F Blood Loss –

PERIOPERATIVE F Examples:
o Cesarian Section
o M.R.M (Modified Radical Mastectomy)

NURSING – removal of entire breast

o Cholecystectomy
o T.A.H.B.S.O. – Total abdominal
PREOPERATIVE NURSING hysterectomy and bilateral salpingo-
SURGICAL PROCEDURES ARE CLASSIFIED ACCDG. TO: oophorectomy
2. MINOR SURGERY
A. PURPOSE F Less important body structure – removed/
involved
B. RISK INVOLVED F Risk – less risk
F Complications – few
F Done under local anesthesia
C. URGENCY F Often performed in a day surgery
F Examples:
o Excision of breast mass
o Circumcision
A. PURPOSE o D and C
o Debridement – treating a wound skin
1. DIAGNOSTIC
C. BASED ON URGENCY
- Removal and study of tissue to make a diagnosis
- Example: Excision of Breast Mass and Finger Mass CLASSIFICATION INDICATIONS FOR EXAMPLES
2. EXPLORATORY SURGERY
- To estimate the extent of the disease 1. Severe bleeding
- Example: Exploratory Laparotomy and Exploratory 2. Bladder or
Laparoscopy intestinal
EMERGENCY Without delay obstruction
3. ABLATIVE
3. Fractured Skull
- To remove a diseased organ 4. Gunshot or stab
- Example: Cholecystectomy – removal of gallbladder wounds
Hip Replacement 5. Extensive Burns
4. PALLIATIVE
- Done to relieve symptoms of a disease without 1. Acute
treating or correcting the disease itself URGENT/ gallbladder
IMPERATIVE Within 24-30 hours infection
- Example: Colostomy
- Patient requires 2. Kidney or
5. RECONSTRUCTIVE prompt attention ureteral stones
- to repair tissue/ organs whose function and
appearance has been damaged 1. Prostatic
- Example: Creation of new breast, hyperplasia
5.1. Skin grafting of burn injury REQUIRED/ Plan within few without bladder
5.1. Constructive PLANNED weeks or months obstruction
- Patient needs to 2. Thyroid
- To repair a congenitally malformed tissue/organ
have surgery disorders
Cheiloplasty – repair of cleft lip 3. Cataracts
Uranoplasty – repair of cleft palate
6. COSMETIC AESTHETIC 1. Repair of scars
- To improve personal appearance ELECTIVE Failure to have 2. Simple hernia
- Example: Rhinoplasty - Patient should surgery is not 3. Vaginal Repair
7. CURATIVE have surgery catastrophic
- Elimination or repair of pathology
1. Cosmetic
- Example: Perforated appendix
OPTIONAL Personal Surgery
8. PROCUREMENT FOR TRANSPLANT - The decision rest preference
- Example: Kidney Transplant with the patient
9. REMOVAL – removal of foreign body
- Example: Nasal foreign body removal

B. DEGREE OF RISK INVOLVED SURGICAL SETTING

1. MAJOR SURGERY  ELECTIVE SURGERY

F Major organ – removed/ surgical manipulated - Carefully planned event
F Risk – high degree  EMERGENCY SURGERY
F Prolonged/ complicated
- may arise with unexpected urgency
Page 1 of 15
  SAME-DAY ADMISSION decrease cardiac function
- Patient most often admitted on the day of surgery
for in-patient surgery
 AMBULATORY SURGERY OBSTRUCTIVE SLEEP APNEA Airway is blocked and air does
- Is done on an out-patient basis F Morphine Sulfate not move through
- Advantages:
F Less stress to the px UPPER RESPIRATORY INFECTION Increase risk of respiratory
F Less risk of nosocomial infection complications
F Less decrease in px’s productivity
F Less costly to the px Alters metabolism and
LIVER DISEASE elimination of drugs
- Disadvantages:
F Less time to monitor and asses px Impairs wound healing and
F Less time to establish holistic care clotting time
F Patient will be responsible for assessing
complications Predisposes – fluid and
GOALS: PREOPERATIVE PHASE FEVER electrolyte imbalances

May indicate underlying

F Assess and correct physiologic and psychological
infection
problems - surgical risk.
F Give the person and significant others complete
learning/teaching guidelines regarding surgery. CHRONIC RESPIRATORY DISEASE
F Instruct and demonstrate exercises - benefit (post- - Emphysema, Anesthetic agents reduce
operative) Bronchitis, Asthma respiratory function
F Plan for discharge /any projected changes in lifestyle
due to surgery.
IMMUNOLOGICAL DISORDERS
- Leukemia, AIDS,
bone marrow Increased risk of infection and
RISK ASSESSMENT delayed wound healing after
depression and use
of surgery
MEDICAL CONDITIONS THAT INCREASE THE RISKS OF SURGERY chemotherapeutic
drugs or
immunosuppressiv
TYPE OF CONDITION REASONS FOR RISK e agents
BLEEDING DISORDERS Increase risk of hemorrhage
DRUG ABUSE Increased risk of HIV/
1. Thrombocytopenia Hepatitis
- Platelet count

2. Haemophilia CHRONIC PAIN Higher tolerance

- Ability of the blood to clot is
severely reduced (little or no
clotting factor)
ASSESSMENT CONSIDERATIONS FOR CLIENTS
UNDERGOING SURGERY

