Ncm 112: MedSurg Lecture - Module 3 join that which has been divided and repair the

defects of nature.”
Clients in Need of Surgery: Perioperative Nursing
Introduction: Basic Concepts
Trepanation (burr holing)
- first surgical techniques were developed to treat injuries and
traumas
- oldest operation in which a hole is drilled or scraped into
the skull for exposing the dura mater to treat health
problems related to intracranial pressure and other diseases
- in the case of head wounds, surgical intervention was
implemented for investigating and diagnosing the nature of
the wound and the extent of the impact while bone splinters
were removed preferably by scraping followed by post
operation procedures and treatments for avoiding infection
and aiding in the healing process.
Perioperative
- Encompasses the three phases of the surgical experience:
• Pre-operative
- period of time from when the decision for surgical
intervention is made to when the patient is 
transferred  to the OR table.
• Intraoperative
- period of time from when the patient is transferred to
the operating table to when he or she is admitted to
the PACU.
• Post-operative
- period of time that begins with the admission of the
patient to PACU and ends after a follow-up
evaluation in the clinical setting or home.

Sushruta Perioperative Nursing

- "the father of surgery" - activities that occur in any or all of the three phases
- early surgical procedures were carried out in the Indian
subcontinent by him Word elements that make up a surgical term or phrase:
- word root
Joseph Lister • meaning of the word
- “father of modern surgery” • describes a body part of function
- developed antiseptic surgery by spraying medical • usually Greek & Latin Origin
instruments, catgut and bandages with a 1-in-20 solution of - prefix
carbolic acid - suffix
- many surgeons claimed that Lister's antiseptic methods - combining vowel
slowed things, at a time when speed was still essential • connets the word root with a suffix
because of blood loss. • usually the letter “o”
- October 26, 1877, Lister, at King's College Hospital, for
the first time performed the then-revolutionary operation of During the Perioperative period, command of medical and
wiring a fractured patella, or kneecap. surgical terminology is essential, since it can be used to
describe a disease process, a procedure, and supplies or
Since humans first learned to make and handle tools, they equipment that will be needed in order to perform the
have employed their talents to develop surgical techniques, surgery.
each time more sophisticated than the last; however, until
the  industrial revolution, surgeons were incapable of Prefix Examples
overcoming the three principal obstacles which had plagued - cyst – bag, bladder
the medical profession from its infancy —  bleeding, pain and  - angio – to do with arteries
infection. Advances in these fields have transformed surgery - chole – to do with bile
from a risky "art" into a scientific discipline capable of treating - colo – to do with colon
many diseases and conditions.
Abdomen lapar Nose rhino, nas
1. Basic Concept & Terminologies
Bladder cysto Ovary oophoro
Surgery
- branch of medicine concerned with diseases and trauma Blood Vessel angio Skull cranio
requiring operative procedures.
Breast mast, mammo Stomach gastro
- deals with the physical manipulation of a bodily structure to
diagnose, prevent, or cure an ailment. Fallopian Tubes salping Testicles orchio, orchid

Gallbladder cholecysto Uterus hystero

Ambroise Paré
• a 16th-century French surgeon Heart cardio Vagina colpo
• stated that to perform surgery is, "To eliminate that
Kidney nephro
which is superfluous, restore that which has been
dislocated, separate that which has been united,

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 AFFIXES MEANING TYPES DEFINITION EXAMPLE

- centesis surgical procdure A. According to PURPOSE

- ectomy surgical removal of To establish the presence of a - Biopsy

1. Diagnostic disease condition - Exploratory
- graphy recording or represent a specified thing (Laparotomy)

- lysis separation; destruction; loosening To determine the extent of

Reparative multiple wound repair
damage
- orrhaphy surgical repair
2. Curative To treat disease condition excision of tumors
- oscopy direct visualization by a scope
Involves removal of an organ - appendectomy
- ostomy opening made to allow the passage of drainage Ablative - cholecystactomy
(suffix -ectomy)

