Introduction to operating room (Part three).pdf

ALL YOU NEED
TO KNOW ABOUT
CENTRAL
STERILE SUPPLY
DEPARTMENT

BY TALAL ALBUDAYRI
INTRODUCTION
TO OPERATING
ROOM
(PART THREE)
A CSSD Presentation on Operation Rooms.

NOT EVERYONE
WORKS IN AN
OFFICE!
CONTRIBUTE TO THE
PLANNING CARE FOR
PRE/ POST AND INTRA
OPERATIVE CLIENT
Preoperative Nursing
Interventions

OBJECTIVE
AT THE END OF THE LESSON YOU
WILL BE ABLE TO
Provide preoperative informed consent,
pt. education , pain management and
psychological interventions
Perform bowel, urinary and skin
preparations

INFORMED CONSENT
TO ATTAIN THE RIGHT TO OPERATE IT
IS NECESSARY FOR THE SURGEON TO
OBTAIN A VOLUNTARY AND INFORMED
CONSENT FROM THE PATIENT.
SUCH WRITTEN PERMISSION
PROTECTS THE PATIENTS AGAINST
UNAUTHORIZED SURGERY AND
PROTECTS THE SURGEON AGAINST
UNAUTHORIZED OPERATION.

THE NURSES RESPONSIBILITY IS TO ENSURE
THAT WITH INFORMED CONSENT HAS BEEN
TAKEN/ VOLUNTARILY
BEFORE THE PATIENT SIGNS THE CONSENT
THE SURGEON SHOULD INFORM THE
PATIENTS
RISK COMPLICATION ,DISFIGUREMENT,
DISABILITY AND REMOVAL OF BODY PARTS
AS WELL AS WHAT TO EXPECT IN THE EARLY
AND LATE POSTOPERATIVE PERIODS

INFORMED CONSENT IS NECESSARY
WHEN
The process is invasive
Anesthesia is used
A non surgical procedure is performed
when it is going to have a risk to patient
Procedure is performed that involves
radiation.

Brief Introduction
Preoperative
Patient
Education

A. DIAPHRAGMATIC BREATHING
(DEEP BREATHING)
Refers to a flattening of the dome of the
diaphragm during inspiration with resulting
enlargement of the upper abdomen as air rushes
in during expiration, the abdominal muscles
contract position your patient in fowler’s position
1.
With the hands in loose fist position, allow the
hands to rest lightly on the front of the lower ribs
fingernails against lower chest to feel the
movements
2.

BREATH OUT GENTLY AND FULLY
AS THE RIBS SINKS DOWN AND
INWARD TO WARD MIDLINE.
1.
THEN TAKE A DEEP BREATH
THROUGH YOUR NOSE AND
MOUTH LETTING THE ABDOMEN
RISE AS THE LONGS FILL WITH AIR
2.

HOLD HIS BREATH FOR A COUNT
OF FIVE
1.
EXHALE AND LET OUT ALL THE AIR
THROUGH THE NOSE & MOUTH
2.
REPEAT 15 MINUTES WITH A SHORT
REST AFTER EACH GROUP OF FIVE
3.
PRACTICE THIS TWICE A DAY
PREOPERATIVELY
4.

B. COUGHING
LEAN FORWARD SLIGHTLY FROM A SITTING
POSITION IN BED INTERLACE THE FINGERS
TOGETHER, AND PLACE HANDS ACROSS
THE INCISION SIZE TO ACT AS A SPLINT
WHEN COUGHING
1.
BREATHE WITH THE DIAPHRAGM AS
DESCRIBED IN “A”
2.
WITH THE MOUTH SLIGHTLY OPEN,
BREATHE IT FULLY
3.
REPLY FOR THREE SHORT BREATHS
4.

THEN, KEEPING THE MOUTH OPEN,
TAKE IN QUICK DEEP BREATH AND
IMMEDIATELY GIVE A STRONG
COUGH ONCE OR TWICE.
THIS HELPS CLEAR SECRETION
FROM THE CHEST, IT MAY CAUSE
SOME DISCOMFORT BUT WILL NOT
HARM INCISION.

C. LEG EXERCISE
LIE IN SEMI FOWLERS POSITION
BEND THE KNEE AND RAISE THE FOOT
HOLD IT A FEW SECOND THEN EXTEND
THE LEG AND LOWER IT TO THE BED
DO THIS FIVE TIMES FOR BOTH LEGS
THEN TRACE CIRCLES WITH FEET BY
BENDING THEM DOWN, IN TOWARD,
EACH OTHER, UP AND THEM OUT
REPEAT THIS MOVEMENTS FIVE
MINUTES

D. TURNS TO THE SIDE
TURN-ON YOUR SIDE WITH THE
UPPERMOST LEG FLEXED MOST
AND SUPPORTED ON A PILLOW
GRASP THE SIDE RAIL AS AN AID
TO MANEUVER THE SIDE
PRACTICE DIAPHRAGMATIC
BREATHING AND COUGHING
WHILE ON TOUR SIDE.

