perioperative nursing unp

7/24/2019 Perioperative Nursing unp

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OR Skills &OR Skills &

TechniquesTechniquesRaymund Christopher R.Raymund Christopher R.

dela Pedela Pea, RM, RNa, RM, RN


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DEFINITION OF TERMSDEFINITION OF TERMS

SURGERYSURGERY -It is the branch of-It is the branch of

medicine concerned with diseasesmedicine concerned with diseases

and conditions which reqire or areand conditions which reqire or are

amenab!e to o"erati#e "rocedres$amenab!e to o"erati#e "rocedres$Sr%er& is the wor' done b& aSr%er& is the wor' done b& a

sr%eon$sr%eon$

-(Sr%er& can in#o!#e-(Sr%er& can in#o!#e

cttin%) abradin%) strin%) !aser orcttin%) abradin%) strin%) !aser or

otherwise "h&sica!!& chan%in% bod&otherwise "h&sica!!& chan%in% bod&

tisses and or%ans$(tisses and or%ans$(


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SURGEONSURGEON- * "h&sician who treats- * "h&sician who treats

disease) in+r&) or deformit& b&disease) in+r&) or deformit& b&

o"erati#e or mana! methods$ *o"erati#e or mana! methods$ *

medica! doctor s"ecia!i,ed in themedica! doctor s"ecia!i,ed in theremo#a! of or%ans) masses andremo#a! of or%ans) masses and

tmors and in doin% other "rocedrestmors and in doin% other "rocedres

sin% a 'nife sca!"e!.sin% a 'nife sca!"e!.

STERI/ESTERI/E- free from !i#in% %erms or- free from !i#in% %erms or

microor%anisms0 ase"tic1 steri!emicroor%anisms0 ase"tic1 steri!e

sr%ica! instrments$sr%ica! instrments$


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*SE2SIS*SE2SIS- The state of bein% free of- The state of bein% free of

"atho%enic microor%anisms$"atho%enic microor%anisms$

- The "rocess of remo#in%- The "rocess of remo#in%

"atho%enic microor%anisms or"atho%enic microor%anisms or"rotectin% a%ainst infection b& sch"rotectin% a%ainst infection b& sch

or%anisms$or%anisms$

SE2SISSE2SIS - a to3ic condition res!tin%- a to3ic condition res!tin%

from the s"read of bacteria or theirfrom the s"read of bacteria or their

to3ic "rodcts from a focs ofto3ic "rodcts from a focs of

infection0infection0 especiallyespecially1 se"ticemia1 se"ticemia


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SE2SISSE2SIS -- is a se#ere i!!ness cased b&is a se#ere i!!ness cased b&

o#erwhe!min% infection of theo#erwhe!min% infection of the

b!oodstream b& to3in-"rodcin% bacteria$b!oodstream b& to3in-"rodcin% bacteria$

- is cased b& bacteria! infection- is cased b& bacteria! infectionthat can ori%inate an&where in the bod&$that can ori%inate an&where in the bod&$

DISINFE5T*NTDISINFE5T*NT- an& chemica! a%ent sed- an& chemica! a%ent sed

chie6& on inanimate ob+ects to destro& orchie6& on inanimate ob+ects to destro& or

inhibit the %rowth of harmf! or%anisms$inhibit the %rowth of harmf! or%anisms$


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*NTISE2TI5S*NTISE2TI5S-- is a sbstance thatis a sbstance that

"re#ents or arrests the %rowth or action"re#ents or arrests the %rowth or actionof microor%anisms either b& inhibitin%of microor%anisms either b& inhibitin%

their acti#it& or b& destro&in% them$ Thetheir acti#it& or b& destro&in% them$ The

term is sed es"ecia!!& for "re"arationsterm is sed es"ecia!!& for "re"arations

a""!ied to"ica!!& to !i#in% tissea""!ied to"ica!!& to !i#in% tisse STERI/I7*TIONSTERI/I7*TION

-the destrction of a!! !i#in%-the destrction of a!! !i#in%

microor%anisms) as "atho%enic bacteria)microor%anisms) as "atho%enic bacteria)

#e%etati#e forms) and s"ores$#e%etati#e forms) and s"ores$


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8*5TERIOST*TI58*5TERIOST*TI5-5a"ab!e of inhibitin% the-5a"ab!e of inhibitin% the

%rowth or re"rodction of bacteria$%rowth or re"rodction of bacteria$

- *n a%ent) sch as a chemica! or bio!o%ica!- *n a%ent) sch as a chemica! or bio!o%ica!

materia!) that inhibits bacteria! %rowth$materia!) that inhibits bacteria! %rowth$

8*5TERI5ID*/8*5TERI5ID*/ - 5a"ab!e of 'i!!in% bacteria$- 5a"ab!e of 'i!!in% bacteria$

8*5TERIO5IDES8*5TERIO5IDES - is a sbstance that 'i!!s- is a sbstance that 'i!!s

bacteria $8actericides are eitherbacteria $8actericides are either

disinfectants) antise"tics or antibiotics$disinfectants) antise"tics or antibiotics$


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2REFI9ES : SUFFI9ES2REFI9ES : SUFFI9ES

Prefxes & Suixes can explain the typeo procedure the client will undergo::

2REFI9ES2REFI9ES

S"ra ; abo#e 0 be&ondS"ra ; abo#e 0 be&ond

Ortho ; +ointOrtho ; +oint

5ho!e ; bi!e or %a!!5ho!e ; bi!e or %a!!

5&sto ; b!adder5&sto ; b!adder

Ence"ha!o- brainEnce"ha!o- brain


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Entero ; intestineEntero ; intestine


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2nemo ; !n%s2nemo ; !n%s

2&e!o ; 'idne& "e!#is2&e!o ; 'idne& "e!#is

Sa!"hin%o ; fa!!o"ian tbeSa!"hin%o ; fa!!o"ian tbe Thoraco ; chestThoraco ; chest

=iscero ; or%an es"$ abdomen=iscero ; or%an es"$ abdomen


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SUFFI9ESSUFFI9ES

Oma ; tmor 0 swe!!in%Oma ; tmor 0 swe!!in%

Ectom& ; remo#a! of an or%an or %!andEctom& ; remo#a! of an or%an or %!and

Rha"& ; strin% or stitchin% of a "artRha"& ; strin% or stitchin% of a "artoror

an or%anan or%an

Sco"& ; !oo'in% intoSco"& ; !oo'in% into

Ostom& ; ma'in% an o"enin% or a stomaOstom& ; ma'in% an o"enin% or a stoma

Otom& ; cttin% intoOtom& ; cttin% into


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2!ast& ; to re"air or restore2!ast& ; to re"air or restore

5e!e ; tmor 0 hernia 0 swe!!in%5e!e ; tmor 0 hernia 0 swe!!in%

Itis ; in6ammation ofItis ; in6ammation of


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2ERIO2ER*TI=E2ERIO2ER*TI=E

NURSINGNURSINGSURGERY ; a branch ofSURGERY ; a branch of

Medicine that encom"assesMedicine that encom"asses

"reo"erati#e care)"reo"erati#e care)intrao"erati#e +d%ement :intrao"erati#e +d%ement :

mana%ement) : "osto"erati#emana%ement) : "osto"erati#e

care of "atients$care of "atients$O2ER*TION ; an in#asi#eO2ER*TION ; an in#asi#e

moda!it& of treatment$moda!it& of treatment$


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NURSINGNURSING DEFII!I":DEFII!I":

a#$#aa#$#a :: O2ER*TING ROOM NURSINGO2ER*TING ROOM NURSING

The identi>cation of "h&sio!o%ica! :The identi>cation of "h&sio!o%ica! :

socio!o%ica! needs of the c!ient) : thesocio!o%ica! needs of the c!ient) : theim"!ementation of an indi#ida!i,edim"!ementation of an indi#ida!i,ed

