Operating Room

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PRE-OPERATIVE CHECKLIST

● Ensure that the client is wearing an ID bracelet. PERIOPERATIVE PHASES


● Assess for allergies. 1. Preoperative period the time prior to surgery.
● Review the preoperative checklist to be sure that - From the patient’s decision/consent to the
each item is addressed before the client is patient received at the OR table.
transported to surgery. 2. Intraoperative period the time spent during the actual
● Ensure that informed consent forms were signed for surgical procedure.
the operative procedure, for any blood transfusion, for - From the OR to the admission of the patient
disposal of limb, or for surgical sterilization to the PACU.
procedures. 3. Postoperative stage is the period when the actual
● Ensure that the history & physical exam were surgery is completed.
completed & documented in the client’s record. From the PACU to the patient follow up check-up and post
● Ensure that consultations prescribed were completed operative evaluation.
& documented in the client’s record.
● Ensure the prescribed laboratory results are NURSING RESPONSIBILITIES OF THE INTRAOPERATIVE
documented in the client’s record. NURSES
● Ensure that ECG & chest radiograph reports are
documented in the client’s record. Circulating Nurse - a registered nurse who coordinates and
● Ensure that a blood type & screening test & cross documents patient care in the operating room. The circulating
match is performed & documented in the client’s nurse works outside the sterile field and is responsible for the
record. management of personnel, equipments, supplies, flow of
● Remove jewelry, dentures, hairpins, nail polish, information, and the environment during a surgical procedure.
glasses & prosthesis.
● Document that valuables were given to the client’s Nursing Responsibilities:
family members or locked in the hospital safe.
● Document the last time the client ate or drank. ● Assess the client preoperatively. This includes
● Document that the client has voided prior to surgery. assessment of client’s medical health history,
● Document that the prescribed preop meds were medication history, psychological, social history,
given. lifestyle habits, pre-surgical screening tests, and
● Monitor & document client’s vital signs. informed consent.
SPONGE LOGBOOK ● Filling out patient’s paperwork which pertains to the
● Straight (10) surgery.
● Curve (10) ● Plan for optimal care during the surgical intervention.
● Allis (10) ● Manages and circulates in the operating room,
● Babcock (4) monitoring the activities of members of the surgical
● Tissue Forceps (6) team and checking the conditions during the surgical
● Towel Clips (10) procedure.
● Needle Holder (3) ● Acts as a patient advocate, ensuring sterility in the
● Blade Holder for #10,20 (2) operating room and protects the safety and health
● Scissors (2) - Surgical and Metz needs of the patient.
● Mixter (2) ● Helps in setting up the operating room for surgery.
● Ochsner - Curved (2) Ensuring all equipments are functioning properly such
● Ochsner - Straight (2) as the cautery machine, suction machine, OR light,
● ATR (2) and the OR table.
● OS or Operating Sponge (10) ● Assists in transferring the patient to the operating
● VP or Visceral Pack (2) room and assists with positioning.
Date: Instrument set used: ● Performs surgical skin preparation.
Patient: Operating Performed Time Started ● Guarantees sterility of instruments and supplies.
Surgeon: Time ended ● Monitor the room and team members for breaks in
Circulating Nurse: Intubation time sterile technique.
Scrub Nurse: Specimen out ● Assist anesthesia personnel with introduction and
Attachments: Extubation time physiological monitoring.
Label Specimen: Name of pt ● Must be very fine to details and active throughout the
Age surgery. The circulating nurse is responsible for
Name of specimen recording and documenting patient care especially the
PRINCIPLES OF STERILITY specific timing of the happenings during the surgery.
1. All objects used in the sterile field must be sterile. The time when the surgery starts, ends, when the
2. Sterile objects can become unsterile when touched by patient is intubated and extubated, and the time when
unsterile objects. a specimen is out, should be recorded.
3. Sterile objects that are out of vision or below the waist level ● Handles specimen. The circulating nurse should know
