medical surgical nursing perioperative nursing by : lowell p. bautista, rn

Medical Surgical Medical Surgical NursingNursing

PERIOPERATIVE PERIOPERATIVE NURSINGNURSING

By : Lowell P. Bautista, RNBy : Lowell P. Bautista, RN

DEFINITION OF TERMSDEFINITION OF TERMS

SURGERY SURGERY -It is the branch of -It is the branch of medicine concerned with diseases medicine concerned with diseases and conditions which require or are and conditions which require or are amenable to operative procedures. amenable to operative procedures. Surgery is the work done by a Surgery is the work done by a surgeon. surgeon.

-"Surgery can involve -"Surgery can involve cutting, abrading, suturing, laser or cutting, abrading, suturing, laser or otherwise physically changing body otherwise physically changing body tissues and organs." tissues and organs."

SURGEONSURGEON - A physician who treats - A physician who treats disease, injury, or deformity by disease, injury, or deformity by operative or manual methods. A operative or manual methods. A medical doctor specialized in the medical doctor specialized in the removal of organs, masses and removal of organs, masses and tumors and in doing other tumors and in doing other procedures using a knife (scalpel)procedures using a knife (scalpel)

STERILESTERILE - free from living germs or - free from living germs or microorganisms; aseptic: sterile microorganisms; aseptic: sterile surgical instruments.surgical instruments.

ASEPSISASEPSIS - The state of being free of - The state of being free of pathogenic microorganisms. pathogenic microorganisms.

- The process of removing - The process of removing pathogenic microorganisms or pathogenic microorganisms or protecting against infection by such protecting against infection by such organisms.organisms.

SEPSIS SEPSIS - a toxic condition resulting - a toxic condition resulting from the spread of bacteria or their from the spread of bacteria or their toxic products from a focus of toxic products from a focus of infection; infection; especiallyespecially : septicemia : septicemia

SEPSIS SEPSIS - - is a severe illness caused by is a severe illness caused by overwhelming infection of the overwhelming infection of the bloodstream by toxin-producing bacteria.bloodstream by toxin-producing bacteria.

- is caused by bacterial infection - is caused by bacterial infection that can originate anywhere in the body. that can originate anywhere in the body.

DISINFECTANTDISINFECTANT - any chemical agent - any chemical agent used chiefly on inanimate objects to used chiefly on inanimate objects to destroy or inhibit the growth of harmful destroy or inhibit the growth of harmful organisms. organisms.

ANTISEPTICSANTISEPTICS - - is a substance that is a substance that prevents or arrests the growth or action prevents or arrests the growth or action of microorganisms either by inhibiting of microorganisms either by inhibiting their activity or by destroying them. The their activity or by destroying them. The term is used especially for preparations term is used especially for preparations applied topically to living tissueapplied topically to living tissue

STERILIZATION STERILIZATION -the destruction of all living -the destruction of all living microorganisms, as pathogenic microorganisms, as pathogenic bacteria, vegetative forms, and spores.bacteria, vegetative forms, and spores.

BACTERIOSTATICBACTERIOSTATIC -Capable of inhibiting -Capable of inhibiting the growth or reproduction of bacteria.the growth or reproduction of bacteria.

- An agent, such as a chemical or biological - An agent, such as a chemical or biological material, that inhibits bacterial growth. material, that inhibits bacterial growth.

BACTERICIDAL BACTERICIDAL - Capable of killing - Capable of killing bacteria.bacteria.

BACTERIOCIDES BACTERIOCIDES - is a substance that kills - is a substance that kills bacteria .Bactericides are either bacteria .Bactericides are either disinfectants, antiseptics or antibiotics.disinfectants, antiseptics or antibiotics.

PREFIXES & SUFFIXESPREFIXES & SUFFIXES

Prefixes & Suffixes can explain the type of procedure the client will undergo::

PREFIXESPREFIXES Supra – above ; beyondSupra – above ; beyond Ortho – jointOrtho – joint Chole – bile or gallChole – bile or gall Cysto – bladderCysto – bladder Encephalo- brainEncephalo- brain

Entero – intestineEntero – intestine Hystero – uterusHystero – uterus Mast – breastMast – breast Meningo – membrane; meningesMeningo – membrane; meninges Myo – muscleMyo – muscle Nephro – kidneyNephro – kidney Neuro – nerveNeuro – nerve Oophor - ovary Oophor - ovary

Pneumo – lungsPneumo – lungs Pyelo – kidney pelvisPyelo – kidney pelvis Salphingo – fallopian tubeSalphingo – fallopian tube Thoraco – chestThoraco – chest Viscero – organ esp. abdomenViscero – organ esp. abdomen

SUFFIXESSUFFIXES Oma – tumor ; swellingOma – tumor ; swelling Ectomy – removal of an organ or glandEctomy – removal of an organ or gland Rhapy – suturing or stitching of a part Rhapy – suturing or stitching of a part

or or

an organan organ Scopy – looking intoScopy – looking into Ostomy – making an opening or a Ostomy – making an opening or a

stoma stoma Otomy – cutting into Otomy – cutting into

Plasty – to repair or restorePlasty – to repair or restore Cele – tumor ; hernia ; swellingCele – tumor ; hernia ; swelling Itis – inflammation ofItis – inflammation of


SURGERY – a branch of SURGERY – a branch of Medicine that encompasses Medicine that encompasses preoperative care, preoperative care, intraoperative judgement & intraoperative judgement & management, & postoperative management, & postoperative care of patients.care of patients.

OPERATION – an invasive OPERATION – an invasive modality of treatment.modality of treatment.


DEFINITION:DEFINITION: a.k.a a.k.a : : OPERATING ROOM NURSINGOPERATING ROOM NURSING The identification of physiological & The identification of physiological &

sociological needs of the client, & sociological needs of the client, & the implementation of an the implementation of an individualized program of nursing individualized program of nursing care in order to restore or maintain care in order to restore or maintain the health & welfare of the patient the health & welfare of the patient before, during & after surgical before, during & after surgical intervention.intervention.


PHILOSOPHY :PHILOSOPHY :

To give service that aims to To give service that aims to provide comprehensive provide comprehensive support physically, morally, support physically, morally, psychologically, spiritually, psychologically, spiritually, & socially to a patient & socially to a patient undergoing surgery.undergoing surgery.


GOALS :GOALS :

1.1.To provide safe, supportive & To provide safe, supportive & comprehensive care.comprehensive care.

2.2.To assist the surgeon by To assist the surgeon by functioning effectively as a functioning effectively as a member of the surgical team.member of the surgical team.

3.3.To create & maintain an To create & maintain an aseptic / sterile environment.aseptic / sterile environment.


Fundamental purposes of the Fundamental purposes of the O.R. O.R. ::

It is a place. . .It is a place. . .

1.1.To correlate theory & practice.To correlate theory & practice.

2.2.To develop skills in assisting the To develop skills in assisting the surgeon in the operation.surgeon in the operation.

3.3.To create a suitable sterile field for To create a suitable sterile field for surgical procedures to prevent surgical procedures to prevent complicationscomplications..

