PERI-OP NSG

SKILLS LAB
PRE-OPERATIVE INTRA-OPERATIVE POST-OPERATIVE
 SURGERY
A medical specialty that uses operative
manual and instrumental techniques on
a person to investigate or treat a
pathological condition such as a disease
or injury, to help improve bodily
function, appearance, or to repair
unwanted ruptured areas.
GOALS OF SURGERY
• Be free from injury related to positioning,
retained foreign objects, chemical, physical and
electrical hazards.
• Be free from infection
• Maintain fluid and electrolyte balance
• Maintain skin integrity
• Explain the physiologic and psychologic
responses to the planned surgery
• Participate in the rehabilitation process
following surgery.
 EFFECTS OF SURGERY ON THE
CLIENT
PHYSICAL EFFECTS:
1. Stress response is activated
2. Resistance to infection is lowered due to incision.
3. Vascular system is disturbed du to severe blood loss.
4. Organ function may be altered due to manipulation.
PHYSIOLOGIC EFFECTS:
5. Pain
6. Anesthesia
7. Loss of control
8. Disfigurement
9. Separation from love ones
10. Alterations in roles/ lifestyles
 FACTORS THAT INCREASES
SURGICAL RISK

• AGE: usually young and elderly clients. • USE OF MEDICATIONS:

• GENERAL HEALTH: - Anti-coagulants may precipitate hemorrhage
- nutritional health - Diuretics may decrease electrolyte levels
- cardiac conditions - Tranquilizers may cause hypotension
- respiratory disorders - Adrenal steroids abrupt withdrawal may cause
- renal disease cardiovascular
- liver disease collapse.
- bleeding disorders - Antibiotics can cause allergic reactions
- neurologic disease • HEALTH HABITS:
• MENTAL STATUS: - It affects the potency of anesthesia
- mental illness, retardation, anxiety, dementia - smoking
- drug abuse
- excessive drinking of alcohol
TYPES OF
ANESTHESIA
• GENERAL ANESTHESIA (GA)
 is a combination of medications that put you in a
sleep-like state before a surgery or other medical
procedure. Under general anesthesia, you don't feel
pain because you're completely unconscious.
General anesthesia usually uses a combination of
intravenous drugs and Inhaled gasses (anesthetics).
 Propofol, etomidate, and ketamine are the
intravenous (IV) sedative-hypnotic agents
commonly used to induce general anesthesia ,
while adjuvant agents opioids, lidocaine,
midazolam are used to supplement the effects of
hypnotic agents.
TYPES OF
ANESTHESIA
• GENERAL ENDOTRACHEAL ANESTHESIA
(GETA)
 Modern endotracheal anesthesia is a technic in
which the administration of an anesthetic may be
facilitated and the patient benefited by an artificial
extension of the tracheobronchial tree by means of
a tube through which the patient's respiratory
exchange takes place.
• REGIONAL ANESTHESIA
 the use of local anesthetics to block sensations of
pain from a large area of the body, such as an arm
or leg or the abdomen. Regional anesthesia allows
a procedure to be done on a region of the body
without your being unconscious.
TYPES OF
ANESTHESIA
• TOPICAL ANESTHESIA
 used on mucous membranes, open skin surfaces,
wounds and burns.
ex. Cream, lidocaine spray, drops
• SPINAL ANESTHESIA (SAB)
 a type of neuraxial anesthesia; local anesthetic
(LA) is injected into cerebrospinal fluid (CSF) in
the lumbar spine to anesthetize nerves that exit the
spinal cord.
• CAUDAL EPIDURAL BLOCK (CEB)
 Method of anesthesia for adult patients undergoing
minor gynecologic procedures.
TYPES OF
ANESTHESIA
• EPIDURAL ANESTHESIA
 often used during labor and delivery, and surgery
in the pelvis and legs.
• COMBINED SPINAL EPIDURAL ANESTHESIA
(CSEA)
 Spinal anesthesia is usually administered as a
single shot, whereas epidural anesthesia is usually
administered via a catheter (thus it is a continuous
technique), and CSE anesthesia combines the two.
• SUPINE POSITION
 lying on the back or with the face
upward.
• PRONE POSITION
 lying on your chest
• TRENDELENBURG
 The patient is supine on the table with
their head declined below their feet at an
angle of roughly 16°.
 used in lower abdominal surgeries,
including colorectal, gynecological, and
genitourinary procedures. In this
position, gravity pulls the intra-
abdominal organs away from the pelvis,
allowing for better surgical access to the
pelvic organs. SURGICAL
POSITIONS
• SUPINE POSITION
 lying on the back or with the face
upward.
• PRONE POSITION
 lying on your chest
• TRENDELENBURG
 The patient is supine on the table with
their head declined below their feet at an
angle of roughly 16°.
 used in lower abdominal surgeries,
including colorectal, gynecological, and
genitourinary procedures. In this
position, gravity pulls the intra-
abdominal organs away from the pelvis,
allowing for better surgical access to the
pelvic organs. SURGICAL
POSITIONS
• SUPINE POSITION
 lying on the back or with the face
upward.
• PRONE POSITION
 lying on your chest
• TRENDELENBURG
 The patient is supine on the table with
their head declined below their feet at an
angle of roughly 16°.
 used in lower abdominal surgeries,
including colorectal, gynecological, and
genitourinary procedures. In this
position, gravity pulls the intra-
abdominal organs away from the pelvis,
allowing for better surgical access to the
pelvic organs. SURGICAL
POSITIONS
 • REVERSED TRENDELENBURG
 a position in which patients' hip and knee are not
flexed but the head and chest are elevated at 30°
than the abdomen and legs. used for neck and
head surgery and gynecological procedures
because it reduces the flow of blood to those
areas.
• FOWLER’S POSITION
 a standard patient position in which the patient is
seated in a semi-sitting position (45-60 degrees)
and may have knees either bent or straight.

