DANDIBORU COLLEGE

DEPARTMENT OF BSC NURSING

OPERATION ROOM THEATRE FOR YEAR II BSC

NURSING STUDENTS

05/27/2025 By Abezash.M 1
 Learning outcome
At the end of this Session learner will be able to:
 Definition
 An operating room (OR)
 The surgery center
 The Unit of a hospital where surgical procedures are
performed.
 Perioperative care
 Drugs during Perioperative
 Positioning During Perioperative
 Instruments During Perioperative
 Fluids During OR

05/27/2025 By Abezash.M 2
 Surgery
 The branch of medicine that deals with the diagnosis
and treatment of injury,deformity,and disease by
manual and instrumental means.

-It is highly technical &complex field of study that

changes rapidly.

-A surgical operation or procedure, especially one

involving the removal or replacement of a diseased
organ or tissue.

05/27/2025 By Abezash.M 3
 Carried out in an operating room or a laboratory of a
surgeon or of a hospital's surgical staff.

 It is the skill or work of a surgical team .

 A medical procedure involving an incision with

instruments; performed to repair damage or arrest
disease in a living body.

05/27/2025 By Abezash.M 4
 Operation room
 The entire area in which surgical operations are
performed and materials are prepared and stored for
surgery is properly called the operating room or the
surgical suite.

05/27/2025 By Abezash.M 5
 OR-----
 A room specifically for use by the anesthesia and
surgical teams& must not be used for other purposes
 Both rooms require:
 Good lighting and ventilation
 Dedicated equipment for procedures
 Equipment to monitor pts, as required for procedure
 Drugs,other consumables for routine & emergency use

05/27/2025 By Abezash.M 6
  Ensure that procedures are established for the correct
use of the O.R. and all staff is trained to follow them.

 Store some sutures and extra equipment in the O.R. to

decrease the need for people to enter and leave the
O.R. during a case.

 Keep to a minimum the number of people allowed to

enter the O.R. , especially after an operation has
started.
05/27/2025 By Abezash.M 7
 OR---
 Keep O.R. uncluttered/organized and easy to clean
 B/n cases, clean & disinfect table & instrument
surfaces
 At the end of each day, clean the O.R.
 Start cleaning at the top and continue to the floor,
including all furniture, overhead equipment and lights.
 Use a liquid disinfectant at a dilution recommended by
the manufacturer
05/27/2025 By Abezash.M 8
 OR------

Sterilize all surgical instruments & supplies after

use

Store instruments in place protected & ready for the

next use.

Leave the OR-ready for use in case of emergency.

05/27/2025 By Abezash.M 9
 Terminology
 OPERATING DEPARTMENT:

 A unit consisting of one or more operating Suites together with

ancillary accommodations .
 Such as:-

 Changing room. - Reception room

 Transfer room. - Rest room

 Recovery room - Circulatory room

05/27/2025 By Abezash.M 10
 Terminology-----
 OPRATING SUITE:
 That comprises of the operating theatre

 Room together with in immediate ancillary areas.

 Such as:–

 Anesthetic rooms.

 Sterile lay up or preparation room

 Disposal room

 Scrub up and gowning areas

05/27/2025 By Abezash.M 11
 Exit room.
 Terminology----

 OPERATING THEATER:
 This is in which surgical operations
and certain diagnostic procedures are
carried up.
Such as:-
 Hysterectomy.
 Herniorrhaphy.

 Thyroidectomy  Hemoroidectomy.

 Cholecystectomy
05/27/2025 By Abezash.M 12
 Designing and planning consideration of physical facility of a theatre:-

Determination of the no of operation rooms.

The future surgical needs of the community.

The future development in surgical technology.

05/27/2025 By Abezash.M 13
 The major consideration during designation

Surgical support system -

e.g. Temperature, Humidify, ventilation.

 Communication and information.

Administration units.

05/27/2025 By Abezash.M 14
 The basic design principles

 The design must be simple and easy to keep it clean

 There should be separate rooms for:-

Clean

Sterile and

Soiled instruments to prevent cross contamination

05/27/2025 By Abezash.M 15
 Design principles----
 Sufficient space to ensure the safe transportation of
patients and staff.

 The layout of department be convenient enough for

the supervisors to control incoming and out going
traffics.

05/27/2025 By Abezash.M 16
 Zonal Division of Operating Department

Protective zone/limited access area/unrestricted area

 Street cloths are permitted to wear in this zone .

 A corridor on the periphery accommodates traffic from

out side including pt.

05/27/2025 By Abezash.M 17
 Protective zone----
The area is isolated by doors from the main
corridor and from other areas.

It serves as an outside to inside access area.

Traffic is not limited.

05/27/2025 By Abezash.M 18
 Protective zone----
 Is monitored at a central location.

 Exit from clean zone and sterile zone

 Transfer or change over section.

 providing 1st stage of entry to an operation department

05/27/2025 By Abezash.M 19
 Protective zone----
 The zone includes:-

Recovery room.

Plaster room

Change room for staff & other personnel

Various offices are located here( reception offices)

Seminar and teaching Byfacilities.

05/27/2025 Abezash.M 20
 Clean /Semi Restricted /Semi sterile zone:-

 Rooms of the department arranged in a continuous

Progression from the entrance through zones

 Traffic is limited to properly attired/dressed personnel

 Body and head coverings are required

 Peripheral support areas & access corridors to the OR.

05/27/2025 By Abezash.M 21
 Clean zone-----

 The pt transferred to a clean side & stretcher is on

entry to this area.

 The pt’s hair must be covered.

 Approach sterility to operating theatre

 Approach to sterile preparation room.

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 Clean zone-----

 The zone includes:-  Exit lobby.

Scrubbing room.  Clean movements

Gowning area  Rest area.

Anesthetic room  Sterile store.

05/27/2025 By Abezash.M 23
 Sterile/restricted Zone

 Completely restricted

 Lay up / surgical preparations for items

 Masks, caps, shoes & trousers are required

 Sterile procedures are carried out

 Surgical scrubbing is done

05/27/2025 By Abezash.M 24
 Sterile Zone -----

 The zone includes:

 Sterile preparation rooms.

 scrubbing rooms

 Consist of operating rooms, scrub sink

 Recovery rooms near by(post anesthesia care unit)

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 The Disposal Zone

 The least clean area of the whole department

 The zone includes:

 The disposal room

 Interim storage area.

 The disposal corridor

05/27/2025 By Abezash.M 26
 List of materials included in each operating theatre:-

Pipe line suction apparatus

Sterile hand lotion bowl ,unopened packet

Diathermy machine (electrosurgical unit)

Cautery cable with knife and needle packed

 Mobile supplementary operating light fitting

Swabs count board.

05/27/2025 By Abezash.M 27
 List of materials-----
 X-ray viewing screen

 Swab or sponge checking rack.

 Operating table

 Anesthetic machines
 O2 cylinder.
 Medication table /supply shelf.

05/27/2025 By Abezash.M 28
 Lighting in Theatre

 Natural light

 Artificial light.

 Service light.

05/27/2025 By Abezash.M 29
 Ventilation in theatre

 The purpose:
 Supply heated or cooled ,humidified, contamination
free air to room.

 Introduce air in to theatre & to remove contaminants

liberated there.

 Prevent entry of air from adjacent contaminated area.

 Should be 25 times air exchange/hr.

05/27/2025 By Abezash.M 30
 Humidity:-

 To prevent ventilating air not to be dry.

 The humidity must be b/n 50-60% .

 Controlled by an instrument called Hygrometer to

measure the level.
05/27/2025 By Abezash.M 31
 Heating:-

 The room temperature of operating room must

be b/n 18.5 and 22 C0 may exceed to 24Co

05/27/2025 By Abezash.M 32
 Peri-operative Nursing protocol:-

 Definition of Surgery
 Is any procedure performed on the human body that uses
instruments to alter tissue or organ integrity .
 Perioperative Nursing-
 The nurse assesses of the client &
collecting ,organizing,& prioritizing patient data.
 Establishing nursing diagnosis; identifies desired patient
outcomes.
 Develop & implements a plan of care & evaluates that
care in terms of outcomes achieved by the patient.

05/27/2025 By Abezash.M 33
 Perioperative Nursing----
 The period extending from the time of
hospitalization for surgery to the time of discharge

 The term used to describe the wide variety of

nursing functions associated with the patient’s
surgical experience.

 It encompassing term that incorporates the three

phases of surgical experience.

05/27/2025 By Abezash.M 34
 Phases

Pre-operative

Intra-operative

 Post- operative phases.

05/27/2025 By Abezash.M 35
 Nursing protocol------

 Through out the entire peri-operative phase the pt is:

Continually assessed

Nursing care plan modified

Implementation is effected

The cycle is evaluated for outcome attainments

05/27/2025 By Abezash.M 36
 Nursing protocol------

Pre Operative Phase.

 It begins when the decision for surgery is made and ends w/n
the pt is transferred to the operating room.

 Major roles of nurse:- Relief anxiety, assesses nutritional

status, correct life style of pt and intervene any health change,
psychological and emotional support

05/27/2025 By Abezash.M 37
 Nursing protocol------

 Intra Operative Phase:-

 It begins from the time the pt is transferred to the

operating room ,until the time the pt is transferred to
the recovery facility.

 Major roles of nurse:- prevention of hemorrhage,

shock, cardiac arrest; keep pt’s dignity

05/27/2025 By Abezash.M 38
 Nursing protocol------
 Post Operative Phase:
 Involves those actives occur from the time the patient is
transferred from the operating room to PACU until the client
has progressed beyond the acute phase of client recovery

Major roles of nurse:

 Prevention of Complications such as:-

 Infection

 Internal bleeding

05/27/2025 By Abezash.M 39
 Major roles------
 V/s abnormality

 Input-out put imbalances.

 Tubing and drainage blockages

05/27/2025 By Abezash.M 40
 post-surgical patient
 Think of the “4 W’s”

 Wind: prevent respiratory complications

 Wound: prevent infection

 Water: monitor I & O,( I = O )

 Walk: prevent thrombophlebitis

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 Immediate patient care----

Keep the patient lying down for the prescribed

length of time.