"ro%ram of nrsin% care in order to"ro%ram of nrsin% care in order to

restore or maintain the hea!th :restore or maintain the hea!th :we!fare of the "atient before) drin%we!fare of the "atient before) drin%

: after sr%ica! inter#ention$: after sr%ica! inter#ention$


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NURSINGNURSING P%I"S"P%' :P%I"S"P%' :

To %i#e ser#ice that aims toTo %i#e ser#ice that aims to

"ro#ide com"rehensi#e"ro#ide com"rehensi#es""ort "h&sica!!&) mora!!&)s""ort "h&sica!!&) mora!!&)

"s&cho!o%ica!!&) s"irita!!&)"s&cho!o%ica!!&) s"irita!!&)

: socia!!& to a "atient: socia!!& to a "atientnder%oin% sr%er&$nder%oin% sr%er&$


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NURSINGNURSING (")S :(")S :

?$?$To "ro#ide safe) s""orti#e :To "ro#ide safe) s""orti#e :

com"rehensi#e care$com"rehensi#e care$@$@$To assist the sr%eon b&To assist the sr%eon b&

fnctionin% eAecti#e!& as afnctionin% eAecti#e!& as a

member of the sr%ica! team$member of the sr%ica! team$B$B$To create : maintain an ase"ticTo create : maintain an ase"tic

C steri!e en#ironment$C steri!e en#ironment$


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NURSINGNURSING Fndamenta! "r"oses of the O$R$Fndamenta! "r"oses of the O$R$ 11 It is a "!ace$ $ $It is a "!ace$ $ $

?$?$To corre!ate theor& : "ractice$To corre!ate theor& : "ractice$

@$@$To de#e!o" s'i!!s in assistin% theTo de#e!o" s'i!!s in assistin% the

sr%eon in the o"eration$sr%eon in the o"eration$

B$B$To create a sitab!e steri!e >e!d forTo create a sitab!e steri!e >e!d for

sr%ica! "rocedres to "re#entsr%ica! "rocedres to "re#entcom"!icationscom"!ications$$


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Period o ti*e that constitutes the surgicalPeriod o ti*e that constitutes the surgical

experience# Includes three phases:experience# Includes three phases:

2reo"erati#e "hase2reo"erati#e "hase: the period o ti*e ro* the: the period o ti*e ro* thedecision or surgery until the patient is transerreddecision or surgery until the patient is transerred

into the operating roo*#into the operating roo*#

Intrao"erati#e "haseIntrao"erati#e "hase: the period o ti*e ro* when: the period o ti*e ro* when

the patient is transerred to the operating roo* tothe patient is transerred to the operating roo* to

the ad*ission to postanesthesia care unit +P),.#the ad*ission to postanesthesia care unit +P),.#

2osto"erati#e "hase2osto"erati#e "hase: the period o ti*e that /egins: the period o ti*e that /egins

with ad*ission to the P), and ends with ollow-upwith ad*ission to the P), and ends with ollow-up

e0aluation in the clinical setting or at ho*ee0aluation in the clinical setting or at ho*e


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5/*SSIFI5*TIONS5/*SSIFI5*TIONS

OF SURGERYOF SURGERY

*ccordin% to Ur%enc&*ccordin% to Ur%enc& ::?.?.EMERGENTEMERGENT11 "t$ reqires immediate"t$ reqires immediate

attention 0 disorderattention 0 disorder ma&be !ife-ma&be !ife-

threatenin%threatenin%$$

indications for sr%er& 1 indications for sr%er& 1withotwithot

de!a&$de!a&$

e3am"!es 1 Se#ere b!eedin%) e3am"!es 1 Se#ere b!eedin%)

e3tensi#e brns) b!adder or intestina!e3tensi#e brns) b!adder or intestina!obstrction) fractred s'!!) %nshotobstrction) fractred s'!!) %nshot

or stab wonds$or stab wonds$


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OF SURGERYOF SURGERY@.@. URGENTURGENT11 "t$ reqires "rom"t"t$ reqires "rom"t

attention$attention$

indications for sr%er& 1 indications for sr%er& 1

within @-B hors$within @-B hors$

e3am"!es 1 *cte %a!!b!adder e3am"!es 1 *cte %a!!b!adder

infectioninfection

idne& C Uretera!idne& C Uretera!

stonesstones


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OF SURGERYOF SURGERYB.B. REHUIREDREHUIRED; "t$ needs to ha#e; "t$ needs to ha#e

sr%er&$sr%er&$

indications for sr%er&1 "!an indications for sr%er&1 "!an

within few wee's or months$within few wee's or months$

e3am"!es 1 2rostatic e3am"!es 1 2rostatic

h&"er"!asia withot b!adderh&"er"!asia withot b!adder

obstrction) Th&roid disorders)obstrction) Th&roid disorders)

5ataracts$5ataracts$


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OF SURGERYOF SURGERY.. E/E5TI=EE/E5TI=E; "t sho!d ha#e; "t sho!d ha#e

sr%er&$sr%er&$

indications for sr%er&1 indications for sr%er&1

Fai!re to ha#e sr%er& notFai!re to ha#e sr%er& not

catastro"hic$catastro"hic$

e3am"!es 1 Re"air of scars e3am"!es 1 Re"air of scars

Sim"!e herniaSim"!e hernia

=a%ina! re"air=a%ina! re"air


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OF SURGERYOF SURGERY.. O2TION*/O2TION*/ ; decision rests with; decision rests with

"t$"t$

indications for sr%er& 1 indications for sr%er& 1

2ersona! "reference2ersona! "reference

e3am"!es 1 5osmetic sr%er& e3am"!es 1 5osmetic sr%er&


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OF SURGERYOF SURGERY*ccd%$ To De%ree Of Ris'*ccd%$ To De%ree Of Ris' ::

M*JORM*JOR; hi%h de%ree of ris'; hi%h de%ree of ris' 11

ma&be com"!icated C "ro!on%ed)ma&be com"!icated C "ro!on%ed)

!ar%e !osses of b!ood ma& occr) #ita!!ar%e !osses of b!ood ma& occr) #ita!or%ans ma&be in#o!#ed) "ost-o"or%ans ma&be in#o!#ed) "ost-o"

com"!ications ma& be !i'e!&$com"!ications ma& be !i'e!&$

e3$ Or%an trans"!ante3$ Or%an trans"!ant O"en heart sr%er&O"en heart sr%er&

Remo#a! of a 'idne&Remo#a! of a 'idne&


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OF SURGERYOF SURGERY MINORMINOR ; !itt!e ris' with few; !itt!e ris' with few

com"!ications$com"!ications$

- often "erformed in a- often "erformed in a

Kda& sr%er&L$Kda& sr%er&L$

e3am"!es1 8reast bio"s& e3am"!es1 8reast bio"s&

Tonsi!!ectom&Tonsi!!ectom& nee sr%er&nee sr%er&


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OF SURGERYOF SURGERY*ccd%$ To 2r"ose*ccd%$ To 2r"ose ::

