Operating Room Team

When a patient is about to undergo a surgical procedure direct patient care will be pass
on to the operating room personnel. The operating room (OR) team is responsible for
the well-being of a patient throughout the operation. This team should not only consider
the patient’s privacy but will also promote safety measures for the patient. One way of
promoting safety of patients inside the OR is by preventing infection from the surgical
incision that will be done.

As described, the OR team is similar to that of a symphony orchestra. There are many
members in an orchestra but they work together in unison and harmony to create a
superb outcome.  The operating room (OR) team does the same thing. They coordinate
their work with each other to have a successful operation.

Patients undergoing surgery will be taken care of the operating room team. Safety and
privacy of patients in the OR is safeguarded by the operating room team members.
Personnel inside the OR consist of the operating surgeon, assistants to the surgeon, a
scrub person, an anesthesiologist and a circulating nurse. Each member of the OR
team performs specific function in coordination with one another to create an
atmosphere that best benefit the patient.

The team is divided into two divisions according to the function of its members.

 Sterile OR team: operating surgeon, assistants to the surgeon and scrub

person
 Unsterile OR team: anesthesiologist or nurse anesthetist, circulator and
other OR members that might be needed in operating specialized machine
or devices.
Classification of OR team
There are two types of OR team according to the functions of its members.

 Sterile team members

1. Surgeon
2. Assistants to the surgeon
3. Scrub person (either a registered nurse or surgical technologist)
 Unsterile team members
1. Anesthesiologist
2. Circulator
3. Biomedical technicians, radiology technicians or other staff that might be
needed to set up and operate specialized equipment or devices essential in
monitoring the patient during a surgical operation
Sterile Operating Room Team
The members of the OR sterile team will do the following things:

1. Perform surgical hand washing (arms are included).

2. Don sterile gowns and gloves.
3. Enter the sterile field.
 4. Handles sterile items only.
5. Functions only within a limited area (sterile field).
6. Wear mask.
Operating Surgeon
The surgeon is a licensed physician (MD), osteopath (DO), oral surgeon (DDS or DMD),
or podiatrist (DPM). This professional is especially trained and is qualified by knowledge
and experience for the performance of a surgical operation.

Responsibilities of a surgeon:

1. Preoperative diagnosis and care of the patient

2. Performance of the surgical procedure
3. Postoperative management of care
Assistants to surgeon
During a surgical procedure, the operating surgeon can have one or two assistants to
perform specific tasks under his/her (operating surgeon) direction. The responsibilities
of a surgeon’s assistant:

1. Help maintain the visibility of the surgical site

2. Control bleeding
3. Close wounds
4. Apply dressings
5. Handles tissues
6. Uses instruments
Types of Assistants to Surgeon:

First Assistants could either be:

1. A qualified surgeon or resident in an accredited surgical education program.
The first assistant should be capable of assuming the operating surgeon’s
responsibility in cases of incapacitation or accidents.
2. Registered Nurse and surgical technologists that have a written hospital
policy permitting the action.
 Second Assistant could be a registered nurse or surgical technologist. These
staff should be trained and they mar retract tissues and suction body fluids to
help provide exposure of the surgical site.
Scrub Person
A scrub person could be the following:

 Registered Nurse
 Surgical technologist
 Licensed practical/vocational nurse
The responsibility of a scrub person is to maintain the integrity, safety and efficiency of
the sterile field throughout the surgical procedure.
Unsterile Operating Room Team
The unsterile operating room members are not allowed to enter the sterile field to
prevent contamination. The responsibilities of the members of this team are the
following:

Handle supplies and equipment that are considered unsterile.

Touches unsterile surfaces only.
Keep the sterile team supplied with supplies handled aseptically.
Give direct patient care.
Assist the sterile team member’s need with strict observation of avoiding
contact to the sterile field.
 Handles other requirements arising during the surgical procedure.
Anesthesiologist or Anesthetist
Difference between an anesthesiologist and anesthetist

An anesthesiologist is a medical practitioner who is certified by a certain institution while

an anesthetist could either be a qualified and licensed nurse, dentist or a physician who
administers anesthetics. The anesthetist works under the supervision of an
anesthesiologist or a surgeon when administering a drug or gas.