1. AGE
DIABETES MELLITUS Increase susceptibility to
infection  FRAGILE SKIN
- Strict glycemic control o Precaution – poisoning
Impaired wound healing o Decreased subcutaneous layer – risk for hypothermia
- 80-110 mg/dL
 BONE LOSS
1. Hypoglycemia o Risk for fracture
- Anesthesia o Careful positioning
- Decrease COOH,
Increase insulin use 2. NUTRITIONAL STATUS
2. Hyperglycemia  Post-op: needs at least 1500 kcal/day to maintain energy
- stress reserves
 Malnutrition – weight loss of 10% within 6 weeks before surgery
must be investigated
HEART DISEASE  Brittle nails- indicate poor nutrition
- Recent MI, F Optimum nutrition is required for wound healing and preventing
dysrhythmias, CHF infection
- Vascular disease  Malnourished clients have risk in mortality and morbidity –
potential for multiple organ failure
F Stress of surgery = increase
cardiac demands 3. OBESITY/ BARIATRIC
F General anesthetic agents =  Reduced ventilator and cardiac function. CAD, DM, CHF
Page 2 of 15
  Post-operative complications Herbal Therapies affect platelet activity and increase susceptibility to
o Embolus - Ginger, ginko, postoperative bleeding.
o Atelactasis ginseng Ginseng may increase hypoglycemia with insulin
o Pneumonia therapy
 Susceptible to poor wound healing – fatty tissues (poor Garlic (anticoagulant properties) that help control
blood supply) BP – be alert if too much in the diet→↑ bleeding
 Often difficult to close surgical wound – thick adipose layer
 At risk for dehiscence (opening of suture line)
10. ALLERGIES
4. IMMUNOCOMPETENCE
 An allergy to shellfish is also allergic to- IODINE SKIN
 Cancer patients: Surgeon waits for 4-6 weeks (ideally) after PREPARATIONS (Iodophor and Betadine) or any other products
completion of radiation treatments before surgery. containing iodine such as dyes.
 Note: allergic to shellfish do not necessarily have an allergy to
5. FLUID AND ELECTROLYTE IMBALANCE seafood
 Latex Allergy – allergic reactions to natural rubber latex and
 Excess body fluid can overload the heart synthetic rubber
 Normal serum potassium concentration is 3.5 – 5.0 mEq/L o At risk for latex allergy if allergic to: (Latex-fruit
 Notify anesthesiologist ↓ or ↑ serum potassium concentration syndrome)
(risk for arrhythmia when under general anesthesia ) may F Bananas
cancel surgical procedure. F Avocados

6. PREGNANCY F Kiwi
F Apricots
 Surgery – emergent or urgent basis F Peaches
o General Anesthesia is administered with caution F Potatoes
o General Anesthesia increases risk for fetal death and F Tomatoes
preterm labor
 C/S – preop diagnosis F Grapes
o Abruptio placenta F Guava
o Active maternal gonorrhea ØP.I.H. F Hazelnuts
o CPD F ADHESIVE TAPE
o Breech
o Placenta previa F ANESTHESIA MASKS
o Fetal bradycardia F TOURNIQUET
o Cord coil F IRRIGATION SYRINGES
F CATHETERS
7. PREVIOUS SURGERY  Latex Allergy Immediate Reaction (life-threatening)
o Pruritus and flushing
 Client’s past experience with surgery can influence physical and o Diaphoresis
psychological responses to a procedure o Nausea and vomiting
o Cramping
8. PERCEPTION AND UNDERSTANDING OF SURGERY o Dyspnea
o DELAYED RESPONSE – 18 -24 hrs. after contact
 The client: o CONTACT DERMATITIS
o is misinformed or unaware of the reason for surgery. o GOAL: Latex-free environment
o has inaccurate perception or knowledge of the
surgical procedure.
11. SMOKING HABITS
 Psychosocial integrity issues – cosmetic surgery
o Coping mechanism
o Situational role changes  Increase amount and thickness of mucous secretions- smokers.
o Body image changes  General Anesthesia - ↑ airway irritation and stimulates pulmonary
secretions (retained ↓ciliary activity during anesthesia).→ Ineffective
Airway Clearance
9.MEDICATION HISTORY  Post- operative deep breathing and coughing is vital.

DRUG CLASS EFFECTS DURING SURGERY

Anticonvulsants Long term use – e.g. phenytoin [dilantin] and
phenobarbital can alter metabolism of
anesthetic agents
Hypertensives interact with anesthetic agents to cause bradycardia,
hypotension and impaired circulation.
Corticosteroids With prolonged use, may cause adrenal
hypertrophy, which reduces the body’s ability to
withstand stress.
Insulin Diabetic client’s need for insulin after surgery is
altered.
Diuretics Diuretics potentiate electrolyte imbalances
(particularly potassium) after surgery.
NSAID’s NSAIDS inhibit platelet aggregation and may
prolong bleeding time, increasing susceptibility to
postoperative bleeding.
12. FAMILY SUPPORT
 Identify client’s source of support.
 Family presence should be encouraged (client’s coach)
13. REVIEW OF EMOTIONAL HEALTH
 Surgery is psychologically stressful.
 Feelings about the surgery.
 Fears and concerns.
 Anger and anxiety.
 SPEND TIME LISTENING TO THE CLIENT
 ANSWER QUESTIONS

Page 3 of 15
 PHYSICAL EFFECTS OF SURGERY ON THE CLIENT PRE-OPERATIVE PREPARATION OF THE PATIENT

o Completed and documented before the patient arrives in the OR

 Stress response is activated. F Preoperative history
 Resistance to infection is lowered due to surgical incision.
 Severing of blood vessels and blood loss.
F Physical examination
 Organ function maybe altered due to manipulation. F Common tests are:
 Body image maybe disturbed Q CBC to check for abnormalities.
 Lifestyle may be changed. Q Electrolytes to assess for imbalances.
Q PT/PTT( Prothrombin time ; partial
thromboplastin time)
PSYCHOLOGICAL EFFECTS OF SURGERY ON THE CLIENT to avoid bleeding problems.
Q Urinalysis
Q Blood type & cross match
 FEAR Manifestations: If a transfusion is anticipated
o Anxiety If the patient refuses to accept blood
o Avoids communication transfusions, documentation it.
o Sad, evasive, tearful, clinging NO BLOOD TRANSFUSION – Jehovah’s
o Inability to concentrate Witnesses
o Dazed Q Chest X-ray
o Anger to assess patient with cardiac or pulmonary
o Tendency to exaggerate disease
for smokers
person age 60 and older
AGE GROUP SPECIFIC FEARS NURSING ACTIONS for cancer patient
Toddler Fear of separation teach parents to expect Q ECG
regression, e.g.. in Known suspected heart disease
toilet training, and 40 ears of age or older by policy
difficult separations
Preschooler Fear of mutilation 1.Allow child to play
with models of F DOPPLER ULTRASOUND - test uses reflected
equipment. sound waves to evaluate blood flow (blood vessel).
2.Encourage expression - shows blocked or reduced blood flow through
of feelings (e.g. anger) narrowing in the major arteries of the neck
School-age Loss of control 1.Explain procedures in - reveals blood clots in leg veins
simple terms.
2. Allow choices when
THE NURSE INTERVIEW
possible.
Adolescence Loss of independence 1. Involve adolescence
being different from in procedures and  to make a preoperative assessment.
peers e.g. alterations in therapies.
body image. 2. Expect resistance.
 to provide emotional support
3. Express  to teaches how to prepare for postoperative recovery – videotape
understandings of
concerns.
 Review the patient’s chart and records.
4. Point out strengths.  Biographic information
 Physical findings
14. SELF CONCEPT
 Special therapy
 Emotional status
 Assess and identify personal strengths and weaknesses.
 Choose an optimal time and place without interruptions.

