NCMB 312 RLE CLASSIFICATION OF SURGICAL PROCEDURES

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID & CLASSIFICATION ACCORDING TO PURPOSE
ELECTROLYTES, INFECTIOUS, INFLAMMATORY & IMMULOLOGIC 1. DIAGNOSTIC - TO CONFIRM THE PRESENCE OF A DISEASE
RESPONSE, CELLULAR ABERRATIONS (ACUTE & CHRONIC) CONDITION, E.G. BIOPSY, COLONOSCOPY.
OR NURSING/OPERATING ROOM NURSING/PERIOPERATIVE 2. EXPLORATORY - TO DETERMINE THE EXTENT OF THE
NURSING DISEASE CONDITION, E.G., EXPLORATORY
DISCUSSED BY PROF. MA. SHEILA MUJEMULTA LAPAROTOMY (EXPLORATION OF THE ABDOMINAL
CAVITY AND ABDOMINAL ORGANS)
INTRODUCTION 3. CURATIVE - TO TREAT THE DISEASE CONDITION. THE
PERIOPERATIVE NURSING PRACTICE DIFFERENT TYPES OF CURATIVE SURGERIES ARE AS
 ASSIST CLIENTS AND THEIR FAMILIES OR SIGNIFICANT FOLLOWS:
OTHERS TO ACHIEVE A LEVEL OF WELLNESS EQUAL TO OR 3.1. ABLATIVE - INVOLVES REMOVAL OF AN ORGAN.
GREATER THAN THAT WHICH THEY HAD, BEFORE THE SUFFIX USED IS “ECTOMY.“
PROCEDURE.  APPENDECTOMY – REMOVAL OF THE APPENDIX
 PROVIDE AN IN -DEPTH UNDERSTANDING OF RELATED  HYSTERECTOMY – REMOVAL OF THE UTERUS
DISEASE PROCESSES THAT HAVE BROUGHT THE CLIENT TO  OOPHORECTOMY – REMOVAL OF THE OVARY
SEEK TREATMENT.  MASTECTOMY – REMOVAL OF THE BREAST
 OFFER QUALITY CARE BY INCORPORATING APPLICATION  PNEUMONECTOMY – REMOVAL OF A LUNG
OF THE NURSING PROCESS.  TONSILLECTOMY – REMOVAL OF TONSILS
 THE PERIOPERATIVE PERIOD IS DIVIDED INTO THREE  CHOLECYSTECTOMY – REMOVAL OF THE GALL
PHASES NAMELY: BLADDER
 PREOPERATIVE PHASE,  MODIFIED RADICAL MASTECTOMY (MRM)
 INTRAOPERATIVE PHASE AND 3.2. CONSTRUCTIVE - INVOLVES REPAIR OF
 POSTOPERATIVE PHASE CONGENITALLY DEFECTIVE ORGAN. SUFFIXES USED
ARE “PLASTY,“ “ORRHAPHY,“ “PEXY.“
PREOPERATIVE PHASE
 CHEILOPLASTY – REPAIR OF CLEFT LIP
 EXTENDS FROM THE TIME THE CLIENT IS ADMITTED TO
 URANOPLASTY – REPAIR OF CLEFT PALATE
THE SURGICAL UNIT, TO THE TIME HE/SHE IS PREPARED
 HERNIORRHAPHY – REPAIR OF HERNIA
PHYSICALLY, PSYCHOSOCIALLY, SPIRITUALLY AND LEGALLY
 ORCHIDOPEXY – REPAIR OF UNDESCENDED TESTES
FOR THE SURGICAL PROCEDURE, UNTIL HE/SHE IS
3.3 RECONSTRUCTIVE - INVOLVES REPAIR OF DAMAGED
TRANSPORTED INTO THE OPERATING ROOM.
ORGAN.
 ADMISSION TO THE SURGICAL UNIT → PREPARATION FOR
 PLASTIC SURGERY AFTER SEVERE BURNS, SCAR
SURGERY: PHYSICAL, PSYCHOSOCIAL, SPIRITUAL, LEGAL →
REVISION, SKIN GRAFTING FROM BURN,
TRANSFER TO OPERATING ROOM (OR)
RHINOPLASTY.
 THE FOUR TTYPES OF CONDITIONS REQUIRING 4. PALLIATIVE. TO RELIEVE DISTRESSING SIGNS AND
SURGERY: SYMPTOMS, NOT NECESSARILY TO CURE THE DISEASE.
 OBSTRUCTION - IMPAIRMENT TO THE FLOW OF  COLOSTOMY, DEBRIDEMENT OF NECROTIC TISSUES,
VITAL FLUIDS, LIKE BLOOD, URINE, BILE, CSF RESECTION OF NERVE ROOTS
 PERFORATION - RUPTURE OF AN ORGAN, RUPTURED
APPENDIX, RUPTURED UTERUS
 EROSION - WEARING OFF OF A SURFACE OR
MEMBRANE, E.G. PEPTIC ULCER
 TUMORS - ABNORMAL NEW GROWTH, BREAST TUMOR,
BONE TUMOR, LUNG TUMOR, BRAIN TUMOR.

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 (RR) /
POST-ANESTHESIA CARE UNIT (PACU)
 ADMISSION TO THE OR → ANESTHESIA SURGERY →
RECOVERY ROOM / PACU

POSTOPERATIVE PHASE
 EXTENDS FROM THE TIME THE CLIENT IS ADMITTED TO
THE RECOVERY ROOM, TO THE TIME HE IS TRANSPORTED
BACK INTO THE SURGICAL UNIT, DISCHARGED FROM THE
HOSPITAL, UNTIL THE FOLLOW - UP CARE.
 CLASSIFICATION ACCORDING TO DEGREE OF  ELECTIVE
RISK/MAGNITUDE/EXTENT  THE PROCEDURE IS NOT ABSOLUTELY NECESSARY
 MAJOR SURGERY - THE CRITERIA ARE AS FOLLOWS: FOR SURVIVAL. DELAY OR OMISSION WILL NOT
 INVOLVES HIGH RISK OF MORBIDITY OR MORTALITY CAUSE ADVERSE EFFECT.
 IT IS EXTENSIVE AND PROLONGED. INVOLVES A  E.G., REMOVAL OF SIMPLE, NON – TOXIC GOITER.
CONSIDERABLE PERIOD OF TIME  OPTIONAL
 IT MAY INVOLVE LARGE AMOUNT OF BLOOD LOSS  THE PROCEDURE IS REQUESTED BY THE CLIENT. IT IS
 VITAL ORGANS ARE MANIPULATED OR REMOVED USUALLY FOR AESTHETIC PURPOSES.
 INVOLVES GREAT RISK OF OCCURRENCE OF  E.G., RHINOPLASTY (REPAIR OF THE NOSE);
COMPLICATIONS BLEPHAROPLASTY (REPAIR OF THE EYELIDS).
 E.G., CRANIOTOMY; OPEN HEART SURGERY;
PNEUMONECTOMY; TOTAL ABDOMINAL
HYSTERECTOMY WITH BILATERAL SALPINGO
OOPHORECTOMY (TAHBSO).
 MINOR SURGERY - GENERALLY:
 THE PROCEDURE IS NOT PROLONGED.
 INVOLVES LESSER RISK.
 DOES NOT USUALLY INVOLVE SERIOUS
COMPLICATIONS.
 E.G., APPENDECTOMY, TONSILLECTOMY,
BLEPHAROPLASTY (REPAIR OF EYELIDS).

