TEACHERS HANDBOOK

HSS404 - NQ2014

OPERATION THEATRE

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PSS Central Institute of Vocational Education, Shyamla Hills, Bhopal
© PSS Central Institute of Vocational Education, 2014

Copyright protects this publication. Except for purposes permitted by the Copyright Act, reproduction,
adaptation, electronic storage and communication to the public are prohibited without prior written
permission.

2
 PREFACE
The Teacher’s Handbook on “OPERATION THEATRE” is a part of the qualification package developed by
the Healthcare Sector Skill Council (HSSC) for the National Skills Qualifications Framework (NSQF) of
“General Duty Assistant/Patient Care Assistant”. The National Vocational Education Qualification
Framework (NVEQF) now subsumed in NSQF is an initiative of the Ministry of Human Resource
Development (MHRD), Government of India to set common principles and guidelines for a nationally
recognized qualification system covering Schools, Vocational Education and Training Institutions,
Technical Education Institutions, Colleges and Universities. It is envisaged that the NVEQF will promote
transparency of qualifications, cross-sectoral learning, student-centered learning and facilitate learner’s
mobility between different qualifications, thus encouraging lifelong learning.

The National Curriculum Framework, 2005, recommends that children’s life at school must be linked to
their life outside the school. This principle makes a departure from the legacy of bookish learning which
continues to shape our system and causes a gap between the school, home, community and the
workplace. Experiential learning, which is a cyclical process involving observation, reflection and action,
should be an integral part of the teaching-learning process. Attempt by the students to solve problems,
guided by the teachers or instructors, would enable them to explore and discover new knowledge and
develop problem solving skills. A range of pedagogies, including interactive lecture, role plays, case
based studies, assignments, projects and on-the-job activities that provide students with generic,
technical and professional knowledge and skills should be adopted by the teachers and instructors to
foster student-centered learning.

The success of this effort of integrating knowledge and skills depends on the steps that the teachers will
take to encourage children to reflect their own learning and to pursue imaginative and on-the-job
activities and questions. Participation of learners in skill development exercises and inculcation of
values and creativity is possible if children are involved as participants in learning, and not as receiver
of information. These aims imply considerable change in school routines and mode of functioning.
Flexibility in the daily time-table would be a necessity to maintain the rigour in implementing the
activities and the required number of teaching days will have to be increased for teaching and training.

The suggestions by the teachers and other stakeholders in education and training will be of great value
to us in bringing about qualitative improvement in the teacher’s handbook.

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 ACKNOWLEDGEMENTS

We place on record our sincerest gratitude to Shri Rajarshi Bhattacharya, I.A.S., Secretary (SE),
Ministry of Human Resource Development (MHRD), Government of India, Smt. Radha Chauhan, I.A.S.,
Joint Secretary (SE), Department of School Education and Literacy, MHRD and Smt. Ankita Mishra
Bundela, I.A.S., Deputy Secretary (VE), Department of School Education and Literacy, MHRD for the
support and guidance. We take this opportunity of expressing our gratitude to MHRD for financial
support to the project on development of curricula and courseware under National Skills Qualifications
Framework (NSQF).

We would like to thank Professor Parvin Sinclair, Director, National Council of Educational
Research and Training (NCERT) and Professor R. B. Shivagunde, Joint Director, PSS Central Institute of
Vocational Education (PSSCIVE) for their guidance.

The contribution of Shri M.K. Mishra and Shri Satish.C.Pandey of MPCON Ltd., Bhopal as
resource person and Dr. Sukhwant Singh, Dr. Jitendra Banweer, Dr. Richa Mishra, Dr. Ratan Lal
Patidar, Dr. Sandhya Singh, Dr. Ashish Acharya, Mr. Ashok Pal, Ms Priyanka Acharya, Ms. Manisha Gupta
and Ms Rashmi Mishra as experts in healthcare sector for developing the content of the courseware is
duly acknowledged.

