Care of Adults with Problems in Oxygenation

(Surgical)
PERIOPERATIVE NURSING

PRIORITIZATION Urinalysis
o
 Airway Specific gravity -  in DHN
 Obstruction 
 Breathing Pattern CPC – Cardiopulmonary Clearance
o
 Lung expansion Required in patient older than 35
 Pain, pleural effusion o
 Circulation Chest x-ray – indicates lung capacity
o
 Tissue perfusion 12L ECG

NURSING PROCESS NPO
o
Required for general anesthesia
ASSESSMENT 
 Subjective (must be followed by assessment) Risk for regurgitation
and Objective data (intervention, priority o
diagnosis) At least 6 to 8 hours

 Maslow’s Hierarchy of Needs Bowel Preparation
 Think of something that will kill the patient if o
widrawn from him 3 days preparation
o
 O2 - fluids - nutrition -thermoregulation -
Progressive diet
comfort o
Laxatives, Enema
PLANNING 
Antibiotics
 Must hae proper objective o
 Specific Neomycin
 Measureable 
 Attainable Aminoglycosides - gram (-)

 Realistic Local effect – intestines
 Time-bound o
Poorly absorbed in the GI
INTERVENTION o
Metronidazole
 Nursing action - independent 
 Priority action - dependent or interdependent Antiprotozoal, antibacterial
o
PERIOPERATIVE NURSING Give 1 hour prior to OR

- Care of patients around the phases of operation IV Line
o
Preoperative - Decided to undergo procedure until D5 containing IV

brought to OR Source of glucose or else will result to
Intraoperative - Patient is brought to OR to PACU catabolic activities
Postoperative - PACU until full recovery o
Large bore needle
o
PHYSIOLOGIC Colors:

CBC G 16
Hgb - oxygen carrying capacity of blood that Gray

helps transport oxygen throughout the body G 18
 Green
At least 120 
Hgb – tissue perfusion problem  G 20
Pink
Blood loss > 500 mL: needs extra 
pRBC G 22
Hct – hemoconcentration or hemodilution Blue
DHN – hemoconcentration 
G 24
Can indicate possible bleeding, internal bleeding Yellow
 active bleeding o
RBC – O2 carrier  number
WBC - if with infx, start antibx tx  size
o
Plt – thrombocytes; blood clotting  number
 size – Fr
Prepared by: Ma. Kristina Cazandra David Ibanez
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Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
 o
Pulse oximeter Vertical first
o o
O2 sat Nurse – sign as witness and verify
o understanding
Remove nail polish including colorless o
o MD – secure consent
NO direct sunlight – Infrared Emotional
o o
If exposed to sunlight - cover Who will be with the patient during surgery
 o
Remove prosthesis, false teeth, loose teeth Circulating RN – informs the family about the status of
o the sx
Crucial for general anesthesia Spiritual
o o
Risk for aspiration Pastoral care service/ chaplain
o Preoperative Medications
Remove before giving anesthesia 
 Anticholinergic
Remove underwear o
Mental  secretions and acidity
 o
Health Teachings (2 types) May cause tachyPR
o o
Process Information Atropine S04
 
About surgical experience, time, Analgesics
meds, set-up o
  pain threshold
Prepare on what to anticipate o
 Nalbuphine, Fentanyl
Do not give too much information o
o Antidote: Naloxone (Narcan)
Procedural Information o
 Check RR, BP (hypotension), GU (urinary
Things that they have to do post-op retention), GI (constipation)
 
