General Orientation (08/17/21)
their families or their folks
RLE Activities/Target Skills
1. Medication Administration (Intramuscular,
Intradermal, Subcutaneous)
2. Perioperative Nursing Skills
3. Others: To follow
Perioperative Nursing
Session 1: Introduction to conditions for
surgical interventions
PERIOPERATIVE NURSING
- a nursing specialty that works with patients
who are having operative or invasive
procedures.
- describes the wide variety of nursing
functions associated with the patient’s
surgical management.
- the nursing care that we gave to our client
before, during, and after operation.
Note: Not only the time during surgery or
the time the patient is lying on the operating
table where the surgeons are operating on
them but it is the care we give during,
before and after the surgery
- specialized nursing area wherein a
registered nurse works as a team member
of other surgical health care professionals.
PERIOPERATIVE NURSE
- works closely with
➢ Surgeons
➢ Anesthesiologists
➢ Nurse Anesthetists
➢ Surgeon’s Assistants
➢ Surgical Technologists
➢ Nurse Practitioners
PREPARATION AND CARE OF CLIENT AND
FAMILIES
Note: We take care not just the patient alone but
• Physically
• Psychologically
• Emotionally
• Spiritually
PRIMARY GOAL OF PERIOPERATIVE NURSING
❖ Safety and welfare of the client in all
phases of the perioperative experience
(during, before and after the surgery)
Assignment:
Familiarize yourselves with the following:
1. Common/important surgical terminologies
2. Common Prefixes
3. Common Suffixes
COMMON/IMPORTANT SURGICAL
TERMINOLOGIES:
● Surgery – branch of medicine that
encompasses pre-operative, intra-operative
judgments and management, and
post-operative care of patients.
● Surgical Procedure – invasive incision into
body tissue or minimally invasive entrance
into a body cavity for either therapeutic or
diagnostic purposes during which protective
reflexes or self care abilities are potentially
compromised.
● Asepsis – absence of microorganisms that
cause disease
● Antisepsis – prevention of sepsis by
destruction or inhibition of growth or
multiplication of microorganisms from body
tissue or fluids
● Antiseptic – inorganic chemical
compounds that combat sepsis by inhibiting
growth of microorganisms without
necessarily killing them. Used in
skin/tissues without destroying them.
● Bacteriostasis – inhibition growth of
bacteria
 ● Carrier – apparently healthy person who
harbors and can transmit a pathogenic
Microorganism
● Disinfectants – agents that kill growing or
vegetative form of microorganism that
completely eliminating them from inanimate
objects
Types of Disinfectants:
➢ Bactericide
➢ Fungicide
➢ Sporicide
➢ Virucide
● Flora – bacteria or fungi normally inhabiting
the body
● Sterile – free of microorganisms including
spores
● Sterile/Aseptic technique – the method by
which contamination with microorganism is
prevented to maintain sterility all throughout
the operative procedure
● Sterile field – the area around the incision
site or site of introduction of any
instrumentation that has been prepared for
use of sterile supply and equipment
● Sterilization – the process by which all
pathogenic and non-pathogenic
microorganism are killed including spores
● Sterilizer – the chamber or equipment
used to attain physical or chemical
sterilization. Also known as autoclave.
Thoraco – chest
Myo – muscle
Oophor – ovaries
Salpingo – fallopian tube
COMMON SUFFIXES:
-oma - tumor
-ectomy - removal of an organ or gland
-rrhaphy - stitching or a part of an organ
-ostomy - making an opening or stoma
-plasty - to repair or restore
-cele/coele - hernia/swelling (denoting to a cavity
or space)
-itis - inflammation
Types of Surgery:
There are hundreds of different types of surgery
and many ways to categorize them. Some
common categories include:
❖ The aim of surgery
❖ The urgency of surgery
❖ The seriousness of surgery
❖ The field of surgery
❖ The surgical approach

COMMON PREFIXES:
A. THE AIM OF SURGERY
Supra – above/beyond
Surgeries can be grouped according to their
Arthro – joint
purpose:
Chole – bule/gallbladder
Cysto – urinary bladder
1. Diagnostic – surgery can establish
Entero – intestine
whether a person has a particular
Hsytero – uterus Mast – breast
illness, disease or condition. Diagnostic
Nephro – kidney
surgery may be recommended when
Neuro – nerve
the person has signs that something
Pneumo – lungs
may be wrong – for example, they may
Pyelo – kidney pelvis
report unusual symptoms or have a
 positive test result. An example of
diagnostic surgery is a breast lump
biopsy.
➔ You send yourself to have an operation or
procedure, diagnostic as what we call
because you have identified or palpated
that there is a mass or lump on your breast
tissue. For you to be able to know what is
really wrong with this lump, is this lump
serious? Cancerous? Or benign? To know
what’s the nature of this lump. For example
breast lump biopsy, this is an operation to
diagnose whether the lump that the client
has palpated in her breast is cancerous or
not, by sending it to laboratory testing.
2. Preventive – the removal of tissue to
stop a disease from happening. An
example of this type of surgery is an
operation to remove bowel polyps that
may turn cancerous if left untreated.
This type of surgery is also called
prophylactic surgery.
➔ There is no problem yet. In this type of
surgery the client submit herself for an
operation to remove something so that
problem can be stopped or prevented.
3. Ablative – means the surgical removal
of tissue. Typically, ablative surgery
involves cutting out diseased or
severely damaged body parts. In most
cases, the name of the surgery ends in
– ectomy. Examples include
mastectomy (removal of a cancerous
breast) or cholecystectomy (removal of
a diseased gallbladder)
➔ In this type of surgery, a certain organ or
tissue is removed because it is already
damaged or it is not already functioning.
4. Reconstructive – the aim is to restore
use (such as knee reconstructive
surgery) or improve appearance (such
as breast reconstruction following
mastectomy). Sometimes,
reconstructive surgery achieves both.
For example, a cleft palate repair
enhances the person’s appearance and
also improves their ability to eat,
swallow and talk.
➔ Reconstructive surgery can both repair
non-functioning organs and improve
appearance.
5. Palliative – the aim is to reduce pain,
control symptoms and improve quality
of life when there is no chance of cure.
An example of this type of surgery is
nerve resection to stop a person from
feeling constant pain.
➔ There are some diseases that you cannot
cure anymore, Palliative means we perform
surgery to help control the pain. We will
not contrast the ablative, you will find a
cure for it. In palliative surgery is done to
help patients in pain control.
6. Transplantation – this surgery is to
replace a body part that no longer
works properly: for example, a hip
replacement or a lung transplant. The
part may be artificial (made from
silicone, stainless steel or titanium) or
natural (donated from a deceased
person).
➔ For example, kidney transplant.
B. THE URGENCY OF SURGERY
Surgeries may be classified by degree of urgency.
For example:
1. Emergency surgery – must be done as soon
as possible to save the person’s life or preserve
function of a body part. An example is surgery to
repair damage to internal organs following a motor
vehicle accident.
➔ For example, the client had an accident
and then his spleen got raptured,
emergency surgery should be done or else
the patient will die of bleeding.
2. Elective surgery – is not urgent but must be
done at some point for the sake of the person’s
ongoing health or quality of life (for example,
surgery to repair severe scoliosis or deformity of
the spine) or because the person chooses to have
an operation which may be helpful but is not
necessarily essential (for example, cosmetic
surgery to change the appearance of a person’s
nose, or rhinoplasty).
➔ Surgery should not be done right away but
it can be scheduled to be done in the
future
C.THE SERIOUSNESS OF SURGERY
All surgery carries risk to the person. The factors
that determine the degree of the risk include the
body part that is affected, the seriousness of the
medical condition, the extent of surgery, the
complexity of the surgery and the expected
recovery time. Categories include:
1) Major surgery – such as surgery to the
organs of the head, chest and abdomen. Examples
of major surgery include organ transplant, removal
of a brain tumor, and removal of a damaged kidney
or open-heart surgery. The person will need to stay
in the hospital for some time. The risk of
complications may be high and the person will take
a longer time to recover.
2) Minor surgery – presents a low risk of
complications and fast recovery time. The person
can usually go home the same day. Examples of
minor surgery include tonsillectomy, sewing up a
cut or biopsy of a breast lump.
D. THE FIELD OF SURGERY
Surgeries can be categorized by field, which
includes body systems, diseases or conditions. For
example:
1. Orthopaedic surgery – musculoskeletal
system.
➔ Ortho - bones or muscles
2. Ocular surgery – the eyes
3. Neurosurgery - brain and spinal cord
4. Cardiac surgery - heart and surrounding blood
vessels
5. Surgical oncology – treats cancer
6. Bariatric surgery - treats obesity
E. THE SURGICAL APPROACH
Surgeries can be categorized by broad technique.
For example:
1) Open surgery – the traditional approach.
The surgeon makes a large single incision
(very long or wide) to access the internal
organs. An example is open-heart surgery,
where the person’s chest is cut down the
middle and opened up like a book. Open
surgery of the abdominal cavity is known as
laparotomy .
2) Keyhole surgery – the surgeon makes
several small cuts (incisions) instead of
large one. Slender surgical instruments are
passed through these incisions, including a
laparoscope. This is a special viewing tube
fitted with a light so the surgeon can see
the internal organs. For this reason,
keyhole surgery is also known as
laparoscopic surgery.
 3) Microsurgery - is used for delicate work on
very small body structures. The surgeon
relies on special equipment and
microscopes to magnify the area to be
operated on using tiny surgical instruments.
An example of an operation that uses
microsurgery techniques is a vasectomy
(removal of vas deferens) reversal or
reattaching a severed finger.
➔ Like open surgery, but surgeons use a
very small delicate instrument.
OR NURSE QUALIFICATION (PER ORNAP-PCS
STANDARDS) (10/28/07 PUB.)
ORNAP - Operating Room Nurses Association of
the Philippines
PCS - Philippine College of Surgeons
1. With at least 6 months experience as a staff
nurse in a surgical ward.
2. With KSA relevant to perioperative nursing
practice.
3. An active member of the ORNAP.
DIFFERENT ROLES OF NURSES IN THE CARE
OF SURGICAL CLIENTS
A. CLINICAL UNIT NURSE
• Responsible for the care of clients in the
pre and postoperative period.
➔ These are the nurses working in the floor or
surgical ward. They are the one providing
care before and after the surgery.
B. OPERATING ROOM NURSE
• Responsible for the safe care of clients
during surgery.
C. NURSE ANESTHETIST
• Assist the anesthesiologist, both
responsible for the safe delivery of anesthesia.
➔ Clients should receive anesthesia in order
to control the pain. The anesthesiologists
are doctors that deliver anesthesia, while
nurse anesthetists can deliver anesthesia.
D. PACU NURSE (Post Anesthetists/ Anesthesia
Care Unit - a department in the hospital where all
patients who underwent surgery is being
transferred to and stayed there for a while to be
monitored for their well being until anesthesia will
wear out.
• Responsible for the care of clients in the
immediate post anesthesia and postoperative
period
CONDITIONS OF SURGICAL INTERVENTIONS
• To preserve life and maintain dynamic
bodily equilibrium
• Undergo diagnostic procedure
• Prevention of infection and promote
healing
• Restoration of a body part that is
congenitally malformed or damaged by
trauma or disease For cosmetic
appearance (the least)
Session 2: Phases of Perioperative Nursing
to Outcome Evaluation
PHASES OF PERIOPERATIVE NURSING
I. PRE-OPERATIVE (before)
II. INTRAOPERATIVE (during)
III. POST OPERATIVE (after)
I. PRE-OPERATIVE PHASE - From the time the
decision is made for a surgical intervention to the
time the patient is transferred on the operating
room table.
 ➔ Pre-Op phase begins when the patient
went to the clinic of a doctor or in the ER,
where the doctor was able to assess the
patient, discuss to the patient and decide to
have a surgery to perform. The patient,
since surgical procedure was decided, that
patient is considered a Pre-op patient.
Whatever take home med, whatever
assessments, whatever laboratories that
was done to the patient, given to the
patient, those belong to the pre operative
phase. And this continues when the patient
is admitted, nurses are performing
preoperative assessment as well as the
doctors, the surgeons and all the members
of the surgical team. Including the giving of
preop medications, until such time when
the patient is being received by the OR
nurse (The floor nurse endorses the patient
to the OR nurse), still this is still a preop
phase. It depends how long the patient will
stay in the holding area, still this is a preop
phase. The preop phase ends when the
patient lies on the OR table.
ASSESSMENT
Begins with the initial contact between patient and
nurse and is ongoing throughout the period.
❖ to obtain baseline data (for comparison
during the intra and postoperative phases)
❖ to identify personal problems (from patient
history) that may require preventive nursing
interventions before surgery
❖ performed in all clients (is done in all clients
- minor, senior, adults or even the patient is
having an emergency surgery. In
emergency surgery patient, the
assessment should be done in a quick
manner but it has to be thorough because
of course the lives of our patients are at
stake if you don't do good in your complete
assessment )
❖ special consideration for pediatric and
elderly clients
1. Identify any obvious risk factors for surgery
related complications.
➢ Incidental Infections
● (e.g. UTIs) should be treated with
antibiotics but should not delay
surgery unless prosthetic material is
being implanted, in which case
incidental infections should be
controlled or eliminated before
surgery if possible
Notes: The patient has a history of infection
already, now we have to take note that there could
be an additional infection other than infections that
can occur due to surgery.
➢ Procedural Risks Factors
● Is the highest with the following:
a. Heart or Lung Surgery
b. Prostatectomy
c. Major orthopedic procedures(e.g., hip
replacement)
Notes: These are major surgeries that cause high
procedural risk. These are very expensive and
very urgent surgeries.
Note: Patients undergoing elective surgery
that has a significant risk of hemorrhage should
consider autologous transfusion. Autologous
transfusion decreases the risk of infection and
transfusion reactions.
➔ All hospitals are required to reserve blood
for surgery, all blood types.
➢ Patient Risk Factors
● Older age is associated with decreased
physiologic reserve and greater morbidity if
a complication occurs.
➔ Older people has less body mass, can
cause additional illness because they have
protein reserves and the muscle mass
decreases. We know protein promotes
healing, older patients might have delayed
 wound healing because they have
decreased body mass.
● However, chronic disorders are more
closely associated with increased
postoperative morbidity and mortality than
age alone.
➔ Meaning, those who have chronic disorders
(chronic disease - has the illness more than
6 months)
● Older age is not an absolute
contraindication to surgery.
➔ That doesn't mean that elderies cannot be
operated on, they can still undergo surgical
procedures however we consider patient
risk factors.Therefore, we need to assess
thoroughly, carefully and more keenly
during the surgical procedures.
● Emergency surgery also has a higher risk
of morbidity (get sicker) and mortality
(death)
➔ Consider them to be in an unstable health.
➢ Cardiac (Heart) Risk Factors
● dramatically increases surgical risk. Among
the most serious are the following:
➔ This will depend on the different kinds of
anesthesia that will be received by the
patients. For example, a general
anesthesia will be given to the patient,
which means that the patient is going to be
unconscious. And of course when the
patient is unconscious, the heart activity will
also be lessened. For those who have
heart problems they will have dramatically
increased surgical risks during surgery.
a. Unstable angina (chest pain - ang circulation
sa heart kulang sa oxygen and gina receive sang
heart. So if less oxygenated ang heart, less man
ang oxygen nga ma distribute sa different parts of
the body. Having an unstable angina also possess
higher risk factor)
b. Recent MI (Myocardial infarction - heart
attack)
c. Poorly controlled heart failure
Note: When a heart disorder cannot be
corrected before surgery, intraoperative and
sometimes preoperative monitoring with pulmonary
artery catheterization may be advised.
➔ When a heart disorder cannot be corrected
before surgery, can a patient go on a
surgical procedure? YES, they can still
continue, we cannot let the patient die. The
pulmonary catheter will monitor the heart
activity of the patient, done peroperatively.
Intraoperative , during the procedure, this
cardiologist or internal medicine nga ang
iya nga focus is on the heart or the vascular
system. This doctor who is not a surgeon
will also go inside the OR. They will be
there only to do this particular procedure
that is to monitor the heart activity of the
patient during the time that the patient is
operated on.
2.Assess patient’s nutritional status
● Optimal/good nutrition is an essential factor
in promoting healing and revisiting infection
and other surgical complications.
Notes: we assess patients both for overnutrition
and undernutrition.
● Assessment provides information on any
nutritional deficiency clients may have and
can be corrected prior to the surgery.
Undernutrition - if surgery can be delayed
for several weeks, sometimes nutritional
deficiencies are correctable.
- Usually the patient’s calorie and
protein (help with wound healing)
intake should be increased during
the perioperative period.
● Overnutrition/Obesity - is unlikely to be
correctable in the time available.
3. Assess respiratory status
● Goal: optimal respiratory function
● Assess for history of asthma, COPD / use
of medications that may affect recovery
● Smoking is urged to stop 2 months before
surgery
➔ Kun elective man lang, so stop smoking
because we all know that smoking
 promotes vasoconstriction. So those who
are smoking can delay wound healing, and
can affect the circulation of the patient.
4.Assess cardiovascular status
● Goal: to ensure a well-functioning
cardiovascular system to meet the oxygen,
fluid and nutritional needs pre-op
● CVD increases surgical risk
5. Assess for reports and evidence of F/E
imbalance
● Dehydration, hypovolemia (decrease level
of volume of blood) and electrolyte
imbalances can lead to significant problems
during surgery; it must be corrected to
promote the best possible preoperative
condition.
● FLUID AND ELECTROLYTE IMBALANCE
should be corrected before surgery if
possible. Dehydration should be treated
with IV normal saline because BP tends to
fall when anesthesia is induced. Potassium
deficiencies should be corrected to reduce
risk of arrhythmia
➔ If dehydrated ka, hypotension follows
especially when anesthesia is introduced.
After induction of anesthesia, naga
decreased and BP sang patient naton, so
kun less nagid ang fluid nila, hypotensive
pagid sila. Potassium is an electrolyte.
6. Assess renal and hepatic function.
● Presurgical Goal: Optimal function of the
liver and urinary system.
● Medications/anesthetic agents, body
wastes and toxins are processed well and
removed from the body.
● Liver aids in metabolism, important in the
biotransformation of anesthetic
compounds. Assessed with the help of
various liver function tests.
● Kidneys involved in excreting anesthetics
and their metabolites
➔ Liver - metabolizes; Kidneys - excretes
7.Examine clients’ record for endocrine and
metabolic problem.
● Note if client is diabetic
● DM clients - Hypo/hyperglycemia may
develop and must be corrected and closely
monitored.
➔ Hypo/hyperglycemia may develop
during the surgery unless be
corrected and closely monitored.
Remember if ang patient mag
undergo surgery and ila body
unstable, if they have existing
diabetes pwede sila mag
Hypo/hyperglycemia.
● Clients receiving corticosteroids are at risk
for adrenal insufficiency and history must
be reported.
● Clients with uncontrolled thyroid disorder
are at risk for thyrotoxicosis (hyper -
increase in T3 and T4 levels) and
respiratory failure (hypo - decreased in T3
and T4 levels).
8. Assess immunologic and hematologic function.
● Determine existence of allergies (food,
drugs, BT (blood transfusion), contrast
agents, latex, etc.), nature of previous
allergic reactions
➔ For example, if the client is allergic
to seafood, seafoods are rich in
iodine. So if the patient is allergic to
seafood, therefore she is allergic to
iodine. In some of the intraoperative
procedures, they used dye which is
also rich in iodine. So it that means
nga if ang client allergic to seafood,
the client might be also allergic to
dye that they might use during the
procedure.
● Clients who are immunosuppressed
(corticosteroid therapy, renal transplant,
radiation therapy chemotherapy, AIDS,
Leukemia) are highly susceptible to
infection
➔ Immunocompromised/
Immunosuppressed - low immune
system
9. Assess for Neurologic function
● GCS (Glasgow Coma Scale) and LOC
(Level of Consciousness)
10. Assess for integumentary system
● Check for presence of existing scars and
any other break in the skin integrity
➔ Especially on the incision site
11. Evaluate medication history.
➔ Any history of illness is very important so
that we would know how to take care of
patient during the surgery
12. Obtain a history of drug and alcohol abuse.
● Obtain a medication history, prescribed and
unprescribed must be documented
because of possibility of drug interaction
especially with anesthetics
➔ So basi hindi mag effect and
anesthesia because ang client is
taking an existing drug that
counteracts the effects of anethesia
● Usually denied if history is obtained poorly
● The nurse should ask frank questions with
patience, care and with a nonjudgmental
attitude
● Surgical risks is increased with chronic
alcoholism/drug abuse
● Alcohol withdrawal delirium/delirium
tremens (DT) is anticipated up to 72 hours.
DT occurring post-op is associated with a
significant mortality rate.
➔ So pwede and patient ma patay if
they will have a delirium tremens.
For example, the surgical team was
not able to identify this, so the
patient can die because the surgery
will not last 24 hours unless the
surgery is very invasive and
complicated.
13. Assess client for any prosthetics or metal
implants.
14. Assess client and his family’s knowledge.
15. Consider psychosocial factors.
● Surgery is somewhat being feared
● The extent to which client fear surgery
depends on:
• General responses to stress
• Mental health
• Preconception during surgery and
anesthesia
Note: Fear of the unknown is one of the most
common causes of pre op anxiety. And anxiety
is an anticipatory response. Also fear of:
❖ Postoperative pain
❖ Discovery of cancer
❖ Loss of an organ or limb
❖ Anesthesia
❖ Vulnerability while unconscious
❖ Loss of social and familial roles
❖ Threats to loss of job or financial security
❖ Disruption of lifestyle
❖ Separation from significant others
❖ Death
16. Assess patients’ spiritual and cultural beliefs.
● Plays an important role in how people cope
with fear and anxiety.
PATIENTS WITH SPECIAL NEEDS:
1. The Ambulatory Surgical Patients
➔ patients who are able to walk, up and about
and able to understand
➢ Nurse must comprehensively assess and
anticipate patients’ needs
➢ Provide orientation of the client and his
family
➔ It doesn't mean that because the
patient is ambulatory you won't
orient them anymore, still they need
to understand what's gonna be
done to their body during an
operation.
➢ Acquaint them with the perioperative flow
➢ Discharge plans and follow up care must
be well in place
3. Age - Extreme Patients ➢ Emergency surgeries are unplanned, with
➔ Elderky and pediatric patients little time of preparation
➢ Note for the hazards of surgery / less ➢ Informed Consent and essential information
physiologic reserve: difficult to obtain especially if unconscious
★ Cardiac reserve is low ➢ Need adequate explanation on
★ GI activity is likely reduced perioperative care and support.
★ with sensory limitations
★ mobility is affected PREOPERATIVE DIAGNOSTICS TESTS
★ susceptible to changes in ➔ These are standard laboratory tests that
temperature needs to be available sa chart sang patient
➔ The thermoregulatory functions of to identify the status of the patient
Pediatric patients are not yet intact. One of Serum K - to identify hyper /
the interventions in the OR is to provide hypokalemia
warmers both in elders and pediatric
patients Serum NA - to identify hyper /
➢ Musts: skillful preoperative assessment and hyponatremia,
treatment, skillful anesthesia and surgery, dehydration and
meticulous and competent postoperative overhydration
and post anesthesia management
Glucose - to identify hyper /
4. Patients with disability. (FBS) fasting hypoglycemia
➢ Needs assistive devices blood sugar
➢ Modification in preoperative teaching
Creatinine - to identify acute or
➢ Additional assistance and attention to
chronic renal disease
positioning and transfer
➢ Note effect of disability on surgery and
anesthesia
- to identify impaired
BUN (Blood liver, kidney function or
5. Patients with nutritional needs urea nitrogen) excessive protein or
tissue catabolism
6.Patients with Diabetes
Hemoglobin - to determine presence
7.Pregnant Surgical Patients Hematocrit and extent of anemia