 THE SURGICAL RISK PATIENT

 EXTEREME O AGE VER YOUNG & VERY OLD)
 EXTREMES OF WEIGHT (EMACIATION & OBESITY)
 DEHYDRATED PATIENTS WITH SEVERE TRAUMA OR
INJURY
 NUTRITIONAL DEFICITS
 PATIENTS WITH SEVERE TRAUMA OR INJURY,
INFECTION/SEPSIS
 PATIENTS WITH CARDIOVASCULAR DISEASE
 PATIENTS WITH ENDOCRINE DYSFUNCTION (DM)
 HYPERTENSIVE AND HYPOTENSIVE PATIENTS
CLASSIFICATION ACCORDING TO URGENCY  HYPOVOLEMIA
 EMERGENCY  HEPATIC DISEASE
 THE SURGERY SHOULD BE DONE IMMEDIATELY TO  PREEXISTING MENTAL OF PHYSICAL DISABILITY
SAVE THE CLIENT’S LIFE OR LIMB.
 E.G., EMERGENCY HYSTERECTOMY DUE TO RUPTURED PRE-OPERATIVE NURSING CARE
UTERUS; EMERGENCY AMPUTATION OF A LIMB GOALS OF NURSING CARE DURING PREOPERATIVE
DUE TO CRUSHING INJURY; EMERGENCY  ASSESSING AND CORRECTING PHYSIOLOGIC AND
APPENDECTOMY DUE TO ACUTE APPENDICITIS. PSYCHOLOGIC PROBLEMS THAT MIGHT INCREASE
 IMPERATIVE SURGICAL RISK.
 THE PROCEDURE SHOULD BE DONE WITHIN 24 TO 48  INSTRUCTING AND DEMONSTRATING EXERCISES THAT
HOURS. WILL BENEFIT THE PERSON DURING POSTOPERATIVE
 E.G., PROFUSELY BLEEDING PEPTIC ULCER, PERIOD.
EVACUATION OF BLOOD CLOTS FROM THE BRAIN.  PLANNING FOR DISCHARGE AND ANY PROJECTED CHANGES
 PLANNED REQUIRED IN LIFESTYLE DUE TO SURGERY.
 THE PROCEDURE IS NECESSARY FOR THE WELL –
BEING OF THE CLIENT. HOWEVER, IT MAY BE PREOPERATIVE NURSING ASSESSMENT
A. PHYSIOLOGIC ASSESSMENT OF THE CLIENT
SCHEDULED WEEKS OR MONTHS. UNDERGOING SURGERY
 E.G., TONSILLECTOMY, THYROIDECTOMY,  THE PHYSICAL PREPARATIONS OF THE PATIENT
CATARACT EXTRACTION. BEFORE SURGERY INCLUDE THE FOLLOWING:
1. CORRECTING ANY DIETARY DEFICIENCIES.  CONSIDER THE PERSON’S CULTURAL AND RELIGIOUS
2. REDUCING AN OBESE PERSON’S WEIGHT, AS TIME PERMITS. PREFERENCES. ARRANGE FOR VISIT BY
3. CORRECTING FLUID AND ELECTROLYTE IMBALANCES. CHAPLAIN/PRIEST/ MINISTER/RELIGIOUS ADVISER AS
4. RESTORING ADEQUATE BLOOD VOLUME WITH BLOOD DESIRED BY THE PATIENT AND HIS FAMILY.
TRANSFUSION.
5. TREATING CHRONIC DISEASES – DM, HEART DISEASE, THE LEGAL ASPECTS OF SURGICAL INTERVENTIONS: WRITTEN
RENAL INSUFFICIENCY, BLEEDING DISORDERS. INFORMED CONSENT/OPERATIVE PERMIT/SURGICALL PERMIT
6. TREATING ANY INFECTIOUS PROCESS  PREOPERATIVE PHASE - THE TIME THE PATIENT IS
7. TREATING AN ALCOHOLIC PERSON WITH VITAMIN PREPARED PHYSICALLY, PSYCHOSOCIALLY, SPIRITUALLY
SUPPLEMENTATION, IV FLUIDS OR ORAL FLUIDS, IF AND LEGALLY FOR THE SURGICAL PROCEDURE.
DEHYDRATED.
 THE PURPOSES OF THE WRITTEN INFORMED CONSENT
B. PSYCHOSOCIAL ASSESSMENT OF THE CLIENT ARE AS FOLLOWS:
UNDERGOING SURGERY 1. TO ENSURE THAT THE CLIENT UNDERSTANDS THE
 THE COMMON CAUSES OF FEARS OF THE NATURE OF THE TREATMENT INCLUDING THE
PREOPERATIVE CLIENT ARE AS FOLLOWS: POTENTIAL COMPLICATIONS AND DISFIGUREMENT.
THESE ARE EXPLAINED BY THE SURGEON.
1. FEAR OF THE UNKNOWN. THIS IS THE GREATEST FEAR OF 2. TO INDICATE THAT THE CLIENT’S DECISION WAS
MOST PATIENTS UNDERGOING SURGERY. MADE WITHOUT PRESSURE.
2. FEAR OF ANESTHESIA. MANY PATIENTS FEAR THEIR 3. TO PROTECT THE CLIENT AGAINST UNAUTHORIZED
VULNERABILITY WHILE UNCONSCIOUS. THEY ALSO FEAR PROCEDURE.
THE POTENTIAL COMPLICATIONS OF ANESTHESIA 4. TO PROTECT THE SURGEON AND THE HOSPITAL
INCLUDING DEATH. AGAINST LEGAL ACTION BY A CLIENT WHO CLAIMS
3. FEAR OF PAIN. PATIENTS FEAR THE AGONY, SUFFERING, THAT AN UNAUTHORIZED PROCEDURE WAS
OR DISTRESS THAT MAY RESULT FROM THE SURGICAL PERFORMED.
PROCEDURE ESPECIALLY POSTOP WOUND AND FROM
CONTRAPTIONS.  THE CIRCUMSTANCES REQUIRING WRITTEN INFORMED
4. FEAR OF DEATH. THIS IS DUE TO THE RISK OF CONSENT ARRE AS FOLLOWS:
COMPLICATIONS OF ANESTHESIA AND THE SURGICAL 1. ANY SURGICAL PROCEDURE WHERE SCALPEL,
PROCEDURE, ITSELF. SCISSORS, SUTURE, HEMOSTATS OF
5. FEAR OF DISTURBANCE OF BODY IMAGE. FOR EXAMPLE, ELECTROCOAGULATION MAY BE USED.
LOSS OF LIMB, LOSS OF REPRODUCTIVE ORGANS, 2. ANY INVASIVE PROCEDURE, OR PROCEDURE THAT
ALTERATION IN BOWEL AND BLADDER ELIMINATION, CAUSE INVOLVES ENTRY INTO A BODY CAVITY.
DISTURBANCE OF A PERSON’S BODY IMAGE.  E.G. PARACENTESIS, BRONCHOSCOPY,
6. FEAR AND WORRIES FROM LOSS OF FINANCES, CYSTOSCOPY, COLONOSCOPY,
EMPLOYMENT, SOCIAL AND FAMILY ROLES. PROCTOSIGMOIDOSCOPY.
3. ANY PROCEDURE THAT INVOLVES GENERAL
 THE NURSE SHOULD ASSESS THE CLIENT FOR ANESTHESIA, LOCAL INFILTRATION ANESTHESIA OR
MANIFESTATIONS OF FEAR THAT INCLUDE THE REGIONAL BLOCK ANESTHESIA
FOLLOWING:
 ANXIOUSNESS  THE REQUISITES FOR VALIDITY OF WRITTEN INFORMED
 ANGER CONSENT ARE AS FOLLOWS:
 TENDENCY TO EXAGGERATE  WRITTEN PERMIT/ CONSENT IS BEST AND IS LEGALLY
 SAD, EVASIVENESS, TEARFULNESS, AND CLINGING ACCEPTABLE.
BEHAVIOR  PATIENT’S SIGNATURE IS OBTAINED WITH THE
 INABILITY TO CONCENTRATE CLIENT’S COMPLETE UNDERSTANDING OF WHAT IS
 SHORT ATTENTION SPAN TO OCCUR.
 FAILURE TO CARRY OUT SIMPLE DIRECTIONS  ADULTS SIGN THEIR OWN CONSENT UNLESS HE/SHE
 DAZED APPEARANCE IS PHYSICALLY AND MENTALLY INCAPACITATED.
 IF THE PATIENT IS A CHILD OR MINOR (BELOW 18
 THE NURSE MAY IMPLEMENT THE FOLLOWING NURSING YEARS OLD), THE PARENT OR LEGAL GUARDIAN WILL
INTERVENTIONS TO MINIMIZE ANXIETY: SIGN THE CONSENT.
 EXPLORE THE CLIENT’S FEELINGS.  CONSENT IS OBTAINED BEFORE SEDATION.
 ALLOW CLIENT’S TO SPEAK OPENLY ABOUT FEARS  THE PATIENT IS NOT UNDER THE INFLUENCE OF
AND CONCERNS. DRUGS OR ALCOHOL & IS SECURED WITHOUT
 GIVE ACCURATE INFORMATION REGARDING SURGERY. PRESSURE OR DURESS OR THREAT.
 PROVIDE EMPATHETIC SUPPORT. ACCEPT  SIGNATURE OF WITNESS IS REQUIRED. THE NURSE,
INDIVIDUAL’S REACTIONS TO THE SURGICAL PHYSICIAN OR OTHER AUTHORIZED PERSONS MAY
EXPERIENCE. SIGN AS WITNESS
  NURSING PRIORITY: THE CONSENT/PERMIT SHOULD  PREPARATION OF THE PATIENT THE EVENING BEFORE
BE SIGNED BEFORE THE CLIENT RECEIVES THE SURGERY INCLUDE THE FOLLOWING:
PREOPERATIVE MEDICATIONS 1. PREPARING THE SKIN
 IN AN EMERGENCY, PERMISSION VIA TELEPHONE IS  IT IS IDEAL FOR THE PATIENT TO BATHE OR SHOWER,
ACCEPTABLE. THE PHYSICIAN SHOULD DOCUMENT USING A BACTERIOSTATIC SOAP TO REDUCE
THE NATURE OF THE EMERGENCY SITUATION. MICROORGANISMS IN THE SKIN
 EMANCIPATED MINORS ARE ALLOWED TO SIGN  SHAVING SHOULD BE PERFORMED AS CLOSE TO THE
WITHOUT WRITTEN CONSENT. OPERATIVE TIME AS POSSIBLE. HAIR GROWS AGAIN,
 (EMANCIPATED MINORS ARE THOSE WHO ARE OVERNIGHT. SHAVING SHOULD BE DONE IN THE
MARRIED, THOSE WHO LIVE ON THEIR OWN OR DIRECTION OF HAIR GROWTH.
FINANCIALLY INDEPENDENT FROM THEIR 2. PREPARING THE GASTROINTESTINAL TRACT
PARENTS. THIS IS APPLICABLE IN THE U.S. PREPARATION OF THE BOWEL FOR INTESTINAL SURGERY TO
ONLY.) PREVENT ESCAPE OF BACTERIA AND SEPSIS INCLUDES THE
FOLLOWING:
 PREPARATION OF THE PATIENT BEFORE SURGERY  CATHARTICS AND ENEMAS.
INCLUDES EXERCISES THAT WILL PREVENT  ORAL ANTIMICROBIALS TO REDUCE BACTERIAL FLORA.
POSTOPERATIVE COMPLICATION  ENEMAS “UNTIL CLEAR“ THE EVENING BEFORE
 THE NURSE SHOULD PROVIDE TEACHING ON THE SURGERY. NO MORE THAN THREE ENEMAS SHOULD
FOLLOWING PREOP EXERCISES: BE GIVEN TO PREVENT FLUID – ELECTROLYTE
a) DEEP BREATHING AND COUGHING EXERCISES - TO IMBALANCES.
PROMOTE ADEQUATE LUNG EXPANSION AND VENTILATION,  NPO FOR 6 HOURS BEFORE SURGERY. PATIENTS
AND EXPEL MUCOUS SECRETIONS. HAVING MORNING SURGERY ARE KEPT NPO FROM
b) INCENTIVE SPIROMETRY - TO ENHANCE DEEP MIDNIGHT. CLEAR FLUIDS, LIKE WATER MAY BE GIVEN
INSPIRATION AND PROMOTE MAXIMUM LUNG EXPANSION UP TO 4 HOURS BEFORE SURGERY IF ORDERED TO
c) TURNING EXERCISES - TO PROMOTE ADEQUATE LUNG HELP CLIENT SWALLOW MEDICATIONS.
EXPANSION, PROMOTE CIRCULATION, AND PREVENT 3. PREPARING FOR ANESTHESIA
PRESSURE SORES.  THE PATIENT SHOULD AVOID ALCOHOL AND
d) FOOT AND LEG EXERCISES - FLEXION AND EXTENSION CIGARETTE SMOKING FOR AT LEAST 24 HOURS
EXERCISES OF THE LOWER EXTREMITIES PROMOTE BEFORE SURGERY. THIS CAN HELP REDUCE
CIRCULATION; PREVENT VENOUS STASIS, THEREBY POTENTIAL COMPLICATIONS OF ANESTHESIA.
PREVENTING THROMBOPHLEBITIS. 4. PROMOTING REST AND SLEEP
 PROVIDE COMFORT MEASURES, E.G. CLEAN GOWN
AND LINENS, CORRECT ROOM TEMPERATURE,
SUBDUED LIGHTING, BACK RUB.
 ADMINISTER SEDATIVE AS ORDERED.

