DEFINITION OF TERMS:

• Ambulatory Surgery - includes outpatient, same day or short-stay surgery that does not require
an overnight hospital stay
• Bariatrics - having to do with patients who are obese
• Informed Consent - the patient's autonomous decision about whether to undergo a surgical
procedure, based on the nature of the condition, the treatment options, and the risks and benefits
involved
• Intraoperative Phase - period of time that begins with transfer of the patient to the operating
room table and continues until the patient is admitted to the post anesthesia care unit
• Perioperative Phase - period of time that constitutes the surgical experience; includes the
preoperative, intraoperative, and postoperative phases of nursing care
• Postoperative Phase - period of time that begins with the admission of the patient to the post
anesthesia care unit and ends after follow-up evaluation in the clinical or home setting
• Preadmission Testing - diagnostic testing performed before admission to the hospital
• Preoperative Phase - period of time from when the decision for surgical intervention is made to
when the patient is transferred to the operating room table
• Minimally Invasive Surgery - surgical procedures that use specialized instruments inserted into
the body either through natural orifices or through small incisions

MEDICAL ASEPSIS

Medical asepsis, sometimes called clean technique, is based on maintaining cleanliness to prevent the
spread of infectious diseases and to assure that the environment is as free of microorganisms as possible.
Medical asepsis involves confining microorganisms to specific areas and making objects either clean or
dirty

Cornerstones of Medical Asepsis

• Know what is dirty

• Know what is clean
• Know what is sterile
• Keep these conditions separate
• Remedy contamination immediately

PRINCIPLES

The basic principles of medical asepsis include:

• Cleanse hands frequently following CDC's Hand Hygiene Guidelines.

• Keep soiled items and equipment from touching clothing.
• Do not place soiled bed linens or other items on the floor. Avoid having the patient cough, sneeze,
or breathe directly on others.
• Move equipment away from you when sweeping, dusting, or scrubbing articles
• Clean the least soiled items first then the more soiled ones.
SURGICAL ASEPSIS

Surgical asepsis, also called sterile technique, is used in the operating room delivery room, during surgical
procedures, catheterization, and during dressing changes.

ELEMENTS OF SURGICAL ASEPSIS

• Hand washing
• Opening of sterile wrapped package
• Use of gloves
• Gowning
• Masking
• Sterilization of articles

13 PRINCIPLES OF STERILE TECHNIQUE

1. Only sterile items are used within the sterile field

2. Sterile persons are gowned and gloved.
3. Tables are sterile only at table level.
4. Sterile persons touch only sterile items or areas. Unsterile persons touch only unsterile items or
areas.
5. Unsterile persons avoid reaching over sterile field. Sterile persons avoid leaning over unsterile
areas.
6. The edge of anything that encloses sterile content are considered unsterile. (1 inch)
7. Unsterile persons avoid sterile areas.
8. Sterile field is created as close as possible to the time of use.
9. Sterile areas are continuously kept in view.
10.
11. Sterile persons keep sterile areas to contact with a minimum.
12. Microorganisms must be kept to irreducible minimum.
13. Destruction of integrity of microbial barriers results in contamination.
- This principle applies to packaging materials as well as to draping and gowning
materials. Obvious contamination occurs from direct contact between sterile and
unsterile objects.

SURGERY

The branch of medical practice that treats injuries, diseases, and deformities by the physical removal,
repair, or readjustment of organs and tissues, often involving cutting into the body.

CLASSIFICATIONS OF SURGERY

• P - Purpose / reason
• U - Urgency
• R - Risk, degree of
• E – Extent
SURGICAL CLASSIFICATIONS: (ACCDG, TO PURPOSE)

1. Diagnostic (biopsy, Exploratory Laparotomy)

2. Curative (excision of a tumor or an inflamed appendix)
3. Reparative (multiple wound repair)
4. Reconstructive or cosmetic (mammoplasty or a facelift)
5. Palliative (to relieve pain or correct problem e.g., debulking)
6. Rehabilitative (total joint replacement surgery to correct crippling pain or progression of
degenerative osteoarthritis.)

CLASSIFICATION INDICATIONS FOR SURGERY EXAMPLES

I. Emergent - patient requires
immediate attention, life
threatening
II. Urgent - patient requires
prompt attention
III. Required - patient needs to
have surgery
IV. Elective - patient should
have surgery
V. Optional - decision rests with
patient
Without delay
Within 24 to 30 hours
Plan within few weeks or
months
Failure to have a surgery is not
catastrophic
Personal preference
Severe bleeding, bladder or
intestinal obstruction, fractured
skull, gunshot or stab wounds,
extensive burns
Acute gallbladder infection,
kidney or ureteral stones
Prostatic hyperplasia without
bladder obstruction, thyroid
disorders cataract
Repair of scars, simple hernia,
vaginal repair
Cosmetic surgery

2 MAIN CLASSES OF SURGERY (ACCDG. TO DEGREE OF RISK)

1. Major
- are usually extensive and warrant an overnight or extended stay in a hospital.
- include extensive work such as entering a body cavity, removing an organ or altering the
body's anatomy.
- Patients undergoing major surgeries usually require anesthesia or respiratory assistance
and sometimes even both.
• Examples: cardiac operations, any bowel cavity operations, reconstructive surgery,
deep tissue procedures, any transplant procedures, as well as any surgeries in the
abdomen, chest or cranium

2. Minor
- are generally superficial and do not require penetration of a body cavity.
- They do not involve assisted breathing or anesthesia and are usually performed by a single
doctor.
• Examples of minor surgeries Include biopsies, repairs of cuts or small wounds, and
the removal of warts, benign skin lesions, hemorrhoids or abscesses.
EXTENT OF SURGERY

1. SIMPLE
- e.g., SIMPLE MASTECTOMY
2. RADICAL
- e.g., RADICAL MASTECTOMY

SETTINGS FOR SURGERY

➢ INPATIENT SETTINGS:
• hospitals
➢ OUTPATIENT SETTINGS:
• hospital based ambulatory surgical centers
• free-standing surgical centers
• physicians' offices
• ambulatory care centers

INPATIENT

- For patients requiring a lengthy recovery or a serious procedure, inpatient surgery is usually
necessary.
- The patients will stay overnight or longer and will have staff available around the clock to monitor
their vitals and ensure proper treatment after surgery.