FUNCTIONS OF INSTRUMENTS
KELLY (BIG) CURVED
 clamping large blood vessels or
manipulating heavy tissue
 used for soft tissue dissection
can be used as a clamp, heat sink, or
third hand
ALLIS
 used to hold or grasp heavy tissue
used to grasp fascia and soft tissues
such as breast or bowel tissue
 can cause damage, so they are
mainly used in tissue about to be
removed
NEEDLE HOLDER
 used in wound closure, ligation,
anastomosis and other surgical
procedures which require suturing
BABCOCK
 used to grasp delicate tissue
 similar to Allis forceps; however,
may be considered less traumatic
due to their wider, rounded grasping
surface
ARMY NAVY
 used for shallow or superficial
wounds used to retract skin or
bones
RICHARDSON DOUBLE END
 a handheld, right angle retractor
used for holding back layers of tissue
close to the surface
TISSUE FORCEP WITH TEETH
 equipped with fine, rat tooth tips
that provide a gentle grasp of tissues
 manipulate soft tissues such as
fascia and skin during suturing
 used for atraumatic tissue grasping
during dissection
TISSUE FORCEP WITHOUT TEETH
 used for fine handling of tissue and
traction during dissection
TOWEL CLIPS
 to hold drapes in place, to keep only
the operating field exposed
BOWL
 used in operating theatres to hold
either sterilized or used instruments
 used to hold swabs and waste
products from the operation
KELLY STRAIGHT
 used to clamp blood vessels and
hold heavy tissues in place
KIDNEY BASIN
 used in medical and surgical wards
to receive soiled dressings and other
medical waste
MOSQUITO CURVED
 used to clamp off blood vessels,
remove small root tips and grasp
loose objects
ADSON WITH TEETH
 to manipulate soft tissues such as
fascia and skin during suturing
ADSON WITHOUT TEETH
 used for grasping delicate tissues
during complex surgeries of the eye,
nose and throat
 commonly used in ophthalmic
procedures, ENT surgeries as well as
general and vascular surgeries
MOSQUITO STRAIGHT
  used as a hemostatic agent to
compress smaller vessels that
regulate blood flow
OCHSNER FORCEP CURVED
 aggressively grasp medium to heavy
tissue or occlude heavy, dense
vessels
OCHSNER FORCEP STRAIGHT
 for clamping off blood vessels to
avoid bleeding during procedures
such as orthopedic surgery
MIXTER
 used for clamping, dissection, or
grasping tissue with their delicate
and partially serrated jaws
INTESTINAL CLAMP
 used to clamp the large organs such
as Intestines, lungs etc. in various
applications in Laparoscopic Surgery,
Onco Surgery, Gastroenterology and
Bariatric / Obesity Surgery
VASCULAR CLAMP
 used for hemostasis and stabilization
of the operative field during
minimally invasive direct coronary
artery bypass
DEBAKEY
 used in vascular procedures to avoid
tissue damage during manipulation
MAYO SCISSORS
 for cutting body tissue near the
surface of a wound.
 Straight - used for cutting sutures,
they are also referred to as "suture
scissors"
 Curved - allow deeper penetration
into they wound than the type with
straight blades
METZENBAUM SCISSORS
 used for fine dissection and cutting
MALLEABLE RETRACTORS
 used to hold back tissues and organs
during surgery
SELF-RETAINING RETRACTORS
 can be clamped into position to hold
tissues away from the operative field
without constant use of the hands
DEAVER
 used to retract deep abdominal or
chest incisions used in
Cholecystectomy (removal of
gallbladder) for retraction of right
lobe of liver
OVUM FORCEPS
 used to grasp, hold, manipulate
and remove tissue from inside the
uterus including the ovum and
placenta.
 Ovum forceps are used during
procedures such as caesarean
section, hysterectomy, and uterine
repair and are also sometimes used
as a hemostat.
