History of Surgery: Key Figures and Terminology

• Lesson # 1 goes over common terminology and a history of surgery

History of Surgery

• Hippocrates (460-370 BC) is considered the Father of Medicine

• Foreshadowed asepsis advocating wine and boiled water for irrigating wounds

• Soranus of Ephesus (98-138 AD) was a Roman physician, famed as the Founder of Gynecology and Gynecology Nursing

• Claudius Galen(131-210 AD) was a Greek surgeon in Rome

• Introduced boiling instruments to care for wounded gladiators

• Andreas Vesalius (Dec. 31 1514 - Oct. 15, 1564) was a Dutch physician, one of the chief founders of modern anatomy

• Ambroise Paré (c. 1510 - Dec. 20, 1590) was a French military surgeon

• Noted for dressing wounds and pioneering artificial limbs for soldiers

• Dulled blood vessels and nerves near the operative area

• Considered a pioneer in surgical techniques and one of the fathers of surgery

• Joseph Priestly (Mar. 23, 1733 - Feb. 6, 1804) was an English chemist

• First to isolate oxygen, carbon monoxide, carbon dioxide, ammonia, and sulfur dioxide but also invented nitrous oxide

• Discovered oxygen and nitrous oxide combination in surgery

• Ephraim McDowell (Nov. 11, 1771 - Jun. 25, 1830) was an American physician and surgeon, the Father of Ovariotomy (1809)

• Invented absorbable sutures and stomach pumps (gastric lavage)

• Founding founder of abdominal surgery

• Philip Syng Physick (Jul. 7, 1768 - Dec. 15, 1837) was an American physician known as the father of American Surgery

• Ignaz Semmelweis(Jul. 1, 1818 - Aug. 13, 1865) was a Hungarian gynecologist, known as the "Savior of Mothers" discovering the etiology for "puerperal fever" in Vienna, Austria

• Earliest known practice of "handwashing" with chlorinated lime solutions in 1847.

• Horace Wells (Jan. 21, 1815 - Jan. 24, 1848) was an American dentist pioneering nitrous oxide in dentistry

• William T.G. Morton (Aug. 9, 1819 - Jul. 15, 1868) was an American dentist who demonstrated the use of inhaled ether as a surgical anesthetic in 1846

• James Young Simpson (Jun. 7, 1811 - May 6, 1870) was a Scottish obstetrician

• First to popularize using chloroform, opposed John Lister’s antiseptic technique

• Oliver Wendell Holmes Sr. (Aug. 29, 1809 - Oct. 7, 1894) was an American physician raising awareness about puerperal fever and its origin, healthcare provider to patient transmission

• Louis Pasteur (Dec. 27, 1822 - Sept. 28, 1895) was a French chemist, considered a father of germ theory

• Pioneered fermentation and pasteurization

• Henry Jacob Bigelow (Mar. 11, 1818 - Oct. 30, 1890) was an American surgeon, recognized for the "Bigelow maneuver" for hip dislocation and litholaplaxy (crushing and washing bladder stones in 1878)

• Ernst von Bergmann (Dec. 16, 1836 - Mar. 25, 1907) was a German Surgeon

• Introduced steam sterilization using a bichloride solution and pioneering Aseptic Surgery

• Robert Koch (Dec. 11, 1843 - May 27, 1910) was a German physician who isolated TB bacilli, advocating bichloride of mercury as an antiseptic.

• Joseph Lister (Apr. 5, 1827 - Feb. 10, 1912) was a British surgeon and pathologist

• Known as the father of modern surgery and antisepsis who used carbolic solution and believed sutures soaked in antiseptic prevents infection

• William Stewart Halsted (Sept. 23, 1852 - Sept. 7, 1922) was an American surgeon who initiated rubber gloves as protection from harsh antiseptic and first to perform radical mastectomy

• Wilhelm Roentgen (Mar. 27, 1845 - Feb. 10, 1923) was a German physicist and mechanical engineer who invented the X-ray

• Friedrich Trendelenburg (May 24, 1844 - Dec. 15, 1924) was a German surgeon known for advancements in medicine, especially endotracheal anesthesia via Trendelenburg cannula

• Founder of the German Surgical Society in 1872

• Marie Curie (Nov. 7, 1867 - July 4, 1934) was a Polish physicist and chemist

• Discovered radium and polonium in 1898 and developed wartime radiological cars in World War I to x-ray wounded soldiers

• Harvey Cushing (Apr. 8, 1869 - Oct. 7, 1939) was an American neurosurgeon known as the father of neurosurgery

• Championed the use of a sphygmomanometer in 1900 after learning about it from the Italians and Discovered Cushing disease

• Antonio Egas Moniz (Nov. 29, 1874 - Dec. 13, 1955) was a Portuguese neurologist who developed cerebral angiography in 1927 and psychosurgery to develop lobotomy

• Chevalier Jackson (Nov. 4, 1865 - Aug. 16, 1958) developed the laryngoscope as an aid in intubation

