Positions during Surgery: Equipment Used for proper positioning:

1. Supine  Straps
 used for hernia repair, mastectomy,  Wrist restraints
bowel resection, coronary artery by  Arm boards
past.  Donuts
2. Trendelenburg  Sandbags or roll
 used for lower abdomen, pelvic  Stirrups
surgeries permits displacement of
intestines into upper abdomen. Gowning and gloving
3. Lithotomy  Methods of gloving
 Expose perineal and rectal areas o Open
vaginal repairs, D and C, rectal o Closed
surgery, APR (abdomino - perineal o Offering
resection)
18% decrease vital lung capacity of Sterile Draping
the lungs  Purpose
4. Prone
 Kinds of lines :
 Used for spinal surgeries, o Towel
laminectomy o Whole or half sheets
5. Lateral o Fenestrated or slit drapes
 Used for kidney, chest, hip surgeries
6. Semisitting Position Instrumentation and sutures
 For surgeries on thyroid and neck
areas.  Instruments are classified according to their
7. Jackkinfe use during surgery, such as :
 Used for proctologic surgeries o Cutting – such as scalpel, knife,
(removal of hemorroids) and some scissors
spinal surgeries o Grasping and holding such as allis,
 12% decrease vital capacity of the tissues forceps
lungs. o Clamping and Occluding – Such as
hemostats
 o Viewing – speculums, retractors,
endoscopic instruments.
o Suturing or stapling – needle holders
and needles; staplers
o Suctioning – Irrigating and aspirating
o Dilating and probing
o Measuring - calipers
o Accessory mallets, one drill,
screwdrivers
o Exposing and retracting – retractors
Types of suture materials
 Absorbable sutures – ex. Chromic, plain,
Vicryl
 Nonabsorbable sutures – ex. Silk, Cotton,
Nylon
Common skin closure suturing methods:
 Plain, Interrupted
 Mattress – continuous
 Subcuticular or Buried
 Single interrupted closure
 Running closure
 Subcuticular
 Horizontal Mattress
 Vertical mattress
Health Hazards Associated With the surgical
Environment
o Faulty equipment
o Improper use of equipment
o Exposure to toxic substances,
infectious waste, cuts needle-
stick injuries and lasers
o Exposure to blood and body
fluids
The Surgical Experience
o During the surgical procedure
o The client will need sedation
o Anesthesia or some combination
of these.
o Anesthesia
 From the greek word
Anesthesis meaning
“negative sensation”
 Procedures
unconsciousness,
analgesia, reflex loss, and
muscle relaxation during
surgery.
General – covers entire body
Local – treats only the location of the plain
Epidural/ Nerve block – covers the affected limbs
Different types of Anesthesia
o General Anesthesia
 Stage I – Onset/ Induction
 Administration of
anesthesia to the
 time of loss of  Loss of lid reflexes
consciousness surgical procedure is
 Nursing Intervention started
 Close operating  Nursing Intervention
room doors and  Assist anesthesia
control traffic in and personnel with
out of room intubation of client
 Position client in position for
securely with safety surgery
belts  Prep the client’s skin
 Maintain minimal in area of operative
discussion in the OR site.
 Stage II – Excitement/  Stage IV – Medullary/
delirium Stage of danger
 Loss of  Characterized by
consciousness to the cardiac/ respiratory
time of loss of lid depression or arrest
reflex characterized due to overdose of
by shouting, anesthesia,
struggling of the resuscitation must
client be done
 Nursing Intervention  Nursing Intervention
 Shield client from  Prepare for and
extra noise and assist in treatment
physical stimuli of cardiovascular
 Protect the client’s and/ or pulmonary
extremities arrest.
 Assist anesthesia  Documentation in
personnel as needed record
 Stay with the client o Regional Anesthesia
 Stage III – Surgical
 o Combined General and Epidural entrance and exist of
Anesthesia agent
o Monitored Anesthesia care with o Combination of IV and
Conscious Sedation Inhalation
General Anesthesia Gas Agent: Nitrous Oxide
o Total loss of consciousness and o Must be given with oxygen
sensation o Require assistance to
o Produce amnesia mechanical ventilation
o Methods of administration o Frequently shiver
 Intravenous o Taken in & excreted via lungs
 Thiopental
Volatile Liquids
sodium(pentothal)
commonly called o Examples: halothane, ethrane,
“sodium penthotal” Isoflurane, Desflurane,
(class: Barbiturate) Sevoflurane
 Diprivan ( Propofol –
Milk of amnesia) Adjuncts to general Anesthesia
o Rapid Acting o Hypnotics (Versed, vallum) also
o Monitor vital used for conscious sedation
signs o Opioid analgesics (Morphine,
o Respiratory Demerol) causes respiratory
depression depression
o Inhalation o Neuromuscular blocking agents
 Mask, Endotracheal tube – causes muscle paralysis
(ETT) or laryngeal (Examples Pavulon,
managed airway (LMA) Succinycholine)
 Inhalation – most
controllable method, lungs Complication of general Anesthesia
act as passageway for
o Minor complications
o Hypotension
o Malignant Hyperthermia – acute,
life- threatening complication of
certain drugs
o Symptoms included:
 Tachycardia
 Continual increase in body
temperature (which can
recur) during the post-
operative period
 Cyanosis
 Hypotension
 Dark color of blood in the
surgical wound
 Arrhythmias
o Treatment
 Immediate discontinuation
of the surgery
 Cooling of the patient
(administration of iced IV
solution)
 Iced nasogastric gavage
 Packing the client in ice
 Dantrolene sodium
( dantrium), Steroids,
diuretics, and 100%
oxygen (To induce
hyperventilation) are
administered
simultaneously