RGN 214 SURGICAL NURSING 1 �3 CREDITS (3T)��MR EDWARD AMPONSAH�

PRESENTATION OUTLINE

• Course objectives
• Concept of surgery
• Theatre Nursing
• Wounds and Inflammations
• Neoplasm
• Gynaecological disorders
• Pain

COURSE OBJECTIVES

By the end of the course the student will be able to:

• List members of the theatre team
• Describe operating room techniques; scrubbing, gloving and gowning
• Set trolleys for operations/surgery
• Assist surgeon in operations

​

​

COURSE OBJECTIVES CONT’D

• Describe inflammation and its healing processes
• Manage wounds and inflammation
• Manage neoplastic conditions
• Manage gynaecological conditions
• Manage pain effectively

CONCEPT OF SURGERY

• Surgery is any procedure performed on the human body that uses instruments to alter tissue or organ integrity.
• In other words, it is the art and science of treating injuries, diseases and deformities by operation and instrumentation.

​

CONCEPT OF SURGERY CONT’D

Naming of surgical Procedures

• Surgical procedures are named according to:
• the involved body organ, part or location
• a suffix that describes what is done during the procedure
• Examples;
• -ectomy (removal by cutting) e.g. myomectomy
• -orrhaphy (suture of or repair) e.g. herniorrhaphy

​

CONCEPT OF SURGERY CONT’D

Examples cont’d….

• -oscopy (looking or viewing into) e.g. urethroscopy
• -ostomy (formation of artificial permanent/temporal opening) e.g. colostomy
• -otomy (incision or cutting into) e.g. herniotomy
• -plasty (formation or repair) e.g. laminoplasty
• -lysis (destruction of) e.g. adhesiolysis
• -desis (binding or fixation) e.g. arthrodesis

​

CLASSIFICATION OF SURGERY�

• Surgery may be performed for various reasons:
• Purpose (exploratory, diagnostic – biopsy, aesthetic, curative – excision of tumour, palliative etc)
• Urgency (emergency/emergent, urgent, elective, optional)
• Physical setting (day/ambulatory)
• Degree of risk/extent/magnitude (major, minor)

​

PHASES OF SURGERY

• The surgical experience consists of three phases namely:
• Preoperative phase
• Intraoperative phase
• Postoperative phase
• Collectively these three phases together are referred to as perioperative period.

INTRODUCTION TO ANAESTHESIA

EA/SURG1/2017/001

10

INTRODUCTION TO ANAESTHESIA

• Anaesthesia originates from two Greek words
• an- without and
• aesthesis – sensation
• Meaning without sensation.
• Literally it refers to “negative sensation.”

​

EA/SURG1/2017/001

11

INTRODUCTION TO ANAESTHESIA CONT’D

• Anaesthesia is an induced state of partial or total loss of sensation, occurring with or without loss of consciousness.

EA/SURG1/2017/001

12

INTRODUCTION TO ANAESTHESIA CONT’D

• The purpose of which is to;
• Block nerve impulse transmission
• Suppress reflexes
• Promote muscle relaxation
• Achieve a controlled level of unconsciousness (in some cases).

​

EA/SURG1/2017/001

13

INTRODUCTION TO ANAESTHESIA CONT’D

Types of Anaesthesia

• Anaesthesia can be induced in many forms.
• The most common forms available include;
• General
• Regional and local.

​

EA/SURG1/2017/001

14

INTRODUCTION TO ANAESTHESIA CONT’D

Factors that influence the selection of type of anaesthesia

• Type and duration of the surgery
• Area to be operated
• Safety issues to reduce injury e.g. airway management
• Whether the surgery is emergency
• Options for management of pain after surgery

EA/SURG1/2017/001

15

INTRODUCTION TO ANAESTHESIA CONT’D

Factors that influence the selection of type of anaesthesia

• How long it has been since patient ate, had any liquids, or had any drugs
• Patient position needed for the surgical procedure
• Whether the patient must be alert enough to follow instructions during surgery
• Patient previous responses and reactions to anaesthesia

EA/SURG1/2017/001

16

INTRODUCTION TO ANAESTHESIA CONT’D

• General anaesthesia (GA)
• This is a reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the CNS.
• It can be achieved with single agent or combination of agents.
• GA depresses the CNS, leading to analgesia, amnesia and unconsciousness and also loss of muscle tone and reflexes.

EA/SURG1/2017/001

17

INTRODUCTION TO ANAESTHESIA CONT’D

General anaesthesia (GA)

• Mostly GA is indicated in
• Head, neck, upper torso and abdominal surgeries.
• General anaesthetic agents are administered by
• Inhalation (e.g. Enflurane, Halothane, Isoflurane, Sevoflurane)
• IV injection (e.g. Etomidate, Ketamine, Midazolam, Propofol)
• Neuromuscular blockers (e.g. Vecuronium, pancronium)
• Opioids (e.g. fentanyl, alfentanil)
• Balanced (e.g. the use of thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, and pancuronium for muscle relaxation)

EA/SURG1/2017/001

18

INTRODUCTION TO ANAESTHESIA CONT’D

Stages of General Anaesthesia

• Stage 1 (analgesia and sedation, relaxation):
• Begins with induction and ends with loss of consciousness.
• Stage 2 (excitement, delirium):
• Begins with loss of consciousness and ends with relaxation, regular breathing and loss of the eyelid reflex.