CLASSIFICATION OF SURGICAL
PROCEDURES
SERIOUSNESS
MAJOR
 Involves extensive reconstruction or
alteration in body parts; poses great
risks to well-being
EXAMPLE
 Coronary artery bypass, colon
resection, removal of larynx,
resection of lung lobe
MINOR
 Involves minimal alteration in body
parts; often designed to correct
deformities; involves minimal risks
compared with major procedures
EXAMPLE
 Cataract extraction, facial plastic
surgery, tooth extraction
URGENCY
ELECTIVE
 Performed on basis of patient’s
choice; is not essential and is not
always necessary for health
EXAMPLE
 Bunionectomy, facial plastic surgery,
hernia repair, breast reconstruction
URGENT
 Necessary for patient’s health; often
prevents additional problems from
developing (e.g., tissue destruction or
impaired organ function); not
necessarily emergency
EXAMPLE
 Excision of cancerous tumor,
removal of gallbladder for stones,
vascular repair for obstructed artery
(e.g., coronary artery bypass)
EMERGENCY
 Must be done immediately to save
life or preserve function of body part
EXAMPLE
 Repair of perforated appendix or
traumatic amputation, control of
internal hemorrhaging
PURPOSE
DIAGNOSTIC
 Surgical exploration that allows
health care providers to confirm
diagnosis; often involves removal of
tissue for further diagnostic testing
EXAMPLE
 Exploratory laparotomy (incision
into peritoneal cavity to inspect
abdominal organs), breast mass
biopsy
ABLATIVE
 Excision or removal of diseased
body part
EXAMPLE
 Amputation, removal of appendix,
cholecystectomy
PALLIATIVE
 Relieves or reduces intensity of
disease symptoms; does not produce
cure
EXAMPLE
 Colostomy, debridement of necrotic
tissue, resection of nerve roots
RECONSTRUCTIVE/RESTORATIVE
 Restores function or appearance to
traumatized or malfunctioning
tissues
EXAMPLE
 Internal fixation of fractures, scar
revision
PROCUREMENT FOR TRANSPLANT
 Removal of organs and/or tissues
from a person pronounced brain dead
for transplantation into another
person
EXAMPLE
 Kidney, heart, or liver transplant
CONSTRUCTIVE
 Restores function lost or reduced as
result of congenital anomalies
EXAMPLE
 Repair of cleft palate, closure of
atrial septal defect in heart
COSMETIC
 Performed to improve personal
appearance
EXAMPLE
 Blepharoplasty for eyelid
deformities; rhinoplasty to reshape
nose
TYPES OF SURGERY
SURGICAL EMERGENCY 
is a medical emergency for which immediate
surgical intervention is the only way to solve
the problem successfully.  •
ELECTIVE SURGERY or elective
procedure is surgery that is scheduled in
advance because it does not involve a
medical emergency. Semi-elective surgery is
a surgery that must be done to preserve the
patient's life, but does not need to be
performed immediately.   operating surgeon,
WHAT ARE SOME MAJOR
SURGERIES?
There are many different surgeries that fall
into this category. They include:
• Cesarean section
• Organ replacement
• Joint replacement
• Full hysterectomy
• Heart surgeries
• Bariatric surgeries,
including the gastric bypass
While some of these procedures may be able
to be performed in less invasive ways, they
still involve major trauma to the body and
can have long-lasting complications.
WHAT ARE SOME MINOR
SURGERIES?
Minor surgeries include:
• Cataract surgery
• Dental restorations
• Circumcision
Breast biopsy
• Arthroscopy
• Laparoscopy
• Burn excision and debridement
procedures
PERSONNEL INSIDE THE OR
Consist of the:
 assistants to the surgeon,
 a scrub person,
 an anesthesiologist and
 a circulating nurse.
The team is divided into two divisions
according to the function of its members.
 Sterile OR team: operating surgeon,
assistants to the surgeon and scrub
person
 Unsterile OR team: anesthesiologist
or nurse anesthetist, circulator and
other OR members that might be
needed in operating specialized
machine or devices.