Responsibilities of an anesthesiologist or anesthetist

1. Choice and application of appropriate agents.

2. Choice and application of suitable techniques of administration.
3. Monitoring of physiologic function.
4. Maintenance of fluid and electrolyte balance.
5. Blood replacement.
6. Helps in minimizing the hazards of shock, fire and electrocution.
7. Use and interpret correctly a wide variety of monitoring devices.
8. Overseeing the positioning and movement of patients.
9. Oversee the post anesthesia care unit (PACU) to provide resuscitative care
until the patient has regained vital functions.
Circulator
A circulator is preferably a registered nurse. However, in some cases a surgical
technologist can perform the role of a circulator with the direct supervision from a
registered nurse.

Responsibilities of a circulator:

1. Monitor and coordinate all activities within the room.

2. Manage the care required for each patient.
3. Provides assistance to any member of the OR team with strict observation to
avoid a break in sterility.
 4. Creates and maintains a safe and comfortable environment for the patient
through the implementation of aseptic technique.

Perioperative nursing describes the wide variety of nursing functions associated with

the patient’s surgical management. Perioperative Nursing is the care of a client or
patient before, during, and after and operation. It is a specialized nursing area wherein
a registered nurse works as a team member of other surgical health care professionals.

Reasons

1. To cure an illness or disease by removing the diseased tissue or organs.

2. To visualize internal structures during diagnosis.
3. To obtain tissue for examination.
4. To prevent disease or injury.
5. To improve appearance.
6. To repair or remove traumatized tissue and structures.
7. To relieve symptoms or pain.
Classifications of Surgical Procedures

There are different classifications of surgical procedures which can be classified as to:
urgency, purpose and risk. These classifications can help identify the risk of degree of
the surgery.
Based on Purpose

 Diagnostic. These kind of surgeries are done to determine cause of

illness and/or make confirm a diagnosis. Examples includes: biopsy,
exploratory laparotomy (explore lap)
 Ablative/Curative. These kind of surgeries are performed to remove a
diseased part or organ. Examples include: gastrectomy (partial or full
removal of stomach), thyroidectomy, and appendectomy.
 Palliative. To relieve symptoms without curing the disease. These include:
colostomy, debridement of necrotic tissue.
 Re-constructive. These includes skin graft, plastic surgery, scar
revisions. These are done to restore function to traumatized or
malfunctioning tissue and to improve self-concept.
 Transplant. To replace organs or structures that are diseased or
malfunctioning.
 Constructive. To restore function in congenital anomalies. Cleft
palate repair (palatoplasty), closure of atrial-septal defect.
 Exploratory. To estimate of the extend of the disease or confirmation of
diagnosis. Examples: Exploratory laparotomy, pelvic laparotomy.
 Aesthetic. To improve of physical features that are within normal range.
Example: breast augmentation.
Based on Urgency

 Elective. These are kind of surgeries wherein they are pre-planned. Delay

of surgery has no ill-effects. These can be scheduled in advanced based
on the client’s choice. Examples:
tonsillectomy, hernia repair, cataract extraction, mammoplasty, face lift,
and cesarean section.
 Urgent. Surgeries that are necessary for the client’s health, usually done
within 24 to 48 hours. Examples: Removal of gall bladder,
amputation, colon resection, coronary artery bypass, surgical removal
of tumor
 Emergent. Surgeries that must be done immediately to preserve client’s
life, body part of body function. Examples: Control of hemorrhage,
perforated ulcer, intestinal obstruction, repair of trauma, tracheostomy
Related Concerns

 Alcohol: acute withdrawal
 Cancer
 Diabetes mellitus/Diabetic ketoacidosis
 Fluid and electrolyte imbalances
 Hemothorax/Pneumothorax
 Metabolic acidosis
 Metabolic alkalosis
 Peritonitis
 Pneumonia, microbial
  Psychosocial aspects of care
 Respiratory acidosis
 Respiratory alkalosis
 Sepsis/Septicemia
 Thrombophlebitis: DVT
 Total nutritional support
Assessment

Data depends on the duration/severity of underlying problem and involvement of other

body systems. Refer to specific plans of care for data and diagnostic studies relevant to
the procedure and additional nursing diagnoses.