 WHEN PREPARING THE PATIENT ON THE DAY OF

SURGERY, THE NURSE SHOULD INCLUDE THE
FOLLOWING:
1. AWAKEN THE PATIENT, ONE HOUR BEFORE
PREOPERATIVE MEDICATIONS.
2. PROVIDE MORNING BATH AND MOUTH WASH.
3. PROVIDE CLEAN GOWN.
4. REMOVE HAIRPINS, BRAID LONG HAIRS, COVER HAIR
WITH CAP.
5. REMOVE DENTURES, FOREIGN MATERIALS (CHEWING
GUM) FROM PATIENT’S MOUTH.
6. REMOVE COLORED NAIL POLISH, HEARING AID,
CONTACT LENS, JEWELRIES. IF THE PATIENT
REFUSES TO REMOVE THE WEDDING RING, TIE IT
WITH GAUZE AND FASTEN AROUND THE WRIST.
7. TAKE BASELINE VITAL SIGNS BEFORE
ADMINISTRATION OF PREOP MEDICATIONS.
8. CHECK PATIENT IDENTIFICATION (ID) BAND AND AREA
OF “SKIN PREP“ AS APPLICABLE.
9. CHECK FOR SPECIAL ORDERS, E.G. ENEMA,
GASTROINTESTINAL TUBE INSERTION, IV LINE.
ENSURE THAT THESE ORDERS ARE CARRIED OUT.
10. CHECK IF NPO IS MAINTAINED.
 11. HAVE CLIENT VOID BEFORE ADMINISTRATION OF  EXPLAINING REASON FOR LONG INTERVAL OF
PREOP MEDICATIONS. SOME PREOP MEDICATIONS WAITING. THIS IS DUE TO ANESTHESIA PREPARATION,
MAY CAUSE HYPOTENSION AND INCREASE RISK FOR SKIN PREP, SURGICAL PROCEDURE AND RECOVERY
FALLS. FOR PATIENT SAFETY, PUT UP SIDE RAILS, ROOM/POST ANESTHESIA CARE UNIT STAY. THIS
PUT CALL LIGHT WITHIN PATIENT’S REACH, AND ACTION HELPS PREVENT UNNECESSARY ANXIETY BY
INSTRUCT PATIENT TO ASK FOR HELP IF HE/SHE THE FAMILY.
NEEDS TO VOID.  EXPLAINING WHAT TO EXPECT DURING THE
12. CONTINUE TO SUPPORT THE PATIENT EMOTIONALLY. POSTOPERATIVE PERIOD, E.G., IV FLUIDS, BLOOD
ANXIETY LEVEL MAY BE HIGH AT THIS TIME. TRANSFUSIONS, OXYGEN THERAPY, TUBES AND
13. ACCOMPLISH THE “PREOP CARE CHECKLIST“. OTHER CONTRAPTIONS.
 BEST PRACTICE: IF SURGERY WILL BE DONE TO A BODY
PART WHICH IS PRESENT ON BOTH SIDES OF THE BODY,
E.G., EYES, EARS, ARMS, BREASTS, LEGS, PRACTICE “TIME
OUT“ TO CHECK IF THE RIGHT PATIENT IS SENT FOR
SURGERY. AVOID SENTINEL EVENT RELATED TO SURGERY
OF THE WRONG BODY PART.