Document all observations in the patient’s chart

05/27/2025 By Abezash.M 42
 Immediate patient care-----
 Dressing the wound:

Sterile material used to cover the incision

Serves to keep wound clean

Reduces bleeding

Absorbs fluid drainage

05/27/2025 By Abezash.M 43
 Postoperative Procedures ---

Dressing the wound:

Reduces discomfort to the patient

Speeds healing

Reduces the possibility of scarring

05/27/2025 By Abezash.M 44
 Postoperative Procedures ---
Bandaging the wound:

A clean strip of gauze or elastic material

Holds the dressing in place.

05/27/2025 By Abezash.M 45
 Bandaging the wound-----

May also improve circulation.

Provides support or reduces tension on the wound.

Prevents the wound from reopening.

Prevents movement of the area of the body.

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 Postoperative Instructions

 Guidelines for pain management

 Instruction for wound care

 Dietary restriction

 Activity restriction
05/27/2025 By Abezash.M 47
 Postoperative Instructions

 Follow-up appointment

 Timing for follow-up appointments

 Provided in writing and included in the

postoperative information packet.

05/27/2025 By Abezash.M 48
 Apply Your Knowledge
 A dressing is a sterile material used to cover the
incision.

 whereas a bandage is a clean strip of gauze or elastic

material used to hold the dressing in place.

05/27/2025 By Abezash.M 49
 Surgical Indications & Classifications
 Surgical Indications :
 Diagnostic- biopsy, exploratory laparotomy.

 Exploratory- Seeing and feeling.

 Curative- Tumor excision, acute/chronic, infectious disease

of(tissue, organ) treatment.

 Organ transplantation- Replacement/substitution of

organs
05/27/2025 By Abezash.M 50
 Surgical Indications----

 Corrective surgery-Reposition, enhancement of (bone,

ligaments, tendons/organ conduits)

 Reparative- multiple wounds are repaired

 Implantation-Artificial and electronic devices

replacement
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 Indications----
 Reconstructive or cosmetics sugary.

mammoplasty

cheloplasty

palatoplasty

Rhinoplasty

05/27/2025 By Abezash.M 52
 Indications----
 PALLIATIVE SURGERY:

 Relief of pain,discharge,spotting.

 Transient Problems are corrected

e.g.
 Gastrostomy tube insertion for swallowing problem.

 Hysterectomy for chronic cervical bleeding (ca)

05/27/2025 By Abezash.M 53
 Surgery Classification based on severity

 Required
Emergency
 Elective

Urgency  Optional.

05/27/2025 By Abezash.M 54
 Classification-----
classification indications Examples
Emergency : With out delay -severe bleeding
pt requires immediate - bladder or
attention disorders may be intestinal
life threatening obstruction
-fractured skull.
- Gunshot/ stab
wounds
- Extensive burns.
-Urgent- with in 24-30 Acute gall bladder
pt require prompt quick hrs
attention in faction
05/27/2025 By Abezash.M 55
-Kidney& urethral
 Classification-
Classification indications Examples

Failure to have -repair of scars

Elective : surgery ,not
pt should or cold case operated catastrophic -simple hernia
up on -Eu- thyroid
-Vaginal repair….etc

Optional: Personal Cosmotics surgery

decision resets with patient preference

05/27/2025 By Abezash.M 56
 Selected factors that increase surgical risk.

Age- Very young and older clients.

 Nutrition- a malnourished client is prone to poor

tolerance of anesthesia, infection, poor wound healing
and the potential for multiple organ failure after
surgery.

 Obesity- often have difficulty in resuming normal

activity after surgery.

05/27/2025 By Abezash.M 57
 Physical assessment/clinical manifestations
 General survey- gestures and body movements may
reflect decreased energy or weakness caused by illness.
 Cardiovascular system- alterations in cardiac status
are responssible for as many as 30% of perioperative
death.
 Respiratory system- a decline in ventilatory function,
assessed through breathing pattern and chest
excursion, may indicate a client’s risk for respiratory
complications.
05/27/2025 By Abezash.M 58
 Physical assessment---
 Renal system-Abnormal renal function can altered
fluid and electrolyte balance and decrease the
excretion of preoperative medications and anesthetic
agents.
 Neurologic system- a client’s LOC will change as a
result of general anesthesia but should return to the
preoperative state of consciousness after surgery.

05/27/2025 By Abezash.M 59
 Physical assessment---
Musculoskeletal system- Deformities may
interfere with intraoperative and postoperative
positioning. Avoid positioning over an area where the
the skin shows signs of pressure over bony
prominences.
Gastrointestinal system- alteration in function
after surgery may result in decreased or absent bowel
sound and distention.
Head and Neck- the condition of oral mucous
membranes reveals the level of hydration.
05/27/2025 By Abezash.M 60
 Gerontological Considerations

Cardiovascular
Coronary flow decreases
Heart rate decreases
Response to stress decreases
Peripheral vascular decreases
Cardiac output decreases
Cardiac reserve decreases

05/27/2025 By Abezash.M 61
 Gerontological Considerations----
 Respiratory System

Static lung volumes decreases

Pulmonary static recoil decreases

Sensitivity of the airway receptors decreases

 Nervous system

Increased incidence of post.op confusion

Increased incidence of delirium

Increased sensitivity to anesthetic agents

05/27/2025 By Abezash.M 62
 Gerontological Considerations----
 Renal System
 Renal blood flow declines 1.5% per year
 Renal clearance reduced

 Gastrointestinal

 Decreased intestinal motility

 Decreased liver blood flow
 Delayed gastric emptying

05/27/2025 By Abezash.M 63
 Gerontological Considerations----

 Musculoskeletal
 Decreased mass, tone, strength

 Decreased bone density

 Integumentary
 Decreased elasticity
 Decreased lean body mass
 Decreased subcutaneous fat
05/27/2025 By Abezash.M 64
 Laboratory and diagnostic studies
 Screening tests depend on the condition of the client
and the nature of the surgery. If test reveals severe
problems the surgery may be canceld until the
condition is stabilized.
 Blood type and Rh screen,Hgb
 urinalysis,
 EKG
 Chest X-ray are ordered to screen for pre-existing
abnormalities.
05/27/2025 By Abezash.M 65
 Surgical settings
 Surgical suites /set
 Ambulatory care setting
 Clinics
 Physician offices
 Community setting
 Homes

05/27/2025 By Abezash.M 66
 Surgical settings----
 Disadvantages
 Less time for rapport/empathy
 Less time to assess, evaluation, teach
 Risk of potential complication post operatively.
 Advantages of outpatient:
 Low cost
 Low risk of infection
 Less interruption of routine
 Less resource for work
 Less stress
05/27/2025 By Abezash.M 67
 Method of teaching surgical pt
 Timing-most useful when started a week before
admission and reinforced before surgery & the client is
less anxious.

 Content:
 Surgical Procedure

 Preoperative routines

 Intra operative routines

 Postoperative routines

 Sensory preparation

 Pain relief
05/27/2025 By Abezash.M 68
 Iv fluids

Body fluids are vital to maintain normal body

function
Total body water (TBW), accounts for
approximately 60% of total body weight.
• This will be :
 70% in new born
 50-55% in matured women
 60% in male
 Body fluid can be intracellular or extracellular

05/27/2025 By Abezash.M 69
 Fluids types
• Fluids used in clinical practice are usefully classified as
Colloids, crystalloids , blood products
1. colloids
 Contains large molecules
 Expands the intravascular and draw fluids from extracellular
compartment
e.g. Dextran & artificial plasma volume,blood transfusion
2. Crystalloids: small molecules that easily flows across cell
membrane
 Allowing transfer of fluid from blood stream to cells body tissues

 Increase intravascular volume and interstitial space (extracellular)

05/27/2025 By Abezash.M 70
 Fluids ----
• Crystalloids are subdivided in to :
 A. Isotonic B. Hypotonic C. Hypertonic
A. Isotonic fluids : Similar concentration, increase,
intravascular volume
e.g.
 0.9 % sodium chloride ( Nacl)
 Lactated ringer’s solution
 5% dextrose in water (D5W)
 Ringer’s solution

05/27/2025 By Abezash.M 71
 fluid -------
B. Hypotonic fluids

 lower concentration

 Flows from intravascular space to intracellular and

interstitial space

e.g.

0.45% Nacl, dextrose 2.5%

05/27/2025 By Abezash.M 72
 Fluids used ---
• Hypertonic fluids :
Higher tonicity /solute concentration

Draws water out of cellular space

Used as volume expander

Increases intravascular volume

e.g. 3% Nacl, 5% dextrose in normal saline (D5NS)

05/27/2025 By Abezash.M 73
 Surgical Team

Definition:
 A group of professionals providing the continuum
of care during :-

 pre-operative.

 intra-operative and

 postoperative and recovery area

05/27/2025 By Abezash.M 74
 Surgical Team---
The specialized team members:

surgeon

assistant surgeon

circulating nurse/runner
05/27/2025 By Abezash.M 75
 specialized team----
scrubbing nurse

Anesthetist.

Anesthesiologist

janitor/ cleaner

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 Responsibility of the surgeon team

 The surgeon is the leader of the surgical team

 He has ultimate responsibility for performing the

surgery in an effective and safe manner.

 He is dependent upon other members of the team.

 Coordinate the team for the patient's emotional

well-being and physiologic monitoring.

05/27/2025 By Abezash.M 77
 Responsibility----

 The anesthesiologist/anesthetist must be

constantly aware of the surgeon's actions.

 He must do every thing possible to ensure the

safety of the patient

 Reduce the stress of the operation.

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 Definitions of

 Anesthesiologist:

is a physician who is trained in the

administration of anesthetics.

 Anesthetist. is a registered professional nurse

who is trained to administer anesthetics.

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The responsibilities of the anesthesiologist/anesthetist

 Providing a smooth induction of the patient's

anesthesia in order to prevent pain.

 Maintaining satisfactory degrees of relaxation of the

patient for the duration of the surgical procedure

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 The responsibilities of the anesthesiologist

 Continuous monitoring to the physiologic status of

the patient(oxygen exchange, circulatory functions,

systemic circulation, vital signs.)

 Advising the surgeon of impending complications

and independently intervening as necessary.

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 Responsibility of Scrub Nurse:

The scrub nurse prepares the setup

Work with the surgeon

Select surgical instruments

Identify appropriate suture materials

05/27/2025 By Abezash.M 82
 Circulating Nurse Responsibility
 Obtain supplies
 Answer the team requests
 deliver supplies to the sterile field,
 carry out the nursing care plan
 liaison between scrubbed personnel and those
outside of the operating room.
 Teaches students
 Strictly observes the team activities
05/27/2025 By Abezash.M 83
 Circulating Nurse-----

 Providing for psychological comfort of the patient

prior to and during induction of anesthesia.

