OR Bible

Scalpel

Used for initial incision and cutting tissue. Consists of a blade and a handle. Surgeons often refer to the instrument by its blade number.

#10 Blade

#11 Blade

#15 Blade

Used primarily for making large skin incisions, e.g., in laparotomy.

Used for making precise or sharply angled incisions.

Smaller version of #10 blade used for making finer incisions.

Scissors

Used for cutting tissue, suture, or for dissection, can be straight or curved, and may be used for cutting heavy or finer structures.

Forceps

Also known as non-locking forceps, grasping forceps, thumb forceps, or pick-ups. Used for grasping tissue or objects. Can be toothed (serrated) or non-toothed at the tip.

Clamps

Also called locking forceps, these are ratcheted instruments used to nold tissue or objects, or provide hemostasis.Can be traumatic or traumatic.

Needles

come in many shapes and cutting edges for various application. Suture can be absorbable, non-absorbable, and available in different sizes.

needle point

needle body

swaged

3 parts of surgical needle

round

reverse cutting

cutting

common shapes of needle

Taper point

Blunt point

Reverse cutting

Common Uses of Atraumatic Needles

Soft tissue closure below skin surfaces, dura, fascia, Gl, muscle, nerve, pleura, vessels

Frlable tissues, spleen, liver, kidneys, cervix CUTTING EDGE: Ligaments, tendons, calcified or fibrous tissue. thoracic, plastic, Ob &Gyn, scar tissue

Skin closure, retention suture, S/C. ligaments or fibrous tissue, mucosa

Taper cut

Spatulated Curved

Common Uses of Atraumatic Needles

Bronchus, calcified tissues, nasal &oral cavity, periosteum, trachea, uterus, vessels

Ophthalmic surgery for muscle and retinal repair, eyelld suturing

Knots

—Art of suturing!

—An appropriate type of know should be used for

the specific suture material

Slip knot

Surgeon’s knot

Knots

used with silk, chromic or plain gut suture

used with synthetic resorbable and other nonresorbable synthetic suture materials to prevent untimely knot untying.

Intermittent

Continuous

Blanket continuous

Retention

Types of Stitches

Stitches

Steri-strips

Staples

Types of Knots

Retractors

are used to hold an incision open, hold back tissues or other objects to maintain a clear surgical field, or reach other structures. They can either be hand-held or self- retaining via ratcheting mechanism.

Scapula and Scopes

Are used to expose body orifices by widening for better viewing.

Suction

help to remove debris and fluid from the surgical field. It can also be used to clear surgical smoke,

Staplers and Clips

Used for reanastomosis of viscera, vessel ligation, and excision of specimens. Can be one-time use, reloadable, manual, or electronically powered. Staples come in multiple sizes.

Energy system

Broad term used to describe various methods of cutting tissue or sealing vessels. May use electricity or sonic waves. Available in open or laparoscopic forms.

Preoperative period

Intraoperative period

Postoperative period

Phases of Surgery

Preoperative period

Intraoperative period

Postoperative period

Decision for surgical interventiont to transfer to OR

Received in OR to admission in the recovery room.

Admission in the recovery room to follow-up evaluation.

Perforation

Obstruction

Erosion

Tumor

General Types of Pathologic Process Requiring Surgery

Perforation

Obstruction

Erosion

Tumor

the rupture of an organ

impairment to the flow of fluids

wearing off of a surface of a membrane

abnormal new growth

Optional

Elective

Planned/Required

Urgent/Imperative

Emergency

Time Requirement for Surgery

Optional

Elective

Planned/Required

Urgent/Imperative

Emergency

At the preference of pt. Surgery. not needed.

At the convenience of the pt. Failure to have surgery is not catastrophic

Within a few weeks as surgery is important

Within 24-48 hrs

Immediately without delay

Diagnostic

Explanatory

Ablative

Constructive

Reconstructive

Palliative

Purpose of Surgery

Diagnostic

Explanatory

Ablative

Constructive

Reconstructive

Palliative

To confirm diagnosis

To estimated the extent of the dose and confirm the dx as well

Removal of diseased organ

Repair of congenital defects

Restoration of damaged organ

Relieves symptoms but does not cure the disease

Maj

Extent of Surgery

• there is a high risk to the patient

• it is extensive, prolonged

• with large amount of blood loss

• vital organs may be handled

• longer recovery time

• involves less risk

• usually not prolonged

• leads to few serious complications

• shorter recovery time

• Stress response is elicited

• Defense against infection is

lowered

• Vascular svstem is disrupted

• Organ function is disturbed

• Body image may be disturbed

• Lifestyle may change

Effects of Surgery to the Patient

Local

Types of Anesthesia

Local

General

Anesthesia

Reduces all painful sensations in one region without inducing unconciousness.

