visibility of all sterile objects
PRINCIPLES OF SURGICAL
ASEPSIS
Moisture causes contamination
 Prevent splashing of liquids in the
sterile fields
 Place wet objects on sterile,
water-impermeable surfaces, such
as sterile basin
Rationale: microorganisms travel
more easily through moist
environment. When sterile
surface becomes moist,
microorganisms
 Never assume that an object is
sterile
 Ensure that it is labeled as sterile
 Always check the integrity of the
packaging
 Always verify the expiration date
on the package
 Whenever in doubt of the sterility
of an object, consider it unsterile
Rationale: commercially prepared
products are labeled as sterile on
their packaging; special indicators
are used to show that objects
have completed their sterilization
process; packages that are torn,
punctured, or moist are
considered unsterile
Rationale: objects that are out of
the line of vision may be
inadvertently contaminated
 Always face the sterile field
 Sterile articles may touch only
sterile articles or surfaces if they
are to maintain their sterility
Rationale: anything considered
unsterile may transfer
microorganisms to the sterile
object it touches
Rationale: Waist level is the limit
of good visual field. Maximum
prevents inadvertent
contamination
Sterile equipment or areas must
be kept above the waist and on
top of the sterile field
 Close doors
 Unfold drapes or wrappers
properly
 Do not sneeze, cough, or talk
excessively over the sterile field
 Do not reach across sterile fields
 Move around a sterile field to
reach for an object, if necessary
Prevent unnecessary traffic and
air currents around the sterile
area
Rationale: microorganisms cannot
be completely excluded from the
air; overreaching across sterile
fields will render sterile objects
unsterile
Rationale: once protective
wrapping have been removed, the
article is being contaminated by
air so, it must be discarded or
sterilized before it is used; liquids
opened during the procedure that
remain in the container are also
considered contaminated.
Open, unused sterile articles are
no longer sterile after the
procedure
Rationale: if a “scrubbed” person
punctures the gloves or is
contaminated by touching an
unsterile object, he or she must
change the contaminated articles;
if a “scrubbed” person leaves the
area of the sterile field, he or she
must go through the procedure of
rescrubbing, gowning, and gloving
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
 A person who is considered sterile SURGEON – Performs the surgical
who becomes contaminated must procedure and heads the surgical
reestablish sterility team

Surgical technique is a team THE SCRUB ROLE

effort  Performs a surgical hand scrub
 A collective and individual “sterile  Setting up the sterile tables
conscience” is the best method of  Prepares sutures, ligatures, and
enhancing sterile technique special equipment
Rationale: staff members must  Assists the surgeon and the
rely on one another to maintain surgical assistants during the
sterile technique; periodic review procedure by anticipating the
of procedures and infection instruments and supplies that will
control surveillance reports be required
enhance everyone’s sterile  As the surgical incision is closed,
technique. the scrub person and the
circulator count all needles,
THE SURGICAL TEAM sponges, and instruments
(basically counts are done before,
during and before closure)
2 GROUPS THAT COMPOSES
 Standards call for all sponges to
THE SURGICAL TEAM
be visible on x-ray and for sponge
STERILE TEAM counts to take place at the
1. Surgeon beginning of surgery and twice at
2. Scrub Nurse/Role the end
3. First Assistant  Tissue specimens obtained during
NON-STERILE TEAM surgery are labeled by the scrub
1. Circulating Nurse/Circulator person and sent to the laboratory
2. Anesthesiologist/Anesthetist by the circulator

FOUR MAJOR TYPES OF

  
PATHOLOGIC
PROCESSES REQUIRING
SURGICAL
INTERVETION (POET)
P – Perforation
Rupture of an organ
O – Obstruction
Impairment to the flow of vital
fluids e.g. blood, urine, csf, bile
Wearing off of a surface or
membrane
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
 E – Erosion  induction of anesthetic agents
Abnormal new growths wherein pain is controlled by
T – Tumors general insensibility
 produces loss of consciousness,
analgesia, interference with
ANESTHESIA undesirable reflexes and muscle
relaxation