We are grateful to Dr. Vinay Swarup Mehrotra, Professor and Head, Curriculum Development
and Evaluation Centre (CDEC) and National Skills Qualifications (NSQF) Cell, PSSCIVE, Bhopal for
coordinating the development of curricula, student workbooks and teachers‟ Handbooks.

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 GENERAL INSTRUCTIONS FOR TEACHERS

 Read the Teacher’s Handbook carefully before teaching or conducting the training.
 Follow the session plan strictly
 Familiarize yourself thoroughly with the relevant knowledge and skills to be transacted.
 Ensure all materials/aids/equipment required for teaching and training is available.
 Introduce the skill by explaining the purpose.
 Demonstrate the skill to the participants, explaining each step in detail.
 Invite the students to ask questions.
 Ask the students to practice the skill themselves and make observation while they perform the
task.
 Provide the students with constructive feedback.
 Discuss in class, the problems faced by the students in performing the task.
 Summarize the key learning.
 Ensure key learning is captured and performance standards are met at the end of each session.
 Regularly check student’s workbook to ensure all exercises are being completed on time.
 Ensure that all participants complete the required assessments given in the student workbook.
 Always encourage participants. Never discourage them from getting actively engaged in
discussions, question-answer sessions and task-oriented activities.

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 TABLE OF CONTENTS

PREFACE 03

ACKNOWLEDGEMENTS 04

GENERAL INSTRUCTIONS FOR TEACHERS 05

SESSION 1: AREAS IN OPERATION THEATRE 07

SESSION 2: STAFFING AND EQUIPMENT OF OPERATION THEATRE 12

SESSION 3: PREPATION OF PATIENT FOR OPERATION THEATRE 17

SESSION 4: POST OPERATIVE CARE 22

Table of Content

6
Session 1: Areas in Operation Theatre
Relevant Knowledge In this session, we will learn about aims of planning, location,
size, area of operation theatre.
The Operation Theater (OT)

An operating theater, operating room or surgery suite is a room

within a hospital, within which surgical operations are carried
out. Operating theater was so called in the United Kingdom
because they traditionally consisted of semicircular amphitheater
to allow students to observe the medical procedures. The old
operating theatre in London is one of the oldest, dating back to
1822. It is similar in age to the Etherdome in Boston built in 1824.
The surgical suite is entire surgical facility including operating
room, hall, ways, workrooms, storage and front desk.

Aims of Planning

a. To promote high degree of asepsis.

b. Ensure maximum safety to patients and staff working in
OT.
c. Ensure maximum utilization of the OT.
d. Ensure maximum comfort to the surgical team,
considering long hours of work in difficult posture.
e. To provide complete environmental control.
f. Flexibility of uses of operating suites.

Location of OT

The best location for the OT is the one which permits a

convenient and uncomplicated flow of patients, staff and clean
supply traffic. It should be close to surgical wards and ICU, OT
receives patients from the floor through non public corridor,
elevators and ramps. In most cases they are returned through the
same route. Convenient access to elevators is, therefore,
essential.

Size of the Operation Room

The size will depend upon the surgical facilities:

1. General Operating Room – 40 sq. meters.

2. CVTS, Neurology, Orthopedics – 60 Sq. meter additional
adjoining room is required for Heart lung machine.
3. Endoscopy suite will require procedure room 20 sq.
meter.
4. For OT of 200 – 300 bed district hospital the optimum size
is 18’ x 18’ to 18’ x 20’ but not more than 400 sq. feet.

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Areas of OT

This is designed to achieve a high degree of asepsis the OT is

divided into 4 zones.

1. Protective Zone: This is at the entrance of operating

theater. The main facilities which lie in this area are:
a. Patient’s waiting area and reception
b. Trolley bay
c. Lifts
d. Stairs
e. Switch room
f. Pre anesthesia room, changing room, store room.