Perioperative Patient-Perioperative Patient-Focused ModelFocused Model

Period of time that constitutes the surgical Period of time that constitutes the surgical experience. Includes three phases:experience. Includes three phases: Preoperative phasePreoperative phase: the period of time from the : the period of time from the

decision for surgery until the patient is transferred decision for surgery until the patient is transferred into the operating room. into the operating room.

Intraoperative phaseIntraoperative phase: the period of time from when : the period of time from when the patient is transferred to the operating room to the patient is transferred to the operating room to the admission to postanesthesia care unit (PACU). the admission to postanesthesia care unit (PACU).

Postoperative phasePostoperative phase: the period of time that begins : the period of time that begins with admission to the PACU and ends with follow-up with admission to the PACU and ends with follow-up evaluation in the clinical setting or at homeevaluation in the clinical setting or at home

CLASSIFICATIONS CLASSIFICATIONS OF SURGERYOF SURGERY

According to Urgency According to Urgency ::

1)1)EMERGENTEMERGENT – – pt. requires immediate pt. requires immediate attention ; disorder attention ; disorder maybe life- maybe life- threateningthreatening..

> indications for surgery : > indications for surgery : without without delay.delay.

> examples : Severe bleeding, > examples : Severe bleeding, extensive burns, bladder or intestinal extensive burns, bladder or intestinal obstruction, fractured skull, gunshot obstruction, fractured skull, gunshot or stab wounds.or stab wounds.

CLASSIFICATIONSCLASSIFICATIONS OF SURGERY OF SURGERY

2)2) URGENTURGENT – – pt. requires prompt pt. requires prompt attention.attention.

> indications for surgery : > indications for surgery : within 24-30 hours.within 24-30 hours.

> examples : Acute gallbladder > examples : Acute gallbladder infectioninfection

Kidney / Ureteral Kidney / Ureteral stones stones


3)3) REQUIREDREQUIRED – pt. needs to have – pt. needs to have surgery. surgery.

> indications for surgery: plan > indications for surgery: plan within few weeks or months.within few weeks or months.

> examples : Prostatic > examples : Prostatic hyperplasia without bladder hyperplasia without bladder obstruction, Thyroid disorders, obstruction, Thyroid disorders, Cataracts.Cataracts.


4)4) ELECTIVEELECTIVE – pt should have – pt should have surgery.surgery.

> indications for surgery: > indications for surgery: Failure to have surgery not Failure to have surgery not catastrophic.catastrophic.

> examples : Repair of scars> examples : Repair of scars

Simple herniaSimple hernia

Vaginal repairVaginal repair


5)5) OPTIONAL OPTIONAL – decision rests with – decision rests with pt.pt.

> indications for surgery : > indications for surgery : Personal preferencePersonal preference

> examples : Cosmetic surgery> examples : Cosmetic surgery


Accdg. To Degree Of Risk Accdg. To Degree Of Risk :: MAJORMAJOR – high degree of risk – high degree of risk : :

>maybe complicated / prolonged, >maybe complicated / prolonged, large losses of blood may occur, vital large losses of blood may occur, vital organs maybe involved, post-op organs maybe involved, post-op complications may be likely.complications may be likely.

>ex. Organ transplant>ex. Organ transplant

Open heart surgery Open heart surgery

Removal of a kidneyRemoval of a kidney


MINOR MINOR – little risk with few – little risk with few complications.complications.

- often performed in a - often performed in a “day surgery”.“day surgery”.

> examples: Breast biopsy> examples: Breast biopsy

TonsillectomyTonsillectomy

Knee surgeryKnee surgery


Accdg. To Purpose Accdg. To Purpose ::

1.1. DIAGNOSTICDIAGNOSTIC – verifies suspected – verifies suspected diagnosisdiagnosis

- ex. Biopsy- ex. Biopsy

2.2. EXPLORATORYEXPLORATORY – estimates the extent of – estimates the extent of the disease or injury. the disease or injury.

- Ex. Explore laparotomy- Ex. Explore laparotomy

3.3. CURATIVE CURATIVE – removes or repairs damaged – removes or repairs damaged tissues .tissues .


4.4. ABLATIVE ABLATIVE – removing diseased organ – removing diseased organ that can’t wait anymore.that can’t wait anymore.

- emergency surgery.- emergency surgery.

5.5. PALLIATIVEPALLIATIVE – relieves symptoms but – relieves symptoms but does not cure the underlying disease does not cure the underlying disease process.process.

6.6. RECONSTRUCTIVE RECONSTRUCTIVE – partial or complete – partial or complete restoration of a damaged organ/tissue to restoration of a damaged organ/tissue to bring back the original appearance & bring back the original appearance & function.(mammoplasty, face-lift)function.(mammoplasty, face-lift)

7.7. CONSTRUCTIVE CONSTRUCTIVE – repairing the – repairing the damaged tissue or congenitally damaged tissue or congenitally defective organ. (multiple wound defective organ. (multiple wound repair)repair)

Accdg. To Location Accdg. To Location ::

1.1. INTERNALINTERNAL – inside the body . – inside the body .

Ex. HysterectomyEx. Hysterectomy

2.2. EXTERNAL EXTERNAL – outside the body .– outside the body .

Ex. Skin graftingEx. Skin grafting

FOUR BASIC PATHOLOGIC FOUR BASIC PATHOLOGIC CONDITIONS THAT REQUIRE CONDITIONS THAT REQUIRE SURGERYSURGERY::

1)1)OBSTRUCTION OBSTRUCTION – a blockage ; are – a blockage ; are dangerous because they block dangerous because they block the flow of blood, air, CSF, urine the flow of blood, air, CSF, urine & bile through the body.& bile through the body.

2)2)PERFORATION PERFORATION – is a rupture of – is a rupture of the organ, artery or bleb.the organ, artery or bleb.

3)3) EROSIONEROSION – break in the – break in the continuity of tissue surface. It can continuity of tissue surface. It can be caused by irritation, infection, be caused by irritation, infection, ulceration or inflammation. It can ulceration or inflammation. It can damage the walls of blood vessels damage the walls of blood vessels resulting in serious bleeding.resulting in serious bleeding.

4)4) TUMORSTUMORS – abnormal growth of – abnormal growth of tissue that serves no physiologic tissue that serves no physiologic function in the body.function in the body.

THE SURGICAL RISK THE SURGICAL RISK PATIENTSPATIENTS

Extremes of age ( very young & very old )Extremes of age ( very young & very old ) Extremes of weight (emaciation, obesity)Extremes of weight (emaciation, obesity) Dehydrated pts.Dehydrated pts. Nutritional deficitsNutritional deficits Pts. with severe trauma or injury, Pts. with severe trauma or injury,

infection/sepsisinfection/sepsis Pts. with cardiovascular diseasePts. with cardiovascular disease Endocrine dysfunction (diabetes mellitus) Endocrine dysfunction (diabetes mellitus)

Hypertensive & hypotensive pts.Hypertensive & hypotensive pts. HypovolemiaHypovolemia Hepatic diseaseHepatic disease Preexisting mental or physical Preexisting mental or physical

disability disability

PROBLEMS THAT MAY ARISE IN PROBLEMS THAT MAY ARISE IN SURGERY:SURGERY:

1.1. Surgical risk pts – probability of Surgical risk pts – probability of morbidity or mortality following morbidity or mortality following surgery.surgery.

