Mam Gail - Perioperative Nursing

ANGELES UNIVERSITY FOUNDATION
College of Nursing
COURSE SYLLABUS FOR COMPETENCY APPRAISAL I (CA1)
1st Semester, AY 2022-2023
PERIOPERATIVE NURSING
Learner Objectives :
1. Define the three phases of the surgical experience.

2. Describe the scope of perioperative nursing practice.
3. Identify members of the surgical team.
4. Discuss the outcomes a patient can be expected to achieve following a surgical intervention.
5. Describe the roles of surgical team members.
6. Describe the responsibilities of the perioperative nurse in the circulating role.
LESSON OUTLINE
I. Phases of the Surgical Experience
A. Preoperative
B. Intraoperative
C. Postoperative
II. Perioperative Care Categories and Purposes
III. Nursing Process Throughout the Perioperative Period.
A. Assessment
B. Nursing Diagnosis
C. Planning
D. Intervention
E. Evaluation
IV. Patient Outcomes : Standards of Perioperative Care
V. Roles of the Perioperative Nurse
VI. Members and Responsibilities of the Surgical Team
PERIOPERATIVE NURSING
Perioperative Nursing - used to describe the nursing care provided in the total surgical experience of
the patient in 3 phases : Preoperative, Intraoperative, and Postoperative.
Preoperative Phase - extends from the time the client is admitted in the surgical unit, to the time
he/she is prepared for the surgical procedure, until he is transported into the operating room.
Intraoperative Phase- extends from the time the client is admitted to the Operating Room, to the time
of administration of anesthesia, surgical procedure is done, until he/ she is transported to the Recovery
Room/ Post Anesthesia Care Unit.
COMPETENCY APPRAISAL 1 A.Y. 2022-2023

Postoperative Phase- extends from the time the client is admitted to the recovery room, to the time he/
she is transported back into the surgical unit, discharged from the hospital, until the follow-up care.
1. Regarding the surgical patient, which of the following terms constitutes the entire surgical
experience?
A. Preoperative
B. Intraoperative
C. Postoperative
D. Perioperative
(4) FOUR MAJOR TYPES OF PATHOLOGIC PROCESS REQUIRING SURGICAL INTERVENTION

(OPET)
1. Obstruction- impairment to the flow of vital fluids (blood, urine, CSF, bile)
2. Perforation- rupture of an organ
3. Erosion- wearing off of a surface or membrane
4. Tumors- abnormal new growths.
CLASSIFICATIONS OF SURGICAL PROCEDURE

I. According to PURPOSE :
● Diagnostic- to establish the presence of a disease condition ( e.g biopsy)
● Exploratory- to determine the extent of disease condition (e.g Ex-lap)
● Curative- to treat the disease condition
**Ablative-removal of an organ (e.g Appendectomy)

**Constructive- repair of congenitally defective organ (e.g cleft palate, closure of atrial septal)
**Reconstructive- repair of damage organ ( e.g skin graft, plastic surgery)
● Palliative - to relieve distressing sign and symptoms not necessarily to cure the disease (e.g
colostomy)
● Transplant -replacement of a new organ (e.g Kidney, heart, liver)
● Aesthetic- Beautification and enhancement ( e.g nose lift, face lift,)
2. A 21-year-old female was rushed to the hospital after she was accidentally shot in the chest. You
would expect that the operation would identified as:
A. Elective
B. Urgent
C. Emergent
D. Required
3. A patient having excess fat suctioned from the thighs for cosmetic reasons is an example of which
category of surgery?
A. Elective
B. Urgent
C. Emergent
D. Required

II. According to URGENCY
Classification Indication for Surgery Examples
Emergent-patient requires Without delay -severe bleeding

immediate attention, life -gunshot/ stab wounds
threatening conditions -fractured skull
Urgent/ Imperative- patient within 24 hours to 30 hours -kidney/ ureteral stones

requires prompt attention
Required- patient needs to have Plan within a few weeks or -cataract

surgery months -thyroid
Elective- patient should have Failure to have surgery not -repair of a scar
surgery that catastrophic -vaginal repair
Optional- patient’s decision Personal preference -cosmetic surgeries
III. According to DEGREE OF RISK

● Major Surgery
-High Risk/ Greater Risk for infection

-Extensive
-Prolonged
-Large amount of blood loss
-Vital organ may be handled or removed
● Minor Surgery
- Generally not prolonged
- Leads to few serious complication
- Involves less risk
IV. Ambulatory Surgery/ Same-Day Surgery / Outpatient Surgery

Advantages :
- Reduces length of hospital stay and cuts costs
- Reduces stress for the patient
- Less incidence of hospital acquired infection
- Less time lost from work by the patient
- minimal disruptions on the patient’s activities and family life.
Disadvantages:
- Less time to access the patient and perform preoperative teaching
- Less time to establish rapport
- Less opportunity to assess for late postoperative complications.
Examples of Ambulatory Surgery

● Teeth extraction
● Circumcision
● Vasectomy
● Cyst removal
● Tubal ligation
Surgical Risks
● Obesity
● Poor Nutrition
● Fluid and Electrolyte imbalances
● Age
● Presence of Disease or comorbidities
● Concurrent or prior pharmacotherapy
A. PRE-OPERATIVE PHASE
- begins when the patient, or someone on the patient’s behalf, is informed of the need for
surgery and makes the decision to have the procedure.
Goals of the Phase :

● Assessing and correcting physiologic and psychologic problems that may increase surgical risk
● Giving the person and significant others complete learning/ teaching guidelines regarding the surgery
● Instructing and demonstrating exercises that will benefit the person during the postoperative period.
● Planning for discharge and any projected changes in lifestyle due to surgery.
Preoperative Phase Assessment

1. Physiologic Assessment of the Client Undergoing Surgery /PE
● Age, Height, Weight, VS, BMI
● Presence of Pain
● Nutritional and Fluid and Electrolyte Balance
● Cardiovascular/ Pulmonary Function- (pulses, edema) complications such as emboli, arrhythmias
● Renal Function- check for voiding functions
● Gastrointestinal/ Liver Function -bowel sounds
● Endocrine Function - metabolism
● Neurological Function- (LOC, mood, motor & sensory function – affected by anesthesia
● Hematologic Function- bleeding parameters, anemia borders
● Use of Medication
● Presence of Trauma and Infection
2. Nursing History
● past and present diseases
● medications
● allergies
● personal habits
● occupation
● finances
● support system
● knowledge of the surgery
● attitude towards surgery
3. Diagnostic Test/ . Routine Preoperative Screening Test
TEST RATIONALE
CBC RBC, Hgb, Hct are important to the oxygen carrying capacity of blood.
WBC are indicators of immune function.
Blood Grouping/ Cross Matching Determination in case of blood transfusion is required during or after
surgery.
Serum Electrolyte to evaluate fluid and electrolyte status
PT, PTT( prothrombin and partial Measure time required for clotting and bleeding
prothrombin time)