2. Clean zone: Next zone is the clean zone. It provides –

a. Preoperating room
b. Recovery room
c. Theater work room
d. X-ray room, plaster room
e. Sister’s room, staff nurse / GDA room and
anesthesia store room.

3. Sterile zone: this zone will include:

a. Operating suite in particular
b. Scrub room
c. Anesthesia room
d. Instruments trolley area.

4. Disposal Zone: it will include dirty room, disposal corridor

and janitors corridor.

Following physical facilities must be provided in operating theatre

complex:

a. Reception and office

b. Transfer area
c. Entrance
d. Cloak room
e. Pre-operative room
f. Staff changing room
g. Notice Board
h. Holding bay
i. Anesthesia room
j. Scrub room
k. Operating room

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 Clean Zone -
Preoperating room,
recovery room,
Theater work room, x-
ray plaster room,
sister's room staff
nurse / GDA and
anesthesia store room.

Protective Zone
Patient’s waiting Sterile zone
area and reception, Operating suite in
Trolley bay, Lifts, Area of particular, Scrub
Stairs, Switch room, OT room, Anesthesia
Pre anesthesia room, Instruments
room, chaning trolley area.
room, store room.

Disposal Zone
dirty room,
disposal corridor
and janitors
corridor

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Session Plan 1 T1: Interactive Lecture

1. SESSION TOPIC: Areas in DURATION: 02 HOURS

Operation Theatre PROCESS
1. Prepare the points for the lecture.
2. OBJECTIVE: To develop 2. Introduce the topic.
student’s knowledge, 3. Make an opening by telling students the purpose personal
skills and abilities to hygiene and its importance.
identify the aims of 4. Introduce the topic in the class and provide relevant
planning of OT, location, knowledge to the students. Topics may include but not
size and different areas limited to the following:
of operation theatre a) Explain about operation theatre
b) Describe the aims of planning of OT
3. MATERIALS/EQUIPMENT c) State the standard size of OT
REQUIRED: Charts, d) Explain about different zones of OT with their significance
Sketch Pens, Computer, 5. Make a slide presentation on personal hygiene education and
Open Source Software health education and explain the same to the students.
for Slide Presentation, 6. Relate the topic to the situation and ask questions.
LCD Projector. 7. Provide specific examples.
8. Involve students by giving them the opportunity to ask
4. PREPARATIONS questions related to the topic.
o Arrange all the 9. Clarify any questions students may have.
materials well in 10. Summarize the topic and emphasize on the key points.
advance
T2: Activity
5. TEACHING/TRAINING
DURATION: 03 HOURS
METHODOLOGY:
Ask your students to visit a nearby hospital and:
1. Draw a layout of OT.
2. Identify the following zones of OT and fill the table
given below with name of different parts in the
particular zone :
Zone Parts
Protective
Clean
Sterile
Disposal

Checklist for Assessment Activity

Use the following checklist to check whether your students could

meet all the requirements for assessment.

Part A
Students could differentiate between the following:

1. Protective and sterile zone of OT

2. Clean and disposal zone of OT

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 3. Pre operating room and recovery room

Part B
Students could answer in class the following:

1. Ideal location of OT
2. Aims of planning of OT
3. Zones of operation theatre

Part C

Performance Standards
Students demonstrate the generic, technical, professional and
organizational knowledge and skills in order to perform up to the
required standards. Performance standards may include, but not
limited to:
Performance standards Yes No
Demonstrate the knowledge of the size of OT on
the basis of surgical facilities
Identify the ideal location of OT in hospital
Demonstrate the knowledge various zones of OT
Demonstrate the knowledge of procedures to
achieve high degree of asepsis in protective zone,
clean zone, sterile zone and disposal zone of OT

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Session 2: Staffing and Equipments of OT
Relevant Knowledge In this session, we will learn about range of equipments of OT. We
will also study about the policies and procedures, OT scheduling
and training of staff associated with operation theatre.