FUNCTIONAL CHART
 Participates in procurement of supplies,
instruments, and equipment’s.
 Accomplishes and maintains records
and reports.
 Participates in the in-service training
program and in the orientation of new
nurse student affiliates and in-service
trainees. - conducts meeting conference
with or personnel and trainees.
 Plans and maintains clean and orderly
and safe environment for patient.
 Evaluate performance of operating room
personnel and trainee.
 Participates in formulating or policies.
 Represents the or department in the
nursing service.
NURSE III
 Makes schedule of or personnel monthly
meeting and other hospital meeting
when necessary.
 Maintains nursing staff by recruiting,
selecting, orienting, and training nurses
and auxiliary staff.
 Maintains nursing staff job results by
coaching, counseling, and disciplining
employees; planning, monitoring and
appraising job results.
 Assures quality care by developing and
interpreting hospital and nursing
division's philosophies and standards of
care.
 Maintains nursing guidelines by writing
and updating policies and procedures.
 Ensures operation of medical and
administrative equipment by verifying
emergency equipment availability;
completing preventive maintenance
requirements; following manufacturer's
instructions; troubleshooting
malfunctions; calling for repairs;
maintaining equipment inventories;
evaluating new equipment and
techniques.
 Maintains nursing supplies inventory by
studying usage reports; identifying
trends; anticipating needed supplies;
approving requisitions and cost
allocation.
 Participates in the in-service training
program and in the orientation of new
nurse, student affiliates and in-service
trainees.
 Protects patients and employees by
developing and interpreting infection-
control policies and protocols; enforcing
medication administration, storage
procedures and controlled substance
regulation.
 Maintains safe and clean working
environment by designing and
implementing procedures, rules and
regulations; calling for assistance prom
other health care professionals.
NURSE II
CIRCULATING NURSE
 Assists in positioning, responding to
comfort and safety of the patient.
 Provides for accurate care and handling
of specimens.
 Observes and enforces strict standards
of asepsis.
 Observes, checks and monitors all
equipment used during surgery to
confirm they are running smoothly.
 Handles patient documentation.
SCRUB NURSE
 Selects and handles instruments and
Supplies used for operation, passing
them to surgeon
 Inventories all items both pre.- and post-
surgery
FIRST ASSIST NURSE
• Delivers direct surgical care by assisting
physician.
• helps control bleeding.
• provides wound exposure.
POST ANESTHESIA CARE UNIT
NURSE
• Checks emergency drugs and other supplies
and equipment’s.
• acts as circulating nurse.
• assists the anesthesiologist during the
induction of anesthesia
• makes and maintain records of post-
operative patents.
• checks and determine usability of
equipment’s.
• helps maintain cleanliness and safe
environment.
• receive patient from or and provide safety
and quality care.
• accompany the patient in endorsing to the
ward.
NURSE I
• Packs clean linens, instruments, surgical
gauze and other supplies for sterilization.
• prepare patient for operation.
• clean soaking trays.
• checks articles and linens for or use.
• maintains cleanliness and orderliness of the
entire unit.

NURSING ATTENDANT
• transport patient from OR to the ward.
• cleans the wall, floor, alley, and comfort
room of the entire unit.
• gets oxygen tanks and supplies from the
supply section.
• empties and cleans garbage cans.
• fold linens and packs ready for sterilization.
• helps the nurse in the preparation of patient.
