Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 109 RLE:

CARE OF MOTHER AND CHILD AT-RISK OR WITH
PROBLEMS (ACUTE AND CHRONIC)

OR TECHNIQUE

Group F-3
Papa, Mechiella
Perandos, Eunice
Prestosa, Rheanne
Resgonia, Angela
Ruiz, Dylan
Ruste, Geneva
Salinas, Vince
Secretaria, Realm
Semblante, Joji
Sibal, Bonzee
Sta. Cruz, Lance
Sulapas, Danielle Jayne

Facilitator: ​Ms. Nikki Rae Cayanan

Date Submitted: ​February 9, 2021

Objectives:
After 8 hours of varied learning activities, the level II students will:

1. define the following terms:

1.1 Peri-operating Nursing

1.1.1 Pre-operative phase
1.1.2 Intra-operative phase
1.1.3 Post-operative phase
1.2 analgesia
1.3 anesthesia
1.4 antiseptic
1.5 asepsis
1.6 consent
1.7 disinfection
1.8 hemostasis
1.9 medical asepsis
1.10 resident bacteria
1.11 sterile
1.12 sterilization
1.13 surgery
1.14 surgical asepsis
1.15 surgical conscience
1.16 surgical team
1.17 surgically clean
1.18 transient bacteria

2. describe the operating room as to its:

2.1 Personnel
2.1.1 sterile
2.1.2 unsterile
2.2 Physical lay-out
2.3 Attire
2.3.1 basic components
2.3.2 protective
2.4 Set-up (equipment and apparatus)

3. cite the:

3.1 scientific principles involved in OR Technique

3.2 basic rules of surgical asepsis
3.3 duties and responsibilities of the scrub and the circulating nurse
3.3.1 pre-operative
3.3.2 intraoperative
3.3.3 post-operative

4. enumerate the:

4.1 basic instruments in Basic Set as to:

 4.1.1 clamping and occluding
4.1.2 cutting and dissecting
4.1.3 grasping and holding
4.1.4 exposing and retracting
4.1.5 suturing and stapling
4.1.6 viewing
4.1.7 suctioning and aspirating
4.1.8 dilating and probing
4.1.9 measuring
4.2 contents of the major and minor pack

5. list the various:

5.1 sites for skin preparation

5.2 operative positions

6. discuss the:

6.1 classification of surgery according to:

6.1.1 Major or Minor
6.1.2 purpose
6.1.3 category of surgery based on urgency
6.2 common surgical complications
6.3 different layers of the abdomen
6.4 common abdominal incisions
6.5 different types of:
6.5.1 suture
6.5.2 suture needle
6.5.3 blades

7. Differentiate:

7.1 sterilization process as to its:

7.1.1 types
7.1.2 advantages and disadvantages
7.2 types of anesthesia

8. show the common Operative Checklists needed for surgery:

8.1 Consent Form

8.2 Pre-operative Checklist
8.3 WHO Surgical Safety Checklist

9. Demonstrate the beginning skills in performing:

9.1 medical handwashing

9.2 surgical hand scrubbing
9.3 arranging the instruments
9.4 serving instruments
9.5 circulating experience
1. define the following terms:
1. Perioperative Nursing - nursing care provided in the total surgical experience of the
patient. The period of time extending from when the patient goes into the hospital, clinic,
or doctor's office for surgery until the time the patient is discharged home.

i. Pre-operative Phase
1. Extends from the time the client is admitted to the surgical unit, to
the time he/she is prepared for the surgical procedure, until he/she
is transported into the operating room (OR).
ii. Intra-operative Phase
1. Extends from the time the client is admitted to the operating room,
to the time of administration of anesthesia, surgical procedure is
done, until he/she is transported to the recovery room (RR)/ post
anesthesia care unit (PACU).
iii. Post-operative phase
1. Extends from the time the client is admitted to the RR/PACU, to
the time the patient is transported back into the surgical unit,
discharged from the hospital, unit follow up care.

2. Analgesia - absence of pain

3. Anesthesia - absence of all sensation, especially sensitivity to pain, as induce by an

anesthetic substance or by hypnosis or as occur with traumatic or pathophysiologic
damage to nerve tissue.
4. Antiseptic - chemical agent that slows or stops the growth of microorganisms on external
surfaces of the body and helps to prevent infections.

5. Asepsis - absence of bacteria, virus, and other microorganisms. To decrease the

possibility of transferring microorganisms from one place to another.

6. Consent - permission for something to happen or agreement; give assent or approval;

patient’s authorization or agreement to.
7. undergo a specific medical intervention
8. Disinfection - act of disinfecting, using disinfectant and specialized cleaning techniques
that destroy or prevent growth of organisms capable of infection.

9. Hemostasis - ​ is a process which causes bleeding to stop, meaning to keep blood within
a damaged blood vessel (the opposite of hemostasis is hemorrhage).

10. Medical Asepsis - destroying pathological organisms after they leave the body.
Procedure used to reduce the number of microorganisms and prevent their spread.
11. Resident bacteria - indigenous flora. It can be removed by medical hand washing or
surgical handwashing.

12. Sterile - free from bacteria or living microorganisms.

13. Sterilization - process to eradicate all forms of live microorganisms from a substance,
including pore-forming bacteria.

14. Surgery - specialty of medicine that treats disease and disorder by cutting, removing, or
changing the body with an operative procedure that opens the body for therapy.
15. Surgical asepsis - exclusion of all microorganisms before they can enter and open
surgical wound or contaminate a sterile field during surgery.

16. Surgical conscience - professional behavior that demonstrates understanding and

application of principle of surgical surgery and legal, ethical and moral responsibilities for
patients and team members for which each practitioner is accountable.

17. Surgical team - a team that consists of scrubbed and unscrubbed team who perform
surgery and related tasks composed of; surgeon, anesthesiology or nurse
anesthesiologist, scrub nurse, circulating nurse.

18. Surgically clean - medically or physically cleaned, but not sterile.

 19. Transient bacteria - temporary skin flora refers to the microorganisms that transiently
colonise the skin. This includes bacteria, fungi and viruses, which reach the hands, for
example, by direct skin-to-skin contact or indirectly via objects.

