Lusaka Institute Of Applied Sciences

SURGERY AND SURGICAL NURSING I

Intake: July 2015

Lecturer: Mr P. Kolala

UNIT1.
INTRODUCTION TO SURGERY

 Surgery is the art and science of treating diseases, injuries and deformities using
operative procedures.
 It is a medical specialty that uses operative, manual and instrumental techniques on a
patient to investigate and/or treat a pathological condition such as disease or injury.
 To help improve bodily function, appearance and to prolong life.
 An act of performing surgery may be called a surgical procedure, operation, or simply
surgery. In this context, the verb operating means performing surgery.

Surgery represent personal crisis in life, because any operation, however minor, always carries
some risks and involves a certain amount of expenses, discomfort, pain, and emotional stress for
the patient as well as disruption of a person’s usual life patterns.

All forms of surgery are considered invasive procedures because of access to internal body
tissues.

GENERAL EFFECTS OF SURGERY TO THE PATIENT

1. Stress response is elicited

The stressful response combines both psychological factors (anxiety, fear) and physiologic
factors. The sympathetic nervous system stimulates the adrenal medulla, resulting in an increased
production of norepinephrine and epinephrine and this will lead to:
Increased heart rate

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 Increased blood sugar
Bronchial dilatation
Vaso-construction
Increased BP

2. Defence against infection lowered

When the skin is incised, the first line of defence against microorganism invasion is destroyed.

3. Vascular system disrupted: Blood loss always occur during surgery.

4. Organ functions are disturbed

During surgery, organs are often manipulated causing the organ functions to be temporally
disturbed during the post-operative period.

5. Body image may be disturbed

Body image is a unique sense of identity.
E.g Disturbance as result of amputation of the limb, breast disfiguring or Scar on the face.

6. Life style may change.

Certain types of operations may force radical alteration in the patients’ ways of life.
To some extent, the ability to perform certain activities is limited.

DEFINITION OF CONCEPTS AND TERMS

Surgery: A branch of medicine that treats disease conditions by operative measures.

Surgeon: A medical practitioner who specializes in surgery.

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.

Wound: A cut or break in continuity of the skin, caused by injury or operation.

Laparo: abdomen

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Scopy: to look into

Laparotomy: Incision of the abdominal wall for exploratory purpose.

Laparoscopy: Viewing the abdominal cavity by passing an endoscope through a small hole
made on the abdominal wall.

Anastomosis: This end to end, side to side or side to end union of a hollow tubular organ. E.g
Intestines

Ectomy: Removal of an organ. E.g Hysterectomy is the surgical removal of the uterus..

Resection: removal of a part of an organ.

Dissect/dissection: to cut apart or separate

Ostomy: Procedures for formation of a permanent or semi-permanent opening called a stoma in

the body. e.g. colostomy or tracheotomy. It is a surgical opening in the body which connects the
portion of the body to the external.

Otomy: opening into an organ. E.g Craniotomy is the surgical opening in the skull

Fistula: an abnormal connection between 2 organs or cavity and the surface of the body e.g.
Rectal vaginal fistula or Vesicle Vaginal Fistula

Excise/excision: Removal by cutting

Incise/incision: to cut or a cut

Rhaphy: Repair E.g Herniorrhaphy is the surgical repair of a hernia.

Plasty: Reconstruction. E.g Hernioplasty is the repair of hernia and reconstruction to the
abdominal wall.

Dilate: To stretch

Curettage: Removal by scrapping of material from wall or cavity

Ligation: to tie using a surgical material such as Surturing material.

Pre: before

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Intra: in, within, interior

Post: after

Pre-operative Phase: This is a period before an operation.

It is a period of time from when the decision for surgical intervention is made to when the patient
is transferred to the operating room.

Intra Operative Phase: a period of time from when the patient is transferred to the operating
room table to when he/she is admitted to the post anesthesia care unit (PACU), recovery room or
acute bay.

Post-Operative Phase: a period of time that begins with admission of the client to the PACU, a
cute bay or recovery room and ends after the follow up at the clinic for evaluation and
rehabilitation at home.

Peri-Operative Phase: This is an encompassing term that incooperates the three phases of the
patient’s surgical experience i.e. preoperative, intra operative and post-operative periods.

Anaesthesia: a state of severe central nervous system depression produced by pharmacologic

agents resulting in analgesia, relaxation and reflex loss.
Anaesthesia can be General or Local.
PRINCIPLES OF SURGERY
 To preserve life.
 To alleviate suffering.
 To repair damaged tissues and to limit complications
 To relieve symptoms.
The benefit of Performing Surgery should outweigh the risk.

