OR Skills &

Techniques
Raymund Christopher R.
dela Pea, RM, RN

DEFINITION OF TERMS

SURGERY -It is the branch of

medicine concerned with diseases
and conditions which require or are
amenable to operative procedures.
Surgery is the work done by a
surgeon.
-"Surgery can involve
cutting, abrading, suturing, laser or
otherwise physically changing body
tissues and organs."

SURGEON - A physician who treats

disease, injury, or deformity by
operative or manual methods. A
medical doctor specialized in the
removal of organs, masses and
tumors and in doing other procedures
using a knife (scalpel)
STERILE - free from living germs or
microorganisms; aseptic: sterile
surgical instruments.

ASEPSIS - The state of being free of

pathogenic microorganisms.
- The process of removing
pathogenic microorganisms or
protecting against infection by such
organisms.
SEPSIS - a toxic condition resulting
from the spread of bacteria or their
toxic products from a focus of
infection; especially :septicemia

SEPSIS - is a severe illness caused by

overwhelming infection of the
bloodstream by toxin-producing bacteria.
- is caused by bacterial infection
that can originate anywhere in the body.
DISINFECTANT - any chemical agent used
chiefly on inanimate objects to destroy or
inhibit the growth of harmful organisms.

ANTISEPTICS - is a substance that

prevents or arrests the growth or action
of microorganisms either by inhibiting
their activity or by destroying them. The
term is used especially for preparations
applied topically to living tissue
STERILIZATION
-the destruction of all living
microorganisms, as pathogenic bacteria,
vegetative forms, and spores.

BACTERIOSTATIC -Capable of inhibiting the

growth or reproduction of bacteria.
- An agent, such as a chemical or biological
material, that inhibits bacterial growth.
BACTERICIDAL - Capable of killing bacteria.
BACTERIOCIDES - is a substance that kills
bacteria .Bactericides are either
disinfectants, antiseptics or antibiotics.

PREFIXES & SUFFIXES

Prefixes & Suffixes can explain the type
of procedure the client will undergo:
PREFIXES

Supra above ; beyond

Ortho joint

Chole bile or gall

Cysto bladder

Encephalo- brain

Entero intestine
Hystero uterus
Mast breast
Meningo membrane; meninges
Myo muscle
Nephro kidney
Neuro nerve
Oophor - ovary

Pneumo lungs
Pyelo kidney pelvis
Salphingo fallopian tube
Thoraco chest
Viscero organ esp. abdomen

SUFFIXES

Oma tumor ; swelling

Ectomy removal of an organ or gland

Rhapy suturing or stitching of a part

or
an organ

Scopy looking into

Ostomy making an opening or a stoma

Otomy cutting into

Plasty to repair or restore

Cele tumor ; hernia ; swelling
Itis inflammation of

PERIOPERATIVE
NURSING
SURGERY

a branch of
Medicine that encompasses
preoperative care,
intraoperative judgement &
management, & postoperative
care of patients.
OPERATION an invasive
modality of treatment.

PERIOPERATIVE
NURSING
DEFINITION:
a.k.a : OPERATING ROOM NURSING
The identification of physiological &
sociological needs of the client, & the
implementation of an individualized
program of nursing care in order to
restore or maintain the health &
welfare of the patient before, during
& after surgical intervention.

PERIOPERATIVE
NURSING

PHILOSOPHY :

To

give service that aims to

provide comprehensive
support physically, morally,
psychologically, spiritually,
& socially to a patient
undergoing surgery.

PERIOPERATIVE
NURSING

GOALS :

1. To

provide safe, supportive &

comprehensive care.
2. To assist the surgeon by
functioning effectively as a
member of the surgical team.
3. To create & maintain an aseptic
/ sterile environment.

PERIOPERATIVE
NURSING

Fundamental purposes of the O.R. :

It is a place. . .
1. To correlate theory & practice.
2. To develop skills in assisting the
surgeon in the operation.
3. To create a suitable sterile field for
surgical procedures to prevent
complications.

