3 Phases of Operating

Room Technique
Preoperative Phase
Intraoperative Phase
Post Operative Phase
What is operating room
technique?
• Strict aseptic technique is needed at all times in
an operating room. Freshly cut living tissue can
become infected easily. It is therefore essential for
all members of the operating team to know the
common sources of bacteria in an operating
room and the means by which they reach the
sterile field to contaminate it.
DEFINITION OF TERMS
• SURGERY -It is the branch of medicine concerned
with diseases and conditions which require or are
amenable to operative procedures. Surgery is the
work done by a surgeon.
-"Surgery can involve cutting,
abrading, suturing, laser or otherwise physically
changing body tissues and organs."
• SURGEON - A physician who treats disease, injury, or
deformity by operative or manual methods. A
medical doctor specialized in the removal of organs,
masses and tumors and in doing other procedures
using a knife (scalpel)
• STERILE - free from living germs or microorganisms;
aseptic: sterile surgical instruments.
• ASEPSIS - The state of being free of pathogenic
microorganisms.
- The process of removing pathogenic
microorganisms or protecting against infection by
such organisms.
• SEPSIS - a toxic condition resulting from the
spread of bacteria or their toxic products from a
focus of infection; especially : septicemia
• SEPSIS - is a severe illness caused by
overwhelming infection of the bloodstream by
toxin-producing bacteria.
- is caused by bacterial infection that can
originate anywhere in the body.
• DISINFECTANT - any chemical agent used chiefly
on inanimate objects to destroy or inhibit the
growth of harmful organisms.
• BACTERIOSTATIC -Capable of inhibiting the growth
or reproduction of bacteria.
- An agent, such as a chemical or biological
material, that inhibits bacterial growth.
• BACTERICIDAL - Capable of killing bacteria.
• BACTERIOCIDES - is a substance that kills
bacteria .Bactericides are either disinfectants,
antiseptics or antibiotics.
• ANTISEPTICS - is a substance that prevents or arrests
the growth or action of microorganisms either by
inhibiting their activity or by destroying them. The
term is used especially for preparations applied
topically to living tissue
• STERILIZATION
-the destruction of all living microorganisms, as
pathogenic bacteria, vegetative forms, and spores.
PREFIXES & SUFFIXES
• Prefixes & Suffixes can explain the type of
procedure the client will undergo:
• PREFIXES
 Supra – above ; beyond
 Ortho – joint
 Chole – bile or gall
 Cysto – bladder
 Encephalo- brain
 Entero – intestine
 Hystero – uterus
 Mast – breast
 Meningo – membrane; meninges
 Myo – muscle
 Nephro – kidney
 Neuro – nerve
 Oophor - ovary
 Pneumo – lungs
 Pyelo – kidney pelvis
 Salphingo – fallopian tube
 Thoraco – chest
 Viscero – organ esp. abdomen
• SUFFIXES
 Oma – tumor ; swelling
 Ectomy – removal of an organ or gland
 Rhapy – suturing or stitching of a part or
an organ
 Scopy – looking into
 Ostomy – making an opening or a stoma
 Otomy – cutting into
 Plasty – to repair or restore
 Cele – tumor ; hernia ; swelling
 Itis – inflammation of
PERIOPERATIVE NURSING
• SURGERY – a branch of Medicine
that encompasses preoperative
care, intraoperative judgement &
management, & postoperative
care of patients.
• OPERATION – an invasive modality
of treatment.
PERIOPERATIVE NURSING

• DEFINITION:
• a.k.a : OPERATING ROOM NURSING
The identification of physiological & sociological
needs of the client, & the implementation of an
individualized program of nursing care in order to
restore or maintain the health & welfare of the
patient before, during & after surgical
intervention.
PERIOPERATIVE NURSING
• PHILOSOPHY :
• To give service that aims to
provide comprehensive support
physically, morally,
psychologically, spiritually, &
socially to a patient undergoing
surgery.
PERIOPERATIVE NURSING
• GOALS :
1.To provide safe, supportive &
comprehensive care.
2.To assist the surgeon by functioning
effectively as a member of the surgical
team.
3.To create & maintain an aseptic /
sterile environment.
PERIOPERATIVE NURSING
• Fundamental purposes of the O.R. :
• It is a place. . .
1.To correlate theory & practice.
2.To develop skills in assisting the surgeon
in the operation.
3.To create a suitable sterile field for
surgical procedures to prevent
complications.