INSTITUTIONAL WORKER
TYPES OF ANESTHESIA
GENERAL ANESTHESIA
IV first, Inhaled second
 involves the total loss of body
sensation and consciousness induced
by anesthetic agents administered
primarily by inhalation or
intravenous injection
SEDATIVES-HYPNOTICS
 Sedatives relieve anxiety; hypnotics
induce sleep
Barbiturates: significant CNS (and resp)
depression; stimulate hepatic enzymes which
leads to tolerance and can affect other med
blood level; no antidote
Benzodiazepines: safer than barbs unless
taken with alcohol or other CNS depressants;
antidote is flumazenil
NEUROMUSCULAR BLOCKING
AGENTS
 Block neuromuscular transmission at
the neuromuscular junction, causing
paralysis of the affected skeletal
muscles. (ex. Anectine, Pavulon)
OPIOIDS
 These drugs act in the CNS by
binding to opiate receptor sites on
afferent neurons. The pain signal is
stopped at the spinal cord level and
does not reach the cortex where pain
is perceived.
ANESTHETIC AGENTS
 Used in a procedure in which an
altered state of consciousness is
induced to a depth adequate to
permit comfortable performance of
moderately painful diagnostic
procedures of short duration.
 Examples are lidocaine for local
procedures and nitrous oxide
(laughing gas), ether and chloroform
for general surgery.
NERVE BLOCK
 method of regional anesthetic to stop
the passage of sensory stimulation
along the nerve path
SPINAL ANESTHESIA
 injecting anesthetic into sub-
arachnoid space though lumbar
puncture. Causes sensory motor and
autonomic blockage. For lower
abdomen, perineum, and legs.
EPIDURAL ANESTHESIA
 regional anesthesia resulting from
injection of an anesthetic into the
epidural space of the spinal cord
 EX. sensation is lost in the
abdominal and genital and pelvic
areas; used in childbirth and
gynecological surgery
LOCAL ANESTHETIC
 medication which produces a loss of
sensation in a localized area
 administered via Injection, and/or
topical
(sub-uh-RAK-noyd blok) A temporary loss
of feeling in the abdomen and/or the lower
part of the body. Special drugs called
anesthetics are injected into the fluid in the
lower part of the spinal column to cause the
loss of feeling.
Where is the subarachnoid block?
Subarachnoid (spinal) block is a safe and
effective alternative to general anesthesia
when the surgical site is located on the lower
extremities, perineum (eg, surgery on the
genitalia or anus), or lower body wall (eg,
inguinal herniorrhaphy).
What type of anesthesia is subarachnoid
block?
Spinal anesthesia is a neuraxial anesthesia
technique in which local anesthetic is placed
directly in the intrathecal space
(subarachnoid space). The subarachnoid
space houses sterile cerebrospinal fluid
(CSF), the clear fluid that bathes the brain
and spinal cord.
SURGICAL PHASES
WHEN DOES THE PREOPERATIVE
PHASE BEGIN?
 begins when the decision to proceed
with surgical intervention is made
and ends with the transfer of the
patient onto the operating room (OR)
bed
WHEN DOES THE INTRAOPERATIVE
PHASE BEGIN?
 begins when the patient is transferred
onto the OR bed and ends with
admission to the PACU
WHEN DOES THE POSTOPERATIVE
PHASE BEGIN?
 begins with the admission of the
patient to the PACU and ends with a
follow-up evaluation in the clinical
setting or home
A PREOPERATIVE ASSESSMENT takes
place before surgery to help the patient
prepare for the operation and recovery.  The PACU is a critical care unit where the
The goal of preoperative care, or care given
leading up to an operation, is to establish a
baseline for the patient. Once the baseline
is defined, noticing deviations from this
baseline during and after surgery becomes
easier. Thoroughly examining the patient
allows the healthcare team to establish this
baseline.
Preoperative goals include:
 Assessing pre-existing health
problems
 Identifying any new medical issues
 Assuring the patient is ready
physically and psychologically for
surgery
But, how exactly are these pre-operative
goals accomplished? Through obtaining and
performing:
1. Detailed patient history
2. Complete physical exam, including
necessary imaging and blood work
3. Patient education
A POSTOPERATIVE ASSESSMENT takes
place after surgery to determine the effects
of the operation and help the patient get
back to their usual level of functioning.