 Making initial assessment of the patient and continued

monitoring.

 Saving all discarded sponges; during surgery.

 participates in the sponge count .

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 Circulating Nurse-----

 Observing the surgical procedure

 anticipating the needs for equipment, instruments,

medications, blood units.

 Preparing labels for the patient specimens

 Submits to the laboratory for analysis.

05/27/2025 By Abezash.M 85
 Sterile team

 Definition:- persons working together in the sterile

field during operation
 Sterile team members:

Surgeon

asst. surgeon

Scrub nurse

The patient
05/27/2025 By Abezash.M 86
 Surgical Team---
 Clean team- those persons working
together out of sterile field in the operating
theatre during the operation.
 clean team members:
circulating nurse .

anesthetist/ anesthesiologist.

Cleaner/ janitor.

05/27/2025 By Abezash.M 87
 Sterile field

 Definition:

the only restricted area where sterile team

members are supposed to work together
during operation.

It is not allowed to clean team to work in

and cross the sterile field.
05/27/2025 By Abezash.M 88
 Intra- Operative Nursing
Described in terms of circulating and scrubbing
nurse.
 The Circulating Nurse Activities:-
Manage the operating room

Protects the safely and health needs of the pt.

Monitor the activities of the members of the

surgical team.

Checking the conditions in the operating room

05/27/2025 By Abezash.M 89
 Circulating Nurse----
 Assuring cleanliness

 Assuring proper temperature, humidity, lighting.

 Assuring safe fun of the equipment.

 Looks for availability of supplies and materials.

 Monitors the aseptic technique/ practices

 Monitor the pt condition through out the procedure

05/27/2025 By Abezash.M 90
 The Scrub Nurse activities
scrubbing for surgery

setting up the sterile tables .

Preparing the suturing materials and ligatures.

Collect special equipment.

Assisting the surgeon and surgical assistant

Anticipating the required instruments , sponges,

drains and procedures
05/27/2025 By Abezash.M 91
 Scrub Nurse-----
Keeping the track of time, the pt is under
anesthesia and the wound opened.

Make the surgical count.

Collect the specimen for pathology.

Keep the principles of asepsis

The capacity to handle any emergency situation in

the operating room.
05/27/2025 By Abezash.M 92
 Safety surgery

 DEFINITION

Is one that does not harm or expose the

patient or the provider to any avoidable risk.

05/27/2025 By Abezash.M 93
 Safety--------
 Safe Surgery will focus on two main points:

 The implementation of the safe surgery checklist.

 The monitoring and evaluation of surgical outcomes.

05/27/2025 By Abezash.M 94
 WHO safe surgery check list

1.The team will operate on the correct patient at the

correct site.

2.The team will use methods known to prevent harm

from administration of anesthetics, while protecting
the patient from pain.

3.The team will recognize and effectively prepare for life

threatening, loss of airway or respiratory function.

05/27/2025 By Abezash.M 95
 check list------

4.The team will recognize and effectively prepare

for risk of high blood loss.

5.The team will avoid inducing an allergic or

adverse drug reaction for which the patient is
known to be at significant risk.

6.The team will consistently use methods known

to minimize the risk for surgical site infection.
05/27/2025 By Abezash.M 96
 check list------

7.The team will prevent inadvertent retention of

instruments and sponges in surgical wounds.

8.The team will secure and accurately identify all

surgical specimens.

05/27/2025 By Abezash.M 97
 check list------

9.The team will effectively communicate and

exchange critical information for the safe
conduct of the operation.

10.Hospitals and public health systems will

establish routine surveillance of surgical
capacity, volume and results
05/27/2025 By Abezash.M 98
 Operating Room Attire/PPE
 Purpose:-To provide effective barriers that
prevent the dissemination of m/os to the pt or
from the pt.
 General Principles:-

 Each operating room department should have a

specific complete written policy.

 Only approved clean OR attire worn with in

restricted area of OR suites.

05/27/2025 By Abezash.M 99
 PPE-----
 The OR attire is not worn outside of operating room suite.

 Eye glasses should be wiped with tissue wet with

antiseptic solution.

 Comfort table supportive shoes should be worn to relieve

fatigue.

 Personal hygiene must be re-emphasized.

 No, person with acute infection allowed to visit OR.

05/27/2025 By Abezash.M 100
 Components Of OR Attire

 body cover

 mask muslin 40%

Muffin- 99%

 Head cover/ caps

05/27/2025 By Abezash.M 101

 Components----
Foot cover/ shoes

Goggles

Gloves

mackintosh/ plastic apron

05/27/2025 By Abezash.M 102

 Types of Gloves
sterile/ HLD surgical glove

clean examination glove

utility/ heavy duty gloves

Elbow length gloves

05/27/2025 By Abezash.M 103
 Gloves Requirements for Procedures
Task/ activity Are gloves Preferable Acceptable
needed ? gloves gloves

blood pressure check No - -

Temperature check No - -

injection No - -

blood drawing Yes exam HLD

Iv insertion/ removal Yes exam HLD

IUD insertion Yes exam HLD

IUD removal Yes exam HLD

manual vacuum aspiration Yes exam HLD

Norplant’s implants insertion Yes s. glove HLD

Vaginal delivery Yes s. glove HLD

C/S/ Laparotory Yes s. glove HLD

Vasectomy/ laparotory Yes s. glove HLD

Handling and cleaning instrument Yes Utility Exam/ HLD

05/27/2025 By Abezash.M 104

Handling contaminated waste Yes Utility Exam/ HLD
 When to Double Gloves

 The procedure that involves coming in contact

with large amounts of blood/ body fluids.

 Orthopedic procedure in sharp bone fragments,

wire sutures and other sharps.

 Surgical gloves when re-used.

 Surgical procedures lasting more than 45 minutes.

05/27/2025 By Abezash.M 105
 Elbow Length Gloves Are Used During:-

vaginal deliveries

Cesarean section .

Manual removal of placenta.

Large volume of blood/ body fluids contact .

05/27/2025 By Abezash.M 106
 Elbow Length----

Cut the four fingers of gloves completely off

sterilize or disinfect 2-3 pairs of cut off (finger

less) gloves

05/27/2025 By Abezash.M 107

 How to Use It

Perform surgical scrub

Put finger less sterile/ HLD gloves & pull up to

the fore-arms.

Put intact sterile/ HLD glove

05/27/2025 By Abezash.M 108
 Some Do’s and Don’ts about gloves.

Do- wear the correct size gloves

Do- change s- gloves every 45 minutes ’

Do- keep finger nails trimmed moderately short.

Do- pull the gloves up over cuffs of gown

Do -use water soluble hand lotions

05/27/2025 By Abezash.M 109
 Don’t------
Don’t – oil based hand lotions or creams.

Don’t – use latex gloves if you have allergy.

Don’t – store gloves that are cracked

Don’t -reprocess gloves that are cracked.

Don’t –reprocess exam gloves for reuse.

05/27/2025 By Abezash.M 110
 Surgical Scrubbing/hand hygiene

Definition: -

 It is the process of removing as many M/os as

possible from the hands and arms by mechanical

washing and chemical antisepsis before

participating in an operative procedure.

05/27/2025 By Abezash.M 111

 WHO 5 Stages of Hand Washing
Before touching a patient.

Before cleaning aseptic procedure.

After body fluid exposure risk.

 After touching a patient.

 After touching a patient’s surrounding

area.
05/27/2025 By Abezash.M 112
 Nursing responsibility of Hand Washing
Practice safe hand washing techniques.

Be pro-active and lead by example.

Encourage other health staff to do the same.

Educate patients and colleagues.

Help build hand wash stations in your hospital

05/27/2025 By Abezash.M 113

 Three types of hand hygiene

Normal, between daily activities at home.

 When at work and caring for patients.

When getting ready for surgery: surgical scrub.

05/27/2025 By Abezash.M 114
 Normal hand hygiene
carried out :-
 Before touching food.

 After using the toilet.

 After gardening or outside activity.

 After touching animals.

 Before touching your eyes.

05/27/2025 By Abezash.M 115
 Normal hand hygiene----

 It takes 15-30 second hand wash with home soap

and clean water.

 Clean the back and front of the hand, between

fingers, the nails and wrist.

05/27/2025 By Abezash.M 116

 Normal hand------

 Wipe with clean cloth or paper-towel

 Tip: Try and buy liquid soap because a bar of soap

can sit there holding bacteria from the last person
who used it.

05/27/2025 By Abezash.M 117

 At work and caring for patients

 Before and after patient care, after toilet, before and

after food, after touching contaminated materials.

 Can be a 15-30 second hand wash to the entire hand

and wrist (just like the home wash)

05/27/2025 By Abezash.M 118

 At work and caring----

 You can do this with hospital grade and approved

liquid hand soap and clean water or waterless jelly
foam

 Dry with a clean paper-towel

 Wait till your hands are dry before you touch the
next patient or other objects.

05/27/2025 By Abezash.M 119

 Surgical scrub
 Before a surgical operation
1. Alcohol hand rub

2. Routine hand wash 10-15 seconds

3. Aseptic procedures 1 minute

4. Surgical wash 3-5 minutes

05/27/2025 By Abezash.M 120

 M-o:- the skin is inhibited by-

1.Transient organism:

acquired by direct contact

usually loosely attached to the skin surface

Completely removed by thorough washing with

soap or detergent and water.
05/27/2025 By Abezash.M 121
 Resident organism:-

Are below the skin surface in hair follicles and

in sebaceous and sweat glands.

Are more adherent and resistant to removal.

Their growth is inhibited by the chemical phase

of the surgical scrub .
05/27/2025 By Abezash.M 122
 The purpose: -

 To remove soil, debris natural skin oil, M/Os from the hands
and fore arms of the surgical team/sterile team .

 To decrease the no of M/os on skin to an irreducible

minimum.

 To reduce the hazards of microbial contamination of the

operative wound by skin flora.

 To keep the population of the M/os minimal during the

operative procedure by suppression of growth.
05/27/2025 By Abezash.M 123
 General preparations:-

The skin and nails should be kept clean.