Deep breathing Sedatives
o o
Inhale – nose Diazepam, Midazolam
o 
Exhale – pursed-lip Anti-histamines
o o
Every hour x 10 during Anticholinergic and sedative property
waking hours o
 Promethazine, Diphenhydramine
Coughing exercises 
o Antibiotics
Effort comes from the lungs AREAS IN THE OPERATING ROOM
o 
Deep breathing first Non-restricted Area
o o
At least every 2 hours OR lobby
o o
 Tympanoplasty, Neuro - Street clothes
 ICP 
 Semi-restricted Area
Incentive spirometry o
o Hallways, work area, instruments room,
Semi-fowler’s sterilization room
o o
Breath through the mouth – Scrub suit – clean
tight seal o
o OR shoes, bonnet
Sustain 
o Restricted Area
3 to 4 secs o
o Suite, operating instruments open
500 – 600 immediate post o
op Scrubs, OR shoes, bonnet, mask
 o
Consent Scrub sink (IDEAL)
o INTRAOPERATIVE PHASE
18 year old and above Reasons for Surgery
o 
Free will, sound mind Diagnostic
Prepared by: Ma. Kristina Cazandra David Ibanez
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Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
o Supra
Removal and study of instruments to make a above
diagnosis Suffixes
o 
Breast biopsy Algia
 pain
Exploratory 
o Centesis
More extensive means to diagnose, puncture
exploration of body cavity or use of scopes 
inserted through small incision Copy
o to view
Exploratory laparotomy - exploration of 
abdomen for unexplained pain Ectomy
 surgical removal
Curative 
o Itis
Removal or replacement of defective tissue to inflammation
restore fxn 
o Lith
Cholecystectomy, hip replacement stone or calculus
 
Palliative Lithotomy
o removal of stones
Relief of symptoms or enhancement of 
function w/o cure Logy
 study
Cosmetic 
o Lysis
Improve the appearance destruction, dissolution, loose
o 
Correction of defects Oma
Categories of Surgery tumor
 
Emergency Ostomy
o opening into
Done immediately to save life or limb 
o Plasty
Takes precedence over any other sx surgical formation
scheduled 
 Pexy
Elective fixation
o 
Done at the pt and surgeon’s convenience Rrhapy
o
May be performed w/in days and even
repair; suturing of repair Perioperative Nursing
University of Santo Tomas – College of Nursing / JSV
months after diagnosis
Rootwords
Prefixes


Adeno
A
gland
without, absence


Ano
Ecto
anus
external, outside


Arthro
Infra
joint
below


Angio
Inter
blood or lymphatic vessel
between


Blephar
Pan
eyelid
all


Broncho
Peri
bronchus
around


Cardio
Poly
heart
many


Cephalo
Pseudo
head
false


Cerebro
Retro
brain
behind, posterior


Cheilo
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Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
lip 
 Procto
Chole rectum
gall, bile 
 Pyelo
Cholecyst renal pelvis
gall bladder 
 Rhino
Choledocho nose
common bile duct 
 Salphingo
Chondro fallopian tube
cartilage 
 Thoraco
Colo chest
large intestine, colon 
 Urano
Colpo palate
vagina 
 Uretero
Costo ureter
rib Lith – stone
 Lithiasis – condition
Cranio Lithotomy – removal
skull Ostomy – opening into; input or output
 Otomy – opening for sx
Cysto Pexy – fixation; suturing into place
bladder Paxy – endoscopic crushing
 * No incision in TURP, ESWL or –scopy
Esophago * Layman’s term if communicating w/ patient
esophagus Operating Room Team Members
 
Gastro Surgeon
stomach o
 Leader
Glosso o
tongue Decision maker
 
Hepar Asst. Surgeon
liver 
 Anesthesiologist
Hyster o
uterus In tandem with surgeon
 o
Lapar Monitors hemodynamic stability
abdomen o
 Checks amount of blood loss
Lipo 
fat Scrub Nurse
 o
Mast/Mammo Overall maintenance of sterility
breast o
 One step ahead, anticipate needs
Nephron o
kidney Sterile team
 o
Oculo Indispensible nursing tandem
eye 
 Circulating Nurse
Oophor o
ovary Coordinate
 o
Orchi Two step ahead
testis o
 Indispensible nursing tandem
Osteo o
bone Overseer; more senior
 o
Oto Counting instruments, before closing the 1st
ear layer
 o
Phlebo Initiates Surgical Safety Checklist
vein Sign IN
 
Pneumo Before the actual start of surgery
lungs 
Prepared by: Ma. Kristina Cazandra David Ibanez
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Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
Identifying the patient, site Orderly
 o
Allergies, Antibiotics, Anticipated blood loss (if Transport patient, position, draping
greater than 500 or 7ml/kg in children, need 
BT), Pulse Oximeter Clerk
Time OUT 
 Ward Clerk
Introduction of patient and procedure by o
doctor Documentation
 