DEEP BREATHING & COUGHING
EXERCISE
BREATHING DEEPLY:
Moves air down to the bottom areas of the
lungs
Opens air passages and moves mucous out
(coughing is also easier)
Helps the blood and oxygen supply to your
lungs, boosting circulation

LOWERS THE RISK OF LUNG
COMPLICATIONS SUCH AS PNEUMONIA
AND INFECTIONS
COUGHING HELPS BRING UP MUCOUS
FROM DEEP WITHIN YOUR LUNGS.
AS YOU DO YOUR BREATHING EXERCISES,
YOU MAY FEEL THIS IN THE BACK OF YOUR
THROAT OR HEAR A RATTLING SOUND
WHEN YOU BREATH.
BE SURE TO COUGH WHEN THIS OCCURS.

HOW TO PERFORM DEEP BREATHING
& COUGHING EXERCISES
GET YOURSELF INTO A COMFORTABLE
POSITION SUCH AS: LYING ON YOUR BACK
WITH YOUR KNEES BENT, LYING ON YOUR
SIDE OR SITTING UP IN A SEATED
POSITION.
PLACE YOUR HANDS ON YOUR STOMACH.
TAKE A DEEP BREATH IN THROUGH YOUR
NOSE. CONTINUE UNTIL YOUR LUNGS FEEL
FULL OF AIR AND YOU NOTICE YOUR
STOMACH PUSHING AGAINST YOUR HAND.

THROUGH PURSED LIPS, SLOWLY BLOW AIR OUT
IN ONE LONG, SLOW BREATH.
WHEN YOU BREATHE OUT, CONCENTRATE ON
MAKING YOUR STOMACH SINK IN. REPEAT
STEPS ONE, TWO AND THREE TO COMPLETE
FIVE BREATHING CYCLES.
TAKE ANOTHER DEEP BREATH – HOLD FOR
THREE SECONDS THEN HUFF OUT THREE TIMES.
(HUFFING IS A SHORT SHARP PANT – IMAGINE
THAT YOU ARE TRYING TO CREATE MIST ON A
PANE OF GLASS.)

ON THE THIRD HUFF, COUGH DEEPLY
FROM THE LUNGS, NOT THE THROAT.
REPEAT STEPS TWO AND FOUR TO
COMPLETE FIVE COUGHING EXERCISES.
UNTIL YOU ARE WALKING, THESE
EXERCISES SHOULD BE DONE EVERY
HOUR WHILE AWAKE. ASK FOR PAIN
MEDICATION IF YOU ARE SORE AND NOT
ABLE TO DO YOUR COUGHING EXERCISES.

PREOPERATIVE PAIN
MANAGEMENT
PRE-ANESTHETIC MEDICATION
1. Barbiturates (Tranquilizers)
for sedation
2. Opiates
To reduce the general anesthesia
required to produce analgesia

ANTICHOLINERGICS
To decrease respiratory secretion
atropine is given.
TIMING OF ADMINISTRATION OF
MEDICATIONS
it should be given 45-75 minutes before
anesthesia is began

PREOPERATIVE RECORD
All patients records such as history
,consent and laboratory reports attached
to it has to be placed in good condition
TRANSPORTATION TO PRE
SURGICAL SUITE
On a bed or stretcher

PREOPERATIVE
PSYCHOLOGICAL INTERVENTION
LEVEL OF ANXIETY
COPING ABILITY
SUPPORT SYSTEMS

ANXIETY
The nurse must consider the patient’s family
and friends when planning psychological
support.
Empowering their sense of control.
Activities that decreasing anxiety are deep
breathing, relaxation exercises, music therapy,
massage and animal-assisted therapy.
Use of medication to relieve anxiety

GENERAL PREOPERATIVE
NURSING INTERVENTION
PROVIDE TEACHING REGARDING
TURNING IN THE BED.
Instruct the patient to use a pillow or bath
blanket to splint where the incision will be.
Ask the patient to raise his or her left knee
and reach across to grasp the right side rail
of the bed when turning toward his or her
right side.

IF PATIENT IS TURNING TO HIS OR HER
LEFT SIDE, HE OR SHE WILL BEND THE
RIGHT KNEE AND GRASP THE LEFT SIDE
RAIL.
WHEN TURNING THE PATIENT ONTO HIS
OR HER RIGHT SIDE, ASK THE PATIENT
WHEN TURNING THE PATIENT ONTO HIS
OR HER RIGHT SIDE, ASK THE PATIENT

TO PUSH WITH BENT LEFT LEG AND
A.
PULL ON THE RIGHT SIDE RAIL.
B.
EXPLAIN TO PATIENT THAT YOU WILL
PLACE A PILLOW BEHIND HIS/HER BACK TO
PROVIDE SUPPORT, AND THAT THE CALL
BELL WILL BE PLACED WITHIN EASY REACH.
EXPLAIN TO THE PATIENT THAT POSITION
CHANGE IS RECOMMENDED EVERY 2
HOURS.

