Principles of Sterility, Layers of Abdomen, Sutures, Anesthesia, & Laboratory Tests
Arlyn B. Celestial, RN, MAN || First Semester, Level Three
Transcribed by: Aisha R. Corobong
PRINCIPLES OF STERILITY
• Sterile persons are gown and gloved.
• Tables are only sterile at Table Level.
• Sterile persons touch only sterile items while
unsterile OR personnel touch only unsterile
Items.
• Unsterile persons avoid reaching over sterile
field and sterile persons avoid touching or
leaning over an unsterile area.
• Edges of anything that encloses sterile contents
are considered unsterile.
• Sterile field is set-up just before a surgical
procedure.
• Sterile areas are continuously kept in view.
• Sterile persons keep well within sterile area.
• Sterile persons keep in contact with sterile
areas to minimum.
• Unsterile persons avoid sterile areas.
• Destruction of integrity of microbial barriers
result in contamination.
• A sterile package’s integrity is destroyed by the
following instances.
• Microorganisms must be kept to irreducible
minimum.
LAYERS OF ABDOMEN
The abdomen refers to the region between the pelvis
(pelvic brim) and the thorax (thoracic diaphragm) in
vertebrates, including humans.
The abdominal wall surrounds the abdominal cavity,
providing it with flexible coverage and protecting the
internal organs from damage.
MAIN LAYERS
• Skin
• Superficial fascia
• Muscles
• Fascia (Tranversalis and Extraperitoneal)
• Parietial peritoneum
MEDICAL-SURGICAL
NURSING – RLE
LAYERS OF ANTEROLATERAL ABDOMINAL WALL
• Skin
- Acts as protective barrier of the interior
layers of the abdominal wall.
• Camper's Fascia
- Composed of loose areolar tissue and is
found deep in the skin and superficial to
Scarpa's fascia.
• Scarpa's Fascia
- Scarpa's fascia s a membranous layer of
the anterior abdominal wall.
- Scarpa's fascia lies below the Camper's
fascia and above the external oblique
muscle.
• External Oblique Muscle
- The external oblique muscle is the
outermost muscle, whose fibers run
inferomedially.
• Internal Oblique Muscle
- The internal oblique is innervated by
both the lower intercostal nerves as well
as branches of the lumbar plexus.
• Transverus Abdominis
- The deepest meaning of the flat muscles
and its fibers run transversely.
• Rectus Abdominis
- The rectus abdominis muscles are a pair of
long, straight muscles which run
vertically on either side of the anterior
abdominal wall.
• Pyramidalis Muscle
- The pyramidalis muscle is a small
traingular muscle lying anterior to the
rectus abdominis muscle that can be
absent in approximately 20% of the
population.
• Transversalis Fascia
- The inner outermost layer of the
transversus abdominis muscle which is
lined by a thin layer of fascia.
• Extraperitoneal Fascia
- Separates the transversalis fascia from the
peritoneum.
• Peritoneum
- The peritoneum is the serous membrane
that lines the abdominal cavity. It is
composed of mesothelial cells that are
supported by a thin layer of fibrous tissue
Principles of Sterility, Layers of Abdomen, Sutures, Anesthesia, & Laboratory Tests MEDICAL-SURGICAL
Arlyn B. Celestial, RN, MAN || First Semester, Level Three NURSING – RLE
Transcribed by: Aisha R. Corobong

and is embryologically derived from the - Thickness of sutture material

mesoderm.
TYPES OF SUTURES
Sutures, also known as stitches, are
sterile surgical threads used to repair cuts. They are also
commonly used to close incisions from surgery.
- How it is handled in the tissue
Absorbability
Suture materials may be absorbable or non-
absorbable. This property must be taken into
consideration when choosing suture materials for specific
wound closures. Oral mucosa and deep suture need to be
absorbable suture materials but vascular anastomoses need
non-absorbable suture materials.
Biological Behavior
It depend upon the constituents raw materials

