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NURSING
Presented by:
Ms. Monica L. Añonuevo, RN, MAN
Course Objectives
Definition of Terms
Surgery
- branch of medicine concerned with disease or conditions
requiring or amenable to operative or manual procedures
Peri-operative nursing
- total surgical experience that
encompasses pre-operative, intra-
operative, and post-operative phases of
patient care
OR nurse
- duly licensed registered nurse legally
responsible for the nature and quality of
the nursing care patients
Surgical conscience
- awareness which develops from a
knowledge base of the importance of
strict adherence to principles of aseptic
and sterile techniques
Asepsis
- freedom from infection or absence of
microorganism
Sepsis
- general reaction from the action of bacteria
or their products
Disinfection
- process of destroying all pathogenic
microorganisms except spore bearing
ones
Aseptic technique
- methods by which contamination of
microorganism is prevented
Antiseptic
- substance which combat sepsis and
cause bacteriostasis
Anesthesia
Transverse gastrectomy
Rectus Right side – AP, small bowel
resection
Left side – sigmoid colon
resection
Mc Burney AP
CLASSIFICATION of Surgical
Procedures
I. According to Purpose
Psychological Care
Preoperative Teaching
Physical Care
Nurses Responsibility
Psychological
Preparation
Fears related to surgery
General fear
The elderly
- tolerates trauma of surgery poorly.
Nutrition
Anxiety
Deficient knowledge
C. PLANNING AND OUTCOME
IDENTIFICATION
Major goals:
1. Decreased anxiety and increased
knowledge of the surgical experience.
Purposes:
to ensure that the client understands the nature
of the treatment including the potential
complications and disfigurement (explained by
AMD)
to indicate that the client’s decision was made
without pressure
to protect the client against unauthorized
procedure
to protect the surgeon and hospital against legal
action by a client who claims that an authorized
procedure was performed
Circumstances Requiring a
Permit:
I. ANTICHOLIGERNICS
Action:
SIDE EFFECTS:
EXAMPLES:
ATROPINE SULFATE
SCOPOLAMINE
GLYCOPYRROLATE
II. ANTIEMETICS
Action
Side Effects
EXAMPLE:
Droperidol
Promethazine (phenergan)
III. TRANQUILIZERS
Action
S/E
EXAMPLE
- Hypnotics (diazepam)
- Valium (flurazepam)
- Dalmane torazepam,
(ativan)
IV. SEDATIVES
Action
S/E:
EXAMPLE:
Midazolam
Barbiturates
Phenobarbital (Nembutal)
secobarbital (seconal)
V. OPIODS (NARCOTICS)
ACTION
S/E:
EXAMPLE:
Morphine,
Meperidine (Demerol)
THE OPERATING ROOM
OR Furniture & Other
Equipments
OR Table
Instrument table or Back table
Mayo table
Small table
Anesthesia table
Anesthesia machine
Sitting stools and foot stool
IV stands
OR Furniture & Other
Equipments ( cont…)
Transition Zone
1. Semi restricted / semi
sterile area
Operating Room Unit
Semirestricted Area
OR Suite
Surgeon
First Assistant
Scrub nurse
Anesthesiologist
Circulating Nurse
Sterile
Unsterile
The Surgeon
Anesthesiologis
t – makes a
preoperative
assessment to plan the
type of anesthetic to be
administered and to
evaluate the client’s
physical status.
Circulating nurse – managing
the overall nursing care in the
operating room and helping to
maintain a safe, comfortable
environment.
Scrub Nurse
responsible for
scrubbing for
surgery, including
setting up sterile
tables and
equipment and
assisting the
surgeon and
surgical technicians
during the surgical
procedure.
THE INTRAOPERATIVE
PERIOD
a. ASSESSMENT
1. classify the client’s physical status for
anesthesia
Total or partial loss of sensation to
touch or pain, caused by nerve injury
or diseased, or induced intentionally,
especially by the administration of
anesthetic drugs, to provide medical
treatment
Types of Anesthesia
GENERAL ANESTHESIA –
(inhaled or I.V.) refers to drug – induced depression of the
CNS that produces analgesia, amnesia and unconsciousness
(affects whole body)
Stages:
stage I – BEGINNING
from. Anesthetic administration to loss of consciousness
drowsy, dizzy
stage II – EXCITEMENT
from Loss of consciousness to Loss of EYELID REFLEX
Increase in autonomic activity, irregular breathing
Stage III – surgical anesthesia
From Loss of EYELID REFLEX to Loss of
most reflexes, depression of vital
functions
Stage IV – danger
FromFunctions excessively depressed
to Respiratory and circulatory failure
REGIONAL anesthesia
is a form of local anesthesia that suspends sensation and
motion in a body region or part; the client remains
awake.
Types:
a. Local anesthetic – provides loss of sensation, used
primarily for dental, eye and minor surgeries
A. ASSESSMENT
Classify the client’s physical status for anesthesia
Maintenance of fluid
balance
Maintenance of
normothermia
Prevention of infection
Absence of injury
IMPLEMENTATION
PROMOTE MEASURES THAT MAINATAIN
ADEQUATE FLUID AND ELECTROLYTE
BALANCE
Monitor I/O accurately
Assess for dehydration
Assess for circulatory overload (assess
breath sounds, peripheral edema and
jugular vein distention)
Monitor electrolyte values
PROMOTE MEASURES THAT MAINTAIN A
CLIENT’S NORMAL TEMP.
(36.6 – 37.5)
PROMOTE MEASURES THAT DECREASE
RISK OF INFECTION
ENSURE THE CLEINT’S SAFETY IN THE OR
promote measures that ensure tissue
perfusion in the client during surgery
assess the client’s vital signs
assess the client’s respiratory status and
assist with mechanical ventilation
assess the client’s peripheral vascular status
minimum
Types of Surgical
Incisions
2 PHASES OF CARE:
WHO’S RESPONSIBLE ??