The operating theaters are under the department of surgical

facilities. The work cannot be assigned to a single entity, as it is
team work. The operating theaters are the perfect examples of
the team work, under the dedicated team leadership of the head
of the department of surgery and a fully devoted sister OT / GDA
and Technicians of the theatre, who are responsible for the
functioning of the theatre. The following staffs are present in the
OT:

1. Surgeons: Specialized in the particular branch of surgery.

2. Assistant Surgeons: Specialized but practicing with the senior
surgeons.
3. House surgeons: If it is a medical college hospital
4. Medical student: if any
5. Theatre sister
6. Other theatre nurses : specialized to work in special operating
rooms
7. Head nurses of each OT
8. Staff nurses
9. Medical and nursing students
10. Operation room technicians
11. Other workers such as attenders, cleaners, Dhobi etc.
12. The number of nurses and other workers depends upon the
type of hospital and the number of daily operation.
13. General Duty Assistant: Depending upon the policies of the
hospital.

Equipment of OT

The modern OT is highly equipment intensive. The range of

equipments of OT will depend upon the OT of a particular
specialty; however some of the equipments, used in modern OT
are being renumbered as follows
1. OT tables
2. Anesthesia machines
3. Anesthesia ventilators
4. Defibrillator
5. Neonatal multi parameter monitor
6. Cautery machine
7. Central suction
8. C-arms
9. Phako emulsification machine
10. AO drilling system

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 11. Arthroscope
12. Endoscopic surgery system
13. Lithoclast & Lithotripter
14. The equipments in Cardiac Surgery OT.
a. Heart lung machine
b. Octopus
c. Defibrillator
d. Fibrillator
e. Multiparameter
f. Hemotherm
g. ACT machine

Policies and Procedures

Administration of the OT : - The OT management is an example

of perfect team management, where a variety of personnel
ranging from highly skilled surgeons to minimal skilled OT
attendants, work under tremendous stress and strain, long
duration of work in uncomfortable posture, without much verbal
communication. It requires a discipline head of surgery team,
dedicated OT nurse, devoted anesthesiologist, who are self
motivated for high degree of aspesis and quality assurance.

OT scheduling

There should be perfect planning of the OT scheduling, timely

preparation, complete PAC, preoperative treatment and shifting
of patient to theater. No wastage of time between two
operations.

Punctuality

If an operation is scheduled at 0900 hrs, it means everything

should be ready by that time, and 0900 hrs means start of the
operation right on time, right every time.

Training of staff

All staff member should be trained in the maintenance of asepsis

and universal precaution. Nobody is watching the OT staff, the
patient is unconscious, the relatives are waiting outside, the
patient’s life is totally in the hands of OT team. No body, in fact
is required to observe the OT team, it is the team, who knows it.
The team has to be well trained in “NO TOUCH TECHNIQUE”

Operating list

The list must be planned well in advance with perfect time

management. The postponement of an operation is not desirable;

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it is highly dissatisfying to a patient and causes lot of
inconvenience to the surgical team, the patients and relatives. It
may more the reputation of the hospital.

Dirty Cases

These kinds of cases should be handled at last of the OT and OT

must be cleaned and disinfected after the procedure.

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Session Plan 2 T1: Interactive Lecture

1. SESSION TOPIC: Staffing DURATION: 02 HOURS

and Equipments of OT PROCESS
1. Prepare the points for the lecture.
2. OBJECTIVE: To develop 2. Introduce the topic.
student’s knowledge, 3. Make an opening by telling students the purpose personal
skills and abilities of hygiene and its importance.
staffing and equipments 4. Introduce the topic in the class and provide relevant
of OT knowledge to the students. Topics may include but not
limited to the following:
3. MATERIALS/EQUIPMENT a) Explain about the staff present in OT
REQUIRED: Charts, b) Explain the procedure of care of instruments before
Sketch Pens, Computer, and after use in operation theatre
Open Source Software c) Describe the policies and procedures adopted for
for Slide Presentation, maintenance of OT
LCD Projector. 5. Make a slide presentation on personal hygiene education and
health education and explain the same to the students.
4. PREPARATIONS 6. Relate the topic to the situation and ask questions.
o Arrange all the 7. Provide specific examples.
materials well in 8. Involve students by giving them the opportunity to ask
advance questions related to the topic.
9. Clarify any questions students may have.
5. TEACHING/TRAINING 10. Summarize the topic and emphasize on the key points.
METHODOLOGY:
T2: Practical Session