➢ We deal with the mother and the fetus Prothrombin - to identify blood
➔ Pregnant patients are not exempted for Time clotting dysfunction
surgery when they need it
Partial - to identify deficiency of
➔ plays an important role in how people with Thromboplastin coagulation factors
fear and anxiety Time

8. Obese Patients Chest x-ray - to determine size and

➢ Increases risk for surgical complications contour of the heart,
➢ Increases technical and mechanical lungs and major vessels
problems related to surgery

9. Clients undergoing Emergency

Electrocardiogram - to determine the Session 3: Informed Consent to Preparing
electrical activity of the the Client on the Day of the Surgery
heart
➔ Take note that the clients who will undergo INFORMED CONSENT
surgery are prone to bleeding. So if they ➢ A legal document
have problems with the PT and the PPT ➔ it has to be signed by the patient
this poses a bleeding tendency for them ➢ Guards the client against unwanted
invasive procedures
NURSING DIAGNOSIS
➔ before the patient is brought to the
1. Anxiety OR, the patient needs to sign this
2. Pain consent. This would inform/serve as
3. Deficient knowledge a document telling the public or
allowing the surgeon that a surgery
can be done to the patient. The
➔ These are the common nursing diagnosis patient allows the surgeon that a
after surgery surgery can be done
➢ Protects the health care facility and
personnel
PLANNING AND OUTCOME IDENTIFICATION ○ Validity:
1. Promote measures to decrease 1. Be of legal age (18 & above)
anxiety 2. Signed before
2. Discuss the surgical experience. premedications
3. Provide client and family health (medications given before
teaching the surgery) are given
4. Perform preoperative skin preparation ➔ Most of the medications given alters the
5. Provide GI prep as prescribed brain function of our patient. They are
6. Secure an informed consent placed into an unconscious state or they
7. Perform standard preoperative become drowsy. So the consent form
procedure should be signed before the pre-op
8. Ensure safe transport of the client to medications. The level of consciousness
OR/surgical unit. should be intact.
3. Signed before going to the
OR/treatment area, except in
OUTCOME EVALUATION life threatening situations
1. The client exhibit and reports (we have to adjust in
decreased anxiety emergency situations)
2. The clients’ family reports decrease in 4. Given freely without coercion
anxiety (does it freely, allowing the
3. The client is able to verbalize an surgeon to do an operation)
understanding of the surgical 5. If the patient is a minor, a
procedure, preop care and expected court of competent
postop course. jurisdiction may legalize the
4. The client verbalizes understanding of procedure in the absence of
postop pain relief
 a legal guardian.
(emergency situations)
6. A spouse or a responsible
relative may sign for an adult
or emancipated minor who is
under the influence of
alcohol or chemical
substance.
NOTE:
● An emancipated minor is a child who has
been granted the status of adulthood by a
court order or other formal arrangement.
This status is not automatically bestowed
on minors who have simply moved away
from their parents’ homes, however. The
majority of legally emancipated minors are
working teenagers who have demonstrated
the ability to support themselves financially.
For example, a professional
actress/musician who is at least 14 yrs old
is more likely to be considered
emancipated minor than a runaway who
works part-time for minimum wage.
● In many countries (esp in US) when a child
reaches what is known as the age of
majority-often 18 yrs old - he or she is said
to be fully emancipated from parental
control. This means that he/she can enjoy
all the privileges & responsibilities of
adulthood, such as voting, marriage and
financial independence. For certain children
who are younger than this age, however,
adult - level responsibilities and
independence are already a reality, and
many of them have become emancipated
minors.
7. A signed consent is legally regarded as valid
for as long as the patient still consents for the
procedure.
➔ Every procedure there is an informed
consent
8. Institutional policy may vary.
➔ some has only 24/48 hrs validity, the nurse
should abide the policy depends on the
institution you’re working at.
➔ The informed consent becomes invalid if
the client signed for a procedure for
appendectomy however, during the time
he/she was in the OR another problem was
identified, so before doing a different
operation the patient has to sign again
another consent. If the patient is already
asleep in the OR the doctor needs the (for
ex.) spouse/parents to sign another
consent
CONSENT IN EMERGENCY SITUATION
● In life-threatening emergency, consent is
derived but not essential
For a minor, telegram or written
communication or by telephone maybe
accepted from a legal guardian/responsible
relative
➔ The doctor can sign the consent on
behalf of the patient.
● If obtained by PHONE a nurses should
monitor the call and will be signed later by
the legal guardian upon arrival at the
hospital
● In lieu of this method, a written consultation
by 2 physician other than the surgeon can
suffice until a relative can sign
Note: The consent must be on the chart
and is properly signed and the information
on the form must be correct
➔ Informed consent varies per
institutional policy. The phase and
the content are usually similar but
different lang b ang interface but the
content are usually similar if not the
same.
➔ Always check for the correct
spelling of the name of the patient,
name of the surgical procedure, the
details, and etc.