- otomy opening into Involves repair of damaged organ

plastic surgery after
Reconstructive or restoraion of tissue to its
- pexy fixation of burns
original appearance and function
- plasty plastic surgery
Involves repair of congenitally
- tome instrument for cut Constructive defective organ to improve its cleft lip repair
function and apperance
- tripsy crushing
An intestinal bypass
MEANING operation may relieve
To relieve distressing signs and
the symptoms of
3. Palliative symptoms not necessarily to cure
Adhesiolysis to separate adhesions intestinal obstruction
the disease
(Gastrostomy Tube
Amniocentesis aspirate fluid from amniotic sac insertion)

Cholecystectomy removal of gallbladder B. According to DEGREE OF RISK (magnitude/ extent)

Cystoscopy looking into the bladder - generally not prolonged

- leads to few serious
Colonoscopy visualization of the colon Minor Skin Biopsy
complications
- less risk
formation of an opening of the colon onto
Colostomy
the surface of the abdomen - extensive
- prolonged - Nephrectomy
Colporrhaphy repair of the vaginal wall - large amount of blood loss
Major - Radical Neck
- vital organs may be handled or
Lumpectomy removal of just a part of the breast Dissection
removed
- great risk of complications
Mammoplasty reshaping/ reconstructing the breast

Degree of Risk or Seriousness

Masectomy removal of the breast
- surgery is also classified as major or minor according to the
Rhinoplasty plastic repair of the nose degree of risk to the client
- this is affected by the client’s age, general health, nutritional
Salpingectomy excise part of the fallopian tub
status, presence of sleep apnea, use of medications, and
Types of Pathologic Processes Requiring Surgical Intervention mental status
- Obstruction
• impairment of the flow of vital fluids (blood, urine, bile, • Major Surgery
CSF) - involves a high degree of risk, for a variety of reasons:
- Perforation may be complicated or prolonged, large losses of
• rupture of an organ blood may occur, vital organs may be involved, or
- Erosion postoperative complications may be likely
• wearing (tiring) off of a surface or membrane - Ex: organ transplant, open heart surgery, and removal
- Tumors of a kidney
• abnormal new growths
- Proliferation • Minor Surgery
•  increase in number.. Stone formation; prostate - n o r m a l l y i n v o l v e s l i tt l e r i s k , p ro d u c e s f e w
complications, and often performed in an outpatient
Classification of Surgical Procedures setting
- purpose - Ex: breast biopsy, removal of tonsils, and cataract
- seriousness extraction
- urgency

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 TYPES DEFINITION
C. According to URGENCY
Immediate surgery required
- to maintain and to save life
- to maintain an organ or
1. Emergency limb function
- to remove a damaged
organ
- to stop hemorrhage
★ STAT – from the Latin “statum” meaning immediately
To be done within 24 to 48
hours
2. Imperative or
(necessary, unavoidable)
Urgent Surgery
Necessary for well-being but
not urgent, scheduled weeks
3. Planned or  or months in advance
Required
EXAMPLE
- Severe trauma
- intestinal obstruction
- extensive burns
- gunshot or stab wounds
- perforated ulcer
Severe bleeding
hemorrhoids, kidney
stones eroding, bleeding
cancerous tumors,
bleeding duodenal ulcers
Cataract removal,
Tonsillectomy,
Laminectomy,
Cholecystectomy if acute
inflammation is not
present
- Patients who, consequent to the application of the triage
system, are not prioritized for surgery, should continue to
receive supportive care as well as be given alternative
options, including palliative care. 
- Structural and procedural adjustments should be adopted
to ensure optimal infection control as well as rapid and
adequate response in ORs, especially for emergent cases.