DURATION: 03 HOURS
1. Ask your students to visit a nearby hospital and prepare the
list of staff working in the OT with their roles and functions
and fill the table given below:
Staff Roles and Functions

2. Ask the students to tabulate the range of equipments

available in OT
Checklist for Assessment Activity

Use the following checklist to check whether your students could

meet all the requirements for assessment.

Part A
Students could differentiate between the following:
1. Equipments of general OT and cardiac OT

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 2. Administration of OT and ICU

Part B
Students could answer in class the following:
1. OT Scheduling
2. Safety policies adopted for OT
3. Training of staff of OT

Part C

Performance Standards
The performance standard may include, but not limited to:

Performance Standards Yes No

Identify the range of equipments of OT
Identify the staff present in the OT with their
duties
Demonstrate the knowledge of the care of
equipments present in the OT
Describe the safety measures followed in OT
Demonstrate the knowledge of importance of
schedule, policies and procedures and training of
staff of OT

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Session 3: Preparation of Patient for OT
Relevant Knowledge In this session, we will learn about the role of GDA in preoperative
preparation of the patient. We will also study the local
preparation for surgery and preparations before sending the
patient to OT.

The GDA has to do the following things as a part of the pre-

operative preparation of the patient:

1. The drugs the patient is receiving are noted, because they

may have some adverse effect on the anesthesia and or
the surgery
2. Patient’s general condition is noted. It should be optimum
before the surgery.
3. Adequate diet is given and its proper digestion is
confirmed.
4. Adequate proteins and vitamin C are given in the diet,
because they promote wound healing.
5. Adequate liquids and water are given to the patient, so
that his hydration is maintained. If the patient is not to
take anything orally, intravenous fluids are given to
maintain fluid and electrolyte balance.
6. Adequate calories are provide, that the patient does not
develop hypoglycemia and acidosis under anesthesia.
7. The patient I prepared mentally for various investigations
he has to undergo.
8. Preoperative investigations are done as shown in the
following table, so as to ensure fitness for anesthesia and
surgery.
9. If the patient’s hemoglobin is low, it is build up by
administration of appropriate therapy including blood
transfusions.
10. Grouped and cross – matched blood is kept ready for the
patient
11. Any medical disorders present are treated appropriately,
so that they are under control at the time of the surgery.
12. Breathing exercises are taught to the patient and he is
asked to perform them well, so that he can breathe in a
similar way postoperatively That is important for
improving the venous return to the heart and reduce the
risk of deep vein thrombosis as well as hypostatic
pneumonia.
13. A written informed consent is obtained from the patient
and his relatives for the operation to be performed.
14. A sedative is administered on the night before surgery to
reduce anxiety and ensure adequate rest.
15. The patient is kept nil by mouth from the night before the
operation.
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 If the stomach is full at the time of surgery, the patient
may regurgitate the stomach contents under general
anesthesia and aspirate them, which should cause
aspiration pneumonia.
16. A simple enema is given on the morning of the operation
so as to empty the rectum and lower colon. A purgative is
avoided because it may cause strong purgation, which
may cause dehydration and electrolyte imbalance.
17. The stomach is decompressed using a nasogastric tube is
case of an intestinal obstruction.
18. Smoking and drinking are prohibited.
19. Vital parameters are checked and recorded twice a day.

