The document discusses surgery, surgical nursing care, and the roles of the surgical team. It defines surgery and its classifications. It describes preoperative, intraoperative, and postoperative nursing care. Preoperative care includes assessment, education, and preparation of the patient. Intraoperative care involves monitoring the patient and assisting the surgical team in the operating room. Postoperative care focuses on recovery, monitoring for complications, and providing education. The surgical team works together, with specific sterile and non-sterile roles, to ensure patient safety during surgery.

1. SURGERY AND SURGICAL
NURSING

2. SURGICAL NURSING
Definition of surgery
• It is a branch of medicine that treat diseases, injuries
and deformities whether in part or whole through
physical manipulation or operative measures.
Activities performed include
1. Elimination of damaged parts,
2. Separation of united parts,
3. Joining parts that have been separated and
4. Repairing the defects in the body

3. Classification of surgery
• Surgery is classified according to
A. Purpose of surgery and
B. Degree of urgency surgery
C. Degree of risk

4. A. Classification according to the
Purpose
1. Diagnostic surgery: - example taking a biopsy or
performing an exploratory laparotomy.
2. Curative: - if a diseased part is removed to cure as in
appendicectomy.
3. Reparative: when there is a need to repair damaged
tissues as in grafting
4. Reconstructive: when there is a need to refigure or
reshape how an organ looks after injury or surgery
5. Cosmetic: when there is a need to refigure or reshape
how an organ looks though it may not be causing any
physical discomfort.
6. Palliative surgery is done to relieve pain and to improve
quality of life but not to produce a cure.
7. Adjuvant:

5. According to the degree of urgency
• Emergency surgery: when the patient requires
immediate attention and the disorder is life-
threatening.
• Urgent surgery is when patient requires attention
within 24 – 30 hours as in gallbladder infection.
• Required Surgery is when a patient needs to
have operation within few weeks or months as in
BPH
• Elective/Ambulatory Surgery is when operation is
not a necessity as in repair of scars.

6. Some terminologies used in surgery
• Abscess: collection of pus in a
cavity
• Anastomosis: the artificial
surgical union of one or two
organs.
• Adhesions: the union of two
surfaces which are usually
separated which is caused or
as a result of inflammation
• Algia: related to pain
• Anaesthesia: loss of sensation
• Biopsy: removal of a
tissue/part of an organ for
pathological examination
• Calculi: the formation of
stones
• Cele: swelling
• Curette: to scrape
• Diathermy: the production of
heat by using powerful electric
• Dactyl: either a finger or a toe
• Dilate: to stretch
• Ectomy: a permanent removal
• Excise: to cut off
• Resect: to cut off from the
middle
• Fissure: crack or a slit
• Itis: inflammation
• Incise: cut into or the open into
• Hyper: excess
• Hypo: deficient or scanty
• Ligate: to tie

7. Terminologies cont’d
• Lumen: the interior of an open
organ
• Ostomy: permanent opening
into an organ
• Otomy: temporal incision into an
organ.
• Oophoro: ovaries
• Oscopy: inspection of an interior
of an organ using an instrument
• Osteo: bone
• Ophthalmo: the eye
• Orchi: testes
• Oligo: diminished or scanty
• Oma: tumor or growth
• Oti: ear
• Megaly: enlargement
• Palpate: manual examination
with the hand
• Plasty: reconstruction of a
diseased part
• Radical: total or complete
removal of an organ
• Phlebo: vein eg. phlebitis
• Rrhaphy: repair of a part
• Rupture: tear or disruption of a
tissue
• Stenosis: narrowing of a lumen
• Subtotal: incomplete or part
removal of an organ
• Torsion: twisting

8. PERIOPERATIVE NURSING
CARE

9. PERIOPERATIVE NURSING
• Perioperative period is the period between
the patient’s first and last contact with the
surgeon.
• It consists of three phases namely;
1. The preoperative phase
2. The intraoperative phase
3. The postoperative phase

10. PREOPERATIVE CARE
1. This is done to identify any risk factors that could lead
to postoperative complications and hinder recovery
2. It begins when decision for surgery is made and ends
when patient is transferred to operative theater
3. We will look at it under
i. Psychological
ii. Physiological
iii. Physical
iv. Socio-economic
v. Spiritual