DEFINITION OF TERMS 3 METHODS OF ADMINISTRATION

 inhalation
 ANESTHESIA – loss of feeling or
 iv injection
sensation, especially loss of the
 rectal instillation
sensation of pain with loss of
protective reflexes  mask inhalation
 ANESTHESIOLOGIST – a doctor  laryngeal mask
who specializes in the field of  endotracheal administration
anesthesiology
 ANESTHESIOLOGY – branch of INHALATION ANESTHETIC AGENTS
medicine that is concerned with  HALOTHANE (FLOUTHANE)
the administration of medication  reduces myocardial Oxygen
or anesthetic agents to relieve consumption more than it
pain & support physiologic depresses cardiac function
functions during a surgical  induces bronchodilatation
procedure  toxic to liver
 AMNESIA – loss of memory; an  depressant to respiration
indifference to pain  profound uterine relaxant not
 ANALGESIA – lessening of used for obstetric surgery
insensibility to pain
 ANESTHESIA - used to produce ISOFLURANE (FORANE)
unconsciousness, analgesia, reflex  more potent muscle relaxant
loss & muscle relaxation during a  protects heart against
surgical procedure catecholamine-induced
dysrhythmia
TYPES OF ANESTHESIA  less cardiac depression, increased
1. General cardiac output
2. Regional  expensive
 profound respiratory depressant
 reduces respiratory minute
volume

