The whole surgical procedure that has three phases, which are preoperative, intraoperative, and postoperative phases.

a method that is either invasive, minimally invasive or non-invasive procedures.

penetration to the body by the means of an opening in the integrity of the body.

these are usually diagnostics procedures that are only to assess and do not enter the body.

a place in the hospital that provides sterile area for invasive procedures

clean technique designed to reduce the number of pathogens

sterile technique designed to remove all microorganism

a nurse who works inside the sterile field and primarily assist the doctors in performing the surgery

a nurse who works outside the sterile field and renders patient care, giving supplies and assist surgical team members

leader of the surgical team and has the ultimate responsibility of the surgery

part of the unsterile team that administers anesthesia and ensures the normal physiological status of the patient.

to obtain a body sample from the body such as biopsy tissue sample

to inspect and visualize internal structures

to treat the disease by removing the tissue or organ. Example: inflamed gallbladder with stones

To remove traumatized tissue and structures.

repairing malformations such as cleft lip, cleft palate, and/or hernia.

- to lessen the pain or discomfort by removing obstruction around the tissue or organ

- to alleviate distressing signs and symptoms or a medical condition, however, it does not cure or manage the disease itself

improving the appearance by the means of surgery. Example: facelift

used as a preventive measure for possible occurrence of medical condition. Example: breast removal for breast cancer.

to add new tissues and improve it. Example: breast implants.

harvesting an organ for donation

creation of new pathway. Example: coronary artery bypass graft (CABG)

fixing and promoting stability of alignment of the body. Example: repair of fracture

to divert a body part to a new opening. Example: colostomy

These are pathologic condition that gives an obstruction to a tissue or organ.

These are pathologic condition that arises a new tissue or mass. These can either be benign or malignant.

These are pathologic condition that causes the discontinuity in the integrity of tissues or organs

These are pathologic condition that causes the tissue or body organ to erode or wear down.

FOUR MAJOR TYPES OF PATHOLOGIC PROCESSES REQUIRING SURGICAL INTERVENTION

to determine and validate the medical condition or diagnosis

to identify the extent of disease process

to provide therapeutic intervention

removal of tissue or organ.

repair of damage organs or tissue

repair of congenital malformation organs or tissue

removal of tissue or organ that may cause medical condition such as cancer formation.

minor surgeries. select all that apply

major surgeries. select all that apply

needs to be done immediately to save life or limb

needs to be done within 24 to 48 hours

this may be done in succeeding weeks or months. This procedure is necessary for promoting of total well-being

(ACCORDING TO URGENCY) a delay or omission will not cause an untoward event, therefore it is not needed for daily lives and survival. This is not a medical emergency

(ACCORDING TO URGENCY) commonly for aesthetic purposes and requested by the patient.

Cut into the tissue to form an opening

To inspect a body cavity or hollow organ by the means of endoscope.

Removal of a body part

Suffixes: - ectomy

- otomy

- ostomy

- centesis

- exeresis

- scopy

- plasty

- desis

- pexy

Breaking down of tissues

Stitching together using a sterile material

Performed by the physician for assessment and serves as a baseline data. such as:

- Vital signs, height, weight and review of systems

- Allergies (Drugs and/or foods)

Usually done 24 hours prior to procedure

- CBC, Renal function test, Glucose monitoring, Urinalysis, Clotting and Bleeding time

Diagnostic for better visualization

- X-Ray, Ultrasounds, CT-Scans, and/or MRI

To rule out cardiac disease and to accomplish a cardiopulmonary clearance prior to surgery

Used prophylactically to prevent the occurrence of infection. It aids the immune system to against microorganism’s contamination.

These are consent needed for admission and authorizing the healthcare team to perform standard care to the patient.

- Consists of explanation of procedure, risk, benefits, and alternative therapy to the patient.

- Protective act for the patient and physician and should properly documented.

- The nurse (circulating nurse) should document the presence of informed consent prior to transfer to operating room.

- This must be accomplished prior to premedicating the patient.

main responsible for explaining the surgical procedure and answering the questions arises from the explanation and the procedure matter itself. The __________ should also obtain the consent from the patient.

main responsible in obtaining consent for anesthesia and sedation

may witness the consent if the patient understands the procedure. The ______ verifies the understanding of the patient regarding the procedure

In life threatening emergency, the consent to treat and stabilized IS essential. However, the consent should still be acquired during procedure or after the procedure. Patient’s life is the priority rather than the consent.

Emergency procedures: Telephone consent from legal guardian or power of attorney is accepted. There should be two nurses should witness the call and sign the form and have it signed later. Document the telephone consent.

It aids the assessment of the nurses to the patient if the patient is prepared for the surgical operation.

- street clothes

– serves as a transition zone from ________ area to semi restricted area

- For authorized personnel that are properly attired with scrub suits, head covers.

- Includes the peripheral support area, central processing and access to corridors

- Patient is also dressed and the head is covered.

- Properly attired personnel equipped with mask which the sterile items and sterile team are in the field.