are considered unsterile what specimen is being handled and does proper
4. Sterile objects can become unsterile by prolonged exposure labelling.
to airborne microorganisms. ● Must be able to anticipate the scrub nurse’s needs.
5. Fluids flow in the direction of gravity ● Coordinate activities with other departments such as
6. A sterile object or field becomes contaminated when a radiology and pathology.
sterile surface comes in contact with a wet, contaminated ● Minimize conversation and traffic within the OR suite.
surface. ● Delegate and monitor unlicensed personnel.
7. The edge of the sterile field or container is considered ● Monitor responsible cost compliance associating with
unsterile. operative procedures.
8. The skin can’t be sterilized and is unsterile ● Document care provided.
9. Conscientiousness, alertness and honesty are essential
qualities in maintaining surgical asepsis.
● Assist the scrub nurse in cleaning the instruments and COMMON O.R INSTRUMENTS
the operating room. Ensuring that the OR is ready for Instrument Description
the next case. Kelly Curved and Straight
● Assess patient’s condition postoperatively.
Used for clamping
large blood vessels or
Surgical Nurse - a registered nurse who scrubs for surgery, manipulating heavy
performs sterile technique procedures who works with the tissue.
surgeon and the medical team in the operating room. The scrub
nurse performs multiple tasks during an operation/procedure.
They are completely responsible in the maintenance of sterility
of the sterile area and materials. They can also have direct
access within the immediate surroundings of the operative site.
Allis
Nursing Responsibilities:
Used to firmly grasping
● Scrubs for surgery. Performs proper surgical dense tissue during
handwashing, gowning, and gloving. surgery.
● Gather and prepares the instruments and equipments
needed for the surgical procedure.
● Perform assisted gowning and gloving to the surgeon
and assistant surgeon as soon as they enter the
operating room.
● Assemble the drapes according to use and assist in Babcock
draping the patient aseptically according to the routine
procedure. Secure with clips.
● Perform the baseline counting of instruments with the Non-perforating
assistance of the circulating nurse. forceps used to grasp
● Place blade on the blade holder using a needle delicate tissue.
holder, assemble suction tip and suction tube.
● Bring Mayo stand and back table near the draped Tissue forceps with out teeth
patient after draping is completed. Arrange
instruments on the mayo table and on the back table. Non-toothed forceps
● Prepare sutures and needles according to use. used for fine handling
● Hand instruments and supplies to the surgeon during of tissue and traction
surgery. during dissection.
● Passes the first blade for the skin to the surgeon with
blade facing downward.
● Maintain sterility throughout the surgical procedure. Towel Clips
● Perform the first counting of instruments with the
assistance of the circulating nurse and maintain an
accurate account of these instruments of the sterile To hold tissues,
field. towels, and drapes.
● Informs the surgeon and the medical team of the
count result.
● Watch the field or procedure and anticipate the
surgeon’s needs.
● Remove excess instruments from the sterile field. Needle Holder They are used in
● Keep instruments as clean as possible by wiping it. wound closure,
● Notify the circulating nurse as clear as possible if ligation, anastomosis
additional instruments are needed. and other surgical
● Adhere and maintain sterile techgnique and watch for procedures which
any breaks in sterility throughout the surgical require suturing.
procedure.
● Undertake second counting of instruments with the Blade Holder
circulating nurse before closing.
● Helps to apply dressing after the surgical operation. The blade holder is
● Removes and disposes drapes. mounted or integrated
● Responsible for cleaning up the operating room into the doctor or roll
together with the circulating nurse after a case. cleaning structure. Its
main purpose is to
hold the blade in
place.
Mayo Scissors Mayo scissors are
used to cut connective
tissues, fascia and
sutures, primarily
Metzembaum Scissors Metzenbaum scissors rubbing alcohol or iodine,
or “Metz” are used for onto a wound or site of
fine dissection and incision.
cutting.

