Perioperative Care and Wound Management Essentials

Posted on Mar 14, 2026 in Medicine & Health

Chapter 39: Perioperative Care

Preoperative Preparation

  • Medical Evaluation: Includes mCXR, CBC, urinalysis, and EKG.
  • Fasting: NPO for 6–8 hours before surgery.
  • Personal Care:
    • Hygiene: Complete bath, shower, or shampoo to reduce microbes.
    • Grooming: Remove makeup, nail polish, and artificial nails to monitor color and circulation.
    • Hair Care: Remove hairpins, clips, combs, wigs, and hairpieces. Use a surgical cap.
    • Oral Hygiene: Do not allow the person to swallow water.
    • Dentures: Provide care and store safely; allow wear as long as possible.
    • Devices: Remove eyeglasses, contact lenses, hearing aids, artificial eyes, and limbs.
    • Compression: Apply elastic stockings or SCDs before transport.
  • Informed Consent: The person must be informed about the surgery, risks, complications, treatment alternatives, recovery time, and the consequences of refusing surgery.
  • Hair Removal: Use electric clippers or hair removal cream.

Pre-Surgery Medication

Drugs are administered before transport to the OR to help the person relax, reduce respiratory secretions, and prevent nausea. The person will feel sleepy and must remain in bed to prevent falls.

Postoperative Positioning and Care

  • Positioning: Ensure comfortable breathing, prevent stress on the incision, and prevent aspiration. Reposition at least every 1 to 2 hours using gentle motions and support pillows.
  • Respiratory Health: Encourage coughing, deep breathing exercises, and incentive spirometry.
  • Elimination: Monitor bowel and urinary function. Measure I&O; the person must void within 6 to 8 hours post-surgery.

Chapter 40: Wound Care and Skin Integrity

Common Skin and Wound Conditions

  • Excoriation: Loss of epidermis due to scratching or friction.
  • Arterial Ulcer: Open wound on the foot caused by diabetes or poor arterial blood flow.
  • Venous/Stasis Ulcer: Open sore on lower legs caused by poor venous blood flow.
  • Skin Tears: Caused by friction, falls, bumping, or improper handling.

Wound Healing Intentions

  • First (Primary) Intention: The wound is closed.
  • Second Intention: Contaminated wounds are cleaned and dead tissue is removed.
  • Third Intention: The wound is left open and closed later.

Drainage Types

  • Serous: Clear, watery fluid.
  • Sanguineous: Bloody drainage.
  • Serosanguineous: Thin, watery, blood-tinged drainage.
  • Purulent: Thick green, yellow, or brown drainage.

Dressing Management

Montgomery ties are used for large dressings requiring frequent changes to protect the skin from repeated tape application.

Pressure Injury Stages

  • Stage 1: Non-blanchable erythema of intact skin.
  • Stage 2: Partial-thickness skin loss with exposed dermis.
  • Stage 3: Full-thickness skin loss; fat may be visible.
  • Stage 4: Full-thickness skin and tissue loss; muscle, tendon, or bone exposed.
  • Unstageable: Extent of tissue loss obscured by slough or eschar.
  • Deep Tissue: Persistent non-blanchable deep red, maroon, or purple discoloration.

Pressure Prevention Equipment

  • Bed Cradle: Prevents pressure from linens on legs and feet.
  • Protective Padding: Elbow/heel protectors, gel pads, and cushions.
  • Specialized Beds: Air-flow or alternating pressure mattresses.
  • Positioning Aids: Pillows, trochanter rolls, and footboards.