SURGICAL
POSITIONS
 • REVERSED TRENDELENBURG
 a position in which patients' hip and knee are not
flexed but the head and chest are elevated at 30°
than the abdomen and legs. used for neck and
head surgery and gynecological procedures
because it reduces the flow of blood to those
areas.
• FOWLER’S POSITION
 a standard patient position in which the patient is
seated in a semi-sitting position (45-60 degrees)
and may have knees either bent or straight.

SURGICAL
POSITIONS
SURGICAL
POSITIONS

• SEMI-FOWLER’S POSITION
 The patient is usually on their
back. The bed angle is between
30 degrees and 45 degrees.
SURGICAL
POSITIONS

• MODIFIED PRONE POSITION

or JACK KNIFE POSITION
 position in which the patient
lies on the back, shoulders
elevated, legs flexed on thighs,
thighs at right angles to the
abdomen.
SURGICAL
POSITIONS

• KNEE-CHEST POSITION
 a prone posture resting on the
knees and upper part of the
chest.
SURGICAL
POSITIONS

• LITHOTOMY POSITION
 supine position of the body
with the legs separated, flexed,
and supported in raised
stirrups, originally used for
lithotomy and later also for
childbirth.
 MEMBERS OF
THE SURGICAL
TEAM
• CIRCULATING NURSE
 Manages the OR
 Protects the safety and health needs of the
patient by monitoring the activities of the
members and checking the conditions of the
OR theater.
-lights
-temperature
-equipment/ machines
-supplies
-monitor asepsis and documents
 MEMBERS OF
THE SURGICAL
TEAM
• SCRUBNURSE/ OR technician
 Scrubs for surgery
 Sets up the sterile tables ( mayo and back-up
tables)
 Manages the accountables
• SURGEONS
• ANESTHESIOLOGIST
• OR TECHNICIANS/ MALE AIDE
PRINCIPLES OF HEALTH AND OR ATTI