Iris Scissors
Visceral Pack
Used for fine
dissection and cutting Visceral packing of
fine suture. Originally posttraumatic abdominal
for ophthalmic wounds circumvents
procedures, but now expected complications
serves multipurpose of intraperitoneal
role. hypertension and
Potts Scissor enhances the chance for
survival.
Fine scissors used for Adson’s Forceps or Tissue
creating incisions in Forceps with teeth Used on tissues that
blood vessels. require a firm grip such
as fascia, skin or the
abdominal wall.
Mixter Forceps
Deaver Retractor

Mixter Forceps are


ratcheted, finger ring
Used to hold back the
forceps commonly
abdominal wall
used for working in
obscured surgical Army Navy Retractor Used to gain exposure of
sites. They are most skin layers.
frequently used for
clamping, dissection,
or grasping tissue.
Richardson Retractor

Ochsner Forceps Straight


Used to hold back deep
tissue structures. Also
Clamping off blood
called “Rich.”
vessels to avoid
bleeding during
procedures such as
orthopedic surgery Yankauer Suction Tube

Used primarily for


Ochsner Forceps Curved surface suction and
some intra-abdominal
Clamping off blood suction.
vessels to avoid bleeding Ovum Forceps
during procedures such Used to grasp, hold,
as orthopedic surgery manipulate and remove
tissue from inside the
Needle and Suture or ATR uterus including the
(atraumatic) ovum and placenta.
Helps in holding body Electrosurgery
tissues together after a
surgery or an injury
Instrument that cuts or
cauterizes tissue via an
alternating electrical
current.

Gauze Pad
To guard and cushion a
wound, to absorb blood
or other fluids, to apply
ointments, or to rub
cleansing fluids, such as
Peanut Used to clean and This takes within 2-6 hours to complete.
separate interlaced
tissues. LAMINECTOMY Removal of a portion of the lamina or spinal
bone. The procedure could take within 2-3 hours.

LAPAROTOMY Surgical opening of the abdominal cavity to


investigate. This procedure takes 30 minutes to 1 hour.
Surgical Disposable Stapler Creates a linear staple
line; no cutting function. LOBECTOMY Removal of a lobe of the lungs.
Used in ligation and On the average, it takes within 1.5-4 hours.
anastomosis. May be
curved. LUMPECTOMY Removal of a tumor or lump and surrounding
tissue. On the average, it takes within 1 hour to complete.

LYMPHADENECTOMY Removal of the pelvic lymph nodes.


Takes within 1 hour.
COMMON SURGERIES
MAMMOPLASTY Breast repair. The procedure takes
APPENDECTOMY- Surgical removal of the appendix. within 4 to 6 hours.
A normal appendectomy usually takes within 1 hour.
CS - Surgical incision of the abdomen and uterus to deliver MASTECTOMY Surgical removal of all or part of the breast.
a baby transabdominally. The procedure usually lasts within The operation takes about 90 minutes.
30-45 minutes.
NEPHRECTOMY Surgical removal of the kidney.
CHOLECYSTECTOMY -Surgical removal of the gallbladder. This procedure takes 3 or more hours.
A laparoscopic cholecystectomy usually lasts within 1-2 hours.
NEPHROLITHOTOMY Surgical removal of the renal
COLECTOMY -Removal of the large bowel/ colon. calculi. Takes about 3-4 hours to complete.
Procedure lasts within several hours.
OOPHORECTOMY Surgical removal of the ovaries.
COLONOSCOPY- Endoscopic viewing of the colon/ large This operation takes within 1-4 hours.
bowel and the distal small bowel with a CCD camera or fiber
optic camera. Usually lasts within 30-60 minutes. ORIF or Open Reduction Internal Fixation Bone ends
secured together with pins and wires. The procedure takes 1-2
COLOSTOMY Surgical opening of the colon. hours depending on the fracture.
The procedure usually takes within 2-4 hours. PNEUMONECTOMY Removal of the entire lung with cancer,
abscess, etc. Surgery takes within 1-3 hours.
CRANIECTOMY Excision of a part of the skull. Depending on
the underlying problem being treated, the procedure could last PROSTATECTOMY Partial or complete removal of the
3-5 hours or more. prostate. Takes about 1-2 hours to complete.