GENERAL INTRAVENOUS ANESTHETIC

AGENTS

CHARINA AUBREY RIODIL / SPCIS-BSN-IV

 KETAMINE HYDROCHLORIDE  local anesthetic agents injected
(KETALAR) into epidural space, outside the
 rapid induction dura mater of the spinal cord
 respirations not depressed unless  can be used for surgeries of the
rapidly administered abdomen & lower extremities
 mild stimulant on cardiovascular  produces blockade of the
system – elevate blood pressure autonomic nerves and
 produces psychologic hypotension
manifestations
 Used for short procedures not NERVE BLOCK ANESTHESIA
requiring skeletal muscle  injecting anesthetic agents at the
relaxation nerve trunk to produce a lack of
 contraindicated to procedures sensation over a specific area,
involving tracheobronchial such as extremity
stimulation
 contraindicated to hypertension, LOCAL NERVE INFILTRATION
increased ICP, and intraocular  injecting lidocaine around a local
procedure nerve to depress nerve sensation
over a limited area of the body
REGIONAL  used when a skin or muscle biopsy
 type of local anesthesia in which is obtained or when a wound is
medication is instilled around the sutured
nerve blocks transmission
impulses in a particular area SURFACE OR TOPICAL
 pain is controlled without loss of  anesthesia is applied to the skin or
consciousness mucous membranes to block
 produces analgesia, relaxation and nerve impulses at that site
reduced reflexes  Objects on the sterile drape are
considered sterile
SPINAL ANESTHESIA  Remain a minimum of 12” away
 injecting a local anesthetic agent from draped tables & sterile fields
into the subarachnoid space
 used for surgical procedures
involving the lower half of the
body
 produces loss of sensation and PERIOPERATIVE
paralysis of the toes, feet, legs
NURSING
and later the abdomen
Definition of Surgery
EPIDURAL ANESTHESIA Surgery is any procedure
performed on the human body that
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
 uses instruments to alter tissue or
organ integrity.
Perioperative Nursing- connotes the
delivery of patient care in the
preoperative, intraoperative, and
postoperative periods of the patients
surgical experience through the
framework of the nursing process.
- The nurse assesses the patient-
collecting,organizing, and
prioritizing patient data;
establishing nursing
diagnosis;identifies desired
patient outcomes;develop and
implements a plan of care; and
evaluates that care in terms of
outcomes achieved by the patient.
PERIOPERATKVE NURSING PHASES
1. Preoperative phase – begins
when the decision to have
surgery is made and ends when
the client is transferred to the
OR table.
2. Intraoperative phase – begins
when the client is transferred to
the OR table and ends when the
client is admitted to the PACU.
3. Postoperative phase - begins
with the admission of the client
to the PACU and ends when the
healing is complete.
TYPES OF SURGERY
 Purpose/reasons -
 Degree of urgency – necessity to
preserve the client’s life, body
part, or body function.
 Degree of risk – involved in
surgical procedure is affected by
the client’s age, general health,
nutritional status, use of
medications, and mental status.
 Extent of surgery – Simple and
radical
TYPES OF SURGERY (PURPOSE)
1. Diagnostic-Allows to confirm or
establishes diagnosis.
2. Corrective- Excision or removal
of diseased body part.
3. Reconstructive-Restore function
or appearance to traumatized or
malfunctioning tissues.
4. Ablative – Removes a diseased
body parts
5. Palliative – Relieves or reduces
pain or symptoms of a disease; it
does not cure
6. Transplant – Replaces
malfunctioning structures
7. Cosmetic- Performed to improve
personal appearance.
TYPES OF SURGERY (URGENCY)
 Emergency- performed
immediately to preserve
function or the life of the client.
 Elective – is performed when
surgical intervention is the
preferred treatment for a
condition that is not imminently
life threatening or to improve
the client’s life.
 Urgent – Necessary for client’
health to prevent additional
problem from developing; not
necessarily an emergency.
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
  Required – has to be performed at
some point; can be pre-scheduled.
TYPES OF SURGERY (DEGREE OF RISK)
 Major – involves a high degree
of risk.
 Minor – normally involves little
risk.
 Age – very young and elder
clients are greater surgical risks
than children and adult.
 General health- surgery is least
risky when the client’s general
health is good.
 Nutritional Status – required for
normal tissue repair.
 Medications – regular use of
certain medications can increase
surgical risk.
 Mental status – disorder that
affect cognitive function
SURGICAL SETTINGS
SURGICAL SUITES
AMBULATORY CARE SETTING
CLINICS
PHYSICIAN OFFICES
COMMUNITY SETTING
HOMES
SURGICAL SETTINGS
Disadvantages
 Less time for rapport
 Less time to assess,
evaluation, teach
Risk of potential
complication post D/C.
Advantages of outpatient:
 Low cost
 Low risk of infection
 Less interruption of routine
 Less than from work
 Less stress
CONSENT
 Nature and intention of the
surgery
 Name and qualifications of the
person performing the surgery.
 Risks, including tissue damage,
disfigurement, or even death
 Chances of success
 Possible alternative measures
 The right of the client to refuse
consent or later withdraw
consent.
ASSESSMENT (NURSING HISTORY)
 Current health status-
 Allergies
 Medications- list all current
medications
 Previous surgeries
 Understanding of the surgical
procedure and anesthesia
 Smoking
 Alcohol and other-altering
substances
 Coping
 Social resources
 Cultural considerations
PHYSICAL ASSESSMENT
 Cardiovascular system
 Respiratory system
 Renal system
 Neurological system
 Musculoskeletal system
 Nutritional status
 Gerontological considerations