Intraoperative Phase
The intraoperative nurse uses the nursing process to design,
coordinate, and deliver care to meet the identified needs of
clients whose protective reflexes or self-care abilities are
potentially compromised because they are having operative
or other invasive procedures.
Anesthesia
- state of narcosis (severe CNS depressionproduced by
pharmacologic agents) analgesia, relaxation, reflex loss
- Anesthetic agents usually are administered by an
anesthesiologist or a certified registered nurse anesthetist
(CRNA)

★ Laminectomy - a surgical operation to remove the back of one or more Types of Anesthesia
vertebrae, usually to give access to the spinal cord or to relieve pressure on - General
nerves
•  total loss of consciousness and sensation (also produces
Not absolutely necessary for amnesia)
Simple hernia repair, scar
4. Elective
survival. Delay or omission of
repair, hemorrhoids that • Under this, protective reflexes such as cough and gag
surgery has no adverse
are not bleeding reflexes are lost
effect.
• Acts by blocking awareness centers in the brain so that
Requested by the client amnesia (loss of memory), analgesia (insensibility to
5. Optional Face lift, liposuction
usually for aesthetic purposes pain), hypnosis (artificial sleep), and relaxation (rendering
a part of the body less tense) occur
6. Day
(Ambulatory Done on out-patient basis Excision of cyst • are usually administered by IV infusion or by inhalation of
surgery) gases through a mask or through an endotracheal tube
inserted into the trachea. 
Question: Does a patient’s COVID status affect eligibility
- Intravenous: Thiopental Na
for emergency surgery?
- Even if patients are suspected to have COVID-19, such - Inhalation: Halothane; Isoflurane
- Rectal: Methohexital Na
cannot be definitively confirmed for most emergent cases.
In these instances, only the relevant concurrent diagnoses— • Advantages:
- Because the client is unconscious rather than awake
such as severe pneumonia requiring assisted ventilation—
and anxious, respiration and cardiac function are
bear upon the logistical and other triage criteria.

readily regulated
- anesthesia can be adjusted to the length of the
Question’s Key Points
- During crisis standards of care, OR access should be limited operation and the client’s age and physical status
to patients in need of immediate or urgent surgical • Disadvantages:
- depresses the respiratory and circulatory systems
interventions. 
- A triage system, based primarily on clinical parameters, - some clients become more anxious about a general
anesthetic than about the surgery itself because they
should be instituted to be able to objectively and
fear losing the capacity to control their own bodies
transparently prioritize emergent surgeries. Triage officers
- Regional
may be designated to facilitate the implementation of the
system, including communicating the allocation basis and • reduces all painful sensations in one region without
inducing unconsciousness
decisions to patients and their family. 
- Patients known or suspected to have COVID-19, unless there • temporary interruption of the transmission of nerve
impulses to and from a specific area or region of the
are overriding medical contraindications or logistical
body
constraints, should, in emergencies, still be provided the
required surgical care. 
 • client loses sensation in an area of the body but remains
conscious

