Patient Teaching Earlier in this chapter, under “Patient Education,” the goals and principles of patient teaching were addressed. When taken in the context of the medical patient, there are some general areas of patient teaching needs that must be considered, particularly as the patient approaches discharge from an inpatient status. Those areas include the following:  Follow-up appointments  Modification in daily living activities and habits  Modification in diet, including fluid intake  Medications and treatment to be continued after discharge  Measures to be taken to promote health and prevent illness Rest The primary reason for prescribing rest as a therapeutic measure for the medical patient is to prevent further damage to the body or a part of the body when the normal demand of use exceeds the ability to respond. However, prolonged or indiscriminate use of rest—particularly bed rest—is potentially hazardous. Some of the common complications occurring as a result of prolonged bed rest are  circulatory problems (such as development of thrombi and emboli) and subsequent skin problems (such as decubiti);  respiratory problems (such as atelectasis and pneumonia);  gastrointestinal problems (such as anorexia, constipation, and fecal impactions);  urinary tract problems (such as retention, infection, or the formation of calculi);  musculoskeletal problems (such as weakness, atrophy, and the development of contractures); and  psychological problems (such as apathy, depression, and temporary personality changes). The prevention of complications is the key concept in therapeutic management for the patient on prolonged bed rest. Awareness of the potential hazards is the first step in prevention. Alert observations are essential: Skin condition, respirations, food and fluid intake, urinary and bowel habits, evidence of discomfort, range of motion, and mood are all critical elements that provide indications of impending problems. When this data is properly reported, the healthcare team has time to employ measures that will arrest the development of preventable complications. THE SURGICAL PATIENT LEARNING OBJECTIVE: Evaluate the needs of a surgical patient during the preoperative, operative, recovery, and postoperative phases of his treatment. Surgical procedures are classified into two major categories: emergency and elective. Emergency surgery is that required immediately to save a life or maintain a necessary function. Elective surgery is that which, in most cases, needs to be done but can be scheduled at a time beneficial to both the patient and the provider. Regardless of the type of surgery, every surgical patient requires specialized care at each of four phases. These phases are classified as p re o p e r a t i v e , o p e r a t i v e , re c o v e r y , a n d postoperative. The following discussion will address the basic concepts of care in each phase. Preoperative Phase Before undergoing a surgical procedure, the patient must be in the best possible psychological, spiritual, and physical condition. Psychological preparation begins the moment the patient learns of the necessity of the operation. The physician is responsible for explaining the surgical procedure to the patient, including the events that can be expected after the procedure. Since other staff personnel reinforce the physician’s explanation, all members of the team must know what the physician has told the patient. In this manner, they are better able to answer the patient’s questions. All patients approaching surgery are fearful and anxious. The staff can assist in reducing this fear by instilling confidence in the patient regarding the competence of those providing care. The patient should be given the opportunity and freedom to express any feelings or fears concerning the proposed procedure. Even in an emergency, it is possible to give a patient and the family psychological support. Often this is accomplished simply by the confident and skillful manner in which the administrative and physical preoperative preparation is performed. 2-15