Period of time that constitutes the surgical

experience. Includes three phases:
Preoperative phase: the period of time from the
decision for surgery until the patient is transferred
into the operating room.
Intraoperative phase: the period of time from when
the patient is transferred to the operating room to
the admission to postanesthesia care unit (PACU).
Postoperative phase: the period of time that begins
with admission to the PACU and ends with follow-up
evaluation in the clinical setting or at home

CLASSIFICATIONS
OF
SURGERY
According to Urgency :
1) EMERGENT

pt. requires immediate

attention ; disorder maybe lifethreatening.
> indications for surgery : without
delay.
> examples : Severe bleeding,
extensive burns, bladder or intestinal
obstruction, fractured skull, gunshot
or stab wounds.

CLASSIFICATIONS
OF SURGERY
2)

URGENT pt. requires prompt

attention.
> indications for surgery :
within 24-30 hours.
> examples : Acute gallbladder
infection
Kidney / Ureteral
stones

CLASSIFICATIONS
OF SURGERY
3)

REQUIRED pt. needs to have

surgery.
> indications for surgery: plan
within few weeks or months.
> examples : Prostatic
hyperplasia without bladder
obstruction, Thyroid disorders,
Cataracts.

CLASSIFICATIONS
OF SURGERY
4)

ELECTIVE pt should have

surgery.
> indications for surgery:
Failure to have surgery not
catastrophic.
> examples : Repair of scars
Simple hernia
Vaginal repair

CLASSIFICATIONS
OF SURGERY
5)

OPTIONAL decision rests with

pt.
> indications for surgery :
Personal preference
> examples : Cosmetic surgery

CLASSIFICATIONS
OF SURGERY
Accdg. To Degree Of Risk :
MAJOR high degree of risk :
>maybe complicated / prolonged,
large losses of blood may occur, vital
organs maybe involved, post-op
complications may be likely.
>ex. Organ transplant
Open heart surgery
Removal of a kidney

CLASSIFICATIONS
OF SURGERY
MINOR

little risk with few

complications.
- often performed in a
day surgery.
> examples: Breast biopsy
Tonsillectomy
Knee surgery

CLASSIFICATIONS
OF SURGERY
Accdg. To Purpose :
1. DIAGNOSTIC verifies suspected
diagnosis
- ex. Biopsy
2. EXPLORATORY estimates the extent of
the disease or injury.
- Ex. Explore laparotomy
3. CURATIVE removes or repairs damaged
tissues .

CLASSIFICATIONS
OF SURGERY

4.

5.

6.

ABLATIVE removing diseased organ

that cant wait anymore.
- emergency surgery.
PALLIATIVE relieves symptoms but
does not cure the underlying disease
process.
RECONSTRUCTIVE partial or complete
restoration of a damaged organ/tissue to
bring back the original appearance &
function.(mammoplasty, face-lift)

7.

1.

2.

CONSTRUCTIVE repairing the

damaged tissue or congenitally
defective organ. (multiple wound
repair)
Accdg. To Location :
INTERNAL inside the body .
Ex. Hysterectomy
EXTERNAL outside the body .
Ex. Skin grafting

FOUR BASIC PATHOLOGIC

CONDITIONS THAT REQUIRE
SURGERY:
1) OBSTRUCTION a blockage ; are
dangerous because they block the
flow of blood, air, CSF, urine & bile
through the body.
2) PERFORATION is a rupture of
the organ, artery or bleb.

3)

4)

EROSION break in the

continuity of tissue surface. It can
be caused by irritation, infection,
ulceration or inflammation. It can
damage the walls of blood vessels
resulting in serious bleeding.
TUMORS abnormal growth of
tissue that serves no physiologic
function in the body.

THE SURGICAL RISK

PATIENTS

Extremes of age ( very young & very old )

Extremes of weight (emaciation, obesity)
Dehydrated pts.
Nutritional deficits
Pts. with severe trauma or injury,
infection/sepsis
Pts. with cardiovascular disease
Endocrine dysfunction (diabetes mellitus)

Hypertensive & hypotensive pts.