Finger nails should not reach beyond the finger

tip.

Finger nail polishing avoided.

Artificial devices should not cover natural finger

nails.
05/27/2025 By Abezash.M 124
 Surgical scrub procedures:-

 The pre-operative surgical antisepsis consists of

three processes.

 Hand hygiene

 Gloving of the surgical team

 Applying antiseptic agent to the surgical site

05/27/2025 By Abezash.M 125
 The methods of scrubbing:-

Two methods:-

The counted brush-stroke method

The time scrub method

Note :-The Surgical Scrub Is Prior to Gowning.

05/27/2025 By Abezash.M 126
 The length of surgical scrubbing depends on:-

The frequency of scrubbing.

The agent used.

The method.

05/27/2025 By Abezash.M 127

 What hand solution being used
 Bar of soap.
 Liquid soap for home.

 Liquid soap for hospital daily use.

 Liquid soap for surgical scrub.

 Waterless gel/spray for use at home.

 Waterless gel/spray for hospital daily use.

 Waterless gel/spray for surgical scrub
05/27/2025 By Abezash.M 128
 Steps in surgical scrubbing:-

 Remove rings, watches, and bracelets.

 Wash hands thoroughly b/n fingers and forearms

to the elbow with soap, water, brush/ sponges

 Clean nails with nail cleaner.

 Rinse hands and fore arms with water.

05/27/2025 By Abezash.M 129

 Steps----
 Apply antiseptic agent to all surface of hands and
forearm.

 Holding the hands higher than the elbows, rinse

hands and fore arms with clean water.

 Keep hands up and away from the body don’t

touch any surface.

 Put sterile surgical gown, then gloves on both

hands after drying hands .
05/27/2025 By Abezash.M 130
 Gowning & gloving

The sterile gown is put on immediately after

the surgical scrub.

The sterile gloves are donned immediately

after gowning .

05/27/2025 By Abezash.M 131

 Before You Wash

Bad Good

05/27/2025 By Abezash.M 132

 Jewelry and Watch

It is hard to clean under

Remove jewelry to
your jewelry or watch
ensure a complete clean
Bacteria and dirt can sit
under your jewelry or watch

05/27/2025 By Abezash.M 133

 Nail Polish and False Nails
Good
Bad If it is less than 4 days old
you can keep it on

05/27/2025 By Abezash.M 134

 Nail Length
Bad Good

05/27/2025 By Abezash.M 135

 Skin Integrity (condition)
Bad Good
No open wounds,
Cuts, breaks and weeping
bleeding or weeping
can spread infection

05/27/2025 By Abezash.M 136

 Result

 No jewelry
 No watch
 No nail polish
 No false nails
 No long nails
 No cracked skin
 You are now ready to wash

05/27/2025 By Abezash.M 137

 General consideration
The scrub person gowns and gloves himself.

Gown packages opened on separate table.

Avoid splashing water on scrub attire.

The circulator nurse assists gowning.

05/27/2025 By Abezash.M 138
 General consideration---
 Two types of gloving technique.

 closed system

 open system

05/27/2025 By Abezash.M 139

 Universal precaution:

Wear appropriate protective equipments.

Always wash your hands.

Wear gloves for direct contact with:

Blood/body fluids

Broken skin or mucus membranes

05/27/2025 By Abezash.M 140
 Universal precaution----
 Discard sharps safely:

Never re-sheath needles

Place all sharps directly in to sharps bin

Discard bin when three-fourth full.

05/27/2025 By Abezash.M 141
 Universal precaution-----

 Keep cuts and abrasions covered.

 Disinfect blood/body fluid spillages.

05/27/2025 By Abezash.M 142

 Maintaining a safe, Environment
The role of cleaners:-

cleaners to wash wall and windows weekly .

cleaners to clean floors, showers and latrines

twice daily.

Cleaners to empty and wash basins, bowls as

they are used.

05/27/2025 By Abezash.M 143

 Maintaining a safe---

Cleaners to discarded dirty water outside

Cleaners to discard contaminated drapes

post- operatively.

Cleaners clean the floor of theatre after

each operation/TOT

05/27/2025 By Abezash.M 144

 Health Care Provider.

Avoiding malpractice
Leave the pt alone
 Negligence malpractice Talking, laughing

Not monitoring V/S

failure to make Pre-op ass’ment

In correct intubations
 Criminal malpractice partiality out looks
Incorrect dosage
Incorrect installation
.

05/27/2025 By Abezash.M 145

 Surgical Instruments

 Historical prospective:-

 The history of surgical instruments dates

back to 2500 BC: - ancient Greece, Egyptians

and Hindu instruments resemble today’s

instrument.

05/27/2025 By Abezash.M 146

 Instruments---

• The 1st surgical instruments were made of

Animal teeth

Wood

Ivory

05/27/2025 By Abezash.M 147

 Instruments---

 In mid 1800’s (civil war in USA) instruments made of:

 Kitchen Knife

 Carpenter saw

 Table pork
05/27/2025 By Abezash.M 148
 Instruments---

In the beginning of 20th century-delicate

instrument seen more useful than heavy one
and

Replaces the handles of wood, ivory, so that

instrument could resist repeat sterilization.

05/27/2025 By Abezash.M 149

 Composition of surgical instrument
 Surgical instruments are manufactured
from stainless steel of:

Iron

Carbon

Chromium of varying qualities

05/27/2025 By Abezash.M 150

 Instruments---

 Types of Instrument Finishes are several

Bright –called mirror finish.

satin (dull)- tend to eliminate reselections .

Embodied finish- finish-black and the golden

handle.
05/27/2025 By Abezash.M 151
 Instruments---

 Categories of Surgical Instruments.

1.Cutting, dissecting, sharp.

2.Hemoeostasis/ occluding/ clamping

05/27/2025 By Abezash.M 152

 Instruments---

3.grasping, holding,(a traumatic to tissue )

4.Retractors (Exposing )

5.Dilating

6.Probing

7.suturing
05/27/2025 By Abezash.M 153
 Categories and examples
Cutting / dissecting /sharps:
eg.scissors, scalpels, curettes,kelly artery forceps

Grasping /holding:
eg.allies, babkocks,pinsets, sponge holders,

 Hemostasis/ occluding/ clamping:

eg.forceps, hemostats, clamps.

05/27/2025 By Abezash.M 154

 Categories and examples---
Retracting, dilating, and probing :
e.g. retractors, dilators, probes

Suturing :-e.g. needle holders, needles,

packaged suture materials.

05/27/2025 By Abezash.M 155

 Order of handling instruments :-

Cutting instruments

Grasping instruments

Retractors

Probes

Suture materials

Needle holders, sponge holders

05/27/2025 By Abezash.M 156
 Instruments---

 The purpose of surgical instruments :-

Simply selection for arranging the basic sets of

instrument for surgical procedures.

Specific Instrument selection for specific operation

To specialize in operating room nursing and types

of instruments

05/27/2025 By Abezash.M 157

 Instruments---

OR trays /sets named according to their functions

e.g. Operating sets prepared as :-

 Major/general set

 Minor set

 Plastic/ suturing sets.

According to each pts need instruments are more

individualized e.g. intestinal set, vascular sets….etc.
05/27/2025 By Abezash.M 158
 Instruments---

In the same way basic instruments are selected for

operating other body cavities: eg chest, skull,
pelvic.

Instruments are selected according to the size of

the body, structure and nature of organ involved.

Instruments designed for surgery on infants, eyes,

ear, blood vessel, nerve and brain are differing from
the above. They are fine, more delicate according
to the purpose, but the same basic principles are
used.
05/27/2025 By Abezash.M 159
 Principles of Passing instruments

Gown and glove.

Selected according to standard basic sets.

Arrange instruments on instrument table

and make count.

Drape the mayo tray.

05/27/2025 By Abezash.M 160

 Principles------

Don’t go beyond the confine of the room

Grown and glove the surgeon and assistant

Don’t interrupt the surgical counts.

Bring mayo- stand to the position over, after

draping completed.

Be sure it should not rest over the pt.

05/27/2025 By Abezash.M 161
 Principles------

Hand the knife to the surgeon, and hemostasis to

the assistant.

W/n passing always hold the handle blade down

and point to ward your wrist never to surgeon.

Anticipate surgeons need one- step ahead of him

w/n passing surgical instruments.
05/27/2025 By Abezash.M 162
 Principles------
Pass instruments in decisive & positive manner.

W/n passed properly surgeon known that he has it.

His eyes do not have to leave operative site

W/n the surgeon extends his hand instruments

should be slapped firmly in his palm in proper
position for him to use it.
05/27/2025 By Abezash.M 163
 Instruments---

 Proper Positions for Scrub Nurse to the Surgeon :-

If the surgeon is opposite side of the table pass

with your Rt hand.

If the surgeon is on the same side of the table

and to the Lt of you use your Rt hand.

05/27/2025 By Abezash.M 164

 Proper Positions----

If the surgeon is opposite side of the table pass

with your right hand.

If the surgeon is on the same side of the table

and to the left of you, use your right hand.

05/27/2025 By Abezash.M 165

 Instruments---

• Your Consideration in the sterile field:-

Keep instruments clean.

Keep the table and sterile field as dry as possible.

Discard a piece of suture material, tubings, gauze.

Keep hands at waist level.

Don’t reach behind a member of sterile team/field.

05/27/2025 By Abezash.M 166

 Your Consideration----
Go another side of members of sterile team back to
back not back to front.

Don’t return your back to sterile team/ field.

Keep talking to a minimum.

Don’t allow cross b/n sterile team .

05/27/2025 By Abezash.M 167

 General Instruments

Are arranged according to the types of

operation.

It must include sufficient basic instrument for

any of the operations performed in theatre.

The basic general set of instruments could

consist of the following
05/27/2025 By Abezash.M 168
 The General Set:-

 Scalpel handles No. 3,4,5,7 (2)

 Dissecting forceps toothed small (2)

 Dissecting forceps toothed large (2)

 Dissecting forceps non-toothed small & large (2)

 Mayo scissors curved small and Large (2)

05/27/2025 By Abezash.M 169

 The General Set---

 Mayo scissors straight (2) for cutting tissue

 Mayo scissors straight (2) for cutting stitch

 Artery forceps curved (10 )for clamping

 Artery forceps Straight (10 Monyhan)

 Artery forceps Straight 10 (spencer wellis)

05/27/2025 By Abezash.M 170
 The General Set---
Dissector for tissue-------- 2

 Aneurysm needle ----------2

Curetting spoon------------2

Sponge holding forceps---------6

05/27/2025 By Abezash.M 171

 The General Set---
Needle holder small and large -----4
(short and long ones)

Retractors different type and size---------6

Tissue forceps------------------------------6

05/27/2025 By Abezash.M 172

 Diathermy

 Definition:-Production of heat in the body tissue by a

high frequency of electric current.