PROVIDE TEACHING ABOUT
PAIN MANAGEMENT.
Discuss past experiences with pain and interventions
that the patient has used to reduce pain.
Discuss the availability of analgesic medication
postoperatively.
Discuss the use of patient controlled analgesia (PCA),
as appropriate.
Explore the use of other alternative and non
pharmacologic methods to reduce pain, such as
position change, massage, relaxation/diversion,
guided imagery, and meditation.

PROVIDE SKIN
PREPARATION.
Ask the patient to bath or shower with the
antiseptic solution. Remind the patient to clean the
surgical site.
PREPARING THE PATIENTS SKIN- SHAVE
AGAINST THE GRAIN OF HAIR SHAFT TO
INSURE CLOSE SHAVE. MOST OF THE TIME
IN ACTUAL PRACTICE THIS IS DONE
BEFORE THE PATIENT IS TRANSFERRED TO
OR
Provide teaching about and follow dietary/fluid
restrictions.
1.

EXPLAIN TO THE PATIENT THAT
BOTH FOOD AND FLUID WILL BE
RESTRICTED BEFORE SURGERY TO
ENSURE THAT THE STOMACH
CONTAINS A MINIMAL AMOUNT OF
GASTRIC SECRETIONS.
1.
THIS RESTRICTION IS IMPORTANT TO
REDUCE THE RISK OF ASPIRATION.

Emphasize to the patient the importance of
avoiding food and fluids during the prescribed
time period, because failure to adhere may
necessitate cancellation of the surgery.
3. Provide intestinal preparation, as
appropriate. In certain situations, the bowel
will need to be prepared by administering
enemas or laxatives to evacuate the bowel
and to reduce the intestinal bacteria.

4. AS NEEDED, PROVIDE EXPLANATION OF
THE PURPOSE OF ENEMAS OR LAXATIVES
BEFORE SURGERY.
IF PAY CHECK ADMINISTRATION OF
REGULARLY SCHEDULED MEDICATIONS.
REVIEW WITH THE PATIENT ROUTINE
MEDICATIONS, OVER-THE-COUNTER
MEDICATIONS, AND HERBAL
SUPPLEMENTS THAT ARE TAKEN
REGULARLY.

CHECK THE PHYSICIAN’S ORDERS AND
REVIEW WITH THE PATIENT WHICH
MEDICATIONS HE OR SHE WILL BE
PERMITTED TO TAKE THE DAY OF
SURGERY.
PATIENT WILL BE ADMINISTERING AN
ENEMA, CLARIFY THE STEPS AS NEEDED.
5.REMOVE PPE, IF USED. PERFORM
HAND HYGIENE.