11. Preoperative Assessment
1. Age: young children and older adults have lowest
tolerance to stress effect of surgery
2. Pain: (socrat)
3. Nutritional / hydration status
4. Infections (skin, respiratory, systemic etc)
5. Drug history (anticoagulants, steroids, hypoglycemic,
antibiotics, etc)
6. Cardiopulmonary functioning
7. Renal
8. GIT / Liver functioning tests
9. Endocrine and neurological functioning
10. Sensory and perceptual functioning
11. Lifestyle (smoking, alcohol, etc)
12. Any other deformities

12. Psychological care
• Assess patient’s fears and anxiety levels
• Reassure patient of the competency of the
surgical team
• Educate patient on condition and the surgery
• Allow patient to ask questions and explain
• Encourage patient’s participation in decision
making and care
• Show patient to others who have successfully

13. Psychological care cont’d
• Allow the surgeon to explain the surgical
experience to the patient
• Allow family and other support network to visit
• Teach patient deep breathing and coughing as
well as turning exercises
• Explain the rationale for frequent position
changes
• Demonstrate to patient how to splint the wound
when performing the deep breathing and
coughing exercises.
• Relieve pain before the exercises
• Discuss how patient’s pain will be managed

14. • A consent form is the legal document that indicates the
patient informed consent for the procedure
• Signed consent form is necessary for every invasive
procedure
• Patient/family must have full understanding of the
procedure before given consent
• Alternate treatment must be explained to him
• He must know of potential risk, complications, and
disfigurements or loss of body part.
• Pain management through anesthesia should be
explained to him.
• Patient should know who will perform surgery,
whether or not body part will be remove
• Doctor can use Durable Power of Attorney in
Emergency situations
Informed consent form

15. Physiological care
• Assess patient’s nutritional status
• Serve high calorie diet to boost nutritional
status and promote recovery
• Assess for dehydration, hypovolemia, shock
and electrolyte imbalance
• Administer prescribed IV fluids for hydration
and electrolyte balancing
• Monitor fluids on intake and output chart
• Administer prescribed premedication

16. Physiological care cont’d
• Assess vital signs (T, P, R & BP) and record. Report any
abnormality
• Ensure that all Lab and X-ray examinations are done
and reports collected
• Maintain NPO 6 – 8 hours before surgery
• Administer prophylactic antibiotics to decrease
intestinal flora.
• All previous medications should be noted or reviewed
or stopped prior to surgery. Eg. Aspirin
• Perform range of motion exercises to improve
circulation, prevent venous stasis, DVT and optimal
respiratory function.

17. Physical care
• Let patient have a thorough bath in the morning
• Inspect the mouth and remove any dentures and keep in
safe place
• Remove all jewelries, watches, contact lenses, pins, etc.
and cover hair (for females)
• Put on identification wrist band
• Assess skin for abrasions, lacerations or signs of infection at
the operative site
• Prepare the skin by wash the site and with soap and water
(shave PRN)
• Clean with antiseptic lotion (savlon or povidone-iodine)
• Cover with sterile towel and hold it in place with adhesive
tapes
• Change patient into theater gown

18. Physical care cont’d
• Provide bedside rails if premedication is given to
prevent falls
• Pass urethral catheter to monitor urine output or keep
the bladder empty
• Pass NG tube for gastric or intestinal decompression
• Apply anti-embolic stockings
• Prepare patient’s bowel by giving enema a night before
the surgery and rectal washout the morning of surgery
• Check and document items for surgery including the
folder
• Transport patient to the theater
• Direct patient’s relatives to the waiting room

19. • GIT needs special preparation before surgery
in order to:
1. Reduce the possibility of vomiting and
aspiration during anesthesia
2. Reduce the possibility of a bowel
obstruction
3. Reduce the possibility of a bowel injury
4. Prevent contamination from fecal material
during intestinal tract or dowel surgery .
GIT preparation

20. Bowel preparation
• Serve low residue diet 48 hours before surgery
• Serve light diet a day before the surgery
• Increase fluid intake to prevent constipation
• Ensure nil per os 6 – 8 hours before the surgery
• Give parenteral nutrition to provide nutrients
• Administer prescribed stool softeners such as Lactulose
• Administer laxatives as prescribed
• The night before the surgery, perform rectal enema
• In the morning of surgery, perform rectal washout
• Administer prescribed antibiotics to decrease intestinal
flora (neomycin)
• N/G Tube may be passed to reduce intestinal pressure

21. 1. To prevent the contamination to peritoneal
cavity
2. Prevent injury to the colon
3. Provide adequate visualization of the
surgical site.
NB. Some patients may require further bowel
cleaning on the morning of surgery
N/G tube are usually inserted during surgery
if they are use at all
Reasons for Enemas

