Chronic Illness-2

Introduction
A chronic disease/ non communicable disease  (disease that persists for a long time)
is one lasting 3 months or more, by the definition of the U.S. National Center for
Health Statistics.

 Chronic diseases generally cannot be prevented by vaccines  or cured by

medication, nor do they just disappear.
 Eighty-eight percent of Americans over 65 years of age have at least one
chronic health condition (as of 1998).
 Globally, of the 58 million deaths in 2005, approximately 35 million will
be as a result of chronic diseases. They are currently the major cause of
death among adults in almost all countries and the toll is projected to
increase by a further 17% in the next 10 years.
 Globally, approximately one in three of all adults suffer from multiple
chronic conditions.[
 Health damaging behaviors - particularly tobacco use, lack of physical
activity, and poor eating habits - are major contributors to the leading
chronic diseases. Obesity incidences are increasing worldwide, and
incidence of type 2 diabetes is growing
 Chronic diseases tend to become more common with age.

The leading chronic diseases in developed countries include (in alphabetical order)
arthritis, cardiovascular disease eg.heart attacks and stroke, cancer eg breast and
colon cancer, diabetes, epilepsy and seizures, obesity, and oral health problems.
Each of these conditions plague older adults.
This rise in CDs is a very serious situation, both for public health and for the
societies and economies affected. Until recently, the impact and profile of chronic
disease has generally been insufficiently appreciated.

Characteristics of a Chronic Diseases

Chronic illnesses are mostly characterised by:

 complex causes
 many risk factors
 long latency periods (time between onset of the illness and feeling its
effects)
 a long illness
 functional impairment or disability.

Most chronic illnesses do not fix themselves and are generally not cured completely.
  Some can be immediately life-threatening, such as heart disease and
stroke.
 Others linger over time and need intensive management, such as
diabetes.
 Most chronic illnesses persist throughout a person’s life, but are not
always the cause of death, such as arthritis.

Common Chronic Diseases

While many illnesses can be considered chronic, 13 major chronic conditions that
are a significant burden in terms of morbidity, mortality and healthcare are:

 heart disease 
 stroke
 lung cancer 
 colorectal cancer 
 depression 
 type 2 diabetes 
 arthritis
 osteoporosis
 asthma 
 obesity 
 chronic obstructive pulmonary disease (COPD )
 chronic kidney disease 
 oral disease.

Common stresses of Chronic Diseases

Chronic or long-term illness and its treatment pose special problems. People living
with CD need to

 deal with the treatments

 make sure understand the condition and management strategies
 maintain emotional balance to cope with negative feelings
 maintain confidence and a positive self-image.[

Comorbidity of CDs
Comorbidity refers to the occurrence of two or more conditions or diseases in a
person at one time. Chronic conditions often occur together.
In Australia, like many nations, the rate is higher for:

 people aged 65 and over (60%) compared with people aged 0–44 (9.7%)
 females (25%) compared with males (21%)
 people in the lowest socioeconomic areas (30%) compared with those in
the highest socioeconomic areas (19%)
  people living in Regional and Remote areas (28%) compared with those
in Major cities (21%).

The most common combination—or comorbidity—is arthritis with cardiovascular

disease (7.4%), followed by arthritis with back pain and problems (5.1%), and back
pain and problems with cardiovascular disease (5.0%).
Some chronic diseases may act as a precursor or as a risk factor for other chronic
diseases. eg diabetes is known to be a risk factor for developing cardiovascular
disease; asthmatics are at greater risk of developing chronic obstructive pulmonary
disease later in life.
Management / Interventions
Chronic Diseases – including cardiovascular diseases, cancer, chronic respiratory
diseases and diabetes – kill 41 million people every year. Prevention and investment
in CDs is important.

 Investing in better management of CDs is critical.

 Management of CDs includes detecting, screening and treating these
diseases, and providing access to palliative care for people in need.
 High impact essential CD interventions can be delivered through a
primary health care approach to strengthen early detection and timely
treatment.
 Evidence shows such interventions are excellent economic investments
because, if provided early to patients, they can reduce the need for more
expensive treatment.
 Countries with inadequate health insurance coverage are unlikely to
provide universal access to essential CD interventions.
 CD management interventions are essential for achieving the global
target of a 25% relative reduction in the risk of premature mortality from
CDs by 2025, and the SDG target of a one-third reduction in premature
deaths from CDs by 2030.