NURSES ROLE IN INFORMED CONSENT
A Nurse…
•May witness the IC process between the
physician and the patient
➔ Who is responsible for the signing of
the informed consent? - It is the
physician, not the nurse. The nurse
will just witness. If the physician is
not around, the resident
doctor/physician is the one
explaining the surgery to the patient
and the one who will initiate the
signing of the informed consent.
•May not be delegated with the
responsibility of obtaining an IC behalf of
the physician
➔ For example, if we are friends with
the attending physician or the
resident doctor, can he or she ask a
favor from you to delegate the
responsibility to sign the informed
consent? -No, because this is a
legal document. You can be sued if
as a nurse you will initiate.
•May witness the signature of the patient in
the consent form
•However, in much the same way that the
physician must discuss the medical
information concerning the treatment or the
procedure, a nurse also has an
independent duty to inform the patient of
nursing care and services rendered.
➔ As a nurse, explain only the nursing
intervention. If the patient asks about a
surgical / medical procedure, ask them to
address the question to the surgeon or to
the doctor, or ask “ano ang gin
discuss/explain sang doctor mo na wala mo
ma intindihan?” then explain that certain
part.
PREOPERATIVE TEACHING
➔ It is very important to do the health teaching
that should be done during the pre-op
phase
➔ This is very important because these are
the things they need to do most especially
during the pre-op phase, and take note that
there are so many things that could happen
during the post op phase, and these
complications can be prevented if we were
able to give the complete and correct
preoperative teaching
Essential aspects that must be covered:
1. Deep breathing, coughing exercise
& incentive spirometry
➔ During the post op phase, the
effects of the anesthesia dies down,
pain will rise up meaning the pain of
the patient increases. There will be
medications that will help with the
pain but again this is one of the fear
of our patients during post op
phase. So the tendency of the
patient, especially in an abdominal
surgery or the patient has an
incision in the abdomen, for
example, when you inhale, you
notice that your intrathoracic cavity
expands, your lungs go bigger. So
ang tendency the lungs will inflate
will push the diaphragm down, so
the abdomen will also be inflated, so
ang tendy if may inflate na ang
abdomen it will stretch out, so ma
feel pain ang patient sa operative
site. So ang tendency, they will hold
their breath, they will not do the
deep breathing, and coughing
exercises. Because it will increase
their pain. That is why atelectasis
or lung collapse is common in post
operative patients because and
tendency they try to hold their
breath. So if they hold their breath,
 their lungs cannot expand so their
lungs collapse. So that is why we
teach them deep breathing and
cough exercises and incentive
spirometry during preoperative
phase. We teach them and then we
let them practice.
2. Turning and extremity exercise.
Mobility and active body movement.
➔ Like we have discussed in
abdominal surgery, the patient
has a difficulty to turn, so the
tendency is that they will lie down
on bed so they are prone to
immobility and many
complication one of which is they
can develop a decubitus ulcer.
Very important and early
ambulation. It doesn't mean na
the patients just lie there in their
beds, and stay their because of
the pain, NO, we need to
encourage them to do early
ambulation so that they could go
back to their daily activities.
3. Pain control/management
➔ Pain control is not only applicable by
receiving medications. One of our nursing
responsibilities - pain control can also be
done by splinting exercises. Splinting
exercises especially in abdominal
surgeries.
➔ Splinting exercises - take a pillow, put it at
top of patients abdomen or on top of the
incision site, so that when the patient’s
inhales the entire thoracic cavity increases,
pushing the diaphragm down and
expanding the abdomen so the incision will
stretch and there will be pain. When patient
inhales, the client pushes the pillow
towards the abdomen, towards the incision
site so that ma splint or ma control ang
pain.
➔ Pressure sensation is being interpreted by
the brain faster than the pain receptor.
Instead of feeling the pain, the client can
feel the pressure, amo na ga minimize and
feeling of pain.
➔ For example, have you experienced having
a cut in your hand and there is bleeding
and there is pain. Ang tendency naton is to
put pressure on it, so when we put pressure
on it we can still feel the pain but it has
been minimized.
4. Postoperative appearance
➔ For example, they will be undergoing a
c-section, the baby will be taken out
through the abdomen via an incision, so e
orientation mo na daan ang patient na after
the surgery they will expect that an incision
will be seen here. Dapat ikaw man as a
nurse balan mo man ano ang plan of action
sa surgery.
➔ Especially for example, those patients na
expected na may mga drain, like colostomy.
For example may mga bowel movement,
their feces will go out on the colostomy,
giving time for the bowel to clear.
5. Early ambulation
➔ This is very important, remember the client
should not be independent, he or she
should be active post op.
PHYSICAL PREPARATION
A. Preparing the skin
➢ Purpose: to render the
surgical site free from
microorganisms, dirt and
skin oils
➢ Mechanical Cleaning:
•Bathing patient prior to
surgery (antiseptic solution)
Hair removal
•Can injure skin, potential for infection
 •Remove thick hairs surrounding incision
site, may interfere with exposure
•Skin closure or dressing, and prevent skin
contact with electrodes
•Carried out per doctors’ order
(preoperative unit or in OR) close to
scheduled time as possible
➔ We don't shave or do hair removal
without the doctor's order.
•Provide privacy – cover patient
•Apply depilatory cream or careful shaving
with razor
A. SKIN PREPPING
1. Lower Extremity Front/Back
Ø If the operation is in the distal
portion, clean from 2 inches above
the knee, all around the extremity to
the toes.
Ø If the operation is at the knee or
little bit above or below it, clean the
entire extremity from the groin to the
toes.
Ø Pay attention to digital spaces.
2. Upper Extremity Front/Back
Ø If operation is at the distal portion,
clean from 2 inches above the
elbow to the fingers all around.
Ø If the operation is at the elbow or a
little above or below it shave from
the axilla to the fingers and all
around the extremities.
3. Thoracic-Front/Back
Ø In chest operation, shave from the
base of the neck to the waistline
including the axilla and inner aspect
of the arm.
Ø Posteriorly, shave from the shoulder
line down to the waist extending 2.5
beyond the spinal column.
4. Neck Front/Back
Ø Anteriorly shave from the chin down
to the nipple line. Laterally shave
from the patient’s hairline to the
sides of the neck including the
shoulders and axilla. Posteriorly,
shave the hairline down to the level
of the clavicle.
5. Abdomino-Perineal/Pelvic
Ø Shave from the nipple line down to
the symphysis pubis, vulva,
perineum and the thighs 2 inches
from the groin. Include the sides or
flanks of the patient.
6. Vaginal, Scrotal and Rectal
Operations
Ø Shave the waistline to the perineum.
Ø Include the anterior and inner
aspects of the thighs 6 inches from
the groin.
Ø Posteriorly, shave entire buttocks.
Ø Pay particular attention to the hair
between the folds of the buttocks
and anus.
7. Eye operation
Ø Cut the eyelashes of the affected
eye this is down in the operating
room use small straight eye
scissors.
Ø Clean with alcohol and apply
Vaseline
8. Kidney Operation
Ø Anteriorly shave from the nipple line
down to the perineum from side to
side
Ø Posteriorly on the affected side,
shave from the subscapular area
 down to the buttocks and 2 inches
beyond the spinal column
9. Nasal and Sinus Operation
Ø No shaving is done unless the
patient has moustache, with hairy
face or hairy nose
10. Ear operation
Ø Shave 2.5 inches around the ear
SPECIAL CONSIDERATIONS:
1. To determine the area to be shaved,
know the operation to be done, the
organ involve and its location and the
proposed incision
2. Practice modesty and provide privacy
3. Ask the patient’s permission in cutting
the eyelashes and hair
4. Examine the area to be shaved for any
signs of irritation or any abnormal
conditions. Report this to your head
nurse
5. Do not cut the patient’s skin
6. In abdominal operations, pay particular
attention to the umbilicus (to minimize
infection)
7. Shave the operative site on the day or
the night before the operation
8. Discard soiled sponges in your kidney
basin
9. In shaving, follow the direction of the
growth of hair while free hand exerts an
opposite force by pulling the skin to the
opposite direction
10. If a wound is present on the area to be
shaved, start from the clean area to the
dirty area
B. Preparing the Gastrointestinal Tract: done
the night prior to surgery
Purpose:
➢ Reduce the possibility of vomiting and
aspiration during anesthesia
➔ When the client receives
anesthesia, the bowel motility of the
patient decreases. When there is a
decrease in bowel motility, vomiting
and aspiration can occur. That is
why the GI tract is cleansed or prep
prior (wala unod). Make sure that
the client is able to defecate.
➢ Reduce possibility of bowel obstruction
➢ Prevent contamination from fecal material
during intestinal or bowel surgery
Preparation includes:
1. Restricting food and fluids/NPO
o Latest updates on NPO
status according to
American Society of
Anesthesiologists (ASA)
o Clear liquids
consumption
● 2 hours prior to surgery
requiring GA, RA or Sedation
Anesthesia
o A light breakfast
● permitted 6 hours before
procedure/surgery
o A heavy meal
● 8 hours before surgery
2. Administration of enema as needed
3. Insertion of GI tubes when appropriate (NGT,
Rectal tubes)
C. Preparing for Anesthesia: The
Anesthesiologist / Nurse Anesthetist must:
1. Do pre-op visit, check CP clearance,
neurological examination
2. Discuss type of anesthesia
3. Address fears concerning anesthesia
D. Promoting Rest and Sleep. The night prior to
surgery client must be:
• Physically comfortable
• Mentally at ease
• Adequately sedated for apprehensive
clients – tranquilizers are given)
PREPARING CLIENT ON THE DAY OF THE
SURGERY
➢ Check and carry out doctors order
➢ Ensure checking of vital signs, ID bands,
skin prep as ordered, NPO status and urine
output
➢ Remove jewelries, dentures, braces, nail
polish, contact lens, make ups and
underwear
➢ If wearing a hearing aid, notify OR nurse
➢ Continue to assess for anxiety/fear
NOTE: immediate Preoperative Care begins 1-2
hours before surgery
1. Preoperative medication
➢ Prior to administration, check consent
and transfusion permit are correctly
signed and attached to chart
o Allay anxiety
o Decrease pharyngeal
secretions
o Reduce side effects of
anesthetic agents
o Creates amnesia
2. Maintaining the preoperative record
3. Transporting patient to the pre-surgical
area
4. Attending to the family needs
Session 4: Intraoperative Phase to Key words
of OR practice
II. INTRAOPERATIVE PHASE
Ø Begins when client is transferred to
OR table and ends in admission to
Post Anesthesia Care Unit (PACU)
➔ There are times that the patient is already
inside the OR but there are times that they
stay at the holding area for continuous
assessment that is still part of the
preoperative phase.
Ø Nursing care focuses in the clients
emotion well-being and physical factors
➔ Take note, that there are many cases that
the anesthesia has not yet been delivered
unless pre medication is already given in
the holding area.
Ø At this time, the client is identified by
the surgeon and anesthesiologist,
anesthetized, positioned, has the skin
prepared and is draped for surgery
MEMBERS OF THE SURGICAL TEAM
➔ Remember: circulating nurse is un-strile
while the scrub nurse is sterile
Ø A group of highly trained individuals
who must work together as a
coordinated team for the welfare and
 safety of the client undergoing surgery
The team is composed of the following:
A. Surgeon
❖ Heads the surgical team and makes
major decisions concerning the
course of surgery like removing an
organ, amputate a limb, etc.
➔ Act as the captain of the ship. Decides how
the surgery will flow.
B. Anesthesiologists/Nurse
Anesthetist (a RN with special
education on anesthesia) Alleviates
pain and promotes relaxation with
medication. They must:
1. Maintain airway
2. Ensure client has O2 and CO2 exchange
3. Infuse blood, fluids and meds. To maintain
hemodynamic stability
4. Monitor clients circulation and respiration
5. Alert the surgeon immediately about
complication
C. Circulating Nurse
❖ RN who acts as the manager of the
operating room for a particular case
➔ Remember that during a surgical
procedure, the circulating nurse and the
scrub nurse is necessary. In some
particular cases, there are two nurses in
incharge of the operation (circulating nurse
and scrub nurse).
❖ Promotes smooth and safe function of the
OR by bringing needed supplies to the
operating table, assists in sponge, sharps
and instrument count and removes
unnecessary items and specimen.
❖ Runner of the surgical team
D. Scrub Nurse
❖ RN, member of the staff who prepares the
sterilized instruments and equipment ready
for the operation
➔ The one touching the instruments and
supplies that are sterile, the one passing
instruments to the doctor.
NOTE: The surgical team may also include other
members of the health care team when surgical
procedure so dictates such as:
➔ assistant scrub nurse, assistant to the
surgeon.
E. X-ray technicians—for cholangiograms
F. Pathologist –for frozen section
procedures (ex: mastectomy)
➔ To identify if it is cancerous or benign
Assisting the surgeon: What are expected of an
O.R. Nurse?
An OR Nurse must:
1. Have a good technical skill
2. Be a good communicator—able
to identify sigh languages
especially
3. Be flexible—able to adjust
easily in any kind of situation
4. Have anticipation—be quick
thinker
5. Be able to work on a high
tension environment of the
operating room
SURGICAL SUITE DESIGN / O.R. DESIGN
➢ The activities that occur in the OR has one
common goal: “To provide a safe,
therapeutic environment for the patient”.
❖ Purpose of a modern surgical suite
• To ensure geographic isolation
from unauthorized persons
• To centralize equipment,
supplies and personnel
 • To obtain bacteriologic isolation o Peripheral support consists of storage
through specific practices, attire, area for clean and sterile supplies, a sterile
delivery and disposal systems. processing areas and corridors leading to
procedure rooms and sub sterile utility
areas.
THREE ZONES OF THE OR
A. Unrestricted Area (unsterile area) C. Restricted area (sterile area)
o Entrance / exit o Procedure room in which surgery is
from OR performed; and other sub sterile areas
where the scrub sink and autoclave is
o Holding or located
admission area and
PACU o proper operating room attire and surgical
mask is worn by all in this area for
o Dressing rooms,
maximum protection from possible
Lounges, offices, contamination
storage rooms / areas

➔ As an OR nurse or a PROTECTIVE BARRIERS:

member of the ➢ lessen the risk to infection
surgical team, we ➢ OR attire includes:
change into our scrub 1. Scrub suits
suits when we get 2. Head caps or hoods - to protect
inside the OR. we your hair from falling out
don't wear the same 3. Shoe covering (OR shoes/OR
scrub suits that we slippers)
are wearing outside 4. Masks
the OR. (additional:clean gloves and gown)
B. Semi-restricted Area Special Considerations:
(semi-sterile area) ❖ Jewelries like dangling earrings/necklace or
o Access to the ring with stone are not allowed—they might
procedure rooms and fall into the sterile field.
peripheral support ❖ Leap aprons—to protect from radiological
areas within the OR examination
➔ Here, it is expected
that the members of NOTE: No OR attire should be worn outside the
the surgical team operating room
have suits here and
MAINTAINING A STERILE FIELD
OR caps.
A. Sterile gowns and gloves
o Proper OR attire is
required ➢ Prevents microorganism on hands and
clothing from contaminating the wound
 during surgery and protect personnel from
microorganism present in the patient
B. Draping materials
➢ Barrier between the sterile and unsterile
areas
➢ Patient and operating table is covered with
sterile drapes exposing the operative site
➢ Good surgery draping is one of the keys to
reducing surgical site infections (one of the
most common and most dangerous)
complications of surgery.
➢ Proper draping for abdominal surgery is
important because the abdomen is a site
where avoiding infection is of particular
concern
UNIVERSAL PRECAUTION
❖ Routine medical history and examination
cannot determine patients with HIV,
hepatitis and other blood borne pathogens,
universal precautions are used for all
patients
❖ Eyewear—protects mucous membranes of
the eye
❖ Googles w/ enclosed sides—offer better
protection
❖ Double gloving—when procedure is
considered dirty
Environmental Control
❖ Humidity and temperature are important
design factor
❖ High relative humidity should be maintained
❖ Moisture provide relatively conductive
medium for bacterial growth
➔ Sweat produces moisture that
produces bacterial growth
❖ Temperature is kept purposely cool to deter
or prevent bacterial growth
Sterilization of Supplies
❖ Adequately “sterilize” all supplies and
instrument used for surgical procedure to
ensure total absence of microorganism
including spores
Surgical Hand Scrub
➢ Hands are the major source of pathogenic
bacteria, thus SHS before donning sterile
gown and gloves is a must
6 Steps in Pre-Surgical Hand Washing
Technique
1. Palm to palm
2. Right palm over left dorsum and left
palm over right dorsum
3. Palm to palm fingers interlaced
4. Backs of fingers to opposing palm with
fingers interlocked
5. Rotational rubbing of right thumb
clasped in left palm and vice versa
6. Rotational rubbing , backwards and
forwards with clasped fingers of right
hand in left palm and vice versa
Methods of Surgical Hand Scrubbing
a) Timed method.
Using a clock or some other timing device
to measure brushing time, the length of
the scrub varies from one institution to
another. This method has been most
frequently used in the past.
b) Counted brush-stroke.
A prescribed number of brush-strokes,
applied lengthwise of the brush or
sponge, is used for each surface of the
fingers, hands, and arms.
o Scrub the spaces under the
fingernails of the right or left
hand 30 circular strokes
 o Scrub 20 circular strokes on all
four sides of each finger
o Lather palm, back of hand, heel
of hand, and space between
thumb and index finger choosing
either of the structures, scrub 20
circular strokes on each surface
NOTE: Surgical scrub agents come in many forms.
Not at all forms meet all characteristics
1. Liquid or foam soaps. These are
the most common products for surgical
scrubs and are used in conjunction with
water and dry scrub brushes or
sponges. These agents are very drying
and with repeated scrubbing with the
scrub brush can cause skin damage.
a. CHG (chlorhexidine
gluconate)
b. iodophor
c. PCMX
(parachlorometaxylenol).
➔ In the future, when we will
require you to duty in OR,
we will require you to bring
your hand lotions because
this will help you nourish the
skin to prevent damage, or
skin breaks
2. Impregnated scrub
brushes/sponges. Scrub
brushes/sponges are preloaded
with CHG, iodophor or PMX and are
water-aided products
➔ Difference of liquid or foam soaps to
impregnated scrubs is that liquid or
foam needs a separate brush or
scrub and you will obtain it from the
container while the impregnated
sponge is loaded already from the
agent.
3. Brush-free surgical scrub. These
products use an antimicrobial agent
and water but no scrub brush.
● STERILLIUM (alcohol
based)
● AVAGARD (lotion based)
SURGICAL CONSCIENCE
❖ It is personal moral values and
professional ethics that guide health care
professionals to carefully and vigilantly
protect their patients May simply be stated
as the golden rule:
❖ “Do unto the patient as you would have
other do unto you” (one must consider each
patient as oneself)
❖ Involves a concept of self inspection
coupled with moral obligation
❖ It is one’s inner voice for conscientious
practice of asepsis and sterile technique at
all times
❖ Does not permit a person to excuse an
error but rather admit and rectify one
➔ Surgical conscience is very important
because this will guide us to do our work
well and we will not lie. So that we will do
our best.
Florence Nightingale Quotes:
“The nurse must keep a high sense of duty in her
own mind, must aim at perfection in her care and
must be consistent always in herself .”
SC does not permit a person to excuse an
error but rather admit and rectify one.
Keywords of OR Practice
• Caring
• Conscience
• Discipline
• Technique
 Session 5: Principles of Sterile
Technique
PRINCIPLES OF STERILE TECHNIQUE.
Standard of OR practice
➔ 13 principles of sterile technique, guide that
we need to remember so that we can
maintain a sterile field and we are able to
perform our duties and responsibilities both
as a OR nurse, who is functioning as a
scrub nurse or a circulating nurse
Surgical asepsis, or aseptic technique
❖ Is designed to get rid of pathogenic
microorganisms from areas or objects
➔ We make sure that the items,
objects that we are gonna use in
surgical procedures in our patient is
free of this microorganisms
❖ It is also used to keep areas and objects
free of microorganisms
❖ Surgical asepsis demands more
precautions than medical asepsis
➔ Medical asepsis, usually it is a clean
technique but in surgical asepsis we
follow sterility
❖ Aseptic technique is commonly used in
surgery, labor and delivery, in procedures
that involve puncturing the skin, when the
skin’s layers are penetrated by surgical
incisions or burns, and during procedures
that involve putting objects into normally
sterile body cavities
1. Only sterile items are used within the sterile field
Discard any contaminated items:
○If a sterile package is found in a
contaminated area
➔ For example, you have this sterile
item and then you notice that it fell
down, so you have to remove it.
➔ All items should undergo
sterilization process before it can be
used in a surgical
operation/procedure
○If uncertain about the actual timing or
operation of the sterilizer
○ If an unsterile person comes into close
contact with a sterile table
➔ For example, the circulating nurse
(they are not gowned, they are not
gloved-unsterile). So, if the
circulating nurse comes accidentally
in contact with a sterile table.
○ If a sterile table or unwrapped sterile
items are not under constant supervision.
➔ Meaning, gin pabayan mo da siya
for a certain time that nobody is
watching it.
○ If the integrity of the packaging material is
not intact
➔ For example, a tear. So it means
that, that item is already unsterile
○ If a sterile package wrapped in a material
other than plastic or another
moisture-resistant barrier becomes
damp or wet
➔ In wet items,
microorganisms can grow
and becomes unsterile.
○ If a sterile package wrapped in a
previous woven material drops on the
floor or another areas of questionable
cleanliness
➔ It has to be discarded or taken out of the
sterile field because only sterile items are
used within the sterile field.
2. Gowns are considered sterile only
from waist to shoulder level in front
and the sleeves
➔ Gowns, remember if you are scrub nurses
you are to create a sterile field within
yourselves. You have to undergo surgical
hand scrubbing, gowning and gloving.
➔ So what is the principle that we need to
remember in regards to gowning?
 - Gowns are considered sterile only
from waist of the nurse and to the
shoulder area only, in front and the
sleeves.
- That means that the back of the
scrub nurse, even they are already
gowned, the back of that gown is
considered unsterile. So that means
that waist level only to shoulder. So
it means also that the knee of the
OR nurse or the Scrub nurse is
considered unsterile.The hips is
also considered unsterile. Only
waist level or the waist line, sa
umbilical area only, up to the
shoulder.
- The mask is above the elbow level
or the shoulder level, it is also
considered unsterile the same with
the cap.
➔ If you are a OR nurse or scrub nurse, you
do not touch your mask when you are
already gowned and gloved. If so, you
touch it accidentally you become unsterile.
So students nurses, if this happens to you,
we will require you to scrub out, and do
repeat the process of surgical hand
scrubbing, gowning and gloving so that you
can come again inside the OR and join the
surgical procedure.
3. Tables are sterile at the table level
only.
➔ Tables - OR table where the
instruments are being placed and
the table where the patient is lying.
Sterile table.
o Only the top of a sterile, draped table is
considered sterile. The edges and sides
of the drape extending below table
level are considered unsterile.
➔ Tables should be draped, when the tables
are not draped it is considered unsterile.
➔ The edges and sides of the drape
extending below table level are considered
unsterile. That is why, nurses do not touch
the edges of the table because it is
considered unsterile.
o Anything falling or extending over the
table edge, such as piece of suture, is
unsterile.
➔ For example, you took something from the
OR table and then you place it back and
then it went out, extending over the table
edge, so that item become unsterile.
following the principle the one, we have to
take that out because only sterile items are
used within the sterile field.
➔ Take note that you should be able to
understand this and connect these
principles to each other and brace these
principles before going on duty in the OR.
that means that you should learn this by
heart.
o When unfolding a sterile drape, the part
that drops below the table surface is not
brought back up to the table level.
4. Persons who are sterile touch only
sterile items or areas; persons who
are not touch only an unsterile area
➔ Because when an unsterile person
touches sterile items, that item
becomes unsterile.
➔ For example, the circulating nurse
(considered unsterile) touches only
unsterile area or item. Scrub nurse
only touches sterile area and items.
So when the circulating nurse
opens a sterile item, she doesn't
touch the inside of the item, she
may only touch the wrapper or the
unsterile part of the item. The inside
part of the item should only be
touched by the scrub nurse or a
sterile person.
➔ Remember, Scrub nurse -sterile,
Circulating nurse - unsterie.
o Sterile team members maintain
contact with the sterile field by
means of sterile gowns and gloves
 o The unsterile circulator does not directly
contact the sterile field
➔ When she needs something from the sterile
field, for example a specimen is taken out
already and the specimen is need to be
send to the histopath or there is a need of
the unsterile doctor to check the specimen,
so the circulator does not take the
specimen from the sterile field, instead the
scrub nurse touches the specimen and
gives it to the circulator without coming in
contact with the body parts, especially the
hands of the circulator.
o Supplies are brought to sterile team members
by the circulator, who opens the wrappers
on sterile packages.
5. Unsterile persons avoid reaching over
a sterile field; sterile person avoid
leaning over an unsterile area.
➔ For example, the wall is considered
unsterile, if the scrub nurse becomes tired,
she/he cannot lean on the wall to rest. SHe
has to maintain a distance from the
unsterile areas.
o The unsterile circulator never reaches
over a sterile field to transfer sterile items
o The circulator holds only the lip of the bottle over
the basin when pouring solution into a sterile basin
in order to avoid reaching over the sterile area.
o The scrub person sets basins or glasses to be
filled at the edge of the sterile table
6. The edges of anything that encloses
sterile contents are considered unsterile
o The inside of a wrapper is considered
sterile to within 1 inch of edges. The
circulator opens top flap away from self.
Then turns the sides under. The ends of
the flaps are secured in the hand so they
do not dangle loosely. The last flap is
pulled towards the person opening the
package, thereby exposing the package
contents away from the unsterile hand
o Sterile persons lift contents from packages by
reaching down and lifting them straight up, holding
their elbows high.
o The flaps on peel-open packages should be
pulled back, not torn, to expose the sterile
contents.
The contents should not be permitted to slide
over the edges
o After a sterile item is opened, the contents
are either used or discarded. The cap cannot
be replaced without contaminating the
pouring edges
7. A sterile field is created as close as
possible to the time of use
➔ That means that when a surgery for
example is scheduled 3pm, so they will
open the package and prepare the items in
the afternoon, in close time of its use.
Probably an hour before or the closes time
possible. You do not open the sterile
packages in the morning when its gonna
be used in the afternoon.
➔ Usually in the policy of SPH, we create the
sterile field and open the packs of the
sterile items, one hour before the surgery,
and it has to be used right away. If the
surgery becomes delayed because of
certain incidents, we discard the opened
packages because it is considered unsterile
because sterile field is created as close to
the time possible. One hour is already
maximum,
o Sterile tables are set up just prior to
the surgical procedure
o It is virtually impossible to undercover a table of
sterile contents without contamination
➔ That means that if ma open na na sa, even
the temperature is very very cold, you could
not ensure that the sterility is not violated
 because ma harbor gid na ya ang
organisms kay because it is already
opened, unless it is sealed.
➔ Of course, inside the OR you cannot feel
everything, the doors even if it is closed
there is a small opening sya gyapon na
maka sulod ang microorganisms can still
go inside that is why we create sterile fields
as close as possible to the time of its use.
o Covering sterile tables for later use is not
recommended
➔ For example, nadelay and surgery but the
scrub nurse and the circulating nurse are
able to prepare on time. They are able to
open and prepared the sterile field, then
there is a call that the surgery is to be
postponed or delayed. So can they just get
sterile drapes and cover the sterile table so
that it can be used later on? - NO, because
even when you cover the sterile table with
the sterile drape, still its not intact or its not
sealed, so consider it unsterile if cannot be
used in later time.
o A covered table is not under observation at all
times
➔ For example, if we opened the packages
and put it in the table and cover it, that
means that we can go out in the OR room
because it is less covered, for as long as
you will used the covered table right away.
Maybe you just have to leave it for just a
few mins because you really have to get
something, thats okay. If you cover it and
you will use it later on pa, that is a violation
of the principle of the sterile technique.
➔ If the table is left uncovered, it has to be
under supervision of the nurse at all times.
So it means that after you open a sterile
field, and you need to go out and check the
patient, you just have to cover it with a
sterile drape. So you can leave it for a
while and not for a long time.
8. Sterile areas are constantly kept in
view
o Sterile persons face sterile areas
o Someone must remain in the room to maintain
vigilance when sterile packs are opened in a room
or a sterile field is set up. Sterility cannot be
ensured without direct observation. An unguarded
sterile field should be considered contaminated
➔ If there is nobody to watch the sterile items,
cover it with a sterile drape.
9. Sterile persons keep well within the
sterile area
➔ They stay in the sterile area, they do not go
outside and they keep their sterility well in
the sterile area.
o Sterile persons stand back at a safe
distance from operating bed when
draping the patient
o Sterile persons pass each other back
to back at a 360-degree turn
o Sterile persons turn their backs to an
unsterile person or area when passing
➔ Remember that the back of the
gown is unsterile, so unsterile to
unsterile.
o Sterile persons face a sterile area to
pass it
o Sterile persons ask an individual to step aside
rather than risk contamination
o Sterile persons stay within sterile field. They do
not walk around or go outside the room
o Movement within and around a sterile area is
kept to a minimum to avoid contamination of sterile
items or persons
10. Sterile persons keep contact with
sterile areas to a minimum
➔ So it doesn't mean that when you are
already gowned and gloved you can touch
everything or anything at any time you
want. No, you can touch it only when you
need it.
o Sterile persons do not lean on sterile
tables or on the draped patient
o Sitting or leaning against an unsterile
surface is a break in technique
11. Unsterile persons avoid sterile area
o Unsterile persons maintain a
distance of at least 1 foot from any
area of the sterile field
o Unsterile persons face and observe
a sterile area when passing to be
sure they do not touch it
o Unsterile persons never walk
between two sterile areas
o The circulator restricts to a minimum
all activity near the sterile field
12. Destruction of the integrity of
microbial barrier result in
contamination
o Sterile packages are laid on dry
surfaces only
o If a sterile package wrapped in
absorbent material becomes damp
or wet, it is discarded
o The package is considered unsterile
if any part of it comes in contact with
moisture
o Drapes are placed on a dry field
o If solutions soak through a sterile drape to a
sterile area, the wet area is covered with
impervious sterile drapes or towels
o Sterile items are stored in clean, dry areas o
Sterile packages are handheld with clean, dry
hands
13. Microorganisms must be kept to an
irreducible minimum
➔ You cannot reduce the microorganisms but
do everything to minimize them.
o Observed gowning practices.
o Self-gowning and gloving should be done
from a separate sterile surface to avoid
dripping water onto sterile supplies or a
sterile table.
o Sterile persons keep their hands in sight
at all times and at or above waist level
or the level of the sterile field.
o Hands are kept away from the face, and
the elbows are kept close to the sides.
o The back of the gown is considered
contaminated.
o The gown is considered sterile only to
the highest level of the sterile tables.
NOTE: Observed gowning practices
o Self-gowning and gloving should be done
from a separate sterile surface to avoid
dripping water onto sterile supplies or a
sterile table
o The stockinet cuffs of the gown are
enclosed beneath sterile gloves. The
stockinet is absorbent and retains
moisture, and doesn’t provide a
microbial border
o Sterile persons keep their hands in sight
at all times and at or above waist level
or the level of the sterile field
o Hands are kept away from the face, and
the elbows are kept close to the sides
 o The back of the gown is considered
contaminated
o The gown is considered sterile only to
the highest level of the sterile tables
Note: STERILITY IS NEVER TAKEN FOR
GRANTED. IT MUST BE MAINTAINED AND
CHECKED. THERE IS NO COMPROMISE WITH
STERILITY. AN ITEM IS EITHER STERILE OR
UNSTERILE. A SINGLE BREAK IN THE
TECHNIQUE CAN COST THE LIFE OF PATIENT.
IF IN DOUBT, CONSIDER THE ITEM UNSTERILE
Session 6: Wound closure technique to
surgical dressing -WOUND CLOSURE
TECHNIQUES
➢ SUTURES
➢ STAPLES
➢ ADHESIVE SKIN GLUE
SUTURES
➢ Any strand of material used for ligating or
approximating tissue
➔ Skin incisions or surgical incisions
can be closed by the use of sutures
➢ To Suture (verb) - the act of sewing by
bringing the tissues together and holding
them until healing has taken place
➔ It is like sewing your clothes. You
bring the open tissue together,
make it close to each other as much
as possible so that healing can take
place and the wound can close.
The different types of sutures can be classified in
many ways.
A. Absorbable or Non-absorbable
1. Absorbable suture
➢ Sterile strands prepared from a collagen
derived from healthy mammals
➔ These are sterile items; sutures,
staples (kist like staplers but just
sterile), and adhesive skin glues.
➢ Don’t require your doctor to remove them.
This is because enzymes found in the
tissues of your body naturally digest them
➢ Ex. Gut, Polydioxanone (PDS),
Poliglecaprone (MONOCRYL), Polyglactin
(Vicryl). - these are the generic names and
brand names of sutures commonly you
hear during OR duties
2. Non-absorbable suture- are strands of material
that effectively resist enzymatic digestion or
absorption of living tissues
➢ Need to be removed by your doctor at a
later date or in some cases left in
permanently.
➔ Proximately removed 14 days or
monothree weeks a month after the
surgery
➢ Ex. Nylon, Polypropylene (prolene), Silk,
Polyester (ethibond)
B. According to the Actual structure of the material
1. Monofilament Suture
➔ Also known as a dye.
➢ Suture consists of a single thread.
This allows the suture to more
easily pass (the skin of the client)
2. Braided/Multifilament Sutures
➢ Consist of several small threads put
together by spinning, braiding or
twisting. This can lead to better
 security, but at the cost of increased
potential for infection
C. Classified as either being made from natural or
synthetic material
1. Natural material are more
traditional and are still used in
suturing today
➔ It means that it comes from
a natural component taken
from animals.
2. Synthetic material cause less
reaction, and the resultant
inflammatory reaction around
the suture material is minimized
NOTE: However, since all suture material is
sterilized, this distinction is not particularly useful
➔ Because we use materials that are sterile
USES OF SUTURE:
a)Ligature / suture ligature—the
material that is tied around a blood
vessel to occlude the lumen
➔ Used to ligate, to block or to suture a lumen
• It is especially used for arteries,
because the thicker wall and
increased interior pressure of an
artery can cause a regular tie to
come off the vessel.
➔ With the use of a forcep, it can securely, it
can attach or suture the blood vessel
SURGICAL NEEDLES
➢ Needed to carry the suture material
through tissue with the least amount
of trauma Basic parts of the needle:
1. Point (sharp part that comes in
contact first in the skin)
2. Body
3. Eye (attached to tie)
Eye of the needles:
1. Oblong / regular eye
2. French / spring eye (little bit triangular)
3. Eyeless (swaged)
➔ It doesn't have an eye, instead a suture is
attached to it
• Rolled-end (wrapped around /
roll around the needle)
• Drilled-end (being drilled in)
4. French/Spring Double eyes (has two eye)