?$?$ DI*GNOSTI5DI*GNOSTI51 0erifes suspected1 0erifes suspected

diagnosisdiagnosis

- ex# 2iopsy- ex# 2iopsy@$@$ E92/OR*TORYE92/OR*TORY1 esti*ates the extent o1 esti*ates the extent o

the disease or in3ury#the disease or in3ury#

- Ex# Explore laparoto*y- Ex# Explore laparoto*yB$B$ 5UR*TI=E5UR*TI=E 1 re*o0es or repairs da*aged1 re*o0es or repairs da*aged

tissues #tissues #


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OF SURGERYOF SURGERY$$ *8/*TI=E*8/*TI=E ; remo#in% diseased or%an; remo#in% diseased or%an

that cant wait an&more$that cant wait an&more$

- emer%enc& sr%er&$- emer%enc& sr%er&$

$$

2*//I*TI=E2*//I*TI=E

; re!ie#es s&m"toms bt; re!ie#es s&m"toms bt

does not cre the nder!&in% diseasedoes not cre the nder!&in% disease

"rocess$"rocess$

$$ RE5ONSTRU5TI=ERE5ONSTRU5TI=E ; "artia! or com"!ete; "artia! or com"!ete

restoration of a dama%ed or%anCtisse torestoration of a dama%ed or%anCtisse tobrin% bac' the ori%ina! a""earance :brin% bac' the ori%ina! a""earance :

fnction$mammo"!ast&) face-!ift.fnction$mammo"!ast&) face-!ift.


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$$ 5ONSTRU5TI=E5ONSTRU5TI=E ; re"airin% the; re"airin% the

dama%ed tisse or con%enita!!&dama%ed tisse or con%enita!!&

defecti#e or%an$ m!ti"!e wonddefecti#e or%an$ m!ti"!e wond

re"air.re"air. *ccd%$ To /ocation*ccd%$ To /ocation 11

?$?$ INTERN*/INTERN*/; inside the bod& $; inside the bod& $

E3$


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FOUR 8*SI5 2*T


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B.B. EROSIONEROSION; brea' in the; brea' in the

continit& of tisse srface$ It cancontinit& of tisse srface$ It can

be cased b& irritation) infection)be cased b& irritation) infection)

!ceration or in6ammation$ It can!ceration or in6ammation$ It candama%e the wa!!s of b!ood #esse!sdama%e the wa!!s of b!ood #esse!s

res!tin% in serios b!eedin%$res!tin% in serios b!eedin%$

.. TUMORSTUMORS; abnorma! %rowth of; abnorma! %rowth oftisse that ser#es no "h&sio!o%ictisse that ser#es no "h&sio!o%ic

fnction in the bod&$fnction in the bod&$


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T


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%ypertensi0e & hypotensi0e pts#%ypertensi0e & hypotensi0e pts#

%ypo0ole*ia%ypo0ole*ia

%epatic disease%epatic disease Preexisting *ental or physicalPreexisting *ental or physical

disa/ilitydisa/ility


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P6"2E7S !%)! 7)' )6ISE IP6"2E7S !%)! 7)' )6ISE I

S6(E6':S6(E6':

?$?$ Sr%ica! ris' "ts ; "robabi!it& ofSr%ica! ris' "ts ; "robabi!it& of

morbidit& or morta!it& fo!!owin%morbidit& or morta!it& fo!!owin%sr%er&$sr%er&$

@$@$ 2ain2ain

B$B$


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2


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6SI( ),!I8I!IES6SI( ),!I8I!IES ::

)ssess*ent o the client +/aseline)ssess*ent o the client +/aseline

e0aluation o the pt# /eore the day oe0aluation o the pt# /eore the day o

surgery-inter0iew.surgery-inter0iew. Identifcation o potential5actual healthIdentifcation o potential5actual health

pro/le*s#pro/le*s#

P6E)D7ISSI" !ES!I(- ensureP6E)D7ISSI" !ES!I(- ensure

necessary tests ha0e /een peror*ednecessary tests ha0e /een peror*ed Pre-op teaching in0ol0ing client & supportPre-op teaching in0ol0ing client & support

persons#persons#


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Day o surgery :Day o surgery :

pt# teaching re0iewedpt# teaching re0iewed

inor*ed consent confr*edinor*ed consent confr*ed pt#9s identity & surgical site 0erifedpt#9s identity & surgical site 0erifed

I8F started#I8F started#


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2RE2*R*TION FOR2RE2*R*TION FOR

SURGERYSURGERY 2s&cho!o%ica! S""ort 12s&cho!o%ica! S""ort 1

a.a.*ssess c!ients fears) an3ieties)*ssess c!ients fears) an3ieties)

s""ort s&stems : "atterns ofs""ort s&stems : "atterns of

co"in%$co"in%$

b.b.Estab!ish trstin% re!ationshi" withEstab!ish trstin% re!ationshi" with

c!ient : si%ni>cant others$c!ient : si%ni>cant others$

c.c.E3"!ain rotine "rocedres)E3"!ain rotine "rocedres)encora%e #erba!i,ation of fears :encora%e #erba!i,ation of fears :

a!!ow c!ient to as' qestions$a!!ow c!ient to as' qestions$


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d.d. Demonstrate con>dence inDemonstrate con>dence in

sr%eon : staA$sr%eon : staA$

e.e. 2ro#ide for s"irita! care if2ro#ide for s"irita! care if

a""ro"riate$a""ro"riate$


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2REO2ER*TI=E2REO2ER*TI=E

TE*5


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TE*5


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D a" ra%mat c 8reat n%a" ra%mat c reat n%and S"!intin% Phenand S"!intin% Phen

5o%hin%5o%hin%

i d/ E i d F


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/e% E3ercises and Foot/e% E3ercises and Foot

E3ercisesE3ercises

i i2 i N i


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2reo"erati#e Nrsin%2reo"erati#e Nrsin%

Inter#entionsInter#entions 2


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?$?$ 585585

@$@$ E!ectro!&tesE!ectro!&tes

B$B$ 2TC2TT 2rothrombin2TC2TT 2rothrombinTime02artia! thrombo"!astinTime02artia! thrombo"!astin

time.time.

$$

Urina!&sisUrina!&sis

$$ E5GE5G

$$ 8!ood t&"in% : crossmatch8!ood t&"in% : crossmatch


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N2O- to "re#ent as"irationN2O- to "re#ent as"iration

8owe! "re" and s'in "re"8owe! "re" and s'in "re"

- c!eansin% enema or !a3ati#e- c!eansin% enema or !a3ati#e

before sr%er& to a!!ow satisfactor&before sr%er& to a!!ow satisfactor&

#isa!i,ation of the sr%ica! site$#isa!i,ation of the sr%ica! site$

- %oa! of "re-o" s'in "re" is to- %oa! of "re-o" s'in "re" is to

decrease bacteria withot in+rin%decrease bacteria withot in+rin%the s'in$the s'in$


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Immediate "reo"erati#e "re"arationImmediate "reo"erati#e "re"aration 5om"!ete chec'!ist and chart5om"!ete chec'!ist and chart


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/EG*/ 2RE2*R*TION1/EG*/ 2RE2*R*TION1

Sr%eonSr%eon obtains o"erati#e "ermitobtains o"erati#e "ermitinformed consent.informed consent.