2.2. PainPain

3.3. HemorrhageHemorrhage

4.4. InfectionInfection

5.5. UTIUTI

PHASES OF O.R. NURSING :PHASES OF O.R. NURSING :

I.I. PREOPERATIVE PHASEPREOPERATIVE PHASE The rendering of nursing care to The rendering of nursing care to

the surgical client as soon as he the surgical client as soon as he is admitted & the decision to is admitted & the decision to undergo surgery is made.undergo surgery is made.

It ends on the time the client is It ends on the time the client is transferred to the O.R. transferred to the O.R.

NURSING ACTIVITIES NURSING ACTIVITIES :: Assessment of the client (baseline Assessment of the client (baseline

evaluation of the pt. before the day of evaluation of the pt. before the day of surgery-interview)surgery-interview)

Identification of potential/actual health Identification of potential/actual health problems.problems.

PREADMISSION TESTING- ensure PREADMISSION TESTING- ensure necessary tests have been performednecessary tests have been performed

Pre-op teaching involving client & support Pre-op teaching involving client & support persons.persons.

Day of surgery : Day of surgery : pt. teaching reviewedpt. teaching reviewed informed consent confirmedinformed consent confirmed pt.’s identity & surgical site verifiedpt.’s identity & surgical site verified IVF started.IVF started.

PREPARATION FOR PREPARATION FOR SURGERYSURGERY

Psychological Support :Psychological Support :

a)a)Assess client’s fears, anxieties, Assess client’s fears, anxieties, support systems & patterns of support systems & patterns of coping.coping.

b)b)Establish trusting relationship Establish trusting relationship with client & significant others.with client & significant others.

c)c)Explain routine procedures, Explain routine procedures, encourage verbalization of fears & encourage verbalization of fears & allow client to ask questions.allow client to ask questions.

d)d) Demonstrate confidence in Demonstrate confidence in surgeon & staff.surgeon & staff.

e)e) Provide for spiritual care if Provide for spiritual care if appropriate.appropriate.

PREOPERATIVE PREOPERATIVE TEACHINGTEACHING

Frequently done on an outpatient Frequently done on an outpatient basis.basis.

Assess client’s level of understanding Assess client’s level of understanding of surgical procedure & its of surgical procedure & its implications.implications.

Answer questions, clarify & reinforce Answer questions, clarify & reinforce explanations given by the surgeon.explanations given by the surgeon.

Explain routine pre- & post-op Explain routine pre- & post-op procedures & any special equipment procedures & any special equipment to be used.to be used.

PREOPERATIVE PREOPERATIVE TEACHINGTEACHING Preoperative experiencePreoperative experience

Preoperative medication Preoperative medication Breathing exercises, coughing, incentive Breathing exercises, coughing, incentive

spirometerspirometer Leg exercises Leg exercises Position changes and movementPosition changes and movement Pain managementPain management Reducing anxiety and fear, support of copingReducing anxiety and fear, support of coping Special considerations related to outpatient Special considerations related to outpatient

surgerysurgery

Diaphragmatic Breathing Diaphragmatic Breathing and Splinting When and Splinting When

CoughingCoughing

Leg Exercises and Foot Leg Exercises and Foot ExercisesExercises

Preoperative Nursing Preoperative Nursing InterventionsInterventions

PHYSICAL PREPARATIONS:PHYSICAL PREPARATIONS: Patient safety is a primary concern.Patient safety is a primary concern. Obtain history of past medical conditions, Obtain history of past medical conditions,

surgical procedures, dietary restrictions surgical procedures, dietary restrictions & medications.& medications.

Perform baseline head-to-toe assessment, Perform baseline head-to-toe assessment, including VS, height & weight.including VS, height & weight.

Ensure that diagnostic procedures Ensure that diagnostic procedures pertinent to surgery are performed as pertinent to surgery are performed as orderedordered::

1.1. CBCCBC

2.2. ElectrolytesElectrolytes

3.3. PT/PTT (Prothrombin PT/PTT (Prothrombin Time;Partial thromboplastin Time;Partial thromboplastin time)time)

4.4. UrinalysisUrinalysis

5.5. ECGECG

6.6. Blood typing & crossmatchBlood typing & crossmatch

NPO- to prevent aspirationNPO- to prevent aspiration Bowel prep and skin prepBowel prep and skin prep

- cleansing enema or laxative - cleansing enema or laxative before surgery to allow before surgery to allow satisfactory visualization of the satisfactory visualization of the surgical site.surgical site.

- goal of pre-op skin prep is to - goal of pre-op skin prep is to decrease bacteria without injuring decrease bacteria without injuring the skin. the skin.

Immediate preoperative preparation Immediate preoperative preparation Complete checklist and chartComplete checklist and chart Hospital gown, voiding, removal of Hospital gown, voiding, removal of

dentures, jewelry, contacts, etc. dentures, jewelry, contacts, etc. Preoperative medicationPreoperative medication

Transporting the pt. to the Transporting the pt. to the Presurgical area about 30 to 60 Presurgical area about 30 to 60 minutes before anesthetics is to be minutes before anesthetics is to be given.given.

Attend to family needsAttend to family needs

LEGAL PREPARATION:LEGAL PREPARATION: Surgeon Surgeon obtains operative permit obtains operative permit

(informed consent)(informed consent)

1.1. Surgical procedures, alternatives , Surgical procedures, alternatives , possible complications & possible complications & disfigurements or removal of body disfigurements or removal of body parts are explained.parts are explained.

2.2. It is part of the nurse’s role as client It is part of the nurse’s role as client advocate to confirm that the client advocate to confirm that the client understands information given.understands information given.

INFORMED CONSENT INFORMED CONSENT is necessary in is necessary in the ff. Circumstances: the ff. Circumstances:

Invasive procedures, such as surgical Invasive procedures, such as surgical incisions, biopsy, cystoscopy or incisions, biopsy, cystoscopy or paracentesis.paracentesis.

Procedures requiring sedation or Procedures requiring sedation or anesthesiaanesthesia

A non-surgical procedure, such as A non-surgical procedure, such as arteriographyarteriography

Procedures involving radiationProcedures involving radiation

Adult client Adult client (over 18 y/o) signs own (over 18 y/o) signs own permit unless unconcious or permit unless unconcious or mentally incompetent.mentally incompetent.

1.1. If unable to sign, If unable to sign, relativerelative (spouse or (spouse or next of kin) or next of kin) or guardianguardian will sign. will sign.

2.2. In an emergency, permission via In an emergency, permission via telephone or telegram is acceptable; telephone or telegram is acceptable; have a 2have a 2ndnd listener on phone when listener on phone when telephone permission is giventelephone permission is given

3.3. Consents Consents are not needed are not needed for for emergency emergency care if all 4 of the ff. care if all 4 of the ff. criteria are met:criteria are met:

a.a. There is an immediate threat to life.There is an immediate threat to life.

b.b. Experts agree that it is an Experts agree that it is an emergency.emergency.

c.c. Client is unable to consent.Client is unable to consent.

d.d. A legally authorized person cannot A legally authorized person cannot be reached.be reached.