Types of diathermy

 Medical diathermy:- sufficient heat is used to warm the

tissues but not harm them.

 Short – wave diathermy:- used in physiotherapy to

relieve pain or heat infection.

 Surgical diathermy:- of very high frequency, used to

coagulate blood in vessels,
05/27/2025
cut & desiccation of tissues.173
By Abezash.M
 Functions of Diathermy

 Electrotomy/ cutting (generation of heat destroys tissue cell)

Blend (cutting & coagulation )

Fulguration (cell walls destroyed through dehydration)

Coagulation / Desiccation( dryness of tissues)

05/27/2025 By Abezash.M 174

 Physiology ofcoagulation of diathermy.

Retraction of blood vessels

Contraction of the muscle

The dryness of tissue cell

Minimum out put of power.

05/27/2025 By Abezash.M 175
 Advantages of diathermy

Relief pain

Prevention of infection

Shortens the duration of surgery

Controls minute bleedings

05/27/2025 By Abezash.M 176

 Disadvantages of diathermy

Delayed wound healing

Channeling (thrombosis formation)

Explosions/sparking

Burn/ignition

Organ perforation

Gas embolism
05/27/2025 By Abezash.M 177
 two ways of delivering
1.Monopolar delivery 2. Bipolar delivery
Monopolar
 The current is passed through a large volume
of tissue.

Large surface area of the body contact.

A very low current density passed through

most of the body.
05/27/2025 By Abezash.M 178
 bipolar delivery
 Involves the current being passed b/n two point
electrodes .A very high current density.

 High heating effect, is produced over a very small

volume of tissue.

 Virtually no heat generated else where in the body. be

used with relatively low currents

 For coagulation of small blood vessels. Its greatest

application is in microsurgery(the hand &
05/27/2025 By Abezash.M
in neurosurgery. 179
 Diathermy burn occurs b/c of:-

Faulty applications of different electrodes

Failure to insulate/protect the pt

Failure to insulate the cable

Inadvertent actions/activity
05/27/2025 By Abezash.M 180
 proper applications
place the diathermy plate near to
operation site
 If the site is below the heart-

 Put on the gluteus muscle portion

 If the site is above the heart-

 Put on the shoulder muscle portion

05/27/2025 By Abezash.M 181

 Wound Closure (suture) Materials

Are used to approximate the edge of incision

(=tissue apposition)

Facilitates wound healing.

Minimizes the size of scar.

Firmly holds the organs in position.

05/27/2025 By Abezash.M 182
 Wound Closure---

Classifications

 A suture – a stitch used in surgery to approximate

living tissue or Structures until the normal process
of healing are completed.

 A ligature- is a suture used to encircle blood vessels

to arrest or control bleeding

05/27/2025 By Abezash.M 183

 Characteristics of Suture Material

 Absorbable Vs. Nonabsorbable

 Monofilament Vs. Multifilament

 Natural Vs Synthetic
05/27/2025 By Abezash.M 184
  Absorbable – sutures or ligatures are two types

 Absorbable natural
Catgut

Collagen

 Living tissue

05/27/2025 By Abezash.M 185

 Absorbable
Absorbable synthetic :-
 polygicolic acid

 PDS/ Polyd-ioxinon suture

 Vicryl

 Dexon

05/27/2025 By Abezash.M 186

 The absorbable- Natural sutures

Are digested and absorbed during process of

healing

The most commonly used in this group is

surgical catgut .

It is made of from sub mucosa layer of 1st, 3 rd

layer of the intestine of the sheep

05/27/2025 By Abezash.M 187

 Natural absorbable sutures----

It has two parts.(plain and chromic catgut)

Plain catgut: absorbable rate 5-7 day.

Chromic catgut: absorbable rate 15-21 days.

05/27/2025 By Abezash.M 188

 Natural sutures----

In order to prolong the time of absorption and

to reduce irritation, the row, catgut can be
hardened or chromicised by immersing strands
in chromic salt solution

The degree of hardness depends up on how long

the cat gut is immersed in chromic salt solution
• e.g.- in peritoneum and serous membrane less
day(2-3) day’s immersion.
05/27/2025 By Abezash.M 189
 Natural sutures----

 The size of catgut:- has two systems

metric system 0.75, 1, 1.5, 2, 2.5 , 3 4, 5, 6

Old system 6/0, 5/0,4/0,3/0, 2/0, 0, 1, 2,

3.
05/27/2025 By Abezash.M 190
 sutures----
 Sterilization of surgical catgut effected by Gamma-
radiation, before it has been packed and sealed.

 The choice of the surgical catgut for ligature of

small blood vessels are 2/0, 3/0 plain cat gut is
sufficient.

 For ligation of large blood vessels 2/0, 3/0 and

pedicles in gynecological requires chromic catgut
3 or 2.

05/27/2025 By Abezash.M 191

 sutures----
 The size of the catgut depends on the
requirements of particular surgeon.

 The suturing of stomach and bowels in adult are

2/0, 3/0 but in children 3/0 chromic catgut is
sufficient .

 Adult peritoneum and muscle are sutured with the

size of 2/0 or o chromic catgut.

 Fascia can be sutured with the size of 1and 2

chromic catgut but, in children 2/0, 3/0 is sufficient
05/27/2025 By Abezash.M 192
 sutures----
 Subcutaneous tissue can be sutured with plain
catgut 2/0, 3/0 are preferable.

 Some surgeons use chromic catgut through out

the operation.

 Plain catgut is not used in peritoneum or fascia

suturing due to its rapid absorption.

 It is widely used in urinary tract operation to

prevent formation of renal calculi.
05/27/2025 By Abezash.M 193
 Absorbable Synthetic- Polymers

 They are either dyed or undyed, are intruded and

braided to form multifilament absorbable suture.

 Are absorbed by a slow hydrolysis process in the

presence of tissue fluid.

 Are – non antigenic, no pyrogenic and produce

only mild tissue reaction during absorption.

05/27/2025 By Abezash.M 194

 Synthetic-----
 Are very tensile strength longer than catgut
e.g. PDS- 60-90 day’s duration for absorption.

 Dexon- maximum absorption, 30 days but

complete absorption 60-90days.

 Coated vicrygl- absorption takes place with in 30

days to complete absorption. The sizes are like cat
gut.

05/27/2025 By Abezash.M 195

 Non- Absorbable, Ligature/ Suture.

natural (silk worm linen cotton)

 Silk warm gut- from animal larval is obtained

from the glands of silk worm and it is draw
out in to monofilament.

It lacks flexibility and difficult to tie

05/27/2025 By Abezash.M 196
 Non- Absorbable-----

It is braided or twisted ,stronger used to

close GI tract, fascia and skin.

Used also in ophthalmic surgery

The sizes are the same with others

05/27/2025 By Abezash.M 197

 synthetic non absorbable

– Polyamides monofilament – single nylon

• Multi filament
– Polyesters ------ Polyethylene

– Polyethylene (prolene) is: –

monofilament
Colored deep blue
Stronger than line
It will be easily crushed at the note- holding
It is suitable for any instance where a non
absorbable suture is required.
05/27/2025 By Abezash.M 198
 The Metallic Wires
• Prepared from:-
Stainless steel used for orthopedic & thoracic
surgery.

Alloys of tantalum

Silver obtained as a single strained suture & /

twisted/braided.
.

05/27/2025 By Abezash.M 199

 Prepared-----

used in closing abdominal incisions in obese or (ca)

client.

For esophageal anastomosis for closure of chest

incision or as mesh in the repair of hernial defect

05/27/2025 By Abezash.M 200

 Metal Clips (Sutures)
 Applied with special instrument:-

 The insertion forceps known as:

 Michel-----applier

 Kifa------ Removal

 Adhesive skin closure.

05/27/2025 By Abezash.M 201
 Surgical Needles:-

 Are needed to safely carrying the suture material

via tissue with the least amount of trauma.

 Are strong enough doesn’t break easily

 Are rigid enough to prevent excess bending

05/27/2025 By Abezash.M 202

 Surgical Needles---
 Sharp enough to penetrate tissue with minimal
resistance.

 Approximately the size with suture

 Free of corrosion to prevent infection and trauma.

05/27/2025 By Abezash.M 203

 Metal Clips-----

All surgical needles have 3 basic

components:-

 The point the body/ shaft of the eyes.

 The point of needles mostly used for cutting

tapered or blunt.
05/27/2025 By Abezash.M 204
 Metal Clips-----
Body of needle- naries in wire length shape
and finish (depend on nature and location of
tissue.)

French eye needle (spring eye/ spring eye.)

Eyeless needle- continuous suture.

05/27/2025 By Abezash.M 205
 Common Suturing Technique

• The primary suture: - that holds wound edges in

approximation during healing by
1st intention continuous
Intermittent

• Continuous technique: - A series of stitches

taken with one strands of material tied only at the
end of suture line. e.g. peritoneum and
subcutaneous tissue .
05/27/2025 By Abezash.M 206
 Common Suturing-----

 Interrupted suture: –Each stitch is taken and tied

separately.

 If an interrupted suture brakes or looses the

remaining suture may still hold the wound
together.

05/27/2025 By Abezash.M 207

 Common Suturing-----

In the presence of infection M/os are less

likely to follow the primary suture line.

Buried suture: - placed under skin.

purse- string suture: - A continuous suture placed

around the lumen and tightened

05/27/2025 By Abezash.M 208

 Common Suturing-----
subcuticular suture:- Type of continuous suture
is placed beneath the epithelial layer of the skin
cosmetic stitch minimal scar left on the skin.

Retention:-suture line with interrupted non

absorbable suture on each side of 1st degree
suture line to relieve tension.

 The suture line passed includes the skin,

subcutaneous tissue, fascia rectus muscle,
peritoneum of the abdominal tissue.
05/27/2025 By Abezash.M 209
 Positioning Surgical Patient.