15. BODY IMAGE

PRE-OPERATIVE VISIT – O.R. NURSE

 Response is determined by culture, self-concept, degree of self-

esteem.  Walk in, sit down, maintain eye contact, and introduce yourself.
 Nurse should encourage expressions of concerns about sexuality. F Explain – purpose
F Assess - understanding of the surgical procedure.
16. COPING RESOURCES F Orient to the environment of the OR suite and interpret policies
 Be aware of the responses and routines
 Assists in stress management
 Identify sources of support  Review the preoperative preparations
17. CULTURE
 Anesthesia provider will visit

 The nurse should acquire knowledge of the client’s cultural and  Encourage px/family to discuss their feelings or anxieties
ethnic heritage  Identify any special needs of the patient.
18. CLIENT EXPECTATIONS - A pad of paper and pencil - unable to speak or hear.
 Assess expectations - Ask - wears any type of prosthetic device.
 Provide accurate information and clarify misconceptions  Preoperative vital signs
 Elevated temperature (underlying infection) - postpone the surgery until
infection has been treated.
PREPARING CLIENTS FOR SURGERY

Page 4 of 15
 Implanted pacemaker – Monopolar electrosurgery could cause 11. Answers the questions of the patient and allay fears related to
anesthesia.
malfunction

PHYSICAL ASSESSMENT KEY POINTS INFORMED CONSENT

It is an agreement by a client to :
 Jugular vein distention
 Loose or cap teeth  accept a course of treatment or procedure after being provided
 Dentures – must be remove complete information
 The surgeon has the ultimate responsibility for obtaining informed
 Inspect bony prominences of the skin – prolonged surgery may consent
increase the risk of pressure ulcers. The witness signing a consent document attest only to the following:
 Inform surgeon skin disease (pimple) near the site of surgery, increase  Identification of the patient or legal substitute
risk of infection.  Voluntary signature, without coercion.
 Ex. LAMINECTOMY – skin problem on the lower back, might  Mental state of signatory (i.e. not coerced, sedated, or confused) at the
cancel surgery. time of signing.
Purposes of Informed Consent
 Inspect bony prominences of the skin – prolonged surgery may  CLIENT-
increase the risk of pressure ulcers. understands the nature of the treatment including the potential
 Older adult – positioning and sliding on the OR table, may cause shear complications and disfigurement.
and pressure decision was made without pressure.
Is protected against unauthorized procedure. SURGEON AND
 Peripheral pulses are not palpable – use of a Doppler instrument for HOSPITAL-
assessment of their presence. protected against legal action by a client who claims that an
unauthorized procedure was performed.

CIRCUMSTANCES REQUIRING A PERMIT:

THE PATIENT WITH INDIVIDUALIZED NEEDS
 Any surgical procedure where scalpel, scissors, suture, hemostats of
electrocoagulation may be used.
 Entrance into a body cavity- thoracic parecentesis, bronchoscopy
 Language Barrier - Get an interpreter  Use of general anesthesia, local infiltration, regional block
 Hearing Impairment/Deafness –
- sign language VALIDATION OF CONSENT:
- hearing aid
 Visual Impairment/Blindness
- Make some noise as you approach so as not to startle the  If the patient is :
patient. F Legal age -18 y/o ,if minor, a parent or legal guardian
- Eyeglasses should be permitted to be worn should sign.
- If a general anesthetic is used, glasses should be sent to – PACU. F An emancipated minor (not subject to parental control),
- Contact lenses must be removed before the administration of a married, or independently earning a living he/she may sign.
general anesthetic, because they may dry on the cornea or become (not in the Philippines)
dislodged. F Unconscious, a responsible relative or guardian should
sign. Illiterate, he/she may sign it with an X, after which
the witness writes “Patient’s mark”.
PRE OP VISIT: ANESTHESIOLOGIST
F Mentally incompetent, the legal guardian should sign.
1. Takes a history pertinent to administration of anesthetic agents
F Mentally incapacitated by alcohol or other chemical
substance the spouse or responsible relative of legal age
- past anesthetic experiences may sign
- Allergies
- Adverse reactions to drugs
CONSENT IN EMERGENCY SITUATIONS
- Habitual drug usage.
2. Evaluates the patient’s physical, mental and emotional status to
determine the most appropriate type and amount of anesthetic  Permission for a lifesaving procedure - by telephone, fax, or
agent/s. other written communication.
3. Investigates patient’s cardiac reserve and observes signs of  TELEPHONE – 2 nurses should monitor the call and sign the
dyspnea. form
4. Asks about teeth. If indicated explains the dental work may be
damage inadvertently during airway insertion.
5. Evaluates physique of the patient for technicalities in WRITTEN PREOPERATIVE INSTRUCTIONS
administration of anesthesia:
a. A short stout neck may cause respiratory problems or
difficult intubation. F NPO before the surgical procedure( “NPO after midnight”) to prevent
b. Active athletic and obese persons require more anesthetic regurgitation or emesis and aspiration of gastric contents.
than inactive persons. F NPO before 5 am:
c. Accurate body weight - dosage of many medications is - Can eat gelatin desert at 4:30am
calculated from body weight. - Can brush his teeth at 5am (do not swallow water)
6. Explains preference of anesthetic.
7. Tells patient that oral intake is restricted before anesthesia and gives F NOTE: CAN NOT SMOKE AT 7: 00 AM
reason for this I.V. therapy is explained. Smoking increases production of gastric HCl, which can increase the
8. Discusses preoperative sedation in relation to the time the surgical risk of aspiration in an anesthesized client.
procedure is scheduled to begin. F Shower with antibacterial soap to cleanse the skin
9. Reassures - constant observation F The physician may want the patient to take any essential oral
10. Explains risks of anesthesia medications that she/he normally takes, with a minimal fluid intake.
Page 5 of 15
 F Jewelry and valuables should be left at home to ensure
safekeeping.
F Nail polish and acrylic nails should be removed - inhibit
contact between these devices and the vascular bed. – TO ASSESS
HYPOXIA Uncover at least one finger nail.
F Patients should be given other instructions about what is
expected
When to arrive at the surgical facility.
Where to wait
Where the patient will be taken after the surgical
procedure.
Who will take the patient home if the procedure,
medication or anesthesia renders the patient incapable of 3. BOWEL CLEANSES
driving.  Purpose:
Reduces the risk of contamination from fecal matter during operation.
Prevent post-op distention until normal bowel functions return
PREOPERATIVE TEACHING Prevents constipation and straining in the postoperative period.
§Recheck potassium levels after bowel preparation
Implementing the Teaching Program
4. PROMOTION OF REST AND COMFORT
F Begin at the patient’s level of understanding Rest is essential for normal healing
Sedative – Hypnotics (diazepam[Valium]) to promote sleep
F Include family members and significant others in teaching
Anxiolytic agents (e.g. alprazolam [Xanax]) - to relieve anxiety.
process.
F Use of Audiovisual aids if available 5. ELIMINATING WRONG SITE AND WRONG PROCEDURE
F Instruct patient - postoperative activities. SURGERY.
§Diaphragmatic (Abdominal) breathing Site has been marked by the surgeon.
- To promote lung expansion and ventilation and enhance blood Indelible ink is used to mark left and right distinction multiple
oxygenation. structures (e.g.fingers), and levels of the spine.
§Incentive Spirometers If the patient refuses a mark, document and note on the procedure
checklist.
- Preoperatively - measures deep breaths (inspired air) while
exerting maximum effort.
- Postoperatively – used 10 -12 times an hour.
- Promotes removal of chest secretions to prevent EARLY MORNING CARE
complications (pneumonia, obstruction)
- Interlace the fingers and place the hands over the
a. Awaken the patient one hour before preop medications will be given to
proposed incision site → SPLINTING INCISION WHEN
him.
COUGHING AND MOVING.
§Coughing
§Turning b. Morning bath, mouth wash.
- Stimulates circulation, encourages deep breathing, and relieves
pressure areas. c. Provide a clean hospital gown. Sanitary napkin for menstruating
- Turn every 2 hours as ordered patients
§Muscle pumping exercises
- Contract and relax calf and thigh muscles at least 10 times
consecutively. d. Remove hairpins, braid long hair, cover hair with cap. Remove wigs or
§Leg execises hair pieces.
- Moving the legs improve circulation and muscle tone. This is
taught to the client who is at risk for developing e. Remove dentures and foreign materials (chewing gum) to prevent
thrombophlebitis (inflammation of the vein), which is aspiration.
associated with the formation of blood clots. - Dentures allowed in local anesthesia and for some plastic surgery
§Ankle and foot exercises procedures to retain facial contours
§Pain management
f. Remove colored nail polish
PREPARING THE PATIENT BEFORE SURGERY - to permit observation/access to the nail bed during the procedure. –
PULSE OXIMETER
at least one fingernail should be uncovered.
PHYSICAL PREPARATION
1. PRE OPERATIVE DIET
- High CHON, sufficient CHO g. Removed jewelry for safekeeping.
2. REDUCTION OF RISKS FOR SURGICAL WOUND - If wedding ring cannot be removed, it is taped loosely or tied securely to
INFECTION prevent loss.

Remove all removal prostheses:

false lashes
eye glasses

The patient may be permitted to keep a religious symbol

Page 6 of 15
 PREPARING THE PATIENT ON THE DAY OF SURGERY - Glycopyrrolate (Robinul).

Antiembolic stockings or elastic bandages may be ordered for the

Administering “On Call” Medications
lower extremities to prevent embolic phenomena.
§Have medications ready and administer as soon as call is received from the
operating room.
a. Take baseline VS before preop medication.
b. Check ID band, skin prep
c. Check for special orders- enema, GI tube insertion, IV line. TRANSPORTING THE PATIENT TO THE OR
d. Check NPO
e. Have client void before PREOP medication to prevent over §Maintain comfort and safety of the patient.
distention of the bladder or incontinence during
unconsciousness
f. Continue to support emotionally §Accompany OR attendants to the patient’s bedside for introduction and proper
g. Administer pre-op medication as ordered – identification.
NOTE: Have the client void first before administering it.
§Assist in transferring the patient from bed to stretcher (unless bed goes to the
OR floor.

§Complete chart

§Coordinate - arrival of the patient in the OR

§Consent form needs to be signed before the administration of pre-operative PRE-OPERATIVE HOLDING AREA
medications.
Elevate side rails & provide quiet environment
Warn the client to expect drowsiness and dry mouth Family – is informed when the operation is finished.

OPERATING ROOM
PRE-OPERATIVE MEDICATIONS

§Oral medications – given 60-90 minutes (with a minimal amount of

water)before the patient goes to the OR.

§IM and SC injections- should be given 30-60 minutes before arrival at the
OR(minimally 20 min)

§IV medications - are usually administered to the patient after arrival in the
preoperative holding area or OR.