22. Socio-economic care
• Inform patient of the possible cost of the surgery
• Enquire whether patient is on NHIS and provide
necessary information
• Allow patient to pay deposits according to hospital
protocol
• Encourage support network to assist in the care of the
patient
• Encourage patient participation in the care
• Inform social welfare department if patient cannot pay
his hospital bills
• Inform patient of the duration of stay in the hospital

23. Spiritual / Cultural beliefs
• Assist patient in using religious coping as it
helps to reduce anxiety and fear
• Allow patient to receive spiritual support that
he or she requests for
• The nurse supports the religious beliefs of the
patient by praying with him
• Respect patient’s cultural values as it
facilitates rapport and trust between patient
and nurse
• Restrict the intake of any concoction

24. 1. Ensure that patient baths in the morning
2. Skin preparation is done according to protocol
3. Check and record vital signs
4. Check identification band to make sure it is
legible, accurate
5. Ensure informed consent form is signed
6. Check and carry out specific orders .eg. IV line,
administration of enemas, premed, etc
7. Ensure Nil Per Os
General Preparation of client on the
day of surgery

25. 8. Ask client to void or pass urethral catheter
9. Remove dentures that could obstruct the
airway
10.Remove jewelry
11.Help patient don the gown
12.Remove nails polish
13.Put patient on a Stretcher and transport him
to the theater
• Prepare the patient bed for postoperative care
General preop care Cont’d

26. POSTOPERATIVE CARE
• The postoperative care starts when ……
• The objective is to provide care until the
patient recovers from the effects of anesthesia
• Prepare operation bed with the accessories
• Quickly review postoperative instructions and
receive the patient
• Monitor patient’s level of consciousness,
• Position patient in supine and turn his head

27. Postoperative care cont’d
• Modify the position to semi-fowlers or high fowlers
• Document baseline vital signs every 15 minutes for one
hour, then every 30 minutes till stable and then 4
hourly
• Check the surgical site/incision site for bleeding/
dehiscence and evisceration.
• Reinforce if there is bleeding. Notify the surgeon if
bleeding persists
• Monitor all drainage tubes including IV infusions or
blood transfusion
• Assess respiratory pattern and airway for obstruction
• Suction patient PRN and administer oxygen as
prescribed.

28. Postoperative care cont’d
• The head of the bed may be elevated to about 15
– 30 degree unless contraindicated
• If patient vomits, provide vomit bowl and care for
the mouth
• Observe for shock (usually hypovolemia)
• Monitor blood transfusion if required
• Administer IV fluids (R/L and N/S) as prescribed
• Monitor on Intake and Output chart
• Administer all postoperative medications such as
antibiotics, analgesics, etc.

29. Postoperative care cont’d
• Maintain personal hygiene of the patient
• Observe for bowel sounds to return
• Introduce sips, then liquid and then normal diet.
• Serve food high in calories (high protein,
carbohydrates, vegetables, vitamins)
• Change wound dressing usually on the third day
post operation using aseptic technique.
• Remove wound drain as indicated
• Provide education on discharge information
covering areas such as medication, identification
of possible complications, review dates, nutrition,
rest and sleep.

30. Complications of surgery
1. Infection
2. Bleeding
3. Shock
4. Adhesion
5. Dehydration
6. Over-hydration
7. DVT

31. THANK YOU

32. INTRAOPERATIVE NURSING
• Surgical interventions have improved
• Surgery and anesthesia still place patient at
risk for several complications.
• It is the duty of the surgical team to protect
this patient.

33. THE SURGICAL
ENVIRONMENT/THEATER
• The surgical environment is a cool place and
access is limited to authorized personnel only
• It is located central to all supporting services.
• It has air filtration devices to screen out
contaminating particles, dust, and pollutants.
• Surgical asepsis and traffic control are ensured.

34. • Changing room
• Lobby
• Scrub – up area
• The set-up area
• Anesthetic room or office
• Operation room
• Recovery or ICU
• Offices
• Sterilization room
• Stores, sterile pack room, and non-sterile
• Sluice room
• Holding area
• Others are; CT scanner unit, MIR
Rooms in the OR and their uses

35. The theater cont’d
• To help decrease microbes, the surgical area is
divided into four zones:
1. the outer or unrestricted zone, where street
clothes are allowed;
2. The clean or semirestricted zone, where attire
consists of scrub clothes and caps; and
3. the aseptic or restricted zone, where scrub
clothes, shoe covers, caps, and masks are worn.
4. Disposal zone; where the used instruments and
scrubs are decontaminated, washed, dried and
packaged for sterilization

