PATIENT – most important member of the health team
SURGERY
Minimally invasive surgery – surgical procedure that
use specialized instruments inserted into the body
either through natural orifices or through small incision
Physiotherapy – helps restore movement and function
when someone is affected by injury, etc.
PERIOPERATIVE – time period describing the duration
of a patient’s surgical procedure
3 phases:
Preoperative Phase – begins with the discussion of the
patient and surgeon to proceed w/ surgical intervention
and ends w/ the transfer of patient onto the OR
Intraoperative Phase – begins when the patient is
transferred onto OR bed and ends with admission of the
patient to the recovery room or PACU
Postoperative Phase – begins with the admission of the
patient to the recovery room or PACU and ends with
discharge of the patient or follow-up evaluation in
clinical setting or home
SURGICAL CLASSIFICATIONS
1. Diagnostic – confirmation of suspected diagnosis
(ex.: you palpated a mass while doing BSE > you
go to doctor > doctor will order tissue biopsy to
check if cyst is benign or malignant)
2. Explorative – confirms type of and extent of disease
3. Reconstructive – repair of physical deformities;
improve appearance
(ex.: nose lifting, liposuction, breast reduction)
4. Curative – disease or damaged body organ or
structure is removed or repaired
(ex.: appendectomy)
5. Palliative – alleviates pain or other disease symptoms
but does not cure; slow progression but does not cure
(ex.: difficulty swallowing = NGT)
SURGERY BASED ON URGENCY
1. Emergent – requires immediate attention; w/o delay
> surgery w/in 1 to 2 hours
2. Urgent – patient requires prompt attention
> surgery w/in 24 to 48 hours
4. Elective – surgery is planned by the patient
> something wrong but can wait
> can have surgery anytime
PREOPERATIVE ASSESSMENT
1. Hx of previous surgery
 To avoid problems that can be encountered
(ex.: px undergone C/S 4x > skin is thin > teach px
coughing exercises & support w/ abdominal binder)
(ex.: pneumonectomy [1 lung left] > think of NI for
px with 1 lung)
2. Hx of allergy
 Seafood - anaphylactic shock
 Contains iodine, w/c can be seen in
the OR (as surgery prep)
 Ampicillin
3. Hx of chronic disease(s)
 DM, HPN, cancer, asthma
 To provide necessary medications
 To be alert for possible complications
 (HPN) – med: ASPIRIN – s/e: BLEEDING
>> STOP 5 to 7 days before surgery
** ask SINCE WHEN
** asymptomatic
 (DM) – under stress > ᛏ
metabolism/activities of cells > need
more glucose > alert hypothalamus >
hypothalamus release hormone to
stimulate adrenal cortex to produce
cortisol > alert liver to produce glucose
via glycogenolysis
 (FBS) – fasting blood sugar
- check before surgery if
HIGH
Stressors - bleeding – pain (surgery) > postoperative pain >
after surgery you can’t eat – NPO > cortisol > glycogenolysis &
gluconeogenesis > lots of glucose in blood > blood is viscous >
slow circulation > px is under stress, stimulate SNS, constrict
BV > still slow circulation > less blood is going to the wound >
slow healing
*px that will undergo surgery will have hyperglycemia
4. Hx of smoking
 1 month stop before surgery
 ᛏ risk of post-op complications
 (Nicotine) causes vasoconstriction, ∴ less
blood supply >> wound will not heal faster
 Paralyzes cilia (found in the lining of
trachea) – px stay in the hosp. for several
 days (prone to infectious disease) – can’t
cough || unconscious
 Produces CO
 when a person smokes, CO is
produced
 RBC (hemoglobin inside RBC) attach
with O2 from the lungs, but
smoking produces CO (3rd gas) > the
hemoglobin (carrier of O2) in the
RBC is 200x more attracted to CO
than O2 > less O2 is distributed to
different parts of the body > slow
healing
5. Height and Weight
 For drug calculation
6. Vital signs
 For baseline data
7. Medications
 Aspirin – stop for 5-7 days because s/e is
bleeding
Demerol - make patient sleep
Valium – make patient sleep
POSTOP EXERCISES
(to be taught preoperatively)
*let client demonstrate
1. Breathing
- lungs will temporarily collapse when given anesthesia
(general)
- position: SITTING
- to dilate airways
- to expand lung tissue surface, thus improving
respiratory gas exchange
- stimulates production of surfactant: alveoli contain
water molecules > can be attracted to each other >
once attracted, alveoli will collapse > surfactant present
as early as 8 mos. > it will prevent attraction of water
molecules so alveoli will not collapse
2. Splinting
-