CRANIOTOMY Surgical opening of the skull. A craniotomy RHINOPLASTY Surgical repair of the nose. This operation
can take 1-2 hours. takes between 1.5 to 3 hours.

DEBRIDEMENT Removal of the foreign/dead, damaged or SALPINGECTOMY Surgical removal of the fallopian tube.
infected tissue from a wound/burn. The procedure could take The procedure lasts about 1.5 hours.
20 to 30 minutes or more.
SPLENECTOMY Surgical removal of the spleen.
DILATION AND CURETTAGE (D&C) Widening of the cervical The surgery usually takes within 3-5 hours.
canal with a dilator and scraping the uterine cavity with a
curette. The procedure could take within 15-30 minutes. TAH BSO or Total Abdominal Hysterectomy and Bilateral
Salpingo-Oophorectomy Surgical removal of the uterus, both
ECCE or Extracapsular Cataract Extraction Lens and fallopian tubes and ovaries. This surgery takes within 1-2
anterior capsule removal of the eye. hours.
Usually takes within 30-45 minutes.
THYROIDECTOMY Surgical resection of the part of the
GASTRECTOMY Complete or partial removal of the stomach. thyroid. Thyroidectomy usually takes within 1-2 hours.
The operation can take between 2-6 hours. TURP or Transurethral Resection of the Prostate Resection
of the prostate by means of cystoscopy passed through the
GASTROSTOMY Surgical opening of the stomach. urethra. A TURP can take about 1 hour.
The operation lasts from 30-45 minutes only.

HEMORRHOIDECTOMY Surgical removal of the


hemorrhoids. Takes within 30 minutes to 1 hour.

HYSTERECTOMY Surgical removal of the uterus.


About 1 hour to complete.

ICCE or Intracapsular Cataract Extraction Lens and entire


capsule removal of the eye. Operation is completed within 30
minutes.
ILEOSTOMY Surgical opening of the ileum.
POSITIONING (SURGICAL POSITIONS)

COMMON O.R MEDS AND DRUG CALCULATIONS

IVF

Types of IV Solutions
HYPERTONIC: ( more concentrated and increased
osmolarity)
D5NS- Used when low levels of sodium or chloride and for
metabolic alkalosis
5% dextrose in 0.45% saline – commonly used as
maintenance fluid
5% dextrose in LR- Replaces fluids. For burns, bleeding,
dehydration

ISOTONIC: ( same osmolality as body fluids)


0.9 saline (NS) – helpful for chloride replacement. Used with
blood products
Ringer’s Lactate (LR) – Replaces fluids. For burns, bleeding
and dehydration
5% dextrose (D5W)- Replaces deficits of total body water.
Not used alone: dilution of electrolytes can occur

HYPOTONIC: ( more diluted and increased osmolality)


0.45% NS - helps kidneys excrete excess fluids
2.5 % dextrose - treats intracellular dehydration such as
DKA
or liver disease
0.33% NS- Never give to pts w/ burns or liver disease
Anesthesia – state of narcosis, analgesia and reflex loss
2 types: Laparoscopy drape
Those that suspend sensation in the body (GA)
Those that suspend in parts of the body (local,regional,spinal Used for abdominoperineal resection
and nerve bock. with the patient in lithotomy position.
General- blocks pain stimulus at cerebral cortex and induce
depression of the CNS that is reversed by metabolic changes

METHODS OF ADMINISTRARTION Leggings

A. INHALATION ANESTHESIA A rectangle shaped drape closed on


- VOLATILE LIQUIDS: two sides to form a tent-like pocket.
Halothane ,desflurane ,enflurane,isoflurane,
seroflurane
Administered with oxygen and with nitrous
oxide
- ANESTHETIC GASES Lithotomy drape
Nitrous Oxide (blue cyclinder)
Cyclopropane (orange cylinder) Fits over the body to expose only
Ethylene (red cylinder) the perineal area.
B. INTRAVENOUS ANESTHETICS
-benzodiazepines, barbiturates, opiods, and
dissociative agents Shoulder surgical drape

used in the sterile operation of


shoulder surgery. The product is
non-irritating, non-toxic, odorless
and has no side effects on the
human body. Effectively improve
surgical efficiency and reduce the
risk of cross-infection

Cesarean drape

Used in the operation room for


cesarean and laparotomy
surgery.The purpose is to prevent
cross-infection, protect patients
and doctors, and also benefit the
fetus.