Minors (under 18 y/oMinors (under 18 y/o) must have ) must have consent signed by an adult (i.e. consent signed by an adult (i.e. Parent or legal guardian)Parent or legal guardian)

Emancipated minor Emancipated minor (married or (married or independently earning his or her independently earning his or her own living)may sign his/ her own own living)may sign his/ her own consent.consent.

Witness to informed consent may Witness to informed consent may be a nurse, another M.D., clerk be a nurse, another M.D., clerk or any other authorized person.or any other authorized person.

The nurse witnessing informed The nurse witnessing informed consent, specifies whether consent, specifies whether witnessing explanation of witnessing explanation of surgery or just signature of the surgery or just signature of the client.client.

PREOPERATIVE PREOPERATIVE MEDICATIONSMEDICATIONS

PURPOSES:PURPOSES:

1.1. To relieve fear & anxiety.To relieve fear & anxiety.

2.2. To reduce dose needed for To reduce dose needed for induction & maintenance of induction & maintenance of anesthesia.anesthesia.

3.3. To prevent reflex bradycardia that To prevent reflex bradycardia that happens during induction of happens during induction of anesthesia.anesthesia.

4.4. To minimize oral secretions.To minimize oral secretions.

PREOPERATIVE PREOPERATIVE MEDICATIONSMEDICATIONS

II.II. INTRAOPERATIVE PHASEINTRAOPERATIVE PHASE Giving nursing care to client Giving nursing care to client

undergoing surgery.undergoing surgery. It starts from the time the pt. It starts from the time the pt.

was admitted to the O.R. , was admitted to the O.R. , during operation until it ends & during operation until it ends & transferred to the PACU.transferred to the PACU.

NURSING ACTIVITIESNURSING ACTIVITIES:: Activities providing for pt’s safety.Activities providing for pt’s safety. Maintenance of aseptic environment.Maintenance of aseptic environment. Ensuring proper function of equipments.Ensuring proper function of equipments. Providing surgeons with specific Providing surgeons with specific

instruments & supplies for surgical field.instruments & supplies for surgical field. Completing documentation.Completing documentation. Positioning pts.Positioning pts. Acting as scrub/circulating nurse.Acting as scrub/circulating nurse.

Members of the Surgical Members of the Surgical TeamTeam

PatientPatient AnesthesiologisAnesthesiologis

t or anesthetistt or anesthetist SurgeonSurgeon Nurses (Scrub Nurses (Scrub

& Circulating)& Circulating) Surgical Surgical

technologiststechnologists

SCRUB TEAM @ WORKSCRUB TEAM @ WORK

PATIENTPATIENT – the most important member of – the most important member of the surgical team. May feel relaxed & the surgical team. May feel relaxed & prepared, or fearful & highly stressed.prepared, or fearful & highly stressed.

- is also subject to several risks.- is also subject to several risks. OPERATING SURGEON OPERATING SURGEON – pre-op dx & care.– pre-op dx & care.

- performance of operation.- performance of operation.

- post-op mgt & care - post-op mgt & care

- assumes all responsibility for all medical - assumes all responsibility for all medical acts of judgement & mgt.acts of judgement & mgt.

SURGEON & ASSISTANTS SURGEON & ASSISTANTS – scrub & – scrub & perform the surgery.perform the surgery.

REGISTERED NURSE 1REGISTERED NURSE 1STST ASST ASST. – . – practices under the direct supervision practices under the direct supervision of the surgeon. (handling tissue, of the surgeon. (handling tissue, suturing, maintaining hemostasis)suturing, maintaining hemostasis)

ANESTHESIOLOGIST / ANESTHESIOLOGIST / NURSE ANESTHETIST NURSE ANESTHETIST – administers the – administers the

anesthetic agent & monitors the pt’s anesthetic agent & monitors the pt’s physical status throughout the surgeryphysical status throughout the surgery..

SCRUB NURSE SCRUB NURSE – provides sterile – provides sterile instruments & supplies to the surgeon instruments & supplies to the surgeon during the procedure.during the procedure.

- performs surgical hand - performs surgical hand scrub.scrub.

CIRCULATING NURSE CIRCULATING NURSE – coordinates the – coordinates the care of the pt. in the O.R.care of the pt. in the O.R.

- care provided includes assisting with - care provided includes assisting with pt. positioning , skin prep, managing pt. positioning , skin prep, managing surgical specimens & documenting surgical specimens & documenting intraoperative eventsintraoperative events. .

SCRUB NURSESCRUB NURSE

CIRCULATINGCIRCULATING NURSENURSE

:O) anesthesiologist.Assistant surgeon

surgeon

Prevention of InfectionPrevention of Infection

The surgical environment The surgical environment – stark – stark appearance & cool temperature. appearance & cool temperature. Located central to all supporting Located central to all supporting services. services. Unrestricted zone Unrestricted zone – where street – where street

clothes are allowed.clothes are allowed. Semirestricted zone- Semirestricted zone- where attire where attire

consists of scrub clothes & caps.consists of scrub clothes & caps. Restricted zone- Restricted zone- where scrub clothes, where scrub clothes,

shoe covers, caps & masks are worn.shoe covers, caps & masks are worn.

THE OPERATING ROOMTHE OPERATING ROOM

Basic Guidelines for Basic Guidelines for Surgical AsepsisSurgical Asepsis

All materials in contact with the wound and All materials in contact with the wound and within the sterile field must be sterile.within the sterile field must be sterile.

Gowns are sterile in the front from chest to Gowns are sterile in the front from chest to the level of the sterile field, and sleeves the level of the sterile field, and sleeves from 2 inches above the elbow to the cuff.from 2 inches above the elbow to the cuff.

Only the top of a draped table is considered Only the top of a draped table is considered sterile. During draping, the drape is held sterile. During draping, the drape is held well above the area and is placed from well above the area and is placed from front to back.front to back.


Items are dispensed by methods to Items are dispensed by methods to preserve sterility.preserve sterility.

Movements of the surgical team are Movements of the surgical team are from sterile to sterile and from from sterile to sterile and from unsterile to sterile only. unsterile to sterile only.

Movement around the sterile field Movement around the sterile field must not cause contamination of the must not cause contamination of the field. At least a 1-foot distance from field. At least a 1-foot distance from the sterile field must be maintained.the sterile field must be maintained.


Whenever a sterile barrier is Whenever a sterile barrier is breached, the area is considered breached, the area is considered contaminated.contaminated.

Every sterile field is constantly Every sterile field is constantly maintained and monitored. Items of maintained and monitored. Items of doubtful sterility are considered doubtful sterility are considered unsterile.unsterile.

Sterile fields are prepared as close Sterile fields are prepared as close as possible to time of use.as possible to time of use.

SURGICAL ASEPTIC SURGICAL ASEPTIC TECHNIQUE TECHNIQUE

BEFORE AN OPERATIONBEFORE AN OPERATION, it is , it is necessary to sterilize and keep sterile necessary to sterilize and keep sterile all instruments, materials, and supplies all instruments, materials, and supplies that come in contact with the surgical that come in contact with the surgical sitesite. . Every item handled by the surgeon Every item handled by the surgeon and the surgeon's assistants must be and the surgeon's assistants must be sterilesterile. . The patient's skin and the The patient's skin and the hands of the members of the surgical hands of the members of the surgical team must be team must be thoroughly scrubbed, thoroughly scrubbed, prepared, and kept as aseptic as prepared, and kept as aseptic as possible. possible.