Conclusion
Chronic diseases are already the major cause of death in almost all countries, and the
threat to people’s lives, their health and the economic development of their countries
is growing fast.

 Chronic diseases are the leading cause of death and disease burden
worldwide, in all WHO regions except Africa.
 Chronic diseases are the leading cause of death in all World Bank
income groups (four income groups — high, upper-middle, lower-
middle, and low).
 The death and burden of disease rates are similar in men and women and
increase with age.
  Chronic disease death rates are higher in low and middle income
countries than in high income countries.
 Some 45% of chronic disease deaths and 86% of the burden of chronic
diseases occur in people under 70 years of age
 The knowledge exists to deal with this threat and to save millions of
lives.
 Effective and cost-effective interventions, and the knowledge to
implement them, have been shown to work in many countries.
 If existing interventions are used together as part of a comprehensive,
integrated approach, the global goal for preventing chronic diseases can
be achieved. The question is how governments, the private sector and
civil society can work together to put such approaches into practice.

PERI-OPERATIVE NURSING
PERIOPERATIVE NURSING: GENERAL CONSIDERATION
Conditions Requiring Surgery:
a. Obstruction or blockage (Impairment to the flow of vital fluids)
b. Perforation or rupture of an organ
c. Erosion or wearing away of the surface of a tissue
d. Tumors or abnormal growth
Categories of Surgical Procedures:
According to Purpose:
a. Diagnostic: to verify suspected diagnosis, e.g. biopsy
b. Exploratory: to estimate the extent of the disease, e.g. exploratory
laparotomy
c. Curative: to remove or repair damaged or diseased organs or tissues
a. Types of Curative Surgery:
 i. Ablative: removal of diseased organs. (-ectomy) e.g.
appendectomy, hysterectomy
ii. Reconstructive: partial or complete restoration of a damaged
organ, e.g. plastic surgery after burns
iii. Constructive: repair of a congenitally defective organ, (-plasty, -
orrhaphy, -pexy) e.g. cheiloplasty, orchidopexy
d. Palliative: to relieve pain, relieve distressing S/Sx
e. Cosmetic:
According to Degree of Risk to Client:
a. Major surgery
Major surgery: High degree of risk
 Prolonged intraoperative period
 Large amount of blood loss
 Extensive, vital organs may be handled or removed
 Great risk of complications, e. g. liver biopsy
b. Minor surgery
Minor surgery: Lesser degree of risk to the client
 Generally not prolonged; described as “one-day surgery” or
outpatient surgery
 Leads to few serious complications
 Involves less risk, e.g. cyst removal
According to Urgency:
a. Emergency: must be performed immediately without delay, e.g. gunshot
wound, severe bleeding,
b. Imperative or Urgent: must be performed as soon as possible within 24 –
48 hours, e.g. appendectomy
c. Required: necessary for the well-being of the client, usually within weeks
to months, e. g. cholecystectomy, cataract extraction, thyriodectomy
d. Elective: should be performed for the client’s well being but which is not
absolutely necessary, e.g. simple hernia, vaginal repair, repair of scar
e. Optional: surgery that a client requests, e.g. rhinoplasty, liposuction,
mammoplasty
Factors that Affect the Estimation of Surgical Risk
a. Physical and Mental Condition of the Client
 Age: premature babies and elderly persons are at risk
 Nutritional status: malnourished and obese are at risk
 State of fluid and electrolytes balance: dehydration and hypovolemia
predispose a person to complications
 General health: infectious process increase operative risk
 Mental health
 Economic and occupational status
b. Types of drugs taken regularly:
i. Steroids: may improve the body’s ability to response to the stress of
anesthesia and surgery
ii. Anticoagulants and salicylates: may increase bleeding during surgery
iii. Antibiotics: maybe incompatible with or potentiate anesthetic agents
iv. Tranquilizers: potentiate the effect of narcotics and can cause
hypotension
v. Antihypertensives: may predispose to shock by the combined effect
of blood pressure reduction and anesthetic vasodilation
vi. Diuretics: may increase potassium loss
vii. Alcohol: will place the surgical client at risk when used chronically
c. The Extent of the Disease
d. The Magnitude of the Required Operation
e. Resources and Preparation of the Surgeon, Nurses, and the Hospital
Suffixes Related to Surgery:
-ostomy (make artificial opening) Colostomy
-otomy (cut into or incision) Phlebotomy
-plasty (plastic repair) Rinoplasty
-orrhaphy (suturing; repair) Herniorrhaphy
-oscopy (visual examination) Endoscopy
-ectomy (excision; removal) Cholecystectomy
PERIOPERATIVE NURSING: PHASES OF PERIOPERATIVE NURSING
 Because clients experience varying degrees of anxiety and deficient
knowledge related to surgery, careful planning by the nurse can help ensure a
positive outcome.
 Encompasses a client’s total surgical experience, including preoperative,
intra-operative, and postoperative phases
 Refers to activities performed by the professional nurse during these phases.
a. Pre-Operative Phase: begins with the decision to perform surgery and ends with
the client’s transfer to the operating room table