Basically surgical positioning are three :-

Supine, dorsal or laparotomy.

Lateral.

prone
05/27/2025 By Abezash.M 210
 Guide lines for surgical pt positioning

 Knowledge: both the theoretical and practical

principles of arranging the posture of an unconscious
or an awake patient for operation.

 Planning: encompasses an understanding of the

intended operation, as well as the specific problems
that face the surgeon and the anesthesia provider

05/27/2025 By Abezash.M 211

 Guide lines------

 Teamwork: involves the careful coordination of the

activities of all personnel.

 Housekeeping: includes having the appropriate

positioning devices on hand and ensuring that each
part fits and functions as intended.

05/27/2025 By Abezash.M 212

 Steps of safe pt positioning

Assessing the patient’s needs.

Developing a plan of care .

Assembling the necessary positioning devices

05/27/2025 By Abezash.M 213
 Steps of-----

The actual positioning of the patient.

Re-evaluating body alignment and tissue

integrity intra-operatively.

Evaluating patient outcomes with respect to

positioning-related complications.
05/27/2025 By Abezash.M 214
 Modified positions
Trendlenberg –Places head down along with
the whole body

 Reverse trendlenberg- places head end up & feet

down

Lithotomic

fowler’s

05/27/2025 By Abezash.M 215

 Modified positions----
Sitting upright.

knee-chest

Simi’s position.

05/27/2025 By Abezash.M 216

 Types Of Positions depends On

Age

 sex

types of operative site

 size of pt.

05/27/2025 By Abezash.M 217

 Criteria For Qualifications Of Positioning.

optimum exposure of the operative site

free access of breathing

free access of circulation.

05/27/2025 By Abezash.M 218

 Criteria-------
no, pressure on any nerve
e.g.
 Bracheal plexus.

Ulnar

 Radial

 Facial.

05/27/2025 By Abezash.M 219

 Criteria-------
Accessibility for anesthetic administration

 No, undue post operative discomforts

e.g.
-Strain on muscle.

- Prolonged neck extension stiffness

05/27/2025 By Abezash.M 220

 Positioning-------
• Individual requirements while positioning

Obesity

Size of pt

Arthritis pt

 Cardiac pt
05/27/2025 By Abezash.M 221
 Positioning-------

The obese pt’s hands should be put on arm

boards.

preservation of pt’s dignity

05/27/2025 By Abezash.M 222

 Positioning-------
 operating table different type and attachment,
joints/ breaks for diversification

 Special equipments for stabilizing the pt on

desired position to prevent trauma or abrasions

 Anesthesia screen. To prevent breathing from the

nose of pt contaminating the sterile field

05/27/2025 By Abezash.M 223

 Positioning-------

 Anesthesia screen Placed after positioning and

induction

 Metal clips to hold the towel.

 Wrist or arm strips to fix the pts hands

05/27/2025 By Abezash.M 224

 Positioning-------
Arm board- to rest the pt’s hand

Elbow pads or protectors.

Shoulder bridge/ thyroid elevator

Ring pads for head rest.

05/27/2025 By Abezash.M 225

 Surgical Procedures & their Specific Positions

supine/laparatomy/ dorsal/ recumbent for

operations on:

orthopedic, urologic, ophthalmologic,

otorhinolaryngologic, plastic and thoracic
operations.

 eye, ear, nose, face, chest, abdomen, legs, breast,

arms or hands.
05/27/2025 By Abezash.M 226
 Specific Positions---
 Trendelenburg position for:- head tilt down

Bladder operation

Hydorocelectomy.

Sulphingectoy

Sulphingo- ooprorectomy

Sulphengostomy.

Rectal operation.
05/27/2025 By Abezash.M 227
 Specific Positions----
 Gall bladder and liver position.

 Reverse trendelenberg position : leg tilt down

 for throidectomy eye, ear, nose , throat , dental;
thyroidectomies & laparoscopic cholecystectomy
operations

 Lateral position for- Nephrectomy operation.

05/27/2025 By Abezash.M 228

 Specific Positions----
 Lithotomy position- for external genitalia :-

hemorroidectomy

circumcision /vaginal hystrectomy

scopic examination
05/27/2025 By Abezash.M 229
 Specific Positions----
• prone position- used for cerebral operation
-High cervical
- On back e.g. lipoma,lamenectomy

• fowler’s position- for craniotomy

cranial procedure s cranioectory

Cranioplasty.

• Sitting position- upright: - oto- rhinology.

• Knee chest position- sigmodoscopy,Cord prolapse
05/27/2025 By Abezash.M 230
 Hazards during positioning patient

 Both for pt and personnel are.

 potential electrical shock.

 burns fire

 Explosions/ flammable substances e.g. oxygen.

05/27/2025 By Abezash.M 231
 Positioning------
 mechanical injury.

e.g. fall from the table

. Sliding fall and injury

.Sharp injures

05/27/2025 By Abezash.M 232

 Common Terms in Anesthesia

Amnesia – loss of memory

Analgesia – lessening of insensibility to pain

Anesthesia – loss of feeling or sensation of

pain

Anesthesiologist – a doctor of medicine who

specialization in the field of anesthesia.
05/27/2025 By Abezash.M 233
 Common Terms-----
Anesthetic agent – a drug that produces
local or general loss of sensitivity.

 Anesthetist- a person who has been

trained to administer an anesthetics .

Hypoxia – low blood oxygen, subnormal

oxygen content absence of oxygen.

Anoxia -Absence of oxygen

05/27/2025 By Abezash.M 234
 Common Terms-----
 Apnea -suspension or cessation of breathing.

 Arrhythmia- lack of rhythm designating alteration

or abnormality of normal cardiac rhythm.

 Assisted respiration- the maintenance of

adequate alveolar ventilation by supplementing
the pts respiration by manual or mechanical
means .respiratory rate is controlled by pt, tidal
volume by an anesthesiologist.

05/27/2025 By Abezash.M 235

 Common Terms-----
 Biotransformation- metabolism of anesthetic
drugs. It occurs by one of the four mechanisms.
oxidation, conjugation, hydrolysis, reduction

 Brady cardiac- slowness of heart beat less than 60

beat per minute .

 Depolarization- neutralization of polarity as in

nerve or muscle cells in the conduction of
impulses

05/27/2025 By Abezash.M 236

 Common Terms-----
 Fasciculation – it is uncoordinated skeletal muscle
contraction in which groups of muscle fibers
innervated by the same neuron contract together.

 Hemodynamic- the study of how the physical

properties of the blood and its circulation

 Hypomania- less amount of CO2 in the blood

 Hypercapina – excessive amount of carbon dioxide in

the blood
05/27/2025 By Abezash.M 237
 Common Terms-----
hyperkalemia – above normal elevation of
potassium in the blood

Hypnosis – a state of altered consciousness or

sleep.

Hypnotic – a drug or verbal suggestion that

induces sleep.

Hypovolemia – Low or decreased blood volume.

05/27/2025 By Abezash.M 238
 Common Terms-----
 Induction- the period from the beginning of
administration of anesthetics until the pt loses
consciousness.

 Pa o2- partial pressure of arterial O2 tension.

 Perfusion – introduction of fluids in to tissues by

their injection in to blood vessels/passage of a
fluid through spaces.

05/27/2025 By Abezash.M 239

 Common Terms-----
Ph. Expression for H2 ion concentration
(acidity of blood)

Alkalemia :blood alkaline value above 7.42

Acidemia – blood acid value below 7.34

Normal –Ph value 7.3

05/27/2025 By Abezash.M 240
 Common Terms-----
 Polarity. The state of having poles or regions
intensity with mutually opposite qualities.

 Regional anesthesia- In sensitivity of part of the

body to pain .

• Ventilation. The constant supply of O2 through

the lungs.

05/27/2025 By Abezash.M 241

 Common Terms-----
Respiratory acidosis. The reduction of CO2
excretion through lungs caused by respiratory
depression or obstruction or pulmonary disease

Pain- is a perceptual phenomenon, a disturbed

sensation causing suffering to pt .

05/27/2025 By Abezash.M 242

 Pre-Operative Premeditation
 Types of medication given to the client prior to
operation in order to alleviate anxiety for
operation.
 Purposes.

To allay pre- operative anxiety

To produce some amnesia

To have dull awareness of the OR environment

05/27/2025 By Abezash.M 243

 Purposes--------.

Have secretion in the respiratory tract.

It counteract undesirable side effects of

anesthetic

It raises pain threshold.

Prolog the effect of anesthetics and are

respiratory depressant effect

05/27/2025 By Abezash.M 244

 Choice of Drugs for pre-medicaion
Made by anesthetic sinologist/ anesthetist.

Based on pt’s physical and emotional status

including age and weight.

The surgeons’ requirements for minimal or

maximal relaxation.

The anesthetist anesthetic sinologist own skills

and personal experience.

05/27/2025 By Abezash.M 245

 Right time Given

Time is calculated then maximum effect is reached

before induction.

It is usually given 45-60 minutes prior to induction.

Adequate action is desired for induction and

maintenance.

05/27/2025 By Abezash.M 246

 Drugs Used Classified
As sedatives.

As tranquilizers

As narcotics

As anticholinegics

05/27/2025 By Abezash.M 247

 Drugs Used-----
for hypnotic and sedative effect.

.Barbiturates:.
e.g.
Seco - barbital

 Pentobarbital

 Phenobarbital

05/27/2025 By Abezash.M 248

 Tranquilizer actions

 allays anxiety

 relieves tension

 calming effect

1.Diazepam e.g.
 Valium

 Benzodiazepine

 Droperidol

 Haloperidol (haldol)

05/27/2025 By Abezash.M 249

 Drugs Used-----

 Narcotics e.g. morphine sulphate – commonly used

 Meperidin deemed (Deemed - synthetic narcotic)

 Anti cholinergic drugs- e.g.

 Atropine

 Scopolamine
05/27/2025 By Abezash.M 250
 Special Consideration in Premeditation

Hypnosis- is valuable as a premedicant in children.

Clients metabolic rate varies with age, body fluid

and general condition

Heavy smokers, alcoholics, hyperthyroid, toxic,

emotional, high fever pts, require more medication.

Person with drug addiction (abuse of barbiturates,

narcotics, cocaine or amphetamine.)