EA/SURG1/2017/001

19

INTRODUCTION TO ANAESTHESIA CONT’D

Stages of General Anaesthesia

• Stage 3 (Operative anaesthesia, surgical anaesthesia):
• Begins with generalized muscle relaxation and ends with loss of reflexes and depression of vital functions.
• Stage 4 (Danger):
• Begins with depression of vital functions and ends with respiratory failure, cardiac arrest and possible death

EA/SURG1/2017/001

20

INTRODUCTION TO ANAESTHESIA CONT’D

Local or Regional Anaesthesia

• Disrupts sensory nerve impulse transmission from a specific body area or region.
• Motor function may or may not be affected.
• Local or regional anaesthesia is often supplemented with sedatives opioid analgesics, or hypnotics to reduce anxiety and increase comfort.

​

EA/SURG1/2017/001

21

INTRODUCTION TO ANAESTHESIA CONT’D

Local or Regional Anaesthesia

• Local anaesthesia is delivered topically and by local infiltration.
• It is indicated
• When GA cannot be used because of medical problems
• When the patient has had adverse reactions to general anaesthesia
• Has a preference and a choice is possible
• When pain management after surgery is enhanced by regional anaesthesia.

​

​

EA/SURG1/2017/001

22

INTRODUCTION TO ANAESTHESIA CONT’D

Local or Regional Anaesthesia

• Types of regional anaesthesia include;
• Field block
• Nerve block
• Spinal anaesthesia
• Epidural space

EA/SURG1/2017/001

23

THEATRE NURSING

• Also known as operating room nursing
• Currently known as perioperative nursing
• It is the delivery of client care in the preoperative, intraoperative and postoperative periods of the clients’ surgical experience through the framework of the nursing process.

​

THEATRE TEAM MEMBERS

• Basically the surgical/theatre team can be categorized into two (2) major groups namely;
• Sterile team and
• Unsterile or non-sterile team members

THEATRE TEAM MEMBERS CONT’D

• The sterile team members
• surgeon, surgeon (first) assistant or technologist and the scrub (sterile) nurse.
• The non-sterile team consists of:
• anaesthesiologist or anaesthesia provider, circulating (scout) nurse, others (students, x-ray technician, orderlies, etc).

​

ROLES OF THEATRE TEAM MEMBERS �

Role of the surgeon

• Leader/Heads the surgical team
• Ultimate responsibility of performing the surgery
• Carries out preoperative diagnosis
• Dependent on other team members for the client’s emotional well-being and physiologic monitoring

​

ROLES OF THEATRE TEAM MEMBERS CONT’D�

Role of the first assistant

• Helps maintain visibility at the surgical site
• Helps control bleeding
• Closes wounds and apply dressings
• Handles tissues and instruments

​

ROLES OF THEATRE TEAM MEMBERS CONT’D�

Role of the scrub nurse

• Performs surgical hand scrub, gowns and glove to assist surgery
• Gown and gloves the surgeon and assistant
• Drapes the operating trolleys
• Prepares and arranges appropriate sterile instruments and supplies bearing in mind surgeons position

​

ROLES OF SCRUB NURSE CONT’D�

• Assists in cleaning operative.
• Assists surgeon in draping the client
• Moves trolley to convenient position
• Facilitates the surgical procedure by anticipating the need and providing the required sterile instruments and supplies to surgeon

​

ROLES OF SCRUB NURSE CONT’D�

• Prepares sutures, special equipments, etc.
• Assists surgeon and assistant during surgery.
• Count instruments, sutures and sponges with the circulating nurse before skin incision and closure of cavity.
• Keep operative field tidy at all times

​

ROLES OF SCRUB NURSE CONT’D�

• Maintains sterility of field throughout the procedure
• Keeps instruments clean by frequently wiping them with sterile wet swab
• Hands over specimen to the circulator in a receiver for preservation in a specimen container

​

ROLES OF SCRUB NURSE CONT’D�

• Covers wound with dressing after cleaning with an antiseptic solution post-surgery
• Assists in lifting of client gently from operating bed onto stretcher.
• Sort out instruments and decontaminate accordingly.

​

ROLES OF CIRCULATING NURSE�

• Checks the operation list and calls patients from the various wards according to the list.
• Serves as the liaison between the scrubbed personnel and those outside the operating room (OR)
• Performs duties outside the sterile field
• Monitors the activities of the surgical team so as to timely meet their needs

​

ROLES OF CIRCULATING NURSE CONT’D�

• Continually assess the client for signs of injury and implement appropriate interventions
• Monitor aseptic practices to avoid breaks in technique while coordinating movement.
• Coordinates “sign-in, time-out and sign-out”

​

ROLES OF CIRCULATING NURSE CONT’D�

• Responsible for checking the OR conditions (humidity, proper temperature, lighting, proper function of equipment, etc.)
• Ensures that all necessary items accompany patient
• Receives client into the OR
• Assists in positioning of client

​

ROLES OF CIRCULATING NURSE CONT’D�

• Participates in count
• Prepare labels for the client specimen
• Arranges items to be used in the theatre for easy access
• Assists the scrub team in scrubbing, gowning and gloving

​

ROLES OF CIRCULATING NURSE CONT’D�

• Monitors blood loss via suction and soiled swabs when required
• Assist in securing dressing after surgery

​

THANK YOU!!!!