b. Intra-Operative Phase: begins with the client is received in the OR and ends with
his admission to the PARR or PACU
c. Post-Operative Phase: begins with the client is admitted to PARR or PACU and
extends through follow-up home or clinic evaluation
PERIOPERATIVE NURSING: THE PERIOPERATIVE TEAM
 The Surgeon
An Anesthesiologist or Nurse Anesthetist
Makes the preoperative assessment to plan for the type of anesthesia to be
administered and to evaluate the client’s status
The Professional Registered OR Nurse
Makes preoperative assessment and documents the perioperative client care plan
(Scrub, Circulating, PACU Nurse)
a. The Circulating Nurse
Manages the OR and protects the safety and health needs of the client by monitoring
the activities of the members of the surgical team and monitoring the conditions in
the OR
b. The Scrub Nurse
 Responsible for scrubbing for surgery, including setting up sterile tables and
equipment and assisting the surgeon and surgical technicians during the surgical
procedure
c. The PACU Nurse
Responsible for caring for the client until the client has recovered from the effects of
anesthesia, is oriented, has stable vital signs, and shows no evidence of hemorrhage
PERIOPERATIVE NURSING: PRINCIPLES OF PERIOPERATIVE
ASEPSIS
General:
a. Keep sterile supplies dry and unopened
b. Check package sterilization expiration date to verify sterility
c. Maintain general cleanliness in surgical suite
d. Maintain surgical asepsis: activities designed to keep sites free from the
presence of microorganisms throughout the procedure
Personnel:
a. Personnel with signs of illness should not report to work
b. Surgical scrub, a specific hand washing technique used by operating room
personnel designed to reduce microorganisms in the hands and arms, is done
for the length of time designed by hospital policy
Surgical Scrub
i. A sensor-controlled or knee- or foot-operated faucet allows the water to be
turned on and off without the use of the hands
ii. Remove all rings and watches
iii. Use liquid soaps to prevent the spread of organisms
iv. Keep the finger nails short and well-trimmed
v. Clean fingernails with a nail stick under running water
vi. Hold the hands higher than the elbows throughout the hand washing
procedure so that run-off goes to the elbows
vii. Allows the cleanest part of the arms to be the hands
viii. A scrub brush facilitates the removal of microorganisms
ix. Clean all areas of skin on the hands and arms in sequence starting at the hands
and ending at the elbows
 x.  After rinsing, dry the hands with paper towels, drying first one arm from the
hand to the elbow, then using a second towel to dry the second hand
Maintaining a Sterile Field (a microorganism-free area):
a. Create a sterile field using sterile drapes
b. Use the sterile field to place sterile supplies where they will be available
during the procedure
c. Drape equipment prior to use
d. Keep drapes dry and out of contact with nonsterile objects
e. Utilize sterile technique while adding or removing supplies from sterile fields
Sterile Supplies and Solutions:
a. Check expiration dates for sterility
b. Don’t use solutions that were opened prior to current use
c. “Lip” the solution after initial use by pouring a small amount of liquid out of
the bottle into a waste container to cleanse the bottle lip
PERIOPERATIVE NURSING: PRINCIPLES OF SURGICAL ASEPSIS
1. OR personnel must practice strict Standard Precautions (i.e., blood and body
substance isolation)
2. All items used in the sterile field must be sterile
3. Sterile objects become unsterile when touched by unsterile objects
4. Sterile items that are out of vision sterile or below the waist level of the
nurse are considered unsterile
5. Sterile objects can become unsterile by prolonged exposure to air-born
organism
6. The skin can not be sterilized and is unsterile
 All personnel must perform a surgical scrub
7. All OR personnel are required to wear specific, clean attire, with the goal of
“shedding” the outside environment.
 Specific clothing requirements are prescribed and standardized for all
ORs:
a. OR personnel must wear a sterile gown, gloves, and specific
shoe covers
b. Hair must be completely cover
 c. Masks must be worn at all times in the OR for the purpose of
minimizing air-borne contamination and must be changed
between operations or more often, if necessary
8. Any personnel who harbors pathogenic organisms must report themselves
unable to be in the OR to protect the client from outside pathogens
9. Scrubbed personnel wearing sterile attire should touch only sterile items
10. Sterile gowns and sterile drapes have defined borders for sterility.
 Sterile surfaces or articles may touch other sterile surfaces or articles
and remain sterile.
 Contact with unsterile objects at any point renders a sterile area
contaminated.
11. The circulator and unsterile personnel must stay at the periphery of the of the
sterile operating area to keep the sterile area free from contamination
12. Sterile supplies are unwrapped and delivered by the circulator following
specific standard protocol so as not to cause contamination
13. The utmost caution and vigilance must be used when handling sterile fluids
to prevent splashing or spillage
14. Anything that is used for one client must be discarded or, in some cases, re-
sterilized