DURING THE OPERATIONDURING THE OPERATION, the surgeon, , the surgeon, surgeon's assistants, and the scrub nurses surgeon's assistants, and the scrub nurses must wear sterile gowns and gloves and must wear sterile gowns and gloves and must not touch anything that is not sterile.must not touch anything that is not sterile.

Maintaining sterile technique is a Maintaining sterile technique is a cooperative responsibilitycooperative responsibility of the entire of the entire surgical team.surgical team.

Each member must develop Each member must develop a surgical a surgical conscience, conscience, a willingness to supervise and a willingness to supervise and be supervised by others regarding the be supervised by others regarding the adherence to standards. adherence to standards.

BASIC PRINCIPLES OF BASIC PRINCIPLES OF SURGICAL ASEPSISSURGICAL ASEPSIS

All personnel assigned to the All personnel assigned to the operating room must practice good operating room must practice good personal hygiene. This includes personal hygiene. This includes daily bathing and clothing change.daily bathing and clothing change.

Those personnel having colds, sore Those personnel having colds, sore throats, open sores, and/or other throats, open sores, and/or other infections should not be permitted infections should not be permitted in the operating room. in the operating room.

Operating room attire (which includes Operating room attire (which includes scrub suits, gowns, head coverings, and scrub suits, gowns, head coverings, and face masks) should not be worn outside the face masks) should not be worn outside the operating room suite. If such occurs, operating room suite. If such occurs, change all attire before re-entering the change all attire before re-entering the clean area. (The operating room and clean area. (The operating room and adjacent supporting areas are classified as adjacent supporting areas are classified as "clean areas.") "clean areas.")

All members of the surgical team having All members of the surgical team having direct contact with the surgical site must direct contact with the surgical site must perform the surgical hand scrub before the perform the surgical hand scrub before the operation. operation.

All materials and instruments used in All materials and instruments used in contact with the site must be sterile. contact with the site must be sterile.

· The gowns worn by surgeons and scrub · The gowns worn by surgeons and scrub corpsmen are considered sterile from corpsmen are considered sterile from shoulder to waist (in the front only), shoulder to waist (in the front only), including the gown sleeves. including the gown sleeves.

· If sterile surgical gloves are torn, · If sterile surgical gloves are torn, punctured, or have touched an unsterile punctured, or have touched an unsterile surface or item, they are considered surface or item, they are considered contaminated. contaminated.

The safest, most practical method of The safest, most practical method of sterilization for most articles is steam sterilization for most articles is steam under pressure. under pressure.

· Label all prepared, packaged, and · Label all prepared, packaged, and sterilized items with an expiration date. sterilized items with an expiration date.

· Use articles packaged and sterilized in · Use articles packaged and sterilized in cotton muslin wrappers within 28 cotton muslin wrappers within 28 calendar days.calendar days.

Use articles sterilized in cotton muslin Use articles sterilized in cotton muslin wrappers and sealed in plastic within 180 wrappers and sealed in plastic within 180 calendar dayscalendar days

Unsterile articles must not come Unsterile articles must not come in contact with sterile articles.in contact with sterile articles.

Make sure the patient's skin is Make sure the patient's skin is as clean as possible before a as clean as possible before a surgical procedure. surgical procedure.

Take every precaution to prevent Take every precaution to prevent contamination of sterile areas or contamination of sterile areas or supplies by airborne organisms. supplies by airborne organisms.

HANDLING STERILE HANDLING STERILE ARTICLES ARTICLES

When you are changing a dressing, When you are changing a dressing, removing sutures, or preparing the removing sutures, or preparing the patient for a surgical procedure, it will patient for a surgical procedure, it will be necessary to establish a sterile field be necessary to establish a sterile field from which to work. The field should be from which to work. The field should be established on a stable, clean, flat, dry established on a stable, clean, flat, dry surface. surface.

An article is either sterile or unsterile; An article is either sterile or unsterile; there is no in-between. If there is doubt there is no in-between. If there is doubt about the sterility of an item, consider it about the sterility of an item, consider it unsterileunsterile

Any time the sterility of a field Any time the sterility of a field has been compromised, replace has been compromised, replace the contaminated field and setup. the contaminated field and setup.

Do not open sterile articles until Do not open sterile articles until they are ready for use. they are ready for use.

Do not leave sterile articles Do not leave sterile articles unattended once they are opened unattended once they are opened and placed on a sterile field. and placed on a sterile field.

Do not return sterile articles to a Do not return sterile articles to a container once they have been removed container once they have been removed from the container.from the container.

Never reach over a sterile field.Never reach over a sterile field. When pouring sterile solutions into When pouring sterile solutions into

sterile containers or basins, do not sterile containers or basins, do not touch the sterile container with the touch the sterile container with the solution bottle. Once opened and first solution bottle. Once opened and first poured, use bottles of liquid entirely. If poured, use bottles of liquid entirely. If any liquid is left in the bottle, discard it. any liquid is left in the bottle, discard it.

Never use an outdated article. Never use an outdated article. Unwrap it, inspect it, and, if Unwrap it, inspect it, and, if reusable, rewrap it in a new reusable, rewrap it in a new wrapper for sterilization. wrapper for sterilization.

SURGICAL HAND SCRUB SURGICAL HAND SCRUB

PURPOSE: To reduce resident and PURPOSE: To reduce resident and transient skin flora (bacteria) to a transient skin flora (bacteria) to a minimum.minimum.

Proper hand scrubbing and the Proper hand scrubbing and the wearing of sterile gloves and a wearing of sterile gloves and a sterile gown provide the patient sterile gown provide the patient with the best possible barrier with the best possible barrier against pathogenic bacteria in the against pathogenic bacteria in the environment and against bacteria environment and against bacteria from the surgical team.from the surgical team.

1.1. Before beginning the hand scrub, don a Before beginning the hand scrub, don a surgical cap or hood that covers all hair, both surgical cap or hood that covers all hair, both head and facial, and a disposable mask head and facial, and a disposable mask covering your nose and mouth. covering your nose and mouth.

2.2. Using approximately 6 ml of antiseptic Using approximately 6 ml of antiseptic detergent and running water, lather your detergent and running water, lather your hands and arms to 2 inches above the elbow. hands and arms to 2 inches above the elbow. Leave detergent on your arms and do not Leave detergent on your arms and do not rinse.rinse.

3.3. Under running water, clean your fingernails Under running water, clean your fingernails and cuticles, using a nail cleaner. and cuticles, using a nail cleaner.

4.4. Starting with your fingertips, rinse each Starting with your fingertips, rinse each hand and arm by passing them through the hand and arm by passing them through the running water. Always keep your hands above running water. Always keep your hands above the level of your elbows. the level of your elbows.

5.5. From a sterile container, take a sterile brush From a sterile container, take a sterile brush and dispense approximately 6 ml of antiseptic and dispense approximately 6 ml of antiseptic detergent onto the brush and begin scrubbing detergent onto the brush and begin scrubbing your hands and arms.your hands and arms.

