SURGERY
SURGERY - designates the branch of medicine that encompasses pre-operative care,
intra-operative judgement, and post-operative care of patients.
OPERATION - for correction of deformities and defects, repair of injuries, diagnosis and
cure of disease processes, relief of suffering and prolongation of life.
PERIOPERATIVE NURSING- describes the nursing functions in the total surgical
experience of the patients
3 PHASES OF PERIOPERATIVE NURSING:
1. PREOPERATIVE PHASE
2. INTRAOPERATIVE PHASE
3. POSTOPERATIVE PHASE
CONDITIONS REQUIRING SURGERY:
1.) Obstruction
2.) Perforation
3.) Erosion
4.) Tumor
CLASSIFICATION OF SURGICAL PROCEDURES
I. According to PURPOSE:
1.) Diagnostic - eg. breast biopsy, bronchoscopy
2.) Exploratory - eg. exploratory laparotomy
3.) Curative
3.1) Ablative - eg. appendectomy, amputation
3.2) Constructive - eg. cheiloplasty, herniorrhaphy,orchiopexy
3.3) Reconstructive - eg. skin graft after a burn, total joint
replacement,rhinoplasty, perineorrhaphy
4.) Palliative - eg. bowel resection in patient with terminal cancer
5.) Transplant - eg. heart, lung, liver, kidney transplant
II. According to DEGREE of RISK ( Magnitude/Extent ):
1.) MAJOR - eg. transplant, total hip replacement, cholecystectomy
2.) MINOR - eg. removal of skin lesions, dilatation and curettage, debridement
III. According to URGENCY:
1.) Emergency - eg. obstetric emergencies, ruptured aneuryms, life-threatening
trauma, intestinal obstruction
2.) Urgent/Imperative - eg. amputation resulting from gangrene, fractured hip, heart
bypass surgery
3.) Elective - eg. ORIF
4.) Planned/Required - eg. cataract surgery
5.) Optional - eg. cosmetic surgery
SURGICAL RISK FACTORS
1.) Age
Nsg. Implications:
1.) consider using lesser doses for desired effect
2.) adjust nutritional intake to conform to higher protein and vitamin needs
3.) anticipate problems from long standing chronic disorders
2.) Obesity
Nsg. Implications:
1.) Promote weight reduction if time permits.
2.) Monitor closely for complications postoperatively.
3.) Encourage postop exercises and early ambulation
3.) Malnutrition
Nursing. Implications:
1.) Promote weight gain by providing a well-balanced diet
2.) Administer total parenteral nutrition intravenously, nutritional supplements and tube
feedings as prescribed.
3.) Daily weights and calorie counts also may be ordered
4.)Dehydration/ electrolyte imbalance
Nursing Implications:
1.) Administer intravenous fluids as ordered.
2.) Keep a detailed input and output record.
3.) Monitor client for evidence of electrolyte imbalance
5.)Cardiovascular disorders
Nursing Implications:
1.) Diligently monitor vital signs and general condition of the client.
2.) Closely monitor fluid intake.
3.) Assess skin color.
4.) Assess for chest pain, lung congestion, and peripheral edema.
5.) Observe for signs of hypoxia, and administer oxygen as ordered.
6.) Early postoperative ambulation and leg exercises
7.) Encourage change of position but avoid sudden exertion.
6.) Respiratory Disorders
.
Nursing. Implications:
1.) Closely monitor respirations, pulse, and breath sounds.
2.) Assess for hypoxia, dyspnea, lung congestion, and chest pain.
3.) Encourage postop exercises and early ambulation.
4.) Encourage to quit smoking or at least to reduce the number of cigarettes smoked.
5.) Patients with chronic pulmonary problems should be treated for several days
preoperatively
7.) Diabetes Mellitus
Nursing Implications:
1.) Monitor closely for signs and symptoms of hypoglycemia and hyperglycemia.
2.) Monitor blood glucose levels every 4 hrs. as ordered.
3.) Administer insulin as prescribed.
4.) Encourage intake of food at the designated meal and snack times.
8.) Renal & liver dysfunction
Nursing Implications:
1.) Monitor for fluid volume overload, I&O, and response to medication.
2.) Evaluate closely for drug side effects and evidence of acidosis or alkalosis.
9.) Alcoholism
Nursing. Implications:
1.) Monitor closely for signs of deliriun tremens.
2.) Encourage well-balanced diet.
3.) Monitor for wound complications.
4.) Administer supplemental nutrients parenterally as ordered.
10.) Medications
a. Anticoagulants and Salicylates
1.) Monitor for bleeding.
2.) Assess PTT/PT values.
b. Diuretics
1.) Monitor I&O and electrolytes.
2.) Assess cardiovascular and respiratory status.
c. Antihypertensives
1.) Closely monitor blood pressure.
d. Antidepressants
1.) Closely monitor blood pressure.
e.) Antibiotics
1.) Monitor respirations.