3. Deep breathing exercises

- to dilate airways
CONSENT
- stimulates production of surfactant
- patient’s autonomous decision about whether to
- to expand lung tissue surface, thus improving
undergo a surgical procedure
respiratory gas exchange (takes place in alveoli)
- protects patient and the consultant
*diaphragm – separate thoracic from abdominal organs
- nurses act as WITNESS
= breathing > push diaphragm down > giving enough
- before giving preop meds, px should be awake and let
space for the lungs to expand
them sign the consent
- legally responsible in obtaining consent: SURGEON
4. Coughing (breathing and coughing)
- explain procedure to px: SURGEON
- loosens secretions and forces them into the bronchus
- px ask about operation: talk to SURGEON
to be expectorated or suctioned
- position: sitting upright > push ab organs down and
more space for the lungs to expand
MUSCLES OF RESPIRATION
- 10x / hour, holding each breath for 3 secs. & cough
> External intercostals - to prevent atelectasis (collapse of lungs)
> Internal intercostals - pneumonia (inflamed lungs) – caused by
> Diaphragm – major muscle of respiration microorganism
- pushes organs downward, giving lungs enough - expand collapsed lung tissue
space
Contraindicated when:
*sign consent before giving…
- there’s ᛏ intracranial pressure
PREOP MEDICATIONS - eye surgery (ᛏ IOP)

Atropine sulfate - counteracts bradycardia d/t adverse 5. Incentive Spirometer

effect of anesthesia (temporarily collapse of lungs) - position: upright / semi-fowler’s
- for lung expansion
- px sit > exhale normally > put mouthpiece to lips > seal
with lips > breathe through the mouth >
 promote lung expansion and ᛏ respiratory
function
 causes maximal inspiration and ᛏ cardiac
output
- to the direction of hair growth
- not done anymore; open pores = infection
7. Bowel preparation
- enema = abdominal or cervical surgery
- to ensure bowel are cleared
- clear liquid diet = water, black coffee, black tea
- dulcolax (Bisacodyl)

*cardiac output – amount of blood ejected by the heart

per minute (5-8L/min) (SV x CR) PURPOSES OF PREANESTHETIC MEDICATIONS
1. Facilitation of anesthesia
ᛏ cardiac output – when doing breathing exercises 2. Lowering the dose of the anesthesia agent used
3. Reduction of pain and anxiety
*doing breathing exercises increases cardiac output,
therefore increasing the amount of blood going to
different body parts

6. Leg exercises
- contract muscle > squeeze vein > push blood back to
the heart = diminishing fluid in the legs

Viscous blood because not moving

Venous stasis –

Accumulated blood becomes viscous – can be clotted

7. ROM exercises
- to prevent joint rigidity and muscle contracture
- 3 to 5 times per day

PREOP TEACHING

CLIENT PREPARATION
1. NPO status
- px under general and spinal anesthesia
- to prevent aspiration bec… ᛎ
- s/e of anesthesia: vomiting

2. IV access
- since NPO, can serve as a food
- provide route for giving emergency medication
- for fluid and replacement
- IV medication administration
- administering blood product

3. Oxygen
- because lungs are collapsed d/t the s/t of anesthesia

4. Foley catheter
-
5. Oral airway
6. Hair removal
INTRAOPERATIVE 3. PRONE
- head is turned to one side to breathe
- craniotomy, spinal cord surgery, neuro
- from the patient’s transfer to the OR to admission to
surgery, back surgery
the recovery room/PACU
4. TRENDELENBURG
RESTRICTED AREA
- head is lower than extremities
 purpose: to control infection
- head-down-tilt
 cold: one way of inhibiting the growth of
-
bacteria
 safe environment: positioning of the px; never
leave the px alone
 circulating nurse: use safety belt to restrain

nursing responsibility: providing emotional support to

the px family

principles to implement while in OR:

MAIN POLICY: control infection
>> once there is a surgical wound, infection can easily
develop > px will stay longer in the hospital
* so implement surgical asepsis

Purpose of separating the public from the restricted

attire:
1. Maintain aseptic environment
2. Prevent contamination of the environment by
organism

NURSING RESPONSIBILITY
1. Let the family know of the surgical process
2. Ensure safe environment while in the OR
- proper positioning of the px
- using safety straps
- bed rails up
- not leaving the (sedated) px alone/unattended

SURGICAL POSITIONS
1. SUPINE
- best position when administering anesthesia
- transfer from bed to OR
- thoracic, abdominal, breast, lower limb
surgery

2. LATERAL/SIMS/SIDE-LYING
- px either in R or L side-lying position
depending on what side is to be operated
- no bony prominences should touch each other
= can cause wound
 pillow in between knees/legs
 head, rear of chest and pelvis is supported
with padded table attachments
 hip surgery, thoracic (lung) surgery, some
kidney procedure
POST-OPERATIVE

> RESPIRATORY – most important assessment