6.6. Begin with the fingertips. Bring your thumb Begin with the fingertips. Bring your thumb and fingertips together and, using the brush, and fingertips together and, using the brush, scrub across the fingertips using 30 strokes. scrub across the fingertips using 30 strokes.

7.7. Now scrub all four surface planes of the Now scrub all four surface planes of the thumb and all surfaces of each finger, thumb and all surfaces of each finger, including the webbed space between the including the webbed space between the fingers, using 20 strokes for each surface fingers, using 20 strokes for each surface area. area.

8.8. Scrub the palm and back of the hand in a Scrub the palm and back of the hand in a circular motion, using 20 strokes each. circular motion, using 20 strokes each.

9.9. Visually divide your forearm into two parts, Visually divide your forearm into two parts, lower and upper. Scrub all surfaces of each lower and upper. Scrub all surfaces of each division 20 strokes each, beginning at the division 20 strokes each, beginning at the wrist and progressing to the elbowwrist and progressing to the elbow

10.10. Scrub the elbow in a circular motion using Scrub the elbow in a circular motion using 20 strokes. 20 strokes.

11.11. Scrub in a circular motion all surfaces to Scrub in a circular motion all surfaces to approximately 2 inches above the elbow. approximately 2 inches above the elbow.

12.12. Do not rinse this arm when you have Do not rinse this arm when you have finished scrubbing. Rinse only the brush. finished scrubbing. Rinse only the brush.

13.13. Pass the rinsed brush to the scrubbed Pass the rinsed brush to the scrubbed hand and begin scrubbing your other hand hand and begin scrubbing your other hand and arm, using the same procedure and arm, using the same procedure outlined aboveoutlined above

14.14. Drop the brush into the sink when you are Drop the brush into the sink when you are finished.finished.

15.15. Rinse both hands and arms, keeping your Rinse both hands and arms, keeping your hands above the level of your elbows, and hands above the level of your elbows, and allow water to drain off the elbows. allow water to drain off the elbows.

16.16. When rinsing, do not touch anything with When rinsing, do not touch anything with your scrubbed hands and arms. your scrubbed hands and arms.

17.17. The total scrub procedure must include all The total scrub procedure must include all anatomical surfaces from the fingertips to anatomical surfaces from the fingertips to approximately 2 inches above the elbow. approximately 2 inches above the elbow.

18.18. Dry your hands with a sterile towel. Dry your hands with a sterile towel. Do not allow the towel to touch Do not allow the towel to touch anything other than your scrubbed anything other than your scrubbed hands and arms. hands and arms.

19.19. Between operations, follow the Between operations, follow the same hand- scrub procedure. same hand- scrub procedure.

Gowning and Gloving Gowning and Gloving GOWNINGGOWNING 1. Dry one hand and arm, starting with the 1. Dry one hand and arm, starting with the

hand and ending at the elbow, with one end of hand and ending at the elbow, with one end of the towel. Dry the other hand and arm with the towel. Dry the other hand and arm with the opposite end of the towel. Drop the towel. the opposite end of the towel. Drop the towel.

2. Pick up the gown in such a manner that 2. Pick up the gown in such a manner that hands touch only the inside surface at the hands touch only the inside surface at the neck and shoulder seams. neck and shoulder seams.

3. Allow the gown to unfold downward in front 3. Allow the gown to unfold downward in front of you. of you.

GLOVINGGLOVING 1. Pick up one glove by the cuff using 1. Pick up one glove by the cuff using

your thumb and index finger. your thumb and index finger. 2. Touching only the cuff, pull the 2. Touching only the cuff, pull the

glove onto one hand and anchor the glove onto one hand and anchor the cuff over your thumb. cuff over your thumb.

3. Slip your gloved fingers under the 3. Slip your gloved fingers under the cuff of the other glove. Pull the glove cuff of the other glove. Pull the glove over your fingers and hand, using a over your fingers and hand, using a stretching side-to-side motion. stretching side-to-side motion.

4. Anchor the cuff on your thumb. 4. Anchor the cuff on your thumb. With your fingers still under the With your fingers still under the cuff, pull the cuff up and away from cuff, pull the cuff up and away from your hand and over the knitted cuff your hand and over the knitted cuff of the gown. of the gown.

5. Repeat the preceding step to 5. Repeat the preceding step to glove your other hand. glove your other hand.

6. The gloving process is complete. 6. The gloving process is complete.

To gown and glove the surgeon, To gown and glove the surgeon, follow these steps: follow these steps: 1. Pick up a gown from the 1. Pick up a gown from the sterile linen pack. Step back sterile linen pack. Step back from the sterile field and let the from the sterile field and let the gown unfold in front of you. Hold gown unfold in front of you. Hold the gown at the shoulder seams the gown at the shoulder seams with the gown sleeves facing you. with the gown sleeves facing you.

2. Offer the gown to the surgeon. Once the 2. Offer the gown to the surgeon. Once the surgeon's arms are in the sleeves, let go of the surgeon's arms are in the sleeves, let go of the gown. Be careful not to touch anything but the gown. Be careful not to touch anything but the sterile gown. The circulator will tie the gown. sterile gown. The circulator will tie the gown.

3. Pick up the right glove. With the thumb of 3. Pick up the right glove. With the thumb of the glove facing the surgeon, place your the glove facing the surgeon, place your fingers and thumbs of both hands in the cuff of fingers and thumbs of both hands in the cuff of the glove and stretch it outward, making a the glove and stretch it outward, making a circle of the cuff. Offer the glove to the circle of the cuff. Offer the glove to the surgeon. Be careful that the surgeon's bare surgeon. Be careful that the surgeon's bare hand does not touch your gloved hands. hand does not touch your gloved hands. (Repeat for left hand)(Repeat for left hand)

TYPES OF ANESTHESIATYPES OF ANESTHESIA

ANESTHESIA - ANESTHESIA - is a state of narcosis, is a state of narcosis, analgesia, relaxation & reflex loss.analgesia, relaxation & reflex loss.

involves the use of medications involves the use of medications that block pain sensations that block pain sensations (analgesia) during surgery and (analgesia) during surgery and other medical procedures. other medical procedures.

Anesthesia also reduces many of Anesthesia also reduces many of your body's normal stress your body's normal stress reactions to surgery.reactions to surgery.

TYPES OF ANESTHESIATYPES OF ANESTHESIA

I. General AnesthesiaI. General Anesthesia II. Local AnesthesiaII. Local Anesthesia III. Regional AnesthesiaIII. Regional Anesthesia IV. Moderate SedationIV. Moderate Sedation V. Monitored Anesthesia Care V. Monitored Anesthesia Care

GENERAL ANESTHESIAGENERAL ANESTHESIA

I. GENERAL ANESTHESIA - I. GENERAL ANESTHESIA - affects your entire body and affects your entire body and renders you unconscious. renders you unconscious.

The patient would be completely The patient would be completely unaware and not feel pain during unaware and not feel pain during the surgery or procedure.the surgery or procedure.

Also causes forgetfulness Also causes forgetfulness (amnesia) and relaxation of the (amnesia) and relaxation of the muscles throughout your body.muscles throughout your body.

