Hello!

Guide lamang po ito para sa darating na OR Return Demonstrations.

Basahin pa rin ang mga rubrics at mga modules regarding sa mga na-mention na topics.

Maaaring sa actual return demonstrations ay hindi masunod ang mga nandito, o kaya naman ay mabawasan o
madagdagan ang mga info o steps na nandito. Mahalaga pa rin talaga na maging handa sa lahat ng posibilidad at alamin
muna ang mga dapat gawin bago sumabak sa actual demo.

Marami pa ang surgical instruments ang hindi ko nailagay rito. Nilagay ko lang yung mga na-mention sa OR Lecture at
yung mga instruments na may mga kahawig at mahirap i-identify. Makatutulong pa rin ang mag-research sa internet o
humingi ng tulong sa mga kakilala o kaibigan na may experience rin sa OR duty.

Hindi ko magiging pagkakamali o pananagutan kung sakaling magkamali ka o mababa ang score na nakuha mo dahil dito
ka lang bumase at hindi ka na nagaral gamit ang iba pang mga available references, o kaya naman ay may mga nakalagay
rito na info na para sa standards ng ating school ay mali o outdated.

Nevertheless, pinagbasehan ko ang lahat ng ito sa OR Lecture ng ating mga guro, kumuha rin ako ng mga iba pang
impormasyon sa modules sa Canvas at sa internet na ang links ay makikita sa dulo.

Hangad ko lang ay makatulong sa nakararami.

Kapag may dapat itama rito, paki message na lang ako at aayusin ko.

Study well and good luck!

Bautista, J.R.B
Class President of BSN-3-16
OR Return Demonstrations:

1. Hand washing
5 Moments for Hand Hygiene

2. Surgical Scrub

Please watch this (my reference, ito rin yung itinuro sa amin sa OR duty):
https://youtu.be/WpZqLbWL0c0?si=JhrQEYnK3mH_53oE

Note: Perform these steps first before doing the Surgical Scrub (Surgical Hand washing).
1) Essential steps (refer to the rubrics):
a) Gathering materials,
b) Inspecting Skin Integrity,
c) Removing Jewelries and nail polish, and
d) Opening a sterile package.
2) Wet both hands and apply soap, perform the 7 steps of Hand washing.
3) Clean the fingernails using the disposable nail pick.
4) Rinse both hands and arms.
5) After both hands have been washed, get/ask for a brush.
These are the next steps (start of surgical scrub):

1) Rinse the brush and apply soap.

2) With fingertips together, use a light but firm pressure to stroke the nails in a back and forth motion with the
abrasive brush side of the sponge approximately 30 times.

3) Brush the non-dominant hand by the dominant hand using the non-abrasive side of the sponge (All 10 strokes),
a) Scrub the surface of the palm (10 strokes)
 b) Scrub the back of the hand (10 strokes)

c) Scrub the outside surface of the thumb, from wrist to the tip of the thumb (10 strokes)

d) Continue scrubbing each side of the fingers (each side with 10 strokes)

4) After scrubbing the fingers, proceed to the forearm. Divide the forearm into three sections. Each section is also
divided into the ventral side (front), right/left side, dorsal side (back), and right/left side of the forearm.

a) Scrub the ventral (front) surface of the first section of the forearm (10 strokes)
b) Then continue to scrub any side of the first section of the forearm (it’s up to you if left/right side muna ang
gagawin mo, basta paikot) (10 strokes)
c) Scrub the dorsal (back) surface of the first section of the forearm (10 strokes)
 d) Scrub the (yung side na hindi mo pa na-scrub) other side of the first section of the forearm (10 strokes)
e) Repeat the steps 4a-4d on the remaining sections of the forearm.

5) Repeat steps 2-4 on the dominant hand by non-dominant hand.

6) Rinse the brush (it could be disposed of after scrubbing, depending on the rubrics or CI’s instruction)
7) With both hands in an upright (90-degree/right angle flexed) position, start rinsing at the fingertips and continue to
the hand, forearm, and elbow, moving forward through the water (don’t move the arms back and forth through the
water).

Note: If you need more rinsing, re-enter the fingers, hands, forearm, and elbow in one forward motion with the forearm
in the right angle position.

8) Don’t shake or wave hands and arms to remove excess/dripping water (sa experience ko, ginamit namin na pangtuyo
yung bottom part of the gown before kami mag-closed gowning and gloving)

3. Closed Gowning and Gloving

Please watch this: https://youtu.be/TPKxAaL_fL0?si=3qd6k9Iwjm6-eQKn

Things to remember:
1. Circulating nurse (kunwari) ang magtatali ng higpitan (tie) sa likod ng gown na isusuot natin.
2. When performing a closed gloving technique, dapat nasa loob pa rin ng sleeves ang mga kamay.

