OPERATING ROOM CONCEPTS

Outline:
•Terminologies
•Operative phases
•Types of surgery
•Anesthesia
•OR attire
•OR team/ Duties and responsibilities
•Principles of OR technique
•Surgical Incisions
•Different positions
Outline:
• Skin preparation
• Surgical scrub
• Gowning
• Gloving
• Basic instruments – Functions
 Return demonstration
• Surgical scrub
• Gowning
• Gloving- open/ close technique
• Serving the gown and gloves
Surgery
• Is a unique
experience of a
planned
physical alteration.
 Terminology
• Excision surgery names
often start with a name for
the organ to be excised (cut
out) and end in -ectomy.
• POLYPS – Polypectomy
• Uterus – hysterectomy
• Appendix - Appendectomy
 Terminology
• Procedures involving cutting into an organ
or tissue end in -otomy.
A surgical procedure cutting through the
abdominal wall to gain access to the
abdominal cavity is a laparotomy.
• Colon – colostomy
 Terminology
• Reparation or restore of damaged or
congenital abnormal structure ends in -rraphy.
Herniorraphy is the reparation of a hernia,
while perineorraphy is the reparation of
perineum.
 Terminology
• Reconstruction, plastic or
cosmetic surgery of a body
part starts with a name for
the body part to be
reconstructed and ends in -
oplasty.
• Rhino is used as a prefix for
“nose”, so rhinoplasty is
basically reconstructive or
cosmetic surgery for the nose.
 Terminology
• Minimally invasive procedures involving small
incisions through which an endoscope is
inserted end in -oscopy. For example, such
surgery in the abdominal cavity is called
laparoscopy.
 Terminology
• Procedures for
formation of a
permanent
or semi-permanent
opening called
a stoma in the body
end in -ostomy.
 STAGES OF SURGERY
1.Pre-operative phase - begins when the
client decides to have surgery and ends
when the client is transferred to the OR
bed.

Nursing Activity
• Assessment of the client, evaluate medical
history
• Identification of potential or actual health
problems.
• Planning specific care based on individual
needs
- preoperative skin preparation as
appropriate
- provide GI preparation as prescribed
NPO (restricting solid food and fluid for 8 to
10 hours before surgery, administering
enema)
• Pre-operative teaching including client and
family.
- deep breathing and coughing exercises
- relaxation techniques
- postoperative exercises of extremities
- turning and moving techniques
- pain-control techniques
- incentive spirometer use
• Perform standard preoperative procedure (complete pre-op
checklist)
Take and record Vital signs, weight
verify allergy, identification bands
Validate NPO status
Remove jewelry, nail polish and hair pins, dentures, eyeglasses
Have the client void and don a clean hospital gown and turban
Administer pre anesthetic medication and
instruct the client to stay in bed.
2. Intraoperative Phase – begins with the
admission of the client to the operative
bed and ends when the client is admitted
to the post anesthesia care unit (PACU)
or recovery room (RR).

Nursing Activity:
1. To provide the client with comprehensive, safe, and
effective care during the surgical procedure.
Intraoperative Phase
2. Assess the client’s physiologic and psychologic
status
3. Reviewing the results or the dx test and lab
studies
4. Positioning the client for surgery
5. Performing the surgical skin prep.
6. Assisting in preparing the sterile field.
7. Opening and dispensing sterile supplies
during surgery.
 Intraoperative Phase
8. Monitoring and maintaining a safe, aseptic
environment.
9. Managing catheters, tubes, drains and specimens.
10. Performing sponge, sharps, and instrument
counts.
11. Administering medications and solutions to the
sterile field.
12. Documenting the nursing care provided and the
client’s response to the nsg. Interventions.
3. Postoperative Phase – begins with the
admission to the post anesthesia care unit
and ends with the discharge from the
hospital or facility providing the continuing
care.
3 segments of Postoperative phase
a. Immediate post-op period
b. Intermediate period
c. Postoperative stage
Immediate post-op period – care given to the
client in the RR and in the 1st few hours in the
surgical floor.

Intermediate period – care given during the course

of surgical convalescence to the time of discharge.