Local preparation for surgery

1. The part to be operated on is shaved, except the face in case

of women and children. The following points are carefully
noted.
a. Hair is removed from skin folds.
b. Cutting the skin is avoided, because bacterial
infection may develop at the site of the cuts.
2. The shaved part is cleaned carefully with cetavlon. It removes
dirt and oiliness from the skin
3. The patient is asked to take a clean bath
4. The patient is given clean clothes to wear.

Preparation before sending the patient to operating theater

1. The patient is given long gown to wear, which open on the

back.
2. She is given long socks to wear, so that she does not feel
embarrassed.
3. Lipstick and nailpolish are removed. This is important
because the anesthetist has to note pallor and syanosis,
which will not be seen in the presence of these colors.
4. The head is covered with a triangular bandage or a cap so
that all hair is covered.
5. Dentures are removed.
6. Spectacles or contact lenses are removed.
7. All ornaments are removed.
8. A label is tied around the wrist of the patient, giving the
following information.
a. Name
b. Indoor number
c. Doctor’s name
d. Ward
e. Diagnosis
f. Operation to be done

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9. The patient is asked to pass urine. This avoids the risk of
development of urinary tract infection during
catheterization.
10. The drugs prescribed to be given pre-operatively are
given. Appropriate records are maintained of the drug
administration.
11. The patent is taken to the operation theater on a trolley,
along with his case papers and reports of his
investigations.
12. The operation theater GDA is given over the patient.

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Session Plan 3 T1: Interactive Lecture

1. SESSION TOPIC: DURATION: 03 HOURS

Preparation of Patient for PROCESS
OT 1. Prepare the points for the lecture.
2. Introduce the topic.
2. OBJECTIVE: To develop 3. Make an opening by telling students the purpose personal
student’s knowledge, hygiene and its importance.
skills and abilities to 4. Introduce the topic in the class and provide relevant
prepare a patient for OT knowledge to the students. Topics may include but not
limited to the following:
3. MATERIALS/EQUIPMENT a) Describe the duties of GDA in pre-operative preparation
REQUIRED: Charts, Sketch of the patient
Pens, Computer, Open 5. Make a slide presentation on personal hygiene education and
Source Software for Slide health education and explain the same to the students.
Presentation, LCD 6. Relate the topic to the situation and ask questions.
Projector. 7. Provide specific examples.
8. Involve students by giving them the opportunity to ask
4. PREPARATIONS questions related to the topic.
o Arrange all the 9. Clarify any questions students may have.
materials well in 10. Summarize the topic and emphasize on the key points.
advance
T2: Activity
5. TEACHING/TRAINING
METHODOLOGY: DURATION: 02 HOURS
1. Ask your students to visit a nearby hospital and observe how
to prepare a patient for OT and fill the table given below:
Name of surgery Preoperative care given

Checklist for Assessment Activity

Use the following checklist to check whether your students could

meet all the requirements for assessment.

Part A
Students could differentiate between the following:
1. Medical asepsis & Surgical asepsis
2. Hypoglycemia and Acidosis

Part B
Students could answer in class the following:
1. The role of GDA in providing pre surgery care
2. Preparation of a patient for surgery

20
 3. Importance of triangular bandage

Part C

Performance Standards
Students demonstrate the generic, technical, professional and
organizational knowledge and skills in order to perform up to the
required standards. Performance standards may include, but not
limited to:

Performance standards Yes No

Demonstrate the knowledge of the vital parameters to
be observed before sending the patient in OT
Prepare the patient for local surgery
Describe the duties of GDA in pre-operative
preparation of the patient

21
Session 4: Post Operative Care
Relevant Knowledge
In this session, we will learn about important care to be rendered
by GDA in the post operative phase.