PERIOPERATIVE NURSING: PREOPERATIVE PHASE

 Begins at the time of decision for surgery and ends when the client is
transferred to the OR
 This period is used to physically and psychologically prepare the client for
surgery
 The nurse plays a major role in client teaching and in relieving the client’s
and the family’s anxieties
Goals:
a. Assessing and correcting physiologic and psychologic problems that might
increase surgical risk
 b. Giving the person and significant others complete learning/ teaching
guidelines regarding surgery
c. Instructing and demonstrating exercises that will benefits the person during
post-op period
d. Planning for discharge and any projected changes in lifestyle due to surgery
Psychologic Preparation for Surgery
 Preparation for hospital admission: includes explanation of the procedure to
be done, probable outcome, expected duration of hospitalization, cost, length
of absence from work, and residual effects
Causes of Fears:
 Fear of the unknown
 Fear of anesthesia, vulnerability while unconscious
 Fear of pain
 Fear of death
 Fear of disturbance of body image
 Worries: loss of finances, employment, social and family roles
Manifestations of Fears:
 Anxiousness
 Confusion
 Anger
 Tendency to exaggerate
 Sad, evasive, tearful, clinging
 Inability to concentrate
 Short attention span
 Failure to carry out simple directions
 Dazed
Nursing Interventions to Minimize Anxiety:
 Assess client’s fears, anxieties, support systems, and patterns of coping
 Establish trusting relationship with client and significant others
 Explain routine procedures, encourage verbalization of fears, and allow
client to ask questions
 Demonstrate confidence in surgeon and staff
 Provide for spiritual care if appropriate
Legal aspect: “Informed Consent”, operative permit, surgical consent
  This is to protect the surgeon and the hospital against claims that
unauthorized surgery has been performed and that the patient was unaware
of the potential risks of complications involved
 Protects the client from undergoing unauthorized surgery
a. The Surgeon obtains operative permit or informed consent:
 Surgical procedure, alternatives, possible complications,
disfigurements, or removal of body parts are explained
 Note: It is part of the nurse’s role as a client advocate to confirm
that the client understands information given.
b. Informed consent is necessary for each operation performed,
 It is also necessary for major diagnostic procedures where major body cavity is
entered, e.g. thoracentesis
c. Adult client (over 18 years of age) signs own permit unless
unconscious or mentally incompetent
 If unable to sign, relative, (spouse or next of kin) or guardian will sign
 In an emergency, permission via the telephone is acceptable; have a
second listener on phone when telephone permission being given
Consents are not needed for emergency care if all four of the following
criteria are met:
i. There is an immediate threat to life
ii. Experts agree that it is an emergency
iii. Client is unable to consent
iv. A legally authorized person cannot be reached
d. Minors (under 18) must have consent signed by an adult (i.e. parent or
legal guardian). An emancipated minor may sign own consent:
i. Married,
ii. College student living away from home,
iii. In military service,
iv. Any pregnant female or anybody who has given birth
v. Witness to informed consent may be nurse, other physician,
clerk, or authorized person
e. If nurse witnesses informed consent, specify whether witnessing
explanation of surgery or just signature of client
Physiologic Preparation Prior to Surgery:
a. Respiratory preparation: chest x-ray
b. Cardiovascular preparation: ECG, CBC, blood typing, cross-matching,
PT/PTT (prothrombin time, partial thromboplastin time), serum electrolytes
c. Renal preparation: urinalysis
Obtain history of past medical conditions, allergies, dietary restrictions, and