?$?$ Sr%ica! "rocedres) a!ternati#es )Sr%ica! "rocedres) a!ternati#es )

"ossib!e com"!ications :"ossib!e com"!ications :

dis>%rements or remo#a! of bod&dis>%rements or remo#a! of bod&"arts are e3"!ained$"arts are e3"!ained$

@$@$ It is "art of the nrses ro!e as c!ientIt is "art of the nrses ro!e as c!ient

ad#ocate to con>rm that the c!ientad#ocate to con>rm that the c!ient

nderstands information %i#en$nderstands information %i#en$


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INFORMED 5ONSENTINFORMED 5ONSENT is necessary in theis necessary in the

# ,ircu*stances:# ,ircu*stances:

In#asi#e "rocedres) sch as sr%ica!In#asi#e "rocedres) sch as sr%ica!

incisions) bio"s&) c&stosco"& orincisions) bio"s&) c&stosco"& or"aracentesis$"aracentesis$

2rocedres reqirin% sedation or2rocedres reqirin% sedation or

anesthesiaanesthesia

* non-sr%ica! "rocedre) sch as* non-sr%ica! "rocedre) sch asarterio%ra"h&arterio%ra"h&

2rocedres in#o!#in% radiation2rocedres in#o!#in% radiation


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*d!t c!ient*d!t c!ient o#er ?Q &Co. si%ns owno#er ?Q &Co. si%ns own

"ermit n!ess nconcios or menta!!&"ermit n!ess nconcios or menta!!&

incom"etent$incom"etent$

?$?$ If nab!e to si%n)If nab!e to si%n) re!ati#ere!ati#es"ose ors"ose orne3t of 'in. orne3t of 'in. or %ardian%ardianwi!! si%n$wi!! si%n$

@$@$ In an emer%enc&) "ermission #iaIn an emer%enc&) "ermission #ia

te!e"hone or te!e%ram is acce"tab!e0te!e"hone or te!e%ram is acce"tab!e0

ha#e a @ha#e a @ndnd!istener on "hone when!istener on "hone when

te!e"hone "ermission is %i#ente!e"hone "ermission is %i#en


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B$B$ 5onsents5onsents are not neededare not needed forfor

emer%enc&emer%enc& care if a!! of the A$care if a!! of the A$

criteria are met1criteria are met1

a$a$ There is an immediate threat to !ife$There is an immediate threat to !ife$b$b$ E3"erts a%ree that it is anE3"erts a%ree that it is an

emer%enc&$emer%enc&$

c$c$ 5!ient is nab!e to consent$5!ient is nab!e to consent$d$d$ * !e%a!!& athori,ed "erson cannot* !e%a!!& athori,ed "erson cannot

be reached$be reached$


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Minors nder ?Q &CoMinors nder ?Q &Co. mst ha#e. mst ha#e

consent si%ned b& an ad!t i$e$consent si%ned b& an ad!t i$e$

2arent or !e%a! %ardian.2arent or !e%a! %ardian.

Emanci"ated minorEmanci"ated minor married ormarried or

inde"endent!& earnin% his or herinde"endent!& earnin% his or her

own !i#in%.ma& si%n hisC her ownown !i#in%.ma& si%n hisC her own

consent$consent$


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Pitness to informed consent ma&Pitness to informed consent ma&

be a nrse) another M$D$) c!er'be a nrse) another M$D$) c!er'

or an& other athori,ed "erson$or an& other athori,ed "erson$

The nrse witnessin% informedThe nrse witnessin% informed

consent) s"eci>es whetherconsent) s"eci>es whether

witnessin% e3"!anation ofwitnessin% e3"!anation of

sr%er& or +st si%natre of thesr%er& or +st si%natre of thec!ient$c!ient$



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MEDI5*TIONSMEDI5*TIONS 2UR2OSES12UR2OSES1

?$?$ To re!ie#e fear : an3iet&$To re!ie#e fear : an3iet&$

@$@$ To redce dose needed for indctionTo redce dose needed for indction

: maintenance of anesthesia$: maintenance of anesthesia$

B$B$ To "re#ent re6e3 brad&cardia thatTo "re#ent re6e3 brad&cardia that

ha""ens drin% indction ofha""ens drin% indction of

anesthesia$anesthesia$$$ To minimi,e ora! secretions$To minimi,e ora! secretions$



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MEDI5*TIONSMEDI5*TIONS


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II$II$ INTR*O2ER*TI=E 2


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6SI( ),!I8I!IES6SI( ),!I8I!IES::

)cti0ities pro0iding or pt9s saety#)cti0ities pro0iding or pt9s saety# 7aintenance o aseptic en0iron*ent#7aintenance o aseptic en0iron*ent#

Ensuring proper unction o euip*ents#Ensuring proper unction o euip*ents#

Pro0iding surgeons with specifcPro0iding surgeons with specifcinstru*ents & supplies or surgical feld#instru*ents & supplies or surgical feld#

,o*pleting docu*entation#,o*pleting docu*entation#

Positioning pts#Positioning pts#

)cting as scru/5circulating nurse#)cting as scru/5circulating nurse#

Members of the Sr%ica!Members of the Sr%ica!


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Members of the Sr%ica!Members of the Sr%ica!

TeamTeam 2atient2atient

*nesthesio!o%is*nesthesio!o%is

t or anesthetistt or anesthetist

Sr%eonSr%eon

Nrses ScrbNrses Scrb

: 5irc!atin%.: 5irc!atin%.

Sr%ica!Sr%ica!

techno!o%iststechno!o%ists


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S5RU8 TE*M PORS5RU8 TE*M POR


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2*TIENT2*TIENT; the most im"ortant member of the; the most im"ortant member of the

sr%ica! team$ Ma& fee! re!a3ed : "re"ared) orsr%ica! team$ Ma& fee! re!a3ed : "re"ared) or

fearf! : hi%h!& stressed$fearf! : hi%h!& stressed$ - is a!so sb+ect to se#era! ris's$- is a!so sb+ect to se#era! ris's$

O2ER*TING SURGEONO2ER*TING SURGEON ; "re-o" d3 : care$; "re-o" d3 : care$

- "erformance of o"eration$- "erformance of o"eration$

- "ost-o" m%t : care- "ost-o" m%t : care

- assmes a!! res"onsibi!it& for a!! medica!- assmes a!! res"onsibi!it& for a!! medica!

acts of +d%ement : m%t$acts of +d%ement : m%t$


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SURGEON : *SSIST*NTSSURGEON : *SSIST*NTS ; scrb :; scrb :

"erform the sr%er&$"erform the sr%er&$

REGISTERED NURSE ?REGISTERED NURSE ?STST*SST*SST$ ;$ ;"ractices nder the direct s"er#ision"ractices nder the direct s"er#ision

of the sr%eon$ hand!in% tisse)of the sr%eon$ hand!in% tisse)

strin%) maintainin% hemostasis.strin%) maintainin% hemostasis.