- Substerile room consist of scrub sink

- Personnel who will temporarily enter the this area may wear surgical cover gowns or jumpsuits to cover street clothes together with mask and head cover

Restricted area to maintain controlled environment such as sterility and minimal traffic.

indicated for endovascular stenting, balloon angioplasty, cardiac catheterization and other fluoroscopic examination and management.

indicated for laparoscopic procedures with video monitors inside for visualization but has the capability to convert the room into an open procedure room if an untoward event noted.

these members perform surgical asepsis and apply sterile accessories such as gown and gloves so that these personnel may have a direct contact in the sterile field. All the equipment needed for the procedure that is not currently at the sterile field must be given in a sterile manner.

STERILE TEAM COMPOSED OF:

team are not allowed to have a direct contact in the sterile field. They give sterile supplies to the sterile field in an aseptic manner. Further, they manage any complication or untoward events during the perioperative care.

UNSTERILE TEAM COMPOSED OF:

Absence of microorganism that cause disease; freedom from infection

free from any microorganism including spores.

These are ways to protect the healthcare workers from bodily fluids of patients.

Worn in the semi-restricted and restricted areas

Worn in the sterile field

method of removing as many microorganisms as possible from the skin before donning the sterile suit.

This procedure to prepare the skin site to reduce the number of any microorganisms as possible. This, however, cannot keep the skin free from any microorganism. Also, to remove any visible dirt, hair, oils that can interfere with the surgery.

reduce the number of microorganisms on the body by the means of bathing and shampooing.

less traumatic as compared to shaving however, this leaves a small hair on the skin that does not affect the surgery.

chemical means of removing the hair strands on the surgical site. Cannot be used in the sensitive area such as the genitalia and might cause irritation due to the chemicals

Method to cover the patient in a sterile manner and to create an adequate sterile field over the patient.

To clean inanimate objects and noncritical surfaces by physical or chemical means.

Destroying most of the pathogens except spores using physical or chemical means.

Eliminates all pathologic and non-pathologic microorganisms including spores. This is the only method in destroying all microbial life. This method can be done either physical or chemical means.

(Levels of Disinfection)

- destroys all bacteria, viruses and fungi. Spores may be destroyed depending on the contact time. This should be used when an item cannot be sterilizes such as endoscopes.

(Levels of Disinfection)

- removes vegetative bacteria, fungi and

least resistant viruses on non-critical items such as HIVs.

(Levels of Disinfection)

- kills most bacteria, viruses and fungi on non-critical items but does not affect spores. It also inactivates mycobacterium tuberculosis.

(Methods of Disinfection)

- high level disinfection that is indicated for reusable respiratory devices and anesthesia breathing circuits by hot water decontamination with chlorine agents

(Methods of Disinfection)

- Indicated for materials that cannot be heated.

(Methods of Disinfection)

- This can be used in surgical environments to decrease the airborne microorganism to low level, however, this can cause skin irritation.

Methods of Sterilization:

- ethylene oxide (EO) gas, ozone gas. Hydrogen peroxide plasma

Methods of Sterilization:

- X-ray (ionizing) and Microwave (nonionizing)

Methods of Sterilization:

- steam with pressure, hot air/dry heat, autoclaving

Most common and best method of sterilization; works like a pressure cooker that uses steam and pressure to achieve the temperature.

Indicated for items that are sensitive to heat or moisture.

- Highly sporicidal even at a low temperature and concentration.

- Converts the hydrogen peroxide into plasma or vapor,

- Indicated for metal and nonmetal surgical devices.

- dorsal position, natural position when at rest

- palms extend alongside the body, legs are straight and parallel with head and spine.

upper torso is lowered and feet are raised. Decreased the lung expansion due to gravity

Head is elevated and feet is lowered; promotes better respiratory clearance

Buttocks are place on the back and the legs are placed on the stirrups (usually 90 degrees) and adjusted the height according to the patient’s legs and maintain symmetry.

Lawn chair position; the head of bed is raised to 45 degree angle; improves chest expansion

Lies the body on their abdomen.

Hips are raised at a 90 degree angle and lowering the trunk; arms are extended on arm boards and flexed and palm down; head is placed on the side and supported by a pillow or donut.

Extension is attached to the foot part, the table is flexed at the center. Leg section is lowered and legs flexed at right angle

- Lateral decubitus or sims position

- Anesthetized supine on the operating table and turn to unaffected side. The ankle and foot are of the upper leg are supported to prevent foot drop. Arms are placed on a padded arm board. Cervical part should be aligned with the spine and supported by a pillow.

Exposes the upper thoracic cavity and easier visualization; arms are extended on a double arm board

The flank region is positioned over the operating table elevator and turned into the unaffected side.

broadest category; used to cut away tissues or open cavities

seal or occlude hollow vessels

grasping or moving things

pull back surgical wound edges to provide visualization; classified as manual or self-retaining

movable parts that are manipulated by the surgeon; precised drilling, cutting, or shaping tissues or bones

Knife-like instrument; oldest surgical instrument

Blade Number:

- rounded tip and used commonly for skin

Blade Number:

- curved cutting edge; tonsillectomy

Blade Number:

-linear edge and sharp; initial skin puncture

Blade Number:

- short rounded edge for shallow short controlled incision

Photo

Composed of two opposing blades;

Length of the body is determined by the depthness of surgical site.