36. THE OPERATING ROOM (OR)
• Slightly higher pressure
• Humidity 50 – 60 %
• Temperature 22 – 24 degrees celcius
• Special lighting
• Overhead source
• Has bright and shadowless qualities
i. Can control intensity
ii. equipped with reserve light
iii. Provide blue- white colour of the day light
iv. Freely adjustable, and manipulation fixtures
v. Produce minimum heat (halogen bulb)
vi. Easy cleaning, no crevices and uneven surface

37. The Surgical Team
• It is divided into Sterile and Nonsterile members.
A. The sterile members include
• The Surgeon,
• First assistance,
• The Scrub nurse.
B. The nonsterile members include
• The patient
• The anaesthetist,
• The circulating nurse,
• The perianaesthesia nurse,
• others (students, orderlies, lab & X-ray and account
personnel)

38. The Surgeon
1. He is the head of the surgical team
2. He is responsible for carrying out the operation.
3. He also assists in positioning of the patient on
the theater table.
4. He marks the surgical site with indelible mark.
5. He prepares the patient surgical site.
6. He drapes the patient.
7. He decides on the surgical method to use
8. Together with the anaesthetist ensures the
safety of the patient

39. The scrub nurse
• The scrub nurse performs a surgical hand scrub
• She sets up the sterile tables (Mayo’s trolley or Tables)
• She prepares sutures, ligatures and special equipment
eg. Laparoscope.
• She assists the surgeon and the surgical assistant
during the procedure
• She labels the specimen taken from the patient and the
circulating nurse sends it to the laboratory
• As the incision is closed, the scrub nurse counts the
instruments and sponges etc to make sure they are not
retained as a foreign body in the patient
• The items are counted before the procedure and twice
after the procedure

40. The Circulating Nurse
• The circulating nurse coordinates the care of the
patient in the OR
• She is responsible for
1. Verifying consent for the operation
2. Managing the OR and Checking the OR conditions
such as ensuring proper cleanliness and temperature,
humidity, lighting of the OR
3. Assists in positioning of the patient
4. Protects the patient’s safety and health by monitoring
the activities of the surgical team
5. Continually assess the patient for signs of injury and
implement appropriate interventions

41. The Circulating Nurse
1. Monitor aseptic practices to avoid break in technique
while coordinating movement of related personnel
2. Ensuring safe functioning of equipment
3. Make available supplies and materials
4. Coordinating the team by Anticipating the needs of
the surgical team
5. Checks with the scrub nurse the surgical sites, swabs,
instruments before wound is closed
6. Monitor activities and documents specific activities
throughout the operation
7. Managing surgical specimen
8. Implementing fire safety precautions

42. The anaesthetist / Anaesthesiologist
• Assesses the patient before the surgery
• Selects the type of anesthesia based on the type
of surgery
• Prescribes and administers the premedication
• Intubates the patient when necessary
• Manages any technical problems related to the
administration of anesthetic agent
• Supervises the patient’s condition (vital signs,
ECG, SPO2 tidal volume, blood gas, ) throughout
the surgical procedure
• They initiates patient’s resuscitation from after
the surgery is completed

43. The patient
• Patient is the individual coming for the surgery
and has fears and anxieties
• Patient’s fears are mainly about Fears about loss
of control, The unknown, Pain, Death, Changes in
body structure or function.
• These fears can increase the amount of
anesthetic needed, the level of postoperative
pain, and overall recovery time.
• Hence the need to prepare the patient well
before the surgery

44. THANK YOU
QUESTIONS AND COMMENTS

45. SURGICAL ASEPSIS
• Surgical asepsis is the principle of prevention of
contamination of surgical wounds.
Sources of postoperative wound infection include
1. The patient’s natural skin flora or
2. A previously existing infection
3. The instruments used
4. The environment of the theater or ward
5. Droplet infections from the surgical team members
• Strict adherence to the principles of surgical asepsis by
OR personnel are necessary to reduce the risk of
contamination and infection

46. SURGICAL ASEPSIS cont’d
Measures include
• All surgical supplies such as instruments,
needles, sutures, dressings, gloves, must be
sterilized before use
• The surgeon, surgical assistants, and nurses
must scrub
• Surgical team members wear long-sleeved,
sterile gowns and gloves
• The head and hair are covered with a cap, and
a mask is worn over the nose and mouth to
minimize URT droplets

47. SURGICAL ASEPSIS cont’d
• During surgery, only sterile personnel touches
sterile objects such as instruments
• Larger than required skin is meticulously cleansed
with an antiseptic solution
• The remainder of the patient’s body is covered
with sterile drapes.
• The movements of the surgical team are from
sterile to sterile areas and from unsterile to
unsterile areas.
• Only sterile personnel touch sterile items
• Circulating nurse touches the unsterile items.