CIRCULATION

May report: History of cardiac problems, heart failure (HF), pulmonary


edema, peripheral vascular disease, or vascular stasis (increases risk of
thrombus formation)
 May exhibit: Changes in heart rate (sympathetic stimulation)
EGO INTEGRITY

May report: Feelings of anxiety, fear, anger, apathy


Multiple stress factors, e.g., financial, relationship, lifestyle

May exhibit: Restlessness, increased tension/irritability

Sympathetic stimulation, e.g., changes in heart rate (HR), respiratory rate

ELIMINATION

 May report: History of kidney/bladder conditions; use of diuretics/laxatives

FOOD/FLUID

May report: Pancreatic insufficiency/DM (predisposing


to hypoglycemia/ketoacidosis)
 Use of diuretics
 May exhibit: Malnutrition (including obesity)
 Dry mucous membranes (limited intake/nothing-by-mouth [NPO] period
preoperatively)
RESPIRATION

 May report: Infections, chronic conditions/cough, smoking

 May exhibit: Changes in respiratory rate (sympathetic stimulation)
SAFETY

 May report: Allergies or sensitivities to medications, food, tape, latex, and

solution(s)
  Immune deficiencies (increases risk of systemic infections and delayed
healing)
 Presence of cancer/recent cancer therapy
 Family history of malignant hyperthermia/reaction to anesthesia,
autoimmune diseases
 History of hepatic disease (affects drug detoxification and may alter
coagulation)
 History of blood transfusion(s)/transfusion reaction
 May exhibit: Presence of existing infectious process; fever

TEACHING/LEARNING

May report: Use of medications such as anticoagulants, steroids, antibiotics,

antihypertensives, cardiotonic glycosides, antidysrhythmic, bronchodilators,
diuretics, decongestants, analgesics, anti-inflammatories, anticonvulsants,
or antipsychotics/antianxiety agents, as well as over-the-counter (OTC) medications,
herbal supplements, or alcohol or other drugs of abuse (risk of liver damage affecting
coagulation and choice of anesthesia, as well as potential for postoperative withdrawal)

Diagnostic Studies

 General preoperative requirements may include: Complete blood

count (CBC), prothrombin time (PT)/activated partial thromboplastin time
(aPTT), chest x-ray. Other studies depend on type of operative procedure,
underlying medical conditions, current medications, age, and weight.
These tests may include blood urea nitrogen (BUN), creatinine
(Cr), glucose, arterial blood gases (ABGs), electrolytes; liver function,
thyroid, nutritional studies, electrocardiogram (ECG). Deviations from
normal should be corrected if possible before safe administration
of anesthetic agents.
 CBC: An elevated white blood cell (WBC) count is indicative of
inflammatory process (may be diagnostic, e.g., appendicitis); decreased
WBC count suggests viral processes (requiring evaluation because
immune system may be dysfunctional). Low hemoglobin (Hb)
suggests anemia/blood loss (impairs tissue oxygenation and reduces the
Hb available to bind with inhalation anesthetics); may suggest need for
crossmatch/blood transfusion. An elevated hematocrit (Hct) may
indicate dehydration; decreased Hct suggests fluid overload.
 Electrolytes: Imbalances impair organ function, e.g., decreased
potassium affects cardiac muscle contractility, leading to decreased
cardiac output.
 ABGs: Evaluates current respiratory status, which may be especially
important in smokers, patients with chronic lung diseases.
  Coagulation times: May be prolonged, interfering with
intraoperative/postoperative hemostasis; hypercoagulation increases risk
of thrombosis formation, especially in conjunction with dehydration and
decreased mobility associated with surgery.
 Urinalysis: Presence of WBCs or bacteria indicates infection. Elevated
specific gravity may reflect dehydration.
 Pregnancy test: Positive results affect timing of procedure and choice of
pharmacological agents.
 Chest x-ray: Should be free of infiltrates, pneumonia; used for
identification of masses and COPD.
 ECG: Abnormal findings require attention before administering
anesthetics.
Nursing Priorities

1.Reduce anxiety and emotional trauma.

