Surgical Nursing Assignment: Pre- and Post-Operative Care

This nursing assignment covers pre- and post-operative care for a patient undergoing an exploratory surgery of the abdomen. Topics include pre-operative assessments, common post-operative complications, vital sign assessment, shock management, and discharge planning. References are included.

Running head: SURGICAL NURSING ASSIGNMENT
Surgical nursing assignment
Name of the student:
Name of the university:
Author note:

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Table of Contents
Question 1:.................................................................................................................................2
Question 2:.................................................................................................................................2
Question 3:.................................................................................................................................3
Question 4:.................................................................................................................................4
Question 5:.................................................................................................................................4
Question 6:.................................................................................................................................5
References:.................................................................................................................................6

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Question 1:
The patient in the case study is Guminder Singh, who is a 68 year old man who had
been wanted to undergo an exploratory surgery of the abdomen. Exploratory surgery of the
abdomen is stated to be a laparotomy surgery where the abdomen of the patient is opened and
the abdominal organs and investigated for any chances of injury or diseases. This is a fairly
common abdominal investigative surgery which is generally carried out with general
anaesthesia. Although, this surgery requires a pre-operative preparation and assessments.
First and foremost, the nursing professional must carry out total blood count assessment, X-
ray or MRI, vital signs assessment, and a thorough physical examination to ensure that the
patient does not have any diseases that can be aggravated or exacerbated by the surgical
procedure (Nanavati, A.J. and Prabhakar). In terms of further preparation, the nurse will also
have to explore the past medical history of the patient along with a thorough outline of the
medications that the patient is or had been taking including over-the-counter medicines,
prescription medicines, herbs, street drugs, herbs, vitamins, and other supplements. Along
with that, the nurse will also have to investigate the patient on his alcohol addictions and if he
has any considerable allergies or any hypersensitivity reactions that the patient might be
having. Along with that, the nurse will also have to educate the patient about the need for the
surgery, the nature of the surgery and what it would entail and all the possible precaution and
aftereffects that the patient might be needed to consider before consenting to going through
the surgical procedure (Brichant et al. 2018).
Question 2:
A surgical procedure is associated with many risks and complications, even the
exhaustion and fear from having to undergo a surgery has the potential to cause complication
in the health and wellbeing of the patient in the post-operative period. Hence, post-operative

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complications are common and with adequate interventions in a timely manner can easily
mitigate any considerable risk to the health and wellbeing status of the patient. For this
patient who had been admitted in the facility to undergo the abdominal exploratory surgery
depends on the present health condition of the patient, age, the addiction to tobacco and
alcohol, and his allergic respiratory complications (Tolstrup, Watt and Gögenur 2017). A few
common critical issues that might arise includes pain, fever and wound infection which are
very common aftereffects of a surgical procedure. Although, paralytic licus,
hypoproteinemia, respiratory or chest infection, burst abdomen, anastomotic leak, and
abscess have also been reported to be common complications in the post-operative period.
Specifically for the patient, respiratory issue and shortness of breath is a very likely concern
owing to the burden of the surgery coupled with the presenting respiratory issues and history
of smoking and chemical allergy of Mr Singh (Mungroop et al. 2017).
Question 3:
Adequate post-operative care is based on recognizing the onset of any post-operative
complications immediately and proactively and implement interventions to address these
complications so that there is no risk to the health and wellbeing of the patient under any
circumstances. A very important task to be completed in order to achieve this care goal is
thorough and time assessment in the post-operative period which will help the nursing
professional recognize the onset of any complication that may arise. In this case, the first
most important assessment that the patient has to carry out is the vital signs (Stephens and
Whitman 2015). The vital signs provide key information regarding any changes in the
haemodynamic equilibrium of the body and indicate the probability of respiratory distress,
infection or shock, which are three most common severe post-operative complications. The
nurse must conduct vital sign assessment and documentation in every alternate hour until the
first 24 hours after the surgery is over. Pain assessment is also a very important assessment

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that the nurse must carry out using a standard pain assessment tool every 6 hours or so.
Lastly, infection risk assessment is also needed to be carried out by the nurse every 6 hours or
so to ensure the patient is not under any notable risk and is recovering effectively (Zemlyak,
Heniford and Sing 2015).
Question 4:
Shock can be defined as the complex life threatening condition that is facilitated by
inadequate blood flow to the cells and tissues of the body (Schorr,Zanottin and Dellinger
2014). Surgical shock is one of the most common sever complications that may arise after a
surgery and it can lead to fatal consequences if not addressed properly. The mechanism by
which shock develops is the failure of the circulatory system in the body to provide
adequately oxygen flow to the body due to the bodily injury caused by the invasive surgical
procedure. the local loss of whole blood or plasma reduces the total circulatory blood volume,
which without treatment interventions, leads to blood pressure drop, anoxia, tissue damage or
necrosis and impairment or organ functioning. The most common signs of surgical shock
includes severely low blood pressure, cool clammy skin due to inadequate peripheral
perfusion, resultant pale skin and/or cyanosis, rapid pulse and respiratory distress with high
respiratory rate and low oxygen saturation due to increased cardiac load, nausea and enlarged
pupils, weakness and dizziness (Bleszynski, Chan and Buczkowski 2016). These are the
symptoms which the nurse can assess by evaluating the changes in vital signs and respiration
along with the physical appearance and determine whether the patient is going into shock or
not.
Question 5:
First and foremost treatment intervention to manage the occurrence if shock in the
patient needs to focus on enhancing the blood pressure, eliminating the respiratory distress

