Topic: Surgery

Ms. Emmie G. Basas || First Semester, Level Three Medical

From PowerPoint Presentation of Emmie G. Basas
Transcribed by: Aisha R. Corobong Surgical
Nursing
SURGERY Classifications According to PURPOSE
DEFINITION  DIAGNOSTIC
 Is branch of medicine concerned with treatment of diseases, - Is used to determine the cause of an illness or disorder
deformities, and injuries through invasive operative method - Makes it possible to verify a suspected diagnosis.
called operations and instrument  CURATIVE
 It is a unique experience, with no two clients responding - Tending to overcome disease and promote recovery
alike to similar operations. - Removal of disease organ or tissues.
 It is the art and science of treating diseases, injuries, and  RECONSTRUCTIVE
deformities by operations and instruments. - Concerned with the restoration, construction,
TERMS reconstruction, or improvement in the shape and
 ECTOMY - excision or removal (tonsillectomy) appearance of body structures that are missing,
 LYSIS - destruction of (adhesiolysis) defective, damaged, or misshapen
 ORRAPHY - repair or suture of (herniorrhapy)  PALLIATIVE
- Affording relief but not cure
 OSCOPY - looking into(endoscopy)
 OSTOMY - creation of opening (craniostomy)
 PLASTY - repair of scar or tissue (rhinoraphy) Classification of Surgery According to URGENCY
 OPTIONAL SURGERY
PERIOPERATIVE NURSING OVERVIEW THE - is done totally at the client’s discretion (e.g. cosmetic
PERIOPERATIVE PERIOD surgery)
 Encompasses a client’s total surgical experience, including  ELECTIVE SURGERY
the preoperative and postoperative phrases - refer to procedures that are scheduled at the client’s
convenience (e.g. cyst removal, repair of scars, simple
hernia or vaginal repair)
THE PERIOPERATIVE NURSING
 REQUIRED SURGERY
 Refers to activities performed by the professional nurses
- Is warranted for conditions necessitating intervention
during these phases
within a few weeks (e.g. cataract surgery, thyroid
disorder)
PHASES  URGENT OR IMPERATIVE SURGERY
1. The PREOPERATIVE phase - Is indicated for a problem requiring intervention
- Begins with the decision to perform surgery and ends within 4 to 48 hours (e.g. some cancers, acute
with the client’s transfer to the operating room (OR) gallbladder infection appendicitis, kidney stones)
table.  EMERGENCY SURGERY
2. The INTRAOPERATIVE phase - Describes procedure that must be done immediately to
- Begins with the client is received in the OR and ends sustain life or maintain function
with his admission to the post anesthesia recovery
room (PARR) or post anesthesia care unit (PACU) Classification According to MAGNITUDE or EXTENT
3. The POSTOPERATIVE phase Major surgery: High risk; Extensive; Prolonged; Large
- Begins when the client is admitted to PARR and amount of blood loss; Great risk of complication
extends through follow-up home or clinic evaluation.
Minor surgery: Generally not prolonged; Leads to few
THE PERIOPERATIVE TEAM serious complications; Involves less risk
1. THE ANESTHESIOLOGIST OR NURSE ANESTHETIST
- Makes a preoperative assessment to plan the type of
anesthetic to be administered and to evaluate the client SURGICAL RISK
physical status General Risk Factors
2. THE PROFESSIONAL REGISTERED OR NURSE 1. Age
- Makes preoperative nursing assessment and 2. Obesity
documents the intra-operative client care plan 3. Immobility
3. THE CIRCULATING NURSE 4. Malnutrition
- Manages the OR and protects the safety and health 5. Emergency
needs of the client by monitoring the conditions in the 6. Endocrine related condition
OR 7. Steroid therapy
4. THE SCRUB NURSE Major Causes of Death
- Is responsible for scrubbing for surgery, including  Pneumonia
setting up sterile tables and equipment, and assisting  Cardiac arrest
the surgeon and surgical technicians during the  Renal failure
surgical procedure  Stroke
5. THE PACU NURSE  Pulmonary embolism
- Is responsible for caring for the client until the client  Sepsis; peritonitis
has recovered from the effects pf anesthesia, is  Hypovolemic shock
oriented, has stable vital signs, and show no evidence
of hemorrhage Degree of SURGICAL RISK depends on the:
1. Nature, location, and duration of the condition
CONDITIONS Requiring Surgery 2. Type and classification of surgery
 Obstruction or blockage 3. Person’s mental attitudes
4. Available professional resources
 Perforation
 Erosion
 Tumor IDENTIFICATION OF POTENTIAL RISK
 Elicitation of stress response
CATEGORIES of Surgical Procedure  Decreased resistance to infection
 According to PURPOSE  Description of the vascular system
 According to URGENCY  Disturbance of body image
 According to MAGNITUDE or EXTENT of surgery

