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Preoperative Phase

Begins when the decision for surgery is made and ends when the patient is transferred onto the operating room (OR) bed.

Intraoperative Phase

Begins when the patient is transferred onto the OR bed and ends with admission to the PACU.

Postoperative Phase

Begins with admission to the PACU and ends with the final follow-up evaluation.

Informed Consent (Surgeon's Role)

To completely explain the procedure, benefits, risks, and potential complications.

Informed Consent (Nurse's Role)

To clarify information, advocate for the patient, and witness the signature.

Informed Consent Validity

Consent is ONLY valid if signed BEFORE administering any psychoactive or sedative premedication.

Preoperative Teaching

Teach deep breathing, coughing, incentive spirometry, and early mobility before the surgery occurs.

Circulating Nurse

An unsterile role. Manages the OR environment, protects patient safety, monitors the surgical team, and documents the procedure.

Scrub Nurse

A sterile role. Directly assists the surgeon with instruments and maintains the sterile field.

Surgical Asepsis (Gown)

Gowns are considered sterile only in the front, from the chest to the level of the sterile field, and sleeves from 2 inches above the elbow to the cuff.

Surgical Asepsis (Distance)

Unsterile team members must maintain at least a 1-foot distance from the sterile field.

Malignant Hyperthermia

A life-threatening, inherited muscle disorder triggered by inhalation anesthetics or succinylcholine.

Malignant Hyperthermia (Early Sign)

Tachycardia is the most frequent early sign, accompanied by increased CO2 levels and muscle rigidity.

Malignant Hyperthermia (Treatment)

Stop surgery immediately, administer IV Dantrolene, give 100% oxygen, and infuse iced 0.9% Normal Saline.

Nausea and Vomiting (PACU Intervention)

At the first sign of nausea, turn the patient completely to their side to prevent aspiration.

Aldrete Scoring System

Used to determine if a patient is ready for discharge from the PACU. Evaluates activity, consciousness, respiration, O2 saturation, and circulation.

Wound Dehiscence

The spontaneous opening or separation of the surgical incision.

Wound Evisceration

The protrusion of internal organs through an opened surgical incision.

Evisceration Interventions

Call for help. Cover the wound with a sterile towel moistened with sterile saline. Place patient in low Fowler's with knees bent. Do NOT push organs back in.

Jackson-Pratt (JP) Drain

A closed, self-contained drainage system that uses a compressed bulb to apply gentle suction to the wound.

Hemovac Drain

A large, closed suction device with a spring-loaded reservoir, commonly used after mastectomies or orthopedic surgeries.

Penrose Drain

A simple, open latex tube that allows fluid to drain directly onto a sterile dressing.

T-Tube Drain

Placed in the common bile duct after gallbladder surgery to allow passage of bile. Expect 500-1000 mL of drainage initially.

Patient-Controlled Analgesia (PCA)

A computerized pump allowing the patient to self-administer small, preset doses of IV pain medication. Only the patient should push the button.

Deep Vein Thrombosis (DVT) Prophylaxis

Apply anti-embolism stockings (TEDs) or sequential compression devices (SCDs), administer low-molecular-weight heparin, and encourage early ambulation.

Paralytic Ileus

Absent GI peristalsis caused by anesthesia or abdominal surgery. Keep patient NPO until bowel sounds or flatus return.

Hypovolemic Shock (Signs)

Decreased BP, increased HR (tachycardia), increased RR, narrowing pulse pressure, and slow capillary refill.