Post-operative period – discharge planning,

teaching, referral
 Post-operative Phase
Nursing Activities:
- Monitor client’s response to the surgery
- Teaching and providing support to client &
support persons.
- Main goal is to assist client to achieve the
most optimal health status by:
 Client free from infection
 Client’s F/E balance will be maintained
 Client’s skin integrity will be maintained.
 TYPES OF SURGERY
A. Degree of Urgency
1. Elective Surgery – planned weeks or
months ahead and is based on the client’s
choice. It is performed for the client’s and
the surgeon’s convenience.

Example: circumcision, hemorrhoidectomy,

thyroidectomy, cosmetic surgery.
 TYPES OF SURGERY
2. Urgent Surgery – frank attention within
24-48 hours
Example: Appendicitis, kidney stones,
amputation
3. Emergency Surgery – performed to
preserve client’s life, body parts, or body
functions.
Example: Gunshot wounds or stab
wounds, control of hemorrhage
 TYPES OF SURGERY
B. Degree of Risk
1. Major - it involves a high degree of risk for a
variety of reasons, it maybe complicated or
prolonged. (large losses of blood, vital organs
may be involved.
Examples: open heart surgery
removal of kidney
 TYPES OF SURGERY
B. Degree of Risk
2. Minor - it involves little risk; produces few
complications.

Examples: Breast biopsy

Removal of tonsils
 TYPES OF SURGERY
Purpose
1. Diagnostic
- to confirm a
diagnosis

e.g. Excision
Biopsy
 TYPES OF SURGERY
2. Exploratory – e.g. Exploratory Laparotomy
- To estimate the extent of a disease & Confirm
Diagnosis As well.
 TYPES OF SURGERY
3. Curative
a. Ablative – removal of a diseased organ
e.g. Hysterectomy
 TYPES OF SURGERY
b. Constructive –repair of congenital defects
e.g. Cheiloplasty
 TYPES OF SURGERY
c. Reconstructive –restoration of a damaged
organ organ or cosmetic revision
e.g. Rhinoplasty
 TYPES OF SURGERY
4. Palliative – relieves symptom but does not
cure the disease e.g. myringotomy (otitis media)
 INFORMED CONSENT
• Operative permit/ Surgical Consent
• An agreement by a client to accept a course of
treatment or a procedure after complete
information, including the risk of treatment
and facts relating to it has been provided by
the physician.
• The client signs the form and the nurse acts as
a witness.
Operative permit/ Surgical Consent
 INFORMED CONSENT
3 ELEMENTS:
1. It must be given voluntarily
2. It must be given by an individual
with the capacity and competence
to understand.
- 18 years and above, conscious &
oriented.’
 INFORMED CONSENT
3 ELEMENTS:
Are not considered functionally
competent:
- Confused, disoriented, sedated,
minors, unconscious, mentally ill
3. The client must be given enough
info to be the ultimate decision
maker.
 CIRCUMSTANCES REQUIRING A
CONSENT:
1. Any surgical procedure where a scalpel,
scissors, sutures, hemostats maybe used.
2. Entrance into a body cavity.
3. General anesthesia, local infiltration, regional
block
CIRCUMSTANCES REQUIRING A CONSENT:

• In a life-saving emergency, the

surgeon may operate without
consent.

• Every effort must be made to

contact the family.
12 Principles of OR technique
Surgical Conscience
 is one’s inner voice for the conscientious practice
of asepsis and sterile technique at all times.
 Is the foundation for the practice of strict aseptic
and sterile techniques.
 It is self-regulation in practice according to a deep
personal commitment to the highest values.
1
12 Principles of OR technique
1. All articles in the OR are previously sterilized.
 12 Principles of OR technique
2. Persons who are sterile touch only sterile
articles; persons who are unsterile touch only
unsterile articles.
12 Principles of OR technique
3. If in doubt of the
sterility of something
consider it unsterile.
4. Non-sterile persons
avoid reaching over the
sterile field; sterile
persons avoid leaning
over unsterile field.
 12 Principles of OR technique
5. Tables are sterile only at table level.
 12 Principles of OR technique
6. Gowns are considered sterile only from the
waist to shoulder in front level, and on the
sleeves.
 12 Principles of OR technique
7. Edges of anything
that encloses sterile
articles is considered
unsterile.
8. Sterile persons keep
well within the sterile area
 12 Principles of OR technique
9. Non-sterile persons keep away from sterile
area.
10. Sterile persons keep in contact with sterile
areas in a minimum.
11. Moisture may cause contamination.
12. When bacteria cannot be eliminated from a
field, they must be kept to irreversible
minimum.