Used to block vessel and prevent blood loss and pooling with a minimal tissue damage to prevent loss of visibility during surgery.

To reach deep tissues or blood vessels

clamp down small blood vessels

Occlude deep blood vessels

Larger blood vessels and tissues

Small inter-digiting teeth at the tip to prevent slippage of tissue while holding tissue.

Teethless, rounded, atraumatic holder to grasp tubular structure, ovaries and intestines.

Transverse serration with large teeth to

handle large slippery tissues such as fascia

Grasps sponges. Sponge forceps

Atraumatic, groove at the tip.

it used to grasp the skin and tissues

instead serrated or groove at the tip, it has teeth at the tip hold a firm grasp on the skin and tissues.

Used to hold the needle for suturing

Chest incision and abdominal incisions

Shallow incisions

deep incisions; bendable according to the shape of the body part

Self-retaining and shallow incisions

self retaining and used for deep abdominal incisions

It is needed to achieve hemostasis. Wound includes deep and superficial structure.

Counts sponges, instruments and sharps before the procedure

Scalpel

Drapes

Assumes all the responsibility for all medical actions and management of the patient

Washes used instruments and prepares them for sterilization.

Saves tissue/organ specimens.

Stockinette cuffs of the gown after gloving

Intravenous bottles

Electrocautery

Above the waist

Anticipates the surgeon’s needs

After-care of the operating theater.

Cardiac monitor

Endorses patient to the recovery room

Performs the surgical safety checklist

Focuses overhead operating light on the operative field.

Above the head

First assist

Facemask

Practices surgical conscience within the OR

Specimen bottle

Scrub suit

Basin for povidone iodine

- Fever, dyspnea, crackles, cough resulting from infection or aspiration

- inflammation of the alveoli that arises 3-5 days postoperatively as a result of infection, aspiration or immobility.

Abrupt sharp chest pain and difficulty of breathing resulting from a dislodged blood clot causing blockage to the pulmonary artery

Usually occurs 3-5 days after surgery; presents with fever, warm, painful and tender incision site with or without pus

Injury or irritation of the phrenic nerve resulting in diaphragm spasm and sudden closure of epiglottis

Airway obstruction resulting in collapsed alveoli

Treated with Metoclopromide

Pain and inflammation of veins in the lower extremities with accompanying thrombus formation

Hypoactive to absent bowel sounds and movement, abdominal distention

Treated with Dantrolene

Sudden change in mental function resulting from medications, infection or electrolyte imbalances post-operatively

Lower abdominal pain with inability to void and tympanitic bladder

Protrusion of internal organs through surgical incision

Dorsiflexion can elicit a sign that indicates presence of this complication

Hypotension, weak pulse, anuria resulting from extravasation of blood

Dyspnea, cyanosis, low oxygen saturation resulting from shallow breathing

If vomiting occurs in post-operative patients, position to semi-fowler’s while vomiting to prevent the occurrence of aspiration.

The environment of the operating theater, exposure of skin and organ during surgical procedure and anesthesia puts the patient at risk for hyperthermia during the post-operative period.

According to WHO, antibiotics should be started immediately post-operatively to prevent infections.

Wound drainage from surgical site should be patent and free flowing and should have no signs of obstruction.

Aldrete’s score assesses for nerve block of the lower extremities and is a criteria for discharge.

The goal of health care providers in the postoperative phase is to promote healing of surgical wound and overall health status and to prevent the occurrence of postoperative complications.

The post-operative patient should always be placed in a supine position since the pharyngeal reflexes are still depressed.

Only the patient can press the delivery system of a patient-controlled analgesic infusion.

The circulating nurse endorses the hand-off report to the PACU nurse

Extended postoperative care and interventions are given to the patient in the patient’s room and focuses on the patient’s comfort and well-being.

Pinkish-colored drainage

Thick, milky, yellowish, greenish drainage/pus

- Clear, slightly yellow drainage, appears after 2 – 3 days

Yellow, cloudy or tan that indicates possible infection/colonization

rapid onset and offset of volatile anesthesia

given simultaneously with oxygen and nitrous oxide; serves as an analgesic and relaxes muscles.

Use for adults and children; rapid induction and emergencies and rapid elimination

short acting IV sedation; rapid induction and recovery; can be used for short procedures.

high narcotic used with oxygenation; respiratory depressant

conscious sedation

- dissociative drug

– induces amnesia and analgesia; rapid induction and for short procedures. promotes bronchodilation to promote oxygenation.

Combination of different medication to achieve stable physiologic status

Parameter to test if the patient can be safely discharged from the PACU to the surgical unit

It is an assessment tool to measure the motor block. It assesses the intensity of motor block and the ability to voluntarily move the patient’s lower extremities.

- Loss of circulatory fluid volume and plasma secondary to hemorrhage, gastrointestinal fluids such vomiting and diarrhea, diaphoresis.

- Prolonged decrease blood volume results into a decreased blood flow to organ and causing dysfunctions.

separation of wound edges at the suture line. 6 to 8 days after surgery

Anesthesia machine