PANOPDOPAN DISTRICT HOSPITAL
OPERATING ROOM
MAY 8-9, 2023
Submitted by:
Maddawat, Marife M.
Mahicon, Andrea
Malihod, Karl John D.
Mallari, Leizzle Anne L.
Manzano, Audrey Alexis M.
Sir Rey B. Dinamling
Clinical Instructor
NURSING DUTIES AND RESPONSIBILITIES
PRE OPERATIVE
1. Signing of informed consent to the patient, family or significant other.
2. Working with patients prior to surgery to complete paperwork, and help answer questions
or calm fears about surgery. Answer questions and describe what to expect.
3. Before any treatment is initiated, a health history is obtained and a physical examination
is performed during which vital signs are noted and a database is established for future
comparisons.
4. Listen carefully to the patient, especially when obtaining the history. Correct use of
communication and interviewing skills can help the nurse acquire invaluable information
and insight. Remain unhurried, understanding, and caring.
5. Signing of informed consent to the patient, family or significant other.
6. Make sure that the patient is prepared mentally and physically for the surgery and also
assess and correct physiological and psychological problems that may increase surgical
risk.
7. Remove jewellery, including wedding rings and all unnecessary accessories.
8.
Assist patients (except those with urologic disorders) to void immediately before going to
the operating room.
9.
Administer preanesthetic medication as ordered, and keep the patient in bed with the
side rails raised. Observe patients for any untoward reaction to the medications. Keep
the immediate surroundings quiet to promote relaxation.
INTRA OPERATIVE
1. In the operating room, the perioperative nurse may serve as a scrub nurse, selecting and
passing instruments and supplies used for the operation
2. As a circulating nurse managing the overall nursing care in the operating room and
helping to maintain a safe, comfortable environment.
3. Monitoring a patient’s condition during surgery.
4. Managing the overall nursing care in the operating room to help maintain a safe and
comfortable environment.
5. Cleaning surgical equipment and operating rooms to maintain a sterile environment.
POST OPERATIVE
1. Maintaining adequate body system functions.
2. Restoring body homeostasis.
3. Pain and discomfort alleviation.
4. Preventing postoperative complications.
5. Promoting adequate discharge planning and health teaching.
6. Encourage most surgical patients to ambulate as soon as possible unless
contraindicated.
COMPLICATIONS OF SURGERY
1. Shock
- Shock is a severe drop in blood pressure that causes a dangerous slowing of blood flow
throughout the body. Shock may be caused by blood loss, infection, spine injury, or
metabolic problems
2. Bleeding
- Rapid blood loss from the site of surgery, for example, can lead to shock.
3. Wound infection
- When bacteria enter the site of surgery, an infection can happen. Infections can delay
healing. Wound infections can spread to nearby organs or tissue, or to distant areas
through the bloodstream, which when severe can cause death.
4. Deep vein thrombosis
- A deep vein thrombosis is a blood clot in a large vein deep inside a leg, arm, or other
part of the body.
- Symptoms are pain, swelling, tenderness, and skin redness in a leg, arm, or other area.
If you have these symptoms, call your healthcare provider right away. In some cases, the
clot can break off and travel to the lungs or brain.
- This can cause a pulmonary embolism or a stroke.
- Compression stockings are often used to prevent DVTs.
- Treatment once the clot has happened usually involves blood thinners.
5. Pulmonary embolism
-
The clot can break away from the vein and travel to the lungs. This clot is called a
pulmonary embolism. In the lungs, the clot can cut off the flow of blood.
- This is a medical emergency and may cause death. If you have the following symptoms
call or get emergency help right away
- Symptoms are chest pain, trouble breathing, coughing (may cough up blood), sweating,
very low blood pressure, fast heartbeat, lightheadedness, and fainting.
6. Lung problems
- Sometimes lung problems happen because you don’t do deep breathing and coughing
exercises after your surgery. They may also happen from pneumonia or from inhaling
food, water, or blood into the airways.
- Symptoms may include wheezing, chest pain, shortness of breath, fever, and cough.