 PREOPERATIVE MEDICATIONS/PREANESTHETIC DRUGS

 PURPOSES
1. TO FACILITATE THE ADMINISTRATION OF ANY
ANESTHETIC.
2. TO MINIMIZE RESPIRATORY TRACT SECRETIONS AND
CHANGES IN HEART RATE.
3. TO RELAX THE CLIENT AND REDUCE ANXIETY.

 TYPES OF PREOPERATIVE MEDICATIONS

1. OPIATES – MORPHINE (ROXANOL) AND MEPERIDINE
(DEMEROL) ARE GIVEN TO RELAX THE PATIENT AND
POTENTIATE ANESTHESIA.
INTRAOPERATIVE PHASE/NURSING CARE
2. ANTICHOLINERGICS – ATROPINE SULFATE, SCOPOLAMINE, GOALS OF CARE DURING INTRAOPERATIVE PERIOD
AND GLYCOPYRROLATE (ROBINUL) ARE GIVEN TO REDUCE  ASEPSIS AND INFECTION CONTROL
RESPIRATORY TRACT SECRETIONS AND TO PREVENT  HOMEOSTASIS
SEVERE REFLEX SLOWING OF THE HEART DURING  SAFE ADMINISTRATION OF ANESTHESIA
ANESTHESIA.  HEMOSTASIS
3. BARBITURATES/TRANQUILIZERS – PHENOBARBITAL
(NEMBUTAL) AND OTHER HYPNOTIC AGENTS ARE GIVEN  STAGES OF HEMOSTASIS
THE NIGHT BEFORE SURGERY TO HELP ENSURE A RESTFUL  WHEN A BLOOD VESSEL IS INJURED, THE INJURY
NIGHT’S SLEEP. INITIATES A SERIES OF REACTIONS, RESULTING IN
4. PROPHYLACTIC ANTIBIOTIC - ADMINISTERED JUST HEMOSTASIS. IT OCCURS IN THREE STAGES:
BEFORE OR DURING SURGERY WHEN BACTERIAL 1. VASOCONSTRICTION
CONTAMINATION IS EXPECTED; IDEALLY BEFORE SKIN 2. PLATELET PLUG FORMATION
INCISION IS MADE. 3. COAGULATION OF BLOOD
 BEST PRACTICE: PREANESTHETIC MEDICATIONS SHOULD
BE GIVEN EXACTLY THE TIME THEY ARE PRESCRIBED. IF
GIVEN TOO EARLY, THE MAXIMUM POTENCY WILL HAVE
PASSED BEFORE IT IS NEEDED; IF GIVEN TOO LATE, THE
ACTION WILL NOT HAVE BEGAN BEFORE ANESTHESIA IS
STARTED.

WHEN TRASPORTING THE PATIENT TO THE OPERATING ROOM,

PROMOTE SAFELY.
 SURGICAL CONSCIENCE
 CARE OF THE PATIENT’S FAMILY INCLUDES THE  MEANS ATTENTION TO ASEPTIC PRINCIPLES DURING
FOLLOWING: THE PERIOPERATIVE PERIOD.
 DIRECTING THE FAMILY TO THE PROPER VISITING  IT INVOLVES CONSTANT INSPECTION, MONITORING
ROOM OR WAITING LOUNGE. AND REGULATION OF THE SURGICAL PATIENT,
 INFORMING THEM THAT THEY WILL BE CONTACTED ENVIRONMENT, PERSONNEL AND EQUIPMENT.
BY THE SURGEON IMMEDIATELY.  THE NURSE ANTICIPATES THE PATIENT’S AND THE
SURGICAL TEAM’S NEEDS AND GIVES UNSELFISH,
VIGILANT CARE TO THE PATIENT.
 OPERATIN ROOM ATTIRE  OPERATING ROOM DIVISIONS
 PURPOSE: TO PROVIDE EFFECTIVE BARRIERS THAT  DESIGN & TRAFFIC PATTERN – 3 ZONE CONCEPT
PREVENT THE DISSEMINATION OF MICROORGANISMS 1. UNRESTRICTED AREA WHICH INCLUDES THE PATIENT
TO THE PATIENT AND TO PROTECT PERSONNEL RECEPTION AREA, LOCKER ROOMS, LOUNGES AND OFFICES.
FROM INFECTED PATIENTS 2. SEMI-RESTRICTED AREAS WHICH INCLUDE THE STORAGE
 CONSISTS OF BODY COVERS SUCH AS: AREAS FOR CLEAN AND STERILE SUPPLIES, WORK AREAS
1. HEAD COVER / BONNET/ CAP FOR STORAGE AND PROCESSING OF INSTRUMENTS AND
2. MASK CORRIDORS TO RESTRICTED AREAS OF THE SUITE.
3. STERILE GLOVES TRAFFIC IS LIMITED TO AUTHORIZED PERSONNEL AND
4. SCRUB SHOES (WORN ONLY INSIDE THE OR) PATIENTS. PERSONNEL ARE REQUIRED TO WEAR GOWN
5. (SURGICAL GLASSES/ VISOR) AND HAIR COVERING.
3. RESTRICTED AREA INCLUDES ALL AREAS WHERE
PERSONNEL ARE REQUIRED TO WEAR SURGICAL MASKS
AND SCRUB ATTIRE AT ALL TIMES. IT INCLUDES
OPERATING SUITES, CLEAN CORE AND SCRUB AREAS.

“IMPLEMENTATION OF STRATEGIES, SUCH AS STORAGE OF

INSTRUMENTS AND COMPONENTS IN THE OPERATING ROOM
AND EDUCATION OF OR PERSONNEL, IS REQUIRED TO REDUCE
DOOR OPENINGS IN THE OR.“

AMERICAN JOURNAL OF MEDICAL QUALITY

MEASUREMENT OF FOOT TRAFFIC IN THE OPERATING ROOM:
IMPLICATIONS FOR INFECTION CONTROL
 ABSTRACT
SURGICAL SITE INFECTIONS CAUSE SIGNIFICANT MORBIDITY
AND MORTALITY IN THE POSTOPERATIVE PERIOD. OPENING OF
THE OPERATING ROOM DOOR DISRUPTS ITS FILTERED
ATMOSPHERE, INCREASING CONTAMINATION ABOVE THE
WOUND.
WE CONDUCTED A STUDY OF TRAFFIC IN THE OPERATING ROOM
AS A RISK FOR INFECTIONS. THIS IS AN OBSERVATIONAL STUDY
OF RECORDED BEHAVIORS IN THE OPERATING ROOM.
DATA COLLECTED INCLUDED NUMBER OF PEOPLE
ENTERING/EXITING, THE ROLE OF THESE INDIVIDUALS, AND THE
CAUSE FOR THE EVENT. A TOTAL OF 3071 DOOR OPENINGS
WERE RECORDED IN 28 CASES.
TRAFFIC VARIED FROM 19 TO 50 EVENTS PER HOUR ACROSS
SPECIALTIES.
THE PREINCISION PERIOD REPRESENTED 30% TO 50% OF ALL
EVENTS. INFORMATION REQUESTS ACCOUNTED FOR THE
MAJORITY OF EVENTS. DOOR OPENINGS INCREASE IN DIRECT
PROPORTION TO CASE LENGTH, BUT HAVE AN EXPONENTIAL
RELATIONSHIP WITH THE NUMBER OF PERSONS IN THE
OPERATING ROOM. THERE IS A HIGH RATE OF TRAFFIC ACROSS
ALL SPECIALTIES, COMPROMISING THE STERILE ENVIRONMENT
OF THE OPERATING ROOM. (AM J MED QUAL. 2009;24:45-52)