2. describe the operating room as to its:

2.1 Personnel

2.1.1 Sterile Personnel

● Surgeon
○ The Surgeon is the MC Officer in charge of the treatment
given to the patient during the course of an operation.
○ Establishes diagnosis and provides preoperative, operative
and post-operative care.
○ A professional who is trained and qualified by knowledge
and experience for the performance of a surgical
operations
○ Performs the actual surgery; treats injuries, diseases, and
deformities through operations
○ Qualifications of surgeons include a bachelor’s degree, a
medical degree, 3 to 7 years internship and residency
programs as well as a medical license to operate as a
surgeon (ex. United States Medical Licensing Examination
or USMLE)
● Surgeon Assistant
○ Helps to maintain the visibility of the surgical site; also
helps control the bleeding, close wounds and apply
dressing
○ Surgeon assistants require a graduate degree in surgical
assisting and licensing to work in the field (ex. Physician
Assistant National Certifying Exam or PANCE)
○ A surgeon assistant’s duties may include:
■ Confirming the operation with the surgeon
■ Advising, informing and comforting the patient
before surgery
○ Surgeon assistants minimize patients' risks for issues like
nerve damage and decreased circulation.
● Scrub Nurse
○ Maintain the integrity, safety and efficiency of the sterile
field throughout the surgical procedure
○ Scrub nurses require an associate's or bachelor’s degree
in nursing and licensing to work in the field
○ They are either an RN or surgical technologists who are
often certified (CST).
○ The scrub nurse must have a thorough knowledge of each
step of a surgical procedure and the ability to anticipate
each and every instrument and supply needed by the
surgeons (Rothrock, 2015)

● RN First Assistant
○ An expanded role in the OR that requires formal education
(AORN, 2012)
○ They collaborate with the surgeon by handling and cutting
tissue, using instruments and medical devices, providing
exposure of the surgical area and hemostasis, and
suturing (Rothrock, 2015)
2.1.2 Unsterile

● Anesthesiologist
○ Administers the anesthesia to the patient before the
operation
○ Continuously monitors the patient's vital signs and
condition
○ Recognizes potential life-threatening emergencies
○ Qualifications needed for an anesthesiologist include an
undergraduate degree, medical degree, and 4 years
residency program as well as a medical degree
○ An MC Officer who is certified as a specialist in the
administration of anesthetics is an anesthesiologist
○ In actual practice in the surgical suite, the person who
gives the anesthetic is usually referred to as the
anesthetist, even though he may be certified as an
anesthesiologist.
● Circulating Nurse

○ Circulating nurses is an RN who does not scrub in and

uses the nursing process in the management of patient
care activities in the OR suite
○ Creates and maintains a safe and comfortable
environment for the patient through the implementation of
aseptic technique
○ They also manage patient positioning, antimicrobial skin
preparation, medications, implants, placement and function
of IPC devices, specimens, warming devices, and surgical
counts of instruments and dressings (AORN, 2015;
Rothrock, 2015)

● Operating Room Aides

○ Cleans the patient’s quarters, washes laundry, and
changes the patient’s linens
○ Assists the patient in moving in and out of bed
○ OR aides require an associate’s degree
 ● Surgical Technologist
○ Prepares the operating room, arranges equipment, and
also assist the surgeon during the surgery
○ Surgical technologists require a diploma, certificate, or
associate’s degree and licensing to work in the field (ex.
Certified Surgical Technologist credential)
○ An associate in surgical technology typically takes two
years of enrollment

2.2 Physical Layout

A. Arrangement of the operating theater

● Basic principles for efficient workflow are adhered to when

planning the arrangement of rooms within a surgical suite.
● Traffic must move smoothly and without interruption into, through,
and out of the suite.
● Proper arrangement of the rooms reduces the flow of excess
traffic, saves much unnecessary walking, and therefore conserves
time and effort.
B. The number of rooms

a. The factors affecting the size of the surgical suite include:

i. ​The operative load​ or the number of surgical cases to be
done per day. Several operative procedures can be done
per day in each OR, one case following another, but all
should be completed by the end of the usual day shift or
shortly thereafter.
1. The average number of ORs needed is indicated
by the number of operative cases to be done daily
divided by the number of cases that can be done
daily in one OR.
2. Operative load can also be broadly interpreted to
include the amount of work to be done per day,
outside of actual cases.

ii. The type of surgery performed ​can affect the number of

rooms. Some surgeries are very long and detailed
requiring many hours of operating time.

iii. The number and frequency of emergency cases.​ These

cases are also considerations related to the necessary size
of the suite. The larger the troop area near a hospital, the
greater the number of accident and emergency cases that
may have to be done.

C. Size of individual operating rooms

a. The operating rooms should have ample space for performing the
procedure and moving around the room.
b. Each room should be sufficiently flexible to provide for the needs
during operation
c. Certain types of surgeries require big, bulky equipment and others
may need minimal equipment.
d. Sufficient floor space should be provided so that breaks in aseptic
technique due to overcrowding will be avoided.
D. Four Zone Concept
● The designations in the four zone concept may not be necessarily
used in some hospitals but whenever feasible the surgical suite is
segregated into four areas for traffic control.
● The purpose of such control is to assure maximum protection
against infections.
● Traffic control design is aided by designation of the four-zone
concept: the interchange area, semirestricted area, restricted
area, and dirty area.

I. Interchange area- ​ provided to enable persons from outside the

surgical suite to meet with personnel within the suite when
necessary.
- This includes the offices of the OR supervisor and
one for the chief of anesthesiology
- These offices are located conveniently but outside
the surgical suite in order to keep traffic within the
suite to a minimum.
 II. Semirestricted area​- this includes the corridor within the work
area, the anesthesia workroom and storage, the utility closet, the
instrument storage room, the workroom, the linen storage room,
the clean linen room, and the soiled linen room
- This area represents the supply center for the
surgical suite.
- Non-sterile procedures are performed in this area,
personnel without OR attire are not admitted.
- A mask need not be worn in this area.

III. Restricted area- ​consists of all rooms in which sterile procedures

are done and sterile goods are opened or exposed.

- This includes the individual ORs and the adjacent

scrub rooms ( where soap, nail files, brushes,
timers, and written directions are available for the
scrub procedure.