Fasting Blood Sugar High level m inay indicate undiagnosed DM
BUN/ Creatinine evaluate renal function for excretory purpose of anesthetics
ALT/ AST/LDH and Bilirubin evaluate liver function
Serum Albumin and total CHON evaluate nutritional status
Urinalysis determine urine composition
Chest -xray evaluate respiratory/ heart size
ECG Identify pre existing cardiac problem
4. Psychosocial Assessment and Care

Causes of Fears of the Preoperative Clients
● Fear of Unknown (Anxiety)
● Fear of Anesthesia
● Fear of Pain
● Fear of Death
● Fear of Disturbance on Body Image
● Worries- loss of finances, employment, social and family roles.
Manifestations of Fears
● anxiousness
● bewilderment
● anger
● tendency to exaggerate
● sad, tearful
● failure to carry out simple task
● inability to concentrate
● short attention span
Nursing Interventions to Minimize Anxiety
● Explore Client’s feeling
● Allow client to speak openly about fears/ concerns
● Give accurate information regarding surgery (brief, direct to the point and in simple terms)
● Give empathetic support
● Consider the person’s religious preferences and arrange for visit by a priest/ minister as desired.
Nursing Process in the Perioperative Care
Assessment Review medical record, validate important findings, collaborate with patient
Analyze, interpret and prioritize information.
Nursing Diagnosis Synthesized data collected ; then label clinical judgment about the patient as a
Nursing diagnosis
Can be actual or risk for
Based on patient assessment and perioperative nurse’s clinical reasoning and
critical thinking.
Outcome Identification Because perioperative nursing is largely preventive, generic outcomes have
been identified that apply to all patients undergoing an operative or other
invasive procedure.
Additional outcomes are identified based on individual patient assessment and
nursing diagnosis
Some outcomes are mutually formulated by the nurse and the patient
Should be SMART
Planning Incorporate information to the plan for the patient’s care.

Identify nursing interventions to achieve identified outcomes.

Implementation Carry out nursing plan of care
Gather equipment and supplies; participate in guide/ supervised patient
preparation, transfer to OR bed, anesthesia induction, antimicrobial skin
preparation , draping, patient positioning, time- out, monitoring of physiologic
alterations during surgery, and patient discharge ( transfer from OR bed, handoff
to PACU or other post operative units
Evaluation Determine whether outcomes are met: use outcome statements

Incorporate outcomes that have been met and those are pending in handoff
report to nurse in PACU discharge area
Steps of the nursing process are interrelated, forming a continuous cycle of thought of action. PACU. Post Anesthesia Care Unit
Standards.
4. The following situations make a surgical consent valid, EXCEPT:

A. Consent secured from the nearest relative if patient cannot write
B. Consent is secured before administration of pre-operative medications
C. Consent signed by a patient who is 18 years old or above and is not mentally challenged
D. Consent secured within 24 hours before surgery
5. A day prior to a patient’s operation, an operative permit must be secure. In that case, the nurse is
responsible for which of the following?
A. Explaining the possible alternatives
B. Witnessing the consent
C. Having the patient sign the consent
D. Explain the possible consequences of not undergoing surgery
6.. A patient with a perforated gastric ulcer is scheduled for surgery. The patient cannot sign the
operative consent form because of sedation from opioid analgesic that has been administered. The
nurse should take which appropriate action in the care of this patient?
A. Obtain a court order for the surgery
B. Send the patient to surgery without the consent form being signed
C. Have the hospital chaplain sign the informed consent immediately
D. Obtain a telephone consent from a family member, following agency policy
INFORMED CONSENT
Purposes:
● To ensure that the client understand the nature of the treatment including potential complications and
disfigurement to be explained by the Attending Physician
● To indicate that the client’s decision was made without pressure.
● To protect the client against unauthorized procedure
● To protect the surgeon and the hospital against legal action by a client who claims that an authorized
procedure was performed.
Informed Consent – obtaining an informed consent is a process in which the healthcare provider discloses or
explains a proposed medical treatment, along with the risk/s, benefit/s, and alternative/s for that treatment. It is
legally required and must be obtained before any procedure or treatment that has a risk of causing injury to the
patient.
An informed consent is/must be:

- a form of protection- not only for the patient but also for the healthcare provider ( patient agrees with
the procedure.
- explained by the surgeon
- witnessed by a nurse - in some agencies, there are some nurses who obtain the signature , but the
doctor must be present (signature indicates patient understood the procedure based on the MD’s
explanation)
- written - cannot be verbal because it can be denied by the patient in the future.
- signed - with date and time
- without duress - when patient signs, he should not be coerced or threatened, no violence involved.
*** if emergency – telephone ( based on hospital policy)
*** if no relatives – can be signed by 2 surgeons
In signing an informed consent, WHAT IF?

- a minor - assigned legal guardian ( if both parents are present with the minor, the MOTHER should
sign the consent because she knows the real father of the child)
- an emancipated minor, married, independent, earning a living - Pillitteri : 15 y/o girl pregnant living
with parents is considered emancipated) married, independent, earning a living ( not under the custody
of parents)
- illiterate - – explain based on the patient’s educational level (if cannot write, X or thumb mark as
signature, with note that it is the patient’s signature with nurse’s signature
- unconscious - signed by parents or assigned legal guardian
- mentally incompetent- signed by parents, assigned legal guardian or agency (if no agency, the court
maylegalize the procedure). Psychiatric patient can refuse signing the consent until the court
determines that he cannot decide for himself
- child of minor/unwed parent- parents can sign the consent.
Informed Consent in emergency cases:

- desired but not essential - saving the life of the patient will supersede the need for informed consent
- exhaust all resources to contact the family
- permit may be accepted through telegram, written communication or by telephone (2 nurses
must monitor the call and sign) - be careful with telephone consent since they may deny especially if
something happens (2 nurses: 1 listen, 1 receives consent = both must sign
- a written consultation by 2 physicians other than the surgeon will suffice until relative can sign a
consent
- LOOK FOR ANY INFORMATION REGARDING THE PATIENT’S DESIRE OR REFUSAL TO ANY
LIFE-SAVING PROCEDURE (DNR) - some carry it always with them) § The patient should sign the
informed consent before administration of preoperative medications (sedatives); otherwise, it is
considered null and void. SOME AGENCIES allow the relatives or next of kin to sign or emergency
telephone consent; or if not signed, abort the scheduled operation.
- = patient must not sign if he or she is already have taken pre-op medications
Circumstances Requiring Consent
● Any surgical procedure where scalpel, scissors, suture, hemostats of electrocoagulation may be used.
● Entrance into the body cavity.
● Radiologic procedures, particularly if a contrast material is required.
● General anesthesia local infiltration and regional block.
,
Essential Elements of Informed Consent
● The diagnosis and explanation of the procedure

● Fair explanation of the procedure to be done and used and the consequences
● description of of the alternative treatment or procedure
● description of the benefits to be expected
● the prognosis if the recommended care or procedure is refused.
Requisites for Validity of Informed Consent
● Written permission is best and legally accepted

● Signature is obtained with the client’s complete understanding of what to occur
● Adult sign their own operative permit obtained before the sedation
● For minors, parents or someone standing in their behalf, give consent.
● For married emancipated minor parental consent is not needed anymore, spouse is accepted.
● For mentally ill and unconscious patients, consent must be taken from the parents or legal guardian.
● If the patient is unable to write, an “ X” is accepted if there is a witness to his mark.
● Secured without pressure and threat
● A witness is desirable- Nurse, physician or authorized persons
● When an emergency situation exists, no consent is necessary because inaction at such time may
cause greater injury. ( permission via telephone/ cellphone is accepted but must be signed within 24
hours)

Legal Consent
▪ Patient’s name in full
▪ Surgeon’s name
▪ Procedure to be performed
▪ Patient’s and authorized witness/es signatures
▪ Date of signatures
7. Which nursing intervention would be most important to assist in decreasing the anxiety of a patient
undergoing surgery?
A. Discouraging the patient from discussing the surgical procedure
B. Verifying that the operative permit is signed on the chart
C. Ensuring the safety of the patient while in surgery
D. Assessing the patient for concerns about the surgical experience
8. A preoperative patient expresses anxiety to a nurse about an upcoming surgery. Which response
by the nurse is most likely to stimulate further discussion between the patient and the nurse?
A. “I will be happy to explain the entire surgical procedure to you.”
B. “Let me tell you about the care that you’ll receive after the surgery and the amount of pain
you can anticipate.”
C. “If it’s any help, everyone is nervous before surgery.”
D. “Can you share with me what you’ve been told about your surgery?”
9. . A nurse is developing a plan of care for a patient scheduled for surgery. The nurse should include
which activity in the nursing care plan for the patient on the day of surgery?
A. Have the patient void immediately before surgery
B. Avoid oral hygiene and rinsing with mouthwash
C. Verify that the patient has not eaten for the last 24 hours
D. Report immediately any slight increase in blood pressure or pulse
10. A nurse is preparing a preoperative patient for transfer to the OR. The nurse should take which of
the following actions in the care of this patient at this time?
A. Administer all the daily medications
B. Ensure that the patient has voided
C. Verify that the patient has not eaten for the last 24 hours
D. Practice postoperative breathing exercises
11. A nurse is conducting a preoperative teaching with a patient about the use of an incentive
spirometer. The nurse should include which piece of information in the discussions with the patient?
A. Inhale as rapidly as possible
B. Keep a loose seal between the lips and the mouthpiece
C. After maximum inspiration, hold breath for 15 seconds and exhale
D. The best results are achieved when sitting up or with the head of bed elevated 45 to 90
degrees
12. A patient was given Atropine sulfate. Which of the following nursing interventions would you
perform as the effects of the drug take place?
A. Elevate HOB at least 30 degrees
B. Moisten lips with wet cotton
C. Elevate patient’s lower extremities at 45 degrees
D. Monitor closely for hypotension
Effects of Surgery to the patient:

- stress response is elicited - Why surgery is needed? why it can’t be treated with medications
- defense against infection is lowered- due to stress, immune response is lowered
- vascular system is disrupted- may experience high/ lower blood pressure/ cold clammy skin
- organ functions are disturbed- i.e cesarian section
- disturbance in body image -i.e removal of an eye, body parts

- lifestyle may change - i.e dietary changes
Surgical Risks:
- obesity - excessive demands on the cardiovascular system; if on abdominal surgery, problem
of tension in the suture lines ( harder to close due to thick adipose tissues) delayed wound
healing ( adipose has less blood supply, less vascularity)
- fluid and electrolyte imbalances- can be aggravated during and after surgery : if not
emergency surgery, this is corrected first as much as possible prior the surgery.
- nutritional deficiencies-– decreased in protein (needed for wound healing; promotes tissue
healing), fats and CHO = impaired wound healing =wound sepsis= infection
- age– extremes of age; elderly = decreased ability to respond to stress, delayed wound healing,
altered responses to anesthesia and meds & infants = decreased total blood volume (small
blood loss can be serious or fatal)
- pre-existing disease
Examples :
o DM = problem in wound healing process
o AKI, CRD = problem in eliminating anesthesia or meds used
o COPD = affects respiration in inducing anesthesia & decreased ability to cope with postoperative
pulmonary complications
o Cardiovascular diseases = adequate pumping of blood and constriction of BVs is needed to prevent
shock during surgery
o Hyperthyroidism = increases risk for HTN and cardiac arrest during surgery
o Liver disease = decreased fibrinogen =prone to hemorrhage
- concurrent/prior chemotherapy -makes the patient immunocompromised
- nature of condition
- location- if it is located near the vital/ critical organs
- magnitude/urgency- more urgent the higher the risk
- mental attitude towards surgery- correct first negative mental attitude because can be
brought along and affect during and after the surgery
- caliber of the surgical team- know the surgical team ( surgeon, anesthesia team, nurses)
PRE-OPERATIVE INTERVENTIONS
Sample matters to check:

▪ Allergies- to latex, medications that may cause allergic reactions
▪ ID Bracelet- Patient Identification ( International Patient Safety Goal No. 1)
▪ Elimination- especially prior to bringing the patient to OR and prior sedation; catheterized
only when appropriate;
▪ Pre-meds-30-45 mins prior to surgery for it to reach effect; inform patient of the desired
effect of the drug; safety: raise side rails; then documented (let the patient void first before
giving pre-meds)
▪ Markers for the site of operation- a significant “mark” is being done to the patient’s
operative site to denote the right site for the surgery especially for bilateral organs.
Pre-op Teaching- this is considered as the best time to teach the client for the upcoming procedure
as the healthcare providers can have ample time to to demonstrate to the client the exercises/
activities to be performed post surgery and their benefits.
▪ Pain management
-– tell what is expected during post-op; instruct the patient to call the nurse for analgesics (if on
patient-controlled analgesia, teach the patient how; not the relatives or family) as this can
lessen anxiety.
▪ TCDB or Turn, Cough, Deep Breath, splinting & incentive spirometry