*NEST


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S5RU8 NURSES5RU8 NURSE ; "ro#ides steri!e; "ro#ides steri!e

instrments : s""!ies to the sr%eoninstrments : s""!ies to the sr%eon

drin% the "rocedre$drin% the "rocedre$

- "erforms sr%ica! hand- "erforms sr%ica! hand

scrb$scrb$

5IR5U/*TING NURSE5IR5U/*TING NURSE ; coordinates the; coordinates the

care of the "t$ in the O$R$care of the "t$ in the O$R$

- care "ro#ided inc!des assistin% with "t$- care "ro#ided inc!des assistin% with "t$

"ositionin% ) s'in "re") mana%in% sr%ica!"ositionin% ) s'in "re") mana%in% sr%ica!

s"ecimens : docmentin% intrao"erati#es"ecimens : docmentin% intrao"erati#e

e#entse#ents##


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S5RU8 NURSES5RU8 NURSE


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5IR5U/*TING5IR5U/*TING


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5IR5U/*TING5IR5U/*TINGNURSENURSE


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2re#ention of Infection2re#ention of Infection

The sr%ica! en#ironmentThe sr%ica! en#ironment ; star'; star'a""earance : coo! tem"eratre$a""earance : coo! tem"eratre$

/ocated centra! to a!! s""ortin%/ocated centra! to a!! s""ortin%

ser#ices$ser#ices$ Unrestricted ,oneUnrestricted ,one ; where street; where street

c!othes are a!!owed$c!othes are a!!owed$

Semirestricted ,one-Semirestricted ,one-where attirewhere attire

consists of scrb c!othes : ca"s$consists of scrb c!othes : ca"s$ Restricted ,one-Restricted ,one-where scrb c!othes)where scrb c!othes)

shoe co#ers) ca"s : mas's are worn$shoe co#ers) ca"s : mas's are worn$


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T


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8asic Gide!ines for8asic Gide!ines for


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Sr%ica! *se"sisSr%ica! *se"sis)ll *aterials in contact with the wound and)ll *aterials in contact with the wound and

within the sterile feld *ust /e sterile#within the sterile feld *ust /e sterile#

(owns are sterile in the ront ro* chest to(owns are sterile in the ront ro* chest to

the le0el o the sterile feld4 and slee0esthe le0el o the sterile feld4 and slee0esro* < inches a/o0e the el/ow to the cu#ro* < inches a/o0e the el/ow to the cu#

"nly the top o a draped ta/le is considered"nly the top o a draped ta/le is considered

sterile# During draping4 the drape is heldsterile# During draping4 the drape is held

well a/o0e the area and is placed ro* rontwell a/o0e the area and is placed ro* rontto /ac$#to /ac$#



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Sr%ica! *se"sisSr%ica! *se"sis Ite*s are dispensed /y *ethods toIte*s are dispensed /y *ethods to

preser0e sterility#preser0e sterility#

7o0e*ents o the surgical tea* are7o0e*ents o the surgical tea* are

ro* sterile to sterile and ro*ro* sterile to sterile and ro*unsterile to sterile only#unsterile to sterile only#

7o0e*ent around the sterile feld7o0e*ent around the sterile feld

*ust not cause conta*ination o the*ust not cause conta*ination o thefeld# )t least a =-oot distance ro*feld# )t least a =-oot distance ro*

the sterile feld *ust /e *aintained#the sterile feld *ust /e *aintained#



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Sr%ica! *se"sisSr%ica! *se"sis >hene0er a sterile /arrier is>hene0er a sterile /arrier is

/reached4 the area is considered/reached4 the area is considered

conta*inated#conta*inated#

E0ery sterile feld is constantlyE0ery sterile feld is constantly*aintained and *onitored# Ite*s o*aintained and *onitored# Ite*s o

dou/tul sterility are considereddou/tul sterility are considered

unsterile#unsterile# Sterile felds are prepared as close asSterile felds are prepared as close as

possi/le to ti*e o use#possi/le to ti*e o use#

SURGI5*/ *SE2TI5SURGI5*/ *SE2TI5


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SURGI5*/ *SE2TI5TE5


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DURING T


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8*SI5 2RIN5I2/ES OF8*SI5 2RIN5I2/ES OF

SURGI5*/ *SE2SISSURGI5*/ *SE2SIS *!! "ersonne! assi%ned to the*!! "ersonne! assi%ned to the

o"eratin% room mst "ractice %oodo"eratin% room mst "ractice %ood

"ersona! h&%iene$ This inc!des"ersona! h&%iene$ This inc!des

dai!& bathin% and c!othin% chan%e$dai!& bathin% and c!othin% chan%e$ Those "ersonne! ha#in% co!ds) soreThose "ersonne! ha#in% co!ds) sore

throats) o"en sores) andCor otherthroats) o"en sores) andCor other

infections sho!d not be "ermittedinfections sho!d not be "ermittedin the o"eratin% room$in the o"eratin% room$

O"eratin% room attire which inc!des scrbO"eratin% room attire which inc!des scrb


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O"eratin% room attire which inc!des scrbO"eratin% room attire which inc!des scrb

sits) %owns) head co#erin%s) and face mas's.sits) %owns) head co#erin%s) and face mas's.

sho!d not be worn otside the o"eratin%sho!d not be worn otside the o"eratin%

room site$ If sch occrs) chan%e a!! attireroom site$ If sch occrs) chan%e a!! attirebefore re-enterin% the c!ean area$ Thebefore re-enterin% the c!ean area$ The

o"eratin% room and ad+acent s""ortin%o"eratin% room and ad+acent s""ortin%

areas are c!assi>ed as (c!ean areas$(.areas are c!assi>ed as (c!ean areas$(.

*!! members of the sr%ica! team ha#in%*!! members of the sr%ica! team ha#in%direct contact with the sr%ica! site mstdirect contact with the sr%ica! site mst

"erform the sr%ica! hand scrb before the"erform the sr%ica! hand scrb before the

o"eration$o"eration$


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*!! materia!s and instrments sed in*!! materia!s and instrments sed in

contact with the site mst be steri!e$contact with the site mst be steri!e$

The %owns worn b& sr%eons and scrb The %owns worn b& sr%eons and scrb

cor"smen are considered steri!e fromcor"smen are considered steri!e from

sho!der to waist in the front on!&.)sho!der to waist in the front on!&.)

inc!din% the %own s!ee#es$inc!din% the %own s!ee#es$

If steri!e sr%ica! %!o#es are torn) If steri!e sr%ica! %!o#es are torn)

"nctred) or ha#e toched an nsteri!e"nctred) or ha#e toched an nsteri!e

srface or item) the& are consideredsrface or item) the& are consideredcontaminated$contaminated$


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The safest) most "ractica! method ofThe safest) most "ractica! method of

steri!i,ation for most artic!es is steamsteri!i,ation for most artic!es is steam

nder "ressre$nder "ressre$ /abe! a!! "re"ared) "ac'a%ed) and /abe! a!! "re"ared) "ac'a%ed) and

steri!i,ed items with an e3"iration date$steri!i,ed items with an e3"iration date$

Use artic!es "ac'a%ed and steri!i,ed in Use artic!es "ac'a%ed and steri!i,ed in

cotton ms!in wra""ers within @Q ca!endarcotton ms!in wra""ers within @Q ca!endarda&s$da&s$

Use artic!es steri!i,ed in cotton ms!inUse artic!es steri!i,ed in cotton ms!in

wra""ers and sea!ed in "!astic within ?Qwra""ers and sea!ed in "!astic within ?Q

ca!endar da&sca!endar da&s


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Unsteri!e artic!es mst not comeUnsteri!e artic!es mst not comein contact with steri!e artic!es$in contact with steri!e artic!es$

Ma'e sre the "atients s'in isMa'e sre the "atients s'in is

as c!ean as "ossib!e before aas c!ean as "ossib!e before asr%ica! "rocedre$sr%ica! "rocedre$

Ta'e e#er& "recation to "re#entTa'e e#er& "recation to "re#ent

contamination of steri!e areas orcontamination of steri!e areas ors""!ies b& airborne or%anisms$s""!ies b& airborne or%anisms$


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e!d from

which to wor'$ The >e!d sho!d bewhich to wor'$ The >e!d sho!d beestab!ished on a stab!e) c!ean) 6at) dr&estab!ished on a stab!e) c!ean) 6at) dr&

srface$srface$

*n artic!e is either steri!e or nsteri!e0*n artic!e is either steri!e or nsteri!e0

there is no in-between$ If there is dobtthere is no in-between$ If there is dobtabot the steri!it& of an item) consider itabot the steri!it& of an item) consider it

nsteri!ensteri!e


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*n& time the steri!it& of a >e!d*n& time the steri!it& of a >e!dhas been com"romised) re"!acehas been com"romised) re"!ace

the contaminated >e!d and set"$the contaminated >e!d and set"$

Do not o"en steri!e artic!es nti!Do not o"en steri!e artic!es nti!the& are read& for se$the& are read& for se$

