GENERAL ENDOTRACHEAL ANESTHESIA (GETA)

PERI-OP NSG SKILLS LAB - Modern endotracheal anesthesia is a technic in which the
SURGERY - A medical specialty that uses operative manual and instrumental
administration of an anesthetic may be facilitated and the patient
techniques on a person to investigate or treat a pathological condition such
benefited by an artificial extension of the tracheobronchial tree by
as a disease or injury, to help improve bodily function, appearance, or to
means of a tube through which the patient's respiratory exchange
repair unwanted ruptured areas.
takes place.
REGIONAL ANESTHESIA
Goals of surgery
- the use of local anesthetics to block sensations of pain from a large
 Be free from injury related to positioning, retained foreign
area of the body, such as an arm or leg or the abdomen. Regional
objects, chemical, physical and electrical hazards.
anesthesia allows a procedure to be done on a region of the body
 Be free from infection without your being unconscious.
 Maintain fluid and electrolyte balance TOPICAL ANESTHESIA
 Maintain skin integrity - used on mucous membranes, open skin surfaces, wounds and burns.
 Explain the physiologic and psychologic responses to the ex. Cream, lidocaine spray, drops
planned surgery SPINAL ANESTHESIA (SAB)
 Participate in the rehabilitation process following surgery. - a type of neuraxial anesthesia; local anesthetic (LA) is injected into
cerebrospinal fluid (CSF) in the lumbar spine to anesthetize nerves that
EFFECTS OF SURGERY ON THE CLIENT exit the spinal cord.
PHYSICAL EFFECTS: CAUDAL EPIDURAL BLOCK (CEB)
 Stress response is activated - Method of anesthesia for adult patients undergoing minor gynecologic
 Resistance to infection is lowered due to incision. procedures.
 Vascular system is disturbed duE to severe blood loss. EPIDURAL ANESTHESIA
 Organ function may be altered due to manipulation. - often used during labor and delivery, and surgery in the pelvis and legs.
COMBINED SPINAL EPIDURAL ANESTHESIA (CSEA)
PHYSIOLOGIC EFFECTS: - Spinal anesthesia is usually administered as a single shot, whereas
 Pain epidural anesthesia is usually administered via a catheter (thus it is a
 Anesthesia continuous technique), and CSE anesthesia combines the two.
 Loss of controe
 Disfigurement SURGICAL POSITIONS
 Separation from love ones
 Alterations in roles/ lifestyles SUPINE POSITION - lying on the back or with the face upward.

FACTORS THAT INCREASE SURGICAL RISK

AGE: usually young and elderly clients.
GENERAL HEALTH:
- nutritional health
- cardiac conditions
- respiratory disorders
- renal disease
- liver disease
- bleeding disorders
- neurologic disease
MENTAL STATUS:
- mental illness, retardation, anxiety, dementia
USE OF MEDICATIONS:
- Anti-coagulants may precipitate hemorrhage
- Diuretics may decrease electrolyte levels
- Tranquilizers may cause hypotension PRONE POSITION - lying on your chest
- Adrenal steroids abrupt withdrawal may cause cardiovascular
collapse.
- Antibiotics can cause allergic reactions
HEALTH HABITS:
- It affects the potency of anesthesia
- smoking
- drug abuse
- excessive drinking of alcohol

TYPES OF ANESTHESIA

GENERAL ANESTHESIA (GA)

- is a combination of medications that put you in a sleep-like state
before a surgery or other medical procedure. Under general
anesthesia, you don't feel pain because you're completely
unconscious. General anesthesia usually uses a combination of
intravenous drugs and Inhaled gasses (anesthetics).
- Propofol, etomidate, and ketamine are the intravenous (IV) sedative-
hypnotic agents commonly used to induce general anesthesia , while
adjuvant agents opioids, lidocaine, midazolam are used to supplement
the effects of hypnotic agents.
TRENDELENBURG SEMI-FOWLER’S POSITION - The patient is usually on their back. The bed
- The patient is supine on the table with their head declined below angle is between 30 degrees and 45 degrees.
their feet at an angle of roughly 16°.
- used in lower abdominal surgeries, including colorectal,
gynecological, and genitourinary procedures. In this position, gravity
pulls the intra-abdominal organs away from the pelvis, allowing for
better surgical access to the pelvic organs.