- for lung expansion, preventing post-op respiratory complications, alleviating pain
(increasing O2 in the body), if CS (teach how to splint the suture line to decrease
tension). With incentive spirometry: best position is on upright position
▪ Leg & Foot exercises, Ambulation

- active and passive ROM in lower extremities (prevent stasis that can lead to thrombophlebitis)
better venous return if with ambulation, Ambulation (as soon as the patient is fully conscious &
alert from anesthesia affect) thus preventing pneumonia or atelectasis
Preparing the Patient the Evening Before the Surgery

● Preparing the Skin
- have a full bath to reduce the microorganisms in the skin
- hair should be removed within 1-2mm of the skin to avoid skin breakdown, use of
electric clipper is preferable.
● Preparing the GI Tract
-Nothing by mouth according to the specific ordered hours
- Perform cleansing enemas as required.
ASA ( American Society of Anesthesiologist Guidelines for Preoperative Fasting
Liquid and Food Intake Minimum Fasting Period
Clear Liquids 2 hours
Breast MIlk 4 hours
Nonhuman MIlk 6 hours
Light Meal 6 hours
Regular/ Heavy Meals 8 hours
● Preparing for Anesthesia

-Avoid alcohol and cigarette smoking for at least 24 hours prior the surgery
● Promoting Rest and Sleep
-Administer sedatives as ordered
Preparing the Patient on the Day of Surgery
● Early AM Care
- Awaken 1 hour before the pre-op medication
- Morning bath, mouth wash
- Provide clean patient gown
- Remove hairpins, braid long hair, cover hair with cap if available
- Removed dentures, colored nail polish, hearing aid. contact lenses, jewelry
- Take baseline vital signs before pre-op medications
- Check ID Band, skin prep
- Check for special orders- enema, IV Line
- Check NPO status/ nutritional preparation
- Have the client to void before pre op medications
- Continue to support emotionally
- Accomplish the Preoperative Checklist

PREOPERATIVE MEDICATIONS
Goals:
● To aid in the administration of an anesthetics

● To minimize respiratory tract secretions and changes in heart rate
● To relax the patient and reduce anxiety
Commonly Used Pre-op Medications :
Tranquilizers and Sedatives
● Midazolam
● Diazepam
● Lorazepam
● Diphenhydramine
Analgesics
● Nalbuphine
Anticholinergics
● Atropine Sulfate
Proton Pump Inhibitors
● Omeprazole
● Famotidine
Bowel Cleansers
● Enema, laxatives
TRANSPORTING THE PATIENT TO OR
● Adhere to the principle of maintaining the comfort and safety of the patient
● Accompany OR Attendants to the patient’s bedside for introduction and proper identification
● Assist in transferring the patient from bed to stretcher.
● Complete the chart and preoperative checklist
● Make sure the patient arrives in the OR.
Patient’s Family
● Direct to the proper waiting room.

● Tell the family that the surgeon will probably contact them after the surgery
● Explain reason for long interval of waiting : Anestesia, skin prep, surgical procedure ,recovery room
● Tell the family what to expect postoperative when they see the patient.

B. INTRAOPERATIVE PHASE
- begins when the patient is transferred to the operating room bed and ends with transfer to the
postanesthesia care unit (PACU) or other area where immediate postsurgical recovery care is
given.
Goal :
● Asepsis
● Homeostasis
● Safe Administration of Anesthesia
● Hemostasis
13. Which denotes the specific rationale for operating room personnel being required to cover hair
and shoes and wear specific clean operating room attire?
A. Promotion of a totally sterile environment
B. Elimination of outside environmental hazards
C. The need for non-static uniforms
D. Isolation of the patient’s diseases from the operating staff
SURGICAL ENVIRONMENT
Unrestricted Area
- Provides an entrance and exit from the surgical suite for personnel, equipment and patient.
- Street clothes are permitted in this area and the area provides access to communication with personnel
within the suite and with personnel and patient’s families outside the suit.
Semi-restricted Area
- provides access to the procedure rooms and peripheral support areas within the surgical suite
- personnel entering this area must be in proper operating room attire and traffic control must be
designed to prevent violation of this area by unauthorized persons.
- peripheral support areas consist of : storage areas for clean and sterile supplies, sterilization equipment
and corridors leading to procedure rooms.
Restricted Area
- includes the procedure room where surgery is performed and adjacent substerile areas where the
scrub sinks and autoclaves are located.
- personnel working in this area must be in proper operating room attire.
ENVIRONMENTAL SAFETY
Temperature control and Humidity controls
- The temperature in the procedure room is maintained between 68F-75F ( 20-24 C)

- Humidity level between 50-55% at all times
Ventilation and air exchange system

- Air exchange in each procedure room should be at least 25 air exchanges every hour and five of that
should be fresh air.
- A high filtration particulate filter, working at 95% efficiency is recommended.
- Each room should be maintained with positive pressure, which forces the old air out of the room and
prevents the air from surrounding areas entering into the procedure room.
Electrical Safety
-Faulty wiring, excessive use of extension cords, poorly maintained equipment and lack of current safety
measures are just some of the hazardous conditions that must be considered and constantly checked.
-All electrical equipment new or used must be routinely inspected by a qualified electrician
-Equipment that fails to function properly should be taken out of service immediately.
PRINCIPLES OF ASEPSIS
- When in doubt---DISCARD!
- Tables are only sterile at the top level
- Sterile to sterile; unsterile to unsterile
- Once open, use at once and NEVER re-used
- Below the top of the sterile field is unsterile
- A sterile field is created as close as possible to the schedule time of use
- Sterile areas must always be kept in sight
- Sterile persons should maintain sterility
- Sterile persons should limit contact with sterile areas
- Unsterile persons should avoid unsterile areas
- Once the sterile pack or drape is damaged, it becomes contaminated
- Microorganisms should be at a minimum level
-
PRINCIPLES OF SCRUBBING AND APPROPRIATE OR ATTIRE
You should be dressed appropriately to enter the operating theatre. Although this may vary from hospital
to hospital, generally you must wear:
● Surgical scrubs (bare below the elbows, including removing watches and rings)
● Footwear such as clogs
● Theatre hat (with hair tied up if necessary)
● ID badge
Ensure you ask the Lead Surgeon whether or not they would mind you scrubbing in, then make your way
to the scrub area.
You must open your gown and gloves before you scrub, so as not to contaminate your hands:
● First, open the gown. Carefully use the edges of the paper to open the packet and expose the
surgical gown.
● Next, choose your gloves. Peel the plastic glove packet open over the gown and drop the
gloves onto the sterile gown without touching them.