THE OFFICIAL VOICE OF PERIOPERATIVE NURSING

AORN JOURNAL
 ABSTRACT
PERIOPERATIVE NURSES AT OUR INSTITUTION VOICED
CONCERNS ABOUT THE AMOUNT OF TRAFFIC IN THE ORS. WE
FORMED A WORKGROUP CONSISTING OF PERIOPERATIVE
NURSES, EDUCATORS, AND LEADERS AND INITIATED A QUALITY
IMPROVEMENT (QI) PROJECT TO IDENTIFY THE AMOUNT OF
OR TRAFFIC THAT OCCURS DURING A PROCEDURE.
THE WORKGROUP DEVELOPED A CHECK SHEET TO RECORD DOOR
SWINGS, STAFF CLASSIFICATIONS, REASONS FOR OPENING THE
DOOR, AND THE NUMBER OF PEOPLE IN THE OR AT 15‐MINUTE  MOST COMMONLY USED SURGICAL POSITION. IT IS
INTERVALS. THE BASIC POSITION FOR MOST ABDOMINAL
BASELINE RESULTS SHOWED THAT AVERAGE DOOR SWINGS SURGERY AND IS ALSO FREQUENTLY USED IN
RANGED FROM 33 PER HOUR IN GENERAL SURGERY TO 54 PER ORTHOPEDIC, UROLOGIC, OPHTHALMOLOGIC,
HOUR IN CARDIAC SURGERY. OTORHINOLARYNGOLOGIC, PLASTIC AND THORACIC
NURSES ACCOUNTED FOR THE MOST TRAFFIC, CITING OPERATIONS.
RETRIEVING SUPPLIES AS THE MAIN REASON. INTERVENTIONS
FOCUSED ON DECREASING NURSE TRAFFIC FOR RETRIEVAL OF
SUPPLIES IN GENERAL SURGERY.
FOLLOW‐UP OBSERVATIONS SHOWED THAT AVERAGE DOOR
SWINGS INCREASED TO 41 PER HOUR IN GENERAL SURGERY,
BUT NURSE TRAFFIC DECREASED. MONITORING AND LIMITING 2. TREDELENBURG’S
TRAFFIC COULD POSITIVELY AFFECT PATIENT SAFETY AND  VARIATION OF SUPINE POSITION WITH THE
OUTCOMES. PATIENT’S HEAD POSITIONED DOWN.
 SHIFT OF THE ABDOMINAL VISCERA IMPEDES FREE
“PRINCIPLES REMAIN THE SAME; IT IS THE DEGREE OF MOVEMENT OF THE DIAPHRAGM AND INTRATHORACIC
ADHERENCE THAT VARIES“ PRESSURE IS INCREASED.
 WHEN REQUESTED IT IS USUALLY INTENDED TO
PREPARATION FOR SURGERY FACILITATE SURGICAL EXPOSURE DURING
 THE SKIN OF THE PATIENT AND THE MEMBERS OF THE COLORECTAL OR GENITOURINARY PROCEDURES..
SURGICAL TEAM REQUIRE DISINFECTION BEFORE THE
SURGICAL PROCEDURE BEGINS.
 THE COMMONLY USED ANTIMICROBIAL AGENTS INCLUDE
POVIDONE-IODINE, CHLORHEXIDINE, ALCOHOL, AND
HEXACHLOROPHENE.
 BEFORE THE APPLICATION OF THE CHOSEN 3. LITHOTOMY
ANTIMICROBIAL AGENT, THE PATIENT’S SKIN MAY BE  LYING ON THE BACK WITH THE LEGS FLEXED AND
PREPARED BY SHAVING, CLIPPING (TRIMMING), OR USING A SUPPORTED ON STIRRUPS.
DEPILATORY.  DECREASES RESPIRATORY EFFECTIVENESS BECAUSE
 THE SKIN OF THE SURGICAL TEAM IS SCRUBBED, USING A THE DIAPHRAGM IS RESTRICTED.
BRUSH AND NAIL CLEANER OR A FOAM PREPARATION FOR  TWO MEMBERS OF THE SURGICAL TEAM SHOULD
A LENGTH OF TIME DETERMINED BY THE FACILITY. MOVE THE LEGS SIMULTANEOUSLY TO PREVENT
 PREPARE THE FIELD USING THE PRINCIPLES OF ASEPSIS. SACROILIAC DISLOCATION.
 USED TO MANIPULATE A SURGICAL INSTRUMENT
EITHER IN THE VAGINA OR IN A PERINEAL INCISION.

4. MODIFIED FOWLER’S
 OR SITTING POSITION IS PHYSIOLOGICALLY BEST
FOR RESPIRATORY FUNCTION.
 PATIENT POSITIONING FOR SURGERY  VENOUS POOLING MAY LEAD TO HYPOTENSION.
 PROVIDES OPTIMAL VISUALIZATION  IT’S OVERALL USE HAS DECREASED. IT MAY BE USED
 PROVIDES OPTIMAL ACCESS FOR ASSESSING AND FOR NECK DISSECTIONS OR DENTAL PROBLEMS.
MAINTAINING ANESTHESIA AND FUNCTION
 PROTECTS PATIENT FROM HARM
1. SUPINE
 BACK-LYING POSITION.
 CAREFUL PLACEMENT OF THE EXTREMITIES IS
IMPORTANT TO AVOID INJURY. THE MOST COMMON
INJURY OCCURS TO THE BRACHIAL PLEXUS WHEN
THE ARM IS ABDUCTED GREATER THAN 90 DEGREES. 5. LATERAL/LATERAL DECUBITUS POSITION
FINGERS, ELBOWS AND BONY PROMINENCES MUST BE  SIDE – LYING OR LATERAL POSITION DECREASES
SUPPORTED WITH PADDING TO PREVENT PRESSURE. RESPIRATORY EFFICIENCY BECAUSE THE BODY’S
WEIGHT IS ON THE LOWER CHEST.
  MAY INTERFERE WITH RESPIRATORY EFFICIENCY. ANESTHESIA
 PERIPHERAL NERVE INJURIES CAN OCCUR IN FAULTY  THE GOALS OF ANESTHESIA ARE TO PROVIDE ANALGESIA,
POSITION OF THE ARM. SEDATION AND MUSCLE RELAXATION, AS WELL AS TO
 HAS BEEN ASSOCIATED MOST COMMONLY WITH CONTROL THE AUTONOMIC NERVOUS SYSTEM.
THORACOTOMIES FOR CARDIOTHORACIC PROCEDURES,
BUT MAY ALSO BE USED TO ADVANTAGE FOR RENAL,  ANESTHETICS ARE CLASSIFIED AS GENERAL AND LOCAL.
OBSTETRIC, GYNECOLOGIC, NEUROSURGICAL AND  GENERAL ANESTHETICS DEPRESS THE CNS,
ORTHOPEDIC OPERATIONS. ALLEVIATE PAIN, AND CAUSE A LOSS OF
CONSCIOUSNESS.
 LOCAL ANESTHETICS BLOCK PAIN AT THE SITE OF
ADMINISTRATION, ALLOWING CONSCIOUSNESS TO BE
MAINTAINED.