medications:
A– Allergy to medications, chemicals, and other environmental products such as
latex
 All allergies are reported anesthesia and surgical personnel before the
beginning of surgery
 If allergy exist, an allergy band must be placed in the client’s arm
immediately
B – Bleeding tendencies or the use of medications that deter clotting, such as
aspirin, heparin, and warfarin sodium.
 Herbal medications may also increase bleeding time or mask potential
blood-related problems
C – Cortisone and steroid use
D – Diabetes mellitus, a condition that not only requires strict control of blood
glucose levels but also known to delay wound healing
E – Emboli; previous embolic events ( such as lower leg blood clots) may recur
because of prolonged immobility
Instructional and Preventive Aspects:
 Frequently done on an out-client basis
 Assess the client’s level of understanding of surgical procedure and its
implications
 Answer questions, clarify and reinforce explanations given by surgeon
 Explain routine pre and post procedures and any special equipment to be used
 Deep breathing exercises: use of diaphragmatic and abdominal breathing
 Coughing exercise: deep breath, exhale through the mouth, and then follow
with a short breath while coughing; splint thoracic and abdominal incision to
minimize pain
 Turning exercise: every 1-2 hours post-operative
 Extremity exercise: prevents circulatory problems and post operative gas pains
or flatus
 Assure that pain medications will be available post-op
Physical Preparation
On the Night of the Surgery:
a. Preparing the client’s skin: shave against the grain of the hair shaft to ensure
clean and close shave
b. Preparing the GIT:
 NPO after midnight
 Administration of enema may be necessary
 Insertion of gastric or intestinal tubes
c. Preparing for Anesthesia
 Promoting rest and sleep: use of drugs
∞ Barbiturates: Secobarbital Na, Pentobarbital Na
∞ Non barbiturates: chloral hydrate, Flurazepam
Note: given after all pre-op treatments have been completed.
On the Day of Operation:
a. Early morning care: about 1 hour before the pre-operative medication
schedule
 Vital signs taken and recorded promptly
 Patient changes into hospital gown that is left untied and open at the back
 Braid long hair and remove hair pin
 Provide oral hygiene
 Prosthetic devices, eyeglasses, dentures removed
 Remove jewelries
 Remove nail polish
 Patient should void immediately before going to the OR
 Make sure that the patient has not taken food for the last 10 hours by asking the
client
 Urinary catheterization may be performed in the OR
b. Pre-Operative Medications:
Generally administered 60-90 min before induction of anesthesia
Purpose:
i. To allay anxiety: the primary reason for pre-operative medications
ii. To decrease the flow of pharyngeal secretions
iii. To reduce the amount of anesthesia to be given
 iv. To create amnesia for the events that precedes surgery
Types of Pre-Operative Medications:
1. Sedative:
 Given to decrease client’s anxiety to lower BP and PR
 Reduce the amount of general anesthesia: an overdose can result
to respiratory depression
∞ e.g. Phenobarbital
2. Tranquilizer:
 Lowers the client’s anxiety level
∞ e.g. Thorazine 12.5 - 25 mg IM 1-2 hours prior to surgery
3. Narcotic analgesia:
 Given to reduce patients to reduce anxiety and to reduce the
amount of narcotics given during surgery
∞ e.g. Morphine sulfate 8-15 mg SC 1 hour prior to preoperative;
*Can cause vomiting, respiratory depression and postural
hypotension
4. Vagolytic or drying agents:
 To reduce the amount of tracheobronchial secretions which can
clog the pulmonary tree and result in atelectasis and pneumonia
c. Recording: all final preparation and emotional response before surgery
should be noted down
d. Transportation to the OR, *Woolen or synthetic blankets must never be sent
to the OR because they are source of static electricity