● This will ensure your gloves and gown are untouched, and therefore sterile.
● Finally, put on a surgical mask and eyewear protection. Make sure you are comfortable, as
you cannot adjust these once you are scrubbed.
Scrubbing Procedure
Step 1
Wet the hands and forearms.
Apply the specified amount of appropriate antimicrobial solution, according to the manufacturer’s
recommendations, from the dispenser (one downward stroke action).
Work the cleaning solution into the hands palm to palm, creating a lather.
Step 2
Rub the right palm over the back of the left and vice versa with the fingers interlaced.
Step 3
Rub hands palm to palm, with fingers interlaced.
Step 4
Perform rotational rubbing backwards and forwards with clasped fingers of the right hand into
the left palm hand and vice versa.
Step 5
Perform rotational rubbing of the right thumb clasped in the left hand and vice versa.
Step 6
Rub the fingertips of the left hand on the palm of the right hand and vice versa.
Step 7
Continue with the rotating action down opposing arms, working to just below the elbows.
Step 8
Rinse and repeat steps 1-7 keeping hands raised above elbows at all times.
The second wash should only cover two-thirds of the forearms to avoid compromising the
cleanliness of the hands.
Local policy may include repeating these steps a third time but to wrists only.
The scrub procedure should last for 5 minutes, with further scrubs during the day lasting 3
minutes.
Step 9
Rinse the hands under running water, allowing the water to run from fingertips to elbows.
Turn the tap off (if necessary) with your elbow and keep your hands up, allowing water to drip
from your elbows.
Step 10
Pick up one hand towel from the top of the gown pack and step back from the surface.
Grasp the towel and open it fully. Do not allow the towel to touch any unsterile object or unsterile
parts of your body.

Hold your hands and arms above your elbow, and keep your arms away from your body.
Step 11
Holding one end of the towel with one hand dry the fingers of the opposite hand using a blotting
rotational motion.
Move to the dry area of the towel and continue in this manner down the forearm to the elbow.
Ensure you do not retrace from the forearm back up to the hands and do not wipe the skin dry.
This may contaminate your hands with micro-organisms from your proximal forearm – you will be
asked to re-scrub.
Repeat with the other towel from the pack for the other hand and arm.
Gowning
Picking up the gown
1. With one hand, pick up the entire folded gown from the wrapper by grasping the gown
through all layers, being careful to touch only the inside top layer which is exposed.
2. Once your hands are securely pinching the gown in these slots, step back from the shelf
and allow the gown to drop.
3. Make sure the gown does not touch any surrounding unsterile objects.
Inserting your arms into the sleeves of the gown
4. Grasp the inside shoulder seams and open the gown with the armholes facing you.
5. Carefully insert your arms partway into the gown one at a time, keeping hands at shoulder
level away from the body.
6. Slide the arms further into the gown sleeves and when the fingertips are level with the
proximal edge of the cuff, grasp the inside seam at the cuff hem using thumb and index finger.
Be careful that no part of the hand protrudes from the sleeve cuff.
Fastening the gown
7. A theater assistant will fasten the gown behind you, positioning it over the shoulders by
grasping the inside surface of the gown at the shoulder seam. The theatre assistant’s hands
should only ever be in contact with the inside surface of the gown.
8. The theater assistant then prepares to secure the gown at the neck and upper back. Gowns
differ in how they are secured, but most have either ties, buttons or velcro tabs.

Gloving
Step 1
Open the inner glove packet that you previously dropped onto your sterile field.
Step 2
Pick up one glove by the folded cuff edge with your sleeve-covered hand.
Step 3
Place the glove on the opposite gown sleeve facing palm down, with the glove fingers pointing towards
you. The palm of the hand inside the gown sleeve must be facing upward toward the palm of the glove.
Place the glove’s rolled cuff edge at the seam that connects the sleeve to the gown cuff. Grasp the
bottom rolled cuff edge of the glove with the thumb and index finger of the hand the glove is on top of.
Step 4
While holding the glove’s cuff edge with one hand, grasp the uppermost edge of the glove’s cuff with the
opposite hand.
Step 5
Continuing to grasp the glove, stretch the cuff of the glove over the hand.
Using the opposite sleeve covered hand, grasp both the glove cuff and sleeve cuff seam and pull the
glove onto the hand. Pull any excessive amount of glove sleeve from underneath the cuff of the glove.
Step 6
Using the hand that is now gloved put on the second glove in the same manner. Check to make sure
that e
Step 7
Adjust the fingers of each glove as necessary so that they fit appropriately.
The Surgical Team: Duties and Responsibilities
Sterile Team: Surgeon, First Assistant, Scrub nurse

Non-sterile Team: Anesthesiologist, Circulating nurse, Technicians
The Surgeon:
1. Captain of the ship
2. Makes the preoperative diagnosis; selects and performs surgical procedures
3. Assumes responsibilities on all medical judgments
4. Determines site
5. Determines position
The First Assistant:

1. Performs skin preparation
2. Positions the patient
3. Helps maintain the visibility of the surgical site, control bleeding, close wounds, and apply
dressing

4. Handles tissues and instruments
5. Documents operating techniques used during the surgery
The Scrub Nurse: Before

1. With the circulating nurse, identifies the patient and completes checklist
2. Validates to the surgeon the preferred sutures and instruments
3. Prepares protective attire
4. Accounts for all sponges, sharps, instruments
5. Checks and labels the drugs and syringes that will be used
The Scrub Nurse: During

1. Prepares sterile instruments and supplies needed during the surgery
2. Establishes and maintains the integrity, safety, efficiency of the sterile field
3. Anticipates, plans for and responds to the needs of the surgeon and other members of the
surgical team
The Scrub Nurse: After

1. Accounts for the sponges, sharps, and instruments
2. Cleans the patient
3. Assists in transferring the patient
4. Assist in after care of the room
5. Labels all specimens
The Anesthesiologist:
1. Induces and maintains anesthesia
2. Manages untoward physiologic reactions of the patient during the operation
3. Observe the care of the patient in the PACU until the patient has regained control of his vital
functions
4. Participates in CPR as a supervisor
5. Acts as a consultant or manager for problems of acute and chronic respiratory insufficiency,
fluids and electrolyte issues, and metabolic disturbances
6. Documents anesthesia induction and patient’s response
The Circulating Nurse:

1. Identifies the patient; preoperative checklist
2. Accompanies the patient in the OR
3. Identifies and reports potential danger in the environment or stressful situation involving the
patient
4. Keeps personal items of the patient or endorses to the relatives
5. Assists scrub nurse in setting the table and instruments
6. Records management
7. Promotes patient safely:

- locks of OR table
- applies necessary straps and restraints
8. Assists anesthesiologist in inducing anesthesia
9. Prepares needed equipment for skin preparation
10. Applies electrosurgical pads
11. Acts as a communication link
12. Requests for blood products
13. Ensures that everyone complies with the principles of asepsis
14. Determines the outcome of the final count
15. Writes an incident report
16. Records any medications used by the surgeon in the operative site
17. Makes the pathology request and proper labeling of specimens
18. Gives health teachings
19. Assists in patient transfer

14. A patient for surgery is to be given epidural anesthesia. She was asking what would be the
advantage of this type of anesthesia. All, but one of the following are correct about epidural
anesthesia.
A. This type of anesthesia can be used even during the postoperative phase
B. Its effect is only for a short duration of time
C. It does not usually cause headache
D. Administration does not have direct contact to the spine
15. Knowing the different stages of general anesthesia would help us anticipate the manifestations of
the patient during anesthesia administration. You would know that the patient is at the first stage if he
manifests:
A. Struggling, shouting
B. Apnea
C. Regular RR and PR
D. Exaggeration of sound reception
16. Which nursing diagnosis would the nurse identify for a 70-year-old patient undergoing surgery
with general anesthesia during which the temperature in the operating room is 20OC?
A. Risk for injury
B. Deficient fluid volume
C. Risk for infection
D. Hypothermia
17. Which of the following is the most dangerous complication during induction of spinal anesthesia?
A. Tachycardia
B. Hypotension
C. Hyperthermia
D. Bradypnea
ANESTHESIA
- state of “ Narcosis”
- Anesthetics can produce muscle relaxation, block transmission of pain nerve impulses and suppress
reflexes.
- It can also temporarily decrease memory retrieval and recall.
The effects of anesthesia are monitored by considering the following parameters:
● Respiration
● O2 saturation/ CO2 level
● HR and BP
● Urine Output
ANESTHESIA INDUCTION
General Anesthesia
● for analgesia & muscle relaxation (can cause loss of memory or amnesia)
● through inhalation –volatile gases ex. halothane; IV – propofol
● can lead to depression of CNS = loss of consciousness (IV then inhalation) *if inhalation is first given
(face mask), patients become anxious
● reversible state consisting of complete loss of sensation
● protective reflexes such as cough and gag are lost
Local/ Regional Block Anesthesia

● does not cause loss of consciousness
● going to anesthesize nerves on a particular area of the body
● achieved by injecting local anesthetic in close proximity to appropriate nerves
● reduce all painful sensation in one region of the body without inducing unconsciousness.
● agents used are lidocaine and bupivacaine.
Spinal Anesthesia (Subarachnoid block)
● local anesthetic is injected through lumbar puncture between L2 and S1

● With a spinal, the anesthesia is injected into the dural sac that contains cerebrospinal fluid.
● anesthetic block conduction in spinal nerve roots and dorsal ganglia: paralysis and analgesia
occur below level of injection.
● agents used are procaine, tetracaine, lidocaine and bupivacaine
Epidural Anesthesia
● achieved by injecting local anesthetic into epidural space by way of a lumbar puncture
● result is similar to spinal anesthesia
STAGES OF ANESTHESIA
1. ONSET/ INDUCTION- Extends from the administration of anesthesia to the time of loss of
consciousness. : exaggeration of sound perception (ringing/buzzing), with auditory & visual
hallucinations (exaggerated sound) *Closing OR door, kept quiet, standby on the side of
patient
2. EXCITEMENT/ DELIRIUM- Extends from the time of loss of consciousness to the time of loss
of lid reflex.shouting, laughing, crying – patient may struggle (irregular breathing) = remain at
the side; assist and report anesthesiologist as needed; loss of eyelid reflexes
3. SURGICAL- Extends from the loss of lid reflex to the loss of most reflexes. Surgical procedure
is started. begin SCRUBBING (fully unconscious, relaxed muscles, no gag reflexes) = wait for
anesthesiologist sign
4. MEDULLARY/ STAGE OF DANGER- It is characterized by respiratory and cardiac depression
or arrest It is due to overdose of anesthesia. Resuscitation must be done. (can lead to
respiratory or circulatory failure); assist to respond immediately in establishing airway, CPR; at
risk: alcoholics (muscles still twitch/contract = needing to increase amount of anesthesia)
*death is common = Antidote for anesthesia overdose: Nalaxon
POSITIONS FOR SURGERY
POSITION TYPE OF SURGERY

DORSAL RECUMBENT Hernia repair, mastectomy, bowel resection
TRENDELENBURG Pelvic Surgeries
LITHOTOMY Vaginal repair, D&C, rectal surgery
PRONE Spinal surgery, laminectomy
LATERAL Kidney, chest, hip surgery
JACK KNIFE Rectal procedures, sigmoidoscopy and colonoscopy
REVERSE TRENDELENBURG Upper abdominal, head, neck, and facial surgery
SUPINE Abdominal surgeries
SURGICAL INCISIONS
INCISION SITE TYPE OF SURGERY
Butterfly Craniotomy
Limbal eye surgeries
Halsted/ Elliptical breast surgeries
Subcostal gallbladder, biliary tract
Paramedian right side- gall bladder, biliary

left- splenectomy
Transverse Gastrectomy
Rectus Right side- small bowel

Left side- sigmoid colon
McBurney Appendectomy
Pfannensteil Gynecologic surgery
Lumbotomy Kidney
C. POSTOPERATIVE
- begins with the patient’s transfer to the recovery unit and ends wth return to an optimal level of
functioning.
Goals :
● Maintain adequate body system functions

● Restore homeostasis
● Alleviate pain and discomfort
● Prevent postoperative complications
● Ensure adequate discharge planning and teaching
Assessment and Care
- On-going assessment
- Provision of safety
- Watch out for possible airway obstruction and hypoventilation
- Parameter for Discharge:
- Activity?
- Respiration?
- Circulation?
- Consciousness?
- Color
Postoperative positions of most cases:

● Cheiloplasty – supine
● Palatoplasty – prone
● Craniotomy – (supra) semi-Fowler’s; (infra) flat
● Hemorrhoidectomy – lateral
● Hypophysectomy – elevated head of bed
● Laminectomy – back straight
● Liver biopsy – right sidelying
● Mastectomy – elevate side of affectation
● Tonsillectomy – lateral/prone
● Thyroidectomy – semi-Fowler's; neck precaution
● Pneumonectomy/Lung biopsy - to affected side
PACU CARE
Transport of client from OR to RR

● avoid exposure
● avoid rough handling
● avoid hurried movement and rapid changes in position
Postoperative Complications:
Shock
- Hypotension, tachycardia, tachypnea
- Apprehension, restlessness
- Thirst
- Cool, clammy skin
- Cyanosis
- Hemodynamic compromise
Management:
1. Position: Trendelenburg
2. Assess for the cause of bleeding
3. Control the bleeders
4. Transfuse fluid as ordered
5. Prepare for possible blood transfusion
6. Drugs: Vitamin K, Hemostan
Pulmonary Complications:
- Atelectasis
- Bronchitis
- Pneumonia
- Pleurisy
Phlebitis
- Pain
- Heaviness

- Signs of inflammation
- (+) Homan’s sign
Management:
1. Hydration
2. Leg exercises (AROM or PROM)
3. Avoid restrictive clothing
4. BED REST! With leg elevation, with knee flexion
5. AVOID MASSAGE!
6. Start management for DVT
Urinary Difficulties
- Retention vs. incontinence
Management:
1. Bladder training
2. Urinary catheterization
Intestinal Obstruction
- Intermittent sharp, colicky abdominal pain
- Fecal (Billous) vomiting
- Abdominal distention
- Diarrhea/constipation
- Shock
Management:
1. NGT insertion
2. Provide adequate nutrition
3. Administer electrolytes
4. Prepare for possible surgical interventions
Hiccups
- Intermittent spasm of the diaphragm
- Irritation of the phrenic nerve between the spinal cord and terminal ramification on the
undersurface of the diaphragm
Management:
1. NGT insertion
2. Hold air while taking a large swallow of water
3. Pressing the eyeball through closed lids for several minutes
4. Breathe in and out using a paper bag
5. Drug: metoclopramide
Wounds
Management:
1. Proper handwashing
2. Proper and consistent wound care
3. Drug: antibiotics
- Dehiscence vs. Evisceration
Management:
1. Apply abdominal binder (splinting)
2. Proper nutrition
3. Stay with the patient; have someone call the doctor
4. Bed rest
5. Position: dorsal recumbent
6. Cover with a moist saline dressing
7. Reassure the patient
8. Prepare for surgery

18. Which type of surgery is most likely to predispose a patient to postoperative atelectasis,
pneumonia or respiratory failure?
A. Upper abdominal surgery on an obese patient with a long history of smoking
B. Upper abdominal surgery on a patient with normal pulmonary function
C. Lower abdominal surgery on a young patient with diabetes mellitus
D. Surgery on the extremities of a non-smoking football player
19. To prevent headache after spinal anesthesia, the patient should be positioned:
A. Semi-Fowler’s
B. Flat on bed for 6-8 hours
C. Prone position
D. Modified Trendelenburg
20. Which of the following assessment data is most important to determine when caring for a patient
who received spinal anesthesia?
A. The time of return of motion and sensation in the legs and toes
B. The character of respiration
C. Level of consciousness
D. Amount of wound drainage
21. A nurse receives a telephone call from the PACU stating that a patient is being transferred to the
surgical unit. The nurse plans to do which of the following first on arrival of the patient?
A. Assess the patency of the airway
B. Check tubes or drains for patency
C. Check the dressing to assess for bleeding
D. Asses the vital signs to compare with preoperative measurements
22. The PACU nurse noticed that a patient has become increasingly restless. Assessment includes
BP dropping from 120/80 to 90/60 mmHg, with HR of 120 bpm, and dressing dry and intact. The
nurse should first:
A. Notify the surgeon and anesthesiologist
B. Increase rate of oxygen delivery
C. Place the patient in the Trendeleburg position
D. Increase rate of IVF
23. A few hours after admitting a patient to the PACU, you noticed that the dressing on the incision is
already soaked with blood. Which would be the best nursing action?
A. Reinforce with sterile dressing moistened with NSS
B. Open the dressing and observe the surgical incision and document
C. Inform the doctor immediately
D. Reinforce the dressing with another sterile dressing
24. Which intervention would be most effective in promoting adequate respiratory function in an
unconscious patient recently admitted to the postanesthesia care unit with no contraindications to
movement?
A. Performing jaw thrust maneuver while the patient is in supine
B. Turning the patient from side to side at 10-minute intervals
C. Extending the patient’s chin while on his side and pillow at the back
D. Placing the patient prone to facilitate drainage of secretions
25. A postoperative patient asks the nurse why is it so important to deep breathe and cough after
surgery. In formulating a response, the nurse incorporates the understanding that retained pulmonary
secretions in a postoperative patient can lead to:
A. Pneumonia
B. Fluid balance
C. Pulmonary edema
D. Carbon dioxide retention
26. Which of the following surgical procedures would most likely predispose an individual to
experience postoperative nausea and vomiting?
A. Laparoscopic appendectomy
B. Liver biopsy
C. TAHBSO
D. Radical mastectomy of the left breast
27. Which of the following interventions would the nurse include when evaluating the patient’s urinary
elimination status?
A. Keeping the siderails up all the time
B. Assessing the patient’s intake and output
C. Monitoring the patient’s vital signs
D. Inspecting the surgical wound for infection
28. Which statement by the patient indicates that the patient understands the nurse’s teaching about
postoperative wounds?
A. “I should expect a slight odor from the surgical dressing.”
B. “I should call my doctor if my wound is intact and has no drainage.”
C. “I should not clean my surgical wound until I go back to my doctor in two weeks.”
D. “I should call my doctor if I have a temperature of 102OF”.
29. A nurse assesses a patient’s surgical incision for signs of infection. Which finding by the nurse
would be interpreted as a normal finding at the surgical site?
A. Red, hard skin
B. Serous drainage
C. Purulent drainage
D. Warm, tender skin
30. When performing a surgical dressing change of a patient’s abdominal dressing, a nurse notes an
increase in the amount of drainage and separation of the incision line. The underlying tissue is visible
to the nurse. The nurse would do which of the following in the initial care of this wound?
A. Leave the incision open to air dry the area
B. Apply a sterile dressing soaked in povidone-iodine (Betadine)
C. Irrigate the wound and apply a sterile dressing
D. Apply a sterile dressing soaked in normal saline
31. Which intervention should the nurse implement first for the patient who develops an abdominal
wound dehiscence after stapler removal?
A. Covering the wound with saline dressings and calling the surgeon immediately
B. Leaving the patient, stating that you will be right back
C. Completing a head-to-toe assessment before calling the surgeon
D. Placing a sign on the patient’s door to indicate the need for drainage precautions
32. As a part of patient’s role in the postoperative period, Cucu is instructed to perform coughing
exercises to remove retained secretions from the airways. The nurse is giving correct health
teachings regarding this exercise if she stated:
A. “You should perform this exercise once every day.”
B. “You need not to perform deep breathing exercises before the procedure for this will not
mobilize secretions.”
C. “Take 3 deep breaths, exhaling through the mouth before coughing deep in the lungs.”
D. “This may be done on a prone position and the patient may splint surgical incision to
minimize pressure.”
33. The nurse is caring for a patient who is complaining of cramping pain in the calf. Upon inspection,
the nurse noticed that it was swollen and red and he suspected thrombophlebitis. Which of the
following interventions are you going to do?
A. Administer anticoagulants
B. Massage the leg
C. Maintain bed rest while affected leg is elevated
D. Rub the site with hot compress