The below mentioned care to be rendered by GDA during the post

operative phase:

1. The patient’s bed is prepared before he comes back from the

operation theater.
a. The bed is made warm with the use of hot water
bottles and bags.
b. Extra blankets are used to keep the bed warm.
c. The following articles are kept ready near the
bed.
i. Oxygen cylinder
ii. Saline stand
iii. Bed blocks
iv. Postanesthetic tray
v. Injection tray
vi. Intravenous infusion tray

2. It is preferable to have a recovery room in which the patient is

kept before he can be shifted to the ward safely. The
proportion of specialist doctors, Nurses and GDA is higher in
the recovery room, so that the patient receives better care
than he would in the ward. The following equipment should be
kept ready in the recovery room.
a. Suction machine
b. Oxygen
c. Sphygmomanometer
d. Equipment for intravenous infusion.
e. Blood transfusion equipment
f. Bed blocks
g. Respirator.
h. Railing cots
i. Cardioscope
j. Equipment for cardiopulmonary resuscitation.

3. Before bringing the patient from the recovery room the

following observation are made:
a. Patency of airway
b. Respiration : normal or abnormal
c. Temperature
d. Pulse

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 e. Blood pressure
f. Syanosis
g. Recovery from anesthesia
h. The nature of the operative wound.
i. Drainage sites and tubes
j. Patency of the intravenous line
k. Presence of catheters and tubes
i. Urinary catheter
ii. Nasogastric tube
l. Completeness of indoor papers and postoperative
orders.
m. Special instruction, if any

4. When the patient is brought to the ward, the hot water

bottles and bags are removed and he is placed on the
bed. The tubes and catheters are connected
appropriately. The intravenous infusion bag or bottle is
hanged from the saline stand.

5. The patient is given semiprone position, which maintains

his airway by preventing the following
a. Tongue falling back.
b. Aspiration of secretions
c. Aspiration or regurgitated stomach contents.

6. Moist oxygen is given by face mask or nasal catheter if the

patient has undergone major surgery and the expansion
power of his lungs is reduced so that he is hypoxic.

7. The patient’s temperature, pulse, and respiration are

noted as soon as the patient is brought to the ward,
because these parameters can change while the patient is
being shifted out of the ward. If there is any change, it
should reach the normal level in a short period. If it does
not, something could be seriously wrong with the patient.
These parameters are examined every half hour to see if
pulse change. In case the patient bleeds internally or
externally, the pulse becomes rapid, and after severs
bleeding, the respiration becomes rapid and labored due
to hypoxia.

8. The patient is kept warm. However overheating is to be

avoided. Since it can lead to perspiration, dehydration,
and electrolyte imbalance. It can also cause
vasodilatation and increase the risk of hemorrhage from
the operated area.

23
9. Fluids like normal saline and Ringer’s lactate are given
intravenously to make up for the loss during surgery and
restore the fluid and electrolyte balance. Five per cent
dextrose is given to supply calories. Over infusion of fluids
is to be avoided because that can lead to pulmonary
edema.

10. If intravenous fluids are to be infused over prolonged

periods. Serum electrolyte levels are checked periodically
so as to maintain electrolyte balance.

11. The patient is allowed to sleep in a comfortable position

when he is fully conscious. He is permitted to move in bed
and from the second day get out of the bed, unless he has
a serious problem. Early mobilization reduces the risk of
the following complications.
a. Deep vein thrombosis.
b. Pulmonary embolism
c. Hypostatic pneumonia.

12. Fowler’s position is given when the patient has undergone

major surgery. It achieves the following.
a. It permits deep breathing.
b. It relieves flatulence.
c. It permits gravity drainage of discharge

13. Some patients vomit during and after recovery from

anesthesia. They are given sip of water and deep
breathing exercises. If that does not relieve vomiting
antiemetic drugs are used.

14. Flatulence is seen often after abdominal surgery.

Flatulence causes severe abdominal pain. The patient
becomes uncomfortable. Its incidence is reduced with
early ambulation. Such patients are given antiflatulent
drugs or a flatus tube I passed per rectum to remove the
gas in the colon and rectum.

15. Pan is experienced during the first 1 to 2 days after the

surgery. It does not permit the patient to sleep well at
night.