The surgery is successfully completed! Now,
the nurse enters postoperative care, or the
care given after the operation is completed
until the time of discharge to home.
Depending on the surgery, the length of
postoperative care can vary from hours to
days, but no matter the length, the nurse is
responsible for observing the patient.
After surgery, the cardiac and respiratory
systems are closely observed. In fact,
respiratory complications are the most
common postoperative cause of morbidity.
The cardiac and respiratory systems are
commonly monitored through observing a
patient's:
 Pulse
 Systolic blood pressure
 Respiratory rate
 Oxygen saturation
POST ANESTHESIA CARE UNIT
patient's vital signs are closely observed,
pain management begins, and fluids are
given. The nursing staff is skilled in
recognizing and managing problems in
patients after receiving anesthesia. The
PACU is under the direction of the
Department of Anesthesiology.
The responsibilities of a nurse in the PACU
may include:
 Monitoring post-operative patients’
levels of recovery and consciousness
from anesthesia and providing
 updates to the treatment team as
needed.  multiple traumatic events, often of an
 Treating pain, nausea, and other
post-operative symptoms of
anesthesia and administering
medication as prescribed. 
 Regularly checking vital signs to
quickly intercept any potential issues
and ensure a smooth recovery.
 Keeping bandages, dressings, etc.
clean, dry, and safe.
 Educating patients and their families
on post-surgery care, as well as
answering questions.
 Updating charts, patient files, and
medical records.
TYPES OF TRAUMAS
There are three main types of trauma:  or flatter in appearance.
Acute, Chronic, or Complex. 
Acute trauma results from a single incident. 
Chronic trauma is repeated and prolonged
such as domestic violence or abuse.  Impacted Fracture/Buckle Fracture - A
Complex trauma is exposure to varied and
invasive, interpersonal nature.
TYPES OF FRACTURES
Fracture - Partial or complete break in the
bone. Classified as either open or closed.
Open Fracture/Compound Fracture -The
bone exits and is visible through the skin, or
a deep wound that exposes the bone through
the skin.
Closed Fracture/Simple Fracture - The
bone is broken, but the skin is intact.
Greenstick Fracture - Incomplete fracture.
The broken bone is not completely separated.
Transverse Fracture - The break is in a
straight line across the bone.
Spiral Fracture - The break spirals around
the bone; common in a twisting injury.
Oblique Fracture - Diagonal break across
the bone.
Compression Fracture - The bone is
crushed, causing the broken bone to be wider
Comminuted Fracture - A fracture in which
the bone fragments into several pieces.
fracture in which the ends are driven into
each other.
Pathologic Fracture - A fracture caused by
a disease that weakens the bones.
Stress Fracture - Tiny cracks in a bone.
Stress fractures are caused by repetitive
application of force, often by overuse.
 ABDOMINAL WALL LAYERS  membrane that lines the abdominal
cavity

1. Skin
(Outermost Layer)
2. Camper's fascia (1st Layer of Fascia)
 superficial fatty layer of
subcutaneous tissue
3. Scarpa's fascia (2nd Layer of Fascia)
 Continuous with colles fascia fuses
to deep fascia of thigh looks like
DIAPER
 deep membranous layer of subcut.
Tissue
4. External oblique (1st Muscle Layer)
Aponeuros of Internal Oblique (Invesitng
deep fascia, intermed)
 fibers travel same direction of
external intercostals
5. Internal oblique (2nd Muscle Layer)
Aponeuros of Transverse Ab. (investing
deep fascia, deep)
 fibers travel same direction of
internal intercostals
6. Transversus abdominis (3rd Muscle
Layer)
 fibers travel same as inner
intercostals
7. Transversalis fascia (Beneath
Transversus Abdominis)
 Abdominal layer continuous with
internal spermatic fascia
8. Extraperitoneal fascia (Beneath
Transversalis Fascia)
 separates the transversalis fascia
from the peritoneum
9. Parietal peritoneum (Innermost Layer)