. Jewelry should be removed for safekeeping.
Do NOT store in bedside stand -- give the jewelry to a relative.
The patient may wear a wedding band to surgery secured with
tape or gauze wrapping. Do not secure it so tightly as to impair
circulation.
(7) Food and fluids. Follow the doctor's orders for type of diet
preoperatively. Usually, the patient will be NPO from midnight

of personal hygine

on. Remove the patient's water pitcher. Place an NPO sign

outside patient's room (see Figure 1-8). Mark the diet roster.
(8) Offer emotional support. Answer questions concerning
surgery. Provide explanation of each preoperative nursing
measure. Ask the patient about spiritual needs. Provide family
members with information concerning their role the morning of
surgery, waiting room location, postoperative visit by surgeon,
rational for stay in recovery room, and presence of any special
tubes or machines attached to their loved one.
d. Communication. Good communication between all members
of the health care team will ensure that the patient is well
prepared and ready to undergo surgery. All shifts and nursing
personnel must be an active participant in the preoperative
phase of the surgical patient.

5. Identify changes that

may occur after
surgical procedure

Appetite loss. Poor appetite after surgery is very common,

especially when general anesthesia was used. It may be
associated with temporary weight loss. Most patients regain
their appetite and return to their normal weight as the effects of
the surgery wear off.
Swelling around the site of surgery. It is natural to experience
some swelling after any surgical procedure. A surgical cut in the
skin, also called an incision, is a form of injury to the body. The
body's natural response to injury is the inflammatory process,
which causes swelling. As the healing occurs after the surgical
procedure, the swelling usually goes away.
Drainage from the site of surgery. Sometimes the fluid that
builds up at the surgery site drains through the surgical wound.
Drainage that smells bad along with a fever and redness around
the wound are signs of infection. If you develop signs of an

One-onone-lecture

Time resource
(5 mins)
Brochure,
pamphlet

Instant oral feedback: the

patient will be able to
enumerate at least 5
changes that may occur
after surgical procedure

infection, you should contact your surgeon's office.

Bruising around the site of surgery. After any surgical
incision, some blood may leak from small blood vessels under
the skin. This can cause bruising, which is a common
occurrence after a surgical procedure. However, if you have
significant swelling along with bruising, contact your surgeon's
office.
Numbness. It is common to experience some numbness in the
incision site since skin nerves are cut during surgery. Though it
usually does not cause patients any problems, it often lasts a
long time.
Bleeding. Patients usually lose some blood during surgery. But,
it is usually very little and does not affect the normal functions of
the body. Sometimes, patients can lose a larger amount of blood
depending on the surgery. In these situations, the surgical team
will have blood available for a transfusion if it is needed. After
surgery, you may experience some bleeding from the wound. If
this occurs, cover it with a clean, dry bandage, and contact your
surgeon's office. If there is a lot of blood, apply pressure until
you can get to your surgeons office or the local emergency
room.
Infection. An infection may occur at the site of the incision, but
it can also occur elsewhere in the body. Surgeons take great
care to lower the risk of infection during the operation. After
surgery, your health care team will teach you how to prevent
infection during recovery. Signs of infection in a surgical incision
include redness, warmth, increased pain, and sometimes,
drainage from the wound. If you have any of these signs,
contact your surgical care team. Antibiotics generally work well
to treat most infections. However, some infections form an
abscess. This is a closed skin cavity filled with fluid and/or pus.
This usually needs to be drained in a doctors office. Antibiotics
do not work as well for an abscess because they may not be

able to reach the infection.

Organ dysfunction. Surgery in certain areas of the body, such
as the abdomen or chest, may cause temporary problems with
the surrounding organs. For example, when surgery is
performed in the abdomen, the intestine may become paralyzed
for a short time. This means that it wont allow food, fluid, and
gas to pass through the bowels. This is called an ileus or bowel
obstruction. It can cause nausea and vomiting, stomach
cramps, and bloating until the bowels begin to function again.
Organ dysfunction after surgery generally goes away as you
heal.

6. Demonstrate proper
wound care

Taking Care of Your Wound

Wash Your Hands:
Rub hands with soap and water for 15 to 30 seconds.
Be sure to wash between fingers and under your nails.
Rinse well and dry thoroughly.
GET YOUR SUPPLIES:
Have everything you need ready before you begin.
REMOVE OLD DRESSING:
Step 1. Loosen old dressing.
Step 2. Place your hand into a small plastic bag.
Step 3. Gently take off the old dressing with bag covered hand.
Step 4. Turn bag inside-out over the old dressing.
Step 5. Close the bag tightly before throwing it in the garbage.
Wash/Irrigate the Wound:
ALWAYS follow your doctors instructions for your wound care.
To clean the open wound, pour enough solution to dampen the
gauze, then wipe your wound using circular motions from the
center of the wound outward. Be sure to clean at least 1"
beyond the wound margins.
Make sure you use a new gauze each time you wipe and
discard the soiled one in a plastic bag.
Dry surrounding skin by patting with new gauze.
REMEMBER TO:
Use dressings only once.

One-onone-lecture

Time resource
(5 mins)
Brochure,
pamphlet

The patient will be able to

demonstrate proper wound
care.

Keep dressings in a clean, dry place.

Throw out the entire dressing if it gets dirty.
CLEAN UP:
Put all your dirty supplies in a double (two) plastic bag.
Wash your hands.
Check that you have enough supplies for a couple of days.
Do not let your supplies run low
Tell Your Doctor or Nurse if:
The wound (sore) gets larger or deeper.
More fluid drains from the wound.
The wound does not begin to show signs of healing in 2 to 4
weeks.
You see signs of infection.

References:
Smeltzer, S. C. O., Hinkle, J. L. ., Cheever, K. H. ., & Bare, B. G.. (2010). Brunner & Suddarth's textbook of medical-surgical nursing (12th, North American Edition,
Combined Volume edition.).Preoperative Nursing Management (pp. 399-414) Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins
Ignatavicius, D. D., Workman, M. L., & Henderson, L. (2015). Medical-surgical nursing: Critical thinking for collaborative care (7th ed.). Care of Preoperative Patients
(pp.239-259). Toronto: Elsevier Saunders. (ISBN 978-1-4377-2801-9.
Kozier, B., Erb, G., Berman, A., Snyder, S. J., Bouchal, D. S. R. et al. (2014). Fundamentals of Canadian nursing: Concepts, process, and practice (3rd ed.). Toronto:
Pearson. (ISBN 978-0133249781)