|| Page 1
Topic: Surgery
Ms. Emmie G. Basas || First Semester, Level Three Medical
From PowerPoint Presentation of Emmie G. Basas
Transcribed by: Aisha R. Corobong Surgical
Nursing
 Correct fluid and electrolyte imbalances
 Restore adequate blood volume
NURSING ASSESSMENT
 Treat chronic disease
A. Physiologic
 Age
 Cure any infections disease
 Presence of pain  Treat alcoholic person with vitamin supplement
 Nutritional status  IVF fluids if dehydrated
 Fluid and electrolyte
 Infection PREOPERATIVE TEACHING
 Cardiovascular function Preoperative Exercises
 Pulmonary function  Coughing
 Renal function  Deep breathing
 Gastrointestinal function  Turning
 Liver function  Moving
 Endocrine function
 Neurologic function
 Hematologic function PREPARATION ON THE EVENING BEFORE SURGERY
 Use of medications 4 Major Considerations
1. Preparing the skin
 Presence of trauma
 Awareness of preop preparation protocol of the health
B. Psychologic
care facility
Pre-op Defense Mechanism
 On procedure
1. Regression
- Proper technique
2. Denial
- Location
3. Intellectualization
- Size of areas to be prepared
- Specific preferences of the surgeon
NURSING ASSESSMENT - Document observation of the surgical site
Nursing interventions :
 help relieve anxiety 2. Preparing GIT
 explore feelings  Special Preparation of the evening before surgery
 allow to speak openly about fears To reduce the possibility of vomiting
 give accurate information - Reduce the possibility of bowel obstruction
 give emphatic support - Prevent contamination from fecal material
during intestinal or bowel surgery
Preparations includes
C. Assessment of Economic and Developmental Status Restrict food/ fluids
✓ Administration of enema as needed
NURSING PEOPLE BEFORE SURGERY ✓ Insert gastric tubes/ intestinal tubes
Preoperative preparation: 4 phases If general anesthesia
1. At the physician’s office before admission to health care ✓ Foods and fluids restricted for 8-10 hours before the
facility operations
2. Upon admission and during days before operation
✓ NPO after midnoc (8-10 hrs)
3. Night before the surgery
4. Morning of surgery
✓ Water be given up to 4 hours before surgery as
ordered
Preoperative admission ✓ When surgery is not schedule until late afternoon
person may eat light breakfast in AM if permitted
 Depend on the amount of preoperative intervention
✓ Extremely debilitated or malnourished receive IV
 Involve family interview infusion amino aid, glucose, plasma till moment of
 Thorough assessment of the body system surgery
 Patient orientation ✓ ENEMA as ordered
 Verify info on preoperative testing
 Initiates teaching appropriate to patient’s needs 3. Preparing for anesthesia
 Done evening before surgery to complete respiratory,
cardiovascular, neurologic examination
PSYCHOLOGIC ASPECT
 Determine the type of anesthesia used during surgery
 Fear of the unknown
 Discuss type anesthesia planned, sensation the person
 Provide information about hospital protocols will experience
 Explains procedures of surgical phases  Address fears. A calm, confident person undergoes
 Explain all nursing intervention anesthesia more smoothly than someone who is
 Allow patient to ask question nervous is frightened
 Introduce to people who had successful operation
 Arrange occupational therapy on extended post 4. Promoting rest and sleep
operative  Physically comfortable; mentally ease;
 Include significant others in discussion adequate sedated.
 Measure to reduce sleeplessness and restlessness have
a well ventilated room, comfortable and clean bed,
LEGAL ASPECT give back rub, warm beverage if fluid not
INFORMED CONSENT (Operative permit/surgical consent) contraindicated.
 Circumstances Requiring Permit
 Requisite for validity of informed consent PREPARATION ON THE DAY OF SURGERY
 Requisite for validity of informed consent A. Early Morning Care
 Record vital signs- slight increase due to anxiety
 Check ID band
PHYSIOLOGIC ASPECT
 Skin prep thoroughly/oral hygiene
 Correct dietary deficiencies  Check order if carried out
 Reduce weight  Identify if not eaten within 4-10 hours
|| Page 2
Topic: Surgery
Ms. Emmie G. Basas || First Semester, Level Three Medical
From PowerPoint Presentation of Emmie G. Basas
Transcribed by: Aisha R. Corobong Surgical
Nursing
 Remove jewelry, hearing aid prosthesis
 Remove colored nail polish FEARS RELATED TO ANESTHESIA
➢ GOING TO SLEEP & NOT WAKING UP
B. Pre-Operative Medication ➢ FEAR OF THE UNKNOWN
 To allay anxiety, reduce pharyngeal secretions, reduce ➢ EFFECTIVENESS OF ANESTHETICS
effect of anesthesia and create amnesia
➢ PAIN DURING SURGICAL PROCEDURE
Before administration anesthesia
1. Get the BP and record ➢ POST-OP NAUSEA & VOMITING
2. If given to early induction is more difficult to administered,
put side rails up, turn off lights, instruct not to get up without POTENTIAL COMPLICATIONS
resistance to prevent dizziness, speak only when necessary, ➢ ANAPHYLAXIS
just before the person goes to surgery “ON CALL” if ➢ NAUSEA / VOMITING
tentative schedule for surgery. ➢ HYPOXIA/ OTHER RESPIRATORY COMPLICATIONS
➢ UNINTENTIONAL HYPOTHERMIA
C. Transporting the person to surgery ➢ MALIGNANT HYPERTHERMIA
 Gently move transporting to stretcher smooth and gentle to ➢ DISSEMINATEDINTRAVASCULAR
prevent am nausea and vomiting, cover with blanket to COAGULOPATHY
prevent exposure and draft. ➢ INFECTION

