Clinical Teaching Plan Format

Surgical Ward

Pre- Entry Competencies of students:

Knowledge in:
1. Anatomy and physiology of the skin and mucous membranes.
2. Difference between normal and abnormal findings of physical assessment of the integumentary system.
3. Factors affecting wound healing.

Skills in:
1. Implementing appropriate dressing changes for different kinds of wounds.
2. Assessing accurately the integumentary system.
3. Accurately assessing and documentation of condition of wounds.

Ward Orientation Activities for Students:

1. Lining before the start of duty.
2. Endorsement from the outgoing group.
3. Orientation of the area as well as the equipments available.
4. Enhancement of skills such as assessment and other basic nursing procedures.

General Objectives of the Rotation, the students will be able to:

At the end of (2) two weeks of clinical exposure at Surgical Ward, the students will be able to gain knowledge, enhance skills
and develop appropriate attitude towards implementation of nursing care to surgical patients.
 Intermediate objectives /Nursing Faculty Students Method of Evaluation
Competencies to be achieved
1. Discuss the process involved in Discuss to students Discuss with themselves  Spot question
wound healing The processes involved in the concept of wound  Paper and pencil test
wound healing. healing.

2. Accurately assess and document the Review the assessment Demonstration on how  Return demonstration
condition of wounds. process to assess and document on assessment
condition of wounds

3. Describe 5 factors affecting wound Discuss to students the Discuss with themselves  Spot question
healing. factors affecting wound the factors affecting  Paper and pencil test
healing wound healing.

4. Assess students concept regarding Discuss structures of skin Review among  Spot question
structure of skin and appendages. themselves the concept  Paper and pencil test
they have learned
Structures of the Skin and Appendages
 Integument refers to the skin
 The integumentary system is made up of the skin, the subcutaneous layer directly under the skin, and the appendages of the
skin – the hair, glands of the skin and the nails.
 The skin is one of the body’s vital organs and is essential for maintaining life.
 The skin has 2 layers
1. The superficial portion, the epidermis, is composed of layers of stratified epithelial cells. These cells are fused to form a
protective waterproof layer of keratin material.
= epithelial cells have no blood vessels of their own and depend on underlying tissues for nourishment and waste removal.
= When well nourished, epithelium regenerates relatively easily and quickly.
2. The second layer of the skin, the dermis – consists of smooth, muscular, nerves, hair follicles, certain glands and their
ducts; arteries, veins, and capillaries and fibrous elastic tissues.
= Each hair consists of the shaft, which projects through the dermis beyond the surface of the skin and hair follicle which lies
in the dermis.
= The dermis rests on a subcutaneous fatty tissue layer that anchors the skin layers and serves as a heat insulator for the body.
This fatty tissue layer contains blood and lymph vessels, nerves and fat cells.
 The skin covers the entire body and is continuous with mucous membrane at normal body orifice.
 Glands in the skin include the sebaceous glands, sweat glands and the ceruminal glands.
1. sebaceous glands – secrete an oily substance called sebum, which lubricates the skin and hair and keeps the skin and scalp
pliant.
2. sweat glands – secrete perspiration
3. cerumen (earwax) in the external ear canals, consisting of a leavy oil and brown pigment is secreted by ceruminal glands.

Functions of the skin:

1. The skin protects the body
2. The skin helps regulate body temperature
3. The skin is a sense organ
4. The skin is an excretory organ
5. The skin helps maintain water and electrolyte balance
6. The skin produces and absorbs vitamin D

Wounds
 A wound is a break or disruption in the normal integrity of the skin and tissues. That disruption may range from a small cut
on a finger to a 3rd degree burn covering almost all of the body.
 Wound may result from mechanical forces (such as surgical incision) or physical injury such as burn.
 Wound classification:
1. intentional wounds – result of planned invasive therapy or treatment.
=Examples of intentional wounds include those that result from surgery, intravenous therapy and lumbar puncture.
= wound edges are clean and bleeding is usually controlled. Because the wound was made under sterile conditions with sterile
supplies and skin preparation, the risk for infection is decreased and healing is facilitated.
2. unintentional wounds – occur from unexpected trauma, such as accident, forcible injury (stabbing or gunshot) and burns.
= because wounds occur in an unsterile environment, contamination is likely.
= wound edges are usually jagged, multiple trauma is common and bleeding is uncontrolled. These factors create a high risk
for infection and a longer healing tissue.
3. open wounds – occurs from intentional or unintentional trauma. The skin surface is broken, providing a portal of entry for
microorganisms.
= bleeding, tissue damage and increased risk for infection and delayed healing may accompany open wounds.
4. closed wounds – results from a blow, force or strain caused by trauma such as fall, an assault, or a motor vehicle crash.
= the skin surface is not broken, but soft tissue is damaged and internal injury and hemorrhage may occur.
5. acute wound – such as surgical incisions, usually heal within days to weeks.
6. chronic wound – do not progress through the normal sequence of repair. Wound edges are not approximated, the risk of
infection is increased and the normal healing time is delayed. These includes deep pressure ulcers and peripheral vascular
arterial or venous ulcers.