IV. Dirty area- ​the dirty area is the disposal area, where all utilized
materials and linen are gathered, packaged, and sent to
appropriate areas.
E. Arrangement of areas

a. The nonrestricted and interchange areas should be located near

the entry door.

b. Workroom areas are situated near the center of the suite, and
storage and supply rooms nearby are positioned to avoid waste in
time and energy of personnel.

c. Areas for storage of both sterile and unsterile supplies must be

clearly marked to avoid mistaking one for the other. If there is no
linen chute in the suite, a room for soiled linen is necessary

d. If the suite has observation galleries, these are provided with

outside entries to eliminate unnecessary traffic of persons in street
clothing.
 2.3 Attire
Patients and health-care givers are presumed to be potentially infectious or susceptible to
infection, thus attire serves as preventive measures in providing effective barriers that prevent
the dissemination of microorganisms to the patient and protect personnel from blood and body
substances of patients and vice versa
2.3.1 Basic Components

● Body cover/scrub suit

- A loose-fitting, two-piece garment worn by healthcare

personnel
- Made of material that is impermeable to shed skin scales
which would thereby “contain” or “hold them in.”

● Surgical Caps

- Offers coverage of hair and bacteria to minimize risks to

sterility

● Surgical Masks
- protects the wearer from inhaling contaminants or particulate
matter generated in the operative field
○ Note: Busting False Claims
“when protecting the nurse, wear the mask with the blue
side in and white side out; when protecting the patient,
wear the white side in and blue side out”

The only correct way is wearing it with the colored side

outward as it pertains to the fluid-repellent layer.
2.3.2 Protective

● Sterile Surgical Gloves

- These are donned over hands during contact with blood or

other body fluids, mucous membranes or non intact skin
and/or invasive procedures.
- Note: Wearing gloves does not replace the need for
handwashing.

● Cover Shoes

- protect the footwear and feet from exposure to blood and

body fluids
- Maintain sanitary environment by eliminating tracked-in dirt
and microbes
● Boots

- Used if it is anticipated that contact with blood and body

fluids, splashes and spills may occur

● Surgical Caps

- may help contain hair and its bacteria away from sterile field

● Masks or Visors

- prevent splashing or spattering of blood and other fluids

into the eyes, nose, or mouth.
● Aprons

- An outer garment, often waterproof for further protective

covering especially during handling of excessive bodily
fluids

● Surgical Gowns

- Plays an essential role in maintaining aseptic technique

- worn by personnel during surgical procedures to protect
both parties from transfer of microorganisms, bodily fluids,
and particulate matter.
2.4 Set-up (equipment and apparatus)

● Surgical Lights - used to provide lighting to the surgical area

● Operating Table - where the patient lies during the operation

● Surgical Booms - hides electrical cords attached to various pieces of

equipment
● Surgical Displays - allows for clear view of the surgical sight for
visualization

● Operating Room Integration System - allows the OR staff to coordinate

and collaborate on medical decisions through image and video
connections

● Blanket Warmers - used to store and warm intravenous fluids, linens, and
blankets
 ● Scrub Sinks - station for “scrubbing in” before surgery

● Nurse Documentation Stations - space for the nurse to do documentation

of the procedure

3. cite the: (AR)

3.1 Scientific Principles involved in OR Technique

● Anatomy and Physiology

○ In depth knowledge of the human body, how it functions, and the

various sites is key when performing invasive procedures on
patients.

● Microbiology

○ Always maintain sterility in the environment, equipment, and

personnel in order to prevent injury to the patient.
 ● Chemistry

○ Know the medications used during the surgery and how much to
administer.
○ Sharp instruments, other delicate equipment and certain catheters
and tubes can be sterilized by exposure to formaldehyde, glutaral
or chlorhexidine.

● Sociology

○ Explain the procedure and what it entails to the patient to gain

their cooperation and to reduce their anxiety.
○ Establish rapport with the patient.

● Body Mechanics

○ Follow proper body mechanics when moving the patient in order to

avoid injury.

● Safety and Security

○ Constantly monitor the patient’s condition, vital signs, and level of

consciousness to prevent any harm to the patient during the
procedure.
○ Make use of the WHO Safety Checklist.

● Time and Energy

○ Have all materials and equipment prepared prior to the surgery.

3.2 Basic Rules of Surgical Asepsis

1. All objects used in a sterile field must be sterile.

2. A sterile object becomes non-sterile when touched by a non-sterile object.
3. Sterile items that are below the waist level, or items held below waist
level, are considered to be non-sterile.
4. Sterile fields must always be kept in sight to be considered sterile.
5. When opening sterile equipment and adding supplies to a sterile field,
take care to avoid contamination.
6. Any puncture, moisture, or tear that passes through a sterile barrier must
be considered contaminated.
7. Once a sterile field is set up, the border of one inch at the edge of the
sterile drape is considered non-sterile.
 8. If there is any doubt about the sterility of an object, it is considered
non-sterile.
9. Sterile persons or sterile objects may only contact sterile areas;
non-sterile persons or items contact only non-sterile areas.
10. Movement around and in the sterile field must not compromise or
contaminate the sterile field.

3.3 Duties and Responsibilities of the scrub

Pre-Operative Intraoperative Post-Operative

1. Ensure the operating 1. Selecting and passing 1. Count all instruments,

room is clean and the instruments to the sponges, and other
ready to be set up. surgeon. tools and inform the
2. Prepare the 2. Anticipate surgeons surgeon of the count.
instruments and and assistance to be 2. Remove tools and
equipment needed for served. equipment from the
the surgery. 3. Keep instruments and operating area.
3. Count all sponges, supplies in order. 3. Helps apply dressing
needles, instruments, 4. Maintain patient’s to the surgical site.
and other tools. safety. 4. Transports patient to
4. “Scrub In” which 5. Clean the tools after the recovery area.
involves washing use and place it back 5. Necessary
hands using sterile on the table for the documentation
technique and putting next use. regarding the surgery.
on sterile garments
such as gloves, gown,
and a face mask.
4. Basic instruments in Basic Set as to:
➢ clamping and occluding
○ These tools are used to compress hollow vessels or hollow organs for
hemostasis or in order to prevent spillage of contents
○ These instruments include:
■ Kelly Curve and Kelly Straight (Hemostatic Forceps)
- Used for clamping large blood vessels or manipulating heavy tissues.
Also used for soft tissue dissection.