Hypovolemia
Hepatic disease
Preexisting mental or physical
disability

PROBLEMS THAT MAY ARISE IN

SURGERY:
1. Surgical risk pts probability of
morbidity or mortality following
surgery.
2. Pain
3. Hemorrhage
4. Infection
5. UTI

PHASES OF O.R. NURSING :

I. PREOPERATIVE PHASE
The rendering of nursing care to
the surgical client as soon as he
is admitted & the decision to
undergo surgery is made.
It ends on the time the client is
transferred to the O.R.

NURSING ACTIVITIES :
Assessment of the client (baseline
evaluation of the pt. before the day of
surgery-interview)
Identification of potential/actual health
problems.
PREADMISSION TESTING- ensure
necessary tests have been performed
Pre-op teaching involving client & support
persons.

Day of surgery :
pt. teaching reviewed
informed consent confirmed
pt.s identity & surgical site verified
IVF started.

PREPARATION FOR
SURGERY
Psychological Support :
a) Assess clients fears, anxieties,
support systems & patterns of
coping.
b) Establish trusting relationship with
client & significant others.
c) Explain routine procedures,
encourage verbalization of fears &
allow client to ask questions.

d)

e)

Demonstrate confidence in
surgeon & staff.
Provide for spiritual care if
appropriate.

PREOPERATIVE
TEACHING

Frequently done on an outpatient

basis.
Assess clients level of understanding
of surgical procedure & its
implications.
Answer questions, clarify & reinforce
explanations given by the surgeon.
Explain routine pre- & post-op
procedures & any special equipment to
be used.

PREOPERATIVE
PreoperativeTEACHING
experience
Preoperative medication
Breathing exercises, coughing, incentive
spirometer
Leg exercises
Position changes and movement
Pain management
Reducing anxiety and fear, support of coping
Special considerations related to outpatient
surgery

Diaphragmatic Breathing
and Splinting When
Coughing

Leg Exercises and Foot

Exercises

Preoperative Nursing
Interventions
PHYSICAL

PREPARATIONS:
Patient safety is a primary concern.
Obtain history of past medical conditions,
surgical procedures, dietary restrictions
& medications.
Perform baseline head-to-toe assessment,
including VS, height & weight.
Ensure that diagnostic procedures
pertinent to surgery are performed as
ordered:

1.
2.
3.

4.
5.
6.

CBC
Electrolytes
PT/PTT (Prothrombin
Time;Partial thromboplastin
time)
Urinalysis
ECG
Blood typing & crossmatch

NPO- to prevent aspiration

Bowel prep and skin prep
- cleansing enema or laxative
before surgery to allow satisfactory
visualization of the surgical site.
- goal of pre-op skin prep is to
decrease bacteria without injuring
the skin.

Immediate preoperative preparation

Complete checklist and chart
Hospital gown, voiding, removal of
dentures, jewelry, contacts, etc.
Preoperative medication

Transporting the pt. to the Presurgical

area about 30 to 60 minutes before
anesthetics is to be given.
Attend to family needs

 LEGAL

PREPARATION:
Surgeon obtains operative permit
(informed consent)
1. Surgical procedures, alternatives ,
possible complications &
disfigurements or removal of body
parts are explained.
2. It is part of the nurses role as client
advocate to confirm that the client
understands information given.

INFORMED CONSENT is necessary in the

ff. Circumstances:
Invasive procedures, such as surgical
incisions, biopsy, cystoscopy or
paracentesis.
Procedures requiring sedation or
anesthesia
A non-surgical procedure, such as
arteriography
Procedures involving radiation

Adult client (over 18 y/o) signs own

permit unless unconcious or mentally
incompetent.
1. If unable to sign, relative (spouse or
next of kin) or guardian will sign.
2. In an emergency, permission via
telephone or telegram is acceptable;
have a 2nd listener on phone when
telephone permission is given

3.

a.
b.

c.
d.