GENERAL PRINCIPLES OF SURGERY

• All equipment for the procedures must be sterilized or high level disinfected.
• Begin with clean procedures then proceed to dirty ones.
• Begin with urgent cases then proceed to non-urgent thereafter.
• Begin with children then consider adults last.
• All procedures should be done 30min – 1hour after the cleaning of the environment.
• Appropriate preparation of the perioperative environment and equipment to ensure
environmental safety for patients and personnel, wearing appropriate attire, maintaining a
safe work area.
• Wash hands before and after each case.
• The nurse should give appropriate IEC to the patient during his/her hospitalization.
• The nurse should provide psychological care to the patient.

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 • Establish a good nurse-patient relationship.
• The nurse should explain all the procedures to the patient so as to gain his/her
cooperation.
• Teamwork and communication are essential for positive attainment of expected outcomes
of care.
• The nurse should provide individualized nursing care.
The preoperative planning and preparation for surgical intervention are individualized to
meet specific needs of the patient.
The surgeon collaborates with nurses in the collection of data for use in the preparation of
the equipment and supplies needed for surgical procedure.
• Each patient’s rights to privacy, dignity, safety and comfort need to be respected and
protected at all times. Uphold patients’ rights.

TYPES OF SURGERY
Surgery may be classified and performed in different ways and for different reasons.
Broad classifications of surgery may include surgery based on;
 Degree of urgency
 Purpose.

Surgery based on degree of urgency

 Emergency surgery: This is a type of surgery done without delay in the interest of the
patient’s survival. The patient requires immediate attention because the disorder is life
threatening and the operation must be carried out without delay. Examples of life threatening
disorders include; -Severe haemorrhage
-Intestinal obstruction,
- Urinary bladder obstruction,
-Fractured skull,
-Gun short or Stab wounds,
-Extensive burns etc.
This type of Surgery is not Planned.

 Urgent surgery: This is the type of surgery done within 24 – 30 hours. The patient requires
prompt attention delays in performing an operation may result into complications. That is
illness becoming more serious. Examples of conditions that require urgent surgery include
acute gall bladder infection, kidney or ureteral stones.

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 Required surgery: This type of surgery is not life threatening although complications may
arise if surgery is not performed within certain time limits. This surgery can be planned
within a few weeks or months Example of conditions that fall into this category of surgery
include prostatic hyperplasia without urinary bladder obstruction, thyroid disorders, cataracts
etc.

 Elective surgery: This type of surgery is usually planned and it is usually not life
threatening Failure to have surgery is not catastrophic. Examples of conditions that fall into
this category include repair of scars, simple hernia, Repair of contractures.

 Optional surgery: As the word implies, the decisions to have an operation entirely rests on
the patient`s preference. Whether the operation is conducted or not, the patient still continues
to live normal life. Examples include male circumcision, cosmetic surgery (Plastic surgery of
the face, breasts or buttocks)

Surgery based on purpose

 Diagnostic surgery/ Explorative surgery: This is a type of surgery is performed for
diagnostic purposes and/or determination of the presence and/or extent of pathology. E.g.
biopsy, exploratory laparotomy, etc.

 Curative surgery: This is a type of surgery performed for elimination of pathological

tissue e.g. Tumour excision, removal of an inflamed appendix (appendicectomy) etc.

 Reparative Surgery: This is a type of surgery where repairing is done due to damage of
the normal structure; e.g. repair of multiple wounds, ruptured uterus or urinary bladder,
etc.

 Preventive surgery: This is a type of surgery which is performed remove threatening

predisposing factor before it triggers pathology or disease. E.g benign tumour before it
becomes malignant

.
 Palliative surgery: This is a type of surgery performed for alleviation of symptoms
without cure. E.g. relief of pain, insertion of a nasogastric tube for failure to swallow,

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 gastric distension, puncturing the bladder through the abdominal wall to drain urine in
order to avoid extensive bladder distension.

 Cosmetic/Reconstructive Surgery: This is a type of surgery done for the purpose of

beautification or alteration in the natural make up of individuals. The indication is
recognised by the person concerned; e.g. mammoplasty, facelift, etc.

SURGERY CATEGORIZED ACCORDING TO DEGREE OF RISK

Major surgery: Involves high risk because the patient may be on operating table for a prolonged
period of time, a large amount of blood may be lost, and the post-operative complications may
develop.

Minor surgery: not prolonged. Involves minor complications or no complications at all.