Robinson D.

Robles RT, RN

I. inpatient settings
a. hospitals

II. outpatient settings

a. hospital-based ambulatory surgical centers b. free-standing surgical centers c. physicians' offices d. ambulatory care centers

a. diagnostic performed to determine the origin and cause of a disorder or the cell type of a cancer
breast biopsy, exploratory laparotomy

b. curative performed to resolve a health problem by repairing or removing the cause

cholelithiasis, mastectomy, hysterectomy

c. restorative performed to improve a patient's functional ability

total knee replacement, finger reimplantation

d. palliative performed to relieve symptoms of a disease process, but does not cure
colostomy, nerve root resection, tumor debulking, ileostomy

e. cosmetic performed primarily to alter or enhance a person's appearance

revision of scars, liposuction, rhinoplasty, blepharoplasty (eyelid)

a. elective planned for correction of a nonacute problem

cataract removal, hernia repair, total joint replacement

b. urgent requires prompt intervention; or may be life-threatening if treatment delayed

intestinal obstruction, bladder obstruction, kidney or urethral stones

c. emergency requires immediate intervention because of life-threatening consequences

gunshot wound, stab wound, severe bleeding

a. minor surgery (low degree of risk) procedure without significant risk, often done with local anesthesia
incision and drainage, muscle biopsy

b. major surgery (high degree of risk) procedure of greater risk, usually longer and more extensive than a minor procedure
mitral valve replacement (MVR), pancreas implant, lymph node dissection

a. simple only the most overtly affected areas involved in the surgery
simple or partial mastectomy

b. radical extensive surgery beyond the area obviously involved; is directed at finding a root cause
radical mastectomy or prostatectomy

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3.

Sterile to sterile contact only. A doubtful article must be considered unsterile. Whatever is sterile for patient is sterile for that patient only. Supplies must be discarded if unused.

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Scrubbed personnel must remain in the area of the surgical procedure; if a scrubbed person leaves the room, the status of sterility will be breached. To return the person has to do scrubbing again.

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The parts of the body which will be considered sterile are:

a. Waist to the shoulder area. b. Forearms and gloves Important: Gloved hand must be kept in front between the shoulders and waistline.

2.

The circulating nurse and any unscrubbed personnel remain at a safe distance to avoid contamination of any sterile area.

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2.

During the draping of a table or a patient, the sterile drape is held above the surface to be covered and is positioned from front to back. Only the top of the patient that is draped is considered sterile; drapes hanging over the edge are not regarded as sterile.

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Sterile drapes are kept in position by the use of clips or adherent material; drapes are not moved during surgical procedure. A tear or puncture on drape permitting access to an unsterile surface underneath renders the area unsterile. Such drapes must be replaced.

4.

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Packages are wrapped or sealed in such a way that they can be opened easily without risk of contaminating contents. Sterile supplies, including solutions, are delivered to a sterile field or handed to a scrubbed person in such a way that sterility of the object remains sterile or intact.

2.

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Edges of wrappers covering sterile supplies or outer lips of bottles or flasks containing sterile solutions are not considered sterile. The unsterile arm of the circulating nurse must not extend over a sterile area. Sterile articles are to be dropped on the sterile field, a reasonable distance from the edge of the sterile area.

4.

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Sterile solutions are poured from a point high enough to prevent accidental touching of the sterile receiving cup or basin but not high enough to cause splashing. (When a sterile area becomes wet, it is considered contaminated.)

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The patient should be comfortable as possible. The operative area adequately exposed. must me

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The vascular supply should not be obstructed by an awkward position or undue pressure.

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5.

There should be no interference on patients respiration. Nerves must be well protected from undue pressure to prevent possible injuries, which may lead to paralysis.

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4. 5.

Dorsal Recumbent hernia repair, mastectomy, bowel resection Trendelenburg lower abdomen, pelvic surgeries Lithotomy vaginal repairs, dilatation and curettage, rectal surgery, abdomino-perineal resection Prone spinal surgery / spinal cordrelated surgeries Lateral kidney, chest, hip surgeries

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5.

Explain the purpose of position Avoid undue exposure Strap the person to prevent falls Maintain adequate respiratory and circulatory function Maintain good body alignment