b) Free tie—are lengths of suture without

a needle
o a single strand of material handed to the
surgeon/assistant to ligate a vessel
➔ It consist of only a tie, notice that there is
no needle attached in suture the end
➔ When offering free tie on the surgeon, you
extend the thread or the suture so that the
surgeon can grasp it
c) Stick tie—a strand attached to a
forceps (kelly curve / kelly straight)
• Is a more secure technique to
control bleeding from a blood
vessel
Needles Point types cannot, it will cause trauma or
break.
4. Appropriate in shape and size for
the type, condition and accessibility
of the tissue to be sutured
5. Free from corrosions and burrs

Surgical staples

➢ Cutting (conventional, reverse, or

side[spatula])
➔ Triangular in shape. ➔ Remember that this is also sterile because
➢ Beveled, conventional cutting edge we use everything in the sterile field, sterile.
The bala is called staples.
➢ Taper-point (round)
➢ Are specialized staples used in surgery in
➔ The point of the needle is sharp and
place of suture to close skin wounds,
the body is round in shape
connect or remove parts of the bowels or
➢ Blunt point
lungs
➔ The point of the needle is not that
➢ The use of staples over sutures reduces
sharp
the local inflammatory response, width of
➔ Similar to taper point, it is also
the wound, and the time it takes to close
known as round point needle but
➔ Mas dasig ang closing time sang wound sa
only blunt
surgical staplers
★ Basically there are two types of needle
point:
Surgical staple remover
➔ Round - taper-point or blunt point
➔ Cutting - conventional cutting,
reverse cutting, or triangular in
shape
Qualities of a good surgical needle
1. Strong
2. Rigid
3. The same diameter as the suture
material
➔ Imagine, if your suture material has
a bigger diameter than your surgical
needle. Your surgical needle can
pass but your surgical material
 ➢ Provides a fast and easy removal of all
brands of surgical skin staples for versatile
use
➢ It removes staples by placing the tips under
each staple for reliable, consistent
performance.
➢ Scissor style
Surgical stapler
SURGICAL SKIN SEALANTS (SKIN GLUE)
❖ Surgical glues (also called surgical sealants
or adhesives)
❖ Used after a surgery or traumatic injury to
bind together external or internal tissue
❖ Surgical glues can be used in conjunction
with or as an alternative to sutures’ and
staples;
❖ They use a chemical bond to hold tissue
together for healing or serve as a barrier to
stop the flow of bodily fluids
❖ The five main types of surgical glues are:
1. fibrin sealants
2. Cyanoacrylates
3. collagen-based compounds
4. glutaraldehyde glues
5. hydrogels
SURGICAL BLADES
➢ Comes in different sizes, forms and
purpose
➔ This is attached to blade handles that will
become your surgical knife or knife used to
cut the skin.
No. 10 - regular blade
No. 11 - stab knife
No. 12 - hook knife
No. 18 - incision knife
Surgical Incision Site preparation
➔ Before we create a surgical incision, we
first prep or clean the site to prevent
infection.
➢ The operative site is cleaned/prepared with
antimicrobial agent
Ex. Betadine soap (7.5% conc.) – povidone
iodine or chlorhexidine ; phisohex/hibiclens
- usually used in genital areas
SURGICAL INCISIONS
➢ The cutting of or into body tissues or
organs (especially by a surgeon as part of
an operation)
➢ The decision to select a specific incision
would depend on several elements:
o Problem site
o Related anatomical structures
o Easy access
o Less complications
o Quicker healing
o Minimum scar
➔ Remember: we are patient pro / propatient.
The lesser the complications, the quicker
the healing and the minimum is the scar,
the better.
Different forms of surgical incisions paramedian; left lower, right lower
paramedian.
4. Lateral Paramedian: incision made at
outer 1/3- medial 2/3 border of rectus,
modification of Para median but with lower
risk of dehiscence or ventral hernia
➔ Dehiscence - reopening of the
wound, a complication that should
not happen in a postoperative client
5. Rutherford Morrison : access to lower
ureter, colon, and iliac arteries
6. Lower midline : access to pelvic organs
7. Pfannenstiel : suprapubic incision for
access to pelvic cavity
➔ Layman term: Bikini cut
8. Grid-iron : incision at McBurney’s point,
access to appendix
9. Collar incision – a cervical incision, placed
a few centimeters above the sternal notch
Frequently used for thyroid or
parathyroid procedure

1. .Kocher’s (subcostal): access to RUQ or

LUO contents
i.e. gallbladder (right), spleen (left)
➔ It could either be right or left
2. Upper midline: access to stomach,
duodenum, gallbladder, liver, transverse
colon
3. Paramedian: can make similar incision in
each quadrant (or access to each
quadrant’s contents)
➔ Depending on the organ. Pwede
siya sa left upper, right upper
 1. Supine position

10. Anterior cervical incision - incision done ➢ Operations on major regions of the body
in the anterior part of the cervical column such as:
11. Anterior lumbar incision - anterior o Peritoneal
lumbar inter body fusion (ALIF) surgery in oThoracic
the 1950s for treatment of lower back pain o Pericardial
for degenerative spine conditions o Head
12. Posterior cervical incision – laminectomy o Neck
13. Posterior lumbar incision – spinal fusion o Extremities
In addition:
Longitudinal Midline incision - incision of entire
2. Sitting
abdominal cavity exploring

INTRAOPERATIVE POSITIONING

Assisting a client with positioning

➢ The OR nurse understands the various
position as well as the physiologic changes
that occur when patient is placed on a
specific position

Essential factors to consider:

● Site of operation
● Age and size of the patient
● Type of anesthesia used
● Pain normally experienced by the patient o Shoulder surgery
on movement o Cranium surgery
o Neck surgery
o Plastic surgery
3. Fowler’s 6. Lateral Chest

o Neurologic surgery

o Shoulder surgery

4. Lateral oUsed for

thoracoplasty,
pneumonectomy, and
lobectomy

➔ Very useful in lung

surgery
o Kidney surgery
o Chest or lung 7. Lithotomy
surgery
o Hip surgery

5. Lateral Kidney

o Giving birth
o Involves the:
★ Reproductive organs
★ Urology
★ Gastrointestinal systems

o Used for surgery on

the kidney or the
proximal third of the
ureter
8. Kraske (jackknife
position)
oSurgery on:
★ Coccyx
★ Buttocks
★ Rectum
9.Trendelenburg
o Used for operations on the
bladder, prostate gland, colon,
female reproductive system, or for
any operation in which It is
desirable to tilt the abdominal
viscera away from the pelvic area
for better exposure
NURSING CARE DURING SURGERY
o Provide emotional care
o Assist with client positioning
o Maintain surgical asepsis
o Maintain clients body temperature by
preventing heat loss
o Monitor for malignant hyperthermia
o Assist with surgical wound closure
o Assess drainage
SURGICAL DRAINS
➢ A tube used to remove pus, blood or other
fluids from a wound
REASON FOR USING DRAINS
➢ To remove unwanted fluid/exudates/gas
➢ To promote tissue apposition
➢ To monitor leakage
➢ To divert body fluids away from a particular
surgical site
➢ To facilitate subsequent access to a cavity
➢ To allow injection of contrast for
radiographic studies
TYPES OF SURGICAL DRAINS:
A. Open drains
➢ do not come with their own drainage
bags
➔ Does Not have a collective
bottle/cup that serve as the one
that collects the drainTypes of
open drains include:
1. Corrugated drain
2. Penrose drain
3. Yeates drain
B. Closed drains
Closed passive drains:
1. Pig-tail catheters
2. Percutaneous trans hepatic
biliary drains
3. Urinary catheter (urethra)
4. Intercostal catheter
(thoracic area)
Closed suction drains
➔ Provide a suction, nga naga suyop
gid man ya sang blood or pus
1. Bellovac 3. Three bottle system: trap, underwater seal
2. Blake drain and suction regulator
3. Exudrain
4. Hemovac
5. Jackson-pratt

C. Cardiothoracic drains

1. One bottle system:

Underwater seal - bottle

filled with water so that the tip
of long tube is at least 2 cm
below water level