Identity of team Billing Clerk Perioperative Nursing
 University of Santo Tomas – College of Nursing / JSV
Special concerns by anesth o
 Charges
Completeness and sterility of equipment by 
scrub nurse OR Tech
 o
Done before skin incision Set-up of instruments
Sign OUT 
 Biomed Tech
Completeness of instruments o
 Engineer repairing the instruments/ equipment
Proper endorsement of specimen o
 Check up and technical assistance of
Must be labeled with name, age, gender, machines
specimen/location, surgeon, pathologist 
 Med Tech
o
For normal histopathology
- Assists pathologist
On buffered formalin sol’n 
- Internist
o
After 7-10 working days
Doctor of Internal Medicine
-
o
Labeled properly
CPC


Frozen section
Resident
- o
Clean plastic bag Licensed
- 
Labeled properly Intern
- o
Labeled immediately and sent Graduate of medicine
right away o
 No license
Follow up histopath results to physician 
 Radiologist
Pathologist o
o Read and check chest x-ray
Clinical – specimens (stool, urine, CBC) o
o Ortho and endoscopic procedures
Histopath – benign or malignant 
o Rad tech
Autopsy – cause of death o
 Operate equipment
Forensic pathologist – more specific Secondary
 
Medico-legal – doctor lawyers Security
o 
Blood bank – lab screening, BT Janitorial
Additional Members o
 Outside the OR
Supervisor o
o Disposal of biowaste
In charge of admin functions 
 Medical/ Social Services
Head Nurse o
o Assist family, support system
Day-to-day tasks, coordinate to other depts. o
 Financial assistance
Nurse Aide 
o Medico-legal
Receptionist, assists o
o Give to head nurse and she will refer to
 scrub medico-legal department
 
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Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
Pastoral (Chaplain) o
 Kept to a minimum
Medical Records 
 Drapes
NBI o
 Should not be removed once placed
MMDA o
o Do not transfer
Disposal 
 Gowns
RMAO (Records Management Archives Office) o
o Below waist, back, elbow and above are
Disposed every 5 years; Cultural Heritage unsterile
PRINCIPLES OF ASEPSIS AND STERILITY 
Definition of Terms Gloves
 o
Asepsis – absence of microorganisms Glove Tear
 
Disinfection – reduction of pathologic microorganisms If w/o time – double
without destroying the spores 
 If w/ time – change
Contaminated – soiled with microorganisms o
 Dressing and tape before removing gloves
Infection – invasion of the body by pathogenic 
microorganisms Room disinfection
 
Spores – inactive but viable state of a microorganism Spilled blood
 o
Sterile – free from microorganisms including spores Contain
 o
Surgical Conscience – involves the concept of self Drainage and floor suction
inspection and moral obligation involving scientific and 
intellectual honesty Lights
Sources of Contamination o
 Moist and dry
Skin – never sterile o
 Smudge – glaring
Respiratory tract 
 1 to 2 ft away from sterile field
Articles used in the procedure MEDICAL AND SURGICAL INSTRUMENTS
o 
First knife used for skin incision should not be Category I: Critical Items
used again o
 Must be sterilized
Circulating air o
o Come in contact with blood vessels and non
Should ideally be closed intact mucosa
o 
Sterile field not open unnecessarily Category II: Semi-critical Items
 o
Scrub team/ patient’s hair Sterilization is preferred but disinfection is
Patient’s hair acceptable
o o
No shaving - Microabrasion Intact mucosa or non-intact skin
o 
Hair clippers – electric razor Category III: Non-critical Items
o o
Depilatory creams (Veet) but patch allergy testing Clean
must be done o
Principles on Asepsis Intact skin
 o
Sterile items Ball pen, stethoscope, BP app
o STERILIZATION PROCEDURES
Sterile to sterile only 
 Physical Sterilization
Sterile field o
o Moist heat
Should always be in the line of vision 
o Autoclaving
Back table, mayo table o
o Steam under pressure
Under table and back are unsterile o
o Temperature: 121 – 123 °C
Back table is the basis for “under the table” o
 Pressure: 15 – 17 psi
Traffic o