BLOOD TRANSFUSION

A blood transfusion is a routine medical procedure in which


donated blood is provided to you through a narrow tube placed
within a vein in your arm. This potentially life-saving procedure
can help replace blood loss due to surgery or injury.

Before a blood transfusion, a healthcare professional will


remove the white blood cells from the blood. This is because
they can carry viruses.
They may transfuse white blood cells called granulocytes to
help a person recover from an infection that has not responded
to antibiotics. Healthcare professionals can collect
DIFFERENT TYPES OF DRAPES IN OPERATING ROOM granulocytes using a process called apheresis.
Here are four common types of blood transfusions:
Purpose of Draping
● Sterile surgical drapes are used during surgery to
● Red blood cell transfusions: A person may receive
a red blood cell transfusion if they have experienced
prevent contact with unprepared surfaces and to
blood loss, anemia (such as iron deficiency anemia),
maintain the sterility of environmental surfaces,
or a blood disorder.
equipment and the patient's surroundings.
● Platelet transfusions: A platelet transfusion can help
those who have lower platelet counts, such as from
chemotherapy or a platelet disorder.
Incise drape ● Plasma transfusions: Plasma contains proteins
important for health. A person may receive a plasma
Drape has an adhesive area that can transfusion if they have experienced severe burns,
be applied directly to the patient’s infections, or liver failure.
skin.
● Whole blood transfusion: A person may receive a
whole blood transfusion if they have experienced a
severe traumatic hemorrhage and require red blood (clots, clumps, or abnormal color). Maintaining appropriate cold
cells, white blood cells, and platelets. storage of red cells in a monitored blood bank refrigerator is
Blood types important. Transfusions should not proceed beyond the
recommended infusion time (4 hours).
During a blood transfusion, a healthcare professional will place
● Hypothermia
a small needle into the vein, usually in the arm or hand. The Cause: Rapid infusion of large volumes of stored blood
blood then moves from a bag, through a rubber tube, and into contributes to hypothermia. Infants are particularly at risk
the person’s vein through the needle. during the exchange or massive transfusion.
Prevention and Management: Appropriately maintained
blood warmers should be used during massive or exchange
transfusions. Additional measures include the warming of other
intravenous fluids and the use of devices to maintain the
They will carefully monitor vital signs throughout the procedure.
patient body temperature.
It can take up to 4-6 hours to complete a blood transfusion.
Immediate adverse effects of transfusion
● Febrile reactions
Cause: Fever and chills during transfusion are thought to be
caused by recipient antibodies reacting with white cell antigens
or white cell fragments in the blood product or due to cytokines
that accumulate in the blood product during storage. Fever
occurs more commonly with platelet transfusion (10-30%) than
with red cell transfusion (1-2%).
Management: Symptomatic, paracetamol
● Urticarial (allergic) reactions
Cause: Seen in approximately 1% of recipients and caused by
foreign plasma proteins. On rare occasions, they may be
associated with laryngeal edema and bronchospasm.
Management: If urticaria occurs in isolation (without fever and
other signs), slow the rate or temporarily stop the transfusion. If
symptoms are bothersome, consider administering an
antihistamine before restarting the transfusion. If associated
with other symptoms, cease the transfusion and proceed with
the investigation.
● Severe allergic (anaphylactic) reactions