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 • Several techniques are used: • Procedures performed under conscious sedation
- Topical (surface) anesthesia - such as endoscopies, incision and drainage of
• applied directly to the skin and mucous abscesses, and even balloon angioplasty
membranes, open skin surfaces, wounds, and
burns Stages of General Anesthesia
• most commonly used topical agents are lidocaine Stage I: Analgesia/ Beginning 
(Xylocaine) and benzocaine • analgesia without amnesia
• are readily absorbed and act rapidly. • warmth, dizziness, sense of detachment from body,
- Local anesthesia (infiltration) ringing of the ears, impaired body movements,
• injected into a specific area hypersensitive hearing
• used for minor surgical procedures such as
suturing a small wound or performing a biopsy Stage II/ Excitement
• Lidocaine or tetracaine 0.1% may be used. • nausea, vomiting, hyperreactivity, irregular
- Nerve Block respiration
• a technique in which the anesthetic agent is • struggling, shouting, pupils dilate but pupillary
injected into and around a nerve or small nerve constriction present upon exposure to light, rapid
group that supplies sensation to a small area of the pulse, irregular breathing
body
• Major blocks: multiple nerves or a plexus (e.g., the Stage III/ Surgical anesthesia
brachial plexus anesthetizes the arm) • sleep, normal respiration and blood pressure
• Minor blocks: a single nerve (e.g., a facial nerve) • pupils small but contract with light, regular pulse
- Spinal anesthesia and breathing
• also referred to as a subarachnoid block (SAB)
• requires a lumbar puncture through one of the Stage IV/ Medullary depression
interspaces between lumbar disk 2 (L2) and the • depression of vasomotor and respiratory centers:
sacrum (S1) coma & death
• an anesthetic agent is injected into the • shallow respirations, weak and thready pulse, non-
subarachnoid space surrounding the spinal cord. reactive dilated pupils, cyanosis and potential
• often categorized as a low, mid, or high spinal death
- Low spinals (saddle or caudal blocks)
• primarily used for surgeries involving the The Surgical Team
perineal or rectal areas. STERILE TEAM NON STERILE TEAM
- Midspinals (below the level of the umbilicus—
T10) - surgeon
- first assist - anesthesiologist
• used for hernia repairs or appendectomies - registered nurse first assistant - certified registered nurse
- High spinals (reaching the nipple line—T4) (RNFA) anesthetist (CRNA)
• used for surgeries such as cesarean sections - SCRUB Nurse - circulating nurse
- Epidural (peridural) anesthesia • RN, LPN, surgical technician
• an injection of an anesthetic agent into the epidural Surgeon
space, the area inside the spinal column but - head of the Surgical Team
outside the dura mater. - considered the teams’ captain of the ship
- Conscious Sedation - a physician specially trained and qualified to perform the
• may be used alone or in conjunction with regional surgical procedure.
anesthesia for some diagnostic tests and surgical
procedures First Assist
• refers to minimal depression of the level of - may be a resident, intern, physician’s assistant, or a
consciousness such that the client retains the ability to perioperative nurse
maintain a patent airway and respond appropriately to - assist in retracting, hemostasis, suturing, and any other tasks
commands requested by the surgeon to facilitate speed while
• Commonly used to induce and maintain conscious maintaining quality during the procedure
sedation:
- IV narcotics such as morphine or fentanyl (Sublimaze) Registered Nurse First Assistant
- Antianxiety agents such as diazepam (Valium) or - expanded role of perioperative nursing.
midazolam (Versed) - practices under the direct supervision of the surgeon.
• increases the client’s pain threshold and induces a - responsibilities may include: handling tissue, providing
degree of amnesia but allows for prompt reversal of its exposure at the operative field, suturing and maintaining
effects and a rapid return to normal ADLs hemostasis.

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Scrub Nurse (RN, LPN, Surgical Technician)
- selects instruments, equipment, supplies appropriate for the
surgery
- prepares the sterile field and sets-up sterile tables
- assist with applying surgical drapes.
- maintain sterility of the sterile field.
- anticipates the surgeons needs. Hands the instruments,
sutures etc in a appropriate & timely manner.
- surgical counts instruments, sponges & sharps.
- clean & prepare instruments for sterilization.
- Surgical technologists
• also called operating room technicians
• assist in surgical operations
• they prepare operating rooms, arrange equipment, and
help doctors during surgeries
Anesthesiologist
- a physician specifically trained in the art and science of
anesthesiology
Certified Registered Nurse Anesthetist (CRNA)
- a qualified health care professional who administers
anesthetics.  - associated w/ the surgical environment:
- administers anesthesia under the direct supervision of the
anesthesiologist .

Anesthesiologist/CRNA Roles:
- assesses the patient before surgery
- selects and administers anesthesia
- intubates the patient if necessary
- manages any technical problems related to the
administration of anesthetic agent
- supervises the patient condition throughout the surgical
procedure
- monitors BP, pulse, respirations, ECG, blood O2 saturation
level.