4. Gastrointestinal drains
a. Nasogastric Tube (NGT)
1. Fine bore feeding NGT
2. Ryle’s tube
3. Salem sump tube
b. P.E.G. (percutaneousendoscopic
gastrostomy)
c. T-tubes (usually used in gallbladder
surgeries)
2. Two bottle system: trap and underwater
seal
SURGICAL DRESSINGS
➢ Loosely woven cotton dressing to cover the
incisions made during surgery
➔ After the surgery, we don’t leave the wound
open, we cover it with dressings.
1. Amorphous hydrogel/ sterile amorphous
hydrogel wound dressing
2. Hydrogel dressing
3. Hydrocolloid dressings
4. Alginate
5. Composite dressings
6. Transparent films
NOTE: As a minimum standard, the ideal
wound dressing should have the
following characteristics:
● It should provide both mechanical and
bacterial protection
● The dressing should maintain a moist
surrounding at the interface of the
wound and dressing
● Should have the capability to allow
exchange of gases and fluids
● Should not be adherent to the wound
● Should be safe to use i.e. Nontoxic,
non-sensitizing, and non-allergic (to the
patient and medical personnel)
● Should have the characteristic of being
highly absorbent
● It should absorb wound odor
● Should be sterile
● It should be available in a range of
forms and sizes
● Usual dressing change is up to 3 times
per week
Session 7: Roles and responsibilities of an OR
nurse
ROLES AND RESPONSIBILITIES OF A
PERIOPERATIVE NURSE
A. Circulating Nurse
● Manager of OR
● Runner
● Brings needed supplies to OR table
● Assists in sponge, sharps and instrument
count
● Removes unnecessary items and specimen
● Helps scrub nurse for the operation
● Available all throughout the procedure
Before the operation
● OR has been cleaned
● Suction apparatus, diathermy equipment,
OR lights are in working condition
● Temperature and humidity correctly set
● Collects necessary stocks and equipment
● Sterility of instruments
During the operation
● Positioning
● Skin prep
● Preparation of sterilized gowns and gloves
● Assist in typing gowns
● Opens instruments and bowl packs
● Connects diathermy and suction leads to
appropriate machines
● Count and record the count (initial
counting)
➔ Sponge counting, or instrument
count is done several times in the
operation.
➔ Done during the intraoperative
phase but make sure that you are
able to do your initial count
➔ Initial count is both done by the
circulating nurse and scrub nurse
before the incision is done.
➔ Why? - Because they should keep a
record of the materials they will be
using in the sterile field. Because
this will be counted/audited again
after the closing of the wound to
make sure that no instrument, no
sponge, towels, drapes, etc left in
the body of the patient.
 ➔ This is a very very important
responsibility of both the circulating
nurse and the scrub nurse.
● Remains in OR all throughout
● Replenishes and record swabs and packs
● Disposal of used swabs
● Fills bowl with sterile water
● OR doors remain closed
● Places swabs collecting bucket
conveniently
● Anticipates the requirements of the surgical
team
● Alert all team members of any break in
sterile technique
● Assist anesthetist o Monitor v/s
★ UO
★ Blood loss
Before the end of the operation
● Assists with the count and records
➔ Done 2-3 times;
1. Before closing a cavity or
the fascia layer of the
abdomen
2. Before closing done before
closing the subcutaneous
layer of the abdomen
3. Before closing the skin
● Final count-before closure of the skin,
inform the team that count is complete
● Prepares the wound dressing
Completion of the operation
● Hands the dressing to SN
● Removal of drapes
● Preparation for client to PACU
● Removes specimen and labels properly
● Removes the inst. Trolley to dirty area
● OR is cleaned and prepared for the next
case
B.Scrub nurse
❖ Prepares the sterilized instruments and
equipment ready for operation
❖ Assist the surgeon
❖ Handling instruments, sutures, and other
supplies.
❖ Maintain accurate count of sponges,
instruments and sharps.
Before the operation
● Surgeon preference card
● Strict surgical hand scrubbing, gowning and
gloving
● Drape the trolleys, table and bowl stands
with sterile drapes
● Check contents of set w/ circulator and w/
enclosed list
● Collects sutures, needles and blades
● Initial count
● Request circulator to double check client’s
identity
● Ensure safe position of the client
At the start of the operation
● Hands skin prep and sponge stick
● Assist in applying and securing drapes
● Position trolleys and bowl stand
● Hands diathermy lead and suction tubing to
the circulator
● Accurate count
● Anticipates needs of the surgeon
● Noise and movement is kept to a minimum
Before the surgeon suture or close the cavity
● Checks swabs, packs, instruments and
needles with the circulator
● Informs the surgeon of the findings
At the end of the operation
● Appropriate dressing is available
● Final count
 ● Removes instruments from the working
surface
● Collects dressing from the circulator
● Removes and disposes blades
● Area around the wound dressing is clean
● Patient’s gown is clean and dry
● Covers patient w/ clean sheet
● Completes entry in the register and signs it
● Checks the instruments and other
equipment, washes and prepares them for
sterilization
Session 8: Anesthesia
ANESTHESIA – absence of pain
Purpose:
● Produce muscle relaxation
● Block transmission of nerve impulses (to
help with pain management)
● Suppress reflexes
● Cause loss of consciousness
Variables
● Age and physical condition of the client
➔ With age, the amount and dosage
of the medication the patient will be
receiving, or the anesthetics that the
patient will be receiving should
depend on whether the patient is
pedia or etc.
➔ For pediatric patients, the dosages
are reduced. Same with adults or
depending on the body mass of the
patient.
● Type, location and duration of surgery
➔ So that anesthesiologist can
somehow measure the amount and
the type anesthesia that they will be
introducing to the patient
● Degree of technical intricacy of the surgery
● Previous anesthesia history
➔ For example, it has been identified
that there are several failures in the
performing general anesthesia to
this particular patient. So the doctor
might be considering doing spinal
anesthesia instead.
● Personal preference, expertise and
judgement of the anesthesiologist or nurse
anesthetist
BALANCED ANESTHESIA
A highly variable technique of general
anesthesia using narcotic analgesics,
muscle relaxation, and minimal
inhalation agent and nitrous oxide to
render the patient unconscious
❖ A hypnotic given the night before
❖ Premedication such as a narcotic
analgesics / benzodiazepine and
anticholinergics given about 1 hour
before surgery
❖ A short acting barbiturate
❖ An inhaled gas (NO and O2)
❖ A muscle relaxant as needed
Advantage of BA
★ Minimizes cardiovascular problems
★ Decreases the amount of general
anesthetic needed
★ Reduces possible post-anesthetics
nausea and vomiting
★ Minimizes the disturbance of organ
function
★ Increases recovery from anesthesia
PHASES OF ANESTHESIA
A. Premedication/pre-induction
➢ Begin as soon as patient is given the
premedication, is then brought to procedure
room and ends immediately before the
induction of anesthesia
➔ All pre-oparation medications that is
given to the, this is already be the
 premedication or preinduction ➢ Also known as “being put
phase of anesthesia under”, “put to sleep” or
“completely out”
B. Induction
➢ Begins with the introduction of anesthetic General anesthetic agents produce:
agents and ends with induction and
stabilization of the patient o Analgesia – insensibility to pain without loss of
consciousness
C. Maintenance phase ➔ The pain is there but the patient is
➢ Starts when stabilization is accomplished insensitive or feel it
and ends with reversal of anesthesia are o Amnesia - loss of consciousness, characterized
initiated near the procedure by the loss of reflexes and muscle tone
➔ Usually, during the maintenance
phase, this is where the surgical Common side effects
procedure is performed when the ● Nausea and vomiting
condition of the patient is stabilized. ● Headache
● Dry mouth
D. Reversal or extubation ● Temporary loss of consciousness
➢ Begins with the closure of the wound and ● Lingering tiredness
ends before patient is transferred to PACU
Precautions:
1) Should not eat until they are awake
2 MAJOR CLASSIFICATION OF ANESTHESIA
or can swallow comfortably and
properly
1. GENERAL ANESTHESIA
2) Should not plan on driving a car or
➢ Drug induced depression of the
make important decisions for at
CNS that is reversed by
least 24hours
metabolic elimination in the
3) Should carefully follow surgical
body or pharmacologic means.
instructions.
➔ General anesthesia
means that we give
Types of GA:
medications or
A. Total Intravenous Anesthesia (TIVA)
anesthetics that can
➢ The use of IV agents(s) exclusively to
cause depression of
provide a complete anesthesia
brain function. When
➔ Given through injection, through a
the patient receive this
vein. Medication is injected.
anesthetics or general
anesthesia, it means
that the body will
➢ Involves achieving desired elements of the
metabolize it and
4 components of GA:
eliminate it. Ma subside
Block of:
ang body from
★ Metal
anesthesia right after
★ Reflexes
the body eliminates it.
★ Sensory
 ★ Motor function
➔ Misconception: if gina GA gani gina
intubate gid na dayun ang patient.
No, pwede kita ka GA through IV
meds.
Advantages of TIVA:
1. Combination of drugs separately infused, allows
titration of each to the specific dose required to
meet the specific needs of the case
intubation by applying pressure to the
cricoid cartilage. The intubation set:
★ Laryngoscope - it should have a
body and blade. It comes with
different sizes. If the patient is a
pediatric patient, we use
mac1(infant) or mac 2(child). Mac 2
(femal) mac 3 (male).

2. The anesthetic is completely dependent on

patients’ airway and breathing

3. Very portable

B. Inhalation General Anesthesia/General

Endotracheal Anesthesia
➔ Inhalation general anesthesia - The
patient’s inhales the anesthetics via a mask
attached to anesthesia machine
➔ General endotracheal anesthesia - this is
with the use of ET (Endotracheal) tube
inserted into the mouth of the patient, going
to the pharynx, going to the larynx and
going to the trachea. It is also attached to a
tube that is attached to the anesthesia
machine.
➔ The anesthesia machine provides the
necessary gas or anesthetic agent in a
form of gas
● Used to cause loss of consciousness
before or during the surgical procedure
● It is inhaled/breathe in via mask or
endotracheal (ET) tube in gas form
● A variable gas mixture, including
anesthetizing and life sustaining gases is
inhaled by the “the anesthesia gas
machine”

SELLICK’S MANEUVER
➢ A method of preventing regurgitation of an
anesthetized patient during endotracheal
★ Endotracheal tube (different sizes) ★ 5 cc disposable syringe - use to
inflate the ET tube
★ Nasal spray (drixine)
★ Terramycin eye ointment
★ Xylocaine 10% spray - local
anesthesia
★ Adhesive tape - to secure the ET
tube to the face of the patient
★ Mogills clamp
★ Stylet

★ Oral airway

MEDICATIONS USED FOR GENERAL

ANESTHESIA
1. Na Pentothal (Thiopental Sodium)
- A sedative hypnotic that sedates the patient
2. Diprivan ( Propofol )
- Same with Na pentothal
3. Sevorane (Sevoflourane)
- A general anesthesia that causes
temporary loss of consciousness and
decreases the cerebral metabolic activity
★ Nasal airway - Comes from a liquid that is used in
anesthesia machine to be converted into
hydrogen gas
4. Forane ( Isoflourane)
- Same with sevorane
5. Nitrous Oxide
- Also known as laughing gas
Color coded tanks:
Green - oxygen
Blue - nitrous oxide
Red - carbon dioxide (used in laparoscopic
surgery)
6. Depolarizing Muscle Relaxant (Ex. Assessment:
Quelicin) ● Patient is not breathing, may or may not
7. Reversal Agent (ex. Narcan) have a heartbeat.
Nursing intervention:
- An opiate antagonist that counteracts the ● If arrest occurs, respond immediately to
effects of respiratory depression assist in establishing airway. Cardiac
cart/anesthesia cart must be within reach,
Four stages of anesthesia provide drugs necessary, syringes, and
1. Onset stage or disorientation—from the long needles. Assist surgeon with closed or
administration of anesthesia to loss of open cardiac massage
consciousness
Assessment: 2. REGIONAL ANESTHESIA
● Patient maybe drowsy ➢ Blocks pain stimulus/sensation in only one
● May experience visual / auditory region of the body and does not result in
hallucinations unconsciousness.
Nursing intervention:
● Close OR doors Types of RA:
● Keep room quiet A. Spinal anesthesia
➢ subarachnoid block, results from the
2. Stage of excitement or delirium—from injection of local anesthetic into the CSF,
loss of consciousness to loss of eyelid reached by lumbar subarachnoid puncture
reflexes only
Assessment: ➔
● From loss of consciousness to onset of B. Epidural anesthesia
automatic breathing ➢ results from injecting local anesthetic into
Nursing intervention the epidural space
● Remain quietly at patients’ side, assist
anesthetist if needed

3. Surgical anesthesia stage—from loss of

eyelid reflexes to loss of most
reflexes/depression of function
Assessment:
● Patient is unconscious, muscles are
relaxed, no blink and gag reflex
Nursing intervention
● Begin preparation (If indicated) only when
anesthesiologist indicated stage III has
been reached and the patient is under
control
4. Danger (death)—from depression of vital
function to respiratory and circulatory failure
C. Peripheral nerve blocks
➢ placing a needle tip near the target nerve
and injecting a local anesthetic by simple
infiltration around bony, vascular and facial
landmarks
➢ Contact between the needle and the nerve
produces a paresthesia, often described as
“ electricity” or “hitting a funny bone”
➢ Nerve stimulators maybe used to locate
peripheral nerves
D. Intravenous regional anesthesia
➢ Or Bier Block, entails IV injection of large
volume of dilute local anesthetic while the
circulation to the extremity is isolated by a
tourniquet
E. Local anesthesia
i. Infiltration
- Introducing an anesthetic agent usually
xylocaine directly into the capillaries,
ii. Surface / topical anesthesia
o Eye drops
o Creams ointments
o Aerosols / spray
o Jelly
o Lotions
Local / regional anesthetic agents:
a. Xylocaine
b. Tetracaine
Adjunct medications to achieve BA
1. Demerol
2. Epinephrine - used with anesthetic
agents to prolong its action
3. Atropine Sulfate - decrease oral
secretions when patient is unconscious;
prevent aspiration
4. Nubain
5. Midazolam
6. Morphine Sulfate
7. Valium
Session 9: Post Operative Phase
III. POSTOPERATIVE PHASE
➢ Begins with the admission of the client in
PACU and ends with the resolution of the
surgical sequelae.
POST ANESTHESIA / POST OPERATIVE
ASSESSMENT
A. Respiratory status
● Patency of airway
● Respiration: depth, rate, character
● Breathe sounds; presence, character
● Chest expansion
● Patient position to facilitate ventilation
● Ability to deep breathe and cough
➔ We also let the patient execute the
preoperative nursing teachings that we
taught them
B. Neurologic status
● Level of consciousness (mostly applicable
with general anesthesia)
● Ability to follow commands
● Sensation and ability to move extremities
after regional anesthesia (sign that the
effects of anesthesia is already getting
subside)
C. Cardiac status
● Blood pressure
● Pulse rate, strength (presence distal to limb
surgery)
● Skin color and temperature
● Capillary filling
● Monitoring systems—connected and
functioning
 D. Temperature
● Skin color
● Body temperature
E. Surgical site dressing and drains
● Dressings: frank bleeding
● Drainage system—connected and
functioning
F. Gastrointestinal status
● Nausea / vomiting
● Nasogastric tube patency: amount and
character of drainage
G. Blood fluids
● Intravenous fluids—rate, amount in bag,
patency of tubing Urine output>30ml./hr.
H. Skin integrity
● Reddened area, skin break
I. Comfort and safety
● Pain—presence, character, severity
● Patient position
● Necessary for side rails
● Call cord within reach
J. Anxiety (patient and family)
● Emotional status—anxiety, restlessness,
family whereabouts, communication
Criteria for discharge from PACU
● Recovery from the effects of anesthesia -
able to move legs
● Stable vital signs
● With moderate to light drainage
● Stabilized effects of narcotic medication
● Regained LOC and maintained a patent
airway
● Post-op care completed
● Urine output adequate
● Clinical unit nurse informed re patient’s
condition
● Thorough documentation
Assessment in the clinical unit
➢ The nurse makes an initial assessment
after the transfer and should include:
❖ Respiratory status
❖ Cardiovascular status
❖ Neurologic status
❖ Surgical wound and drainage
❖ Intravenous line
Establishment of post-op goals
1. Restore homeostasis and prevent
complication
2. Maintain and promote adequate
airway, and respiratory function
3. Maintain adequate cardiac function
and promote tissue perfusion
4. Maintain adequate FE balance and
adequate renal function
5. Promote rest and comfort
6. Promote adequate nutrition and
elimination
7. Promote wound healing
8. Promote and maintain activity and
mobility
9. Provide adequate emotional support
and foster positive body image
10. Plan for discharge
Summary
The nurse plays a critical role in the perioperative
care of the client. No matter what type of surgery
is performed, however, the client needs a great
deal of expert nursing care. The quality of that
nursing care can determine whether or not the
client has a successful perioperative experience.
The ‘time out’ or ‘surgical pause’:
In surgery, there are few examples of systematic
improvements in safety; however, over the past
several years in the United States and other
industrialized countries, a ‘time out’ or ‘surgical
pause’ has been introduced as a standard
component of surgical care (27). This is a brief,
less than one minute pause in operating-room
activity immediately before incision, at which
time all members of the operating team—
surgeons, anesthetists, nurses and anyone
else involved—verbally confirm the identity of
the patient, the operative site and the
procedure to be performed. It is a means of
ensuring clear communication among team
members and avoiding ‘wrong-site’ or
‘wrong-patient’ errors. It has been made
mandatory in the United States and a few other
countries.
Common OR Instruments, Supplies and
Machines
● VAGINAL SPECULUM
- allows physicians and health
providers to better view a
woman's cervix and vagina
during pelvic exams
● HANKS’ DILATOR
- dilators used to treat
vaginismus, induce cervical
dilation, and for inflatable penile
implant procedures