GOALS OF SUTURING ABSORBABLE VS NON-ABSORBABLE SUTURES

• Wound edge apposition. • Absorbable sutures do not require your doctor to
• Provide adequate tension. remove them. The enzymes found in the tissues of
• Maintain hemostasis. your body will naturally digest them.
• Aid in wound healing. Types of Absorbable Sutures
• Avoid wound infection - Polyglycolic Acid
• Produce aesthetically pleasing scar by - Catgut
approximating skin edges - Polyglactin 910
- Polydioxanone (PDS)
SUTURE CHARACTERISTICS - Poliglecaprone (MONOCRYL)
Physical structure: - Polyglactin (Vicryl)
Monofilament • Non-absorbable sutures will need to be removed by
- This suture material is smooth & tends to your doctor in the days or weeks following your
- slide through tissue easily procedure, or may be left in permanently.
- Difficult knot Types of Absorbable Sutures
- Can be damage by gripping it with needle - Silk
holder - Polypropylene
- or forceps. That can lead to fracture of the - Polytetrafluoroethylene
suture material
Multifilaments
- Easy to knot. ANESTHESIA
- Have a greater surface area than All types of anesthesia are administered to keep
monofilaments. you comfortable and pain-free during surgery, medical
- Have a capillary action where bacteria may procedures, or tests. But there are some key differences.
lodge & be responsible for persistent infection The type you receive will depend on factors
like the procedure, your health, and your preference.

Tensil Strength
It can be expressed as the force required to break it
when pulling the two ends apart it depends on:
- Consituent of suture material
TYPES OF ANESTHESIA
• General Anesthesia
General anesthesia is most commonly used for major
operations, such as knee and hip replacements, heart
surgeries, and many types of surgical procedures to treat
cancer. Many of these surgeries are lifesaving or life-
changing and would not be possible without general
anesthesia.
• IV/Monitored Sedation
Principles of Sterility, Layers of Abdomen, Sutures, Anesthesia, & Laboratory Tests MEDICAL-SURGICAL
Arlyn B. Celestial, RN, MAN || First Semester, Level Three NURSING – RLE
Transcribed by: Aisha R. Corobong

Sedation is often used for minimally invasive • Documentation of the condition(s) for which su
procedures like colonoscopies. The level of sedation rgery is needed.
ranges from minimal - drowsy but able to talk - to deep. • Assessment of the patient’s overall health status
• Regional Anesthesia .
Regional anesthesia is often used during childbirth • Uncovering of hidden conditions that could cau
and surgeries of the arm, leg, or abdomen. It numbs a large se problems both during and after surgery.
part of the body, but you remain aware. • Perioperative risk determination.
• Local Anesthesia • Optimization of the patient’s medical condition
Local anesthesia is for procedures such as in order to reduce the patient’s surgical and an
getting stitches or having a mole removed. It numbs a esthetic perioperative morbidity or mortality.
small area, and you are alert and awake. • Development of an appropriate perioperative ca
re plan.
• Education of the patient about surgery, anesthe
PREDISPOSING FACTORS sia, intraoperative care and postoperative pain t
Your anesthesia risk might be higher if you have or have reatments in the hope of reducing anxiety and f
ever had any of the following conditions: acilitating recovery.
• Reduction of costs, shortening of hospital stay,
1. Allergies to anesthesia or a history of adverse reduction of cancellations and increase of patie
reactions to anesthesia nt satisfaction.
2. Diabetes
3. Heart disease (angina, valve disease, heart failure, NURSING MANAGEMENT
or a previous heart attack) • PRE-OPERATIVE
4. High blood pressure - Doctor/Surgeon's Orders
5. Kidney problems - Educate the Client
6. Lung conditions (asthma and chronic obstructive - Provide Emotional Support
pulmonary disease, or COPD) - Keep providing the Hierarchy of Needs
7. Obesity - (food, water, oxygen, elimination, sleep)
8. Obstructive sleep apnea • POST-OPERATIVE
9. Stroke - Check Vitals
10. Seizures or other neurological disorders - Observe respiratory depressions
- Report any deviations
SIGNS AND SYMPTOMS • IN PRACTICE
• Nausea - Check patient's ID Band
• Vomiting - Check for allergies
• Dry mouth - Note any abnormal lab results
• Sore throat - Ensure legal matters are carried out
• Muscle aches
• Itching
• Shivering LABORATORY TESTS
• Sleepiness A medical procedure that involves testing a
• Mild hoarseness sample of blood, urine, or other substance from the body.
Laboratory tests can help determine a diagnosis, plan
MEDICAL ASSESSMENT & MANAGEMENT treatment, check to see if treatment is working, or
• Physical Examination monitor the disease over time.
• Laboratories
• Drug History • COMPLETE BLOOD COUNT (CBC)
• Perioperative Risk Assessment A complete blood count (CBC) is a blood test
• Assessing Cardiovascular Risk used to evaluate your overall health and detect a wide
• Assessing Pulmonary Risk range of disorders
The following primary goals of preoperative evaluation a Normal Findings:
nd preparation have been identified: RBC count:
Male: 4.7 to 6.1 million cells/mcL
Principles of Sterility, Layers of Abdomen, Sutures, Anesthesia, & Laboratory Tests MEDICAL-SURGICAL
Arlyn B. Celestial, RN, MAN || First Semester, Level Three NURSING – RLE
Transcribed by: Aisha R. Corobong