Circulating Nurse
- completes a preoperative assessment
- establish and implement the intraoperative plan of care,
evaluate the care, and provide for the continuity of care
postoperatively.
- assists the anesthesia care provider with endotracheal
intubation
- performing on going patient assessment.
- monitors sterile technique of all members of the team and a
safe OR environment
- assist the surgeon and scrub nurse by operating non sterile
equipment, providing additional instrument and supplies.
- maintain accurate and complete documentation.
- tracking sponge, needle, and instrument counts.
- preparing and disposing of specimens.
 • Perform preoperative skin preparation.
Surgical Environment
- air temperature of 70 to 75°F. (21 to 24°C.) with 50 to 60%
relative humidity provides a compromise between the
requirements of the patients and those of the operators.
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- Surgical Zones:
• Unrestricted zone
- street clothes allowed
- entrance & exit for personnel & patients, dressing
rooms, PACU, offices, holding area, lounges, storage
for supplies
• Semi restricted zone
- scrub suits, caps
- storage areas for clean and sterile supplies,
sterilization processing, preparation area for
equipment
• Restricted zone
- scrub suits, caps, shoe covers, masks
- where surgery is performed. Adjacent sub-sterile areas
where scrub sinks are located.
Health Hazards
- exposure to blood and body fluids
- hazards associated with laser beams
- exposure to latex and adhesive substances
- exposure to radiation and toxic agents
- unintentional leaving of an object 
• object left in the cavity during a surgical procedure

Intraoperative Nursing Management
Assessment
- Presurgical care unit (PSCU)
• urgical holding area outside OR
• confirmation of client’s identity
• assessment of physical & emotional status
- Anesthesiologist/ CRNA
• continuous assessment to prevent, detect and initiate
prompt interventions for adverse surgical responses

Nursing Diagnosis
- Risk for aspiration
- Ineffective protection
- Impaired skin integrity
- Risk for perioperative positioning injury
- Risk for imbalance body temperature
- Ineffective peripheral tissue perfusion
- Risk for deficient fluid volume

Planning
- overall goals of care are to maintain the client’s safety and
to maintain homeostasis.
- Examples of nursing activities to achieve these goals include
the following: 
• Position the client appropriately for surgery. 
• Assist in preparing and maintaining the sterile field. 
• Open and dispense sterile supplies during surgery. 
• Provide medications and solutions for the sterile field. 
• Monitor and maintain a safe, aseptic environment. 
• Manage catheters, tubes, drains, and specimens. 
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 • Perform sponge, sharp, and instrument counts.  • Sterilization of instruments & equipments
• Document nursing care provided and the client’s • Creation & maintenance of a sterile field
response to interventions.
 • Control of the environment sources of infection

Interaoperative Goals III. To prevent intraoperative positioning injury

I. To reduce anxiety - Maintaining the patient’s extremities in good anatomic
- Pedisposing Factors: alignment by slightly flexig joints and supporting the
• Fear of the unknown patient with pillows, trochanter rolls, or pads.
• Fear of death - Benefits of Proper Positioning:
• Fear of anesthesia • Optimal access (surgical site, IV line, monitoring
• Fear of disfigurement devices)
• Financial difficulties • Protection of the client from harm
- Signs and Symptoms: - essential to the maintenance of client safety
• Inability to concentrate, follow conversation - can affect ventilation and circulation and impair
• Inability to verbalize fears peripheral nerve function
• Pacing, inability to rest, insomnia - Complications of Improper Positioning:
• Anger, depression, confusion, or no emotional • Post-operative musculoskeletal pain
response • Joint dislocation
• Increase in pulse and respiratory rates • Peripheral nerve damage
- What to Do? • Skin breakdown including necrosis
• Introduce self • Cardiovascular & Respiratory compromise
• Address the patent by name * Safe patient positioning in preparation for
• Verify details surgery is a critical component of perioperative
• Encourage and answer questions nursing practice. Although patient positioning is
• Pay attention to physical comfort (to provide a team responsibility, it is most often the
blanket) perioperative nurse who coordinates the
II. To prevent infection activities related to positioning.
- Surgical Site Infection (SSI) * Be especially aware of the intraoperative
• creates an opportunity for microorganisms to enter position required for older adults. Because
the body and for infection to result older adults are vulnerable to pressure ulcer
• why patient undergoing surgical intervention is at formation, check the appropriate pressure
high risk for surgical site infection points of that surgical position on the client. 
- Sources of Infection: - Effects of Improper Positioning:
• Endogenous • Severe and permanent patient injury
- arise from within the body; patients • Can hinder the surgeon’s ability to perform surgery
• Exogenous - Positioning Devices:
- from outside the body; personnel, environment, • Typical table attachments:
equipment Headrest
- Control: adherence to aseptic practices Anesthesia screen
Padded arm boards
Surgical Asepsis Shoulder braces
Aseptic Technique Kidney brace
• refers to the practices by which contamination with Table strap
microorganism in the surgical environment is Leg stirrups
prevented Table extensions
• most important measure in preventing the patient Table attachment holders
and staff from acquiring an infection - Positioning Accessories:
Surgical Conscience • Blankets (for patient’s warmth)
•  an inner commitment to adhere to aseptic practice, • Draw sheet (serve as a lift sheet)
to report any break in the aseptic practice, and to • Donut (used as head rest;to protect the ears and
correct any violation, whether or not anyone else is nerves of the head and face)
present or observes the violation • Pillows (to elevate body part)
Aseptic Practices: • Sandbags (used for immobilization)
• Surgical attire • Tape (to secure an extremity in a flexed position.
• Gowning & Gloving • Laminectomy Frame or body rolls made from
• Scrubbing sheets (to support the body off the chest while in a
• Skin Preparation prone position.