Total loss of consciousness and sensation (also produces amnesia).

Onset

Excitement

Surgical Anesthesia

Medullary Depression

4 Stages of General Anesthesia

Onset

Excitement

Surgical Anesthesia

Medullary Depression

4 Stages of General Anesthesia

From anesthetic administration to loss of pain sensation.

From consciousness to loss of eyelid reflex.

From loss of eyelid reflex to loss of most reflex.

Functions are excessively depressed to respiratory and circulatory failure.

Inhalation Anesthesia

Anesthetic Gases

Intravenous Anesthetic

Conscious Sedation

Regional Anesthesia

Spinal Anesthesia

Conduction Blocks

Local Infiltration Anesthesia

Methods of Administration of Anesthesia

Inhalation Anesthesia

Nitrous Oxide

Intravenous Anesthetic

• Include volatile liquid agents and gas anesthetic • Volatile liquids produce anesthesia when their vapors are inhaled

is the most common gas anesthetic used.

• These medications: may be administered for induction or maintenance of anesthesia • Often used along with inhalation anesthetics but may be used alone. • Can be used to produce CONSCIOUS SEDATION

Conscious Sedation

Regional Anesthesia

Spinal Anesthesia

Depressed level of consciousness without impairment of client's ability to maintain a patent airway and to respond appropriately to physical stimulation and verbal command.

Agent is injected around the nerves so that the area supplied by these nerves is anesthetized. Effects depend on the type of nerve involved; local anesthetics block motor nerves least readily and sympathetic nerves most readily.

Produce anesthesia of the lower extremities, perineum and lower abdomen.

Conduction Blocks

Local Infiltration Anesthesia

Achieved by injecting a local anesthetic into the spinal canal in the space surrounding the dura mater. Blocks sensory, motor and autonomic function.

Injection of a solution containing the local anesthetic into the tissue at the planned incision site. Often administered with epinephrine which causes vasoconstriction agent thus prolongs its local action.

Phase I

Phase II

Phase III

3 Phases of Postop Period

Phase I

Phase II

Phase III

Phases

Initial period of time for recovery from anesthesia, during Which the client is monitored closely by PACU nurses.

Time of discharge from PACU to the 1st day or so of surgery while the client is recovering from the effects of the surgery and is beginning to eat and ambulate

Time of healing, which may last for weeks, months, or years after surgery.

IMMEDIATE POST ANESTHETIC STAGE

CONTINUING POST ANESTHETIC STAGE

2 Strategies of Postoperative Phase

IMMEDIATE POST ANESTHETIC STAGE

• is usually provided in the postanesthetic room (PAR).

• Protect the airway

• Maintain normal BP

• Monitor return of consciousness

• Assessment for return of sensation and motion

• Asses for Normothermia

• Assess for perfusion

• Assess surgical site

• Promote fluid and electrolyte balance

• Manage Drainage systems

• Promote comfort

• Maintain safety

Post Anesthesia Care Nursing Interventions

Activity

Respiration

Circulation

Consciousness

Skin color

Discharge from PACU

Primary intention

Secondary intention

Wound Healing Intention

Primary intention

Secondary intention

Wound Healing Intention

• Use of sutures or other wound closures to approximate the edges of an incision or clean laceration. • Healing by collagen synthesis • Minimal tissue defects and infection • Little scarring; usually thin and flat

• Left open rather than closed with sutures • Heal by the generation of connective tissue • Increased risk of infection • More scarring; grafting may be needed• Pressure ulcers

Tertiary

• Also known as delayed primary closure

•for Contaminated wounds

• They must be freed from infection and

debris

a. Assess respiratory status

b. Assess Circulation

c. Monitor the wound

d. Monitor IV lines

e. Monitor drainage tube

f. Provide comfort

g. Reduce N/V

Post-op Nursing Care After Discharge from PACU

Medications

Environment

Treatment

Health teaching

Observable Signs and Symptoms

Diet

Spirituality

Discharge Instruction