PERFORM CLINICAL
NURSING ACTIONS THAT
ARE APPROPRIATE TO
THE CARE OF PRE/POST
AND INTRA OPERATIVE
CLIENTS

THE ACTIVITIES OF THE "SCRUB" NURSE
INCLUDE, BUT ARE NOT LIMITED TO, THE
FOLLOWING:
REVIEWS ANATOMY, PHYSIOLOGY, AND THE
SURGICAL PROCEDURE.
ASSISTS WITH PREPARATION OF THE ROOM.
SCRUBS, GOWNS, AND GLOVES SELF AND
OTHER MEMBERS OF THE STERILE
SURGICAL TEAM.
PASSES INSTRUMENT TO THE SURGEON IN
A PRESCRIBED MANNER.
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MAINTAINS STERILE AND AN ORDERLY
SURGICAL FIELD.
ASSISTS WITH THE DRAPING PROCEDURE.
KEEPS TRACK OF IRRIGATION SOLUTIONS
USED FOR CALCULATION OF BLOOD LOSS.
KEEPS THE INSTRUMENT TABLE NEAT SO
THAT SUPPLIES CAN BE HANDED QUICKLY
AND EFFICIENTLY.
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ANTICIPATES AND MEETS THE NEEDS
OF THE SURGEON BY WATCHING THE
PROGRESS OF THE SURGERY AND
KNOWING THE VARIOUS STEPS OF THE
PROCEDURE.
TAKES PART IN SPONGE, NEEDLE, AND
INSTRUMENT COUNTS
IDENTIFIES AND PRESERVES
SPECIMENS PROPERLY.
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CIRCULATORY NURSE DUTIES
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THE ACTIVITIES OF THE CIRCULATING NURSE
INCLUDE, BUT ARE NOT LIMITED TO, THE
FOLLOWING:
REVIEWS ANATOMY, PHYSIOLOGY, AND THE
SURGICAL PROCEDURE.
ASSISTS WITH PREPARING THE ROOM,
OBSERVES ASEPTIC TECHNIQUE AT ALL TIMES
TO SEE THAT IT IS MAINTAINED PROPERLY.
IDENTIFIES AND ASSESSES THE PATIENT. THEN
PLANS AND COORDINATES THE
INTRAOPERATIVE CARES.
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ADMITS THE PATIENT TO THE OPERATING
ROOM AND ASSUMES RESPONSIBILITY
WITH THE OTHER MEMBERS OF THE TEAM
FOR THE COMFORT AND THE SAFETY OF
THE PATIENT.
KEEPS THE "SCRUB" NURSE WITH SUPPLIES
E.G. SUTURE MATERIALS, DRESSINGS ETC.
OPENS STERILE SUPPLIES BEFORE AND
DURING THE CASE, REPLACE SALINE OR
WATER IN BASINS AS NECESSARY.
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POSITIONS THE PATIENT ON THE
SURGERY TABLE
ASSISTS THE ANESTHETIST WHEN
REQUIRED
TAKES PART IN SPONGE AND
INSTRUMENT COUNTS AND THEIR
DOCUMENTATION,
TIES THE GOWNS OF SCRUBBED
PERSONNEL
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SKIN PREPARATION AND DRAPING OF SURGICAL S
BASIC PREPARATION PROCEDURE FOR SKIN:
EXPOSE ONLY THE SKIN AREA TO BE PREPARED.
1.
WEAR STERILE GLOVES.
2.
PLACE TOWELS ABOVE AND BELOW TO PROTECT
GLOVED HAND FROM TOUCHING THE BLANKET.
3.
WET THE SPONGE WITH ANTISEPTIC AGENT BUT
SQUEEZED OUT
4.
SCRUB THE SKIN .
5.
DISCARD THE SPONGE AFTER REACHING THE
PERIPHERY
6.

DRAPING
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DRAPING IS" THE PROCEDURE OF COVERING PT. AND
SURROUNDING AREAS WITH A STERILE BARRIERS TO
CREATE AND MAINTAIN STERILE FIELD DURING
OPERATION."
TOWELS
1.
LAPAROTOMY SHEET
2.
STOCKINET
3.
ORTHO PACK SHEET
4.
TYPES OF DRAPES:

POSITIONING/SURGICAL POSITIONS
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POSITION AND EXPLANATION ILLUSTRATION
Supine/Dorsal Recumbent
1.
In the supine position, the patient lies face up on
the padded table with arms tucked in at the sides
(using the lift sheet), or extended on (padded) arm
boards
USES: EMPLOYED FOR PROCEDURES ON
THE FACE ,THE NECK, THE ABDOMEN, THE
UPPER EXTREMITIES AND THE LOWER
EXTREMITIES.
Trendelenburg's position
1.
The patient is on the back on a table or bed whose upper
section is inclined 45 degrees so that the head is lower than
the rest of the body; the adjustable lower section of the table
or bed is bent so that the patient's legs and knees are flexed.
There is support to keep the patient from slipping.
Uses: Employed for abdominal hysterectomy and other
procedures in the pelvic area

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REVERSE TRENDELENBURG'S
1.
Supine position with the patient on a plane inclined
with the head higher than the rest of the body and
appropriate safety devices such as a footboard.
USES: EMPLOYED FOR NECK PROCEDURES
AS THYROIDECTOMY, PARA
THYROIDECTOMY, IT IS ALSO USED TO
PERFORM LAPAROSCOPIC PROCEDURES AS
.CHOLECYSTECTOMY
FOWLER'S POSITION A POSITION
1.
In which the head of the patient's bed is raised
30 to 90 degrees above the level, with the
knees sometimes also elevated.
USES: EMPLOYED FOR POSTERIOR
CRANIOTOMY, SELECTED SHOULDER,
AND EAR, NOSE, AND THROAT ,(ENT)
.PROCEDURES

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LITHOTOMY POSITION
1.
The patient lies on the back with the legs
well separated, thighs
acutely flexed on the abdomen, and legs on
thighs; stirrups may be used to support the
feet and legs.
USES :EMPLOYED FOR LOW RECTAL
RESECTIONS, FOR SOME VAGINAL
The patient lies on the left side with the left
thigh slightly flexed and the right thigh
acutely flexed on the abdomen; the left arm
is behind the body with the body inclined
forward, and the right arm is positioned
according to the patient's comfort. See
illustration. Called also lateral position
USES : EMPLOYED FOR PROCEDURES
REQUIRING ACCESS TO THE VAGINA,

