SURGERY
Thursday, 3 November 2022 8:36 am
Surgery
- Treating of diseases by operation and instrumentation
PERIOPERATIVE NURSING
- All dealing with patients undergoing surgery
Three Phases:
1. Pre-operative nursing care: before
2. Intra-operative nursing care: in surgery
3. Post-operative nursing care - after
**Obtain the following prior to the procedure: (*done by the circulating nurse)
• Identify patient using 2 identifiers (wristband, patient's FULL NAME)
• Remove all jewelries and metal accessories.
• Medication (*patient's prescription and maintenance)
• Consent form
• Vital signs
• If patient had followed the NPO order (**6-8 hours before the surgery)
**Upon transferring the patient to the surgical table, drape and restrain them.
**If spinal anesthesia - do not restrain immediately
After restraining, put on:
• ECG Monitor
○ White - right
○ Black - left
○ Red - 5th ICS
• BP cuff
○ Should be opposite to the IV line
○ Avoid placing on the same side where mastectomy is to be performed; and
where patient has AVF
• Pulse oximeter
**After putting on monitor, assist anesthesiologist with the anesthesia. Induct
anesthesia. (**anesthesia will mostly affect the right side)
*Note: during Spinal anesthesia
**= common complication - Hypotension
**Do not lift patient's head after the surgery (due to the lack of CSF; this is to maintain
equilibrium)
Anesthetic Nurse:
• The anesthetic nurse is trained to provide support to the patient and anesthetist
prior to and during the surgical procedure.
• They assist the anesthetist in the administration of anesthetic during surgery, and
tasks include the preparation of equipment, monitoring the patient's condition, and
reaction to instructions from the anesthetist.
• The anesthetic nurse works under direct supervision of the anesthetist. They may
also assume some circulating nurse duties as needed
Common anesthetics:
• General anesthesia:
○ Fentanyl - decreases heart rate
○ Lidocaine 2% - optional; inhibits the patient from feeling propofol because it is
painful
○ Propofol - milky appearance; very painful
○ Succinylcholine/rocuronium - muscle relaxant; fastest muscle relaxant; takes
effect after 10-20 mins; increase body temperature (rocuronium - alt for burn
PTs); before intubation.
○ Atracurium - muscle relaxant; after intubation; lasts for 1 hour
• Spinal anesthesia (lasts for maximum of 4 hrs.)
**Prepare different sizes of endotracheal tubes:
• 6.0
• 6.5
• 7.0
• 7.5
• 8.0
**Prepare laryngoscope for intubation and KY jelly, along with ET guide.
**Prepare suction machine and suction catheter.
**Prepare micropore and leucoplast - will secure ET
*Sevoflorane - medication that will cause amnesia effect; administered through the
vaporizer
Circulating Nurse
• The role of the circulating nurse is to be alert to the needs of the surgical team and
ensure that all surgical supplies are correctly and promptly provided to the
operating theatre.
• They are also responsible for the management and documentation of all supplies
used in the surgical area.
• Other responsibilities include collection of patient specimens, verifying patient
consent forms, preparation of surgical equipment, and ensuring an accurate count
of instrumentation.
**Sponge count:
• Before surgery
• Before closing the peritoneum
• After closing the epidermis
5 Layers of the Abdomen**:
• Epidermis
• Subcutaneous
• Fascia
• Muscle
• Peritoneum
Scrub Nurse
• Scrub nurses, often also an instrument nurse, ensure the equipment in the theatre
is clean and set-up in readiness for use.
• The scrub nurse is responsible for handing equipment or tools to the surgeon upon
request.
• They must be able to respond quickly and efficiently to the doctors requests, often
responding to hand motions from the surgeon, and also be able to assess the
patient's condition and safety.
Post-Surgery Recovery Nurse
• The role of this nurse is to provide patient care immediately post-surgery.
• They are responsible for ensuring the patient’s airway passage remains open,
making and recording results from regular observations of the patient and
responding to changes in the patients condition, as well as taking corrective action
for any post-operative complications, post-operative pain and nausea relief, and
the administration and documentation of all medication ordered by the physician.
Admissions:
• Inpatient
• Outpatient
○ Vital signs (*including weight and pain)
○ Allergies, comorbidities
○ Lab works/results
○ Last meal
○ Gown patient
○ Note time of anesthesia and time procedure ended
○ Medication and maintenance
CLASSIFICATION OF SURGERY:
1. PURPOSE
a. Diagnostic: These kind of surgeries are done to determine cause of illness
and/or make confirm a diagnosis.
i. Examples includes: biopsy, exploratory laparotomy (explorelap)
b. Ablative/Curative: These kind of surgeries are performed to remove a
diseased part or organ.
i. Examples include: gastrectomy (partial or full removal of stomach),
thyroidectomy, and appendectomy.
c. Palliative: To relieve symptoms without curing the disease.
i. These include: colostomy, debridement of necrotic tissue.
d. 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.
e. Transplant: To replace organs or structures that are diseased or
malfunctioning.
f. Constructive: To restore function in congenital anomalies.
i. Cleft palate repair (palatoplasty), closure of atrial-septal defect.
g. Exploratory: To estimate of the extend of the disease or confirmation of
diagnosis.
i. Examples: Exploratory laparotomy, pelvic laparotomy.
h. Aesthetic: To improve of physical features that are within normal range.
i. Example: breast augmentation.
2. URGENCY
a. 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.
i. Examples: tonsillectomy, hernia repair, cataract extraction,
mammoplasty, face lift, and caesarean section.
b. Urgent: Surgeries that are necessary for the client’s health, usually done
within 24 to 48 hours
i. Examples: Removal of gall bladder, amputation, colon resection,
coronary artery bypass, surgical removal of tumor.
c. Emergent: Surgeries that must be done immediately to preserve client’s life,
body part of body function
i. Examples: Control of hemorrhage, perforated ulcer, intestinal
obstruction, repair of trauma, tracheostomy
3. RISK
a. Major - high risk ,extensive. Prolonged large amount of blood loss; vital organ
maybe handled or removed
i. Ex. Cholecystectomy, Nephrectomy
b. Minor – less risk not prolonged, few complication.
i. Ex: Removal of skin lesion, D & C
4. EXTENT
a. Simple (ex. Simple mastectomy, or partial mastectomy)
b. Radical
Common Surgical Suffixes:
• -ectomy: removal of an organ or gland.
○ ex: appendectomy
• -otomy: cutting into an organ or tissue
○ ex: cardiotomy
• -Ostomy: providing an opening (stoma)
○ ex: colostomy
• -plasty: repair, replacement or restoration of a lost part or piece of tissue
○ Ex: blepharoplasty
• -scopy: examination of an organ by viewing
○ ex: bronchoscopy
• -centesis: puncture to aspirate
○ ex: thoracentesis
• -rrhaphy: surgical suturing or repair
○ ex: herniorrhaphy
• -pexy: fixation
○ ex: orchidopexy, orchiopexy
Note: oxygen prolongs the effect of the anesthesia
*Ketamine - for pedia
Blade 10 and 20- skin and subcu
Blade 11 - stab knife
Blade 12