Prepared by: Ma. Kristina Cazandra David Ibanez

6
Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
Time: 15 – 30 mins Shelf life
o o
Not sterile if not all are Time-related – depends on method
achieved 
 Autoclave – 2 weeks
Flash Sterilization 
o Sterrad – 1 month
Temperature: 132 °C 
o Ethylene oxide – 2 months
o
Pressure: 15 – 17 psi Perioperative Nursing Event-related
University of Santo Tomas – College of Nursing / JSV 
o
Sterile as long as package is intact
Time: 3 - 10 mins 
 More recommended
Cost effective 
 Indicators
Sensitive items cannot be o
autoclaved Chemical indicators
 
Sharps become dull Change in color when exposed to a
o
situation or substance
Dry heat (Dry heat autoclaving) 
 Underwent sterilization process –
Chemical Sterilization white to brown or black
o 
Ethylene oxide – Best sterilization Ethylene oxide – yellow to blue
 
Temperature: 16 – 18 °C Plasma gas – red/ maroon to yellow/
 gold
Time consuming o
 Biologic indicators
Scopes 
 Best indicator of sterility
Yellow to blue 
o
Small test tube then sterilize
Plasma hydrogen peroxide gas (Sterrad) ANESTHESIA
 Factors that determine the choice of anesthesia
30 mins 
 Physical and mental condition of patient
 liquid, items with lumix (scopes, o
camera) – hazy  MENTAL – ability to comprehend
 
Best for sharps Age and weight of patient
Disinfection Procedures o
 Child – general
High level disinfectant o
o
Adult - regional
Activated glutaraldehyde 
o
Operation to be performed
Powder (activator) o
o
Above nipple line – general anesthesia
Disinfects but prolonged exposure may o
become unsterile Below nipple line – regional anesthesia
o

After soaking, rinse with sterile water Epidural
 
Intermediate level disinfectant Spinal
o 
70% alcohol, iodine compounds Type and probable duration of operation
o o
Chlorhexidine Epidural – has a port where you can infuse
o
add’l meds
Skin 
 Patient’s preference
Low level disinfectant 
o Laboratory finding
Phenolic compounds, chlorine compounds 
o Any known idiosyncrasies
IV, floor Stages of Anesthesia
STERILIZATION AND DISINFECTION 
 Stage 1 (Induction/ Stage of Analgesia)
Labels – process, date, expiration dates, item, packer, o
processer Starts from induction period until patient loses
 consciousness
Wrappers o

Prepared by: Ma. Kristina Cazandra David Ibanez
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Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
Patient may appear drowsy or dizzy Common anesthetics:
o 
Safety – bed rails and body straps Nitrous oxide
o 
Keep the room quiet Sevoflurane (Sevorane)
 
Stage 2 (Excitement/ Delirium)
o Desflurane (Suprane) Perioperative Nursing
University of Santo Tomas – College of Nursing / JSV
Lasts from the time the patient loses

consciousness until he loses certain reflexes
Isoflurane (Forane)
such as swallowing, gag and eyelid
o 
Halothane (Fluothane)
May appear excited, may breathe irregularly o
o
GAOT (General anesthesia orotracheal)
Sensitive to external stimuli o
o
GANT (General anesthesia nasotracheal)
Maintain silence o

GETA (General endotracheal anesthesia) –
Stage 3 (Surgical Anesthesia)
o fastest
o
From the period the patient lost certain
Laparoscopic sx
reflexes and respiratory paralysis occurs
o 
Intravenous
Patient with regular respiration, constricted o
pupils, jaws relax and auditory sensation is lost
o Drugs that may produce hypnosis, sedation,
amnesia and/ or analgesia is administered via
Assist the team!
IV

o
Stage 4 (Stage of Danger)
o Common anesthetics:

Reached when too much anesthesia has
Thiopental Na (Pentothal)
been given and the patient has not been

observed carefully
Propofol (Diprivan)
o

Death may result from respiratory and or
Ketamine (Ketalar)
cardiac arrest unless resuscitated properly o
o
No premature awakening
Patient is not breathing with little to no heart 
beat Complication:
o o
Medullary paralysis – cardiopulmo arrest Malignant Hyperthermia (GA)
o