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PRONE POSITION
1.
The patient lying face down with arms bent
comfortably at the elbow and padded with the arm
boards positioned forward.
.Uses : Employed for anorectal procedures
LATERAL KIDNEY POSITION
1.
The patient is placed in the lateral position
and the iliac crest positioned over the “kidney”
elevator .The head is placed on a padded
donut, protecting the face and ear on the
unaffected side from undue pressure.
USES : EMPLOYED FOR PROCEDURES ON
THE UPPER URINARY TRACT (E.G.,
KIDNEY),AND STRUCTURES IN THE
.RETROPERITONEAL SPACE

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POSITION AND EXPLANATION
KNEE-CHEST POSITION
1.
The patient rests on the knees and chest with head is turned to one
side, arms extended on the bed, and elbows flexed and resting so
that they partially bear the patient's weight; the abdomen remains
unsupported, though a small pillow may be placed under the chest.
USES : EMPLOYED FOR RECTAL EXAMINATION

SOME CONSIDERATIONS FOR OR STAFFS:
A . GENERAL IMPORTANT CONSIDERATIONS
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PERSONS IN STERILE ATTIRE TOUCH ONLY STERILE ARTICLES.
1.
PERSONS IN STERILE ATTIRE PREPARING A STERILE FIELD OR DRAPING
AN UN-STERILE SURFACE ALWAYS FACE THE AREA BEING PREPARED.
2.
PERSONS IN STERILE ATTIRE DO NOT TURN THEIR BACKS TO A STERILE
FIELD
3.
GLOVED HANDS ARE PROTECTED WHILE DRAPING BY MAKING A CUFF WITH THE DRAPE.
4.
PERSONS IN STERILE ATTIRE DO NOT LEAN OR REACH OVER UN-STERILE
SURFACES
5.
PERSONS IN NON-STERILE ATTIRE ONLY TOUCH NON-STERILE ARTICLES.
6.
PERSONS IN NON-STERILE ATTIRE AVOID REACHING OVER OR TOUCHING
THE STERILE FIELD WHEN DELIVERING STERILE SUPPLIES TO THE
STERILE FIELD.
7.

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TABLES DRAPED WITH STERILE DRAPES ARE STERILE ONLY AT
TABLE LEVEL.
1.
SCRUB PERSONS PERFORM ALL WORK ON THE STERILE
SURFACE OF THE TABLE
2.
MATERIALS THAT HANG OVER THE EDGE OF THE STERILE
FIELD ARE NOT CONSIDERED STERILE AND ARE DISCARDED.
3.
ITEMS THAT FALL BELOW THE LEVEL OF THE STERILE FIELD
ARE NOT BROUGHT BACK ONTO THE STERILE FIELD.
4.
THE GOWN IS CONSIDERED STERILE FROM THE LEVEL OF THE
UMBILICUS TO THE AXILLARY LEVEL IN FRONT.
5.
SLEEVES ARE CONSIDERED STERILE TO TWO INCHES ABOVE
THE ELBOW.
6.
THE BACK OF THE GOWN IS NOT CONSIDERED STERILE.
7.

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AREAS OF THE GOWN OUTSIDE THE SPECIFIED BOUNDARIES DO NOT
TOUCH THE STERILE FIELD OR STERILE ARTICLES.
1.
ARTICLES THAT DROP BELOW THE UMBILICAL LEVEL OF THE GOWN ARE DISCARDED.
2.
HANDS ARE NOT PLACED UNDER THE ARMS IN THE AXILLARY
REGION.
3.
THE EDGES OF CONTAINERS ENCLOSING STERILE ITEMS ARE NOT
CONSIDERED STERILE ONCE THE CONTAINER IS OPENED.
4.
NON STERILE PERSONS MAINTAIN A SAFE DISTANCE FROM STERILE
AREAS.
5.
CORRECTIVE MEASURES ARE TO BE INSTITUTED IMMEDIATELY IF
CONTAMINATION OCCURS. IF THERE IS ANY DOUBT AS TO THE
STERILITY OF AN ITEM OR SURFACE, IT IS CONSIDERED
CONTAMINATED.
6.

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RESPIRATORY CONSIDERATION
A.
CIRCULATORY CONSIDERATIONS
B.
PERIPHERAL NERVES CONSIDERATION:
C.