Perioperative Patient-Focused
Model
• Period of time that constitutes the surgical
experience. Includes three phases:
• Preoperative phase: the period of time from the decision
for surgery until the patient is transferred into the
operating room.
• Intraoperative phase: the period of time from when the
patient is transferred to the operating room to the
admission to postanesthesia care unit (PACU).
• Postoperative phase: the period of time that begins with
admission to the PACU and ends with follow-up evaluation
in the clinical setting or at home
 CLASSIFICATIONS
OF SURGERY
• According to Urgency :
1)EMERGENT – pt. requires immediate attention ;
disorder maybe life- threatening.
> indications for surgery : without delay.
> examples : Severe bleeding, extensive burns,
bladder or intestinal obstruction, fractured skull,
gunshot or stab wounds.
CLASSIFICATIONS
OF SURGERY
2) URGENT – pt. requires prompt attention.
> indications for surgery : within 24-30 hours.
> examples : Acute gallbladder infection
Kidney / Ureteral stones
CLASSIFICATIONS
OF SURGERY
3) REQUIRED – pt. needs to have surgery.
> indications for surgery: plan within few weeks
or months.
> examples : Prostatic hyperplasia without
bladder obstruction, Thyroid disorders,
Cataracts.
CLASSIFICATIONS
OF SURGERY
4) ELECTIVE – pt should have surgery.
> indications for surgery: Failure to have surgery
not catastrophic.
> examples : Repair of scars
Simple hernia
Vaginal repair
CLASSIFICATIONS
OF SURGERY
5) OPTIONAL – decision rests with pt.
> indications for surgery : Personal preference
> examples : Cosmetic surgery
CLASSIFICATIONS
OF SURGERY
• Accdg. To Degree Of Risk :
MAJOR – high degree of risk :
>maybe complicated / prolonged, large losses of
blood may occur, vital organs maybe involved,
post-op complications may be likely.
>ex. Organ transplant
Open heart surgery
Removal of a kidney
CLASSIFICATIONS
OF SURGERY
MINOR – little risk with few complications.
- often performed in a “day surgery”.
> examples: Breast biopsy
Tonsillectomy
Knee surgery
CLASSIFICATIONS
OF SURGERY
• Accdg. To Purpose :
1.DIAGNOSTIC – verifies suspected diagnosis
- ex. Biopsy
2.EXPLORATORY – estimates the extent of the
disease or injury.
- Ex. Explore laparotomy
3.CURATIVE – removes or repairs damaged tissues .
 CLASSIFICATIONS
OF SURGERY
4. ABLATIVE – removing diseased organ that can’t
wait anymore.
- emergency surgery.
5. PALLIATIVE – relieves symptoms but does not cure
the underlying disease process.
6. RECONSTRUCTIVE – partial or complete
restoration of a damaged organ/tissue to bring
back the original appearance & function.
(mammoplasty, face-lift)
7. CONSTRUCTIVE – repairing the damaged tissue
or congenitally defective organ. (multiple
wound repair)
 Accdg. To Location :
1. INTERNAL – inside the body .
Ex. Hysterectomy
2. EXTERNAL – outside the body .
Ex. Skin grafting
• FOUR BASIC PATHOLOGIC CONDITIONS THAT
REQUIRE SURGERY:
1)OBSTRUCTION – a blockage ; are dangerous
because they block the flow of blood, air, CSF,
urine & bile through the body.
2)PERFORATION – is a rupture of the organ, artery
or bleb.
3) EROSION – break in the continuity of tissue
surface. It can be caused by irritation, infection,
ulceration or inflammation. It can damage the
walls of blood vessels resulting in serious
bleeding.
4) TUMORS – abnormal growth of tissue that
serves no physiologic function in the body.
THE SURGICAL RISK
PATIENTS
• Extremes of age ( very young & very old )
• Extremes of weight (emaciation, obesity)
• Dehydrated pts.
• Nutritional deficits
• Pts. with severe trauma or injury, infection/sepsis
• Pts. with cardiovascular disease
• Endocrine dysfunction (diabetes mellitus)
• Hypertensive & hypotensive pts.
• Hypovolemia
• Hepatic disease
• Preexisting mental or physical disability
• PROBLEMS THAT MAY ARISE IN SURGERY:
1.Surgical risk pts – probability of morbidity or
mortality following surgery.
2.Pain
3.Hemorrhage
4.Infection
5.UTI
• PHASES OF O.R. NURSING :
I. PREOPERATIVE PHASE
The rendering of nursing care to the surgical client
as soon as he is admitted & the decision to
undergo surgery is made.