NURSING PEOPLE DURING SURGERY

A. Admitting person to surgery
Introduction for surgical team
Positioning for surgery

B. Administration of Anesthesia
Classification of Anesthesia
Surgical wound closure

INTRAOPERATIVE PHASE BASIC RULES:

• Only sterile materials may be used within a sterile field.
• If there is any doubt of the sterility of the item its
considered unsterile
• Gowns of scrubbed team members are sterile in the front
from shoulder to waist level and sleeves 2 inches above the
elbow.
• Draped tables are considered to be sterile on top only.
• Sterile surface should contact only sterile areas.
• Edges of any sterile package or container are considered
unsterile.
• The sterile field should be created as close to the time it is
going to be used as possible

SAFETY MEASURES
✓ OR table are securely locked
✓ all muscles, nerves and bony prominences are positioned or
padded to avoid injury
✓ heavily sedated patients and elderly are moved slowly &
gently
✓ ensure tubings are not dislodged or obstructed
✓ straps should not interfere with blood circulation
✓ sterile team members should not lean on any part of the
patients body

COMMON POSITIONS

SUPINE - most common used positionused for hernia repair, ex-lap,

cholecystectomy, gastric & bowel resection & mastoidectomy
PRONE - used for surgery on back, spine, & rectal area
TRENDELENBERG - surgery on lower abdomen and
pelvis
REVERSE TRENDELENBERG - biliary surgery LITHOTOMY -
used for perineal, rectal, vaginal surgery
LATERAL - for renal surgery

ANESTHESIA USAGE > PRODUCED UNCONSCIOUSNESS

(G.A)
or to produce loss of sensation in a specific area ( R.A)

EFFECTS OF ANESTHESIA:
AMNESIA - loss of memory
ANALGESIA - insensibility to pain
HYPNOSIS -artificially powered sleep
MUSCLE RELAXATION - a part of body less pain & rigid
|| Page 3