4. Surgical Instrumentations
a) Purposes of surgical operation (Purpose of Surgery, 2019):
 Further explore the condition for the purpose of diagnosis
 Take a biopsy of a suspicious lump
 Remove or repair diseased tissues or organs
 Remove an obstruction
 Reposition structures to their normal position
 Redirect blood vessels (bypass surgery)
 Transplant tissue or whole organs
 Implant mechanical or electronic devices
 Improve physical appearance

b) Stages (or Phases) of operation

(Note: I-include ko lang yung mga sa tingin ko na mga important)

1) Preoperative phase - It is the phase when the patient has decided to have the surgical intervention to
transfer the patient to the procedure room.
 Assessing the patient’s Vital Signs
 Assessing the patient’s risks and benefits of having the procedure
 Assessing the patient’s other health status (Nutrition, Fluid and electrolytes, health issues, etc.)
 The process of obtaining informed consent
 Providing health teaching regarding the operation

2) Intraoperative phase - the time when the patient is received in the operating room to the time the
patient is admitted to the Post Anesthesia Care Unit (PACU) or recovery room.
 The surgical team is now responsible for the patient, composed of the surgeon, assistant
surgeon, anesthesiologist, holding area nurse, circulating nurse, and scrub nurse.
 Nurse’s responsibilities:
  Positioning the client appropriate to the procedure
 Verification of the preoperative checklist,
 Composing of the informed consent,
 Various preparations (skin preparation; disinfecting the patient’s skin, presence of
necessary surgical instruments),
 Verifying if medications were given
 Preparing blood and intravenous access
 Roles of Nurses: Circulating and Scrub nurse.
3) Postoperative phase – the last phase; from the time of admission in the recovery room to the time of
the follow-up evaluation.
 Monitored for complications from the procedure
 Performing the nursing process: assessment, planning, implementation, and evaluation.
 Assessment of the following:
 Airway, Breathing, and Circulation (ABCs)
 Oxygen saturation
 Ventilation
 Vital signs
 Level of consciousness
 Drainage, fluid status, and hydration

c) The function of Circulating and Scrub Nurse

 Circulating nurse:
 Obtaining fluids and medications
 Obtaining supplies and instruments
 Documenting the progress of the surgery
 Pagtali ng tie sa likod ng gowns.

 Scrub nurse:
 Assists the surgeon by handling instruments or preparing sutures while maintaining surgical
asepsis
 Supplies to the surgeon while maintaining surgical asepsis
 Maintains sterility
 Drapes the patient
 (Add ko lang) From my experience, responsibility din ng Scrub Nurse na ang lahat ng instrument
at surgical dressings (gauze) ay hindi maiiwan sa site of operation. For example, kung 2 gauze
ang ginamit na pang-dab ng dugo, dapat 2 gauze din ang mabibilang after the procedure.

d) Principles of sterile technique (Based sa OR Lecture ni Sir. G)

1) Only sterile items are used within the sterile field.
2) Gowns are considered sterile only from the waist to shoulder level in front and the sleeves.
3) Sterile persons wear gown and sterile gloves.
4) Sterile persons keep hands in sight and at or above waist level.
5) Tables are considered sterile only at table level.
6) Items dropped below waist level are considered unsterile.
7) Sterile persons touch only sterile items or areas. Unsterile persons touch only unsterile items or areas.
8) Unsterile persons should not directly get in contact with the sterile field. Use sterile transfer forceps.
9) Unsterile persons avoid reaching over sterile field. Sterile persons avoid leaning unsterile areas.
10) In pouring into a sterile field and sterile persons avoid leaning over the basin to avoid over reaching.
11) The scrub nurse should set the basin or glasses to be filled at the edge of the sterile table.
12) Surgeons turn away from the sterile field and to have perspiration removed from the brow.
13) Edges of anything that encloses sterile content are considered unsterile.
14) Sterile fields are created as close as possible to the time of use.
 15) Sterile areas are continuously kept in view.
16) Sterile persons keep well within the sterile area.
17) Sterile persons pass each other back to back.
18) Sterile persons turn back to non-sterile person or area when passing.
19) Unsterile persons avoid sterile area.
20) Unsterile person should maintain at least 1 foot distance from any sterile area.
21) Unsterile persons never walk between 2 sterile areas.
22) Destruction of integrity of microbial barriers results in contamination.
23) Microorganisms must be kept to an irreducible minimum.

e) Identifications of blades

f) Classification of Instruments (Based sa OR Lecture ni Sir. G)

 Sharps – for cutting and dissecting tissues.
 Knife/Scalpel (Note: Ang blade holder ay iba sa Scalpel, Scalpel ang term kapag yung blader
holder ay may nakakabit ng blade.)
 Blade handle #4
o This is the first knife used to cut tough tissues.
o Uses blade numbers 20, 21, 22, 23, and 25.
 Blade handle #3
o This is the second blade and used for delicate tissues.
o Uses blade numbers 10, 11, 12, 13, and 15.
 Scissors
 Curved Mayo Scissor – used for heavy or tough tissues.
 Metzenbaum Scissor – used for delicate tissues.
 Straight Scissor – used to cut sutures.
 Bandage Scissor – for cutting the uterus and the umbilical cord.
 Steven’s Scissor – for cutting off the eye lashes.