● HEGARS’ DILATOR
- used to induce cervical dilation in
order to gain entry to the interior of the
uterus.
● DEAVERS’
- a large, handheld retractor
commonly used to hold back
the abdominal wall during
abdominal or thoracic
procedures. It may also be used
to move or hold organs away
from the surgical site.
● NEEDLE HOLDERS
- made from stainless steel and is
used to hold a suturing needle
during surgical procedures.
● MAYO SCISSORS
- used to cut bone on either side
of the fused suture, while
endoscope is used to watch that
the scissors remain safely away
from the dura.
● METZENBAUM SCISSORS (METZ)
- or dissecting scissors are primarily
used in surgery to cut tissue and suture
material. The long handles of
Metzenbaum scissors permits to work
in deep tissues, so the surgeon's
manipulation is not hindered by
wide-opening scissor blades.
● IRIS SCISSORS
- type of scissors with short blades that
was originally developed for ophthalmic
surgery.
● ARMY-NAVY / RIGHT ANGLE
RETRACTOR
- sometimes called US or USA Army
Retractor, is used for shallow or
superficial wounds. The Army Navy
Retractor is a basic surgical instrument
included in most minor and major
surgical set. Features: Used to retract
skin or bones.
● BALFOUR SELF-RETAINING
RETRACTOR
- used to hold an incision or wound open
during surgical procedures. They can
be classified as hand-held retractors or
self-retaining retractors. Hand-held
retractors require an assistant to apply
a force to hold apart tissues.
● RICHARDSON RETRACTOR
- retract abdominal or chest incisions.
Used for holding back multiple layers of
deep tissue. This is one of the most
common general retractors.
● CRILE / MALLEABLE / RIBBON
RETRACTOR
- These retractors are made from
malleable stainless steel, allowing for
easy modification of retractor angle and
shape. The blades are available in a
variety of sizes depending on the
surgeon's need and are commonly
used during orbital dissection to keep
orbital fat out of the surgical field.
● LANGENBECK RETRACTOR
- Large, handheld retractor
commonly used to hold back the
abdominal wall during abdominal
or thoracic procedures. It may
also be used to move or hold
organs away from the surgical
site. Also known as Parker
Langenbeck, or retractor double
end.
● SENN AND RAKE RETRACTOR
- double ended retractors used in
surgical procedures. One end is
typically L shaped, and the other has
three bent prongs. The pronged ends
come in sharp and dull tips. They are
regularly used in hand and foot
surgeries.
● ANAL SPECULUM
- Also known as anoscope is a
tube-shaped instrument that
widens the opening of the anus.
Doctors use it to diagnose
diseases of the anus and rectum.
● FRAZIER SUCTION TIP
- This is a thin instrument used for the
removal of fluid or debris from confined
surgical spaces. Suction is controlled by
a small opening on the handle and
there are multiple tip sizes available.
● YANKAUER SUCTION TIP
- an oral suctioning tool used in medical
procedures. It is typically a firm plastic
suction tip with a large opening
surrounded by a bulbous head and is
designed to allow effective suction
without damaging surrounding tissue.
This tool is used to suction
oropharyngeal secretions in order to
prevent aspiration. A Yankauer can also
be used to clear operative sites during
surgical procedures and its suctioned
volume counted as blood loss during
surgery.
● POOLE SUCTION TIP
- an instrument used to remove large
quantities of fluid from surgical sites
during a procedure. Often used during
abdominal procedures the suction tube
has multiple holes so as to prevent
blockages caused by fat or tissue
suctioned during a procedure.
● ELECTROCAUTERY TIP
- Electrocauterization (or electrocautery)
is often used in surgery to remove
unwanted or harmful tissue. It can also
be used to burn and seal blood vessels.
This helps reduce or stop bleeding
during surgery or after an injury. It is a
safe procedure.
● BOVIE PLATE WITH CORD
- a surgical device used to incise tissue,
destroy tissue through desiccation, and
to control bleeding (hemostasis) by
causing the coagulation of blood.
● ELECTROCAUTERY MACHINE
- The electrocautery unit (Bovie, cautery,
or electrosurgical unit) uses
high-frequency electrical energy to cut
tissue or coagulate bleeding. The
preferential conduction of electrical
energy by blood vessels facilitates
coagulation.
● BONE SAW
- Bone saws or bone saw blades and
reciprocating blades are typically used to
cut small and large bones in a way that
enables the best surgical outcome for the
patient. ... Shaver blades and rotating
surgical burrs are used in many medical
devices for orthopedic procedures.
● ANESTHESIA SCREEN
- used to block the anesthesia field from
the patient's line of sight, helping to
eliminate patient anxiety and distraction
that can come with viewing the
anesthesiologist's movements.
● OPERATIVE SPONGE
- disposable medical supplies commonly
used in medicine and surgery. They are
ordinarily made of gauze and are used
to absorb blood and other fluids as well
as clean wounds. When used in
surgery, they are called surgical
sponges.
● JACKSON-PRATT WOUND DRAINAGE
RESERVOIR
- better known as a JP drain. The flat
perforated end of the tube is placed
inside your body so that it can collect
the body fluid that is produced as an
effect from surgery.
● SUCTION MACHINE
- A suction machine, also known as an
aspirator, is a type of medical device
that is primarily used for removing
obstructions — like mucus, saliva,
blood, or secretions — from a person's
airway. ... Clearing blood from the
airway. Removing a foreign substance
from a patient's windpipe and/or lungs
(pulmonary aspiration)
● NITROUS OXIDE TANK
- Nitrous oxide is a colourless gas that is
commonly used for sedation and pain
relief, but is also used by people to feel
intoxicated or high. It is commonly used
by dentists and medical professionals to
sedate patients undergoing minor
medical procedures.
● OXYGEN MASK
- Nasal cannulas and face masks are
used to deliver oxygen to people who
don't otherwise get enough of it. They
are commonly used to provide relief to
people with respiratory disorders. A
nasal cannula consists of a flexible tube
that is placed under the nose.
● GELFOAM
- Gelfoam Sponge (absorbable gelatin
sponge) is a medical device intended
for application to bleeding surfaces is
indicated in surgical procedures as a
hemostatic device, when control of
capillary, venous, and arteriolar
bleeding by pressure, ligature, and
other conventional procedures is either
ineffective
● SURGICAL CUTTING NEEDLES
- A cutting needle has at least two
opposing cutting edges (the point is
usually triangular). This type is
designed to penetrate dense, irregular,
and relatively thick tissues. The point
cuts a pathway through tissue and is
ideal for skin sutures. Sharpness is due
to the cutting edges.
● SURGICAL ROUND NEEDLES
- Round-body needles are used in
tissues that are easy to penetrate and
in crucial procedures such as tendon
repair, where suture cutout would be
disastrous. A blunt-point, round-body
needle dilates rather than cuts, and is
preferred in abdominal fascial closure,
to prevent inadvertent visceral injury
and bleeding.
● SURGICAL GLOVES
- The primary purpose of surgical gloves
is to act as a protective barrier to
prevent the possible transmission of
diseases between healthcare
professionals and patients during
surgical procedures.
● SURGICAL DOUGHNUT
- provide a soft cushion for the patient’s
head in the supine position. 2 in. (5 cm)
thick and available in 7 in.(18 cm) or 9
in. (23 cm) diameter.
- used to put pressure around an
impaled object without putting pressure
on the object itself.
● VAPORIZER
- use is indicated in every
surgery that requires general
anesthesia with inhalation
anesthesia technique.
● MOGILLS
- angled forceps used to guide a tracheal
tube into the larynx or a nasogastric tube
into the esophagus under direct vision.[1]
They are also used to remove foreign
bodies.[1] These forceps are named after
the Irish-born anaesthetist Ivan Magill.
● CORRUGATED TUBINGS
- Flexible and collapsible plastic
corrugated tubing is commonly found
on medical equipment such as
ventilators, respirators as well as
devices for anesthesia and sleep
apnea. Commonly used materials for
medical applications include
polyethylene (PE) and polypropylene
(PP)
● ANESTHESIA VENTILATION BAG
- The anesthesia reservoir bag permits
manual ventilation and acts as a visual
or tactile indicator of spontaneous
breathing. The bag was excluded from
traditional breathing system when the
mechani- cal ventilator was in use.
Discrepancies between the set and
actual tidal volume can occur.
● SCRUB SINK
- Scrub sinks, also referred to as surgical
sinks or medical sinks, are vital to
keeping Operating Rooms (ORs) up
and running, and are imperative to the
health and safety of patients. They
serve as the scrub station for surgeons
and other OR staff to scrub their hands
and arms before a surgical or invasive
procedure.
● ENDOTRACHEAL TUBE
- a tube constructed of polyvinyl chloride
that is placed between the vocal cords
through the trachea. It serves to provide
oxygen and inhaled gases to the lungs
and protects the lungs from
contamination, such as gastric contents
or blood.
● ORAL AIRWAY
- An oropharyngeal airway (also known
as an oral airway, OPA or Guedel
pattern airway) is a medical device
called an airway adjunct used to
maintain or open a patient's airway. It
does this by preventing the tongue from
covering the epiglottis, which could
prevent the person from breathing.
● NASAL AIRWAY
- A nasopharyngeal airway device (NPA)
is a hollow plastic or soft rubber tubes
that a healthcare provider can utilize to
assist with patient oxygenation and
ventilation in patients who are difficult to
oxygenate or ventilate via bag mask
ventilation, for example.
● LARYNGOSCOPE
- designed for visualization of the vocal
cords and for placement of the ETT into
the trachea under direct vision.
● XYLOCAINE 10% SPRAY
- Xylocaine Spray is a non-sterile solution
used to numb (anaesthetise) parts of
the body to reduce pain and reflex
gagging: During medical examination of
the nose, throat, stomach or lungs
requiring the insertion of viewing
instruments. Minor procedures involving
the nose and throat. After childbirth.
● TERRAMYCIN EYE OINTMENT
- TERRAMYCIN Ophthalmic Ointment
with Polymyxin B Sulfate is indicated in
dogs and cats with superficial ocular
infections, such as conjunctivitis,
keratitis, pink eye, corneal ulcer,
blepharitis and bacterial inflammatory
conditions that may occur secondary to
other infectious diseases.
● STYLET
- Stylets, Guides, and Tube Exchangers.
The term “stylet” is somewhat elastic. It
can refer to rigid or malleable rods or
wires used to adjust the curve of an
endotracheal tube in order to make
insertion easier. Used this way, in order
to avoid airway trauma, the stylet
should not extend beyond the tip of the
tube.
● NASAL SPRAY
- Provides fast relief from nasal
congestion due to colds & flu, allergies
and sinusitis.
- It starts to work in minutes providing 12
hours of nasal congestion relief without
drowsiness.
● ANESTHESIA MACHINE
- An anaesthetic machine (British
English) or anesthesia machine
(American English) is a medical device
used to generate and mix a fresh gas
flow of medical gases and inhalational
anaesthetic agents for the purpose of
inducing and maintaining anaesthesia.
● ALLIS
- An Allis clamp (also called the Allis
● OXYGEN TANK
- Breathing oxygen is delivered from the
storage tank to users by use of the
following methods: oxygen mask, nasal
cannula, full face diving mask, diving
helmet, demand valve, oxygen rebreather,
built in breathing system (BIBS), oxygen
tent, and hyperbaric oxygen chamber.
● KELLY STRAIGHT / CURVE FORCEP
(ROUND NOSE)
- An essential component for any
tactical medical kit, these sterile,
curved 5.5" Kelly Hemostatic
Forceps with a serrated blunt tip
can be used to clamp large blood
vessels, manipulate heavy
tissue, and dissect soft tissue.
forceps) is a commonly used surgical
instrument. ... The Allis clamp is a
surgical instrument with sharp teeth,
used to hold or grasp heavy tissue. It is
also used to grasp fascia and soft
tissues such as breast or bowel tissue.
● BABCOCK
- The Babcock's is invented to hold
tubular organs; the orifices in the blades
accommodate some part of the tissue
and reduce the intraluminal pressure,
which protects the organs from getting
damaged. Surgical Procedure: There
are numerous surgical procedures
where Babcock's is used.
● TOWEL CLIPS / T-CLIPS/ TOWEL
CLAMPS
- A towel clamp is a surgical instrument
which is used to secure towels and
surgical draping during a medical
procedure. In addition to being used in
the operating room, towel clamps are
also used in procedures in clinics and
doctor's offices where drapes are used.
● HYSTEROMETER
- The single use hysterometer (also
called single use uterometer) is used for
measuring the depth of the uterine
cavity and the cervix. The single use
uterine sound gauge is made of flexible
plastic, allowing material "memory" to
mark depth and dilate in angles as
needed.
● OVUM FORCEP
- Ovum Forceps, available at
Surgical Holdings, used to grasp,
hold, manipulate and remove
tissue from inside the uterus
including the ovum and placenta.
Ovum forceps are used during
procedures such as caesarean
section, hysterectomy, and
uterine repair and are also
sometimes used as a hemostat.
● SIMPSONS’ FORCEP
- are the most commonly used
among the types of forceps and
has an elongated cephalic curve.
These are used when there is
substantial molding, that is,
temporary elongation of the fetal
head as it moves through the
birth canal.
● UTERINE CURETTE
- During uterine curettage, an
instrument is used to scrape or
suction the uterine lining to
diagnose and/or treat abnormal
bleeding or to remove products
of conception. If not already
dilated, the cervix must first be
opened mechanically or
chemically.
● BONE CURETTE
- This instrument is used to
carefully smooth bone. With a
small spoon on the end of the
tool similar to that of an
ice-cream scoop, a curette
allows the surgeon to scrape
away bone. The spoon of the
bone curette has durable, sharp
edges. Its handle may be large
and thick, taking up the entire
hand, or small and thin.
● SIMS’ VAGINAL RETRACTOR
- Sims' speculum is inserted into
the vagina to retract posterior
vaginal wall. It gives more
exposure of the vaginal walls
than Cusco's Speculum and
therefore is preferred for
gynaecological surgeries. it is
possible to slide the instrument
around the vaginal wall to enable
better visualization.
● FINOCHIETTO RIB SPREADER ● BANDAGE SCISSORS
- A rib spreader, also known as - used for dressings, drapes. The
Finochietto retractor, is a type of blunt tip of the scissor helps to lift
retractor specifically designed to the bandage from the skin safely
separate ribs in thoracic surgery. for easy dressing and safe
Rack-and-pinion-type stainless bandage removal.
steel rib spreaders (with a
thumb-screw to lock it in place)
were an innovation introduced by
French surgeon Theodore
Truffier in 1914.

● LAHEY TENACULUM
- Tenaculum Forceps are
finger-ring and ratcheted
instruments commonly used in
OB/GYN procedures that require
manipulation of uterus or cervix
and are used in abdominal or
vaginal hysterectomy. They are
used to hold, grasp, and move
● EPISIOTOMY SCISSORS
arteries and vessels during
- used in obstetric procedures to
surgical procedures.
prevent traumatic tearing during
delivery.
● KOCKERS / OCHSNERS
- Sklar Rochester-Oschner
(Kocher) Forceps are a heavy
instrument designed to
aggressively grasp medium to
heavy tissue or occlude heavy,
dense vessels. They have
horizontal serrations the entire
length of the jaw as well as 1 X 2
teeth at the tip.
● THUMB FORCEP
- Thumb forceps are spring
forceps used by compression
between your thumb and
forefinger and are used for
grasping, holding or
manipulating body tissue.
They are non-ratchet style. For
example, you could use thumb
forceps to hold or move tissue
during surgery or to move
dressings.
● TISSUE FORCEP
- Tissue forceps are used in
surgical procedures for
grasping tissue. Often, the tips
have "teeth" to securely hold a
tissue. Typically tissue forceps
are designed to minimize
damage to biological tissue.
● ADSON’S WITH TEETH
- Their primary purpose is
to grasp, retract, or
stabilize tissue. They
may also be used to pack
or extract sponges, pass
ligatures, and stabilize
and manipulate needles
during suturing. Forceps
are categorized by the
presence and type of
teeth that are designed for
the specific tissue they
are intended to hold.
● SCALPEL
- Scalpel is an essential
dermatological tool used “for
making skin incisions, tissue
dissections, and a variety of
surgical approaches since the
onset of 'modern' surgery.”
Scalpel blades come in different
sizes, identified by a blade
number, and each serving a
different purpose.
● BLADE HANDLE
- Scalpels or Scalpel Handles are
intended to be use with surgical
blades for tissue separation
and other procedure that
require a sharp surgical blade to
puncture or cut. Scalpel Handle
hold the scalpel blade, it is a
small and extremely sharp
instrument used for surgery and
anatomical dissection.
● SURGICAL BLADES
- are used for cutting skin and tissue
during surgical procedures. There
are different types of blades specific
to the type of procedure. Surgical
blades vary by size and shape. The
number of the blade indicates the
blade size and shape. Surgical
blades are typically made with
stainless steel or carbon steel.
Some of the most common blades are described
below:
- The number 10 blade has a large
curved cutting edge is one of the
more traditional blade shapes and is
used for making large incisions and
cutting soft tissue.
- The number 11 blade is an
elongated, triangular blade
sharpened along the hypotenuse
edge. It has a pointed tip making it
ideal for stab incisions and precise
short cuts in shallow recessed
areas.
- The number 12 blade is a small,
pointed crescent-shaped blade
sharpened along the inside edge of
the curve. It sometimes used as a
suture cutter.
- The number 15 blade has a small,
curved cutting edge ideal for making
short, precise incisions.
- The number 22 blade is a larger
version of the number 10 blade with
a curved cutting edge and a flat,
unsharpened back edge. It is often
used for creating large incisions
through thick skin.
 ● ABSORBABLE SUTURES

● PHACO MACHINE
- The phaco probe is an ultrasonic
handpiece with a titanium or
steel needle. The tip of the
needle vibrates at ultrasonic
frequency to sculpt and emulsify
the cataract while the pump
aspirates particles through the
tip.