Drugs used
1.Sedatives and Tranquilizers
Sedation reduces the effect of anxiety.
Amnesia helps to provide comfort.
Sedatives and tranquilizers produce a calm, hypnotic state.
Benzodiazapines- produce excellent amnesia and mild sedation sufficient
to reduce anxiety and fear.
Diazepam (Valium)- given orally

1.Sedatives and Tranquilizers

§midazolam(Dormicum)-given IM for pre-op med and slow IV for conscious
sedation.
§Barbiturates – usually given the evening and or the morning before the surgery
to promote restful sleep.
Example: pentobarbital (Nembutal)
§Anti-emetics/Antinausents

2. Narcotics
Produce analgesia
Should not be given to asthmatic clients and those with cardiopulmonary
disease.
Side effect: respiratory depressant

3. Anticholinergics - reduces respiratory tract secretions and prevents INTRAOPERATIVE NURSING

severe reflex slowing of the heart during anesthesia.
Given less than an hour before the patient’s trip to the OR. PREFIXES MEANING
Examples: A or An Without / not
- Atropine Sulfate Ante Before / forward
- Scopolamine
Page 7 of 15
 Anti- Against / Opposite - Informs all team members of what are needed in the
Circum- Around / about procedure
Dys- Bad / difficult - Responsible for the postoperative management of
Ecto External / outside care.
Hemi- Half  Fisrt Assist/ SROD (Surgery residence on duty(
Hyper- Above, Over, Excessive  Scrub Nurse
Retro Behind / posterior to - Safety
Supra Above F Manages sharps
ROOTS MEANING ROOTS MEANING
F Prevents retained foreign objects in the
nd patient
Adeno Gland Jejuno 2 part of
intestines F Reconciles counts and is accountable for
Arthro Joint Lamin Post. Vertebral items used in the surgical procedure
arch  Surgical Technologist
Blepharo Eyelids Mast Breast - assist surgical operations, as well as pass instruments
Cardio Heart Myo Muscle to the surgeon.
Cholecys Gallbladder Nephro Kidney - All surgical technologists work primarily under the
Colon Colon Neuro Nerve supervision of the attending surgeon of each
Colpo Vagina Oophor Ovary procedure
Cranio Brain Opthalm Eye NON STERILE TEAM
Cysto Urinary Bladder Orchido Testicles  Anesthesiologist
Dent Teeth Osteo Bone - A medical doctor trained to administer anesthesia and
Dermat Skin Oto Ear/ pharynx, manage the medical care of patients before, during,
throat and after surgery
Entero Intestines - Determines when to position the px.
Gastro Stomach
- Gives the go signal when to transfer the px to the
Hepato Liver
PACU
Hystero Uterus
 Nurse Anesthetist
- A registered nurse and advanced practice nurse who
has acquired additional education and training to
ROOTS MEANING ROOTS MEANING
administer anesthesia.
Algia Pain Phlebo Blood
 Perianesthesia Nurse
Ectomy Removal Procto Anus
- Preoperatively assesses the patient and documents
Itis Inflammation Pyelo Pelvis of
the findings.
kidney
Lith Stone, calculus Rhino Nose
- Any information that contributes to the care of the
patient in the intraoperative area is communicated to
Logy Science Salpingo Fallopian Tube
the intraoperative team members.
Oma Tumor Spermato Semen
 Circulating Nurse
Teno Tendon Thoraco Chest
Vas Vessel/duct
- Coordinates care of the patient with the surgeon, scrub
nurse/tech, and anesthesia provider.
- Provides assistance to the surgical team throughout
HOW OPERATIONS ARE NAMED
the surgical procedure.
To form names operations, place the name of the anatomical site first,  Pathologist
and the name of the foreign root describing the work done last. - Consulted by the surgeon during or after surgery for a
 -Lysis – freeing of diagnosis by gross or microscopic examination of any
 -Rraphy – repair tissue removed.
 -Oscopy – examination of an organ by viewing
DUTIES, RESPONSIBILITIES, AND REMINDERS FOR THE
 -Pexy – to fix/ suture in place
 -Plasty – restoration of a lost part/ piece of tissue;
SCRUB NURSE
reconstruction  Preparation
COMMON ABBREVIATIONS YOU SHOULD KNOW: - Surgeon’s preference card
 AAA – abdominal aortic aneurysm
- Room set up
 AKA – above knew amputation - Establish baseline counts
 BKA – below knee amputation - Time out
 APR – abdominal perineal resection - Establish the sterile field
 APR – anterior posterior repair  Cutting time
 AXR – abdominal x-ray - First knife - initial skin scalpel is contaminated
- Do not remove towel clip on a drape - points are
SURGICAL TEAM contaminated and the drape now has holes.
The operating room provides a sterile environment in which the operating - The tip of the ESU pencil becomes hot and could burn
team can perform surgery the patient or a team member → attach to a
SCURBBED/ STERILE TEAM UNSCRUBBED/ UNSTERILE container(holder/holster).The ESU tip should not be
cleaned with a scalpel blade. The char should not be
Operating surgeon Anesthesiologist
permitted to fall into the patient
Assistant/s to the surgeon Nurse anesthetist
 Prepare sutures in the sequence in which the surgeon will use
Scrub Nurses Circulating nurse
them
Pathologist
 Place a ligature in the surgeon’s hand.
 Prepare 3 working needles in advance
 If the instrument towel on the sterile field becomes bloody, do
STERILE TEAM not remove it but cover it with a fresh, sterile towel.
 Surgeon F Normal saline - for irrigation.
- Performs the surgical procedure
F Sterile water for instrumentation.
- Responsible for the preoperative diagnosis and care
F Syinge with needle
Page 8 of 15
 - for injection and aspiration
- Do not recap any needle by hand.
- Syringes without needle (e.g. Asepto) →irrigation.
 Never put a large clamp on a small specimen; this may crush
cells and make tissue identification difficult.
►Some specimens have borders and margins (PROXIMAL
OR DISTAL) line of Resection)
 Specimen - hand it in a basin or appropriate container; never
place it on a surgical sponge. Tell exactly what the specimen is,
or if the specimen is to have special testing (e.g. frozen section
– NO FORMALIN SOLUTION ADDED).
 Any counted sponge should be unfolded and dropped into the
sponge bucket for counting
 Dressing and Drains
F Double- check before dispensing.
 Wet sponge followed by dry sponge to clean closed incision
 Procedure Completion
- All reusable instruments are opened and disassembled
and laced in bins for decontamination in the
processing area.
F Disarm scalpels
 Room Break-down
- Dispose of sharps in sharps container
F Trash Disposal
F Biologic trash into biohazard containers.
F Clean trash into regular garbage receptacles
F Linen into hampers
DUTIES, RESPONSIBILITIES, AND REMINDERS FOR THE
CIRCULATING NURSE
 Greet and identify the patient(pre-op holding area) introduce
self, and identify title and role.
 Check - CHART Check the wristband
 Offer blanket - patient
 Verifies the operative procedure and site, doctor, pre-op orders
and lab work. An IV may be started
 Validate the area by having the patient point to the spot. (left or
right) The correct surgical site should be marked by the
surgeon’s initials with an ink marker.
 Room Set up
- Clear path for emergency equipment.
- Position-Anesthesiologist
- Check the OR bed .
- Make sure lights are in working order.
F All necessary positioning aids are available.
F Plan setup for position of instrument table in
relation to surgical field.
 Cap – cover hair
 Transfer - OR bed, safety belt applied over the thighs 2-3
inches above the patient’s knees
 Arms on arm boards
 Preparation
- Surgeon’s preference card
- Room set up
 Patient Assessment and safety
o Patient identity and correct site information .
o Physiologic and psychologic status.
- Lab works
- Current medications
- Last intake by mouth
- Location of family and significant other.
F Check for films, digital information or
scans for use during the procedure.
 Assist the anesthesia provider
o Assist with positioning during regional anesthesia.
o Stand at patient’s side during induction of general
anesthesia
F Help anesthesia personnel with IV or
intubation if needed. Prepare to apply
cricoid pressure as needed during
intubation
Page 9 of 15
 Scrub Nurse and Circulating Nurse counts
F S- pongess
F I - instruments
F S- harps(needles,blades)
 Assist scrub person to move sterile table adjacent to surgical
field.
 Attach cords, cables, and tubings to appropriate devices.
 Place suction canister in direct view of anesthesia provider.
 Provide standing platforms/steps as needed.
 The circulator then moves the kick bucket into a convenient
location.
 TIME OUT AND CUTTING TIME
o MONITOR: -
- Vital Signs:
- I and O
- Monitor blood loss.
 Anticipates
o Sequence of the procedure
o Needs of the sterile team
o Breaches of sterile technique →•Hemostatic needs
o Radiation protection for sterile team
 C-arm is an imaging scanner intensifier
 Give hand - off report to RN in post procedural area.
o Patient name and age
o Allergies and sensitivities
o Current procedure and type of anesthesia
o Location of incisions, dressing, and drains
o Pertinent comorbidity
o Special needs(language, vision, hearing)
o Location of family or significant other
o Any procedure specific information
COUNTING – S.I.S.
A counting procedure is a method of accounting for items put on a sterile
table for use during the surgical procedure.
Counting procedures:
1. Initial count when the tray is assembled.
- The person who assembles and wraps items for sterilization will count
them in standardized multiple units.
2. Baseline count during setup for the surgical procedure
- The scrub person and the circulating nurse together count all items
before the surgical procedure
3. Closing counts (First Closing count)
Counts are taken in 3 areas
- Field Count
- Table Count
- Floor Count
4. Final count (Second closing count) during subcuticular or skin closure.
Purpose of Counting
 To account for all surgical and nonsurgical items.
 To ensure that the patient is not injured as a result of a retained
foreign body.
 To promote an optimal perioperative patient care outcome.
Incorrect Count
 The surgeon is informed immediately.
 The entire count is repeated.
 The circulating nurse searches the trash receptacles, under the
furniture, on the floor, in the laundry hamper, and throughout
the room.
 The scrub person searches the drapes and under items on the
table and Mayo stand.
 The surgeon searches the surgical field and wound.
 Immediate supervisor notified.
 Radiograph film be taken before the patient leaves the OR.
 Incident report and document on the OR record
Medical Error
 Sponges – most common retained surgical item
  Detection can be difficult PHASE 3