Too much anesthesia Gases and succinylcholine
Types of Anesthesia 
 Spasm
General Anesthesia 
o
 Carbon dioxide and heat
Association pathways are broken in the 
cerebral cortex to produce more or less lack Blood is brown to black
of sensory and motor perception 
o Acidosis
Pain is controlled by general insensibility, the 
patient is unconscious, he cannot hear, feel, Antidote: Dantrolene Na
or move his whole body 
o Ice bag
Used in operations above the thoracic level Regional Anesthesia
o 
Cannot be aroused Epidural Anesthesia
 o
Regional Anesthesia Used for long procedures below the thoracic
o level
Depresses superficial nerves and interferes o
with the conduction of pain impulses from Used for post-op management of pain
certain area or region o
o Uses an epidural catheter (Perifix)
Pain is controlled without loss of o
consciousness, one region or an area of the Common anesthetics:
body is anesthetized 
General Anesthesia Bupivacaine (Sensorcaine Isobaric
 Marcaine)
Inhalation 
o Lidocaine (for testing)
With the use of volatile gases and vapors o
o Complication:
Either per mask or endotracheal tube 
o Urinary retention – foley catheter
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Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
 
Subarachnoid Block Right subcostal (Kocher’s incision) – biliary, gall bladder
o 
Commonly termed as Spinal Anesthesia Median Upper Abdominal
o 
For short cases below the thoracic level Median Lower Abdominal – pelvic, gyne
 
2 to 3 hrs procedure Paramedian – side of median
 
3 to 4 hrs maximum McBurney’s Incision – appendectomy
o 
Uses spinal needle gauge 22, 25 or 27 Rocky Davies – straight for appendectomy
o 
Relaxes all muscles Inguinal
o 
Common anesthetics: Transverse suprapubic (Pfanessteil) – cuts across the
 muscle, long wound healing
Bupivacaine Hyperbaric Miscellaneous Incision
(Sensorcaine Heavy) 
 Collarline (Curvilinear incision) – used for thyroidectomy
PDE (Tetracaine (Pantocaine)) 
 Coronal, butterfly incisions – craniotomy
Dextrose, Ephedrine – 
vasoconstriction, slow absorption Thoracotomy incision – anterolateral or lateral
o posterothoracic
Wear off 1 hour/ level 
o Lumbotomy incision – kidney surgery
Complications: 
 Sternal split – sternotomy
Spinal Headache – CSF leak – 
pressure Limbal – cataract
o 
Hydrate, flat on bed Elliptical Halsed – radical mastectomy
 
Vasodilation – pre-load 1L IVF to Post/pre Aural incision
prevent drop in BP 
 Caldwell Luc – sinuses
Field/ Nerve Block Positioning
o 
Anesthetizing surrounding tissues (field) or Choice of position is made by the surgeon and
group of nerves at a given point positioning is done by the members of the surgical
o team
Common anesthetics: 
 Factors to consider:
Bupivacaine Isobaric (Sensorcaine, o
Marcaine) Length of the procedure
 o
Lidocaine Site of the operation
 o
Local Infiltration Pain upon moving
o o
Agent is injected into the tissues around Kind of anesthesia
incision site 
o Reflect proper body alignment
Anesthetic: Lidocaine 
 Cystoscopy – lithotomy
Topical 
o Thoracentesis – unaffected side, orthopneic
Agent applied directly into a mucosa or 
surface Chest tube – supine, HOB elevated
o Qualifications of a Good Position
Anesthetic: Lidocaine spray 
INCISION, POSITION AND DRAPING Not interfere with respiratory
Layers 
 Not interfere with circulation
Skin – tough, non-absorbable suture, cutting needle 
 Not cause pressure on any nerve
Subcutaneous - thin 
 Provide total accessibility
Muscle – do not suture Common Injuries related to Positioning
 
Fascia – tough connective tissue, non-absorbable Brachial plexus injury
suture 

Peritoneum – thin
Ulnar/ radial nerve injury Perioperative Nursing
University of Santo Tomas – College of Nursing / JSV
Incisions 
Prepared by: Ma. Kristina Cazandra David Ibanez
9
Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
Saphenous and peroneal nerve damage 4-0 – regular needle holder
o o
Lithotomy – lift together Larger than 4-0 – catalejo
 * Curve of instrument follows the curve of surgeon’s hand
Integumentary damage Knife Handle
 