48. SURGICAL ASEPSIS cont’d
• Floors and horizontal surfaces are cleaned
between cases
• Sterile equipment are inspected regularly to
ensure optimal performance.
• All equipment that comes into direct contact with
the patient must be sterile.
• Sterilized linens, drapes, and solutions are used.
• Instruments are cleaned and sterilized in a unit
near the OR.
• Items are dispensed to a sterile field by methods
that preserve the sterility of the items

49. SURGICAL ASEPSIS cont’d
• Individually wrapped sterile items are used when
additional individual items are needed.
• Unnecessary personnel and physical movement are
also restricted to minimize bacteria in the air
To decrease the amount of bacteria in the air,
• Ventilation provides about 15 air exchanges per hour,
• A room temperature of 20_C to 24_C (68_F to 73_F),
• humidity between 30% and 60%, and
• Positive pressure relative to adjacent areas are
maintained.

50. THANK YOU
QUESTIONS AND COMMENTS

51. PREMEDICATION
• This is the medication given prior to the administration of
anesthetic agent for surgery to commence.
• The main goals are to:
1. Enhance effectiveness of anesthesia
2. Reduce side effects such as nausea and vomiting
3. Reduce or relieve anxiety
4. Dry up mucous secretion
5. Relax smooth muscles
• A thorough examination by the anesthetist is carried out
before the premed is given
• Any underlying disease is treated
• Other medications that might impede surgery are stopped

52. Types of medications given
• Barbiturates / Tranquilizers or benzodiazepaines.
Examples are lorazepine, Midaxolam and
diazepam are given to reduce or relieve anxiety.
• Opiates: examples are Morphine, Meperidine for
patients with severe pain in the preoperative
period.
• Anticholinergics are also given to reduce
respiratory tract secretions. Example is Atropine
• Timing: these are usually given a night before and
morning of surgery.

53. TYPES OF ANESTHESIA AND SEDATION
• Anesthesia is a state of narcosis (central nervous
system depression produced by pharmacologic
agents, analgesia, relaxants and reflex loss).
We have;
1. General anesthesia
2. Regional
3. Moderate sedation
4. Local anesthesia

54. General Anesthesia (GA)
• G.A is the administration of anesthetic agent (through Inhalation or
IV) that makes patients lose all reflexes especially response to pain.
• Patient requires assistance in maintaining patent airway
• Patient requires a ventilator to maintain cardiovascular and
pulmonary functioning
Stages of General Anesthesia
1. The Beginning phase
2. The Excitement phase
3. Surgical anesthesia phase
4. Medullary Depression

55. Regional Anesthesia
Epidural and Spinal anesthesia
1. In epidural anesthesia,
2. In spinal anesthesia,
• The drug is injected at the lumber level usually L4
or L5 into the epidura or subarachnoid space
surrounding the spinal cord respectively.
• It blocks pain sensations in the lower limbs,
perineum bladder and rectum or lower abdomen

56. Moderate Sedation / Anesthesia
• The anesthetic agent or sedative is administered IV to
reduce patient’s anxiety and control pain during
diagnostic or therapeutic short-term surgical
procedures. E.g. Ketamine
• Advantages
• Patient maintains patent airway
• Retains protective airway reflexes eg. coughing
• Responds to verbal and physical stimuli
• Patient is however, monitored closely to prevent over
sedation.

57. Local anesthesia
• This is the injection (infiltration) of an anesthetic
agent into the tissues at the planned incision site.
Advantages
1. It is simple, economical and non-expensive
2. Equipment and skill needed are minimal
3. Postoperative recovery is brief
4. Undesirable effects of GA are avoided
• It is ideal for short and minor surgical procedures

58. Examples of anesthetic agents
• Lidocaine,
• Bupivacaine,
• Tetracaine.
• Diazepam (Valium)
• Ketamine (Ketalar)
• Midazolam (Versed)
• Thiopental sodium (Pentothal)
• Propofol (Diprivan)
• Morphine sulphate

59. Intra-operation Complications
• Bleeding
• Shock
• Nausea and Vomiting
• Anaphylaxis to anesthetic agent
• Hypoxia from cyanosis or asphyxia
• Hypothermia
• Malignant hyperthermia

60. THANK YOU