REMINDERS FOR THE CIRCULATING NURSE PHASE 3

 Cultures should be refrigerated or sent to the laboratory Extended care /observation unit
immediately. Goal: preparing patient for discharge, self-care
 Cultures are obtained under sterile condition. The tips of swabs
must not be contaminated by any other source Thorough reports to be endorsed to the PACU Nurse:
 Smears and fluids should be taken to the laboratory as soon as o Type of surgery performed, any intraoperative complications
possible o Type of anesthesia
- placed on glass slides o Drains and type of dressings
- evacuation tubes. o Presence of ETT or type of oxygen to be administered
 Stones are placed in dry container so they will not dissolve. o Types of lines and locations
 A foreign body may be given to the police, surgeon or patient o Administration of blood, colloids, and fluid and electrolyte
depending on its legal implications, policy or surgeon’s wishes. balance
 Amputated extremities (wrapped in plastic) SENT to the o Drug allergies
laboratory. o Catheters or tubes
 Avoid placing the amputated limb on the patient’s field of vision o Preexisting medical conditions
to prevent emotional distress.
PACU
POST-OPERATIVE NURSING 1) Assess for & maintain patent airway.
a) Position unconscious & conscious client on side (unless
POSTOPERATIVE CARE depends on the type of surgery and health contraindicated) or on back with head to side & chin extended
history. forward
- pain management b) Position patient that he is not lying on and obstructing
- wound care. drains/drainage tubes.
c) Do not move quickly patient from one position to the other
3 PHASES: (lithotomy supine/lateral Orthostatic hypotension
Phase I: Immediate Recovery Phase (intensive care) Ex. D and C, T.U.R.P.
Phase II: Intermediate, Less intensive care (preparing for self-care or d) Check for presence or absence of gag reflex
transfer) 2) Maintain artificial airway in place until gag & swallow reflex have
Phase III: Extended care/Observation Unit - preparing for D/C returned
3) HYPOPHARYNGEAL OBSTRUCTION
S/S - choking; noisy and irregular respirations; decreased oxygen
PHASE 1 saturation scores; and within minutes, a blue, dusky color (cyanosis)
of the skin until gag & swallow reflex have returned
PHASE 1 is the level of care in which close monitoring is required and
basic life-sustaining needs are of the highest priority. During this phase
of care, perianesthesia nurses

1. conduct assessments,
2. engage in monitoring, and intervene to maintain airway patency and
hemodynamic stability as well as manage pain, fluids, thermal comfort,
and other aspects of patient care.
F The primary goal is to facilitate the transition of the patient from
this level of care to Phase II level of care in preparation for
discharge to home or to an inpatient setting for continued care.