PHYSICAL assessment/clinical
manifestations
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
 General survey- gestures and
body movements may reflect
decreased energy or weakness
caused by illness.
 Cardiovascular system-
alterations in cardiac status are
responsible for as many as 30%
of perioperative death.
 Respiratory system- a decline in
ventilatory function, assessed
through breathing pattern and
chest excursion, may indicate a
client’s risk for respiratory
complications.
 Renal system-abnormal renal
function can altered fluid and
electrolyte balance and decrease
the excretion of preoperative
medications and anesthetic
agents.
 Neurologic system- a client’s LOC
will change as a result of general
anesthesia but should return to
the preoperative LOC after
surgery.
 Musculoskeletal system-
Deformities may interfere with
intraoperative and postoperative
positioning. Avoid positioning
over an area where the the skin
shows signs of pressure over
bony prominences.
 Gastrointestinal system-
alteration in function after
surgery may result in decreased
or absent bowel sound and
distention.
 Head and Neck- the condition of
oral mucous membranes reveals
the level of hydration.
GERONTOLOGICAL CONSIDERATIONS
Cardiovascular
Coronary flow decreases
Heart rate decreases
Response to stress decreases
Peripheral vascular decreases
Cardiac output decreases
Cardiac reserve decreases
Respiratory System
 Static lung volumes decreases
 Pulmonary static recoil
decreases
 Sensitivity of the airway
receptors decreases
Nervous system
 Increased incidence of post.op.
confusion.
 Increased incidence of delirium
 Increased sensitivity to
anesthetic agents
Renal System
Renal blood flow declines 1.5% per
year. Renal clearance reduced
Gastrointestinal
Decreased intestinal motility
Decreased liver blood flow
Delayed gastric emptying
Musculoskeletal
Decreased mass, tone, strength
Decreased bone density
Integumentary
Decreased elasticity
Decreased lean body mass
Decreased subcutaneous fat
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
PSYCHOSOCIAL CONSIDERATIONS
 Level of anxiety
 Coping ability
 Support systems
LABORATORY and diagnostic studies
 Screening tests depend on the
condition of the client and the
nature of the surgery. If test
reveals severe problems the
surgery may be cancel until the
condition is stabilized.
 Routine screening test-CBC,
Blood grouping and X-match,
electrolytes, fasting blood sugar,
BUN & Creatinine, ALT, AST, and
bilirubin, Serum albumin, and
Total protein, Urinalysis, Chest X-
ray, ECG
COMMON NURSING DIAGNOSIS
 Knowledge deficit
 Anxiety
 Risk for ineffective airway
clearance
 Fear related to
 Disturbed sleep pattern
Anticipatory grieving related to
PREOP. TEACHING
 The education plan should begin
with assessment, including
baseline knowledge of the
patient and family, readiness to
learn,barriers to learning,
patient and family concern and
learning styles and preferences.
 The content focuses on
information that will increase
patient’s familiarity with
procedural events. This includes
surgical experience (procedural),
what the pt. may experience
(sensory) and what actions may
help decrease anxiety
(behavioral).
PREOPERATIVE Nursing Care
Anxiety
 The nurse must consider the pt’s
family and friends when
planning psychological support.
 Empowering their sense of
control. Activities that
decreasing anxiety are deep
breathing, relaxation exercises,
music therapy, massage and
animal-assisted therapy.
 Use of medication to relieve
anxiety.
Preanesthesia Management Physical
Status Categories
 ASA 1: Healthy patient with
no disease
 ASA 11: Mild systemic ds
without fx limitations
 ASA 111:Severe systemic ds
associated with definite fx
limitations
 ASA 1V: Severe systemic ds
that is a constant threat to
life.
 ASA V: Moribund pt. Who
is not expected to survive
without the operation.
 ASA V1: A declared brain-
death whose organ are being
recovered for donor.
 E: Emergency
Final Preparation for surgery
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
  All personal belongings are
identified and secured.
 Jewelry is usually removed.
 Dentures are removed, labeled
and placed in a denture cup.
 Pt. to verbally confirm the
surgical procedures and the
surgical site. This verification
process is documented in the
medical record on the preop.
checklist.
Preoperative Nursing Care
Pre-op. medications
 Prior to administering – check
permits
 Purpose: Allay anxiety
Decrease pharyngeal secretions-
Decrease gastric secretion.
Decrease side effects of anesthesia.
Induce amnesia
Medications
 Sedatives/hypnotics- Nembutal
 Tranquilizers-Ativan, versed,
valium
 Opiate analgesics- Demerol,
morphine
 Anticholinergics-Atropine
