surgery and guidelines

8/6/2019 Surgery and Guidelines

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Robinson D. Robles RT, RN



� 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



� a. diagnostic

� performed to determine the origin and cause of a

disorder or the cell type of a cancer� breast biopsy, exploratory laparotomy



� b. curative

� performed to resolve a health problem by

repairing or removing the cause

� cholelithiasis, mastectomy, hysterectomy



� c. restorative

�

performed to improve a patient's functionalability

� total knee replacement, finger reimplantation



� d. palliative

� performed to relieve symptoms of a disease

process, but does not cure

� colostomy, nerve root resection, tumor debulking,ileostomy



� e. cosmetic

�

performed primarily to alter or enhance aperson's appearance

� revision of scars, liposuction, rhinoplasty,blepharoplasty (eyelid)



� 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



� a. minor surgery (low degree of risk)

� procedure without significant risk, often donewith local anesthesia

� incision and drainage, muscle biopsy



� 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



� 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



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.



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.



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.



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.



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.



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.)



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.



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.



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



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

surgery and guidelines

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