Phase I emphasizes ensuring the patient's full recovery from anesthesia

and return of vital signs to near baseline.
 used during the immediate
 ECG and more intense monitoring
 Providing care during the immediate postoperative period
 Goal: preparing patient for transfer to PHASE II, or inpatient
unit

PHASE 2
Tilting the head back to stretch the anterior neck structure lifts the base of
the tongue off the posterior pharyngeal wall.
PHASE 2 s the level of care in which clinical care and strategic planning
are aimed at preparing the patient for return home or for transition to
OROPHARYNGEAL AIRWAY
extended care for further observation.
- prevents the tongue to fall backward and obstruct air passages
In this phase, the patient
o has a stable airway with good ventilatory status on room air
(unless baseline status requires supplemental oxygen at home)
o satisfactory pain management (as defined by the patient)
o satisfactory control of postoperative nausea and vomiting
o appropriate ambulatory ability for procedure and baseline,
among other things
Phase II recovery focuses on preparing patients for hospital discharge,
including education regarding the surgeon's postoperative instructions
and any prescribed discharge medications.
o Ambulatory surgery patients
Goal: Preparing patient for transfer to Phase III, home, extended care To prevent skin shearing (ELDERLY)
facility

Page 10 of 15
With two people, one at each side using a draw sheet, one person at the
head, and one person at the feet

Assess Airway flow

1) Administer oxygen as ordered
2) Assess rate, depth, & quality of respirations
3) Check vital signs every 15mins until stable, then, every 30 mins
4) Note level of consciousness; reorient client to time, place, &
situation
5) Assess color & temperature of skin, color of nail beds,& lips
6) Monitor IV infusions
7) Check all drainage tubes & connect to suction or gravity drainage
8) Assess dressing for intactness, drainage & hemorrhage
9) First dressing is changed by the physician

F Wound drainage
a. bright red (sanguineous)
b. pinkish (serosanguineous)
c. serous (straw colored or clear)

10) Monitor & maintain client’s temperature; May need extra blankets
11) Encourage client to cough & deep breath after airway is removed

CONTRAINDICATED:
Head injury – inc ICP
Eye surgery – inc IOP
Plastic sx –inc. tension on delicate tissues
 If spinal anesthesia is used, maintain flat position & check for
sensation & movement in lower extremities

CARE IN SURGICAL FLOOR

1) Maintain good respiratory status
2) Monitor cardiovascular status
3) Promote adequate fluid & electrolyte balance
4) Promote optimum nutrition (Clear liquid diet)
5) Monitor & promote return of urinary function
6) Promote bowel elimination
7) Early ambulation
8) Improved dietary intake
9) Stool softener (if prescribed)
10) Pain management
POST OPEPERATIVE DISCOMFORTS 11) Provide wound care
1. Nausea and vomiting
2. Thirst
3. Constipation and gas cramps
4. Pain

Transfer Responsibilities
1. Endorse condition; point out significant needs
2. Assist in the transfer
3. Orient to room, nurses, call light, and therapeutic devices

 Changing the dressing

1. First post-operative dressing is usually changed by the surgeon or
surgical resident
 Maintain a safe environment
1. Have side rails up
2. Assesses level of consciousness and orientation
3. Determine - can resume wearing eyeglasses or hearing aid

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 Restlessness,
Thirst, cold, clammy, moist, pale skin
Deep, rapid RR, low body temperature
Low CO(cardiac output)
Decreased BP, low hemoglobin

Nursing Intervention
Replace blood- blood transfusion, IV fluids
Monitor vital signs
Use pressure dressing
Give vitamin K (aquamephyton),
Hemostan
Ligation of bleeders
Monitor vital signs
Place in a shock position
- Flat on back, legs elevated at 20 degree angle, knees kept straight

ATELECTASIS
- incomplete expansion of the lung (experienced 2nd day postop)
POST OP COMPLICATIONS CLINICAL MANIFESTATIONS:
1) Shock Dyspnea, cyanosis, cough,
2) Hemorrhage Elevated temperature
3) Deep Vein Thrombosis Pain on affected side.
4) Pulmonary Embolism Tachycardia
5) Pulmonary Complications- Atelectasis, Aspiration, Pneumonia
6) Intestinal Obstruction Nursing considerations:
7) Wound Infections Reinforce deep breathing, coughing, turning exercises
8) Wound Dehiscence Suctioning, Postural drainage, Antibiotics
9) Urinary Retention
10) Psychological Disturbances PARALYTIC ILEUS
- Depression
- Delirium peristalsis stops completely – gas builds up

Clinical manifestations:
SHOCK
Absent bowel sounds
response of the body to a decrease in the circulating blood volume - No flatus or stool
tissue hypoxia Cramping pain
↓ BP=blood loss(if blood loss500 ml, blood transfusion is indicated. Distension

Clinical Manifestations: Nursing considerations:

1. Anxiety or agitation Nasogastric suctioning
2. Cool, clammy skin Use of decompression tubes
3. Confusion Give IV fluids
4. Decreased or no urine output
5. General weakness EMBOLISM
6. Pale skin color (pallor)
7. Rapid breathing Experienced 2nd day post op
Clinical manifestations
Nursing Considerations: Dyspnea,cyanosis,
1) Assess wound dressing cough,restlessness
2) Report excessive drainage or bleeding ABG-low Oxygen
3) Monitor vital signs every 15 min until stable high CO2
4) Note early changes in vital signs
5) Report tachycardia, tachypnea, hypotension Nursing considerations:
6) Monitor input and output give oxygen,
7) Keep intravenous fluid rate on schedule anticoagulants (heparin) to be given
8) Assess respirations before giving opioids IV fluids to be infused
9) Fluid or blood replacement  
10) Vasopressors (drugs to raise blood pressure as ordered) Diagnostic TESTS
11) Additional surgery may be needed to control bleeding Chest x-ray
Watermark’s sign- an abrupt tapering or narrowing of a vessel caused by
pulmonary embolism
HEMORRHAGE
Copious escape of blood from the blood vessels.
Capillary- slow, generalized oozing
Venous- dark in color and bubble out
Arterial- spurts and is bright red in color

