Wound care + Peri-op care
1. Know the routine preoperative test
Complete blood test (CBC): RBC’s, hemoglobin (Hgb), and hematocrit (Hct) are
important to the oxygen carrying capacity of the blood, WBC’s are an indicator of
immune function.
Blood grouping and cross matching: determined in case blood transfusion is required
during or after surgery.
Serum electrolytes (Na+, K+, Ca2+, Mg2+, Cl-, HCO3): to evaluate fluid and electrolyte
status.
Fasting blood glucose: high levels may indicate undiagnosed diabetes mellitus.
Blood urea nitrogen (BUN) and creatine: to evaluate renal function.
ALT, AST, LDH, and bilirubin: to evaluate liver function.
Serum albumin and total protein: to evaluate nutritional status.
Urinalysis: to determine urine composition and possible abnormal components (ex;
protein or glucose) or infection.
Chest X-ray: to evaluate respiratory status and heart size.
ECG (all clients over 40 yrs of age/preexisting heart condition): to identify preexisting
cardiac problems or disease.
Pregnancy test (all female clients of childbearing age): to identify if the client is pregnant.
2. Criteria to advance diet as tolerated post – operatively.
Surgeons order patients post op diet.
When “diet as tolerated” is ordered – offer clear liquids initially, if PT tolerates with no
nausea, give full liquids, then regular or soft diet.
Assist weak patients to eat
, observe tolerance of food, note and report passage of flatus or abdominal distending or
flatulus
3. Risk factors and care of a client with a wound dehiscence or evisceration.
Dehiscence: a partial or total rupture (separation) of a sutured wound, usually with
separation of underlying skin layers.
Evisceration: a dehiscence that involves the protrusion of visceral organs through a
wound opening.
Manifestations involve a significant increase in the flow of sero-sanguineous fluid on the
wound dressings.
ATI connection: immediate history of sudden straining (coughing, sneezing, vomiting).
Client reports of a change or “popping” or “giving away” in the wound area and visualization of
the viscera.
Prevention: thin, folded blanket or small pillow over surgical wounds when client
coughs to support the wound.
Risk factors include:
chronic fatigue,
advanced age, obesity,
invasive abdominal cancer,
vomiting,
excessive straining,
coughing,
sneezing,
dehydration,
malnutrition,
ineffective suturing.
Abdominal surgery, and infection.
EVISCERATION AND DEHISCENCE REQUIRE EMERGENCY TREATMENT.
INTERVENTIONS: Call for help, notify the provider immediately due to the need for
surgical intervention, stay with the client, cover the wound and any protruding organs with
sterile towels or dressings soaked with sterile normal saline solution to decrease the chance of
bacteria invasion and drying of tissues, do not attempt to reinsert the organs.
, 4. Legal aspects regarding informed consents.
Informed consent implies that the client has been informed and involved in decisions
affecting his/her health, surgeon is responsible for obtaining the informed consent by providing
the following information to the client or legal guardian.
The consent must provide the following information:
The nature and the reason for the surgery
All available options and associated risks
Risk of surgical procedure and potential outcomes
Name and qualifications of the surgeon performing the procedure
The right to refuse consent or later withdraw consent
The surgeon documents the informed consent conversation in the pre-op progress NOTE:
The surgical consent form protects the patient from incorrect/unwanted
procedures and the surgeon and agency from litigation related to unauthorized
surgeries or uninformed clients.
The consent form becomes part of the client’s medical record and goes to the
operating room with the client.
1. The patient must sign prior to surgery
2. Protects the patient from having any surgical procedure they do not want or do not know
about
3. Protects the hospital and personnel from a claim that permission was not granted
4. Obtaining legal informed consent is the responsibility of the MD
Reasons for surgery
Options and associated risks
Name and qualification of the surgeon
Right to refuse later time
5. When the patient is told in advance of the character and importance of the surgery, its
probable consequences, the chances of success and alternative measures.