16. Diet
a. After the patient has fully recovered from anesthesia
and is found not be vomiting and when his peristaltic

24
 sounds are normal, he is initially given water to
drink. When he is found to tolerate that well, he is
given liquids orally e.g. tea, coffee, coconut water,
fruit juices etc.
b. The next day he is given soft diet.
c. The following day he is given normal diet. Adequate
quantities of vitamin C are ensured in the diet so
that the operative wound heals well.

17. By the third day morning the patient will have received
adequate diet orally and will pass stools. If he does not,
he is given a simple enema. If the surgery has been done
on the gastrointestinal tract, an enema only when asked
for by the doctor treating the patient.

18. There is a risk of retention of urine postoperatively. It

may be due to any of the following reasons, as shown in
the following table.
Cause
Pain
Lying down position
Lack of privacy
Spasm of bladder neck
Atony of bladder
Measure for correction
Analgesic drugs
Make the patient sit up with
support for passing urine.
Put screens around the
patient’s bed.
Application of hot water bag
to the lower abdomen.
Sound of running water.
Carbachol 1 ml IM.

19. If all measures fail at relieving the retention of urine, the

bladder is catheterized. Repeated episodes of retention of
urine are managed by the use of a self retaining urinary
catheter.
20. Deep breathing exercises are given to patients who have
undergone abdominal surgery.
21. If the patient is unable to breathe on his own, he may
require endotracheal intubation or tracheostomy and
ventilation using a mechanical ventilator.
22. The dressing on the wound is not changed unnecessarily so
as to reduce the risk of wound infection. It is changed if it
gets soaked by blood or discharge. In case of wound
infection, the dressing is changed as frequently as
required.
23. The sutures are removed after 7 days. If the wound has
healed well. It is left open.

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Session Plan 4 T1: Interactive Lecture

1. SESSION TOPIC: Post DURATION: 03 HOURS

Operative Care PROCESS
1. Prepare the points for the lecture.
2. OBJECTIVE: To develop 2. Introduce the topic.
student’s knowledge, 3. Make an opening by telling students the purpose personal
skills and abilities to hygiene and its importance.
provide post operative 4. Introduce the topic in the class and provide relevant
care to the patient knowledge to the students. Topics may include but not
limited to the following:
3. MATERIALS/EQUIPMENT a) Describe the importance of the fowler’s position in post
REQUIRED: Charts, Sketch operative care
Pens, Computer, Open b) Explain the methods of caring the patient required for
Source Software for Slide surgical incision
Presentation, LCD c) Explain different measures for corrections and their
Projector. causes in case of risk of retention of urine post operative
5. Make a slide presentation on personal hygiene education and
4. PREPARATIONS health education and explain the same to the students.
o Arrange all the 6. Relate the topic to the situation and ask questions.
materials well in 7. Provide specific examples.
advance 8. Involve students by giving them the opportunity to ask
questions related to the topic.
5.TEACHING/TRAINING 9. Clarify any questions students may have.
METHODOLOGY: 10. Summarize the topic and emphasize on the key points.

T2: Activity

DURATION: 02 HOURS
1. Ask your students to visit a nearby hospital and observe the
post surgery care given to patient and fill the table given
below accordingly:
Name of surgery Post operative care given

Checklist for Assessment Activity

Use the following checklist to check whether your students could

meet all the requirements for assessment.

Part A
Students could differentiate between the following:
1. Observation to be done prior recovery room and in the
recovery room.
2. Post operative care and pre operative care

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 3. Recovery room and general room in hospital

Part B

Students could answer in class the following:

1. The role of GDA in providing post operative care

Part C

Performance Standards
Students demonstrate the generic, technical, professional and
organizational knowledge and skills in order to perform up to the
required standards. Performance standards may include, but not
limited to:

Performance Standards Yes No

Demonstrate the knowledge of care to be rendered
by GDA in the post operative phase

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