sulfate,atarax
 H2o blockers.- Tagamet, Zantac
 Antiemetic- Reglan, Phenergan
Intraoperative Phase
Surgical Team
 Surgeon
 Anesthesiologist
 Scrub Nurse
 Circulating Nurse
 OR techs
Intraoperative Nursing Care
Roles of team members
Surgeon- responsible for determining
the preoperative diagnosis, the choice
and execution of the surgical procedure,
the explanation of the risks and
benefits, obtaining inform consent and
the postoperative management of the
patient’s care.
Intraoperative Nursing Care
Roles of team members
Scrub nurse- (RN or Scrub tech)
preparation of supplies and equipment
on the sterile field; maintenance of pt’s
safety and integrity: observation of the
scrubbed team for breaks in the sterile
fields; provision of appropriate sterile
instrumentation, sutures, and supplies;
sharps count.
Perioperative Nursing Care
Surgical team
Circulating Nurse
 responsible for creating a safe
environment,
 managing the activities outside
the sterile field,
 providing nursing care to the
patient.
 documenting intraoperative
nursing care and ensuring
surgical specimens are identified
and placed in the right media.
 In charge of the instrument and
sharps count and
 communicating relevant
information to individual outside
of the OR, such as family
members.
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
 Perioperative Nursing Care  Blocks transmission of nerve
Surgical team impulses
Anesthesiologist and anesthetist-  Suppress reflexes
 anesthetizing the pt.  Promotes muscle relaxation
 providing appropriate levels of  Controlled level of
pain relief, unconsciousness
 monitoring the pt’s physiologic
status and
 providing the best operative Intraoperative Phase
conditions for the surgeons. Anesthesia
Factors influencing dosage and type:
Other personnel- pathologist, 1. Type and duration of the
radiologist, perfusionist, EVS personnel. procedure
2. Area of the body being operated
Perioperative Nursing Care on
Surgical team 3. Whether the procedure is an
Nursing Roles: emergency
Staff education 4. Options of management of post.
Client/family teaching Op. pain
Support and reassurance 5. How long it has been since the
Advocacy client ate, had any liquids, or any
Control of the environment medications
Provision of resources 6. Client position for the surgical
Maintenance of asepsis procedures
Monitoring of physiologic and
psychological status
Intraoperative Phase
Intraoperative Nursing Care Types of Anesthesia
Surgical asepsis  General- method use when the
 Ensure sterility surgery requires that the patient
 Alert for breaks be unconscious and/or
paralyzed.
Intraoperative Phase  A general anesthetic acts by
Anesthesia blocking awareness centers in
 Greek word- anesthesis, the brain so that amnesia (loss
meaning “negative sensation.” of memory), analgesia
Artificially induced state of (insensibility to pain), hypnosis
partial or total loss of sensation, (artificial sleep), and relaxation
occurring with or without (rendering a part of the body
consciousness. less tense) occur.
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
 Complications of Local/Regional
Intraoperative Phase Anesthesia
Stages of General Anesthesia  Anaphylaxis
 Stage 1- Analgesia and sedation,  Administration technique
relaxation  Systemic absorption
 Stage 2- Excitement, delirium  Overdosage
 Stage 3- Operative anesthesia,
surgical anesthesia Spinal Anesthesia
 Stage 4- Danger Indications - surgical procedures below
the diaphragm
Complications of General Anesthesia -patients with cardiac or respiratory
 Overdose disease
 Hypoventilation Advantages - mental status monitoring
 Related to anesthetic agents -shorter recovery
 Malignant hyperthermia Disadvantages - necessary extra
 Related to intubation expertise
-possible patient pain
Local or Regional Anesthesia Contraindications - coagulopathy -
Temporarily interrupts the uncorrected hypovolemia
transmission of sensory nerve impulses Involved medications - lidocaine
from a specific area or region. -bupivacaine -tetracaine
Patient assessment
 Motor function may or may not -continuous heart rate, rhythm, and
be affected pulse oximetry monitoring
 Client does not lose -level of anesthesia
consciousness -motor function and sensation return
 Gag reflex remains intact monitoring
 Supplemented with sedatives, Complications
opioids, or hypnotics -hypotension
-bradycardia
-urine retention
Types of Regional Anesthesia -postural puncture headache -
 Topical (surface) back pain
 Local
 Nerve Block Spinal analgesia
 Intravenous (Bier Block) Indications -postoperative pain from
major surgery
 Spinal
Involved medications -lipid-soluble
 Epidural (peridural)
drugs -
preservative-free morphine
Intraoperative Phase