Do not !ea#e steri!e artic!esDo not !ea#e steri!e artic!es

nattended once the& are o"enednattended once the& are o"enedand "!aced on a steri!e >e!d$and "!aced on a steri!e >e!d$


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Do not retrn steri!e artic!es to aDo not retrn steri!e artic!es to a

container once the& ha#e been remo#edcontainer once the& ha#e been remo#edfrom the container$from the container$

Ne#er reach o#er a steri!e >e!d$Ne#er reach o#er a steri!e >e!d$

Phen "orin% steri!e so!tions intoPhen "orin% steri!e so!tions into

steri!e containers or basins) do notsteri!e containers or basins) do not

toch the steri!e container with thetoch the steri!e container with the

so!tion bott!e$ Once o"ened and >rstso!tion bott!e$ Once o"ened and >rst

"ored) se bott!es of !iqid entire!&$ If"ored) se bott!es of !iqid entire!&$ If

an& !iqid is !eft in the bott!e) discard it$an& !iqid is !eft in the bott!e) discard it$


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Ne#er se an otdated artic!e$Ne#er se an otdated artic!e$Unwra" it) ins"ect it) and) ifUnwra" it) ins"ect it) and) if

resab!e) rewra" it in a newresab!e) rewra" it in a new

wra""er for steri!i,ation$wra""er for steri!i,ation$

SURGI5*/


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SURGI5*/


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=#=# 2eore /eginning the hand scru/4 don a2eore /eginning the hand scru/4 don a

surgical cap or hood that co0ers all hair4 /othsurgical cap or hood that co0ers all hair4 /oth

head and acial4 and a disposa/le *as$head and acial4 and a disposa/le *as$co0ering your nose and *outh#co0ering your nose and *outh#


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and ar* /y passing the* through the runningand ar* /y passing the* through the running

water# )lways $eep your hands a/o0e thewater# )lways $eep your hands a/o0e the

le0el o your el/ows#le0el o your el/ows#B#B# Fro* a sterile container4 ta$e a sterile /rushFro* a sterile container4 ta$e a sterile /rush

and dispense approxi*ately ? *l o antisepticand dispense approxi*ately ? *l o antiseptic

detergent onto the /rush and /egin scru//ingdetergent onto the /rush and /egin scru//ing

your hands and ar*s#your hands and ar*s#?#?# 2egin with the fngertips# 2ring your thu*/2egin with the fngertips# 2ring your thu*/

and fngertips together and4 using the /rush4and fngertips together and4 using the /rush4

scru/ across the fngertips using @C stro$es#scru/ across the fngertips using @C stro$es#

## ow scru/ all our surace planes o theow scru/ all our surace planes o the


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pp

thu*/ and all suraces o each fnger4thu*/ and all suraces o each fnger4

including the we//ed space /etween theincluding the we//ed space /etween the

fngers4 using


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=C#=C# Scru/ the el/ow in a circular *otion usingScru/ the el/ow in a circular *otion using


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=A#=A# Drop the /rush into the sin$ when you areDrop the /rush into the sin$ when you are

fnished#fnished#

=B#=B# 6inse /oth hands and ar*s4 $eeping your6inse /oth hands and ar*s4 $eeping yourhands a/o0e the le0el o your el/ows4 andhands a/o0e the le0el o your el/ows4 and

allow water to drain o the el/ows#allow water to drain o the el/ows#

=?#=?# >hen rinsing4 do not touch anything with>hen rinsing4 do not touch anything with

your scru//ed hands and ar*s#your scru//ed hands and ar*s#

=#=# !he total scru/ procedure *ust include all!he total scru/ procedure *ust include all

anato*ical suraces ro* the fngertips toanato*ical suraces ro* the fngertips to

approxi*ately < inches a/o0e the el/ow#approxi*ately < inches a/o0e the el/ow#


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=#=# Dry your hands with a sterile towel#Dry your hands with a sterile towel#Do not allow the towel to touchDo not allow the towel to touch

anything other than your scru//edanything other than your scru//ed

hands and ar*s#hands and ar*s#=#=# 2etween operations4 ollow the2etween operations4 ollow the

sa*e hand- scru/ procedure#sa*e hand- scru/ procedure#

Gownin% and G!o#in%Gownin% and G!o#in%


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% %% % GOPNINGGOPNING

=# Dry one hand and ar*4 starting with the=# Dry one hand and ar*4 starting with thehand and ending at the el/ow4 with one endhand and ending at the el/ow4 with one end

o the towel# Dry the other hand and ar* witho the towel# Dry the other hand and ar* with

the opposite end o the towel# Drop the towel#the opposite end o the towel# Drop the towel#


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G/O=INGG/O=ING

?$ 2ic' " one %!o#e b& the cA sin%?$ 2ic' " one %!o#e b& the cA sin%&or thmb and inde3 >n%er$&or thmb and inde3 >n%er$

@$ Tochin% on!& the cA) "!! the %!o#e@$ Tochin% on!& the cA) "!! the %!o#e

onto one hand and anchor the cA o#eronto one hand and anchor the cA o#er

&or thmb$&or thmb$

B$ S!i" &or %!o#ed >n%ers nder theB$ S!i" &or %!o#ed >n%ers nder the

cA of the other %!o#e$ 2!! the %!o#ecA of the other %!o#e$ 2!! the %!o#e

o#er &or >n%ers and hand) sin% ao#er &or >n%ers and hand) sin% astretchin% side-to-side motion$stretchin% side-to-side motion$


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$ *nchor the cA on &or thmb$$ *nchor the cA on &or thmb$Pith &or >n%ers sti!! nder thePith &or >n%ers sti!! nder the

cA) "!! the cA " and awa& fromcA) "!! the cA " and awa& from

&or hand and o#er the 'nitted cA&or hand and o#er the 'nitted cA

of the %own$of the %own$

$ Re"eat the "recedin% ste" to$ Re"eat the "recedin% ste" to

%!o#e &or other hand$%!o#e &or other hand$

$ The %!o#in% "rocess is com"!ete$$ The %!o#in% "rocess is com"!ete$


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To %own and %!o#e the sr%eon)To %own and %!o#e the sr%eon)fo!!ow these ste"s1fo!!ow these ste"s1

?$ 2ic' " a %own from the?$ 2ic' " a %own from the

steri!e !inen "ac'$ Ste" bac'steri!e !inen "ac'$ Ste" bac'from the steri!e >e!d and !et thefrom the steri!e >e!d and !et the

%own nfo!d in front of &o$


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sr%eons arms are in the s!ee#es) !et %o of thesr%eon s arms are in the s!ee#es) !et %o of the

%own$ 8e caref! not to toch an&thin% bt the%own$ 8e caref! not to toch an&thin% bt the

steri!e %own$ The circ!ator wi!! tie the %own$steri!e %own$ The circ!ator wi!! tie the %own$

B$ 2ic' " the ri%ht %!o#e$ Pith the thmb ofB$ 2ic' " the ri%ht %!o#e$ Pith the thmb of

the %!o#e facin% the sr%eon) "!ace &orthe %!o#e facin% the sr%eon) "!ace &or

>n%ers and thmbs of both hands in the cA of>n%ers and thmbs of both hands in the cA of

the %!o#e and stretch it otward) ma'in% athe %!o#e and stretch it otward) ma'in% a

circ!e of the cA$ OAer the %!o#e to thecirc!e of the cA$ OAer the %!o#e to thesr%eon$ 8e caref! that the sr%eons baresr%eon$ 8e caref! that the sr%eons bare

hand does not toch &or %!o#ed hands$hand does not toch &or %!o#ed hands$

Re"eat for !eft hand.Re"eat for !eft hand.