It ends on the time the client is transferred to the
O.R.
• NURSING ACTIVITIES :
Assessment of the client (baseline evaluation of
the pt. before the day of surgery-interview)
Identification of potential/actual health problems.
PREADMISSION TESTING- ensure necessary tests
have been performed
Pre-op teaching involving client & support persons.
Day of surgery :
pt. teaching reviewed
 informed consent confirmed
pt.’s identity & surgical site verified
IVF started.
PREPARATION FOR
SURGERY
• Psychological Support :
a)Assess client’s fears, anxieties, support systems &
patterns of coping.
b)Establish trusting relationship with client &
significant others.
c)Explain routine procedures, encourage
verbalization of fears & allow client to ask
questions.
d) Demonstrate confidence in surgeon & staff.
e) Provide for spiritual care if appropriate.
PREOPERATIVE TEACHING
• Frequently done on an outpatient basis.
• Assess client’s level of understanding of surgical
procedure & its implications.
• Answer questions, clarify & reinforce explanations
given by the surgeon.
• Explain routine pre- & post-op procedures & any
special equipment to be used.
•
PREOPERATIVE TEACHING
Preoperative experience
• Preoperative medication
• Breathing exercises, coughing, incentive spirometer
• Leg exercises
• Position changes and movement
• Pain management
• Reducing anxiety and fear, support of coping
• Special considerations related to outpatient surgery
Diaphragmatic Breathing and
Splinting When Coughing
Leg Exercises and Foot Exercises
Preoperative Nursing
Interventions
PHYSICAL PREPARATIONS:
• Patient safety is a primary concern.
• Obtain history of past medical conditions, surgical
procedures, dietary restrictions & medications.
• Perform baseline head-to-toe assessment,
including VS, height & weight.
• Ensure that diagnostic procedures pertinent to
surgery are performed as ordered:
1. CBC
2. Electrolytes
3. PT/PTT (Prothrombin Time;Partial
thromboplastin time)
4. Urinalysis
5. ECG
6. Blood typing & crossmatch
• NPO- to prevent aspiration
• Bowel prep and skin prep
- cleansing enema or laxative before surgery to
allow satisfactory visualization of the surgical site.
- goal of pre-op skin prep is to decrease bacteria
without injuring the skin.
• Immediate preoperative preparation
• Complete checklist and chart
• Hospital gown, voiding, removal of dentures, jewelry,
contacts, etc.
• Preoperative medication
• Transporting the pt. to the Presurgical area about
30 to 60 minutes before anesthetics is to be given.
• Attend to family needs
LEGAL PREPARATION:
Surgeon obtains operative permit (informed
consent)
1.Surgical procedures, alternatives , possible
complications & disfigurements or removal of body
parts are explained.
2.It is part of the nurse’s role as client advocate to
confirm that the client understands information
given.
INFORMED CONSENT is necessary in the ff.
Circumstances:
 Invasive procedures, such as surgical incisions,
biopsy, cystoscopy or paracentesis.
 Procedures requiring sedation or anesthesia
 A non-surgical procedure, such as arteriography
 Procedures involving radiation
• Adult client (over 18 y/o) signs own permit unless
unconcious or mentally incompetent.
1.If unable to sign, relative (spouse or next of kin)
or guardian will sign.
2.In an emergency, permission via telephone or
telegram is acceptable; have a 2nd listener on
phone when telephone permission is given
3. Consents are not needed for emergency care if
all 4 of the ff. criteria are met:
a. There is an immediate threat to life.
b. Experts agree that it is an emergency.
c. Client is unable to consent.
d. A legally authorized person cannot be reached.
• Minors (under 18 y/o) must have consent signed
by an adult (i.e. Parent or legal guardian)
• Emancipated minor (married or independently
earning his or her own living)may sign his/ her
own consent.
• Witness to informed consent may be a nurse,
another M.D., clerk or any other authorized
person.
• The nurse witnessing informed consent, specifies
whether witnessing explanation of surgery or just
signature of the client.
PREOPERATIVE
MEDICATIONS
• PURPOSES:
1.To relieve fear & anxiety.
2.To reduce dose needed for induction &
maintenance of anesthesia.
3.To prevent reflex bradycardia that happens during
induction of anesthesia.
4.To minimize oral secretions.