Classification of Hemorrhage:
Primary – hemorrhage during surgery
Intermediate – hemorrhage during the first few hours after surgery, ↑ BP
to its normal level dislodges insecure clots from untied vessels.
Secondary - hemorrhage sometime after surgery if a suture slips
because a blood vessel was not securely tied, became infected or eroded
by a drainage tube.
Diagnostic TESTS
Clinical manifestations:
ABG
Apprehension,
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ECG – to detect dysrhytmias Nursing Considerations
Ventilation and perfusion scan Apply abdominal binder
Pulmonary angiography – confirmatory test. Outlines the pulmonary Encourage proper nutrition-high CHON,vit C
vasculature to show the location of emboli. Stay with the client,have someone call for the doctor
Keep in bed rest
WOUND INFECTION Supine or semi-fowlers position, bend knees to relieve tension on
experienced 3-5 days postop abdominal muscles
Causes-Staphylococcus aureus, E.coli, Pseudomonas aerogenosa Evisceration-cover exposed intestine with sterile moist saline dressing.
Reassure, keep him quiet and relaxed.
Clinical manifestations: Prepare for surgery and repair of wound
Elevated WBC and temperature, chills
Pus or other discharge on the wound-Positive cultures  URINARY RETENTION
Foul smell from the wound occurs most frequently after operation of the rectum, anus, vagina and
Redness,swelling,pain,warmth lower abdomen caused by spasm of the bladder sphincter. Experienced
8-12 Hours postop.
Nursing considerations:
Antibiotic therapy, aseptic technique Clinical manifestations
Good nutrition Unable to void after surgery
Wound care Bladder distension
Rule of thumb-
Fever 1st 24 hours-pulmonary infection Nursing considerations:
Within 48 hours-UTI (urinary tract infection) Catheterized the patient
Within 72 hours-wound infection  
DEEP VEIN THROMBOSIS
WOUND COMPLICATIONS vessel wall injury, hemorrhage
Kinds: Experienced 6-14 days up to 1 year later
1.Hemorrhage/hematoma
2.Wound dehiscence- separation of wound edges(5-6 days postop) Clinical manifestations:
- feeling that wounds are “pulling apart” calf pain(+ Homan’s sign)
3.Wound evisceration-externalization of bowel(experienced 5-6 days edema,tenderness
postop)
Nursing considerations
1. Prevention:
a. Hydrate adequately to prevent hemoconcentration.
b. Encourage leg exercises and ambulate early
c. Avoid any restricting devices that can constrict and impair circulation
d. Prevent use of bed rolls dangling over the side of the bed with pressure
on the popliteal area.

Active intervention
Bed rest; elevate the affected leg with pillow support.
Wear antiembolic support hose from the toes to the groin.
Avoid massage on the calf of the leg.
Initiate anticoagulant therapy as ordered(Heparin)

Post op psychological Disturbances

Delirium(Mental Aberration)
ACS(Acute Confusional State)
Causes: Dehydration, insufficient oxygenation, anemia, trauma
(especially in nervous persons)

Manifestations:
poor memory, restlessness, disoriented, sleeps disturbances

Nursing considerations:
Sedatives - quiet and comfortable.
Explain reasons for interventions
Listen and talk to the client and significant others.
Provide physical comfort

WOUND CARE
SURGICAL WOUND HEALING OCCURS IN 3 PHASES
First Intention
Second intention
Third intention

SURGICAL WOUND HEALING OCCURS IN 3 PROCESS

First Intention – an aseptically made wound with minimal tissue
destruction and minimal tissue reaction
- heals as edges are approximated by close sutures or staples.
- no open areas or dead spaces are left to serve as potential sites of
infection
- granulation tissue not visible
- scar formation minimal
- covered with sterile dressing

Page 13 of 15
Example:
Surgical incision,
wound that is sutured or stapled Healing occurs by epithelialization; heals
quickly with minimal scar formation
2. Second Intention – an infected wound/chronic wound/extensive tissue
damage wound is left open and allowed to heal from inside out.
- periodically cleaning and assessing of wound for healthy tissue
production
- scar tissue is extensive
- healing is prolonged
Wound edges not approximated
Wound heals by granulation tissue formation, wound contraction, and
epithelialization.
Example: wound involving loss of tissue such as a burn, pressure ulcer, or
severe laceration ,surgical wounds that have tissue loss
3. Third Intention – a potentially infected surgical wound may be left
open for several days. If no clinical signs of infection occur, the
wound is then closed surgically.
Page 14 of 15
4 PHASES OF SURGICAL WOUND HEALING:
1. Hemostasis - first response to injury.
- blood vessels in the trauma area constrict to slow blood loss
Platelets are then released at the wound site to coagulate with fibrin
forms a thrombus, or blood clot, that seals broken blood vessels and
stymies blood loss..
entire process can last for two or more days
2. Inflammation Phase: 
characterized by blood vessel dilation shortly after hemostasis has been
achieved to stave off infection during the wound healing process
- redness at the wound site, pain, swelling, and heat.
- can last for six days or more after the initial onset of the wound
3. Proliferative Phase (Proliferation, Granulation and Contraction): 
Begins within 2-3 days after surgery.
Granulation tissue replaces damaged tissue after trauma. This new tissue
is often pink or red in appearance due to inflammatory agents—an
indication of normal wound healing. 
Sutures and staples are removed during this phase.
 entire process can last for two or more weeks after trauma.
4.Remodeling or Maturation Phase: 
Begins about 3 weeks after surgery and can continue for 6 or more
months.
Scar tissue is remodeled by a process of collagen synthesis and
breakdown to increase its strength.
Page 15 of 15