Consents are not needed for

emergency care if all 4 of the ff.
criteria are met:
There is an immediate threat to life.
Experts agree that it is an
emergency.
Client is unable to consent.
A legally authorized person cannot
be reached.

Minors (under 18 y/o) must have

consent signed by an adult (i.e.
Parent or legal guardian)
Emancipated minor (married or
independently earning his or her
own living)may sign his/ her own
consent.

Witness to informed consent may

be a nurse, another M.D., clerk
or any other authorized person.
The nurse witnessing informed
consent, specifies whether
witnessing explanation of
surgery or just signature of the
client.

PREOPERATIVE
MEDICATIONS
PURPOSES:
1. To relieve fear & anxiety.
2. To reduce dose needed for induction
& maintenance of anesthesia.
3. To prevent reflex bradycardia that
happens during induction of
anesthesia.
4. To minimize oral secretions.

PREOPERATIVE
MEDICATIONS

II.

INTRAOPERATIVE PHASE
Giving nursing care to client
undergoing surgery.
It starts from the time the pt.
was admitted to the O.R. ,
during operation until it ends &
transferred to the PACU.

NURSING ACTIVITIES:
Activities providing for pts safety.
Maintenance of aseptic environment.
Ensuring proper function of equipments.
Providing surgeons with specific
instruments & supplies for surgical field.
Completing documentation.
Positioning pts.
Acting as scrub/circulating nurse.

Members of the Surgical

Team
Patient
Anesthesiologis
t or anesthetist
Surgeon
Nurses (Scrub
& Circulating)
Surgical
technologists

SCRUB TEAM @ WORK

PATIENT the most important member of the

surgical team. May feel relaxed & prepared, or
fearful & highly stressed.
- is also subject to several risks.
OPERATING SURGEON pre-op dx & care.
- performance of operation.
- post-op mgt & care
- assumes all responsibility for all medical
acts of judgement & mgt.

SURGEON & ASSISTANTS scrub &

perform the surgery.
REGISTERED NURSE 1ST ASST.
practices under the direct supervision
of the surgeon. (handling tissue,
suturing, maintaining hemostasis)
ANESTHESIOLOGIST /
NURSE ANESTHETIST administers the
anesthetic agent & monitors the pts
physical status throughout the surgery .

SCRUB NURSE provides sterile

instruments & supplies to the surgeon
during the procedure.
- performs surgical hand
scrub.
CIRCULATING NURSE coordinates the
care of the pt. in the O.R.
- care provided includes assisting with pt.
positioning , skin prep, managing surgical
specimens & documenting intraoperative
events.

SCRUB NURSE

CIRCULATING

NURSE

Prevention of Infection

The surgical environment stark

appearance & cool temperature.
Located central to all supporting
services.
Unrestricted zone where street
clothes are allowed.
Semirestricted zone- where attire
consists of scrub clothes & caps.
Restricted zone- where scrub clothes,
shoe covers, caps & masks are worn.

THE OPERATING ROOM

Basic Guidelines for

Surgical Asepsis

All materials in contact with the wound and

within the sterile field must be sterile.
Gowns are sterile in the front from chest to
the level of the sterile field, and sleeves
from 2 inches above the elbow to the cuff.
Only the top of a draped table is considered
sterile. During draping, the drape is held
well above the area and is placed from front
to back.

Basic Guidelines for

Surgical Asepsis

Items are dispensed by methods to

preserve sterility.
Movements of the surgical team are
from sterile to sterile and from
unsterile to sterile only.
Movement around the sterile field
must not cause contamination of the
field. At least a 1-foot distance from
the sterile field must be maintained.

Basic Guidelines for

Surgical Asepsis

Whenever a sterile barrier is

breached, the area is considered
contaminated.
Every sterile field is constantly
maintained and monitored. Items of
doubtful sterility are considered
unsterile.
Sterile fields are prepared as close as
possible to time of use.