■ Crushing Clamp
- Used to crush the diseased part of the gut in resection
anastomosis.

■ Non-crushing Vascular Clamp

- Used to hold and control blood vessels during vascular surgery.
 ■ Pean Intestinal Forceps
- are an intestinal instrument used for surgical procedures.

➢ cutting and dissecting

○ These tools have sharp edges they are used to dissect, incise, separate or
excise tissues.
○ These tools are used to divide sutures or bandages
○ These instruments include:
■ Knives
- Used to cut the skin and anchored on to blade holders

■ Scissors
● Surgical scissors
- Used for cutting multiple things in the surgical/ operative
setting
● Bandage scissors
- Used for sizing dressings and removing circumferential
bandages

● Metzenbaum scissors
- Surgical scissors designed for cutting delicate tissue and
blunt dissection

● Mayo scissors
- Use to cut heavy tissues such as fascia, muscle,
uterus, breasst, often use this during OB-Gyne
Procedure
 ● Tissue dissecting scissors
- Use to cut tissues at the surface or inside the human body.

● Wire scissors
- Used to cut wire sutures in plastic and orthopedic surgery.
Also used to cut metallic mesh.

● Bone cutters
- Used to cut or remove bones.

➢ grasping and holding

○ These tools are used to pick up, hold and manipulate other tools, tissues and
materials
○ Forceps can be ringed or the thumb variety
○ These instruments include:
■ Allis Tissue Forceps
- Used for grasping organs or slippery/ dense tissue and is available
also in a variety of sizes
■ Tissue forceps
- Used for grasping small objects or removing items from small
cavities
● Toothed

● Non-toothed

■ Babcock Forceps
- Utilized to grasp delicate tissue such as intestine, fallopian tube,
ovary, appendix, also available in long size
■ Backhaus Towel Clamp
- Used for grasping tissue, securing towels or drapes , and holding
and reducing small bone fractures

■ Stone Forceps
● Kidney stone forceps
- used for grasping and removing kidney stones, gall stones,
or polyps​.

● Randall stone forceps

- use to grasp, mobilize and extract stones from the kidney.

● Blake gall stone forceps

- used in operations when gallstones need to be removed
from the gallbladder.
 ■ Tenaculums
- used mainly in surgery for seizing and holding parts, such as
blood vessels.

➢ exposing and retracting

○ These tools are used to grasp and hold organs and tissues for the purpose of
improving the exposure and visibility of the surgical field, while preventing trauma
to other organs
○ Has 2 types: Hand held and Self retaining
○ These instruments include:
■ Balfour abdominal retractors
- used in abdominal surgery to hold open the abdominal. Side loops
are used to open up the wound, the central blade can be raised or
lowered to increase the view of the surgical field

■
■ Self-retaining retractors (Weitlaner retractors)
- Use to set against the edges of the wound or the tissue needed to
be held apart and then ratcheted handles are locked manually
while the blades remain apart holding the edges with no
assistance.
■ Army Navy retractors
- Used to retract shallow or superficial incisions

■ GELPI Perineal retractors

- used for holding back organs and tissues while accessing areas
below an incision during lumbar spine procedures​.

■ Handheld retractors
● Richardson-Kelly handheld retractor
- is used to retract deep abdominal or chest incisions.

■ Skin hook
● is a simple and practical instrument for use in dermatologic
surgery. This instrument has been utilized by plastic
surgeons for a long time.

■ Bone hook
● are used to grasp and stabilize skin and tissue, ligaments,
tendons, and​ ​bone fragments.
 ■ Malleable retractor
● Allows shorter incisions to be ​used​ in relation to implant size
without sacrificing precision in preparation of the cavity.

➢ suturing and stapling

○ These tools are used for tissue closure procedures
○ These instruments include:
■ Staplers
● Terminal end staplers
● For linear sutures

● Internal anastomosis staplers

These staplers are basically linear staplers with an 
integrated cutting device. Four staggered lines of staples 
(two "rows") are applied, and the tissue between the two 
inner staple lines is transected.
 ● End-to-end staplers
technology is designed for use as a stapler instrument for
control of rectal prolapse and hemorrhoid disease

■ Needle holder
- is a surgical instrument, similar to a hemostat, used by doctors
and surgeons to hold a suturing needle for closing wounds during
suturing and surgical procedures.

■ Crosshatched serrations
are used for grasping, holding firmly or exerting traction upon
objects.

■ Debakey Needle holder with Tungsten carbide jaws

designed to hold the smallest sutures in microsurgical and plastic
surgery procedures.
➢ Viewing
○ These tools are used to permit viewing in a forward direction. Doctors can
examine body cavities, hollow organs or structures with viewing instruments.
○ These instruments include:
■ Vaginal Speculum
-i​s a duck-bill-shaped device that doctors use to see inside a hollow part
of your body and diagnose or treat disease

■ Nasal Speculum
- This two-bladed instrument is inserted into the nostrils. It lets
doctors examine the inside of the nose.
■ Rectal Speculum
- to diagnose and treat conditions such as: hemorrhoids.
abscesses. tears in the anus (anal fissures)

■ Endoscope
● Hollow
- to examine the interior of a ​hollow​ organ or cavity of the
body.

● Lensed
use special glass rods with optically finished ends, providing
images with higher brightness, contrast and colour reproduction
than conventional lenses.
➢ suctioning and aspirating
○ These tools are used to remove blood and other fluids from a surgical field
○ These instruments include:
■ Frazier tip
- This is a thin instrument used for the removal of fluid or debris
from confined surgical spaces.

■ Yankauer tip
- It is typically a firm plastic suction tip with a large opening
surrounded by a bulbous head and is designed to allow effective
suction without damaging surrounding tissue. This tool is used to
suction oropharyngeal secretions in order to prevent aspiration.

■ Trocar
- The trocar functions as a portal for the subsequent placement of
other instruments, such as graspers, scissors, staplers, etc.
Trocars also allow the escape of gas or fluid from organs within
the body.