TY2ES OF *NEST


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TY2ES OF *NEST


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TY2ES OF *NEST


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GENER*/ *NEST


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Suppresses *any o your /ody9s nor*alSuppresses *any o your /ody9s nor*alauto*atic unctions4 such as those thatauto*atic unctions4 such as those that

contro! breathin%) heartbeat)contro! breathin%) heartbeat)

circ!ation of the b!ood sch ascirc!ation of the b!ood sch as

b!ood "ressre.) mo#ements of theb!ood "ressre.) mo#ements of the

di%esti#e s&stem) and throat re6e3esdi%esti#e s&stem) and throat re6e3es

sch as swa!!owin%) co%hin%) orsch as swa!!owin%) co%hin%) or

%a%%in%%a%%in% that pre0ent oreign *aterialthat pre0ent oreign *aterialro* /eing inhaled into your lungsro* /eing inhaled into your lungs

+aspiration.+aspiration.


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7onitoring o the heart4 /reathing47onitoring o the heart4 /reathing4/lood pressure4 and other 0ital/lood pressure4 and other 0ital

unctions is i*portant# )nunctions is i*portant# )n

endotrachea! ET. tbeendotrachea! ET. tbe or aor alaryngeal *as$ airway is usuallylaryngeal *as$ airway is usually

used to gi0e an inhalant anestheticused to gi0e an inhalant anesthetic

and oxygen4 control and assistand oxygen4 control and assist/reathing# )n E! tu/e is used to/reathing# )n E! tu/e is used to

pre0ent aspiration#pre0ent aspiration#


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Genera! anesthesia is common!&Genera! anesthesia is common!&be%n indced. with intra#enosbe%n indced. with intra#enos

I=. anesthetics) bt inha!ationI=. anesthetics) bt inha!ation

a%ents a!so ma& be sed$ Once &oa%ents a!so ma& be sed$ Once &oare nconscios) anesthesia ma& beare nconscios) anesthesia ma& be

maintained with an inha!antmaintained with an inha!ant

anesthetic a!one) with a combinationanesthetic a!one) with a combination

of intra#enos anesthetics) or aof intra#enos anesthetics) or acombination of the two$combination of the two$

ST*GES OF GENER*/ST*GES OF GENER*/*NEST


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*NEST


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ST*GE II ;ST*GE II ;EXCITEMENTEXCITEMENT Str%%!in%) shotin% )ta!'in%)Str%%!in%) shotin% )ta!'in%)

sin%in%) !a%hin% or cr&in% ;sin%in%) !a%hin% or cr&in% ;

a#oided if %i#en smooth!& : qic'!&.a#oided if %i#en smooth!& : qic'!&. 2"i!s di!ate bt contract if2"i!s di!ate bt contract if

e3"osed to !i%ht.e3"osed to !i%ht.

2R ra"id : RR irre%!ar$2R ra"id : RR irre%!ar$

Restrainin% the "atient ma& beRestrainin% the "atient ma& be

"ossib!e"ossib!e##


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ST*GE III ;ST*GE III ; SURGICAL ANESTHESIASURGICAL ANESTHESIA Reached b& continosReached b& continos

administration of anesthetic #a"oradministration of anesthetic #a"or

or %as$or %as$ 2t$ is nconscios : !ies qiet!&$2t$ is nconscios : !ies qiet!&$

2"i!s are sma!! bt contract when2"i!s are sma!! bt contract when

e3"osed to !i%hte3"osed to !i%ht RR re%!ar) 2R : #o!me PN/) s'inRR re%!ar) 2R : #o!me PN/) s'in

"in'C6shed"in'C6shed


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ST*GE I=ST*GE I= MEDULLARY DEPRESSION MEDULLARY DEPRESSION

Reached when too mch anesthesia hasReached when too mch anesthesia hasbeen administered$been administered$

Res"irations sha!!ow) "!se wea' :Res"irations sha!!ow) "!se wea' :

thread& $thread& $ 2"i!s wide!& di!ated : no !on%er2"i!s wide!& di!ated : no !on%er

contract when e3"osed to !i%ht$contract when e3"osed to !i%ht$

5Y*NOSIS de#e!o"s : wCo "rom"t5Y*NOSIS de#e!o"s : wCo "rom"t

inter#entioninter#ention DE*T


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)nesthetic is discontinued)nesthetic is discontinuedi**ediately#i**ediately#

,irculatory support initiated#,irculatory support initiated#

REGION*/ *NEST


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REGION*/ *NEST


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E2IDUR*/ *NEST


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*D=*NT*GE1 absence of headache*D=*NT*GE1 absence of headache DIS*D=*NT*GE1 %reater technica!DIS*D=*NT*GE1 %reater technica!

cha!!en%e of introdcin% thecha!!en%e of introdcin% the

anesthesia in the e"idra! s"ace$anesthesia in the e"idra! s"ace$

If . accidenta! "nctre of the draIf . accidenta! "nctre of the dra

ha""ens : the anesthetic tra#e!sha""ens : the anesthetic tra#e!s

toward the headtoward the head


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S2IN*/ *NEST


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2ERI2c ner#e or

%ro" of ner#es to b!oc' "ain from the area of%ro" of ner#es to b!oc' "ain from the area ofthe bod& s""!ied b& the ner#e$ Ner#e b!oc'sthe bod& s""!ied b& the ner#e$ Ner#e b!oc's

are most common!& sed for "rocedres on theare most common!& sed for "rocedres on the

hands) arms) feet) !e%s) or face$hands) arms) feet) !e%s) or face$

2rachial plexus /loc$- ar*2rachial plexus /loc$- ar* Para0erte/ral anesthesia- chest4 a/do wall &Para0erte/ral anesthesia- chest4 a/do wall &

ext#ext#

!ransacral +,audal. /loc$- peineu*4lower!ransacral +,audal. /loc$- peineu*4lower

a/do*ena/do*en

/O5*/ *NEST


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/O5*/ *NEST


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*D=*NT*GES 1*D=*NT*GES 1 Sim"!e) economica!) non-e3"!osi#eSim"!e) economica!) non-e3"!osi#e

Eqi"ment needed is minima!Eqi"ment needed is minima!

2ost-o" reco#er& is brief2ost-o" reco#er& is brief

Undesirab!e eAects of Gen$Undesirab!e eAects of Gen$

*nesthesia are a#oided$*nesthesia are a#oided$

Idea! for short : s"er>cia!Idea! for short : s"er>cia!

sr%ica! "rocedressr%ica! "rocedres##

Intrao"erati#eIntrao"erati#e

5 !i i5 !i ti


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5om"!ications5om"!ications ausea and 0o*itingausea and 0o*iting)naphylaxis)naphylaxis

%ypoxia and respiratory%ypoxia and respiratory

co*plicationsco*plications %ypother*ia%ypother*ia

7alignant hyperther*ia7alignant hyperther*ia

Disse*inated intra0ascularDisse*inated intra0ascular

coagulation +DI,.coagulation +DI,.