Suppresses many of your body’s normal Suppresses many of your body’s normal automatic functions, such as those that automatic functions, such as those that control breathing, heartbeat, control breathing, heartbeat, circulation of the blood (such as circulation of the blood (such as blood pressure), movements of the blood pressure), movements of the digestive system, and throat reflexes digestive system, and throat reflexes such as swallowing, coughing, or such as swallowing, coughing, or gagging gagging that prevent foreign material that prevent foreign material from being inhaled into your lungs from being inhaled into your lungs (aspiration)(aspiration)

Monitoring of the heart, breathing, Monitoring of the heart, breathing, blood pressure, and other vital blood pressure, and other vital functions is important. An functions is important. An endotracheal (ET) tube endotracheal (ET) tube or a or a laryngeal mask airway is usually laryngeal mask airway is usually used to give an inhalant anesthetic used to give an inhalant anesthetic and oxygen, control and assist and oxygen, control and assist breathing. An ET tube is used to breathing. An ET tube is used to prevent aspiration.prevent aspiration.

General anesthesia is commonly General anesthesia is commonly begun (induced) with intravenous begun (induced) with intravenous (IV) anesthetics, but inhalation (IV) anesthetics, but inhalation agents also may be used. Once you agents also may be used. Once you are unconscious, anesthesia may be are unconscious, anesthesia may be maintained with an inhalant maintained with an inhalant anesthetic alone, with a anesthetic alone, with a combination of intravenous combination of intravenous anesthetics, or a combination of the anesthetics, or a combination of the two.two.

STAGES OF GENERAL STAGES OF GENERAL ANESTHESIAANESTHESIA

STAGE I – STAGE I – BEGINNING ANESTHESIABEGINNING ANESTHESIA Warmth, dizziness , & feeling of Warmth, dizziness , & feeling of

detachment.detachment. Ringing, roaring or buzzing in the ears.Ringing, roaring or buzzing in the ears. Still conscious but may sense inability to Still conscious but may sense inability to

move the extremities easily.move the extremities easily. Noises are exaggerated – even low voices Noises are exaggerated – even low voices

or minor sounds seem loud & unreal.or minor sounds seem loud & unreal. Unnecessary noises & motions should be Unnecessary noises & motions should be

avoided.avoided.

STAGE II – STAGE II – EXCITEMENTEXCITEMENT Struggling, shouting ,talking, Struggling, shouting ,talking,

singing, laughing or crying – singing, laughing or crying – (avoided if given smoothly & quickly)(avoided if given smoothly & quickly)

Pupils dilate ( but contract if Pupils dilate ( but contract if exposed to light)exposed to light)

PR rapid & RR irregular.PR rapid & RR irregular. Restraining the patient may be Restraining the patient may be

possiblepossible..

STAGE III – STAGE III – SURGICAL ANESTHESIASURGICAL ANESTHESIA Reached by continuous Reached by continuous

administration of anesthetic vapor administration of anesthetic vapor or gas.or gas.

Pt. is unconscious & lies quietly.Pt. is unconscious & lies quietly. Pupils are small but contract when Pupils are small but contract when

exposed to lightexposed to light RR regular, PR & volume WNL, skin RR regular, PR & volume WNL, skin

pink/flushedpink/flushed

STAGE IV STAGE IV – MEDULLARY DEPRESSION– MEDULLARY DEPRESSION Reached when too much anesthesia Reached when too much anesthesia

has been administered.has been administered. Respirations shallow, pulse weak & Respirations shallow, pulse weak &

thready .thready . Pupils widely dilated & no longer Pupils widely dilated & no longer

contract when exposed to light.contract when exposed to light. CYANOSIS develops & w/o prompt CYANOSIS develops & w/o prompt

intervention intervention DEATH DEATH

Anesthetic is discontinued Anesthetic is discontinued immediately.immediately.

Circulatory support initiated.Circulatory support initiated.

REGIONAL ANESTHESIAREGIONAL ANESTHESIA

REGIONAL ANESTHESIA REGIONAL ANESTHESIA involves involves injection of a local anesthetic injection of a local anesthetic (numbing agent) around major nerves (numbing agent) around major nerves or the spinal cord to block pain from a or the spinal cord to block pain from a larger but still limited part of the larger but still limited part of the body. body. TYPES :TYPES :

1. EPIDURAL1. EPIDURAL 2. SPINAL2. SPINAL 3. LOCAL CONDUCTION BLOCKS3. LOCAL CONDUCTION BLOCKS

EPIDURAL ANESTHESIAEPIDURAL ANESTHESIA commonly used conduction blockcommonly used conduction block Injecting a local anesthetic into the Injecting a local anesthetic into the

epidural space that surrounds the dura epidural space that surrounds the dura matter of the SC.matter of the SC.

Blocks sensory, motor & autonomic Blocks sensory, motor & autonomic functions.functions.

Doses are much higher than spinal Doses are much higher than spinal because epidural anesthetic does not because epidural anesthetic does not make direct contact w/ the SC or nerve make direct contact w/ the SC or nerve roots.roots.

ADVANTAGE: absence of headacheADVANTAGE: absence of headache DISADVANTAGE: greater technical DISADVANTAGE: greater technical

challenge of introducing the challenge of introducing the anesthesia in the epidural space.anesthesia in the epidural space.

If (+) accidental puncture of the dura If (+) accidental puncture of the dura happens & the anesthetic travels happens & the anesthetic travels toward the head toward the head HIGH SPINAL HIGH SPINAL ANESTHESIA ANESTHESIA SEVERE SEVERE HYPOTENSION , RESPIRATORY HYPOTENSION , RESPIRATORY DEPRESSION DEPRESSION ARREST ARREST

SPINAL ANESTHESIA SPINAL ANESTHESIA Local anesthetic is introduced @ the Local anesthetic is introduced @ the

lumbar level between L4 & L5.lumbar level between L4 & L5. Produces anesthesia of lower Produces anesthesia of lower

extremities, perineum & lower extremities, perineum & lower abdomen.abdomen.

Lumbar puncture done Lumbar puncture done knee –chest knee –chest positionposition

As soon as the injection has been made As soon as the injection has been made position pt on his backposition pt on his back

PERIPHERAL NERVE BLOCKSPERIPHERAL NERVE BLOCKS. . A local A local anesthetic is injected near a specific nerve or anesthetic is injected near a specific nerve or group of nerves to block pain from the area of group of nerves to block pain from the area of the body supplied by the nerve. Nerve blocks the body supplied by the nerve. Nerve blocks are most commonly used for procedures on are most commonly used for procedures on the hands, arms, feet, legs, or face. the hands, arms, feet, legs, or face.

Brachial plexus block- armBrachial plexus block- arm Paravertebral anesthesia- chest, abdo wall Paravertebral anesthesia- chest, abdo wall

& ext.& ext. Transacral (Caudal) block- peineum,lower Transacral (Caudal) block- peineum,lower

abdomenabdomen

LOCAL ANESTHESIALOCAL ANESTHESIA LOCAL ANESTHESIA involves injection LOCAL ANESTHESIA involves injection

of a local anesthetic (numbing agent) of a local anesthetic (numbing agent) directly into the surgical area to block directly into the surgical area to block pain sensations. It is used only for pain sensations. It is used only for minor procedures on a limited part of minor procedures on a limited part of the body. You may remain awake, the body. You may remain awake, though you will likely receive medicine though you will likely receive medicine to help you relax or sleep during the to help you relax or sleep during the surgerysurgery

Often administered in combination Often administered in combination with with Epinephrine.Epinephrine.