Female: 4.2 to 5.4 million cells/mcL - Dark – dehydration, rhabdomyolisis,

WBC count: liver disease
4,500 to 10,000 cells/mcL - Red tinge – blood in the urine
Hematocrit: - Other colors – medications (e.g.
Male: 40.7% to 50.3% rifampin – red/orange)
Female: 36.1% to 44.3% Clarity
Hemoglobin: - Hazy or cloudy – infection
Male: 13.8 to 17.2 gm/dL
Female: 12.1 to 15.1 gm/dL o Dipstick indicators of infection
Red blood cell indices: pH
MCV: 80 to 95 femtoliter - Normal: 4.5 – 8
MCH: 27 to 31 pg/cell - Alkaline urine in a patient with UTI
MCHC: 32 to 36 gm/dL suggests the presence of a urea-
Platelet count: splitting organism (ex. Proteus)
150,000 to 450,000/dL Leukocyte esterase
- Normal: negative
Nitrate
- Normal: negative
Hemoglobin
- Normal: negative
- RBCs can enter urinary tract due to
• STOOL EXAM disease or trauma
A stool test may also be referred to as a “stool o Non-infectious dipstick tests
sample,” a “stool culture” or “fecal sample.” This Specific gravity
type of test looks at fecal matter for evidence of a - Normal: 1.003 – 1.030
medical condition. The test may look for evidence of - Indication of hydration status
infection, allergy, blood or digestive problems. Protein
Normal Findings: - Normal: negative
The stool appears brown, soft, and well-formed - Positive result could indicate
in consistency. The stool does not contain blood, mucus, infection, diabetes, trauma
pus, undigested meat fibres, harmful bacteria, viruses, Glucose
fungi, or parasites. The stool is shaped like a tube. - Normal: negative
Abnormal Findings: Ketones
- The stool is black, red, white, yellow, or green. - Normal: negative
- The stool is liquid or very hard. - Product of body fat metabolism
- There is too much stool. commonly associated with
- The stool contains blood, mucus, pus, undigested uncontrolled diabetes
meat fibres, harmful bacteria, viruses, fungi, or Urobilinogen
parasites. - Normal: 0.1 – 1.0 mg/dL
- The stool contains low levels of enzymes, such - Excess concentrations can indicate
as trypsin or elastase. liver damage (e.g hepatitis, cirrhosis)
or hemolytic anemia
• URINALYSIS Bilirubin
A urinalysis is a test of your urine. It's used to - Normal: negative
detect and manage a wide range of disorders, such as - Can indicate liver disease or biliary
urinary tract infections, kidney disease and diabetes. obstruction
A urinalysis involves checking the appearance, o Microscopic
concentration and content of urine WBC
o Macroscopic Examination - Normal: 0 – 5 per hpf
Direct visual observation of urine: ▪ Men usually have < 2/hpf; women
Color usually have < 5/hpf
- Normal: pale yellow to deep amber
Principles of Sterility, Layers of Abdomen, Sutures, Anesthesia, & Laboratory Tests
Arlyn B. Celestial, RN, MAN || First Semester, Level Three
Transcribed by: Aisha R. Corobong
- Presence of elevated WBCs indicates
the body may be fighting infection in
the urinary tract
RBC
- Normal: 0 – 1 per hpf
- Presence indicates damage to urinary
tract (e.g., infection, physical trauma,
etc.)
Bacteria
- Normal: negative
- Presence of bacteria is not always
predictive of a UTI (ex. asymptomatic
bacteriuria, catheter colonization)
- Must use in conjunction with other
factors.
Crystals and casts
- Typically indicative of inflammation,
infection, or injury in the urinary
tract
• FASTING BLOOD SUGAR TEST (FBS)
A blood glucose test is a blood test that screens for
diabetes by measuring the level of glucose (sugar) in
a person’s blood
Findings:
Fasting Blood Glucose Level
• If your blood glucose level is 70 to 99* mg/dL (3.9
to 5.5 mmol/L)
MEDICAL-SURGICAL
NURSING – RLE
what it means: your glucose level is within the
normal range.
• If your blood glucose level is 100 to 125 mg/dL
(5.6 to 6.9 mmol/L)
what it means: you have an impaired fasting glucose
level (pre-diabetes)
• If your blood glucose level is 126 mg/dl (7.0
mmol/L) or higher on more than on testing
ocassion
what it means: you have diabetes
• BLOOD UREA NITROGEN (BUN)
Measures the amount of urea nitrogen in your
blood
Urea nitrogen is a waste product that your
kidneys remove from your blood.
Normal Findings:
The range considered normal is between 7 to 20
milligrams per deciliter.
General reference ranges for a normal BUN level
are as follows:
• Adults up to 60 years of age: 6-20 mg/dL
• Adults over 60 years of age: 8-23 mg/dL
Abnormal Findings:
Outside the normal range at the lab blood is sent to, it
could be due to underlying kidney or liver disease.
The following factors can lead to elevated BUN levels:
• kidney damage, failure, or disease
• dehydration
• shock
• urinary tract blockages or disease
• gastrointestinal bleeding
• heart attack
The following factors can lead to elevated BUN levels:
• heart failure
• eating too much protein
• breaking down too much protein
• intense stress
• poor circulation
• obesity
• high cholesterol
Low BUN levels, which are not common, can result from:
• liver failure
• over-hydration
• not consuming enough protein in the diet due to
poor nutrition or a very low-protein diet
• LIPID PROFILE
A pattern of lipids in the blood. A lipid profile
usually includes the levels of total cholesterol, high-
density lipoprotein (HDL) cholesterol, triglycerides,
Principles of Sterility, Layers of Abdomen, Sutures, Anesthesia, & Laboratory Tests MEDICAL-SURGICAL
Arlyn B. Celestial, RN, MAN || First Semester, Level Three NURSING – RLE
Transcribed by: Aisha R. Corobong

