PREOP AND POSTOP CARE
Reynaldo O. Joson, MD, DPBS
Preop and postop care is essentially evaluation of the patient’s condition and patient care.
Preoperative care starts right after the diagnosis of a surgical disease. Preoperative care consists primarily of preparing the patient for operation. Preparation comes in two forms. One is in preparing the patient’s condition for the operation. This includes promoting patient’s acceptance to the operation, screening for conditions that may affect results of the operation, and improving and optimizing the physical condition of the patient for the operation. The second form of preparation is readying materials needed for the performance of the surgical procedure.
Postoperative care starts right after the dressing or after the last act of a surgical procedure. It consists essentially of two things. One is providing the needs of the patient after the operation. The other is monitoring for complications that may occur after the operation.
Below are three illustrative cases of preop and postop care.
CASE NO. 1
A 25-year-old female patient was evaluated to have thyroid cancer confined to the right lobe on physical examination as well as on needle evaluation. She was told of the diagnosis and the plan of operation. She agreed.
History and physical examination did not reveal anything that would contraindicate the operation or that would need investigations or improvement prior to the operation.
Since the surgeon needed a special suture that was not available in the hospital where the operation was to be performed, a prescription was given to the patient to buy at a particular source.
The patient was given an admitting order and was told when to check in to the hospital. The admitting order contained instructions to schedule the thyroidectomy operation on a particular date; to secure consent for the operation from the patient; to contact a particular anesthesiologist for the premedications and anesthesia; and to place the patient on NPO 6 hours prior to the operation.
After the operation, in which a total lobectomy was done, the instructions given were to discontinue the intravenous fluids after 6 hours; to allow the patient to eat as tolerated; to give oral analgesics; and to monitor for postoperative complications such as bleeding and respiratory obstruction. On the second day, in the absence of postoperative complications, the patient was discharged with the proper advise on home care of the wound, on home medications, and on check-up.
An 80-year-old male was evaluated to have non-obstructing sigmoid cancer discovered on barium enema and subsequently confirmed by sigmoidoscopy and biopsy. The patient was told of the diagnosis and plan for operation. He agreed.
Except for an irregular heart rate, the rest of the physical examination findings were normal. An ECG, chest X-ray, FBS, and creatinine were done. Except for the ECG, the rest of the screening examinations were normal. A cardiology consult was done which gave a go signal for the surgeon to push through with the operation.
The patient was scheduled for the operation. He was admitted the day prior to the operation. He was placed on NPO 6 hours prior to the operation. A cleansing enema was done 4 hours prior to the operation. An intravenous antibiotics was given one hour prior to the operation for prophylactic reason.
A sigmoidectomy was done. After the operation, the patient was placed on NPO for one day. On the second day after the operation, he was given diet as tolerated. Analgesics were given. No antibiotics were given after the operation. The urinary catheter which was placed just before the operation was removed on the second day postoperatively. The intraperitoneal drain was removed on the fifth postop day. On the seventh postop day, without any signs of anastomotic leak, with the patient ambulating, eating a regular diet, afebrile, with abdominal wound stitches removed, he was discharged with the necessary advices.
CASE NO. 3
A 23-year-old male underwent an appendectomy for a ruptured appendicitis. Two days after, he was transferred to another hospital because he could no longer pay the bills of the first hospital.
The surgeon in the hospital where he was transferred reviewed his history and examined him. The surgeon noted a transverse right lower quadrant abdominal incision which was closed beautifully. He anticipated a possible wound infection despite the patient being given antibiotics. On the fourth day postop, the patient developed fever and the abdominal wound was tender. Assessing that a wound infection was taking place, the surgeon opened the wound and after which, purulent materials came out. He irrigated and cleansed the wound until it was clean and until the patient could take care of it at home.
1. PREOP AND POSTOP CARE IS ESSENTIALLY
A. EVALUATION OF PATIENT’S CONDITION
B. PATIENT CARE
2. PREOP CARE STARTS RIGHT AFTER DIAGNOSIS OF A SURGICAL DISEASE.
3. POSTOP CARE STARTS RIGHT AFTER WOUND DRESSING OR AFTER THE LAST ACT OF A SURGICAL PROCEDURE.
4. PREOP CARE CONSISTS OF PREPARING THE PATIENT FOR THE OPERATION.
A. PREPARING THE PATIENT’S CONDITION
– PROMOTING PATIENT’S ACCEPTANCE
– SCREENING FOR CONDITIONS THAT MAY AFFECT RESULTS OF THE OPERATION
– IMPROVING OR oPTIMIZING PHYSICAL CONDITION OF PATIENT FOR OPERATION
B. PREPARING MATERIALS NEEDED FOR PERFORMANCE OF OPERATION
5. POSTOP CARE CONSISTS OF:
A. PROVIDING POSTOP NEEDS OF PATIENT
B. MONITORING FOR POSTOP COMPLICATIONS
6. GUIDING PRINCIPLES IN PREOP AND POSTOP CARE
ROJ Writing – 1999