■ Cannula
- is a tube that can be inserted into the body, often for the delivery
or removal of fluid or for the gathering of samples.
 ■ Suction machine
- is a pump used to maintain an airway by removing secretions from
the mouth, throat, or lungs. It is particularly important in
neurological diseases where the ability to cough or swallow is
impaired.

➢ dilating and probing

○ probing tools are used to enter natural openings and dilating tools are used to
expand the size of openings
○ These instruments include:
■ Pratt dilators
- features double-ended rounded dilators to measure the level of
dilation or facilitate further dilation of the uterus.
 ■ Hegar dilators
- are widely used in gynecology to open up the cervix. also used to
overcome stenosis in non-gynecological situations, such as in
urology and proctology.

■ Speculum
- A speculum is a duck-bill-shaped device that doctors use to see
inside a hollow part of your body and diagnose or treat disease.
One common use of the speculum is for vaginal exams.

➢ Measuring
○ These tools are used to measure body parts during surgical procedures
○ These instruments include:
■ Ruler
- is used for measuring aspects in operating room
■ Caliper
is a device used to measure the dimensions of an object.

● Neuro caliper
- Neuro Caliper Measures up to 127mm, Graduated Measure
in Inches and Millimeters with 90mm Delicate Blades

● Townley femur caliper

is a measurement device intended for use in orthopedic surgical
procedures. This instrument itself measures 4" long and is crafted
for use in accurate measurements of the femur.

● Castroviejo caliper
is a commonly used tool in strabismus and other procedures
involving muscles of the eye. The caliper measures the exact
distance for muscle recession or resection
 ■ Goniometer
is essentially a protractor with two arms extending from it, used to
measure a joint's range of motion. They're most often used in physical
therapy to track the progress of a joint's movement.

4.2 contents of the major and minor pack

Major Pack
● 6 OR gowns
● 6 hand towels
● 6 draping towels
● 1 laparotomy sheet
Minor Set (Basic Set)
● 9 Backhaus Towel Clamps
● 9 Small Kelly Curve
● 9 Medium Kelly Curve
● 5 Small Kelly Straight
● 4 Allis Tissue Forceps
● 2 Babcock
● 2 Needle Holders
● 2 Medicine Cups
● 3 Kidney Basin
● 1 Placental Bowl
● 2 Army Navy Retractors
● 6 Tissue Forceps
○ 3 toothed
○ 3 non-toothed
5. list the various:
5.1 ​sites for skin preparation
The location is identified by the patient and validated by the preoperative nurse or
surgeon. The site is marked with in-edible ink.
● Head and Neck preparations:

● Eye
- Don sterile gloves.
- Going from medial to lateral canthus, paint operative eye, cheek, forehead and
nose on correct side, using ½ circle motions above and below the eye.
- Cover the eye with a 4x4 gauze and massage eye gently especially the
fornices.
- For corneal transplantation, glaucoma surgery

● Face
- Ensure a cap or towel is covering the patient’s hair, and use waterproof
tape if necessary to ensure hair is tucked away. The hairline is considered
a contaminated area
- Begin prep at the incision site and extend to the periphery of hairline and
neck.
- Prep the external ear if necessary.
- Repair of cleft palate, Rhinoplasty
● Ear
-Ensure a cap or towel is covering the patient’s hair, and use waterproof tape if
necessary to ensure hair is tucked away. The hairline is considered a
contaminated area.
-Place absorbent cotton into the external ear canal.
-Perform paint
-Cleanse the external ear.
- Extend the prep to the edge of the hairline, face and jaw.
- Remove the absorbent cotton from the external ear canal.

● Neck
- Ensure a cap or towel is covering the patient’s hair and use waterproof
tape if necessary to ensure hair is tucked away. The hairline is considered
a contaminated area
- The area to be prepped includes the neck laterally to the table line and up
to the mandible, tops of the shoulders, and chest almost to the nipple line.
- Tracheostomy, Thyroidectomy
 Torso preparations
● Shoulder
-Elevate the patient’s arm prior to proceeding with prep. Be careful not to pull the
patient’s shoulder laterally to expose the scapular area to avoid dislocation and
further injury to the patient.
- Area to be prepped includes the chest, neck and shoulder, upper arm, scapula
and axilla on the affected side. Prep the axilla last. Hand may be excluded if
surgeon wraps in occlusive drape after the prep.

● Chest/breast
-Area to be prepped includes from the top of the shoulder to below the diaphragm
and from the edge of the non-operative breast to the table-level of the operative
side, including the upper arm to elbow circumferentially and the axilla of the
operative side.
- Prep the axilla last.
- Prep both sides of the chest for a bilateral procedure.
- If incision is in axilla, use a separate sponge for the axilla.
- Mastectomy, lung biopsy, drainage of pleural effusions

● Abdomen
-you will be given general anesthesia.
-A tube to help you breathe will be placed in your throat
-A catheter will be inserted into your bladder to drain urine and to
monitor the amount of urine coming out during surgery.
 -Compression stockings will be placed on your legs to prevent blood clots in your
legs and lungs during surgery.

● Back
-Apply a generous amount of surgical scrub solution to the clipped area and
scrub the skin with gauze sponges or a surgical brush.
-Local anesthetic agent should be administered after the preliminary skin
preparation but before the final preparation.
-Sterile surgical gloves should be worn for the final skin preparation. Supplies,
including solutions, must be sterile.

● Vagina/Perineal/Perianal
-First: prep pelvis, labia, perineum, and thighs as follows:
○ Start prep at the pubis and prep to iliac crest using back and forth strokes.
○ Prep labia majora using downward strokes, including perineum.
○ Use fresh sponge to prep inner thigh of first leg starting at labia majora and
moving laterally using back and forth strokes. Discard sponge when periphery
reached.
○ Use fresh sponge to prep inner thigh of second leg starting at labia majora and
moving laterally using back and forth strokes. Discard sponge when periphery
reached.
- Next: prep vaginal vault using a separate sponge mounted on a forcep.
- Prep anus last.
- Vaginal Reconstruction, clitoral unhooding, Perineorrhaphy
Extremities
○ Upper
■ Arm
- Elevate limb for prep
- Hand and fingernails may require pre-cleaning prior to skin prep.
-The area to be prepped includes: the hand to mid forearm.
-Begin prep at the incision site and complete one side of the hand,
continue prep on the opposite side of the hand, working in a
circular motion towards the elbow.
- During the prep, the nurse wearing sterile gloves may hold the
patient’s painted fingers to assist in the manipulation of hand
during the prep.
- Examples for Upper Extremities Surgeries: Carpal Tunnel
Release, Shoulder replacement

● Arm
-Elevate limb for prep.
- The area to be prepped includes: entire circumference of the arm
to the mid forearm, over the shoulder, scapula and axilla (prep
last).
- Begin the prep at the incision, prep from proximal to distal
boundaries.