PREOPERATIVE
MEDICATIONS
Operating room set up
Operating room set up
Operating room set up
Surgical Handwashing
Gowning Procedure
Examples of Preoperative of the
Team Gloving
What instruments are used in surgery?

Instruments used in general surgery

Cutting and dissecting
instruments: Scalpels, scissors, and saws are
the most traditional. ...
Grasping or holding instruments: Classically
this
included forceps and clamps predominantly. ..
.
Hemostatic instruments: ...
Retractors: ...
Tissue unifying instruments and materials:
Cutting Instruments
Cutting Instruments
Clamping Instruments
Jarit Vascular Clamp
Grasping Instruments
Bobcock Tissue Holding
Laparoscopic Fundus Grasping
Long Instruments
References:
• https://www.google.com/search?
q=operating+room+setup&sxsrf=ALeKk001Qp4ICd85zYfvwY6M9SCCu1Vgw
Q:1599643667838&tbm=isch&source=iu&ictx=1&fir=VX_5njc0LQW30M
%252CqBcaoncV0XoV2M%252C_&vet=1&usg=AI4_-
kR9F4H2Fou5XOso6gb0atPezNPgaA&sa=X&ved=2ahUKEwiOq9qE4dvrAhXF
Zt4KHR9rC2wQ9QF6BAgSEBI&biw=1024&bih=452#imgrc=l5pvDJYsJsJJeM
• https://images.search.yahoo.com/search/images;_ylt=Awr9Gi_WullfHe8Ak
xVXNyoA;_ylu=Y29sbwNncTEEcG9zAzEEdnRpZAMEc2VjA3BpdnM-?
p=cutting+instruments&fr2=piv-web&fr=mcafee
References:
• https://images.search.yahoo.com/search/images;_ylt=Awr9Hr7kullfwnI
AUqeJzbkF;_ylu=X3oDMTBsZ29xY3ZzBHNlYwNzZWFyY2gEc2xrA2J1dHR
vbg--;_ylc=X1MDOTYwNjI4NTcEX3IDMgRhY3RuA2NsawRjc3JjcHZpZANz
ODZzaVRFd0xqS2dqbkhMWDFNMzZnT3BNakl6TGdBQUFBRHIubkJmBG
ZyA21jYWZlZQRmcjIDc2EtZ3AEZ3ByaWQDWDBsZmhYbU9UZ1dQQ3B4b
GpLaUlkQQRuX3N1Z2cDNARvcmlnaW4DaW1hZ2VzLnNlYXJjaC55YWhvb
y5jb20EcG9zAzAEcHFzdHIDBHBxc3RybAMEcXN0cmwDMjAEcXVlcnkDc3
VyZ2ljYWwlMjBzY3J1YmJpbmcEdF9zdG1wAzE1OTk3MTczOTE-?
p=surgical+scrubbing&fr=mcafee&fr2=sb-top-images.search&ei=UTF-
8&n=60&x=wrt
• Operating Room Technique (Instructional Manual 2nd Edition)
References:
• https://images.search.yahoo.com/search/images;_ylt=Awr9JhWyxVlfQT
cAKQmJzbkF;_ylu=X3oDMTBsZ29xY3ZzBHNlYwNzZWFyY2gEc2xrA2J1dH
Rvbg--;_ylc=X1MDOTYwNjI4NTcEX3IDMgRhY3RuA2NsawRjc3JjcHZpZAN
CNXdWelRFd0xqS2dqbkhMWDFNMzZnWFpNakl6TGdBQUFBQ1E0ckdE
BGZyA21jYWZlZQRmcjIDc2EtZ3AEZ3ByaWQDbU5mQlhydC5SWS5QUEE
4dWMyTWlRQQRuX3N1Z2cDMQRvcmlnaW4DaW1hZ2VzLnNlYXJjaC55Y
Whvby5jb20EcG9zAzAEcHFzdHIDBHBxc3RybAMEcXN0cmwDNDAEcXVlc
nkDc3RlcHMlMjBzdXJnaWNhbCUyMHNjcnViYmluZyUyMHRlY2huaXF1Z
QR0X3N0bXADMTU5OTcxOTA0Ng--?
p=steps+surgical+scrubbing+technique&fr=mcafee&fr2=sb-top-
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%2F3.bp.blogspot.com%2F-ixBOQAH3CtA%2FVjtsCYY2T7I
%2FAAAAAAAAGqA%2FXo0NeSN3TBs%2Fs1600%2FWHO%252BSafe
%252BHand%252BHygiene%252BPosters.jpg&action=close