ADVANTAGES :ADVANTAGES : Simple, economical, non-explosiveSimple, economical, non-explosive Equipment needed is minimalEquipment needed is minimal Post-op recovery is briefPost-op recovery is brief Undesirable effects of Gen. Undesirable effects of Gen.

Anesthesia are avoided.Anesthesia are avoided. Ideal for short & superficial Ideal for short & superficial

surgical proceduressurgical procedures..

Intraoperative Intraoperative Complications Complications

Nausea and vomitingNausea and vomiting AnaphylaxisAnaphylaxis Hypoxia and respiratory Hypoxia and respiratory

complicationscomplications HypothermiaHypothermia Malignant hyperthermiaMalignant hyperthermia Disseminated intravascular Disseminated intravascular

coagulation (DIC)coagulation (DIC)

Potential Adverse Effects Potential Adverse Effects of Surgery and of Surgery and

AnesthesiaAnesthesia Allergic reactions and drug toxicity or Allergic reactions and drug toxicity or

reactionsreactions Cardiac dysrhythmiasCardiac dysrhythmias CNS changes and oversedation or CNS changes and oversedation or

undersedationundersedation Trauma: laryngeal, oral, nerve, and Trauma: laryngeal, oral, nerve, and

skin, including burnsskin, including burns HypotensionHypotension ThrombosisThrombosis

Gerontologic Gerontologic ConsiderationsConsiderations

Elderly patients are at increased risk for Elderly patients are at increased risk for complications due to surgery and complications due to surgery and anesthesia because of:anesthesia because of: Increased likelihood of coexisting conditions.Increased likelihood of coexisting conditions. Aging heart and pulmonary systems.Aging heart and pulmonary systems. Decreased homeostatic mechanisms.Decreased homeostatic mechanisms. Changes in responses to drugs and Changes in responses to drugs and

anesthetic agents due to aging changes such anesthetic agents due to aging changes such as decreased renal function, and changes in as decreased renal function, and changes in body composition of fat and water.body composition of fat and water.

Nursing Goals for the Nursing Goals for the Patient in the Patient in the

Intraoperative PeriodIntraoperative Period Reducing anxietyReducing anxiety Preventing positioning injuriesPreventing positioning injuries Maintaining patient safetyMaintaining patient safety Maintaining the patient's dignityMaintaining the patient's dignity Avoiding complicationsAvoiding complications

Laparotomy Position, Laparotomy Position, Trendelenburg Position, Lithotomy Trendelenburg Position, Lithotomy

Position, and Sidelying Position Position, and Sidelying Position for Kidney Surgeryfor Kidney Surgery

Protecting the Patient Protecting the Patient from Injuryfrom Injury

Patient identification Patient identification Correct informed consent Correct informed consent Verification of records of health Verification of records of health

history and examhistory and exam Results of diagnostic testsResults of diagnostic tests Allergies (include latex allergy)Allergies (include latex allergy) Monitoring and modifying the Monitoring and modifying the

physical environment physical environment

Safety measures such as grounding Safety measures such as grounding of equipment, restraints, and not of equipment, restraints, and not leaving a sedated patientleaving a sedated patient

Verification and accessibility of Verification and accessibility of bloodblood

III.III. POSTOPERATIVE PHASEPOSTOPERATIVE PHASE Begins with the admission of Begins with the admission of

the client to PACU & ends with the client to PACU & ends with discharge of client from discharge of client from hospital or facility providing hospital or facility providing continuity of care.continuity of care.

Post-Anesthesia Care Post-Anesthesia Care UnitUnit

The PACU environmentThe PACU environment Beds and other equipmentBeds and other equipment Three phases: Three phases:

Phase IPhase I Phase IIPhase II Phase IIIPhase III

Nursing Management in Nursing Management in the PACUthe PACU

Provide care for the patient until he/she Provide care for the patient until he/she has recovered from the effects of has recovered from the effects of anesthesia. anesthesia.

Patient has resumption of motor and Patient has resumption of motor and sensory function, is oriented, has stable sensory function, is oriented, has stable VS, and shows no evidence of VS, and shows no evidence of hemorrhage or other complications of hemorrhage or other complications of surgery.surgery.

Frequent skilled assessment of the Frequent skilled assessment of the patient is vitalpatient is vital

Responsibilities of the Responsibilities of the PACU NursePACU Nurse

Review pertinent information and baseline Review pertinent information and baseline assessment upon admission to the unit.assessment upon admission to the unit.

Assessments include airway and Assessments include airway and respirations, cardiovascular function, respirations, cardiovascular function, surgical site, function of the central surgical site, function of the central nervous system; also assess IVs and all nervous system; also assess IVs and all tubes and equipment.tubes and equipment.

Reassess VS and patient status every 15 Reassess VS and patient status every 15 minutes or more frequently as needed.minutes or more frequently as needed.

Provide report and transfer the patient to Provide report and transfer the patient to another unit or discharge the patient to another unit or discharge the patient to home.home.

Outpatient Outpatient Surgery/Direct DischargeSurgery/Direct Discharge Discharge planning and discharge Discharge planning and discharge

assessmentassessment

Provide written andProvide written and verbalverbal instructionsinstructions regarding follow-up care, complications, regarding follow-up care, complications, wound care, activity, medications, and diet.wound care, activity, medications, and diet.

Give prescriptions and phone numbers. Give prescriptions and phone numbers. Discuss actions to take if complications Discuss actions to take if complications occur.occur.

Outpatient Outpatient Surgery/Direct DischargeSurgery/Direct Discharge Give instructions to the patient and Give instructions to the patient and

a responsible adult who will a responsible adult who will accompany the patient.accompany the patient.

Patients are not to drive home or be Patients are not to drive home or be discharged to home alone. Sedation discharged to home alone. Sedation and anesthesia may cloud memory and anesthesia may cloud memory and judgment and affect ability.and judgment and affect ability.

Maintaining a Patent Maintaining a Patent AirwayAirway

A primary consideration: necessary to A primary consideration: necessary to maintain ventilation and oxygenation!maintain ventilation and oxygenation!

Provide supplemental oxygen as indicated.Provide supplemental oxygen as indicated. Assess breathing by placing hand near Assess breathing by placing hand near

face to feel movement of air.face to feel movement of air. Keep head of bed elevated 15-30Keep head of bed elevated 15-30oo unless unless

contraindicated.contraindicated. May require suctioning.May require suctioning. If vomiting occurs, turn patient to the sideIf vomiting occurs, turn patient to the side

Head and Jaw Head and Jaw Positioning to Open Positioning to Open

AirwayAirway

Use of Oral AirwayUse of Oral AirwayNote: Do not remove oral airway until Note: Do not remove oral airway until

evidence of gag reflex returnsevidence of gag reflex returns

medical surgical nursing perioperative nursing by : lowell p. bautista, rn

Documents

living microorganisms

microorganisms aseptic

action of microorganisms

overwhelming infection

focus of infection

pathogenic bacteria

bacterial infection

operative procedures