○ Lower
■ Hip
-Elevate limb for prep.
- Area to be prepped includes: abdomen on the affected
 side, thigh to below the knee, the buttocks on the affected side,
the groin, and the pubis.
- Begin the prep at the incision site. Proceed to periphery which is
abdomen midline, inferior rib cage, below knee. Prep the groin and
perineum last.
- Hip Replacement Surgery

■ Leg and foot

-Area to be prepared may vary depending on surgery to be
performed.
- Prepping the foot should include a scrub prior to paint/packaged
single unit applicator in order to reduce the bacterial counts
between the toes and under toenails.
- If top of leg prepped, place a drip towel between the groin and
the fold of the upper thigh to prevent pooling in the area.

5.2 ​operative positions

● Supine or dorsal recumbent
- Most frequently used; procedures on the face and head, neck, abdomen,
upper and lower extremities
 - This position is the natural position of the body at rest, making it the most
common posture for surgery.
- Common complications associated with the supine position are
backaches and pressure-point reactions.

● Trendelenburg
- Used for abdominal hysterectomy and procedures on the pelvic area
- is a variation of the supine position.
- The upper torso is lowered and the feet raised, allowing for optimal
visualization of the pelvic organs during laparoscopy and lower abdominal
procedures.

● Reverse trendelenburg
- For neck procedures and laparoscopic procedures
- Commonly known as the head-up and feet-down position, the reverse
Trendelenburg is often used in head and neck procedures
● Fowler’s
- Fowler’s is used for posterior craniotomy and select ENT procedures
(ears, nose, throat)
- facilitates the relaxing of tension of the abdominal muscles,
allowing for improved breathing.
- used for neurosurgery and shoulder surgeries.

● Dorsal lithotomy
- Used for obstetric, gynecologic, perineal, anorectal, and urologic
procedures
- While in the lithotomy position, the patient is in supine position and their
legs are raised and abducted. Stirrups are needed for this position.

● Sims (semi prone)

- Procedures requiring access to the vagina, anorectum, and perineum
 - increased patient comfort; prevention of pressure injury; and
reduced deep vein thrombosis, pulmonary emboli, atelectasis, and
pneumonia.

● Prone
- Used for adrenalectomy and spinal surgeries and anorectal procedures
- In this position, the patient lies flat on their stomach and their head is
turned to the side. This position is most commonly used for cervical spine,
back, and rectal area procedures

● Lateral kidney
- Used for procedures on the upper urinary tract (ex. kidney) and structures
in the retroperitoneal space
- is much like the lateral position except the patient's abdomen is
placed over a lift in the operating table that bends the body to allow
access to the retroperitoneal space.
● Lateral chest or posterolateral thoracotomy
- Used for procedures needing thoracoabdominal access
- The lateral position places the patient on the non-operative side to that
surgery can be performed on the hip, chest, or kidney.

● jackknife
- For anorectal and coccygeal surgeries
- The safety belt is placed below the knee. It is important to return the
patient slowly to horizontal from this unnatural position. Used in anorectal
procedures .
6. Discuss the:
6.1. Classification of surgery according to:
6.1.1. Major or Minor
Major Surgery​ - usually requires extended stay in a hospital and specialized
care, has a higher degree of risk, involves major body organs or life threatening
situations, has a greater risk for postoperative complications, and an extended
recovery period.

- usually require anesthesia or respiratory resistance and sometimes even both

- any invasive operative procedure in which a more extensive resection is
performed, e.g. a body cavity is entered, organs are removed, or normal anatomy
is altered, the surgery is considered major.

Examples:
○ Open Cholecystectomy
○ Nephrectomy
○ Hysterectomy
○ Radical mastectomy
○ Laparotomy
○ Cesarean section
○ Organ, Joint replacement

Minor Surgery ​- is usually brief, carries a low risk and results in few
complications.
- Minor surgeries are mostly elective.
- Generally superficial and do not require penetration of a body
cavity.
- Does not involve assisted breathing or anesthesia.

● Examples:
○ Teeth extraction
○ Cataract extraction
○ Removal of warts
○ Repair of cuts or small wounds
6.1.2. Purpose
Surgeries based on purpose:
1. Diagnostic Surgery​ - surgeries that confirm or establish a
diagnosis.
Examples: Biopsy, Bronchoscopy, Endoscopy
2. Ablative Surgery ​- surgeries that remove a diseased body part.
Examples: Appendectomy, Amputation, Pharyngectomy
3. Palliative Surgery​ - surgeries that relieves or reduces pains or
symptoms of a disease. It is not curative.
Examples: Colostomy, Nerve root resection
 4. Reconstructive Surgery​ - surgeries that restore function to
traumatized or malfunctioning tissue or to improve self concept.
Examples: Scar revision, Plastic surgery, Internal fixation
of a fracture, Breast reconstruction
5. Transplant Surgery ​- surgeries that replace diseased or
malfunctioning organs or structures.
Examples: Kidneys, lives, heart transplantation.
6. Constructive Surgery​ - surgeries that restore functions or
appearance in congenital anomalies.
Examples: Cleft lip repair, Closure of atrial septal defect

6.2 Common surgical complications

● Shock
○ Elevate patient’s feet about 12 inches above the head level
○ Begin CPR as necessary
○ Keep patient warm and comfortable
● Hemorrhage
○ Assess vital signs and monitor signs of shock
○ Monitor blood loss
○ Administer IV fluids, medications and blood products as necessary
● Risk for Infection
○ Assess skin color, texture, elasticity, and moisture
○ Check patient’s immunization history
○ Encourage adequate rest
○ Encourage a balanced diet
○ Encourage to increase fluid intake
● Urinary Retention
○ Provide fluids prior to voiding
○ Place the patient in an upright position to promote voiding
○ Catheterization if incomplete urination
● Reaction to anesthesia
○ Continue monitoring for any signs of post-anesthetic reactions following
surgery (e.g. pneumonia)
○ Provide comfort measures (pain relief, skin care)
○ Monitor vital signs