Nursing Diagnosis for Preoperative Client

 Anxiety related to lack of knowledge about preoperative routines, physical
preparation for surgery, post operative care and potential body image change

PERIOPERATIVE NURSING: INTRAOPERATIVE PHASE

 Begins the moment the patient is anesthetized and ends when the last stitch
or dressing is in place
  Anesthesia – A state or narcosis, analgesia, relaxation and reflex loss (severe
central nervous system [CNS] depression produced by pharmacologic agent)
Activities during the Intra-op
• Provide patient safety,
• Maintain an aseptic environment
• Ensure proper function of the equipment's,
• Position the client,
• Emotional support,
• Assisting the surgeon as
• scrub nurse,
• circulating nurse,
• nurse assistant,
OPERATING ROOM ENVIRONMENT CONTROL
AIM: The surgical suite should be designed in such a way as to minimize and control the
spread of infectious organisms

ACCESS CONTROL
OPERATING ROOM COMPLEX DIVIDED INTO 3 AREAS
1. UNRESTRICTED AREA
 Areas outside the theatre complex including control point to monitor
the entrance of patients, personnel, visitors, etc
----------------- RED LINE ------------------
 Street clothes are permitted in the area
 Traffic is not limited

2. SEMI RESTRICTED AREA

1. Peripheral support areas within theatre complex, includes corridors
leading to operating rooms, work areas (storage) etc.
2. All persons must wear scrub attire which should be made of low
linting material that minimizes bacterial shedding, comfortable,
clean and provides a professional appearance
3. RESTRICTED AREA
 1. Includes operating rooms, scrub areas and ante-rooms
2. Personnel must wear full surgical attire, hair coverings, masks
where open sterile supplies and scrubbed persons are present
3. Masks are worn to reduce the dispersal of microbial droplets from
the mouth and naso-pharynx of personnel – high filtered
4. Masks must cover the mouth and nose entirely, and be tied securely
to prevent venting
5. Metal strip in the top hem of the masks produces a firm contoured kit
over the bridge of the nose
Four Stages of Anesthesia:
a. Stage I: Onset [Beginning of Anesthesia]
 Patient breath in the anesthetic mixture
 Warmth, dizziness, & feeling of detachment may be experienced
 Ringing, roaring, or buzzing in the ears
 Inability to move extremities
 Surrounding noise is exaggerated
 Still conscious
 Stage II: Excitement
 Struggling, shouting, singing, laughing or crying may be experienced
 Pupils dilate but PERRLA, rapid PR, irregular RR
 Patient restrain might be necessary
b. Stage III: Surgical Anesthesia
 Continued administration of anesthetic agent
 RR, PR normal, skin pink and flushed
 Patient is unconscious
 Stage IV: Danger Stage [Medullary Depression]
 Reached when to much anesthesia has been administered
 Respiration shallow, pulse weak, pupils dilate
 Cyanosis develops, without prompt intervention death may ensue
Stages of Anesthesia, summary:
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Types of Anesthesia:
a. General Anesthesia: a state of analgesia, amnesia, and unconsciousness
characterized by the loss of reflexes and muscle tone
i. Inhalation Anesthesia
Advantage: prevention of pain and anxiety
Disadvantage: circulatory and respiratory depression
* Highly inflammable and explosive
Safety rules:
 Do not wear slips, nylons, wool, or any material which can set-off sparks
 No smoking 12 hours after the operation
 Do not wear shoes that are not conductive
 Do not rise bed materials that are not conductive, e.g. volatile liquid:
halothane, ether; gas anesthetic: e.g. nitrous oxide, cyclopropane
ii. Intravenous Anesthesia: usually employed as an induction prior to
administration of the more potent inhalation anesthetic agents. Used
commonly in minor procedure
Advantage:
 Rapid pleasant induction
 Absence of explosive hazards
 Low incidence of nausea and vomiting
Disadvantage:
 Laryngeal spasm and bronchospasm
 Hypotension
 Respiratory arrest, e.g. Thiopental Na (Pentothal Na), Ketamine
( Ketalar), Fentanyl ( Innovar)
b. Regional Anesthesia: it is the injection or application of a local anesthetic
agent to produce a loss of painful sensation in only one region of the body
and does not result to unconsciousness
i. Topical anesthesia: e.g. lidocaine
ii. Infiltration anesthesia
 Nerve block
 Epidural block
  Caudal block
 Pudendal block
iii.  Spinal anesthesia, e.g. Saddle block for vaginal delivery
iv. Local anesthesia, e.g. Procaine, Lidocaine (Xylocaine)
c. Specialized Methods of Producing Anesthesia:
i. Muscle relaxants: it is a neuromuscular blocking agent used to provide
muscle relaxation
 Use: for endotracheal intubation, e.g. Pancuronium bromide
(Pavulon), Curarine chloride (Curare)