● NON-ABSORBABLE SUTURES
 DRUG STUDY

1.Lidocaine
● Generic Name: Lidocaine
● Brand Name: Xylocaine
● Drug Class: Local Anesthetics
● Method of Administration:
subcutaneous, intramuscular or
intravenous injection. Not intended for
use in the eye.
● Indication: prevention and control of
pain in procedures involving the male
and female urethra, for topical treatment
of painful urethritis, and as an
anesthetic lubricant for endotracheal
intubation (oral and nasal).
● Lidocaine is a local anesthetic (numbing
medication) that is used to numb an
area of your body to help reduce pain or
discomfort caused by invasive medical
● SURGICAL STAPLES
procedures such as surgery, needle
punctures, or insertion of a catheter or
breathing tube.
2. Narcan
● Brand Name: Narcan
● Generic Name: Naloxone
● Drug Class: Opioid Reversal Agents;
Opioid Antagonists
● Method of Administration:
intravenously, intramuscularly, or
subcutaneously.
● Indication: the complete or partial
reversal of opioid depression, including
respiratory depression, induced by
natural and synthetic opioids, including
propoxyphene, methadone and certain
mixed agonist-antagonist analgesics:
nalbuphine, pentazocine, butorphanol,
and cyclazocine.
● This medication is used for the
emergency treatment of known or
suspected opioid overdose. Serious
opioid overdose symptoms may include
unusual sleepiness, unusual difficulty
waking up, or breathing problems
(ranging from slow/shallow breathing to
no breathing).
● Narcan (naloxone) is an opioid
antagonist used for the complete or
partial reversal of opioid overdose,
including respiratory depression.
Narcan is also used for diagnosis of
suspected or known acute opioid
overdose and also for blood pressure
support in septic shock.
3. Nitric Oxide
● Generic Name: Nitric oxide
● Brand Name: Inomax
● Drug class: Dissociative anaesthetic
● Method of Administration: by
inhalation, absorbed by diffusion
through the lungs, and eliminated via
respiration.
● Indication: medication used to manage
and treat hypoxic respiratory failure or
persistent pulmonary hypertension of
the newborn (PPHN). It is in the
miscellaneous respiratory agent class of
drugs.
● Nitrous oxide is an inhalatory gas used
as an adjunct to improve oxygenation
and reduce the need for extracorporeal
membrane oxygenation in certain
neonates with hypoxic respiratory
failure. Nitrous oxide, commonly known
as "laughing gas", is a chemical
compound with the chemical formula
N2O. At room temperature, it is a
colorless non-flammable gas, with a
pleasant, slightly sweet odor and taste.
It is used in surgery and dentistry for its
anesthetic and analgesic effects. It is
known as "laughing gas" due to the
euphoric effects of inhaling it, a property
that has led to its recreational use as an
inhalant drug.
4.Forane
● Generic Name: Isoflurane
● Brand Name: Forane
● Drug class: General Anesthetics
● Method of administration: Inhalation
administration
● Indication: Used for induction and
maintenance of general anesthesia
● Isoflurane potentiates the muscle
relaxant effect of all muscle relaxants,
most notably nondepolarizing muscle
relaxants, and MAC (minimum alveolar
concentration) is reduced by
concomitant administration of N2O.
5.Sevorane
● Generic Name: Sevoflurane
● Brand Name: Sevorane
● Drug class: General Anesthetic
● Method of administration: Inhalation
Administration
● Indication: used for induction and
maintenance of general anesthesia in
adult and pediatric patients for inpatient
and outpatient surgery
● Sevoflurane is a sweet-smelling,
nonflammable, highly fluorinated methyl
isopropyl ether used as an inhalational
anaesthetic for induction and
maintenance of general anesthesia.
After desflurane, it is the volatile
anesthetic with the fastest onset.
6.Diprivan
● Generic Name: Propofol
● Brand Name: Diprivan
● Drug class: Sedative-hypnotic agent
● Method of administration: IV
administration
● Indication: used to help you relax
before and during general anesthesia
for surgery or other medical procedure.
It is also used in critically ill patients
who require a breathing tube connected
to a ventilator.
● Propofol, marketed as Diprivan, among
other names, is a short-acting
medication that results in a decreased
level of consciousness and a lack of
memory for events. Its uses include the
starting and maintenance of general
anesthesia, sedation for mechanically
ventilated adults, and procedural
sedation.
7.Thiopental Sodium
● Generic Name: Thiopental Sodium
● Brand Name: Pentothal
● Drug class: Schedule III controlled
substance
● Method of administration: IV route
● Indication: indicated as the sole
anesthetic agent for brief (15 minute)
procedures, for induction of anesthesia
prior to administration of other
anesthetic agents, to supplement
regional anesthesia, and to provide
hypnosis during balanced anesthesia
with other agents .
● Sodium thiopental, also known as
Sodium Pentothal, thiopental,
thiopentone, or Trapanal, is a
rapid-onset short-acting barbiturate
 general anesthetic. It is the
thiobarbiturate analog of pentobarbital,
and an analog of thiobarbital.
8. Quelicin
● Generic Name: succinylcholine
chloride injection
● Brand Name: Quelicin
● Drug class: Skeletal muscle relaxant
(depolarizing)
● Method of administration:
intramuscularly to infants, older
pediatric patients or adults when a
suitable vein is inaccessible
● Indication: indicated as an adjunct to
general anesthesia and to facilitate
tracheal intubation to provide skeletal
muscle relaxation during surgery or
mechanical ventilation.
● It may be employed to reduce the
intensity of muscle contractions of
pharmacologically or electrically
induced convulsions.
9.Morphine Sulfate
● Generic Name: Morphine Sulfate
● Brand Name: Roxanol
● Drug class: Narcotic Analgesic
● Method of administration: Oral
Administration
● Indication: indicated for the relief of
severe acute and severe chronic pain
● Morphine is an opioid agonist used for
the relief of moderate to severe acute
and chronic pain.
● Morphine, the main alkaloid of opium,
was first obtained from poppy seeds in
1805. It is a potent analgesic, though its
use is limited due to tolerance,
withdrawal, and the risk of abuse.
● Morphine is still routinely used today,
though there are a number of
semi-synthetic opioids of varying
strength such as codeine, fentanyl,
methadone, hydrocodone,
hydromorphone, meperidine, and
oxycodone.
10. Tetracaine
● Generic Name: Tetracaine
● Brand Name: Pontocaine
● Drug class: Local Anesthetic
● Method of administration:
● Indication: for procedures requiring a
rapid and short- acting topical
ophthalmic anesthetic.
● Tetracaine, also known as amethocaine,
is an ester local anesthetic used to
numb the eyes, nose, or throat. It may
also be applied to the skin before
starting an intravenous to decrease pain
from the procedure. Typically it is
applied as a liquid to the area.
11. Nubain
● Generic Name: Nalbuphine
hydrochloride
● Brand Name: Nubain
● Drug class: Opioid Analgesic
● Method of administration:
subcutaneous, IV and IM injection.
● Indication: for the management of pain
severe enough to require an opioid
analgesic and for which alternative
treatments are inadequate. NUBAIN
can also be used as a supplement to
balanced anesthesia, for preoperative
and postoperative analgesia, and for
obstetrical analgesia during labor and
delivery.

12. Atropine Sulfate
● Generic Name: Atropine Sulfate
● Brand Name: Atropine
● Drug class: Anticholinergic,
Antispasmodic Agents.
● Method of administration:
intravenous (IV), subcutaneous,
intramuscular, or endotracheal (ET)
method; IV is preferred. For ET
administration, dilute 1 mg to 2 mg in 10
mL of sterile water or normal saline
before administration.
● Indication: for
antisialagogue/anti-vagal effect,
organophosphate/muscarinic poisoning,
and bradycardia. Atropine acts as a
competitive, reversible antagonist of
muscarinic receptors: an anticholinergic
drug.
● Atropine Sulfate Injection is an
antimuscarinic agent used to treat
bradycardia (low heart rate), reduce
salivation and bronchial secretions
before surgery, as an antidote for
overdose of cholinergic drugs or
mushroom poisoning.
13. Epinephrine
● Generic Name: Epinephrine
● Brand Name: Adrenalin
● Drug class: alpha- and beta-adrenergic
agonists (sympathomimetic agents)
● Method of administration: IM
administration
● Indication: to treat very serious allergic
reactions to insect stings/bites, foods,
drugs, or other substances. Epinephrine
acts quickly to improve breathing,
stimulate the heart, raise a dropping
blood pressure, reverse hives, and
reduce swelling of the face, lips, and
throat.
● Epinephrine is a hormone and
neurotransmitter used to treat allergic
reactions, to restore cardiac rhythm,
and to control mucosal congestion,
glaucoma, and asthma.
● Epinephrine, also known as adrenaline,
is a hormone and neurotransmitter and
produced by the adrenal glands that
can also be used as a drug due to its
various important functions.
14. Demerol
● Generic Name: Meperidine
● Brand Name: Demerol
● Drug class: Synthetic, Opioids, Opioid
Analgesics
● Method of administration: Oral route
● Indication: for the relief of moderate to
severe pain
● Meperidine is used to relieve moderate
to severe pain. Meperidine is in a class
of medications opiate (narcotic)
analgesics. It works by changing the
way the brain and nervous system
respond to pain.
 Surgical Drains
1. Hemovac
- This is a fine tube. With many holes at
the end, which is attached to an
evacuated glass bottle providing
suction. It is used to drain blood under
the skin.
2. U tube Draining
3. Intercostal Catheter
- Chest drainage system
- It is used to remove air in the case of
pneumothorax or fluid such as in the
case of pleural effusion, blood, chyle, or
pus when empyema occurs from the
intrathoracic space. It is also known as
a Bülau drain or an intercostal catheter.
4. Bellovac
- The Bellovac ABT set is used in adults
for postoperative drainage, collection,
filtration and reinfusion of blood, in knee
and hip surgery. Do not leave the
drainage in situ longer than necessary.
Delayed withdrawal may cause
discomfort and tissue damage.
-
5. PTHB Drain
6. Redivac
- This is a fine tube, with many holes at
the end, which is attached to an
evacuated glass bottle providing
suction. It is used to drain blood
beneath the skin, e.g. after mastectomy
or thyroidectomy, or from deep spaces,
e.g. around a vascular anastomosis.
7. T Tube Drain
- Kehr’s T tube :T tube: a tube
consisting of a stem and a cross
head is placed into the common
bile duct while the stem is
connected to a small pouch (i.e.
bile bag). It is used as a
temporary post-operative
drainage of a common bile duct.
Sometimes it is used in ureteric
problems too.
8. Penrose Drain (Open Drain)
- A penrose drain is soft and
flexible. This drain doesn’t have
a collective device. It empties
into absorptive dressing material,
it promotes drainage passively.
With the drainage moving from
the area of grater pressure in the
wound or surgical site to the area
of less pressure.
- A sterile, large pin is often
attached to the outer portion to
prevent the drain from slipping
back into the incised area.
- The drain acts like a straw to pull
fluids out of the wound and
release them outside the body.
9. Corrugated Drain
- Corrugated Rubber Drain (an open
drain)
- Rubber causes a tissue reaction and
the drain track caused by this material
persists longer than when inert
materials are used.
- The drain is fixed by a suture at the end
of the wound and a safety pin must be
placed through the end to prevent the
drain slipping inwards. Corrugated
rubber drains can be used either for the
wound or for deep drainage.
10. Blake Drain
- A blake drain is used to drain
blood and other fluids from your
wound post-surgery. This helps
to prevent infection and speed
up wound healing. It is inserted
by your surgeon during surgery.
You can have one to four drains
depending on the type of surgery
performed.
11. Yeates Drain
- Silicone multitubular (Yeates)
drain. Description. A medical
grade silicone drain with non
wetting multiple lumens,
designed for use where
sustained constant drainage is
essential, permitting tubular and
strip drainage. Tubes can be
separated, producing a tree
shaped multidrain.
12. Pigtail Catheter
- A pigtail is a type of catheter that
has the sole purpose of
removing unwanted body fluids
from an organ, duct or abscess.
Pigtail drains are inserted under
strict radiological guidance to
ensure correct positioning.
- A pigtail is a sterile, thin, long,
universal catheter with a locking
tip that forms a pigtail shape.
The tip of the pigtail has several
holes, which facilitate the
drainage process.
- Pigtail are inserted through the
skin by a radiologist. It may be
inserted to allow, for example,
urine to drain directly from a
kidney, if the ureter is diseased
or blocked. This is called
Nephrostomy. Other conditions
requiring the insertion of the
include a blocked bile that needs
to be drained of bile.
 13. Exudrain - The JP drain removes fluids by
creating suction in the tube. The
Exudrain® is a wound drainage system of the bulb squeezed flat and
highest quality. Exudrain® is designed to be connected to the tube that sticks
activated and suctioned on low pressure, which
out of your body. The bulb
means less blood loss and less tissue aspiration.
expands as it fills with fluid.
With the three non-return valves, they are
completely closed through the process from
Common Uses:
collection to the emptying of the drain fluid.
Exudrain® provides medium volume drainage. Can
● Abdominal surgery
be used in any procedures, and has been a
product of choice for early discharge with the drain
● Breast surgery
in situ after mastectomies with axillary clearance. ● Mastectomy
Surgical procedures: ● Thoracic surgery
● General surgery
● Breast surgery e.g. mastectomies
● Wound drain in situ

14. Jackson Pratt

- Jackson-Pratt drain, JP drain, or
Bulb drain, is a drainage device
used to pull excess fluid from the
body by constant suction.
- The device consists of a flexible
plastic bulb - that connects to an
internal plastic drainage tube.
- A Jackson-Pratt (JP) drain is
used to remove fluids that build
up in an area of the body after
surgery.
- The JP drain is a bulb-shaped
device connected to a tube. One
end of the tube is placed inside
the body during surgery. The
other end comes out through a
small cut in the skin. The bulb is
connected to the end.
- The JP drain is used as a
negative pressure vacuum,
which also collects fluid.