Anaphylactic and anaphylactoid reactions have signs of


cardiovascular instability including hypotension, tachycardia,
loss of consciousness, cardiac arrhythmia, shock, and cardiac
arrest. Sometimes respiratory involvement with dyspnoea and
stridor is prominent.
Cause: In some cases, patients with IgA deficiency who have NURSING MANAGEMENTS
anti-IgA antibodies can have these reactions. 1. Stop the transfusion if a transfusion reaction is
Management: Immediately stop transfusion, supportive care suspected
including airway management may be required. Adrenaline 2. Check vital signs – MET/rapid review if indicated and
may be indicated. Usually given as 1:1000 solution, 0.01mg/kg continue to take vital signs as appropriate
s.c./i.m. or slow i.v. Anaphylaxis
3. Maintain IV access but do not flush the existing IV line
Prevention: Patients with anti-IgA antibodies require special
blood products such as washed red blood cells and plasma 4. Check the right pack has been given to the right
products prepared from IgA-deficient donors. Manage further patient
transfusion in consultation with the hematologist on call. 5. Treat the patient as required
● Acute hemolytic reactions 6. Notify the blood bank, treating medical team, and
The majority of hemolytic reactions are caused by transfusion nurse in charge of the shift
of ABO-incompatible blood, eg group A, B, or AB red cells to a 7. In the EMR blood flowsheet select ‘yes’ to the
group O patient. Most hemolytic reactions are the result of suspected transfusion reaction
human error such as the transfusion of properly labeled blood ○ Document against patient and blood product
to the wrong patient, or improper identification of ID rechecked, notifying blood bank and
pretransfusion blood samples. notifying the doctor
○ Record signs and symptoms of transfusion
Symptoms: Chills, fever, pain (along IV line, back, chest), reaction
hypotension, dark urine, uncontrolled bleeding due to DIC. ○ Record management and investigation of
Management: Immediately stop the transfusion. Notify the transfusion reaction
hospital's blood bank urgently (another patient may also have 8. Complete the EMR flowsheet row and record the
been given the wrong blood!). These patients usually require volume transfused
ICU support and therapy includes vigorous treatment of 9. Order transfusion reaction evaluation in EMR (prints
hypotension and maintenance of renal blood flow. automatically in blood bank)
Prevention: Proper identification of the patient from sample 10. Collect any samples and return the unit to the blood
collection through to blood administration, and proper labeling bank if required/requested
of samples and products is essential. TOTAL PARENTERAL NUTRITION
● Bacterial contamination
What is parenteral nutrition?
Cause: Bacteria may be introduced into the pack at the time of Parenteral nutrition means feeding intravenously (through a
blood collection from sources such as donor skin, donor vein). "Parenteral" means "outside of the digestive tract."
bacteremia or equipment used during blood collection or Whereas enteral nutrition is delivered through a tube to your
processing. stomach or the small intestine, parenteral nutrition bypasses
Symptoms: Very high fever, rigors, profound hypotension, your entire digestive system, from mouth to anus. Certain
nausea, and/or diarrhea. medical conditions may require parenteral nutrition for a short
Management: Immediately stop the transfusion and notify the or longer time. Some people need it to supplement their diet,
hospital's blood bank. After initial supportive care, blood and some people need to get all of their calories intravenously.
cultures should be taken and broad-spectrum antimicrobials What does parenteral nutrition contain?
commenced. Laboratory investigation will include the culture of Parenteral nutrition is a chemical formula with standard
the blood pack. variations and can be customized to your specific nutritional
Prevention: Inspect blood products prior to transfusion. Some requirements. It may include different amounts of any of the six
but not all bacterially contaminated products can be recognized essential nutrients that your body requires: water,
carbohydrates, proteins, fats, vitamins, and minerals. Even a. At least 18 years of age
when you receive total parenteral nutrition, your formula will be b. In sound mind- without psychologic disorder
tailored to you based on lab results. Parenteral nutrition is c. Not under the influence of drugs or alcohol
complete enough to replace mouth feeding for as long as d. Immediate relative over 18 years old
necessary — even for life. 4. Physical Assessment and preparation
a. Physical Preparation – NPO, remove dentures, jewelries,
What are the two types of parenteral nutrition? clothesetc.
Parenteral nutrition can be partial or total b. Nutritional & Fluid Status – should be well hydrated
When is partial parenteral nutrition used? c. Drug or alcohol Use – may experience delirium or
Partial parenteral nutrition is often given temporarily to people intoxication to
who need an immediate boost of calories before transitioning anesthetic drugs because ormal doses do not usually take
to a longer-term solution — either enteral feeding or gradually effect to
resuming mouth feeding. PPN is also commonly given to long- these patients and require heavier dose to achieve anesthetic
term hospital patients who tend to have general malnutrition for effect.
a variety of reasons. d. Respiratory Status - teach breathing exercises
When is total parenteral nutrition used? e. Cardiovascular Status – should have controlled and stable
You might need total parenteral nutrition if your digestive cardiovascular functioning before operation to prevent
system isn’t functioning or if you have a gastrointestinal intraoperative
disease that requires you to give it complete rest. Some people problems
might just need general nutrition therapy but might have f. Hepatic & Renal Functions – normal functioning is important
medical reasons why enteral feeding won’t work for them. in
Specific conditions that may require TPN include: absorbing anesthetic drugs
● Abdominal surgery.
g. Endocrine Functions- important in monitoring to prevent
hypo/hyperglycemia, thyrotoxicosis, acidosis
● Chemotherapy. h. Immune Functions – allergies esp. to anesthetic drugs
i. Psychosocial Factors – emotional and psychological
● Intestinal ischemia. preparation to
ensure cooperation fom the patient with the procedures
● Small or large intestinal obstructions. j. Spiritual & Cultural Beliefs - blood transfusions, transplants,
● Intestinal pseudo-obstruction.
ligation,
etc are against other culture & religion.
● Prolonged ileus. 5. Pre-operative drugs – given 20-60 mins.pre-operative
o Makes patient drowsy, keep siderails up
● Gastrointestinal bleeding. 6. Proper Positioning