ii. Hypothermia: it refers to the deliberate reduction of the patient’s body

temperature between 28°-30° C
 Uses: Heart surgery, Brain surgery, Surgery on large vessels
supplying major organs
Methods:
 Ice water immersion
 Ice bags
 Cooling blanket
Complications:
 Cardiac arrest
 Respiratory depression
Common Surgical Positions
1. dorsal recumbent- for abdominal surgery such as bowel resection; chest
surgery such as mastectomy

2. Trendelenburg- for abdominal/ pelvic surgery as the intestines are displaced

into the upper abdomen
 3. Dorsal lithotomy- for vaginal and rectal surgery

4. Prone- for spinal or back surgery

5. Kraskel/ jack knife- for hemorrhoids or proctologic

6. Reverse trendelenburg- for gall bladder or biliary tract procedure

7. Neurosurgical sitting- for intra cranial procedures

Position Patient during Surgery

 Abdominal surgeries Supine
Bladder surgery Slightly trendelenburg
Perineal surgery Lithotomy
Brain surgery Semi-fowler’s
Spinal cord surgeries Prone mostly
Lumbar puncture Side lying, flexed body

Positioning the Client:

 Commonly Used Operative Positions
 Supine: hernia repair, explore lap, cholecystectomy, mastectomy
 Prone: spine surgery, rectal surgery
 Trendelenburg
 Reverse Trendelenburg
 Lithotomy position
 Lateral position: kidney and chest surgery
 Others: for thyroidectomy- head hyperextended
What is surgical skin prep?
 an aseptic procedure that is used to reduce the resident and transient flora
naturally present on the skin surface.
 Accomplished by application of anti-microbial agents.
 Rendering the skin “surgically clean”
 Is performed by the circulating nurse prior to draping
Antimicrobial Solutions
1. Povidone /Iodine Betadine
 Rapid acting
 Have a broad spectrum of activity
 Have minimal harsh effect on skin
 Inhibit rapid rebound of microbes
 Economical to use
 Based on documentation in scientific literature

Special Areas of Consideration

 Eyes
 Traumatic open wounds
 Fractures
  Tumors, Aneurysm and Ovarian Cyst
 Dirty Contaminated Areas
 Emergency Preps
Abdominal Prep
 Breastline to upper 3rd of thigh
 Table line to table line when in supine position

Chest and Breast

 Shoulders
 Upper arm – elbow
 Axilla
 Chest wall to table-line and 2 inches beyond the sternum to the
opposite shoulder

Preparation of the Head for Craniotomy

Preparation of the neck for Otological surgery

Preparation of the Neck & Thorax for Thyroidectomy

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