05/27/2025 By Abezash.M 251

 Choice of Anesthesia:-

made by anesthetist/ anesthesiologist or

surgeon .

The primary consideration with any anesthetic

is that it should be associated with low
morbidity and mortality.

Anesthetic drugs are not specific but depress

activities of all cells
05/27/2025 By Abezash.M 252
 Special requirements to client

provide maximum safety for the patient

provide optimum operating condition

Provide pt comfort.

Have a low index of toxicity.

05/27/2025 By Abezash.M 253

 Special requirements----
 Provide potent predicable analgesia extending to
post- operative period.

 Produce adequate muscle relaxation.

 Provide ammenesia.

 Have rapid and easy reversibility.

 Provide minimum side effect.

05/27/2025 By Abezash.M 254
 Important Factors during Anesthesia.

Age of patient

Physical and mental status of pt.

Presence of complicating systemic disease.

Previous anesthesia experience.

• Position required for operation.

05/27/2025 By Abezash.M 255
 Important Factors---

Type and expected length of procedure.

Local and systemic toxicity of the agent.

Expertise of the anesthesiologist / anesthetist.

presence of infection at the site of operation

Preference of the pt.

05/27/2025 By Abezash.M 256
 Types of Anesthesia

General anesthesia

regional anesthesia

Local

05/27/2025 By Abezash.M 257

 General Anesthesia

Anesthesia is produced as central nervous system

is affected .

Association path way are blocked in cerebral

cortex to produce more or less complete lack of
sensory perception and motor discharge.

Most anesthetic agents are potentially lethal

substance.

The anesthetist/ anesthesiologist must constantly

observe the body reflex responses to stimuli.
05/27/2025 By Abezash.M 258
 General Anesthesia----

Respiratory and circulatory depression

observed during operation.

Continuous watching and appraisal of all

clinical signs must be monitored.

The levels of anesthesia judged the light

moderate and deep and provide the pt with
optimum care.

05/27/2025 By Abezash.M 259

 Three traditional administration method

Inhalation.

intravenous injection

rectal installation

05/27/2025 By Abezash.M 260

 Characteristics of the ideal general anesthetic.

Produces analgesia.

 Produces complete loss of consciousness.

 Provides a degree of muscle relaxation.

 Obtunds reflexes.

 Is safe and has minimal side effects.

05/27/2025 By Abezash.M 261
 Require of general anesthesia.

Major head and neck surgery.

Intracranial surgery. require

 Thoracic surgery.

 Upper abdominal surgery.

 Upper and lower extremity surgery.

05/27/2025 By Abezash.M 262
 Induction of General anesthesia

 Induction and emergency from general

anesthesia are two crucial periods requiring

maximum attention from operating team.

05/27/2025 By Abezash.M 263

 Key Points during induction

The circulating nurse should remain at the pt’s side.

Should be quite, excitement, cough, vomiting,

laryngospasm should be avoided.

Absolute avoidance of stimulation of the pt is

mandatory.

05/27/2025 By Abezash.M 264

 Precautions during induction
Continuous electrocardiography.

Use of chest stethoscope.

Ready availability of resuscitative

equipment including defibrillator.

Induction is individualized

05/27/2025 By Abezash.M 265

 Inhalational anesthesia

 The most controllable method in the up take.

 The most controllable method of eliminating

anesthetic agents

 Are mainly accomplished by pulmonary

ventilation

 The blood and lungs functioning as the transport

system.
05/27/2025 By Abezash.M 266
 Inhalational take Up has two phases:-

Transfer of anesthetics from alveoli to

blood

Transfer of anesthetics from blood to

tissue.

05/27/2025 By Abezash.M 267

 Technique of Inhalational Anesthesia

 Musk inhalation- in closed system of anesthesia

machine.

 Endotracheal administration: - inhaled in to

trachea through nasal or oral tube insertion.

Intubations- insertion of tub directly in to trachea.

 Extubation- removal of tube from trachea.

05/27/2025 By Abezash.M 268
 Complications of Intubations

Trauma to teeth.

Trauma to pharynx

Trauma to vocal cord.

Trauma to trachea.

Esophageal or endobroncheal intubations

05/27/2025 By Abezash.M 269
 Inhalational Anesthetize Agent

I.Nitrous oxide (N2o)

Commonly used.

Inorganic gas of slight potency.

Has pleasant sweet fruit like odder.

Supports combustion w/n combined with

oxygen.

05/27/2025 By Abezash.M 270

 II.Nitrous oxide (N2o)---

Administration – inhalation.

Advantage – comfortable, rapid induction and

recovery non toxic, none irritating.

Few hrs effect except headache

No vertigo and drowsiness

05/27/2025 By Abezash.M 271

 Nitrous oxide (N2o)---

Excellent analgesia for minor operation

Disadvantage:- poor relaxation

Excitement

 Laryhgospasm.

Hypoxia
05/27/2025 By Abezash.M 272
 III.Cyclopropane-----

Very potent gas very seldom used.

Highly explosive

Administration- inhalation

05/27/2025 By Abezash.M 273

 Cyclopropane-----
• Advantage: –

pleasant

Rapid induction

05/27/2025 By Abezash.M 274

 Cyclopropane-----

Moderate relaxation

Supports circulation.

• Disadvantage: - flammable, explosive

05/27/2025 By Abezash.M 275

 IV.Halothane (fluthane)

Administration--- inhalational.

Volatile liquids.

Very widely used .

Has a pleasant odor.

05/27/2025 By Abezash.M 276

 Halothane----
 Advantage: –

non flammable

Potent

Chemically stable
05/27/2025 By Abezash.M 277
 Halothane Advantage: –---

Rapid induction.

None irritating for respiratory tract.

Does not stimulate respiratory secretion.

Useful for pts with bronchial asthma

05/27/2025 By Abezash.M 278

 Disadvantage: –---

Potentially toxic to liver

Respiratory depressant.

CVS depressant:-
 Hypotension

 Brady cardiac

 Cardiac arrest
05/27/2025 By Abezash.M 279
 V. Thiopental sodium (pentothal sodium)

 Intravenous Administration

 Most commonly used barbiturate

 Short acting in small does

 Used for induction.

05/27/2025 By Abezash.M 280

 Thiopental sodium---
• Advantage-

Pleasant rapid induction (30- 60 seconds)

Nonflammable, nausea, vomiting are rare

Non irritant.

05/27/2025 By Abezash.M 281

 Thiopental sodium---

Disadvantage:

 Large doses cause:

Rapid, prolonged respiratory depression

 Circulatory depression

Coughing, laryngeal-spasm.
05/27/2025 By Abezash.M 282
 Note: - morphine sulfate and nitrous oxide
have a synergistic action with thiopental
sodium. (Each potentates the action of
other).

05/27/2025 By Abezash.M 283

 Ketamine hydrochloride

IV administration or IM to yield profound

anesthesia.

Produces rapid induction 30 sec. IV, 2-4 minutes

05/27/2025 By Abezash.M 284

 Ketamine hydrochloride----
 Advantage –

For short procedure in childres (2-10yrs)

For plastic and eye procedures.

05/27/2025 By Abezash.M 285

 Ketamine----
 Disadvantage: –

Emergence reaction with psychological

manifestations in recovery.

Delirium

Hallucination

Increases B/P
05/27/2025 By Abezash.M 286
 Stages of General
Anesthesia

 Consists of four stages.

 Each stages presents definite group of

s/s

05/27/2025 By Abezash.M 287

 Stages of---
 Stage 1: Beginning Anesthesia.

 As pt breathes in the anesthetic mixture,

warmth, dizziness and feeling of
detachment experienced .

 Pt may have ringing, roaring , buzzing in

ears .

 Pt conscious but unable to move

extremities.
05/27/2025 By Abezash.M 288
 Stages of---
 Stage 2:- Excitement
 Characterized variously by struggling shouting
talking singing laughing, crying.

 W/n anesthesia smoothly and quickly administered

it will be avoided.

 Pupils are dilated, but contract w/n exposed to

light.

 Pulse rate rapid respiration irregular.

 Anesthetist is attended by some one to help

restrain the pt with strap and secure arm board.
05/27/2025 By Abezash.M 289
 Stage 3:- Surgical Anesthesia

 This stages is reached w/n continuous

anesthesia is given as vapor or gas.

 The pt is unconscious, lying quietly, on

table.

 The pupils are small and contract.

05/27/2025 By Abezash.M 290

 Stage 3-----

 Respiration is regular.

 Pulse rate and volume are normal .

 Skin pink, slightly flushed.

 With proper administration the

stage maintained .
05/27/2025 By Abezash.M 291
 Stage 4:- over Dosage

 This stage is reached w/n too much

anesthesia is administered.

 Respiration is shallow.

 Pulse weak and three-day pupil

widely dilated no contraction.

 Cyanosis developed.
05/27/2025 By Abezash.M 292
 Stage 4-----

 Unless prompt action death follows

rapidly.

 Anesthetics showed be
discontinuoued.


 Circulatory and respiratory support

05/27/2025 By Abezash.M 293

 Nurses Role in Anesthetized
Patient
 positioning the patient’s

 Evaluating patient’s ability to detoxify

anesthetic agents and tolerate stress.

 Patient’s respiratory and circulatory care.

 Measuring the pt’s urinary out put.

 Constantly aware of potential trauma to

the patient.
05/27/2025 By Abezash.M 294
 Local Anesthesia

 The local anesthesia depresses

superficial nerves.

 Blocks the conduction of pain.

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 Local Anesthesia

Advantages:-
Infiltrated of anesthetic agents are non
explosive.

 It needs minimal simple equipment.

 Loss of consciousness does not occur.

 It does not need fasting .

Surgeon can do operation with out

anesthesiologist.
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 Local Anesthesia----
 Contra Indication.

Allergic sensitivity.

local infection.

septicemia .

Highly nervous, apprehensiveness.

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 Regional anesthesia

 Nerve block – anesthetizing of a

selected nerve at a given point.

 Field block – blocking off of operative

site with wall of anesthetic solution by
series of injection
e.g. Abdominal wall block for
herinorrhaphy
 Brachial nerve block for hand surgery
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 Spinal Anesthesia
Intrathecal block. Is usually refereed to as spinal
anesthesia.
Currently there are only three medications
approved by the US Food and Drug Administration
(FDA) for use via the intrathecal route, ie,
morphine, ziconotide, and baclofen
The agent is injected in to the subarachnoid space
using the lumber inters pace.

