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All surgeries and emergency procedures except only some of them require preliminary preparation or pretreatment of patients. The time during which the patient is waiting o the surgery is called a preoperative period, the time after the operation is called a post-operative period. A preoperative and post-operative period can be characterized as a perioperative time. Preoperative preparation of patients is a complex of measures. In some cases, they are reduced to a minimum (for emergency and urgent operations), and for elective surgery should be carried out more carefully. Recommendations, according to perioperative period, include preoperative assessment, bowel preparation for surgery, post-operative issues of wearing compression stockings and tie, the nuances of food, behavior, limitations of physical activity in the post-operative period, postoperative treatment of joints, the nuances of registration and other legal documents. It is important that at the time of surgery the patient should be in healthy state (except the surgical site), without cough, runny nose, fever, diarrhea, etc. If one had any inflammatory diseases, such as SARS, he/she should wait at least 2 weeks from the moment of recovery to maximize the recovery of the body's immune system.
The process or procedure in the sphere of its changes
But each surgery needs some preparation. We have chosen for description the routine shaving and skin preparation of the surgical site. To describe the process we should mention that the patient should take a shower or bathe with an antiseptic soap the night before the surgery. Haircut and shaving are conducted immediately before surgery. Some depilatory creams should be used for hair removal, especially in the preparation of large areas of skin for surgery on heart or blood vessels (Eskicioglu, Forbes, Fenech & McLeod, 2010).
The skin of the surgical site should be shaved in the morning of surgery. During surgeries on the skull all hair on the head should be shaved off, only during small surgeries half or the nearby parts of head should be shaved. Before the surgeries in the area of the mouth, cheeks and chin, mustache and beard should be shaved off, before the surgeries near the armpit the hair in the armpits should be shaved off, in surgeries on the stomach - all the entire area of the perineum and pubis should be shaved off before the perineal and vaginal surgeries (Cox & Bridges, 2013).
If shaving causes severe pain in the area surgical site i.e. with an abscess, etc., in these cases a nurse has to shave after soothing the patient before the surgery. The ability to shave is the responsibility of the nursing staff. Place of shaving should be lathered, shaving before 1-1,5 hours before surgery, and it should be moistened with medical liquid, during shaving before the surgery. The razor must be sufficiently sharped, if necessary, it can be replaced several times during shaving. In the presence of minor cuts, they should be lubricated with antiseptic tincture.
The procedure of shaving and skin preparation of the surgical site does not need some routine changes. It needs changes in the sphere of psychological preparation (Cox & Bridges, 2013).
Pending surgeries for a man can be a shock; it is natural state because his concern is justified. Expectation of pain and, in some cases, a premonition of helplessness in the preparation of the skin worries and inhibits sick person. Nurse, conducting shaving and skin preparation, in any case, should not substitute a doctor and try to explain to the essence of the surgery (Eskicioglu, Forbes, Fenech & McLeod, 2010).
He should maintain a confidence of a patient in the fact that due to the high qualification of surgeons and anesthetists, with medication and other special techniques post surgery period will be painless. It is important to convince the patient to the success of the treatment. This is a difficult task, requiring in each case, an individual approach to the sick person. Regardless of own mood a nurse should always maintain good spirits of patients who have a surgery (Cox & Bridges, 2013).
It is important to strengthen the confidence of the patient to those experts who guide its treatment and immediately spends it. This also applies to those professionals who will treat the patient in the first few days after surgery conducting the intensive care (Silva, 2013).
It is always unacceptable for a nurse to be critical in the presence of patients regarding medical personnel.
Determination of the basis for the routine shaving and skin preparation of the surgical site
A nurse determines the basis of the procedure. Further processing of the surgical site is conducted before the surgery in the preoperative or in the surgery room. The skin should be disinfected and tanned by a double lubrication with related drugs (containing iodine). In some cases, before the lubrication of iodine the skin should be defatted. Also, processing the surgical site a number of other liquids can be used. Liquids without iodine are mainly used in surgeries on the surgical site where iodine can cause burns (face, neck, scrotum, anus).
To prepare for the surgery of the mucous a nurse should use pre-rinse weak disinfectant liquids. The preparation of the bladder mucosa in cases of inflammation can be conducted with washing bladder disinfectant. The lining of the rectum can be conducted with disinfectant enemas (Mann, 2013).
The reasons of such performing of the routine shaving and skin preparation
The practice is performed this way because a nurse should pay special attention to the preparation of that part of the body where the surgery will be made (The Surgical Site). First of all it is necessary to inspect the surgical site. Often, the surgery should be canceled due to diseases of the skin at the surgical of a proposed transaction or in neighboring areas due to scratching, rashes, pustules, especially due to the appearance of boils or abscesses. A rash and pustular of inflammatory nature should not be on the skin. If a patient has cold sores on the lips or genitals, the surgery should be postponed until full recovery, because reduced immunity in the perioperative period may lead to the generalization of herpes infection, up to herpes simplex encephalitis (Mann, 2013).
A nurse should say about all seen diseases to a physician. In surgeries that do not require urgent intervention, firstly action to eliminate the detected disease and purulent processes should be taken, and then surgery should proceed. Emergency surgery, even with skin diseases cannot be canceled. If the surgery is carried out on a limb, for a few days before the surgery, warm baths should be done.
The rationale for making the decision for the procedure
It is the absence of hair in a surgical site or into the raphe. The presence of infection in the wound is the cause of emergence and the accumulation of pus in the soft tissue of wounds in the early or late post-operative period. In any normal wound healing process is accompanied by varying degrees of severity of inflammation. Typically, the natural inflammatory response finishes in few days, and subsequently the wound is healed without any complications. However, in some cases, the inflammatory reaction in the wound can exceed its physiological limits, which in turn leads to the formation of pus.
Unfortunately, even a perfectly executed surgery is often accompanied by such an unfortunate occurrence, as fester. Infection may enter into the wound in various ways. This occurs most often in cases where surgery is performed over of any purulent processes in the body. This happens in diseases such as running purulent appendicitis, purulent inflammation of the uterus, lung lesions. Even with ideal manipulations produced during surgery, some of the bacteria can enter into wound that in some cases leads to suppuration (Silva, 2013).
But non-compliance of the rules of aseptic and antiseptic during surgery, poor treatment of hands of a surgeon or surgical site before surgery, or poor-quality routine shaving and skin preparation of the surgical site can produce infection. Direct injury pain of pulsating and shooting nature that lasts for a long time after surgery, sometimes up to several weeks, (normally severe pain after surgery remains rarely more than 2-4 days, and corresponds to the natural inflammatory process which occurs in any wound), high body temperature, which in most cases increase in the evening and can be more than 38-38,5 degrees of Celsius, signs of inflammation in the wound, remaining more than 2-4 days, the redness of the skin around the wound, swelling, increasing of the local temperature of the wound (wound is hot), clear signs of purulent process are the consequences of low-quality routine shaving and skin preparation of the surgical site. This all creates the rationale for making the decision for the procedure.
To provide a description of a nurse in a leadership role on a surgical floor it should be mention, that some routine procedures should be investigated. The routine shaving and skin preparation of the surgical site is the procedure, the role of which is hard to overestimate. The further state of the wound and the absence of the possibility of infection are dependent on the quality of routine shaving and skin preparation of the surgical site. This procedure is determined by nurse and needs some changes in the psychological sphere.