6. PRONE/VENTRAL DECUBITUS POSITION  BALANCED ANESTHESIA, A COMBINATION OF DRUGS, IS

 FACE – DOWN POSITION REQUIRES THE PATIENT TO BE FREQUENTLY USED IN GENERAL ANESTHESIA, BALANCED
ANESTHETIZED ON THE STRETCHER BEING TURNED OVER ANESTHESIA GENERALLY INCLUDES THE FOLLOWING:
ON THE ABDOMEN. 1. A HYPNOTIC GIVEN THE NIGHT BEFORE;
 RESPIRATION IS RESTRICTED BECAUSE OF THE WEIGHT OF 2. PREMEDICATION, SUCH AS NARCOTIC ANALGESIC OR
THE BODY ON THE ABDOMEN; THE BP MAY FALL. BENZODIAZEPINE (E.G., MIDAZOLAM [VERSED]) AND AN
 USED FOR POSTERIOR CRANIOTOMIES AND FOR SPINE- ANTICHOLINERGIC (E.G., ATROPINE, ROBINUL), GIVEN
RELATED PROCEDURES, SUCH AS SPINAL FUSIONS, ABOUT 1 HOUR BEFORE SURGERY TO DECREASE
RESECTIONS OF MASSES (E.G., LIPOMAS) AND REPAIR OF SECRETIONS.
DERMAL DEFECTS. 3. A SHORT-ACTING BARBITURATE, SUCH AS THIOPENTAL
SODIUM (PENTOTHAL);
4. AN INHALED GAS, SUCH AS NITROUS OXIDE AND OXYGEN;
5. A MUSCLE RELAXANT, E.G. ANECTINE (SUCCINYL CHOLINE),
PAVULON (PANCURONIUM HYDROBROMIDE).

7. JACKKNIFE (KRASKE POSITION)  COMMON ANESTHETIC TECHNIQUES

 RESPIRATORY SYSTEM IS SEVERELY COMPROMISED 1. CONSCIOUS SEDATION
 BLOOD POOLING IN THE EXTREMITIES OCCUR  PATIENT REMAINS CONSCIOUS WITH SOME
 SIMILAR TO KNEE-CHEST OR KNEELING POSITIONS AND IS ALTERATION OF MOOD, DROWSINESS AND
OFTEN USED FOR COLORECTAL SURGERIES SOMETIMES ANALGESIA.
 PROTECTIVE REFLEXES REMAIN INTACT.
 COMMONLY USED DRUGS INCLUDE MORPHINE,
MEPERIDINE, FENTANYL, DIAZEPAM (VALIUM),
MIDAZOLAM (VERSED).
2. DEEP SEDATION
 PATIENT IS ASLEEP BUT EASILY AROUSABLE.
 PROTECTIVE REFLEXES ARE MINIMALLY DEPRESSED.
3. GENERAL ANESTHESIA
 COMPLETE LOSS OF CONSCIOUSNESS.
 BEST PRACTICE: WHEN POSITIONING THE CLIENT FOR  A REVERSIBLE STATE THAT PROVIDES ANALGESIA,
SURGERY, THE NURSE SHOULD DO THE FOLLOWING: MUSCLE RELAXATION AND SEDATION
 EXPLAIN THE PURPOSE OF THE POSITION TO THE  PROTECTIVE REFLEXES ARE LOST.
CLIENT.  PRODUCED BY IV OR INHALED ANESTHETICS
 AVOID UNDUE PRESSURE ON ANY BODY PART. 4. REGIONAL ANESTHESIA
 STRAP THE CLIENT SECURELY BUT SNUGLY TO  PRODUCTION OF ANESTHESIA IN A SPECIFIC BODY
PREVENT FALLS. PART.
 MAINTAIN ADEQUATE RESPIRATORY AND  ACHIEVED BY INJECTING LOCAL ANESTHETICS IN
CIRCULATORY FUNCTION. CLOSE PROXIMITY (USUALLY BY INJECTION) TO
 ENSURE GOOD BODY ALIGNMENT
APPROPRIATE NERVES. (NERVE BLOCK)
5. SPINAL ANESTHESIA
 LOCAL ANESTHETIC IS INJECTED INTO LUMBAR
INTRATHECAL SPACE.
 ANESTHETIC BLOCKS CONDUCTION IN SPINAL NERVE
ROOTS AND DORSAL GANGLIA; PARALYSIS AND
ANALGESIA OCCUR BELOW THE LEVEL OF INJECTION.
6. EPIDURAL ANESTHESIA ACTIVITIES DURING THE INTRAOPERATIVE
 ACHIEVED BY INJECTING LOCAL ANESTHETIC INTO  ASSISTING THE SURGEON AS SCRUB NURSE OR
EPIDURAL SPACE BY WAY OF A LUMBAR PUNCTURE. CIRCULATING NURSE
 RESULTS ARE SIMILAR TO SPINAL ANALGESIA
7. PERIPHERAL NERVE BLOCKS
 ACHIEVED BY INJECTING LOCAL ANESTHETIC TO
ANESTHETIZE THE SURGICAL SITE.

STAGES OF ANESTHESIA
 STAGE 1: ANALGESIC (BEGINNING ANESTHESIA)
 PATIENT MAY HAVE RINGING, STILL CONSCIOUS,
SENSE INABILITY TO MOVE EXTREMITIES
 NOISES ARE EXAGGERATED
 AVOID UNNECESSARY NOISES OR MOTIONS
 STAGE 2: EXCITEMENT
 CHARACTERIZED BY STRUGGLING, SHOUTING,
TALKING, CRYING. (AGITATION) SCRUB NURSE CIRCULATING NURSE
 PUPILS DILATE, RAPID PULSE AND IRREGULAR RR  ASSISTS THE SURGICAL  ASSISTS THE SCRUB
 RESTRAIN THE PATIENT TEAM NURSE, OPENS& OBTAINS
 STAGE 3: SURGICAL ANESTHESIA  MAINTAINS STERILITY INSTRUMENT, KEEPS
 SURGICAL ANESTHESIA IS REACHED  HANDLES INSTRUMENTS, RECORD, ADJUST LIGHTS,
 PATIENT UNCONSCIOUS AND LIES QUIETLY PREPARES SUTURES, RECEIVES SPECIMEN,
 RESPIRATIONS ARE REGULAR AND CR RECEIVES SPECIMEN, COORDINATES
 MAY BE MAINTAINED IN HOURS IF PROPERLY GIVEN COUNTS  POSITIONS THE PATIENT
 STAGE 4: MEDULLARY DEPRESSION  DRAPES PATIENT FOR SURGERY
 STAGE IS REACHED WHEN TOO MUCH ANESTHESIA IS  WEARS STERILE GOWN,
GIVEN GLOVES
 RR BECOME SHALLOW, PULSE IS WEAK AND THREADY,
PUPILS WIDELY DILATED
 WITHOUT PROPER TREATMENT DEATH WILL FOLLOW
 DISCONTINUE ANESTHETIC ABRUPTLY

COMPLICATIONS AND DISCOMFORTS OF SPINAL ANESTHESIA

 HYPOTENSION
 NAUSEA/ VOMITING
 HEADACHE
 RESPIRATORY PARALYSIS
 NEUROLOGIC COMPLICATIONS (E.G. PARAPLEGIA, SEVERE
MUSCLE WEAKNESS OF THE LEGS)

 BEST PRACTICE: BLOOD PRESSURE SHOULD BE

MONITORED DURING ADMINISTRATION OF NERVE BLOCK
LOCAL ANESTHETIC, BECAUSE HYPOTENSION MAY OCCUR.