6. If the nurse assess that the PT does not understand the procedure to be performed, the
surgeon is contacted & requested to speak with the PT before surgery
1. Know the routine preoperative test
Complete blood test (CBC): RBC’s, hemoglobin (Hgb), and hematocrit (Hct) are
important to the oxygen carrying capacity of the blood, WBC’s are an indicator of
immune function.
Blood grouping and cross matching: determined in case blood transfusion is required
during or after surgery.
Serum electrolytes (Na+, K+, Ca2+, Mg2+, Cl-, HCO3): to evaluate fluid and electrolyte
status.
Fasting blood glucose: high levels may indicate undiagnosed diabetes mellitus.
Blood urea nitrogen (BUN) and creatine: to evaluate renal function.
ALT, AST, LDH, and bilirubin: to evaluate liver function.
Serum albumin and total protein: to evaluate nutritional status.
Urinalysis: to determine urine composition and possible abnormal components (ex;
protein or glucose) or infection.
Chest X-ray: to evaluate respiratory status and heart size.
ECG (all clients over 40 yrs of age/preexisting heart condition): to identify preexisting
cardiac problems or disease.
Pregnancy test (all female clients of childbearing age): to identify if the client is pregnant.
2. Criteria to advance diet as tolerated post – operatively.
Surgeons order patients post op diet.
When “diet as tolerated” is ordered – offer clear liquids initially, if PT tolerates with no
nausea, give full liquids, then regular or soft diet.
Assist weak patients to eat
, observe tolerance of food, note and report passage of flatus or abdominal distending or
flatulus
3. Risk factors and care of a client with a wound dehiscence or evisceration.
Dehiscence: a partial or total rupture (separation) of a sutured wound, usually with
separation of underlying skin layers.
Evisceration: a dehiscence that involves the protrusion of visceral organs through a
wound opening.
Manifestations involve a significant increase in the flow of sero-sanguineous fluid on the
wound dressings.
ATI connection: immediate history of sudden straining (coughing, sneezing, vomiting).
Client reports of a change or “popping” or “giving away” in the wound area and visualization of
the viscera.
Prevention: thin, folded blanket or small pillow over surgical wounds when client
coughs to support the wound.
Risk factors include:
chronic fatigue,
advanced age, obesity,
invasive abdominal cancer,
vomiting,
excessive straining,
coughing,
sneezing,
dehydration,
malnutrition,
ineffective suturing.
Abdominal surgery, and infection.
EVISCERATION AND DEHISCENCE REQUIRE EMERGENCY TREATMENT.
INTERVENTIONS: Call for help, notify the provider immediately due to the need for
surgical intervention, stay with the client, cover the wound and any protruding organs with
sterile towels or dressings soaked with sterile normal saline solution to decrease the chance of
bacteria invasion and drying of tissues, do not attempt to reinsert the organs.
, 4. Legal aspects regarding informed consents.
Informed consent implies that the client has been informed and involved in decisions
affecting his/her health, surgeon is responsible for obtaining the informed consent by providing
the following information to the client or legal guardian.
The consent must provide the following information:
The nature and the reason for the surgery
All available options and associated risks
Risk of surgical procedure and potential outcomes
Name and qualifications of the surgeon performing the procedure
The right to refuse consent or later withdraw consent
The surgeon documents the informed consent conversation in the pre-op progress NOTE:
The surgical consent form protects the patient from incorrect/unwanted
procedures and the surgeon and agency from litigation related to unauthorized
surgeries or uninformed clients.
The consent form becomes part of the client’s medical record and goes to the
operating room with the client.
1. The patient must sign prior to surgery
2. Protects the patient from having any surgical procedure they do not want or do not know
about
3. Protects the hospital and personnel from a claim that permission was not granted
4. Obtaining legal informed consent is the responsibility of the MD
Reasons for surgery
Options and associated risks
Name and qualification of the surgeon
Right to refuse later time
5. When the patient is told in advance of the character and importance of the surgery, its
probable consequences, the chances of success and alternative measures.
6. If the nurse assess that the PT does not understand the procedure to be performed, the
surgeon is contacted & requested to speak with the PT before surgery