 Wound Healing
 Phases of wound healing:
1. inflammatory
2. proliferative
3. remodeling
 Factors affecting wound healing:
1. age
2. circulation and oxygenation
3. nutritional status
4. wound condition
5. health status
 Procedure: Cleaning a wound and Applying a Sterile Dressing

Equipments:
Sterile gloves additional dressing supplies as needed or
Gauze dressings or squares ordered(antiseptic ointments, extra dressings)
Sterile dressing set or suture set( scissors and forceps) acetone or adhesive remover(optional)
Cleaning solutions sterile normal saline(optional)
Clean disposable gloves
Sterile drape(optional)
Plastic bag for soiled dressing
Waterproof pad
Bath blanket
Tape or ties
Surgi pads

ACTION
1. Explain the procedure to patient
2. Gather equipment
3. Perform hand hygiene
4. Check physicians order for dressing change. Note whether drain is present.
5. Close door or curtain.
6. Assist patient to comfortable position that provides easy access to wound area.
7. Placed opened,cuffed plastic bag near working area.
8. Loosen tape on dressing. Use adhesive remover if necessary. If tape is soiled, don
gloves.
9. Don clean disposable gloves and remove soiled dressings carefully in a clean to
less clean direction. Do not reach over wound. Check position of drains before
removing dressing. If skin is adhering to skin surface, it may be moistened by pouring
a small amount of sterile saline into it. Keep soiled side of dressing away from
patient’s view.
10. Assess amount, type and odor of drainage
11. Discard dressings in plastic disposal bag.
12. Use aseptic technique upon sterile dressings and supplies on work area.
13. Open sterile dressing solutions and pour over gauze sponges in plastic container
or over sponges placed in sterile basin.
14. Don sterile gloves.
15. Clean wound or surgical incisions. Use sterile forceps if desired.
a. clean from top to bottom or from center or toward.
b. use one 4x4 gauze square for each wipe, discarding each square by dropping into
plastic bag. Do not touch bag with forcep.
c. clean around drains ,if present, moving from center outward in a circular motion.
d. dry wound using 4x4 gauze sponge and same motion.
e. apply antiseptic ointment if ordered.
RATIONALE
An explanation encourages patient cooperation and reduces apprehension.
Preparation provides for organized approach to task.
Hand hygiene deters spread of microorganisms
The order clarifies type of dressing.
Doing so provides privacy and warmth.
Proper positioning provides comfort.
Soiled dressings may be placed in disposal bag without contaminating outside
surfaces of bag.
It is easier to loosen tape before putting on gloves.
Using clean gloves protects the nurse when handling contaminated dressings.
Wound healing process or presence of infection should be documented.
This prevents spread of microorganisms by contaminated dressings.
Sterility must be maintained
Sterility of dressing and solution is maintained
Maintains surgical asepsis
a. cleaning is done from least to most contaminated area.
b. previously cleansed area is not recontaminated
c. movement in this manner ensures cleaning from least to most contaminated
area
d. moisture provides medium for growth of microorganisms
e. growth of microorganisms maybe retarded and healing process improved
16. Apply a layer of dry, sterile dressings over wound. Use sterile forceps if desired.
17. Use sterile scissors to cut sterile 4x4 gauze square to place under and around drain
if one is present or use precut sterile gauze
18. Apply wound gauze layer to wound site
19. Place surgi pad or dressing over wound as outermost layer
20. Remove gloves form inside out. Apply tape to secure dressings
21. Perform hand hygiene. Remove all equipment and make patient comfortable
22. Check dressing and wound site every shift. Record dressing change and
appearance of wound and discard any drainage in chart
Primary dressing serves as a for drainage
Drainage is absorbed and surrounding skin area is protected
Additional layer provides increased absorption of drainage
Wound is protected from microorganisms in environment
Tape is easier to apply after gloves have been removed
Hand hygiene prevents spread of microorganisms
Accurate demonstration of procedure ensures continuity of care and provide
information for further assessment.
 Filamer Christian College
College of Nursing
Roxas City

October 16, 2009

Liquidation for Psychiatric Affiliation ( 6th Batch)