SURGICAL INCISIONS
 BUTTERFLY INCISION FOR CRANIOTOMY.
 LIMBAL INCISION FOR EYE SURGERIES.
 HALSTEAD / ELLIPTICAL INCISION FOR BREAST SURGERIES
(MASTECTOMY).
 ABDOMINAL INCISION FOR ABDOMINAL SURGERIES (E.G.
MIDLINE ABDOMINAL INCISIONS; PARAMEDIAN INCISIONS).
 MC BURNEY’S INCISION FOR APPENDECTOMY.
 PFANNENSTIEL INCISION FOR CESARIAN SECTION ALSO
CALLED “BIKINI LINE“ INCISION.
 LUMBOTOMY OR TRANSVERSE INCISION FOR KIDNEY
SURGERIES.
 PRINCIPLE OF STERILE TECHNIQUE
1. ONLY STERILE ITEMS ARE USED WITHIN THE STERILE
FIELD.
2. IF YOU ARE IN DOUBT ABOUT THE STERILITY OF
ANYTHING, CONSIDER IT UNSTERILE.
3. GOWNS ARE CONSIDERED STERILE ONLY FROM THE WAIST
TO SHOULDER LEVEL IN FRONT AND THEMSELVES.
4. STERILE PERSONS KEEP HANDS IN SIGHT AND AT OR
ABOVE WAIST LEVEL.
5. HANDS ARE KEPT FROM THE FACE AND NEVER HELD
UNDER THE AXILLARIES REGION.
6. CHANGING TABLE LEVELS ARE AVOIDED.
7. ITEMS DROPPED BELOW WAIST LEVEL ARE CONSIDERED
UNSTERILE.
8. TABLES ARE CONSIDERED STERILE ONLY AT TABLE LEVEL.
9. ANYTHING THAT EXTENDS BELOW THE TABLE LEVEL IS
CONSIDERED UNSTERILE.
10. IN UNFOLDING STERILE DRAPE, THE PART THAT DROPS
BELOW THE TABLE LEVEL IS CONSIDERED UNSTERILE.
11. STERILE PERSONS TOUCH ONLY STERILE ITEMS OR AREAS,
UNSTERILE PERSONS TOUCH ONLY UNSTERILE ITEMS OR
AREAS.
12. UNSTERILE PERSONS SHOULD NOT DIRECTLY GET IN
CONTACT WITH THE STERILE FIELD. USE STERILE
TRANSFER FORCEPS.
13. UNSTERILE PERSONS A VOID REACHING OVER A STERILE
FIELD AND STERILE PERSONS AVOID LEANING OVER AN
UNSTERILE FIELD.
14. IN POURING INTO A STERILE FIELD AND STERILE PERSONS
AVOID LEANING OVER THE BASIN TO AVOID OVER
REACHING.
15. THE SCRUB NURSE SHOULD SET THE BASIN OR GLASSES
TO BE FILLED AT THE EDGE OF THE STERILE TABLE.
16. SURGEONS TURN AWAY FROM THE STERILE FIELD AND TO
HAVE PERSPIRATION REMOVED FROM THE BROW.
17. STERILE PERSONS KEEP WELL WITHIN THE STERILE AREA.
18. STERILE PERSONS PASS EACH OTHER BACK TO BACK.
19. STERILE PERSONS TURN BACK TO NON-STERILE PERSON
OR AREA WHEN PASSING.
20. UNSTERILE PERSONS AVOID STERILE AREAS.
21. UNSTERILE PERSON SHOULD MAINTAIN AT LEAST 1 FOOT
DISTANCE FROM ANY STERILE AREA.
22. UNSTERILE PERSONS NEVER WALK BETWEEN 2 STERILE
AREAS.
23. STERILE FIELD IS CREATED AS CLOSE AS POSSIBLE TO THE
TIME OF USE.
24. STERILE AREAS ARE CONTINUOUSLY KEPT IN VIEW.
25. DESTRUCTION OF INTEGRITY OF THE MICROBIAL BARRIERS
RESULTS IN CONTAMINATION.
26. MICROORGANISMS MUST BE KEPT TO A MINIMUM.
 OR NURSING/OPERATING ROOM NURSING/PERIOPERATIVE  BANDAGE SCISSORS
NURSING  USED TO CUT THE UTERUS AND UMBILICAL
DISCUSSED BY PROF. GERARDO A. NICOLAS RN, MAN CORD.
CLASSIFICATIONS OF SURGICAL INSTRUMENTS
 CUTTING AND DISSECTING (SHARPS)
 CLAMPING AND OCCLUDING (CLAMPS)
 GRASPING AND HOLDING (GRASPERS)
 EXPOSING AND RETRACTING (RETRACTORS)
 SUTURING AND STAPLING
 VIEWING CLAMPING AND OCCLUDING (CLAMPS)
 SUCTION AND ASPIRATING  HEMOSTATIC FORCEPS
 DILATING AND PROBING  USED TEMPORARILY CLAMP AND OCCLUDE BLEEDING
 MEASURING VESSELS.
 ACCESSORY INSTRUMENTS

CUTTING AND DISSECTING (SHARPS)

 KNIFE/SCALPEL
 HANDLE #4 IS THE FIRST KNIFE USED TO CUT
TOUGH TISSUES. USE BLADE NUMBERS 20, 21, 22, 23,
AND 25.
 HANDLE #3 IS THE SECOND KNIFE USED TO CUT
DELICATE TISSUES, AND IS USED FOR MINOR
SURGERIES. USE BLADE NUMBERS 10, 11, 12, 13, AND
15.

 CAN BE STRAIGHT OR CURVED

 SCISSORS
 MAYO SCISSORS (STRAIGHT / CURVED)
 USED TO CUT TOUGH TISSUES.
 KELLY FORCEPS
 LONGEST; USED FOR DEEP ABDOMINAL
LAYERS AND CAVITIES
 CRILE FORCEPS
 MEDIUM; USED FOR SHALLOW LAYERS
 MOSQUITO FORCEPS
 SHORTEST; USED FOR MINOR SURGERY,
STRAIGHT CURVED PEDIATRICS, AND SUPERFICIAL LAYERS

 METZENBAUM SCISSORS (STRAIGHT / CURVED)  MIXTER FORCEPS

 USED TO CUT DELICATE TISSUES.  USED TO REACH AROUND AND LIGATE BLOOD
VESSELS.

STRAIGHT CURVED
 OCHSNER FORCEPS  PENNINGTON FORCEPS
 USED TO GRASP MEDIUM TO HEAVY TISSUE OR  USED FOR GRASPING TISSUE, PARTICULARLY DURING
OCCLUDE HEAVY, DENSE VESSELS RECTAL OPERATIONS

 BABCOCK FORCEPS
 USED TO GRASP DELICATE TISSUE AND HOLD
TUBULAR ORGANS
 USED WITH INTESTINAL AND LAPAROTOMY
PROCEDURES
GRASPING AND HOLDING (GRASPERS)
 ADSON FORCEPS (TOOTHED)
 USED FOR HANDLING DENSE TISSUE, SUCH AS IN
SKIN CLOSURES

 OVUM FORCEPS
 USED TO REMOVE PLACENTAL FRAGMENTS INSIDE
THE UTERUS

 ADSON FORCEPS (TOOTHLESS)

 USED FOR FINE SURGICAL PROCEDURES TO HOLD
DELICATE OR SUPERFICIAL TISSUES

 TOWEL CLIPS
 USED TO HOLD DRAPES IN PLACE, TO KEEP ONLY THE
OPERATING FIELD EXPOSED

 THUMB FORCEPS
 USED FOR GRASPING, HOLDING OR MANIPULATING
BODY TISSUE

EXPOSING AND RETRACTING (RETRACTORS)

 TISSUE FORCEPS 1. SELF RETAINING RETRACTORS
 USED IN SURGICAL PROCEDURES FOR GRASPING  BALFOUR ABDOMINAL RETRACTOR
TISSUE  USED IN LAPAROTOMY PROCEDURES, AND FOR
 DESIGNED TO MINIMIZE DAMAGE TO BIOLOGICAL SPECIFIC ABDOMINAL PROCEDURES WHERE THE
TISSUE ABDOMEN NEEDS TO BE HELD OPEN FOR
EXAMINATION OR EVALUATION, SUCH AS CESAREAN
SECTIONS AND BOWEL RESECTION.