CHARINA AUBREY RIODIL / SPCIS-BSN-IV

Monitoring recovery -respiratory  Acute pain
depression -urine depression -  Urinary retention
pruritus -nausea and vomiting  Risk for infection
Conscious Sedation
Administration of IV sedative, hypnotic, Postoperative Phase
and opioid medications. Assessment of the Postanesthesia Client
 Airway
 Produces a depressed level of  Vital signs
consciousness  Cardiac monitoring
 Retains ability to maintain a  Peripheral vascular assessment
patent airway  Level of consciousness (LOC)
 Able to respond to verbal  Fluid and electrolytes
commands or physical  GI system
stimulation  Integumentary system
 Used for relatively short  Discomfort/pain
procedures
Perioperative Nursing Care
Postoperative Management
POSTOPERATIVE NURSING CARE  Maintain a patent airway
NURSING ASSESSMENT IN THE PACU  Stabilize vital signs
 Vital signs- presence of artificial  Ensure patient safety
airway, 02 sat,BP,pulse,  Provide pain
temperature.  Recognize & manage
 LOC- ability to follow command, complications
pupillary response
 Urinary output Postoperative Nursing Care
 Skin integrity When caring for post-surgical patient,
 Pain think of the “4 W’s”
 Condition of surgical wound  Wind: prevent respiratory
 Presence of IV lines complications
 Position of patient  Wound: prevent infection
 Water: monitor I & O
Postoperative Nursing Care  Walk: prevent thrombophlebitis
Nursing Diagnosis
 Ineffective airway clearance- Postoperative Phase
increased secretions 2 to Complications
anesthesia, ineffective cough,  Respiratory- atelectasis, pulm.
pain Embolus
 Ineffective breathing pattern-  Cardiovascular- venous
anesthetic and drug effects, thrombosis
incisional pain
CHARINA AUBREY RIODIL / SPCIS-BSN-IV
  Gastrointestinal-Hiccoughs, Postoperative Phase
N/V,abd. Distention, paralytic drainages and tubes
ileus, stress ulcer. Penrose drain
 GU- urinary retention T-tube
 Hemorrhage-slipping of a Hemovac apparatus- JP drain and
ligature(suture) accordion type
 Wound infection-
 Wound dehiscence and Postoperative Nursing Care
evisceration- Gerontologic considerations
 Mental status- attributed to
Dehiscence medications, pain, anxiety,
 Partial or complete separation of depression.
the outer layer of the wound.  Delirium- infection, malignancy,
 Possible causes: trauma, MI, CHF, opioid use.
Poor suturing technique  Dementia-sundowning-sleep
Distention disturbances, lack of structure in
Excessive vomiting the afternoon or early morning,
Excessive coughing sleep apnea.
Dehydration
Infection

Evisceration
 Total separation of the layers &
protrusion of internal organs or
viscera through the open
wound.
 Causes: same as dehiscence
 Treatment:
Call for help
Cover with sterile NS soaked
gauze/towels
Keep moist
DO NOT ATTEMPTS TO REINSERT
ORGANS.
Keep in supine position with
knees/hips bent
Assessment/VS q 5 min. until
MD arrive
Prepare for surgery.

CHARINA AUBREY RIODIL / SPCIS-BSN-IV