SURGICAL ASEPTIC
TECHNIQUE

BEFORE AN OPERATION, it is necessary

to sterilize and keep sterile all
instruments, materials, and supplies
that come in contact with the surgical
site. Every item handled by the surgeon
and the surgeon's assistants must be
sterile. The patient's skin and the hands
of the members of the surgical team
must be thoroughly scrubbed, prepared,
and kept as aseptic as possible.

DURING THE OPERATION, the surgeon,

surgeon's assistants, and the scrub nurses
must wear sterile gowns and gloves and
must not touch anything that is not sterile.
Maintaining sterile technique is a
cooperative responsibility of the entire
surgical team.
Each member must develop a surgical
conscience, a willingness to supervise and
be supervised by others regarding the
adherence to standards.

BASIC PRINCIPLES OF
SURGICAL ASEPSIS

All personnel assigned to the

operating room must practice good
personal hygiene. This includes
daily bathing and clothing change.
Those personnel having colds, sore
throats, open sores, and/or other
infections should not be permitted
in the operating room.

Operating room attire (which includes scrub

suits, gowns, head coverings, and face masks)
should not be worn outside the operating
room suite. If such occurs, change all attire
before re-entering the clean area. (The
operating room and adjacent supporting
areas are classified as "clean areas.")
All members of the surgical team having
direct contact with the surgical site must
perform the surgical hand scrub before the
operation.

All materials and instruments used in

contact with the site must be sterile.
The gowns worn by surgeons and scrub
corpsmen are considered sterile from
shoulder to waist (in the front only),
including the gown sleeves.
If sterile surgical gloves are torn,
punctured, or have touched an unsterile
surface or item, they are considered
contaminated.

The safest, most practical method of

sterilization for most articles is steam
under pressure.
Label all prepared, packaged, and
sterilized items with an expiration date.
Use articles packaged and sterilized in
cotton muslin wrappers within 28 calendar
days.
Use articles sterilized in cotton muslin
wrappers and sealed in plastic within 180
calendar days

Unsterile articles must not come

in contact with sterile articles.
Make sure the patient's skin is
as clean as possible before a
surgical procedure.
Take every precaution to prevent
contamination of sterile areas or
supplies by airborne organisms.

HANDLING STERILE
ARTICLES

When you are changing a dressing,

removing sutures, or preparing the
patient for a surgical procedure, it will be
necessary to establish a sterile field from
which to work. The field should be
established on a stable, clean, flat, dry
surface.
An article is either sterile or unsterile;
there is no in-between. If there is doubt
about the sterility of an item, consider it
unsterile

Any time the sterility of a field

has been compromised, replace
the contaminated field and setup.
Do not open sterile articles until
they are ready for use.
Do not leave sterile articles
unattended once they are opened
and placed on a sterile field.

Do not return sterile articles to a

container once they have been removed
from the container.
Never reach over a sterile field.
When pouring sterile solutions into
sterile containers or basins, do not
touch the sterile container with the
solution bottle. Once opened and first
poured, use bottles of liquid entirely. If
any liquid is left in the bottle, discard it.

Never use an outdated article.

Unwrap it, inspect it, and, if
reusable, rewrap it in a new
wrapper for sterilization.

SURGICAL HAND SCRUB

PURPOSE: To reduce resident and

transient skin flora (bacteria) to a
minimum.
Proper hand scrubbing and the
wearing of sterile gloves and a sterile
gown provide the patient with the
best possible barrier against
pathogenic bacteria in the
environment and against bacteria
from the surgical team.

1.

2.

3.

Before beginning the hand scrub, don a

surgical cap or hood that covers all hair, both
head and facial, and a disposable mask
covering your nose and mouth.
Using approximately 6 ml of antiseptic
detergent and running water, lather your
hands and arms to 2 inches above the elbow.
Leave detergent on your arms and do not
rinse.
Under running water, clean your fingernails
and cuticles, using a nail cleaner.