• STREET CLOTHES, including outside

shoes, are never worn in the OR.
• OR gown is not also worn outside the OR.
• Masks are worn at all times in the OR to
minimize airborne contamination.
• Surgical caps should completely cover the hair.
• Wear well-fitting shoes.
PERI-
OPERATIVE
PROTOCOLS
• Pre-operative
 All surgical materials, instruments, needles,
sutures, dressings, gloves and solutions that
may in contact with the wound must be
sterilized.
• Intra-operative
 Scrubbed personnel should only touch sterile
supplies, instruments and other supplies placed
on the sterile field.
• Post-operative
 The wound must be covered/ protected with a
sterile dressing, betadine antiseptic solution
must be applied before covering it to avoid
contamination and infection.
 CLASSIFICATION OF
INSTRUMENTS AND THEIR
APPLICATIONS

Cutting and dissecting Grasping and handling

surgical instruments: surgical instruments:
 Metzenbaum  tissue forcep
 Cautery (cutting mode)  thumb forcep
 Surgical knife or scalpel  Allis
 babcock
 CLASSIFICATION OF
INSTRUMENTS AND THEIR
APPLICATIONS

Clamping and occluding Retracting and exposing

surgical instruments: instruments:
 Mosquito forceps  self-retaining/ Balfour
 Kelly forceps  deaver
 Army-navy
 Malleable
 Richardson
 Weitlaner
 CLASSIFICATION OF
INSTRUMENTS AND THEIR
APPLICATIONS

Instruments for improving Suturing and stapling

visualization: surgical instruments :
 Speculums  suture needles ( cutting and
 endoscopes (hollow and lens round)
endoscopes)  skin stapler
 anoscopes (for visualizing anus)
and proctoscopes
 CLASSIFICATION OF
INSTRUMENTS AND THEIR
APPLICATIONS

Suctioning and aspiration Dilating and probing

instruments: instruments:
 suction machine with tubing and  dilators
tip( frazier, yankauer)  probes
 ROUND NEEDLE
 used in tissues that are easy to
penetrate and in crucial
procedures such as tendon
repair, where suture cutout would
be disastrous. Preferred in
TYPES OF abdominal fascial closure.

NEEDLES
CUTTING NEEDLE
 used for tough tissue, such as
skin, whereas a reverse cutting
needle is selected to reduce the
risk of tissue cutout.
 SURGICAL
INSTRUMENT
SETUP
 SURGICAL
INSTRUMENT
SETUP
WOUND
DRESSING
 designed to help healing by optimizing the
local wound environment.
 is anything that is used in direct contact with
a wound to help it heal and prevent further
issues or complications.
 Different wound dressings are used based on
the type of the wound, but they all aim to
help reduce infection.
The main reasons that we apply dressings include
the following:
 To provide rapid and cosmetically acceptable
healing
 To remove or contain odor
 To reduce wound-related pain
 To prevent or treat infection
 To contain exudate
 To cause minimum distress or disturbance to
the patient
IMPORTANCE OF
WOUND
DRESSING

Wound dressings should provide the most optimum

conditions for wound healing while protecting the
wound from infection with microorganisms and further
trauma. It is important that the dressings be removed
atraumatically, to avoid further damage to the wound
surface during dressing changes.
 PRINCIPLES OF
WOUND DRESSING

provide a provide the moisture

temporary absorb wound necessary to
protective physical drainage optimize re-
barrier epithelialization
 TREATMENT OF WOUND BY TYPE
Wound Type Treatment
All wounds Aim for optimal nutrition, moisture management, pain control

Venous ulcers • Compression bandages for healing

Pressure injuries
Diabetic foot ulcers
• Stockings for healing and to prevent recurrence
• High compression in absence of arterial disease (ankle-brachial
pressure index [ABPI] >0.9 or audible multiphasic signal with
handheld Doppler)
• Modified compression with mixed venous/arterial disease (ABPI
0.6–0.9)
• Redistribute pressure over bony prominences and areas under
pressure
• Reduce shear forces
• Optimize physical activity and mobility
• Manage incontinence and moisture
V = vascular: confirm adequate vascular supply
I = infection: control superficial critical colonization/deep and
surrounding infection
P = pressure: redistribute plantar/dorsal foot pressure (neuropathy)

S = sharp: surgical serial debridement