2.Provide for physical safety.
3.Prevent complications.
4.Alleviate pain.
5.Facilitate recovery process.
6.Provide information about disease process/surgical procedure, prognosis,
and treatment needs.
Discharge Goals

1. Patient dealing realistically with current situation.

2. Injury prevented.
3. Complications prevented/minimized.
4. Pain relieved/controlled.
5. Wound healing/organ function progressing toward normal.
6. Disease process/surgical procedure, prognosis, and therapeutic regimen
understood.
7. Plan in place to meet needs after discharge.
Preoperative Phase

Main Article: Preoperative Phase

The preoperative phase begins when the decision for surgical intervention is made and
ends when the patient is transferred from the operating room.

Responsibilities included during the preoperative phase are:

Pre-admission Testing

 Initiates initial preoperative assessment.

 Initiates teaching appropriate to patients to patients needs.
 Verifies completion of preoperative testing.
  Verifies understanding of surgeon-specific preoperative orders (e.g. bowel
preparation, preoperative shower)
 Assess patient’s need for postoperative transportation and care.
Admission to Surgical Center or Unit

 Completes preoperative assessment.

 Assess for risk for postoperative complications.
 Reports unexpected findings or any deviation from normal.
 Verifies that operative consent has been signed.
 Reinforce previous teaching.
 Explain phase in perioperative period and expectation.
 Develop a plan of care.
In Holding Area

 Assess patient’s status, baseline pain and nutritional status.

 Review chart.
 Identifies patient.
 Verifies surgical site and marks site per institutional policy.
 Establishes intravenous line.
 Administers medication if prescribed.
 Takes measures to ensure patient’s comfort.
 Provides psychological support.
 Communicates patient’s emotional status to other appropriate members of
the health care team.
Intraoperative Phase

Main Article: Intraoperative Phase

The intraoperative phase begins when the patient is admitted or transferred to the
surgery department and ends when he or she is admitted to the recovery area.

Maintenance of Safety

 Maintains aseptic, controlled environment.

 Effectively manages human resources, equipment, and supplies for
individualized patient care.
 Transfer patient to operating room bed or table.
 Position the patient: function alignment, exposure of surgical site.
 Applies grounding device to patient.
 Ensure that the sponge, needle, and instrument counts are correct.
 Completes intraoperative documentation.
Physiologic Monitoring

 Calculates effect on patient of excessive fluid loss or gain.

 Distinguishes normal from abnormal cardiopulmonary data.
  Reports changes in patient’s vital signs.
Postoperative Phase

Main Article: Postoperative Phase

The postoperative phase begins with the admission of the patient to the recovery area
and ends with a follow-up evaluation in the clinical setting or at home.

Some of the responsibilities entailed during postoperative phase are:

Communicates intraoperative information

 Identifies patient by name.

 States type of surgery performed.
 Identifies type of anesthetic used.
 Reports patient’s response to surgical procedure and anesthesia.
 Describes intraoperative factors (e.g., insertion of drains or catheters,
administration of blood, analgesic agents, or other medications during
surgery, occurrence of unexpected events.
 Describes physical limitations.
 Reports patient’s preoperative level of consciousness.
Postoperative Assessment Recovery Area

 Determines patient’s immediate response to surgical intervention.

 Monitor patient’s physiologic status.
 Assess patient’s pain level and administers appropriate pain relief
measures.
 Maintains patient’s safety(airway, circulation, prevention of injury)
 Administer medication, fluid and blood component therapy, if prescribed.
 Assess patient’s readiness for transfer to in-hospital unit or for discharge
home based on institutional policy.
Transfer to Surgical Unit/Ward

 Continues monitoring of patient’s physical and psychological response to

surgical intervention.
 Provides teaching to patient during immediate recovery period.
 Assist patient in recovery and preparation for discharge home.
 Determines patient’s psychological status.
 Assist with discharge planning.
Home or Clinic

 Provides follow-up care during office or clinic visit or by telephone contact.

 Reinforce previous teaching and answer patients and family questions
about surgery and follow-up care.
 Assess patient’s response to surgery and anesthesia and their effects
on body image and function.