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 - Surgical Positions - Correct images? (scans or x-rays in proper
• Dorsal Recumbent / Supine orientation)
- most common  - Correct implants? (as appropriate)
- abdominal surgeries; anterior approach, head,
neck, extremities  - Safe transferring practices
• Trendelenburg  • If possible, let the patient do as much of the
- lower abdomen, pelvis transfer
• Reverse Trendelenburg • Check chart for precautions (joint disease)
- head and neck  - such as non-weight bearing status and joint
• Lithothomy disease before executing the transfer, to
- perineum, pelvic organs, genitalia minimize discomfort or harm
• Sims’ or Lateral Decubitus
- thorax, kidney, retroperitoneal space, hip Estrablish a wide base of support for your
• Jackknife or Kraske’s  stability
- proctologic, rectal surgeries Hold the patient’s center of gravity close to
• Prone your own for a better mechanical advantage
- spine, back, rectum, extremities Hold the patient with a transfer belt around
• Sitting (Semi-sitting; Semi- Fowler’s) the patient's waist to minimize stress on the
- cranial procedures patient’s shoulder girdle
Lift the patient with your legs.  Avoid back
bending.
Avoid trunk twisting during transfer.
Never lift more than you can. Ask for
assistance when needed

• Watch for signs of orthostatic hypotension

- S/S:dizziness, lightheadedness, blurred vision,
weakness, fatigue, nausea, palpitations, and
headache.
- Less common symptoms include syncope,
dyspnea, chest pain, and neck and shoulder
pain.

IV. To protect from injury - Reduce potential for foreign body retention
- Verify information, check the chart for completeness How to reduce the potential for a retained foreign
• Informed consent with patient’s signature body?
- Validate that the surgical consent has been • Surgical Counts
signed and witnesses - refers to the counting of sponges ,sharps, and
★ Ask pt, “What kind of operation are you instruments that are opened and delivered to
having today?” the field for use during surgery.
★ Co m p a re p at i e n t re s p o n s e s t o o t h e • Purpose:
information on the operative permit & - To reconcile what was delivered to the sterile
operative schedule. field before an incision is made and during the
★ When procedure involves specific site, surgery with what remains at the end of surgery.
validate the side on which the procedure is to • Responsibility:
be performed - usually performed by the scrub person and
★ Investigate any discrepancy and notify the circulating nurse
surgeon - counts must be done together and aloud
• Complete records for history & PE - must share the responsibility equally and items
• Results of diagnostic studies being counted must be visible.
• Allergies • General Rule:
• “TIME OUT”- prevents wrong site injury - counts are performed and documented prior to
- Correct patient? the beginning of the surgery, during surgery
- Correct position? when items are added to the field, before
- Correct site? closure of a body cavity or deep incision, before
- Correct procedure? closure of a cavity within a cavity (cesarean
- Correct equipment? section), and at skin closure.

