Professional Documents
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Dearest Lord, true source of light and wisdom, give us a keen sense of understanding, a
retentive memory, and the capacity to grasp things correctly. Grant us the grace to be
accurate in our expositions, and the skills to express ourselves with thoroughness and
clarity. Be with us at the start of our study, guide its progress and bring it to completion,
grant this through Jesus Christ, our Lord. Amen
Perioperative Nursing
• Pre-operative Phase
• Intra-operative Phase
• Post-operative Phase
Preoperative Phase
• Physical Needs
• Laboratory works
• CP Clearance
• Diagnostics Procedures
• Psychosocial Needs
• Health Teachings
• Informed Consent
• Spiritual Preparation
Preoperative Teachings
• Process Information
• Procedural Information
• Dietary Restrictions
• Preoperative Shave
• Family Orientation
• Postoperative expectations
• Rehabilitation
• Follow up
Preoperative Medications
• Anticholinergics - Atropine SO4
• Analgesics - Nalbuphine
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• Sedatives - Diazepam, Dormicum
• Antibiotics
• Non-restricted Area
• Semi-restricted Area
• Restricted Area
Intra-operative Phase
Categories of surgery
• Emergency - Done immediately to save life or limb, Takes precedence over any other surgery
scheduled
• Elective - Done at the patient’s and surgeon’s convenience , May be performed within days and
even months after diagnosis
Musts for an OR Nurse
• Must be patient
• Surgeon
• Assistant Surgeon
• Anesthesiologist
• Scrub Nurse
• Circulating Nurse
• Pathologist
• Others
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Prefixes • Pan - All
• A -Without, absence • Peri - Around
• Ecto - External, outside • Poly - Many
• Infra - Below • Pseudo - False
• Inter - Between • Retro - Behind, Posterior
• Intra - Within • Supra - Above
Suffixes
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• Gastro - Stomach • Osteo - bone
• Skin
• Respiratory tract
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• Articles used in the procedure
• Circulating Air
Principles on Asepsis
• Traffic • Gloves
• Labels • Indicators
Anesthesia
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Factors That Determine the Choice of Anesthesia
• Patients preference
Stages of Anesthesia
Stage 1 (Induction/stage of analgesia)
• Lasts from the time the patient loses consciousness until he loses certain reflexes such as
swallowing,gag and eyelid.
• Maintain silence
Stage 3 (Surgical anesthesia)
• From the period the patient lost certain reflexes and respiratory paralysis occurs
• Patient with regular respiration, constricted pupils, jaws relax and auditory sensation is
lost
Stage 4 (Stage of Danger)
• Reached when too much anesthesia has been given and the patient has not been observed
carefully.
• Death may result from respiratory and or cardiac arrest unless resuscitated properly
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Types of Anesthesia
General Anesthesia
• Association pathways are broken in the cerebral cortex to produce more or less lack of
sensory and motor perception
• Depresses superficial nerves and interferes with the conduction of pain impulses from
certain area or region
• Pain is controlled without loss of consciousness; one region or an area of the body is
anesthetized
General Anesthesia
Inhalation - with the use of volatile gases and vapors, Either per mask or Endotracheal tube
Common Anesthetics
Regional Anesthesia
Epidural Anesthesia
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Common Anesthetics:
• Lidocaine
Local Infiltration - Agent is injected into the tissues around incision site
Anesthetics: Lidocaine, sensorcaine isobaric
Topical - Agent applied directly into a mucosa or surface Ex: Lidocaine spray
Other Medications Used for Anesthesia
Premedications Used: Midazolam(Dormicum) , Diazepam (valium)
Opiod Narcotic: Fentanyl (sublimaze)
Muscle Relaxants
• Atracurium (tracrium)
Anticholinergics - acetylcholinesterase Inhibitor
Dantrolene
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Incisions, Position and Prepping
Positioning - Choice of Position is made by the surgeon and positioning is done by the members
of the surgical team
Factors to Consider:
• Patient safety
Equipments for Positioning
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• OR Table • Trochanter rolls
• Doughnut
Common Positions
• Dorsal/supine
• Lithotomy
• Trendelenburg/reverse Trendelenburg
• Prone
• Sims, Knee-chest
• Kidney Position
• Chest Position
• Integumentary damage
• Determine the area and the extent to be prepared including proposed incision.
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• Examine area to be prepared
• In shaving follow the direction of the hair growth while the other hand exerts an opposite
force
• If a wound is present start from the clean area first before the dirty area
Basic Surgical Instruments Equipments and Supplies
Instrument Classification
• Clamping/Hemostats
• Grasping/Holding
• Retracting Instruments
• Cutting/Dissecting
• Suturing Instruments
Parts of an Instrument
Gas Tanks/ Gas Cylinders
• Cautery machine
• Suction machine
• Radiologic Devices
• Endoscopic devices
• Laparoscopic Instruments
• Closing
Criteria for a good suture
• Versatility
• Ease of handling
• Minimal tissue reaction and inability to create a favorable environment for infection and
tissue rejection
• Made of non electrolyte, non capillary, non allergenic and non carcinogenic materials
• Point
• Body or Shaft
• Eye
Points
• Taper Point
• Blunt Point
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• Cutting Point
o Tapercut
o Conventional cutting
o Reverse cutting
• Surgical Strips
• Skin Clips
• Skin Staples
Surgical Scrubbing, Gowning and Gloving
• Ligation
Preparations Clips before scrub
immediately
1. Make•sure
Surgical Staples
you have checked your room and table including gowns and gloves to be used.
• toTissue
2. Attend adhesives
your personal needs i.e. Hunger, voiding, defecating etc.
• hands
3. Inspect Hemostatic
for cutsAgents
and abrasions. Skin integrity of hands and arms
• all
4. Remove Bone waxjewelry. Jewelry harbors microorganisms.
finger
• all
5. Be sure hair is covered
Absorbable by cap
gelatine or bonnet.
sponge
6. Adjust• mask snuglysponge
Collagen and comfortably over nose and mouth.
7. Fold sleeves of the cellulose
• Oxidized scrub suit if too long.
8. Clean eyeglasses if worn. Adjust eyewear or face shield comfortably in relation to mask. Secure if
necessary.
Principles of Asepsis Related to Surgical Gowning and Gloving
• Gowns are considered sterile only from the waist to shoulder level, in front and in the sleeves.
• Sterile persons keep hands in sight and at or above waist level only
Legal and Ethical Dimensions in the Practice of OR Nursing
Common Issues
• Consent
• Counting
• Specimen Handling
o Labeling
o RFS
o Medico-legal
• Medication errors
• Negligence
Postoperative Care
General Postoperative responsibilities
• Pain Management