and the calculated low-density lipoprotein (LDL) hyperthyroidism. Healthcare providers typically
'cholesterol. order this test alongside other thyroid function tests.
Normal Findings: Normal Findings:
Normal: Less than 200 mg/dL. The range for normal values are: Total T3 -- 60 to 180
Borderline high: 200 to 239 mg/dL. nanograms per deciliter (ng/dL), or 0.9 to 2.8 nanomoles
High: At or above 240 mg/dL. per liter (nmol/L) Free T3 -- 130 to 450 picgrams per
Abnormal Findings: deciliter (pg/dL), or 2.0 to 7.0 picomoles per liter (pmol/L)
Very low cholesterol levels may be a sign of an underlying
disease. Some potential causes of low overall or LDL • THYROXINE (T4)
cholesterol include: A T4 test measures the blood level of the
• chronic infections hormone T4, also known as thyroxine, which is
• inflammation produced by the thyroid gland and helps control
• malnourishment metabolism and growth. The T4 test is performed as
High lipid levels may also be caused by medical conditions part of an evaluation of thyroid function.
such as: Normal Findings:
• diabetes A normal Total T4 level in adults ranges from 5.0
• hypothyroidism to 12.0μg/dL.
• alcoholism
• kidney disease
• liver disease
• stress

• HBA1C
The A1C test—also known as the hemoglobin
A1C or HbA1c test—is a simple blood test that
measures your average blood sugar levels over the
past 3 months. It's one of the commonly used tests to
diagnose prediabetes and diabetes and is also the
primary test to help you and your health care team
manage your diabetes.

Normal Findings:
For people without diabetes, the normal range for the
hemoglobin A1c level is between 4% and 5.6%.

• CHOLESTEROL
A cholesterol test is a blood test that measures
the amount of cholesterol and certain fats in your
blood. Cholesterol is a waxy, fat-like substance that's
found in your blood and every cell of your body.
Normal Findings:
Here are the ranges for total cholesterol in
adults:
Normal: Less than 200 mg/dL.
Borderline high: 200 to 239 mg/dL.
High: At or above 240 mg/dL.

• TRIIODOTHYRONINE (T3)
A T3 (triiodothyronine) test is a blood test that
helps diagnose thyroid conditions, specifically