Desensitizing of the spinal ganglia and motor

roots.

The absorption in the nerve fiber is rapid.

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 Spinal------
 Depends On Various Factors:-

 Positioning during and immediately after

injection.

 CSF pressure.

 Site and rate of injection.

 Volume, dosage and specific gravity

(baricity) of solution
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 Spinal------

 Procedure.
 Lateral position- the most
common.

 Sitting position.

 Prone position.

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 Spinal------

 Necessary Equipment:-

 drape /fenestrated towel.

 ampoule file.

 Ampoule of local anesthesia.

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 Necessary Equipment:---

 tray (medication glass)

 sponges

 Needles 25 gauge hypodermic for

infiltration.

 22-26 gauge needle for interthecal

with stylet
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 tray (medication glass)

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 Needles 25 gauge

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 21-gauge needles are most commonly used for
drawing blood for testing purposes,
 and 16- or 17-gauge needles are most
commonly used for blood donation
 25gauge needles For Im

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 Indication-----

 Lower abdominal or pelvic

procedure.

 Intestinal obstruction.

 Inguinal/ lower extremities.

 C/S

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 Epidural Anesthesia (REGIONAL ANAESTHESIA

 Lumbar approach – epidural block.

 Caudal approach – epidural sacral

block

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 Epidural-----
Indication :-

 Anorectic
 - obstetrics

 Vaginal
 intractable pain

 Perineal
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 Local and anesthetic Agents
 cocaine – the 1st local anesthetics
introduced Toxic most .

 procaine hydrochloride (Novocain)less

toxic)

 Lido-caine hydrochloride /xylo-caine)

 Toxic more.

 Potent.

 Rapid onset.
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 Tetracaine hydrochloride(pontocaine)

very potent agent

slow onset of anesthesia

duration of effect is long

toxic

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 bupivacine hydrochloride (marcaine)

more potent

long acting

High toxicity.

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 Neuromuscular Blocking Agent

• Non depolarizing agents

1.Tubo curanine chloride (curare)

 Derived from a poison from certain south

American plants.

 1st used centuries ago by the Indians.

 Their poison arrows caused death by

suffocation from respiratory paralysis.
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 Tubo-----
The action is predominately a paralysis
at voluntary muscle by blocking of the
trans mission of nerve impulses to muscle
fibers.

The muscle relaxation is potentate by

curtained anesthetizes (halothane,
effleurage, diethyl ether, matchbox
flurane and by some antibiotics.)

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 Neuromuscular----
 Pancuronium bromide- a long acting systemic
muscle relaxant similar in action to curare but &
more potent.

 Gallamine triethiodide (flaxedil)

 Similar to curare in mechanism and duration of
action.

 It advantages over curare is an absence of

hypotension and bronchus spasm.

 It may cause tachycardia and of in arterial pressure

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 Complication Of Spinal
Anesthesia

 Transient or permanent
neurological sequale from trauma
irritation by the agent.
 Lack of asepsis, loss of spinal fluid.

 Decreased intracranial pressure

syndrome.

e.g. spinal head ache

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 Complication-------

 Auditory and ocular disturbances such as

tinnitus diplopic, arachnoiditis, meningitis.

 Caudal equine syndrome (failure to regain

use of legs or control of urinary or bowel
function.

 Temporary parenthesis such as number

and tingling .
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 Spinal Anesthesia
Advantage:-
 Pt is conscious.

 throat reflexes are maintained

 None irritating to respiratory tract.

 No difficulty with airway problems.

 Quiet breathing.

 Contracted bowel.

 Decreased bleeding
05/27/2025 By Abezash.M 318
 Spinal Anesthesia---
• Disadvantage:-
 Circulatory depressant

 Hypotension.

 Nausea and emesis .

 Danger of trauma, infection

 Pt can hear.

 Distress.
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 Post Anesthesia Care Unit
(PACU)
Nurse’s major considerations:
 Transfer of pt from the operation room to
Pacu.

 Referred to as the post anesthesia recovery

room/ PACU

 Special consideration of the pt’s incision site

vascular changes and exposure.

 Wounds are closed under considerable tension

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 Major Considerations----

 While positioning or transferring the pt not lying

on and obstructing drains or drainage tubes.

 Serious arterial hypotension way occur when the

pt is moved from one position to another such
as :

 From lithotomy position to horizontal.

 From lateral to supine.

 From prone to supine.

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 Transferring the post- operative pt is
the responsibility of anesthesiologist
with members of other surgical team.

05/27/2025 By Abezash.M 322

 Sites of PACU
 usually located adjacent to the operating
room.

 Because of nurses and surgeons to care for

the post operative pt in theatre

 Because of availability of monitoring and

special equipments, emergency
medications, and replacement of fluids in
theatre
05/27/2025 By Abezash.M 323
 PACU----
 PACU painted quiet in soft, pleasing
colors and have :-

 Indirect lighting

 sound proof ceiling

 equipments that controls or

eliminates noise
05/27/2025 By Abezash.M 324
 PACU have ----

 Isolated quarters/ gas encased /for disruptive pts

to decrease anxiety

 Room temperatures should be 20’c to 22. 2 0C

 Room should be well ventilated

 Pt should stay in PACU until adequate respiratory

function, a minimum of 95% of 02 saturation.

 Pt should gain reasonable degree of

consciousness
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 Immediate Post- Operative Assessment

 The PACU nurse should review.

 Medical diagnoses and types of surgery

performed

 Pts age and general condition, airway

potency, vital-signs.

 Anesthetic and other medications used

muscle relaxants, antibiotic, IV
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 Immediate P.O Assessment-----

 Vital signs- presence of artificial

airway, o2 sat,BP,pulse, temperature.

 LOC- ability to follow command,

pupillary response.

 Urinary output
05/27/2025 By Abezash.M 327
 Immediate P.O Assessment----

 Skin integrity.

 Pain.

 Condition of surgical wound.

 Presence of IV lines.

 Position of patient.

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 Immediate Post- Op----
 Any problem that occurred in operating
room that might influence post care. e.g.
extensive hemorrhage, shock, cardiac
arrest.

 Pathology encountered (if Malignant

suspected )

 Types of fluid administered; blood loss

and replacement, ph of the blood.
05/27/2025 By Abezash.M 329
 Immediate Post- Op----

Any tubing, draining catheters, or

supportive aids.

Specific information’s for which surgeon or

anesthetist wishes to be notified

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 Areas of Assessment

 Respiration point score

 Ability to breathe deeply and cough---------2

 Limited respiratory effort (dyspnea )---------1

 No, spontaneous effort -----------------------0

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 Areas of Assessment
 Circulation: SAP point
score

 > 80% of pre anesthetic level-------------2

 50% of pre anesthetic level --------------1

 < 50% of pre anesthetic level ----------0

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 Assessment---
 Color:- point
score
 Normal skin color and appearance--------- 2

 Altered skin color: place---------------------- 1

 Cyanosis--------------------------------------- 0
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 Assessment-----
Muscle activity point score

Ability to move all extremities ----------2

Ability to move two extremities ---------1

Unable to control any extremity---------0

Total: required for discharge form recovery room:

7-8:- points
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 Post Operative Complication

Airway obstruction

 cardiac arrest

Hypoventilation.

Atelectasis / pulmonary collapse.

Pulmonary embolism.
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 Post Operative-----
Pulmonary edema.

Venous stasis .

Hypertension/ hypotension.

Shock.
05/27/2025 By Abezash.M 336
 Post Operative-----

Hemorrhage.

Post- op wound infection.

Urinary retention/ fullbladdder.

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 Gerontologic considerations
Mental status- attributed to medications, pain,
anxiety, depression.

Delirium- infection, malignancy, trauma, MI,

CHF, opioid use.

Dementia-sundowning=sleep disturbances,
lack of structure in the afternoon or early
morning, sleep apnea.
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 Nursing Intervention

V/s are monitored every 15 minutes

Potency of airway and respiratory function.

Cardiovascular function.

Clearing secretion from airway

05/27/2025 By Abezash.M 339

 Intervention ----

Proper positioning of pt.

IV solution drip rate setting.

Level of responsiveness

Pain mgt.

05/27/2025 By Abezash.M 340

 Intervention ----
 Quite environment

 Drainage management

 Body temperature

-Above 37.7c0

- Below 36.1c0

- Bp Sbp < 90 mmHg

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 Summary

1. A 34-year-old man was scheduled to undergo

open repair of multiple fractures in one hand.
The anesthetic management was brachial
plexus anesthesia with bupivacaine. During the
injection of the anesthetic the patient suddenly
exhibited nystagmus, slurred speech, tremors,
muscle twitching, followed by tonic-clonic
convulsions. Which of the following statements
best explain the neurophysiologic mechanism of
the excitatory state Induced by the drug in this
patient?
05/27/2025 By Abezash.M 342
A. The drug caused cardiotoxic effects which in
turn triggered the CNS excitation
B. The drug mediated an allergic reaction in a
sensitized patient
C. The drug inhibited glutamate reuptake into
glutamatergic neurons
D. The drug activated the mesolimbic pathway
in the CNS

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2.You are the recovery room nurse who
is admitting a patient from the OR.
What is the first assessment you would
make on a newly admitted patient?
A. Heart rate
• B. Nail perfusion
• C .Core temperature
• D. Patency of the airway

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3.You are discharging your patient home from
day surgery after a general anesthetic. What
instruction would you give the patient prior to
the patient leaving the hospital?
A The patient is not to drive a vehicle
B. The patient should have a glass of brandy
the first night home to help him or her sleep
C. Eat a large meal at home
D. Do not sign important papers for the first 12
hours after surgery
05/27/2025 By Abezash.M 345
 References

1. Kleinman, W. & Mikhail, M. (2006). Spinal, epidural,

& caudal blocks. In G.E. Morgan et al Clinical
Anesthesiology, 4th edition. New York: Lange
Medical Books.
2. Morgan, G.E., Mikhail, M.S., Murray, M.J. (2006).
Peripheral nerve blocks. In G.E. Morgan et al
Clinical Anesthesiology, 4th edition. New York:
Lange Medical Books.
3. Warren, D.T. & Liu, S.S. (2008). Neuraxial
anesthesia. In D.E. Longnecker et al (eds)
Anesthesiology. New York: McGraw-Hill Medical.

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