Getting up and walking around, deep breathing, and coughing often can help reduce the
chances for these problems
7. Urinary retention
- This means you aren’t able to empty your bladder. This may be caused by the
anesthesia or certain surgeries. It's often treated by using a thin tube (catheter) to drain
the bladder. This may be kept in place until you have regained bladder control.
Sometimes medicines to stimulate the bladder may be given.
8. Reaction to anesthesia
- This is rare, but it does happen. Symptoms can range from mild to severe. Treatment of
allergic reactions includes stopping specific medicines that may be causing the reaction.
You may also be given other medicines to treat the allergy. Tell your healthcare team
about any allergies you have before the surgery to reduce this risk. If an allergic reaction
does occur, ask what caused the allergy so you can stay away from it for any future
surgery.
9. Incisional hernia
- This occurs in 5-20% of laparotomies, usually appearing within the first year but can be
delayed by up to 15 years after surgery.
- Risk factors include obesity, distension and poor muscle tone, wound infection and
multiple use of the same incision site.
- It presents as a bulge in the abdominal wall close to a previous wound. It is usually
asymptomatic but there may be pain, especially if strangulation occurs. It tends to
enlarge over time and become a nuisance.
10. Pain
- Postsurgical pain is an unwanted adverse event in any operation. It leads to functional
limitations and psychological trauma for patients, and leaves the operative team with
feelings of failure and humiliation
- Therefore, it is crucial that preventive strategies for pain are considered in high-risk
operations. Various techniques have been implemented to reduce the risk with variable
success.
- Identifying the risk factors for each patient and applying a timely preventive strategy may
help patients avoid the distress of chronic pain.
-
The preventive strategies include modification of the surgical technique, good pain
control throughout the perioperative period, and preoperative psychological intervention
focusing on the psychosocial and cognitive risk factors.
WHAT IS A CHOLECYSTECTOMY?
-
A cholecystectomy is surgery to remove your gallbladder.
The gallbladder is a small organ under your liver. It is on the upper right side of your belly
or abdomen. The gallbladder stores a digestive juice called bile which is made in the
liver.
There are 2 types of surgery to remove the gallbladder:
a. Open (traditional) method. In this method, 1 cut (incision) about 4 to 6 inches long is
made in the upper right-hand side of your belly. The surgeon finds the gallbladder and
takes it out through the incision.
b. Laparoscopic method. This method uses 3 to 4 very small incisions. It uses a long, thin
tube called a laparoscope. The tube has a tiny video camera and surgical tools. The
tube, camera and tools are put in through the incisions. The surgeon does the surgery
while looking at a TV monitor. The gallbladder is removed through 1 of the incisions.
● A laparoscopic cholecystectomy is less invasive. That means it uses very small incisions
in your belly. There is less bleeding. The recovery time is usually shorter than an open
surgery.
● In some cases the laparoscope may show that your gallbladder is very diseased. Or it
may show other problems. Then the surgeon may have to use an open surgery method
to remove your gallbladder safely.
Why might I need a cholecystectomy?
A cholecystectomy may be done if your gallbladder:
- Has lumps of solid material (gallstones)
- Is red or swollen (inflamed), or infected (cholecystitis)
- Is cancerous
Gallbladder problems may cause pain which:
- Is usually on the right side or middle of your upper belly
- May be constant or may get worse after a heavy meal
- May sometimes feel more like fullness than pain
- May be felt in your back and in the tip of your right shoulder blade
● Other symptoms may include nausea, vomiting, fever, and chills.
The symptoms of gallbladder problems may look like other health problems. Always see your
healthcare provider to be sure.
POSITIONING
Transfer to Surgical Table
Before transferring the patient to the bed the brakes should be applied. The awake patient may
be able to transfer themselves to the surgical table and lie in supine position prior to anesthesia.
If not then 4 qualified members of OR staff are required for safe transfer. The following are
required: a patient transfer roller board.
1. Procedures Supine
The majority of surgical procedures are performed in supine position. This includes open as well
as laparoscopic abdominal procedures.
Equipment and personnel Supine
Transfer equipment as above. As well as: draws sheet; headrest or pillow; arm supports and
pressure point padding (foam or gel pads or pillows).
Head and neck Supine
A pillow or headrest is used to support the head.