4.

5.

6.

Starting with your fingertips, rinse each hand

and arm by passing them through the running
water. Always keep your hands above the
level of your elbows.
From a sterile container, take a sterile brush
and dispense approximately 6 ml of antiseptic
detergent onto the brush and begin scrubbing
your hands and arms.
Begin with the fingertips. Bring your thumb
and fingertips together and, using the brush,
scrub across the fingertips using 30 strokes.

7.

8.

9.

Now scrub all four surface planes of the

thumb and all surfaces of each finger,
including the webbed space between the
fingers, using 20 strokes for each surface
area.
Scrub the palm and back of the hand in a
circular motion, using 20 strokes each.
Visually divide your forearm into two parts,
lower and upper. Scrub all surfaces of each
division 20 strokes each, beginning at the
wrist and progressing to the elbow

10. Scrub

the elbow in a circular motion using

20 strokes.
11. Scrub in a circular motion all surfaces to
approximately 2 inches above the elbow.
12. Do not rinse this arm when you have
finished scrubbing. Rinse only the brush.
13. Pass the rinsed brush to the scrubbed
hand and begin scrubbing your other hand
and arm, using the same procedure
outlined above

14. Drop

the brush into the sink when you are

finished.
15. Rinse both hands and arms, keeping your
hands above the level of your elbows, and
allow water to drain off the elbows.
16. When rinsing, do not touch anything with
your scrubbed hands and arms.
17. The total scrub procedure must include all
anatomical surfaces from the fingertips to
approximately 2 inches above the elbow.

18. Dry

your hands with a sterile towel.

Do not allow the towel to touch
anything other than your scrubbed
hands and arms.
19. Between operations, follow the
same hand- scrub procedure.

Gowning and Gloving

GOWNING
1. Dry one hand and arm, starting with the
hand and ending at the elbow, with one end
of the towel. Dry the other hand and arm with
the opposite end of the towel. Drop the towel.
2. Pick up the gown in such a manner that
hands touch only the inside surface at the
neck and shoulder seams.
3. Allow the gown to unfold downward in
front of you.

GLOVING
1. Pick up one glove by the cuff using
your thumb and index finger.
2. Touching only the cuff, pull the glove
onto one hand and anchor the cuff over
your thumb.
3. Slip your gloved fingers under the
cuff of the other glove. Pull the glove
over your fingers and hand, using a
stretching side-to-side motion.

4. Anchor the cuff on your thumb.

With your fingers still under the
cuff, pull the cuff up and away from
your hand and over the knitted cuff
of the gown.
5. Repeat the preceding step to
glove your other hand.
6. The gloving process is complete.

To gown and glove the surgeon,

follow these steps:
1. Pick up a gown from the
sterile linen pack. Step back
from the sterile field and let the
gown unfold in front of you. Hold
the gown at the shoulder seams
with the gown sleeves facing you.

2. Offer the gown to the surgeon. Once the

surgeon's arms are in the sleeves, let go of the
gown. Be careful not to touch anything but the
sterile gown. The circulator will tie the gown.
3. Pick up the right glove. With the thumb of
the glove facing the surgeon, place your
fingers and thumbs of both hands in the cuff of
the glove and stretch it outward, making a
circle of the cuff. Offer the glove to the
surgeon. Be careful that the surgeon's bare
hand does not touch your gloved hands.
(Repeat for left hand)

TYPES OF ANESTHESIA

ANESTHESIA - is a state of narcosis,

analgesia, relaxation & reflex loss.
involves the use of medications
that block pain sensations
(analgesia) during surgery and
other medical procedures.
Anesthesia also reduces many of
your body's normal stress
reactions to surgery.

TYPES OF ANESTHESIA

I. General Anesthesia
II. Local Anesthesia
III. Regional Anesthesia
IV. Moderate Sedation
V. Monitored Anesthesia Care

GENERAL ANESTHESIA

I. GENERAL ANESTHESIA - affects

your entire body and renders you
unconscious.
The patient would be completely
unaware and not feel pain during
the surgery or procedure.
Also causes forgetfulness
(amnesia) and relaxation of the
muscles throughout your body.