OTHER FACTORS:
1.) Nature of the condition
2.) Location of the condition
3.) Magnitude and urgency of the surgical procedure
4.) Mental attitude of the person toward the surgery
5.) Caliber of the professional staff health care facilities
COMMON SUFFIXES IN SURGERY:
Ectomy - removal of an organ or a gland
Rrhaphy - repair
Ostomy - providing an opening ( stoma )
Otomy - cutting into
Plasty - formation or plastic repair
Oscopy - looking into
COMMON ABBREVIATIONS:
TAHBSO - Total Abdominal Hysterectomy Bilateral Salpingo
Oophorectomy
TURP - Transurethral resection of the Prostate
TURBT - Transurethral resection of the Bladder Tumor
STSG - Split Thickness Skin Grafting
BKA - Below Knee Amputation
AKA - Above Knee Amputation
ECCE w/ IOL - Extra Capsular Cataract Extraction w/ Intra-Ocular Lens
implantation
CHOLE w/ IOC - Cholecystectomy w/ Intra-operative Cholangiogram
D&C - Dilatation of the cervix and Curettage of the uterus
SMR - Submucous resection of the Nasal Septum
MRM - Modified Radical Mastectomy
LCCS - Low Cervical Cesarean Section
LSTCS - Low Segment Transverse Cesarean Section
ORIF - Open Reduction Internal Fixation
BTL - Bilateral Tubal Ligation
EXLAP - Exploratory Laparotomy
SAB - Subarachnoid Block
CEB - Continuous Epidural Block
CSEA - Combined Spinal Epidural Anesthesia
RASAB - Regional Anesthesia Subarachnoid Block
TIVA - Total Intravenous Anesthesia
GA - General Anesthesia
GETA - General Endotracheal Anesthesia
ROOT WORDS
arthro – joint (arthroplasty)
blepharo – eyelids (blepharoplasty)
cholecyst – gallbladder (cholecystectomy)
colpo – vagina ( colporrhaphy)
cranio – skull (craniotomy)
cysto – urinary bladder (cystectomy)
gastro – stomach (gastroscopy)
hepato – liver (hepatotomy)
entero – intestines ( enterostomy)
hystero – uterus (hysterectomy)
mast – breast (mastectomy)
myo – muscle (myomectomy – muscle tumor)
nephro – kidney (nephrectomy)
pneumo – lung ( pneumonectomy)
procto – anus (proctoscopy)
rhino – nose (rhinoplasty)
thoraco – chest (thoracotomy)
tracheo – trachea; windpipe (tracheostomy)
PREOPERATIVE PHASE
Areas of Preoperative PREPARATIONS by the surgical patient:
*PSYCHOLOGICAL Preparation
Fear- is an emotion marked by dread apprehension and alarm caused by anticipation or
awareness of danger and manifested by anxiety
Causes of FEAR of the Preoperative client:
1.) Fear of the unknown
2.) Fear of Anesthesia
3.) Fear of pain and discomfort
4.) Fear of death
5.) Fear of disfigurement, mutilation, loss of a valued body part
6.) Fear of loss of livelihood
Manifestations of Fear:
Anxiousness
Bewilderment
Anger
Tendency to exaggerate
Sad, evasive, tearful, clinging
Inability to concentrate
Short attention span
Failure to carry out simple directions
NURSING INTERVENTIONS to minimize ANXIETY:
1.) Explore client’s feelings.
2.) Allow client to speak openly about fears/ concerns.
3.) Give empathetic support.
4.) Consider the person’s religious preferences and arrange for visit by priest/ minister as
desired.
*LEGAL Considerations
INFORMED CONSENT
Purposes:
1.) To ensure that the client understands the nature of the treatment including the
potential complications and disfigurement.
2.) To indicate that the client’s decision was made without pressure.
3.) To protect the client against unauthorized procedure.
4.) To protect the surgeon and the hospital against legal action by a client who claims
that an unauthorized procedure was performed.
NURSING Responsibility
1.) Witnessing the exchange b/w the client and the surgeon
2.) Witnessing the client’s signature
3.) Establishing that the client really did understand.
3 MAJOR ELEMENTS of Informed Consent
1.) The consent must be given voluntarily
2.) The consent must be given to individual who have the capacity to understand
3.) The client must be given information to be the ultimate decision maker
*PHYSIOLOGICAL Preparations:
a.) Cardiovascular- ECG
b.) Hematologic- CBC, Hgb and Hct, WBC, PTT & PT, Platelet count
c.) Respiratory- Chest X-ray , Pulmonary Function Test/PFT
d.) Metabolic- FBS, Electrolytes ( K+, Na++, etc.)
e.) Genitourinary- routine Urine Analysis
*PHYSICAL Preparations:
TEACHING POST OP EXERCISES:
1.) Deep breathing exercise ( diaphragmatic )
2.) Coughing exercise
3.) Turning Exercise
4.) Leg, Ankle, and Foot exercise
NIGHT prior to Surgery
Preparing the skin
Preparing the GIT
Preparing for Anesthesia
Promoting rest and sleep
On the DAY of Surgery
EARLY AM Care:
Awaken one hour before preop medications
Morning bath, mouth wash
Provide clean gown
Remove hairpins, braid long hair, cover hair with cap
Remove dentures, foreign materials, colored nail polish, hearing aid, contact lens,
wedding ring, underwear
Take baseline VS before preop medication
Check ID band, skin prep
Check special orders- enema, tube insertion, IV line
Check NPO- ensure that the patient has not taken food for the last 10 hours
Have client void before preop medication
PREOPERATIVE Medications/ PREANESTHETIC Drugs
Goals:
1.) To allay anxiety
2.) To minimize respiratory tract secretions to prevent incidence of aspiration and
changes in HR
3.) Create amnesia for the events that precede surgery
4.) To decrease body metabolism so less anesthetic will be used
Pre-op Meds:
1.) Sedatives and Hypnotics
2.) Barbiyurates/Tranquilizers
3.) Narcotic Analgesics
4.) Anticholinergics
5.)Histamine- H2 Receptor Antagonist
6.)Anxiolytics
7.)Antiemetics
8.)Prophylactic Antibiotics
Preoperative NURSING DIAGNOSES
• Anxiety related to the surgical experience (anesthesia, pain)
and the outcome of surgery
• Fear related to perceived threat of the surgical procedure
and separation from support system
• Knowledge deficit of preoperative procedures and protocols and postoperative expectation