Torso Supine
Care should be taken to ensure that head and spine are in alignment horizontally with the hips
parallel to each other. A completely horizontal back is not physiological and a small pillow may
be used to support the lumbar spine, especially during long cases. The surgical table may also
be adjusted to semi-Fowler's position slightly flexing the hips and knees.
Limbs Supine
The arms may be positioned in extension and in less than 90 degrees abduction supported by
padded arm supports. The palms should be in supination. Alternatively the arms may be
positioned adducted (with the elbows extended) at the patient's sides with the palms facing
inward and secured with the draw sheet by encircling the arms and then tucking it underneath
the patient not under the mattress.The legs should be positioned in parallel and not cross or
touch each other. Pillows may be positioned underneath the knees slightly flex them.
2. Procedures Trendelenburg
The Trendelenburg position is a variation of the supine position where the surgical table is tilted
such that the patient's head is below their feet. This position is typically required to improve
visualization during lower abdominal and pelvic surgery.
Procedures Reverse Trendelenburg
The reverse Trendelenburg position is a variation of the supine position where the surgical table
is tilted such that the patient's head is above their feet. This position is typically used for upper
abdominal procedures and in head and neck surgery.
3. Procedures Lithotomy
In lithotomy position, the patient is supine with their legs supported in stirrups such that they are
elevated and apart with both the hips and knees flexed. In standard lithotomy position the
degree of flexion in both joints is between 80 to 90 degrees. The degree of hip and knee flexion
may however vary depending on the procedure and the surgeon's preference. The position
provides optimal access to the perineum and pelvis and is typically used in gynecological, rectal
and urological procedures.
4. Procedures Lateral
The lateral position has the patient lying on their side. The position is described in relation to the
patient's dependent non operative side. Left lateral means that the patient's left side is on the
surgical table and their right side is operated on. This position allows access to the hip,
retroperitoneal space and thorax.
5. Procedures Prone
The prone position is used to position patients to allow posterior procedures to be performed.
These include: some craniotomies; spinal procedures as well as procedures on the buttocks
and anus. The jackknife and kneeling positions are variants of the prone position. The former is
used for hemorrhoidectomies or pilonidal sinus procedures, while the latter is used for lumbar
laminectomies and discectomies as well as some rectal procedures.
6. Procedures Sitting
The sitting position is used to position patients for the following procedures: shoulder; posterior
cervical spine and posterior cranial fossa.
Evaluation
Hazards
Before prepping and draping, the patient should be checked to ensure that all potential hazards
have been accounted for and appropriate action taken to counter them. This should all be
properly documented as per local protocol.
POST-OPERATIVE DIET PLAN
Your diet after surgery is designed to allow your stomach time to heal, prevent disruption or
obstruction, reduce caloric intake, and help develop appropriate eating habits. Following your
surgery, the post-operative diet plan is divided into four phases: Full Liquid, Pureed, Fork Tender
“Soft,” and Regular.
Quick Reference Guide for Gastric Bypass/Sleeve Gastrectomy
Stage One/Full Liquid: (1st 2 weeks after surgery)
• Full liquid diet
• Protein supplements
• 64 ounces of fluid
*Hydration and Protein are your two main dietary concerns at this stage!
Stage Two/Pureed: (week 2-4 after surgery)
• Pureed foods (no chunks/lumps/seeds) with protein
• Protein supplements
• 64 ounces of fluid
Stage Three/Fork Tender/Fork Flaky: (week 4 - 6 months after surgery)
• Soft foods (fork tender)
• Meat introduction (chew thoroughly)
• 64 ounces of fluid Stage Four/Regular: (starting at 6 months after surgery)
• Regular diet
• ½ cup to 1 cup per meal x 6 meals per day
• 64 ounces of fluid • May add raw fruits/vegetables slowly
*Remember to keep fluids with you at all times so that you can sip throughout the day!* Some
patients may experience nausea and/or vomiting.
The most common causes of vomiting following bariatric surgery are the 4 T’s:
• Timing: Eating Too Fast
• Technique: Drinking Fluids While Eating
• Texture: Not Thoroughly Chewing Foods or Need To Eat Softer Foods
• Too Much: Eating Too Much