6.3 Different Layers of the Abdomen

● Skin - most superficial layer

● Superficial fascia
➢ Camper’s fascia - fatty superficial layer
➢ Scarpa’s fascia - deep fibrous layer
● Internal Oblique Muscle
 ● External Oblique Muscle
● Transversus Abdominis Muscle
● Transversalis Fascia
● Extraperitoneal Fascia
● Parietal Peritoneum

6.4 Common Abdominal Incisions

● Kocher’s incision (Subcostal)

○ It affords excellent exposure to gallbladder and biliary tract and can be
made on the left side to afford access to spleen.
○ Started at midline, 2 to 5 cm below the xiphoid, and extends downwards,
outwards and parallel to and about 2.5 cm below costal margin.
○ Especially used in cholecystectomy.
● Lanz Incision
○ Used to access the appendix (for appendectomies)
○ It is a variation of McBurney's incision that is made at the same point but
in a transverse plane.
○ It gives cosmetically good scars.

● Midline Incision
○ Allows the majority of the abdominal viscera to be accessed
○ It is used for a wide array of abdominal surgery
○ This incision will cut through the skin, subcutaneous tissue, and fascia,
the linea alba and transversalis fascia and the peritoneum before
reaching the abdominal cavity
○ Causes minimal blood loss or nerve damage
○ Can be used for emergency procedures
● Paramedian Incision
○ Used to access the lateral viscera (kidneys, spleen, and the adrenal
glands)
○ Runs 2-5 cm away from the midline cutting through the skin,
subcutaneous tissue and the anterior rectus sheath
○ It offsets vertical incision to right or left, providing access to lateral sutures
such as spleen or kidney.
○ This incision takes a long time and is difficult
○ It may damage the muscles lateral blood and nerve supply which may
result in the atrophy of the muscle medial to the incision

● Transverse incision
○ Provide adequate access to the pelvis and pelvic regional nodes, but
relatively poor access to the upper abdomen.
○ Made to run parallel to the costal margin
○ May heal more securely than vertical ones and more easily concealed
under clothing than the more versatile vertical midline incision.
 ● Pfannenstiel Incision
○ Curved incision 10 to 15 cm long and 2 cm above the symphysis pubis
○ Skin and rectus sheath are opened transversely and the fascia is
dissected along the rectus muscles
○ The patient’s position for this incision can be lithotomy, supine, or
modified dorsal supine lithotomy.

6.5 Different types of

● Sutures
○ Classified into two types of sutures: Absorbable and Non-absorbable
■ Absorbable
 ●Will break down harmlessly in the body over time without
intervention
● Degrade, loses tensile strength within 60 days
➢ Types of absorbable sutures:
● Gut
● Polydioxanone (PDS)
● Poliglecaprone (MONOCRYL)
● Polyglactin (VICRYL)
■ Non-absorbable
● Does not break down in the body
● Need to be removed by the doctor at a later date or in
some cases left in permanently
➢ Types of nonabsorbable sutures:
● Nylon
● Polypropylene
● Silk
● Polyester (Ethibond)

● Suture Needles
○ Taper Point
○ Blunt Taper Point
○ Reverse Cutting Edge
○ Cutting Edge
○ Micro-Point Spatulated Curved

● Blades
❏ No. 10
● Blade is generally used for making small incisions in skin and
muscle
● Blade with curved belly
❏ No. 11
● Is an elongated triangular blade sharpened along the hypotenuse
edge with a strong pointed tip which is ideal for stab incisions
● A blade with a straight and an angled edge with a pointed end.
❏ No. 12
● Is a small, pointed, crescent shaped blade sharpened along the
edge of the curve.
● Used in removing sutures, parotid and cleft palate surgeries.
❏ No. 15
● has a small curved cutting edge (short and precise incisions)
❏ No. 23
● A blade with a curved cutting edge.
● The opposite side is blunt
 ● Used in making long incisions
❏ No. 26
● A blade with a straight cutting edge.
● The opposite side is straight and blunt with a downward angle.

7. Differentiate:
7.1. Sterilization process as to its:
7.1.1. Types:
7.1.1.1. ​Radiation​ - the use of a radioactive substance in the diagnosis or
treatment of the disease.

7.1.1.2. ​Boiling water ​- is used as a method of making it portable by

killing microbes that may be present.
- The sensitivity of different microorganisms to heat varies, but if
water is held at 70 °C (158 °F) for ten minutes, many organisms
are killed, but some are more resistant to heat and require one
minute at the boiling point of water.

7.1.1.3. ​Dry heat ​- a thermal effect produced by adding dry air or

reducing the humidity of the environment.
- Oxidative damage.
- Toxic effects of increased level of electrolytes

7.1.1.4. ​Steam sterilization ​- the destruction of all forms or microbial life

on an object by exposing the object to moist heat for 15 minutes at 121F
(49.44C) under high pressure

7.1.1.5. ​Moist Heat ​- to reduce inflammation and pain, stimulate

circulation, and relieve symptoms as directed by a physician.
- Protein denaturation and coagulation
- Hydrolysis and breakdown of bacterial protein
7.1.2. ​ Advantages and disadvantages:

STERILIZATION ADVANTAGES DISADVANTAGES

● Heat Sterilization ● It is the simplest most ● Relatively slow and

effective and many objects cannot
inexpensive method withstand the higher
 temperature.