Suppresses many of your bodys normal

automatic functions, such as those that
control breathing, heartbeat,
circulation of the blood (such as
blood pressure), movements of the
digestive system, and throat reflexes
such as swallowing, coughing, or
gagging that prevent foreign material
from being inhaled into your lungs
(aspiration)

Monitoring of the heart, breathing,

blood pressure, and other vital
functions is important. An
endotracheal (ET) tube or a
laryngeal mask airway is usually
used to give an inhalant anesthetic
and oxygen, control and assist
breathing. An ET tube is used to
prevent aspiration.

General anesthesia is commonly

begun (induced) with intravenous
(IV) anesthetics, but inhalation
agents also may be used. Once you
are unconscious, anesthesia may be
maintained with an inhalant
anesthetic alone, with a combination
of intravenous anesthetics, or a
combination of the two.

STAGES OF GENERAL
ANESTHESIA

STAGE I BEGINNING ANESTHESIA

Warmth, dizziness , & feeling of
detachment.
Ringing, roaring or buzzing in the ears.
Still conscious but may sense inability to
move the extremities easily.
Noises are exaggerated even low voices
or minor sounds seem loud & unreal.
Unnecessary noises & motions should be
avoided.

STAGE II EXCITEMENT
Struggling, shouting ,talking,
singing, laughing or crying
(avoided if given smoothly & quickly)
Pupils dilate ( but contract if
exposed to light)
PR rapid & RR irregular.
Restraining the patient may be
possible.

STAGE III SURGICAL ANESTHESIA

Reached by continuous
administration of anesthetic vapor
or gas.
Pt. is unconscious & lies quietly.
Pupils are small but contract when
exposed to light
RR regular, PR & volume WNL, skin
pink/flushed

STAGE IV MEDULLARY DEPRESSION

Reached when too much anesthesia has
been administered.
Respirations shallow, pulse weak &
thready .
Pupils widely dilated & no longer
contract when exposed to light.
CYANOSIS develops & w/o prompt
intervention DEATH

Anesthetic is discontinued
immediately.
Circulatory support initiated.

REGIONAL ANESTHESIA

REGIONAL ANESTHESIA involves

injection of a local anesthetic (numbing
agent) around major nerves or the
spinal cord to block pain from a larger
but still limited part of the body.
TYPES :
1. EPIDURAL
2. SPINAL
3. LOCAL CONDUCTION BLOCKS

EPIDURAL ANESTHESIA
commonly used conduction block
Injecting a local anesthetic into the
epidural space that surrounds the dura
matter of the SC.
Blocks sensory, motor & autonomic
functions.
Doses are much higher than spinal
because epidural anesthetic does not make
direct contact w/ the SC or nerve roots.

ADVANTAGE: absence of headache

DISADVANTAGE: greater technical
challenge of introducing the
anesthesia in the epidural space.
If (+) accidental puncture of the dura
happens & the anesthetic travels
toward the head HIGH SPINAL
ANESTHESIA SEVERE
HYPOTENSION , RESPIRATORY
DEPRESSION ARREST

SPINAL ANESTHESIA
Local anesthetic is introduced @ the
lumbar level between L4 & L5.
Produces anesthesia of lower
extremities, perineum & lower
abdomen.
Lumbar puncture done knee chest
position
As soon as the injection has been made
position pt on his back

PERIPHERAL NERVE BLOCKS. A local

anesthetic is injected near a specific nerve or
group of nerves to block pain from the area of
the body supplied by the nerve. Nerve blocks
are most commonly used for procedures on the
hands, arms, feet, legs, or face.