Transportation 1500
Laundry 500
Matronship 2000
_ ________
P 4,000.00

Prepared by:

Mrs. Jeannie V. Dumagpi, RN

Clinical Instructor

Noted by:

Mrs. Adela S. Aldea, RN, MAN

Level 3&4 Clinical Coordinator
Agnes
Filamer Christian College
College of Nursing
Roxas City

Clinical Teaching Plan Format

Surgical Ward

Pre- Entry Competencies of students:

Knowledge in:
1. Describing the Perioperative Nursing Concepts
2. Identify the types of wounds
3. Enumerate and describe the complications of wounds
4. Identify the related structure and function of related organs (skin and mucous membranes

Skills in:
1. Perform a comprehensive assessment taking making use of the 4 techniques of physical examination
2. Develop skills in
a. Measure Intake and Output
b. Calibrating Intravenous Fluids
c. Vital Signs Taking with Neurovital signs
d. Documentation and Reporting or referring
3. Enumerate and provide a Post Surgical Unit
a. Surgical bed
b. Suction Machine
c. Oxygen tank with oxygen gauge
d. Vital Signs Equipments
 e. Kidney Basin
f. Hospital gown
g. Tissue Paper
h. Bed pad (when necessary)

Surgical Ward Orientation and Activities of Students

Requirements:
1. Clinical or Ward Class Notebook with an advanced Notes in
a. Phases of Surgery
b. Types of Wounds
c. Complications of wounds
d. Types of Anesthesia
2. Charting Notebook for documentation purposes
3. Vital Signs Equipment
4. Complete set of ballpens (red and black), pentel pens
5. Bandage Scissor
6. A bottled mineral water
7. White towel

Clinical Lining and Nurses’ Rounds

 Change of shift report with the total number of patients covered
 Instructions and reminders on
a. routines and protocols
b. mastery of the physical set up
c. identification of members of the health care team
 Nurses rounds and introduction to clients while checking the latter’s
a. Level of consciousness
b. Patency of Intravenous fluids, catheter or nasogastric tubes
c. Post operative dressing
d. Subjective data if any

General Objectives
At the end of the two week exposure in Surgical Ward, the student will be able to develop the skills, knowledge and attitude in
taking care of the post operative client.

Objectives Faculty Students Method of

Evaluation
1. Identify the * Do the bedside clinic * Receive endorsement or *Paper and
nursing and discuss your reports from the Pencil test
intervention to observations Intraoperative Nurses
meet the patient (OR Nurses) *Performance
needs in the post Evaluation
 Identify the
anesthetic period Checklist
intraoperative
procedures or
medications with
its safety
precautionary
measures
 Perform the
carrying out of
doctor’s orders
with proper
interpretation and
rationale
 Perform the vital
signs taking
 Monitor the
patient’s level of
consciousness

2. Discuss the * Do the bedside clinic * Correlate rationale to

initial nursing with critical thinking every step of the
assessment and activities like asking “on procedure done to the
nursing the spot” questions patient
* Initiate the discussion
management of
on patient’s Medications
the post
operative client
immediately
after transfer
from the
recovery room to
the general care
unit or surgical
ward
* Do the lecture- *Prepare a picture or
3. Describe the discussion on the type metaphor with the
type and process and process of wound metaplan to describe the
of wound healing healing process of wound
and interventions *Identify the post healing.
st
that promote operative days like 1
wound healing post operative day, 2nd
post operative day
through lecture-
discussion
4. Describe * Assess and assist the
possible post post operative patient and
operative facilitate students in their
problems with nursing actions
fluid and * Do the bedside clinic in
electrolyte every nursing action to
balance, include the rationale of
nutrition, the nursing procedures
elimination and
inactivity and the
assessment
parameters and
preventive
measures.
5. Identify the * Rehearse students how
information to do the health teaching
needed by the * Listen to students as
postoperative they give instructions to
client in the patient in relation to
preparation for their recent status
discharge. a. on the day of surgery
b. 1st post operative day
c. 2nd post operative day
d. 3rd post operative day
THE SURGICAL EXPERIENCE

THE POSTOPERATIVE CLIENT

 The post operative period begins after surgery and continues until the client is discharged from medical care.
 The post operative phase can further be broken down into into Phase I, Phase II, and Phase III
 The clients immediately recovery period is supervised by the Recovery Room Nurse – an educated specialist
working in a specially equipped environment.
 The RR or PAR is located close to the Operating suite. In the event of an emergency, the anesthesiologist
and the surgeon are nearby.
 The goal of the Recovery Room Nurse is
1. to promote an uneventful