Eye and facial injury #4
Skin Preparation (Special Considerations) 20 and 
 
Determine the area and the extent to be prepared #3
including proposed incision 10, 11, 12, 15
 
Practice modesty and privacy #7
 7, 11, 12, 15
Examine area to be prepared Gas Tanks/ Gas Cylinders
 
In abdominal operations focus on the umbilicus Green
 Oxygen
In shaving follow the direction of the hair growth while 
the other hand exerts an opposite force Gray
 Carbon dioxide – lap procedures
Inside to outside when infected 
BASIC SURGICAL INSTRUMENTS Yellow
Instrument Classification Compressed air
 
Clamping/Hemostats Blue
o Nitrous oxide
Kelly, Mosquito, Tonsils/Adson, Mixter 
 Black
Grasping/Holding Nitrogen
o 
Delicate – thumb forceps Brown
o Helium
Tough – tissue forceps – w/ teeth Cautery
o 
Russian, Adson Monopolar – needs grounding pad at leg
o (gastrocnemius) - good muscle mass and perfusion
De Bakey – more sensitive tissues o
o May have electrical burns
Bobcock – delicate tissue (fallopian tube, o
ovary) Pads must not be placed in scars, kelloids,
 might get wet, near metal implants and hairy
Retracting Instruments 
o Bipolar – w/ grounding pad
Army navy, Richardson 
o Do’s
Maleable o
o Place it in area with good muscle mass – tissue
Deaver perfusion
o 
Weilaner Don’t
 o
Cutting/Dissecting Areas that might get wet
o o
Metz – delicate tissue blood vessel Near metal implants
o o
Mayo curve – tough Hairy
o o
Straight – supplies Keloids or scars
o SUTURES
Blade Definition of Terms
20 
11 Suture – any material used to sew, stitch or hold tissues
Stab knife or body parts together
I&D 
12 Ligature – a tie, to ligate blood vessels
Hook knife 
Oropharyngeal Primary suture line – main layers of tissues which must
Hallow/ tubular be sutured
structure 
15 Stay or tension suture – sutures placed at the incision to
Small act as reinforcement or support
bellied knife 
 Tensile strength – amount of tension of pull that a strand
Suturing instruments will withstand
o Criteria for a Good Suture
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10
Care of Adults with Problems in Oxygenation
(Surgical)
PERIOPERATIVE NURSING
 Controlled release
Versatility Alternative Methods to Suturing
 
Ease of handling Surgical Strips
 
Minimal tissue reaction and inability to create a Skin clips
favorable environment for infection and tissue rejection 
 Skin staples
High tensile strength 
 Ligation clips
Easy to thread, easy to sterilize and will not shrink 
 Surgical staples
Made of non-electrolyte, non-capillary, non-allergenic 
and non-carcinogenic materials Tissue adhesives
 Hemostatic Agents
Absorbed with minimal tissue reaction 
Uses of Suture Bone wax
 
Ligating Absorbable gelatin sponge
 
Suturing Collagen sponge
 
Closing Oxidized cellulose - Surgicel
Types of Sutures 
 Gel foam
Natural or synthetic Surgical Scrubbing and Gloving
o 
Natural – comes from environment; silk, Fingertips to elbow
catgut, metals, cotton – may react easily 
o 10 mins
Synthetic – more refined, less reaction 
 Grasp the gown at the center, lift and step back, dry
Absorbable or non-absorbable hands at hemline, wrong side facing you
o 
Absorbable –naturally dissolved Open gloving
o
Non absorbable – tough tissues/ high support

Monofilament or multifilament
o
Multifilament – faster reactivity
Progression Chart

Lower than 0 – smaller

Higher than 0 - larger
Surgical Needles

Three basic sections
o
Point

Taper (round) – for delicate tissues

Blunt – for more delicate tissues

Cutting – tough tissues/ skin
o
Tapercut
o
Conventional cutting
o
Reverse cutting
o
Body or Shart Perioperative Nursing
University of Santo Tomas – College of Nursing / JSV
o
Eye (trauma)

Atraumatic or Swaged – attached to
suture since with suture already
o
Keloid formers

French Eyed or Spring

Prepared by: Ma. Kristina Cazandra David Ibanez
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