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and reducing the rapid heart rate of the patient. The patient should be immediately given the
aid of external oxygen via Hudson mask along with bronchodilators to reduce the respiratory
distress. The next step should be to improve the blood circulation and decrease the cardiac
load on the patient which is generally carried out with electrolyte or fluid therapy and
antihypertensive and/or vasodilation medication. Often surgical shock can be preceded by
surgical site infection in which case antibiotic therapy should also commence for the patient.
Improving the perfusion pressure and contractility will also help in maintaining the blood
circulation revive in the body and the shock to be properly managed (Bleszynski, Chan and
Buczkowski 2016).
Question 6:
The nurse has a significant role in outlining the post-operative discharge care plan
preparation which will help the patient recover successfully and effectively. In this case, Mr.
Singh had a laparoscopic abdominal exploratory surgery done and his discharge or after care
planning must include individualized care planning. First and foremost, the nurse will have to
include pain management with regular mild analgesic medication in accordance with the
hypersensitivity complications of the patient (Nanavati and Prabhakar 2014). Along with that,
the patient will also need proper surgical wound infection control which can either involve
assistance from social support carer or a family member, however the nurse will have to
educate the carer to carry out aseptic wound care and management techniques. The nurse will
also have to consider dietary restrictions with the collaboration from a nutritional expert to
ensure that the patient and his family understand the diet requirements that he has to follow.
For mobility restrictions after the surgery, the nurse will have to educate the patient and his
family regarding the need for careful and easy movements while the surgical wound is
healing and arrange physiotherapeutic assistance to help him with mobility (Balentine et al.
2016). Lastly, the nurse will have to educate Mr Singh and his family about medication

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management, showering and other related activities of daily living; the nurse must also
educate them regarding contacting the facility immediately in case of bleeding, pain or any
such complications.

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References:
Balentine, C.J., Naik, A.D., Berger, D.H., Chen, H., Anaya, D.A. and Kennedy, G.D., 2016.
Postacute care after major abdominal surgery in elderly patients: intersection of age,
functional status, and postoperative complications. JAMA surgery, 151(8), pp.759-766.
Bleszynski, M.S., Chan, T. and Buczkowski, A.K., 2016. Open abdomen with negative
pressure device vs primary abdominal closure for the management of surgical abdominal
sepsis: a retrospective review. The American Journal of Surgery, 211(5), pp.926-932.
Brichant, G., Denef, M., Tebache, L., Poismans, G., Pinzauti, S., Dechenne, V. and Nisolle,
M., 2018. Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and
therapeutic tool: a retrospective observational study. Gynecological Surgery, 15(1), p.13.
Drucker, N.A., McDuffie, L., Groh, E., Hackworth, J., Bell, T.M. and Markel, T.A., 2018.
Physical examination is the best predictor of the need for abdominal surgery in children
following motor vehicle collision. The Journal of emergency medicine, 54(1), pp.1-7.
Mungroop, T.H., van Samkar, G., Geerts, B.F., van Dieren, S., Besselink, M.G., Veelo, D.P.,
Lirk, P. and POP-UP trial group, 2017. Serum levels of bupivacaine after pre-peritoneal bolus
vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a
randomized controlled trial. PloS one, 12(6), p.e0178917.
Nanavati, A.J. and Prabhakar, S., 2014. Fast-track surgery: Toward comprehensive peri-
operative care. Anesthesia, essays and researches, 8(2), p.127.
Schorr, C.A., Zanotti, S. and Dellinger, R.P., 2014. Severe sepsis and septic shock:
management and performance improvement. Virulence, 5(1), pp.190-199.

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Stephens, R.S. and Whitman, G.J., 2015. Postoperative Critical Care of the Adult Cardiac
Surgical Patient: Part II Procedure-Specific Considerations, Management of Complications,
and Quality Improvement. Critical care medicine, 43(9), pp.1995-2014.
Tolstrup, M.B., Watt, S.K. and Gögenur, I., 2017. Morbidity and mortality rates after
emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency
laparotomy or laparoscopy. Langenbeck's archives of surgery, 402(4), pp.615-623.
Zemlyak, A., Heniford, B.T. and Sing, R.F., 2015. Diagnostic laparoscopy in the intensive
care unit. Journal of intensive care medicine, 30(5), pp.297-302.