Download - Surgery and Guidelines
8/6/2019 Surgery and Guidelines
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Robinson D. Robles RT, RN
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� I. inpatient settings
�a. hospitals
� II. outpatient settings
� a. hospital-based ambulatory surgical centers
� b. free-standing surgical centers
� c. physicians' offices
� d. ambulatory care centers
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� a. diagnostic
� performed to determine the origin and cause of a
disorder or the cell type of a cancer� breast biopsy, exploratory laparotomy
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� b. curative
� performed to resolve a health problem by
repairing or removing the cause
� cholelithiasis, mastectomy, hysterectomy
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� c. restorative
�
performed to improve a patient's functionalability
� total knee replacement, finger reimplantation
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� d. palliative
� performed to relieve symptoms of a disease
process, but does not cure
� colostomy, nerve root resection, tumor debulking,ileostomy
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� e. cosmetic
�
performed primarily to alter or enhance aperson's appearance
� revision of scars, liposuction, rhinoplasty,blepharoplasty (eyelid)
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� a. elective� planned for correction of a nonacute problem
�cataract removal, hernia repair, total joint replacement
� b. urgent� requires prompt intervention; or may be life-threatening if
treatment delayed� intestinal obstruction, bladder obstruction, kidney or urethral stones
�
c. emergency� requires immediate intervention because of life-threatening
consequences� gunshot wound, stab wound, severe bleeding
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� a. minor surgery (low degree of risk)
� procedure without significant risk, often donewith local anesthesia
� incision and drainage, muscle biopsy
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� b. major surgery (high degree of risk)
� procedure of greater risk, usually longer and
more extensive than a minor procedure
� mitral valve replacement (MVR), pancreas implant,lymph node dissection
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� a. simple
� only the most overtly affected areas involved in thesurgery� simple or partial mastectomy
�
b. radical� extensive surgery beyond the area obviously
involved; is directed at finding a root cause� radical mastectomy or prostatectomy
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1. Sterile to sterile contact only.
2. A doubtful article must be
considered unsterile.
3. Whatever is sterile for patient is
sterile for that patient only.Supplies must be discarded if
unused.
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1. Scrubbed personnel must remain in
the area of the surgical procedure;
if a scrubbed person leaves the
room, the status of sterility will bebreached. To return the person has
to do scrubbing again.
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1. The parts of the body which will beconsidered sterile are:
a. Waist to the shoulder area.b. Forearms and gloves
Important: Gloved hand must be kept in frontbetween the shoulders and waistline.
2. The circulating nurse and anyunscrubbed personnel remain at a safedistance to avoid contamination of anysterile area.
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1. During the draping of a table or apatient, the sterile drape is held
above the surface to be covered and
is positioned from front to back.
2. Only the top of the patient that isdraped is considered sterile; drapes
hanging over the edge are not
regarded as sterile.
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1. Packages are wrapped or sealed in such a way thatthey can be opened easilywithout risk of contaminatingcontents.
2. Sterile supplies, includingsolutions, are delivered to a
sterile field or handed to a´scrubbed personµ in such away that sterility of theobject remains sterile or intact.
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1. Sterile solutions are poured from a
point high enough to prevent
accidental touching of the sterile
receiving cup or basin but not high
enough to cause splashing. (When
a sterile area becomes wet, it isconsidered contaminated.)
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1. The patient should be comfortable
as possible.
2. The operative area must me
adequately exposed.
3. The vascular supply should not be
obstructed by an awkward
position or undue pressure.
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4. There should be no interference on
patient·s respiration.
5. Nerves must be well protected
from undue pressure to prevent
possible injuries, which may lead
to paralysis.
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1. Dorsal Recumbent ² hernia repair,mastectomy, bowel resection
2. Trendelenburg ² lower abdomen,pelvic surgeries
3. Lithotomy ² vaginal repairs, dilatationand curettage, rectal surgery,abdomino-perineal resection
4. Prone ² spinal surgery / spinal cord-
related surgeries5. Lateral ² kidney, chest, hip surgeries
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1. Explain the purpose of position
2. Avoid undue exposure
3. Strap the person to prevent falls4. Maintain adequate respiratory
and circulatory function
5. Maintain good body alignment
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