COUNTING PROCEDURE
A COUNTING PROCEDURE IS A METHOD OF
ACCOUNTING FOR ITEMS PUT ON THE STERILE
TABLE FOR USE DURING THE SURGICAL
PROCEDURE.
SPONGES, SHARPS, AND INSTRUMENTS
SHOULD BE COUNTED AND/OR ACCOUNTED
FOR ON ALL SURGICAL PROCEDURES.
THIS INCLUDES ANY MATERIAL INTRODUCED
INTO THE PATIENT DURING THE PROCEDURE.
A COUNTING PROCEDURE IS MADE THREE
TIMES IN A SURGICAL PROCEDURE.
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FIRST COUNT
THE PERSON WHO ASSEMBLES
AND WRAPS ITEMS FOR
STERILIZATION WILL COUNT THEM.
IN COMMERCIALLY PREPACKAGED
STERILE ITEMS, THE COUNT IS
PERFORMED BY THE
MANUFACTURER
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SECOND COUNT
THE SCRUB NURSE AND THE CIRCULATOR.
THESE INITIAL COUNTS PROVIDE THE BASELINE
FOR SUBSEQUENT COUNTS.
ANY ITEM INITIALLY PLACED IN THE WOUND IS
RECORDED.
AS THE SCRUB NURSE TOUCHES EACH ITEM,
SHE/HE AND THE CIRCULATOR NUMBER EACH ITEM
ALOUD UNTIL ALL ITEMS ARE COUNTED.
THE CIRCULATOR IMMEDIATELY RECORDS THE
COUNT FOR EACH TYPE OF ITEM ON THE COUNT
RECORD
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THIRD COUNT
COUNTS ARE TAKEN IN THREE AREAS
BEFORE THE SURGEON STARTS THE
CLOSURE OF A BODY CAVITY OR A
DEEP/LARGE INCISION:
FIELD COUNT. EITHER THE SURGEON OR
THE ASSISTANT ASSISTS THE SCRUB
NURSE WITH THE SURGICAL FIELD COUNT.
ADDITIONAL ITEMS ARE ACCOUNTED FOR
AT THIS TIME.
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TABLE COUNT. THE SCRUB NURSE AND THE
CIRCULATING NURSE TOGETHER COUNT ALL ITEMS
ON THE MAYO STAND AND INSTRUMENT TABLE.
THE SURGEON AND ASSISTANT MAY BE CLOSING
THE WOUND, WHILE THIS COUNT IS IN PROCESS.
FLOOR COUNT. THE CIRCULATING NURSE COUNTS
SPONGES AND ANY OTHER ITEMS THAT HAVE BEEN
RECOVERED FROM THE FLOOR OR PASSED OFF
THE STERILE FIELD TO THE KICK BUCKETS.
THESE COUNTS SHOULD BE VERIFIED BY THE
SCRUB NURSE.
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OPERATING ROOM NURSES
THE OCCUPATION OF OPERATING ROOM
NURSES IS BOTH DEMANDING AND
REWARDING.
CERTAIN QUALIFICATIONS ARE A
PREREQUISITE TO JOIN THIS FIELD SHOULD
BE .
STAMINA
A.
EMOTIONAL STABILITY
B.
RESPECT
C.
STABLE HEALTH
D.
GOOD HUMOR
E.
TEAM SPRIT
F.
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ANESTHESIA CONCEPTS AND CONSIDERATIONS
<number>
ANESTHESIOLOGY
ANESTHESIA
BRANCH OF MEDICINE THAT IS CONCERNED
WITH THE ADMINISTRATION OF MEDICATION
OR ANESTHETIC AGENT TO RELIEVE PAIN
AND SUPPORT PHYSIOLOGICAL FUNCTION
DURING A SURGICAL PROCEDURE.
GREEK WORDS MEANS NEGATIVE SENSATION.
SO IT MEANS “LOSS OF FEELING OR SENSATION” OF
PAIN WITH LOSS OF PROTECTIVE REFLEXES.
(ABSENCE OF SENSATION)

ANALGESIA
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LOSING OF PAIN SENSATION WITHOUT
PRODUCING LOSS OF CONSCIOUSNESS.
LOSS OF MEMORY.
AMNESIA
INDUCTION OF ANESTHESIA
PERIOD FROM BEGINNING OF ADMINISTRATION OF
ANESTHESIA AGENT UNTIL PT. LOSES
CONSCIOUSNESS.

BIOTRANSFORMATION
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METABOLISM OF ANESTHETIC DRUGS
BY BROKEN DOWN IN HEPATIC CELLS.
INDIVIDUAL TOLERANCE FOR PAIN.
PAIN THRESHOLD
ENDOTRACHEAL INTUBATION
INSERTION OF ENDOTRACHEAL TUBE.
LARYNGOSPASM
INVOLUNTARY SPASMODIC REFLEXES ACTION THAT PARTIALLY OR
COMPLETELY CLOSES THE VOCAL CORD.

PURPOSES OF PRE ANESTHETIC MEDICATION
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DECREASE PREOPERATIVE ANXIETY.
1.
TO PRODUCE SOME ANALGESIA AN AMNESIA .
2.
DECREASE SECRETIONS IN THE RESPIRATORY
TRACT.
3.
I . ANESTHETIC DRUGS MADE BY
ANESTHESIOLOGIST AND BASED ON :
ASSESSMENT OF PHYSICAL AND
EMOTIONAL STATUS.
1.
AGE, MEDICAL HISTORY , WEIGHT.
2.
LAB TEST , X RAYS , ECG, SMOKING.
3.