MODIFIED PRONE POSITION or JACK KNIFE POSITION - position in which

the patient lies on the back, shoulders elevated, legs flexed on thighs, thighs
at right angles to the abdomen.

REVERSED TRENDELENBURG - a position in which patients' hip and knee

are not flexed but the head and chest are elevated at 30° than the abdomen
and legs. used for neck and head surgery and gynecological procedures
because it reduces the flow of blood to those areas.

KNEE-CHEST POSITION - a prone posture resting on the knees and upper

part of the chest.

FOWLER’S POSITION - a standard patient position in which the patient is

seated in a semi-sitting position (45-60 degrees) and may have knees either
bent or straight.
LITHOTOMY POSITION - supine position of the body with the legs - thumb forcep
separated, flexed, and supported in raised stirrups, originally used for - Allis
lithotomy and later also for childbirth. - Babcock
Clamping and occluding surgical instruments:
- Mosquito forceps
- Kelly forceps
Retracting and exposing instruments:
- self-retaining/ Balfour
- deaver
- Army-navy
- Malleable
- Richardson
- Weitlaner
Instruments for improving visualization:
- Speculums
- endoscopes (hollow and lens endoscopes)
- anoscopes (for visualizing anus) and proctoscopes
Suturing and stapling surgical instruments :
- suture needles ( cutting and round)
- skin stapler
Suctioning and aspiration instruments:
- suction machine with tubing and tip( frazier, yankauer)
MEMBERS OF THE SURGICAL TEAM Dilating and probing instruments:
- dilators
CIRCULATING NURSE - probes
 Manages the OR
 Protects the safety and health needs of the patient by Types of needles
monitoring the activities of the members and checking the ROUND NEEDLE - used in tissues that are easy to penetrate and in crucial
conditions of the OR theater. procedures such as tendon repair, where suture cutout would be
-lights disastrous. Preferred in abdominal fascial closure.
-temperature CUTTING NEEDLE - used for tough tissue, such as skin, whereas a reverse
-equipment/ machines cutting needle is selected to reduce the risk of tissue cutout.
-supplies
-monitor asepsis and documents SURGICAL INSTRUMENT SETUP

SCRUB NURSE/ OR technician

 Scrubs for surgery
 Sets up the sterile tables ( mayo and back-up tables)
 Manages the accountable
SURGEONS
ANESTHESIOLOGIST
OR TECHNICIANS/ MALE AIDE

PRINCIPLES OF HEALTH AND OR ATTIRE

• STREET CLOTHES, including outside shoes, are never worn in

the OR.
• OR gown is not also worn outside the OR.
• Masks are worn at all times in the OR to minimize airborne
contamination.
• Surgical caps should completely cover the hair.
• Wear well-fitting shoes.
PERI-OPERATIVE PROTOCOLS
Pre-operative
All surgical materials, instruments, needles, sutures, dressings, gloves and
solutions that may in contact with the wound must be sterilized.
Intra-operative
Scrubbed personnel should only touch sterile supplies, instruments and
other supplies placed on the sterile field.
Post-operative
The wound must be covered/ protected with a sterile dressing, betadine
antiseptic solution must be applied before covering it to avoid
contamination and infection.
CLASSIFICATION OF INSTRUMENTS AND THEIR APPLICATIONS
Cutting and dissecting surgical instruments:
- Metzenbaum
- Cautery (cutting mode)
- Surgical knife or scalpel
Grasping and handling surgical instruments:
- tissue forcep
WOUND DRESSING
- designed to help healing by optimizing the local wound environment.
- is anything that is used in direct contact with a wound to help it heal
and prevent further issues or complications.
- Different wound dressings are used based on the type of the wound,
but they all aim to help reduce infection.
- The main reasons that we apply dressings include the following:
o To provide rapid and cosmetically acceptable healing
o To remove or contain odor
o To reduce wound-related pain
o To prevent or treat infection
o To contain exudate
o To cause minimum distress or disturbance to the patient
Importance of wound dressing

Wound dressings should provide the most optimum conditions for wound
healing while protecting the wound from infection with microorganisms and
further trauma. It is important that the dressings be removed
atraumatically, to avoid further damage to the wound surface during
dressing changes.

Principles of wound dressing

- provide a temporary protective physical barrier
- absorb wound drainage
- provide the moisture necessary to optimize re-epithelialization
TREATMENT OF WOUND BY TYPE