2otent a * #erse E ectsotent a #erse ectsof Sr%er& andof Sr%er& and


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of Sr%er& andof Sr%er& and

*nesthesia*nesthesia)llergic reactions and drug toxicity or)llergic reactions and drug toxicity orreactionsreactions

,ardiac dysrhyth*ias,ardiac dysrhyth*ias

,S changes and o0ersedation or,S changes and o0ersedation orundersedationundersedation

!rau*a: laryngeal4 oral4 ner0e4 and s$in4!rau*a: laryngeal4 oral4 ner0e4 and s$in4

including /urnsincluding /urns

%ypotension%ypotension

!hro*/osis!hro*/osis

Geronto!o%icGeronto!o%ic

5 id ti5 id ti


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5onsiderations5onsiderations Elderly patients are at increased ris$ orElderly patients are at increased ris$ or

co*plications due to surgery andco*plications due to surgery and

anesthesia /ecause o:anesthesia /ecause o: Increased li$elihood o coexisting conditions#Increased li$elihood o coexisting conditions#

)ging heart and pul*onary syste*s#)ging heart and pul*onary syste*s#

Decreased ho*eostatic *echanis*s#Decreased ho*eostatic *echanis*s#

,hanges in responses to drugs and,hanges in responses to drugs and

anesthetic agents due to aging changes suchanesthetic agents due to aging changes suchas decreased renal unction4 and changes inas decreased renal unction4 and changes in

/ody co*position o at and water#/ody co*position o at and water#

Nrs n% Goa s or t ers n% oa s or t e2atient in the2atient in the


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2atient in the2atient in the

Intrao"erati#e 2eriodIntrao"erati#e 2eriod 6educing anxiety6educing anxiety Pre0enting positioning in3uriesPre0enting positioning in3uries

7aintaining patient saety7aintaining patient saety

7aintaining the patientHs dignity7aintaining the patientHs dignity

)0oiding co*plications)0oiding co*plications

/a"arotom& 2osition)/a"arotom& 2osition)

Trende!enbr% 2osition) /ithotom&Trende!enbr% 2osition) /ithotom&


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Trende!enbr% 2osition) /ithotom&e de e b % os t o ) t oto &

2osition) and Side!&in% 2osition for2osition) and Side!&in% 2osition for

idne& Sr%er&idne& Sr%er&

2rotectin% the 2atient2rotectin% the 2atient

f I +f I +


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from In+r&from In+r& Patient identifcationPatient identifcation ,orrect inor*ed consent,orrect inor*ed consent

8erifcation o records o health8erifcation o records o health

history and exa*history and exa* 6esults o diagnostic tests6esults o diagnostic tests

)llergies +include latex allergy.)llergies +include latex allergy.

7onitoring and *odiying the7onitoring and *odiying the

physical en0iron*entphysical en0iron*ent


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Saety *easures such as groundingSaety *easures such as groundingo euip*ent4 restraints4 and noto euip*ent4 restraints4 and not

lea0ing a sedated patientlea0ing a sedated patient

8erifcation and accessi/ility o8erifcation and accessi/ility o/lood/lood


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III$III$ 2OSTO2ER*TI=E 2


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UnitUnit !he P), en0iron*ent!he P), en0iron*ent 2eds and other euip*ent2eds and other euip*ent

!hree phases:!hree phases: Phase IPhase I

Phase IIPhase II

Phase IIIPhase III

Nrsin% Mana%ement inNrsin% Mana%ement in

th 2*5Uthe 2*5U


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the 2*5Uthe 2*5U Pro0ide care or the patient until he5shePro0ide care or the patient until he5she

has reco0ered ro* the eects ohas reco0ered ro* the eects o

anesthesia#anesthesia#

Patient has resu*ption o *otor andPatient has resu*ption o *otor and

sensory unction4 is oriented4 has sta/lesensory unction4 is oriented4 has sta/le

8S4 and shows no e0idence o he*orrhage8S4 and shows no e0idence o he*orrhage

or other co*plications o surgery#or other co*plications o surgery#

Freuent s$illed assess*ent o the patientFreuent s$illed assess*ent o the patientis 0italis 0ital

Res"onsibi!ities of theRes"onsibi!ities of the

2*5U N2*5U Nrse


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2*5U Nrse2*5U Nrse 6e0iew pertinent inor*ation and /aseline6e0iew pertinent inor*ation and /aseline

assess*ent upon ad*ission to the unit#assess*ent upon ad*ission to the unit#)ssess*ents include airway and respirations4)ssess*ents include airway and respirations4

cardio0ascular unction4 surgical site4cardio0ascular unction4 surgical site4unction o the central ner0ous syste* alsounction o the central ner0ous syste* alsoassess I8s and all tu/es and euip*ent#assess I8s and all tu/es and euip*ent#

6eassess 8S and patient status e0ery =B6eassess 8S and patient status e0ery =B*inutes or *ore reuently as needed#*inutes or *ore reuently as needed#

Pro0ide report and transer the patient toPro0ide report and transer the patient to

another unit or discharge the patient toanother unit or discharge the patient toho*e#ho*e#

Ot"atientOt"atient

S r%er CDirect Dischar%eSr%er&CDirect Dischar%e


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Sr%er&CDirect Dischar%eSr%er&CDirect Dischar%e Discharge planning and dischargeDischarge planning and discharge

assess*entassess*ent

2ro#ide written and2ro#ide written and#erba!#erba!instrctionsinstrctionsregarding ollow-up care4 co*plications4regarding ollow-up care4 co*plications4

wound care4 acti0ity4 *edications4 and diet#wound care4 acti0ity4 *edications4 and diet#

(i0e prescriptions and phone nu*/ers#(i0e prescriptions and phone nu*/ers#Discuss actions to ta$e i co*plications occur#Discuss actions to ta$e i co*plications occur#

Ot"atientOt"atient

Sr%er&CDirect Dischar%eSr%er&CDirect Dischar%e


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Sr%er&CDirect Dischar%eSr%er&CDirect Dischar%e (i0e instructions to the patient and a(i0e instructions to the patient and a

responsi/le adult who willresponsi/le adult who will

acco*pany the patient#acco*pany the patient#

Patients are not to dri0e ho*e or /ePatients are not to dri0e ho*e or /e

discharged to ho*e alone# Sedationdischarged to ho*e alone# Sedation

and anesthesia *ay cloud *e*oryand anesthesia *ay cloud *e*oryand 3udg*ent and aect a/ility#and 3udg*ent and aect a/ility#

Maintainin% a 2atentMaintainin% a 2atent

*irwa&*irwa&


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*irwa&*irwa&) pri*ary consideration: necessary to) pri*ary consideration: necessary to

*aintain 0entilation and oxygenationJ*aintain 0entilation and oxygenationJ

Pro0ide supple*ental oxygen as indicated#Pro0ide supple*ental oxygen as indicated#

)ssess /reathing /y placing hand near)ssess /reathing /y placing hand nearace to eel *o0e*ent o air#ace to eel *o0e*ent o air#

Keep head o /ed ele0ated =B-@CKeep head o /ed ele0ated =B-@Coounlessunless

contraindicated#contraindicated#

7ay reuire suctioning#7ay reuire suctioning# I 0o*iting occurs4 turn patient to the sideI 0o*iting occurs4 turn patient to the side


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% "% "

*irwa&*irwa&


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Use of Oral AirwayUse of Oral Airway

Note: Do not remove oral airway untilNote: Do not remove oral airway until


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yy

evidence of gag reflex returnsevidence of gag reflex returns

perioperative nursing unp

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