● Radiation enteritis.
B. Intra-operative Care
1. Ensure sterility of all instruments and supplies at the
● Extremely premature birth.
operating field
Principle: STERILE TO STERILE, CLEAN TO CLEAN
● Necrotizing enterocolitis. Sterile objects touches only sterile surfaces/objects
Clean objects touches only clean surfaces/objects
● Prolonged diarrhea. Sterilization techniques:
● Inflammatory bowel diseases.
o Autoclave – Steam, Ethyl Oxide (Gas)
o Glutaraldehyde Solution- Cidex
● Short bowel syndrome. 2. Ensure safety of client in the operating table- prevent falls,
drape the patient properly,
● Persistent chyle leak. provide warmth

● Graft-versus-host disease of the gut.


3. Stay with the client to relieve anxiety and support during
anesthesia
Sometimes parenteral nutrition is classified by the type of vein Anesthesia Administration:
that is used to deliver the nutrition. a. General Anesthesia via Inhalation
● Central parenteral nutrition (CPN) is delivered
b. General Anestheisia via Intravenous
c. Regional Anesthesia - local anesthesia
through a central vein — usually, the superior vena
d. Conduction Blocks/ Spinal Anesthesia – Epidural & Spinal
cava located under your collarbone, which goes
Block
directly to your heart. The larger central vein allows a
- for operation below the waist line
larger catheter to deliver higher concentrations of
- patient is awake during operation
nutrition with higher calories. For this reason, CPN is
4. Perform sponge count, instrument count and needle count
used to deliver total parenteral nutrition.
5. Aseptic technique in handling and preparing all instruments
● Peripheral parenteral nutrition (PPN) is delivered and supplies
6. Applies grounding device to prevent electrical burn during
through a smaller, peripheral vein, perhaps in your
neck or in one of your limbs. PPN is used to provide use of electrosurgical
partial parenteral nutrition temporarily, using quicker equipment
and easier access to the peripheral vein. 7. Proper documentation
C. Post-operative Care
1. Immediate assessment of VS, and Neuro VS, drainages,
PERIOPERATIVE CARE (summary) surgical dressing
o Phases of Perioperative Nursing 2. Monitoring of vital signs q 15mins until stable
a. Pre-operative Nursing 3. Post-operative positioning depending on the procedure
b. Inraoperative Nursing performed
c. Post-operative Nursing 4. Deep breathing exercises
A. Pre-operative Care 5. Early ambulation
Pre-admission and Admission Test 6. Health teaching for Independent (self) care upon discharge
1. Psychological support
2. Client Education:
a. Importance and practice of breathing exercises
b. Location & support of wound
c. Importance of early ambulation
d. Inform and practice leg exercises, positioning, turning
e. Anesthesia and analgesics
f. Educate regarding drains and dressings to be received post-
op
g. Recovery room policies and procedures
3. Informed consent
UNIVERSITY OF SOUTHERN
PHILIPPINES FOUNDATION