II. CLASSIFICATION OF PRE ANESTHETIC MEDICATION USED:
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SEDATIVE AND TRANQUILIZER :
1.
TO REDUCE ANXIETY, AND PRODUCE AMNESIA TO PROVIDE COMFORT.
(VALIUM, NEMBUTAL
ANTIEMETIC :
2.
TO RELIEVE NAUSEA AND VOMITING EXAMPLE : (
PRAMINE )
NARCOTICS:
3.
TO PRODUCE ANALGESIA BUT DEPRESS RESPIRATION, AND
MAY LEAD TO NAUSEA, VOMITING AND URINARY
RETENTION.(PETHEDINE AND FENTANYL
ANTICHOLINERGIC :
4.
To decrease mucus secretion and to relieve Bradycardia. (Atropine , Scopolamine)

III. CHOICE OF ANESTHESIA :
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FACTORS TO BE CONSIDERED BY ANESTHESIOLOGIST
SOME CHARACTERISTICS OF AN IDEAL ANESTHETIC AGENT
Provides maximum safety for the patient
1.
Provides optimal operating conditions for the surgeon
2.
Provides patient comfort
3.
Has a low index of toxicity
4.
Provides potent, predictable analgesia extending into the postoperative
period
5.
Produces adequate muscle relaxation
6.
Provides amnesia
7.
Has a rapid onset and easy reversibility
8.
Produces minimum side effects
9.

TYPES OF ANESTHESIA
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GENERAL ANESTHESIA :
1.
. Pain is controlled by general insensibility with loss of consciousness.
The depth and duration of anesthesia depends on the type and the amount of
anesthetic employed of the agent(s) administer
2. LOCAL OR REGIONAL BLOCK:
PAIN IS CONTROLLED WITHOUT LOSS OF
CONSCIOUSNESS
SPINAL OR EPIDURAL ANESTHESIA :
2.
SENSATION OF PAIN IS BLOCKED AT THE LEVEL
BELOW THE DIAPHRAGM WITHOUT LOSS OF
CONSCIOUSNESS

GENERAL ANESTHESIA
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ANESTHESIA IS PRODUCED AS CNS IS AFFECTED.
UNCONSCIOUSNESS IS PRODUCED
METHODS OF ADMINISTRATION GENERAL ANESTHESIA:
IV INJECTION:
1.
PRE OXYGENATION : VENTILATING THE PT. BY MASK OF 100 %
OXYGEN FOR FEW MINUTES
A.
LOSS OF CONSCIOUSNESS INDUCED BY IV ADMINISTRATION OF
DRUG AGENT.
B.
DRUGES USED :
PENTOTHAL SODIUM ( CONCENTRATION 2.5% ) 5MG / KG SHORT ACTING
DRUG GIVEN FOR RAPID INDUCTION WITHIN 30 SECOND.
2.
FENTANYL :SHORT ACTING DRUG TO PRODUCE GOOD ANALGESIA.
3.

MUSCLE RELAXANT : DRUGS WHICH GIVEN BEFORE
INTUBATION TO RELAX JAW , LARYNX AND BODY MUSCLES.
<number>
pavlon --- long acting ( 30 -45 minutes ).
1.
Scoline --- short acting ( 5 minutes. )
2.
Performed after administration of general anesthesia.
It can however be performed in the awake patient with local or
topical anesthesia, or in an emergency without any anesthesia at all
Facilitated by using a conventional laryngoscope, or bronchoscope
Inhalation gases can be delivered from anesthetic machine through:
FACE MASK INHALATION
1.
LARYNGEAL MASK INHALATION
2.
ENDOTRACHEAL TUB
3.
INHALATION OF ANESTHESIA :
1.

ADVANTAGES OF ET TUBE:
<number>
ENSURE PATENT AIRWAY AND CONTROL OF RESPIRATION.
1.
PROTECTS LUNGS FROM ASPIRATION OF BLOOD, VOMITING OF
GASTRIC CONTENT.
2.
HELPS IN MINIMIZING SCAPE OF GAS INTO ROOM.
3.
TRAUMA TO TEETH , LARYNX, VOCAL CORD.
1.
PULMONARY ASPIRATION OF STOMACH CONTENTS
2.
HYPOXIA AND HYPOXEMIA INTUBATION OR
EXTUBATION.
3.
COMPLICATIONS OF ENDOTRACHEAL TUBE :

INHALED ANESTHETIC AGENTS:
<number>
HALOTHANE : ( FLUOTHANE)
1.
NONFLAMMABLE
1.
PRODUCE RAPID AND SMOOTH INDUCTION
2.
USEFUL FOR PT. WITH BRONCHIAL ASTHMA.
3.
ADVANTAGES :
DISADVANTAGES:
CAUSE HYPOTENSION AND BRADYCARDIA.
1.
POTENTIALLY TOXIC TO LIVER.
2.
MAY CAUSE HYPOTHERMIA AND LIMITED ABDOMINAL
MUSCLE RELAXATION.
3.

