Surgical Nursing (Perioperative and Postoperative Care)
This domain tests preoperative preparation, intraoperative safety, and recognition of postoperative complications, including consent, asepsis, positioning, anesthesia recovery, wound care, and early mobilization.
Core rules
- Verify identity, procedure, site, and consent before surgery; under the Patient’s Rights Law 1996, informed consent must be obtained and documented.
- Use the WHO surgical safety checklist: sign-in, time-out, and sign-out, with confirmation of allergies, antibiotics, imaging, and instrument counts.
- Follow fasting and ERAS protocols: typically 6 hours for solids and 2 hours for clear fluids, according to institutional policy.
- Maintain normothermia and give VTE prophylaxis as prescribed; hypothermia increases bleeding, infection, and cardiac risk.
- In recovery, monitor airway, breathing, circulation, consciousness, pain, urine output, drains, and wound.
- Postoperative fever has a timeline: early fever suggests atelectasis or infection; later fever suggests wound, urinary, or line infection.
Worked example
On postoperative day 1, a patient has heart rate 118, blood pressure 88/54, urine output 15 mL/hour, and falling hemoglobin. Do not attribute this only to pain or anesthesia. Inspect the dressing and drain, palpate the abdomen, check for distension, and notify the surgeon immediately. Prepare IV access, fluids, crossmatch, and monitoring. Reason: tachycardia, hypotension, oliguria, and dropping hemoglobin suggest postoperative hemorrhage until proven otherwise.
Traps
- Accepting hypotension as “normal after anesthesia” without assessing bleeding.
- Missing compartment syndrome: severe pain out of proportion, pallor, paresthesia, paralysis, pulselessness.
- Failing to confirm consent or site marking before transfer to theatre.
- Ignoring urine output below 0.5 mL/kg/hour.