COLLEGE OF HEALTH SCIENCE


NURSING DEPARTMENT
A.Y 2022-2023

OPERATING ROOM POCKET GUIDE


Circu: get 2 scissors (mayo and metz) using ovum forcep
from the solution and soak, then butang sa set

When the sugeon arrives:


-serve the gown
-serve the gloves(right first ihatag,thumb atubanng sa
SUBMITTED BY:
doctor- inaton dili ipitik , thumbs out)
MARIE ASHLEY E. CASIA
-give the drapes to the doctor and towel clips
-ig naka drape na ang pt:
-give the cautery and suction tip
The circu will plug the cautery and suction
Anchor the cautery and suction using kelly curve
FLOW IN THE O.R
Start of surgery:
-Prepare materials:
1 give first knife ( the bladeholder with blade) with kidney
- put complete pack left side of back table
basin . Say “ first knife doc”, ig balik sa kife – attach it in
-put instruments pack sa right side
the pack of the sterile gloves
-put 2 blades (#20, #10, #15)
2 OS if bloody na ang OS i-open then drop in the basin sa
-get cautery, suction, 2 VP, 10 OS
ubos
-prepare or put at least 2 sterile gloves
3 free tie – magbitay sa mayo table
-ig tie, dapat sa edge using mosquito forcep and prepare
Patient is in the table:
at least 2
Circu and staffs will assist,skin prep, attach
4 Scissor (mayo)
Circu will start recording
5 Richardson – use OS )to wipe the instruments with
blood
6 kelly curve (mosquito)
Before handwashing open na ang sets
7 needle holder (use sa needle)
Surgeon is coming
Ig tunol sharp down
Scrub nurse will perform medical and surgical
handwashing
Hipos, bugkos sa pack (black indicator tip means sterile)
1st layer of the pack: unsterile
2nd layer: use pickig forcep because its sterile
Add VP then drop in the table
Add OS then drop
-add yankeur then drop
-add 2 blades , drop
Then surgical handwashing
Wipe using the sterile gown (paubos)
8 scissors
After gowning perform close gloving
Arrange table:
Counting
Gowns, suction,cauutery, OS,instruments
Straight, Curve, Osch, Forceps, Allis, Needle holder, Blade
Mayo cover with two towel
holder,Ovum,Scissors, VP,OS,
Mayo cover , put sa mayo table
Sutures,Peanut,cautery,suction,
-one towel drop sa pikas side
-put pack sa gloves, shiny part out ( ang nay suwat)
Start counting using tissue forceps
Closing..
Inig count sa scrub , count and confirm ang circu
Count start at :
● Straight (10)
● Curve (10)
● Allis (10)
● Babcock (4)
● Tissue Forceps (6)
● Towel Clips (10)
● Needle Holder (3)
● Blade Holder for #10,20 (2)
● Scissors (2) - Surgical and Metz
● Mixter (2)
● Ochsner - Curved (2)
● Ochsner - Straight (2)
● ATR (2)
● OS or Operating Sponge (10)
● VP or Visceral Pack (2)
In Mayo table, put first two blade holder, 2 forceps, 5
straight, 5 curve, towel clips, needle holder

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