ANESTHESIOLOGIST OR
ANESTHETIST
SURGICAL INCISION
PROBLEMS / PATHOLOGY
FLUIDS / PRESENCE OF DRAINS &
TUBES
CLIENT ASSESSMENT
PREVENT HYPOXEMIA
PREVENT HYPERCAPNIA ( EXCESS CO2)
CLIENT VOMITS ……
PHARYNGEAL SUCTIONING
ASSESS:
MENTAL STATUS (THINK HYPOXIA)
VITAL SIGNS
CARDIAC RHYTHM
SKIN PARAMETERS
URINE OUTPUT
AMOUNT OF BLOOD LOSS
HYPOTENSION
INADEQUATE CELLULAR
VENTILATION & INABILITY TO
EXCRETE METABOLIC WASTE
PRODUCTS
SHOCK - CLASSIC SIGNS
PALLOR
COOL, MOIST SKIN
RAPID BREATHING
CYANOSIS (LIPS/ GUMS)
WEAK & THREADY PULSE
↓ PULSE
USUALLY ↓ B/P & CONCENTRATED URINE
TREATMENT
TREATMENTS:
IV FLUIDS
BLOOD
MEDS ( ↑ B/P)
MANAGE PAIN
BODY TEMPERATURE
(NORMOTHERMIA)
VOLUME REPLACEMENT
PRIMARY INTERVENTION
LACTATED RINGERS SOLUTION
OXYGEN
CONTINUOUS CLIENT
ASSESSEMENT
HEMORRHAGE
PULSE RATE ↑
TEMPERATURE ↓
AIR HUNGER (RAPID & DEEP
RESPIRATIONS)
IF HEMORRHAGE CONTINUES….
CARDIAC OUTPUT ↓
KEEP WARM
CHANGE POSITION FREQUENTLY
POSTOPERATIVE CONFUSION
SOMETIMES COMMON
MOVING OUT OF PACU
....WHEN TO TRANSFER
(PARAMETERS)
STABLE VITAL SIGNS
ADEQUATE PULMONARY
FUNCTION…..HOW WILL YOU KNOW?
NEUROLOGICALLY “ADEQUATE”…
HOW WILL YOU KNOW?
ADEQUATE URINE OUTPUT
NAUSEA/ VOMITING & PAIN
CONTROLLED
PULMONARY COMPLICATIONS
ENCOURAGE D – B – C – T exercise
INCENTIVE SPIROMETER?
THE SURGICAL SITE
ASSESS ADEQUATELY
PAIN CONTROL MEASURES
OPIODS
PATEINT-CONTROLLED
ANALGESIC
COMFORT MEASURES
URINARY ELIMINATION
URINARY RETENTION:
Nursing Interventions:
ANESTHESIA/
OPIOIDS / a. assist patient to sit or
ABDOMINAL, PELVIC, stand up (if permissible)
HIP SURGERY (PAIN) b. provide privacy
c. use psychological aid of
VOID WITHIN 6-8 running tap water
HOURS OF SURGERY ( relaxes bladder
(INCLUDE PACU TIME) sphincter spasm)
d. catheterize when all
measures are
unsuccessful
ACTIVITY
PULMONARY EMBOLISM
DEHYDRATION / LOW CARDIAC OUTPUT/
BLOOD POOLING IN EXTREMITIES / BED
REST
WOUND INFECTION
Causes:
a. resection and handling of the bowel during
surgery
b. swallowing of air during recovery from
anesthesia
c. passing gases from the blood stream to bowel
PHASES OF WOUND
HEALING
First Phase – ‘’INFLAMMATORY PHASE’’
blood clot formation with swelling (lasts fr.1 – 4 days).
Activity limitation
Possible complications
two techniques:
- Closed Method
- Open Method
Principles & Practices of
Surgical Asepsis
Principles & Practices of
Surgical Asepsis
S
T
E
R
I
L
E
Principles & Practices of
Surgical Asepsis
Principles & Practices of
Surgical Asepsis
4 Categories of Instruments
Sharps
• Scalpels/ Knife/
Blade holder – for
incising and #7, #3, #4
dissecting (left to right)
Sharps
• Scissors
Kocher Hemostats
Clamping & Occluding
Instruments
Tonsil Hemostat
Retractors
Deaver Retractors
Retractors
Harrington Retractor
Retractors
Malleable Ribbon
Retractors
Richardson Retractors
Retractors
Goulet Retractor
Retractors
• Self-Retaining Retractor
B. DRAPES
Towel, st. Mary’s, lap sheet, eye sheet, thyroid
sheet, breast sheet, kidney sheet
Quarter (head/foot)
Fenestrated
Mayo table drape
ACRONYMS USED
DURING SURGERY
MRM – modified radical mastectomy
ECCE c PCIOL – extra capsular cataract
extraction w/ posterior chamber intraocular lens
TAHUSO – total abdominal hysterectomy w/
unilateral salpingo oophorectomy
ORIF – open reduction internal fixation
LSCS – low segment caesarean section
EGD – esophago gastroduodenoscopy
CSOM – chronic suppurative otitis media
FBE – foreign body extraction
TURP – trans urethral resection of prostate
BKA – below knee amputation
OD – right eye (ocularis dexter)
PHRA – partial hip replacement arthrplasty
PFC – peritoneal fluid cytology
ESS – endoscopic sinus surgery
FNB – fine needle biopsy
FUTURE OPERATING
ROOM
RECOVERY ROOM
WARD
END OF PRESENTATION
THANK YOU