○ Dry Heat ● It does not cause ● It is relatively slow

metals to corrode or (can take a couple
rust hours)
● It is relatively ● Many objects cannot
inexpensive withstand the very
● It does not release high temperatures
any harmful or required for dry heat
hazardous fumes or sterilization
pollutants
● Non stainless steel
○ Steam (Moist ● Good penetration metal items corrode
Heat) ● Maintain integrity of ● May damage plastic
liquids due to the and rubber items
100% humidity within ● Sharp instruments get
the chamber. dulled.
● It stains including
unprotected skin

● Chemical Sterilization ● Has excellent stability ● Difficult to operate

over a wide range of ● Unsuitable for hospital
pH 3-9 but used in industry
(.e.g. For disposable
○ Gas ● The equipment are materials that can not
Sterilization very effective and tolerate high
reliable in destroying temperature)
pathological
microorganisms along ● The process is a bit
with their spores. lengthier than steam
● They are perfect for sterilization or other
devices and methods.
substances that
cannot tolerate high
temperature.
● This process is ideal
for humidity sensitive
devices too.
● They are material
compatible. They can
perform the
sterilization operation
on almost any kind of
material.
 ○ Liquid ● Extremely effective a
Sterilization killing vegetative
organisms and spores
● Radiation ● High penetration
power
● Clear process
● Dry process
● Ensures full exposure
of object from all
directions
● When sterilizing
liquids and may
contains consideration
hazard potential, if the
sterilization process is
not carried out
properly, as this type
of cooling requires the
liquid to be cooled
down to boil.
● Expensive
● Long process
● Pose threat to human
(radiation)
● Requires very
qualified personnel

7.2 ​Types of anesthesia:

7.2.1. ​Inhalation anesthetics - used during the third stage of anesthesia
delivered via nose
- Gas or volatile liquid that produces general anesthesia when inhaled. The
older agents, ether and cyclopropane, have been replaced by halothane,
enflurane and isoflurane. injectable anesthetic. sedative-hypnotic drugs
produce anesthesia when administered in large doses.
- cause respiratory depression, a decrease in arterial blood pressure and
cerebral metabolic demand, and an increase in cerebral blood flow. While
side effects differ based on the substance (e.g., ​halothane can cause
hepatotoxicity), the most common side effect is nausea.

7.2.2 ​Regional Anesthesia

- Regional anaesthesia involves the injection of local anaesthetic
around major nerve bundles.
- Once local anesthetic is injected in the desired region, patients
may experience numbness and tingling in the area supplied by the
nerves and it may become difficult or impossible to move that part
of the body.
 A. Epidural Anesthetic ​- a type of regional
anaesthetic usually used to numb the lower half of
the body and good for pain relief - for example,
during labour and childbirth.
B. Spinal Anesthetic - a type of regional anaesthetic
about 3 hours to lower parts of the body so that
surgery can be safely carried out in this area.
Examples: Lidocaine, Lignocaine, Bupivacaine,
Tetracaine
7.1.3.3. ​Topical anesthesia - is limited to mucous membranes broken or
unbroken skin surface and burn.
- is a local anesthetic that is used to numb the surface of a body part. They
can be used to numb any area of the skin as well as the front of the
eyeball, the inside of the nose, ear or throat, the anus and the genital
area.
7.1.3.4. ​Local anesthetics
- block pain at the site where the drugs is administered allowing
consciousness to be maintained.
- Local anesthesia involves the injection of local anaesthetic into the tissue
near the surgical site.
- It is usually used for minor surgery, such as toe nail repair, skin lesion or
a cut to remove something (Biopsy)
Example of Local Anaesthetics:
> Lidocaine
- Lidocaine is a local anesthetic (numbing
medication). It works by blocking nerve
signals in your body. Lidocaine injection is
used to numb an area of your body to help
reduce pain or discomfort caused by
invasive medical procedures such as
surgery, needle punctures, or insertion of a
catheter or breathing tube.
> Prilocaine
- Prilocaine is an aminoamide local
anesthetic. It can be used on its own, but it
is also included in the formulation known as
Emla, a eutectic combination of prilocaine
with lidocaine (25 mg/ml each), which is
used as a local anesthetic in topical
administration for, for example, superficial
surgery and venepuncture.
8. Show the common Operative Checklists needed for surgery:

8.1 Consent Form

A consent form is a legal document that is signed by the patient before a medical
procedure that includes information on possible risks and benefits. If the patient chooses to take
part in the treatment, proceduce, trial or testing, he or she signs the consent form. This also
gives the doctor the permission to proceed with the treatment planned and it serves as evidence
that the patient gave consent.
8.2 Pre-operative Checklist

Documentation of the information found on the pre-operative checklist is valuable for preventing
errors in caring for the patient during the surgery and it provides an extra measure of the
patient’s safety. It also allows to detect difficulties or problems in preoperative which can
endanger the patient’s life or the expected result of the surgery. Is there where you must
generate protocols that ensure safety for patients, decreasing the maximum errors and comply
with the premise made by WHO in 2008: “Safe surgery saves lives”.
 8.3 WHO Surgical Safety Checklist

The WHO Surgical Safety Checklist was made to decrease errors and adverse events during
the procedure and to increase teamwork and communication in surgery, in order to significantly
reduce both morbidity and mortality rates. The designated checklist coordinator, which is most
often the circulating nurse, is responsible for checking the boxes on the list, but it can also be
any other clinician or healthcare professional who is part of the operation.

Before the introduction of anesthesia

The person coordinating the checklist will verbally review with the patient (if possible) that
his/her identity has been confirmed, that the procedure and site are correct and that consent
has been given. The coordinator will visually confirm of the site has been marked and that the
pulse oximeter is well functioning and already on the patient. Then the coordinator will verbally
review with the anesthesia professional of the patient’s risk for blood loss, airway difficulty and
allergies and if the full anesthesia safety check has been completed. Ideally, the surgeon should
also be present because he/she has a clearer idea of the patient’s risk factors. However, the
surgeon’s presence is not essential for completing this part.
Before skin incision
The team will introduce themselves to each other or confirm that everyone in the room is known
to each other. The team will pause before the skim incision to confirm out loud that they are
performing the correct operation on the correct patient and site. Then the team will review with
each other the critical elements of their plans for the operation using the checklist as a guide.
They will confirm prophylactic antibiotics have been given within the previous 60 minutes and if
essential imaging is displayed appropriately.
Before patient leaves the operating room
The team will review the performed operation, completion of sponge and instrument counts and
labelling of specimens obtained, including any instruments that malfunctioned or had issues.
Then they will review key plans and concerns about the postoperative management and
recovery before the patient is moved out from the operating room
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