34. Which intervention would be most appropriate to minimize the risk of deep vein thrombosis (DVT)
in a postoperative patient?
A. Applying a sequential compression device to the lower extremities
B. Encouraging the patient to keep his legs mobile
C. Administering IV heparin immediately after surgery
D. Typing and cross-matching the patient for whole blood transfusion
35. A nurse is monitoring the status of a postoperative patient. The nurse would become most
concerned with which of the following signs that could indicate an evolving complication?
A. Increasing restlessness
B. A negative Homan’s sign
C. Hypoactive bowel sounds on all four quadrants
D. Blood pressure of 110/70 mmHg and pulse of 86 beats/minute
36. In order to confirm whether a patient is suffering from hypovolemic shock, the nurse performed a
more detailed assessment. Which of the following data would support the nurse’s suspicion?
A. BP = 90/70 mmHg
B. Capillary refill of 2 seconds
C. Heart rate of 89 bpm
D. Urine output of 80 ml within 2 hours
37. A patient is recovering from abdominal surgery. During the postoperative period, which action
should the nurse take to help prevent pneumonia?
A. Encourage the patient to avoid intake of liquids
B. Have the patient use an incentive spirometer four times daily on a supine position
C. Splint the incision area while the patient coughs and breathes deeply
D. Support the patient in an orthopneic position
38. Proper positioning is among the key interventions which may influence the recovery of a surgical
patient. A patient who has undergone lung biopsy of the right lung should be placed on:
A. Semi-Fowler’s
B. Left side lying
C. Right side lying
D. Flat on bed
39. A patient who has undergone tonsillectomy should be placed on:

A. Semi-Fowlers
B. Dorsal recumbent
C. Prone position
D. Flat on bed
40. Which of the following primarily prevent postoperative complications?

A. Adequate fluid intake
B. Well balanced diet
C. Early ambulation
D. Administration of antimicrobials

lifted from the Hand outs of Maam Jennie C. Junio, RN, MAN
Prepared by:
(SGD) Gail Marie G. Galang, RN, MAN

Competency Appraisal 1 Instructor
Reviewed by:
(SGD) Ma. Corazon M. Tanhueco, RN, MAN

Level 4 Academic Coordinator
(SGD) Debbie Q. Ramirez, RN, Ph.D.

Assistant Dean
Approved by:
(SGD) Zenaida S. Fernandez, RN, Ph.D.

Dean

Mam Gail - Perioperative Nursing

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ANGELES UNIVERSITY FOUNDATION

COURSE SYLLABUS FOR COMPETENCY APPRAISAL I (CA1)

1st Semester, AY 2022-2023

1. Define the three phases of the surgical experience.

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

(4) FOUR MAJOR TYPES OF PATHOLOGIC PROCESS REQUIRING SURGICAL INTERVENTION

CLASSIFICATIONS OF SURGICAL PROCEDURE

**Ablative-removal of an organ (e.g Appendectomy)

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

Classification Indication for Surgery Examples

Emergent-patient requires Without delay -severe bleeding

Urgent/ Imperative- patient within 24 hours to 30 hours -kidney/ ureteral stones

Required- patient needs to have Plan within a few weeks or -cataract

Optional- patient’s decision Personal preference -cosmetic surgeries

III. According to DEGREE OF RISK

-High Risk/ Greater Risk for infection

IV. Ambulatory Surgery/ Same-Day Surgery / Outpatient Surgery

Examples of Ambulatory Surgery

Goals of the Phase :

Preoperative Phase Assessment

Serum Electrolyte to evaluate fluid and electrolyte status

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

BUN/ Creatinine evaluate renal function for excretory purpose of anesthetics

ALT/ AST/LDH and Bilirubin evaluate liver function

Serum Albumin and total CHON evaluate nutritional status

Urinalysis determine urine composition

Chest -xray evaluate respiratory/ heart size

ECG Identify pre existing cardiac problem

4. Psychosocial Assessment and Care

Nursing Process in the Perioperative Care

Planning Incorporate information to the plan for the patient’s care.

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

Evaluation Determine whether outcomes are met: use outcome statements

4. The following situations make a surgical consent valid, EXCEPT:

An informed consent is/must be:

In signing an informed consent, WHAT IF?

Informed Consent in emergency cases:

Circumstances Requiring Consent

● The diagnosis and explanation of the procedure

Requisites for Validity of Informed Consent

● Written permission is best and legally accepted

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

Effects of Surgery to the patient:

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

Sample matters to check:

▪ TCDB or Turn, Cough, Deep Breath, splinting & incentive spirometry

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

▪ Leg & Foot exercises, Ambulation

Preparing the Patient the Evening Before the Surgery

ASA ( American Society of Anesthesiologist Guidelines for Preoperative Fasting

Liquid and Food Intake Minimum Fasting Period

Clear Liquids 2 hours

Breast MIlk 4 hours

Nonhuman MIlk 6 hours

Light Meal 6 hours

Regular/ Heavy Meals 8 hours

● Preparing for Anesthesia

COMPETENCY APPRAISAL 1 A.Y. 2022-2023

● To aid in the administration of an anesthetics

Commonly Used Pre-op Medications :

Tranquilizers and Sedatives

Proton Pump Inhibitors

TRANSPORTING THE PATIENT TO OR