 ALLIS FORCEPS
 USED TO HOLD OR GRASP HEAVY TISSUE LIKE BONES,
TENDONS, UTERUS, AND FASCIA
 MASTOID RETRACT0R  MURPY RAKE RETRACTOR
 USED TO RETRACT THE EXTERNAL CANAL SKIN  USED TO GENTLY RETRACT TISSUE AND GIVE BETTER
ANTERIORLY FOR BETTER VISUALIZATION OF VISIBILITY TO THE SURGICAL FIELD.
EXTERNAL CANAL AND MIDDLE EAR.

 SENN RETRACTOR
 USED TO RETRACT FAT TISSUE IN MINOR SUGERY.
 GELPI RETRACTOR
 USED FOR HOLDING BACK ORGANS AND TISSUES
WHILE ACCESSING AREAS BELOW AN INCISION
DURING LUMBAR SPINE PROCEDURES.

 MALLEABL RETRACTOR
 USED TO RETRACT DEEP WOUNDS, AND MAY BE BENT
TO VARIOUS SHAPES.

2. NON-SELF RETANING RETRACTORS

 ARMY NAVY RETRACTOR
 USED FOR SHALLOW OR SUPERFICIAL WOUNDS, AND
TO RETRACT SKIN OR BONES.
SUTURING AND STAPLING
 NEEDLE HOLDER
 USED TO HOLD A SUTURING NEEDLE FOR CLOSING
WOUNDS DURING SUTURING AND SURGICAL
PROCEDURES.

 RICHARDSON RETRACTOR
 USED TO RETRACT, EXPOSE OR PUSH TISSUE,
MUSCLES, ORGANS OR BONES DURING SURGERY.

 SKIN STAPLER
 USED TO CLOSE INCISIONS AFTER SURGERY.

 DEAVER RETRACTOR
 USED TO HOLD BACK THE ABDOMINAL WALL DURING
ABDOMINAL OR THORACIC PROCEDURES, AND TO
MOVE OR HOLD ORGANS AWAY FROM THE SURGICAL VIEWING
SITE.  SPECULUM
 USED TO SEE INSIDE A HOLLOW PART OF THE BODY.
 ENDOSCOPE DILATING AND PROBING
 USED TO LOOK DEEP INTO THE BODY AND USED IN  URETHRAL SOUNDS
PROCEDURES CALLED AN ENDOSCOPY  USED IN UROLOGICAL SURGERY FOR DILATATION OF
STRICTURES OR FOR OBTAINING ACCESS TO THE
BLADDER.

 SURGICAL PROBES
 A BLUNT-ENDED SURGICAL INSTRUMENT USED FOR
EXPLORING A WOUND OR PART OF THE BODY.

SUCTION AND ASPIRATING

 SUCTION
 USED TO REMOVE SUBSTANCES SUCH AS BLOOD, MEASURING
SALIVA, MUCUS, AND VOMIT.  CALIPER
 USED IN PLASTIC SURGERY PROCEDURES TO
ASCERTAIN PRECISE MEASUREMENTS.

 RULER
 USED TO OBTAIN PRECISE MEASUREMENTS DURING
ORTHOPEDIC SURGICAL PROCEDURES.
 ACCESSORY INSTUMENTS 1. SWAGED END - CONNECTS THE NEEDLE TO THE SUTURE
 MALLET 2. NEEDLE BODY OR SHAFT - THE REGION GRASPED BY THE
 USED WITH A CHISEL TO SPLIT TEETH AND RESHAPE NEEDLE HOLDER, AND CAN BE ROUND, CUTTING, OR
OR REMOVE BONES. REVERSE CUTTING.
 ROUND BODIED NEEDLES ARE USED IN FRIABLE
TISSUE SUCH AS LIVER AND KIDNEY.
 CUTTING NEEDLES ARE TRIANGULAR IN SHAPE, AND
HAVE 3 CUTTING EDGES TO PENETRATE TOUGH
TISSUE SUCH AS THE SKIN AND STERNUM, AND HAVE
A CUTTING SURFACE ON THE CONCAVE EDGE.
SUTURES  REVERSE CUTTING NEEDLES HAVE A CUTTING
 A STITCH OR ROW OF STITCHES HOLDING TOGETHER THE SURFACE ON THE CONVEX EDGE, AND ARE IDEAL FOR
EDGES OF A WOUND OR SURGICAL INCISION TOUGH TISSUE SUCH AS TENDON OR SUBCUTICULAR
 CAN CLASSIFIED INTO ABSORBABLE AND NON- SUTURES, AND HAVE REDUCED RISK OF CUTTING
ABSORBABLE THROUGH TISSUE.
 ABSORBABLE SUTURES ARE BROKEN DOWN BY THE BODY 3. NEEDLE POINT - ACTS TO PIERCE THE TISSUE,
VIA ENZYMATIC REACTIONS OR HYDROLYSIS. THE TIME IN BEGINNING AT THE MAXIMAL POINT OF THE BODY AND
WHICH THIS ABSORPTION TAKES PLACE VARIES BETWEEN RUNNING TO THE END OF THE NEEDLE, AND CAN BE
MATERIAL, LOCATION OF SUTURE, AND PATIENT FACTORS. EITHER SHARP OR BLUNT.
EXAMPLES:  BLUNT NEEDLES ARE USED FOR ABDOMINAL WALL
 VICRYL CLOSURE, AND IN FRIABLE TISSUE, AND CAN
 POLYDIOXANONE SUTURE (PDS) POTENTIALLY REDUCE THE RISK OF BLOOD BORNE
 MONOCRYL VIRUS INFECTION FROM NEEDLESTICK INJURIES.
 SUTURE SIZE  SHARP NEEDLES PIERCE AND SPREAD TISSUES WITH
 THE DIAMETER OF THE SUTURE WILL AFFECT ITS MINIMAL CUTTING, AND ARE USED IN AREAS WHERE
HANDLING PROPERTIES AND TENSILE STRENGTH. LEAKAGE MUST BE PREVENTED.
 THE LARGER THE SIZE ASCRIBED TO THE SUTURE,
THE SMALLER THE DIAMETER IS, FOR EXAMPLE A 7-0  SURGICAL NEEDLES - SHARPS
SUTURE IS SMALLER THAN A 4-0 SUTURE.  THE NEEDLE SHAPE VARY IN THEIR CURVATURE AND
ARE DESCRIBED AS THE PROPORTION OF A CIRCLE
COMPLETED – THE ¼, ⅜, ½, AND ⅝ ARE THE MOST
COMMON CURVATURES USED.
 DIFFERENT CURVATURES ARE REQUIRED DEPENDING
ON THE ACCESS TO THE AREA TO SUTURE.

SURGICAL NEEDLES
 THE SURGICAL NEEDLE ALLOWS THE PLACEMENT OF THE
SUTURE WITHIN THE TISSUE, CARRYING THE MATERIAL
THROUGH WITH MINIMAL RESIDUAL TRAUMA.
 CHARACTERISTICS
 RIGID ENOUGH TO RESIST DISTORTION, YET
FLEXIBLE ENOUGH TO BEND BEFORE BREAKING
 AS SLIM AS POSSIBLE TO MINIMIZE TRAUMA
 SHARP ENOUGH TO PENETRATE TISSUE WITH
MINIMAL RESISTANCE
 STABLE WITHIN A NEEDLE HOLDER TO PERMIT
ACCURATE PLACEMENT
 SURGICAL NEEDLES - 3 PARTS