Brachial plexus block- arm

Paravertebral anesthesia- chest, abdo wall &
ext.
Transacral (Caudal) block- peineum,lower
abdomen

LOCAL ANESTHESIA

LOCAL ANESTHESIA involves injection

of a local anesthetic (numbing agent)
directly into the surgical area to block
pain sensations. It is used only for minor
procedures on a limited part of the body.
You may remain awake, though you will
likely receive medicine to help you relax
or sleep during the surgery
Often administered in combination with
Epinephrine.

ADVANTAGES :
Simple, economical, non-explosive
Equipment needed is minimal
Post-op recovery is brief
Undesirable effects of Gen.
Anesthesia are avoided.
Ideal for short & superficial
surgical procedures.

Intraoperative
Complications

Nausea and vomiting

Anaphylaxis
Hypoxia and respiratory
complications
Hypothermia
Malignant hyperthermia
Disseminated intravascular
coagulation (DIC)

Potential Adverse Effects

of Surgery and
Anesthesia
Allergic reactions and drug toxicity or

reactions
Cardiac dysrhythmias
CNS changes and oversedation or
undersedation
Trauma: laryngeal, oral, nerve, and skin,
including burns
Hypotension
Thrombosis

Gerontologic
Considerations

Elderly patients are at increased risk for

complications due to surgery and
anesthesia because of:
Increased likelihood of coexisting conditions.
Aging heart and pulmonary systems.
Decreased homeostatic mechanisms.
Changes in responses to drugs and
anesthetic agents due to aging changes such
as decreased renal function, and changes in
body composition of fat and water.

Nursing Goals for the

Patient in the
Intraoperative Period

Reducing anxiety
Preventing positioning injuries
Maintaining patient safety
Maintaining the patient's dignity
Avoiding complications

Laparotomy Position,
Trendelenburg Position, Lithotomy
Position, and Sidelying Position for
Kidney Surgery

Protecting the Patient

from Injury

Patient identification
Correct informed consent
Verification of records of health
history and exam
Results of diagnostic tests
Allergies (include latex allergy)
Monitoring and modifying the
physical environment

Safety measures such as grounding

of equipment, restraints, and not
leaving a sedated patient
Verification and accessibility of
blood

III. POSTOPERATIVE

PHASE
Begins with the admission of
the client to PACU & ends with
discharge of client from
hospital or facility providing
continuity of care.

Post-Anesthesia Care
Unit

The PACU environment

Beds and other equipment
Three phases:
Phase I
Phase II
Phase III

Nursing Management in
the PACU

Provide care for the patient until he/she

has recovered from the effects of
anesthesia.
Patient has resumption of motor and
sensory function, is oriented, has stable
VS, and shows no evidence of hemorrhage
or other complications of surgery.
Frequent skilled assessment of the patient
is vital

Responsibilities of the
PACU Nurse

Review pertinent information and baseline

assessment upon admission to the unit.
Assessments include airway and respirations,
cardiovascular function, surgical site,
function of the central nervous system; also
assess IVs and all tubes and equipment.
Reassess VS and patient status every 15
minutes or more frequently as needed.
Provide report and transfer the patient to
another unit or discharge the patient to
home.

Outpatient
Surgery/Direct Discharge

Discharge planning and discharge

assessment

Provide written and verbal instructions

regarding follow-up care, complications,
wound care, activity, medications, and diet.

Give prescriptions and phone numbers.

Discuss actions to take if complications occur.

Outpatient
Surgery/Direct Discharge

Give instructions to the patient and a

responsible adult who will
accompany the patient.

Patients are not to drive home or be

discharged to home alone. Sedation
and anesthesia may cloud memory
and judgment and affect ability.

Maintaining a Patent
Airway

A primary consideration: necessary to

maintain ventilation and oxygenation!
Provide supplemental oxygen as indicated.
Assess breathing by placing hand near
face to feel movement of air.
Keep head of bed elevated 15-30o unless
contraindicated.
May require suctioning.
If vomiting occurs, turn patient to the side

Head and Jaw

Positioning to Open
Airway

Use of Oral Airway

Note: Do not remove oral airway until
evidence of gag reflex returns