 Clamps – for occluding (to stop, close, or obstruct) or hemostasis.

 Mosquito Forcep – the shortest clamp. Used for minor surgery, paediatrics, and superficial
layers.
 Crile Forceps – medium clamp. Used for shallow layers.
 Kelly – longest forcep. Used for deep abdominal layers or cavities.
  Mixter – known for its curved end. Used for hard to reach places.
 Ochsner forceps - crushes the tissue to prevent bleeding.

 Graspers – to grasp and hold tissues.

 Thumb forceps – toothless, holds delicate tissues.
 Tissue forceps – with tooth on the tip. Manipulate tissues, support tissues while making
incisions, and suturing. Retract tissues to improve exposure.
 Adson forceps - forceps toothed at the tip used for handling dense tissue, such as in skin
closures. Used for tougher tissues.
 Allis forceps – for tougher tissues like bones.
 Pennington – for perineal or rectal surgery.
 Bob Cock – for delicate tissues; tubular tissues.
 Ovum forceps – for pick-up forcep. Used for delicate tissues.

 Retractors - used to separate or expose the operative site.

 Self-retaining retractors
 Balfour Abdominal Retractor – for deep abdominal area.
 Mastoid Self Retaining Retractor – for small operative area.
 Gelpi Retractor – for perineal surgery.
 Non-self-retaining retractor
 Army Navy – for superficial layers.
 (Big/Baby) Single-blade Richardson
 (Big/Baby) Double-blade Richardson
 Deaver – used for deep cavities.
 Murphy/Rake retractor
 Senn Retractor – superficial; skin retractor.
 Malleable Retractor

g) Identification of instruments (I only included the instruments na nakalilito o mahirap i-identify)

Kelly Forceps Peans Forceps

Note: To differentiate the two, ang “lines” sa loob ng Kelly Forceps ay hindi sagad, pero yung “lines” sa Peans Forceps ay
sagad.
 Ochsner forceps

Heaney forceps

Heaney forcep
Ochsner forcep

Note: Ochsner forcep ay may ngipin sa tip. Heaney forcep ay nasa gitna ang ngipin (single/double toothed)

Pennington forcep
 Bobcock forceps

Note: Parang “O” yung tip ng Bobcock, so tandaan niyo na lang na kapag Bobcock forcep ay parang naka-“O” yung tip.

Allis forceps

Note: Para matandaan, “ Si Aliss ang hilig mangagat”.

 May mahabang ngipin sa tip ang DeBakey

Thumb forceps
Tissue forcep

Note: Ang Thumb/Tissue Forceps ay tweezer (tyane) like ang body. Ang Adson forceps naman ay may malapad na body
pero may manipis na dulo.
Note: Mas magaan hawakan ang Metzenbaum compared sa Mayo. Mas mukhang malapad/mataba ang sharp edges ng
Mayo kapag tinagilid at hinarap.

Murphy retractor

Senn retractor
 Malleable Retractors
Deaver Retractors

(Big/Baby) Richardson, Double

Ended

(Big/Baby) Richardson

Note: Basta kapag may parang “fusilli pasta” sa hawakan/body, Richardson kagad.
 Mixter Forceps

Kelly Forceps

Mixter Forceps

Note: Para masigurado mo kung Mixter or Kelly/Peans curve ba ang hawak mo, tignan mo yung tip ng dalawa at ipag-
compare mo, mapapansin mo na yung Mixter e parang kumurba kaagad or sobra yung curve unlike sa curve ng
Kelly/Peans. (Alam ko may Mixter Blunt and Mixter Fine din.)
References:

https://www.youtube.com/watch?v=WpZqLbWL0c0

https://www.youtube.com/watch?v=TPKxAaL_fL0

https://enviro-master.com/commercial-cleaning-information/3-types-of-handwashing-social-antiseptic-and-surgical/

https://www.hey.nhs.uk/patient-leaflet/hand-hygiene-information/

https://openwho.org/courses/IPC-HH-en

https://www.verywellhealth.com/surgery-
4014639#:~:text=The%20purpose%20of%20surgery%20varies,for%20surgery%20for%20cosmetic%20reasons.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/purpose-of-having-surgery

https://www.scribbr.com/citation/generator/folders/6VzaooFd0JXpeyfVV6gTbS/lists/4k1vDTaWDEUa41Hdjkxpqa/

https://rnspeak.com/perioperative-nursing-three-phases/

https://nurseslabs.com/perioperative-nursing/