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 Factors that can contribute to an error  in the count
process:
• Over time, counting becomes a routine task, which
contributes to the potential for error.
• Excessive talking during counts
• Sponges placed in the cavities for packing during
the case
• Circulating nurse out of the room when sponges
are added to the field.
• Signing for counts that were not performed.
* When an incorrect count occurs, it is the responsibility of
the nurse to inform the surgeon and for all team members
to assist in locating the missing item before the surgery is
completed.
- Prevent injury related to use of electrosurgery
• Purpose:
-  Cutting tissue or coagulating bleeding points
• Prevent burns; shock
- Patient burn can occur from inadvertent contact
of an active electrode with the patient at an
intended site.
- Proper positioning of the grounding pad under
the patient to prevent electrical burns and shock
Legal & Ethical Aspects
- Borrowed Servant Rule
• surgeon was considered the captain of the ship and was
liable for the negligent acts of the servants (before).  But
courts now recognize that the surgeon does not have
complete control over the acts of the perioperative team
at all times.
- Doctrine of Respondeat Superior
• a subordinate acts according to his/ her superior’s
direction therefore, the hospital is liable for the negligent
actions of the nurse.
- Doctrine of Res Ipsa Loquitor
• “the thing speaks for itself”
• courts allow the patient’s injury to stand as inference of
negligence.
- Assault and Battery
• unlawful threat to harm another physically; carrying out
of bodily harm (touching without consent)
• Periop nurse ensures that informed consent has been
obtained, documented, and placed in the health record/
hospital policy
- Invasion of Privacy
• patient has the right to expect that all communications
and records pertaining to individualized care will be
treated as confidential and will not be misused.
• Confidentiality agreement
- Abandonment
• leaving the patient when patient’s condition is contingent
on the presence of the caregiver
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Question: What do you think is the best way to avoid
malpractice or negligence claim
- Competent patient care is the best way to avoid a
malpractice or negligence claim.
- Unfortunately, even under the best of circumstances, a
patient may be injured and recover monetary damages as
compensation. Understanding how a liability action starts
and how it proceeds is important in the effort to avoid the
many pitfalls that can lead to being named and successfully
sued in a lawsuit.
- Caregivers should consider that liability is not the only
rationale behind competent care
- main focus: the desired outcome for the patient and the
exemplary delivery of care.
- Performing in a particular manner merely to avoid being
sued is not an ethical practice.
- Establish positive rapport with patients. Patients are less
likely to sue if they perceive that they were treated with
respect, dignity, and sincere concern. Patients have the right
to accurate information and good communication. 
Tort
• an act or omission that gives rise to injury or harm
to another and amounts to a civil wrong for which
courts impose liability. 
• Ex. intentional torts, negligence, and strict liability.
V. Maintain patient’s dignity
- Nurses serve as a patient advocate
• Maintain patient’s physical & emotional comfort
• Provide physical privacy 
• Treat patient as a person
• Maintain confidentiality
VI. Monitor and manage complications
- Being alert to and reporting changes in vital signs,
symptoms of nausea and vomiting, anaphylaxis and
other potential intra-op complications
- Assist in managing complications
- Maintain asepsis

Implementation (The Surgical Experience)
- Circulating nurse
• coordinates activities and manages client care by
continuous assessment of client’s safety; monitors aseptic
technique; environment
- Scrub person & RNFA
• assist surgeon

Evaluation
- intraoperative nurse uses the goals developed during the
planning stage (e.g., maintain client safety)
- collects data to evaluate whether the desired outcomes
have been achieved.
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- Determine the effectiveness of the plan as the expected
outcomes and mutual goals are met
• Reformulate the plan and implement new interventions
as necessary.
• Document the effectiveness of the plan of care in an
ongoing, systematic manner. 

Documentation
- intraoperative nurse documents the perioperative plan of
c a re i n c l u d i n g a s s e s s m e n t , d i a g n o s i s , o u t c o m e
identification, planning, implementation, and evaluation. 

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