<number>
ENFLORANE : IT IS SIMILAR TO HALOTHANE.
1.
RAPID INDUCTION AND RECOVERY.
1.
MUSCLE RELAXANT IS PRODUCED.
2.
ADVANTAGES :
DISADVANTAGES:
DEPRESSION OF BP AND RESPIRATION.
1.
CONTRAINDICATION IN RENAL FAILURE.
2.

<number>
ISOFLURANE:
1.
RAPID INDUCTION AND
RECOVERY.
1.
MORE PATENT MUSCLE RELAXANT.
2.
USED FOR ASTHMATIC PT.
3.
ADVANTAGES :
DISADVANTAGES:
EXPENSIVE
1.
RESPIRATORY DEPRESSANT.
2.

<number>
NITROUS OXIDE :
1.
RAPID INHALATION AND ELIMINATION.
ADVANTAGES :
DISADVANTAGES:
NO MUSCLE RELAXANT.
1.
HYPOXIA DEVELOP AND SHOULD NOT USE ALONE.
2.
AT THE END OF SURGERY:
Muscle relaxant should be reversed by using Myostagmine combined
with atropine to manage Bradycardia which is caused by Myostagmine
drug , and the ET tube should be removed when the pt. is breathing
spontaneously and semi or full awake.

LOCAL , REGIONAL ANESTHESIA
<number>
LOCAL ( TOPICAL ) ANESTHESIA :
1.
The anesthesiologist inject the drug to depress sensory nerves
and blocks conduction of pain impulses from their site and the
pt. will stay full awake.
The duration of local anesthesia is 20 -30 minutes.
Agents of local anesthesia could be : ointment , spray , or solution.
e.g. Lidocaine 0.5%–2%
Local anesthesia is frequently used for lesser procedures,
e.g. Dentistry , Ophthalmic, and Anorectal procedures

<number>
REGIONAL ANESTHESIA
1.
THE DRUG IS INJECTED INTO OR AROUND A SPECIFIC NEVER OR
A GROUP OF NERVES TO DEPRESS THE ENTIRE PAIN SENSATION.
THERE ARE MANY TYPES OF REGIONAL ANESTHESIA THAT ARE
PERFORMED ON THE LOWER ABDOMEN AND LOWER
EXTREMITIES
SPINAL ANESTHESIA
A.
IT IS PERFORMED BY ANESTHESIOLOGIST.
A.
THE DRUG IS INJECTED INTO OR AROUND A SPECIFIC NERVE OR
A GROUP OF NERVES TO DEPRESS THE ENTIRE PAIN
SENSATION.
B.
NOTE : THE HEADACHE WHICH CAUSED BY SPINAL ANESTHESIA
IS CAUSED BY LEAKING THROUGH THE NEEDLE HOLE IN DURA.

<number>
REGIONAL ANESTHESIA
1.
EPIDURAL ANESTHESIA
A.
THE EPIDURAL SPACE LIE BETWEEN DURA AND VERTEBRAL
COLUMN CONTAIN NETWORK OF BLOOD VESSELS AND SPINAL
NEVER ROOTS.
A.
THE ANESTHETIC IS INJECTED OUTSIDE THE SPINAL CANAL (NO
DIRECT CONTACT BETWEEN SPINAL FLUID AND ANESTHETIC).
B.
AGENTS OF SPINAL , EPIDURAL AND LOCAL ANESTHESIA:
C.
LIDOCAINE 1.0%–2.0%/
TETRACAINE 0.5%–1.0%/
NOTE: IN CASE OF SEVER HYPOTENSION WHICH CAUSED BY
SPINAL ANESTHESIA, EPHEDRINE IS THE DRUG OF CHOICE.

SPINAL AND EPIDURAL ANESTHESIA
<number>

WOUND HEALING AND METHODS OF HEMOSTASIS
<number>
TYPES OF WOUND:
OPEN WOUNDS
SURGICAL INCISION
1.
LACERATIONS WOUNDS
2.
ABRASIONS WOUND
3.
AVULSIONS WOUND
4.
ULCERATION WOUND
5.
PUNCTURE WOUND
6.
CLOSED WOUND
CONTUSION WOUND

FACTORS INFLUENCING WOUND HEALING:
<number>
AGE
1.
WEIGHT
2.
NUTRITIONAL STATUS
3.
FLUID AND ELECTROLYTE
IMBALANCE
4.
GENERAL HEALTH
5.
DRUG THERAPY
6.
POST-OPERATIVE COMPLICATION.
7.
PHYSICAL ACTIVITY
8.

Thank
you
https://t.me/tolioCSSD
TELEGRAM
Talal Albudayri
DONE BY
taalal.9@hotmail.com
EMAIL ADDRESS

Introduction to operating room (Part three).pdf

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Introduction to operating room (Part three).pdf