• Jay Heidbrink was an American dentist known for inventing the "Heidbrink Anesthetizer" for controlled concentrations of nitrous oxide and oxygen during dental surgery

• Walter Boothby was an American surgeon best known for "Boothby-Cotton nitrous oxide apparatus" / BLB Oxygen aviator mask, used for high altitude hypoxia

• Willem Johan Kolff invented dialysis and artificial heart transplant, 1st heart transplant was installed in 1982 at Salt Lake City, Utah

• Bruce Reitz was an American cardiothoracic surgeon who performed the first heart and lung transplant in 1981 at Stanford University

• Jean-Michel Dubernard was a French transplant surgeon famed for the first successful hand transplant in 1998 and the first successful face transplant in 2005

• Pedro Cavadas was a Spanish surgeon who performed the first double-leg transplant in 2011

• Mats Brannstrom was a Swedish Surgeon who performed womb transplants in 2012, first uterine birth after a womb transplant in 2014

• Notable 2008 event was the first laser keyhole surgery to treat brain cancer in Paris, France.

Surgical Terminology

• Surgery is a branch of medicine

• Concerns diseases and conditions requiring operative or manual intervention, involving making an opening into the body, repair, or replacement

• Excision is removal

• Incision is cutting

• Resection is surgical removal of a considerable portion of an organ

• Dissection is separation of tissues

• Sutures are materials stitch tissue together and hold them until healing has taken place.

• Ligatures are materials tied around a blood vessel occluding the lumen, commonly called a "tie".

• Antiseptics combat sepsis and create bacteriostasis, applied to the skin and tissue to arrest the growth of endogenous bacteria

• Bactericides / Germicides are agents that kills bacteria

• More bacteriostatic than bactericidal

• Contamination describes the process of something soiling, rendering it unfit

• Disinfection destroys pathogenic organisms, but not spores

• Infection describes the invasion of the body by a pathogenic agent producing injury

• Microorganisms are living organisms invisible to the naked eye

• Pathogenic microorganisms cause infectious disease

• Septic/Sepsis is a general reaction resulting from the action of bacteria and their products

• Spores are an inactive but viable form of bacteria resistant to destruction methods

• Sterilization is the eradication of all organisms, including spores

• Analgesia is the reduction or absence of response to stimuli

• Anesthesia means loss of feeling or sensation, with or without loss of consciousness

• Perioperative encompasses the three phases of surgical experience: pre-operative, intra-operative, and the post-operative phase

• Pre-operative begins from the decision of the surgical intervention to the transference of patient to operating room

• Intraoperative is from the time the patient is received in the operating room until admission to the recovery room

• Post-operative is from the time the patient is received in the recovery room to the follow-up home / clinic evaluation.

• Adhesion is the union of two normally separate surfaces

• Amputation is the removal of limb or appendages of the body

• Anastomosis is a connection between two tubular organs

• Biopsy involves examination of tissue extracted from a living body

• Bronchoscopy inspections the tracheobronchial tree

• Calculus refers to small hard mass formed in a hollow organ, also called as stone

• Cataract is opacity of the lens of the eye

• Circumcision entails excision of the foreskin of the penis

• Dehiscence refers to separation of edges previously joined / where the suture opened

• Dilatation and Curettage is expanding the ostium uteri to permit scraping of the walls

• Enucleation is removal of an organ separate from its structures

• Esophagoscopy conducts a direct visual examination of the esophagus

• Evisceration is the protrusion of an organ through a surgical incision

• Fenestration is the action of perforating

• Fissure is a narrow slit or cleft

• Hemostasis is the arrest of bleeding

• Incision and Drainage is cutting and withdrawal of discharge

• Infarct constitutes an area of necrosis following cessation of blood supply

• Laceration refers to a wound produced by tearing of tissues.

• Laminectomy describes excision of the posterior arch of the vertebra.

• Lobectomy means excision of lobe

• Mammoplasty means plastic surgery of the breast

• Occlusion denotes a state of being closed

• Sclerosis means induration or hardening, usually due to scarring after inflammation

• Shunt serves to divert or turn to one side

• Skin Grafting represents portion of skin being implanted to replace the lost part

• Stenosis is a narrowing of a body passage

• Synovectomy means excision of the synovial membrane

• Transfusion refers to the induction of blood and other body fluid into body circulation

• Transurethral Resection of the Prostate is resection of the prostate through the urethra

• Trepination represents opening of the skull through a trephine

• Tumor is any swelling or enlargement due to pathologic tissue overgrowth.

• Vagotomy refers to interruption of impulses carried by a vagus nerve

• Venipuncture is puncturing vein for therapeutic purposes or for collection of a blood sample

• Vesicle is a small sac-like cavity or blister

• Viscera refers to any large interior organ.

Introduction to Surgical Nursing

• Surgery, perioperative, preoperative, intraoperative, and postoperative nursing are important

• Common conditions requiring surgery are types of surgery too

• Surgery is a medical procedure concerned with diseases or conditions needing operative procedure

• Operations denote the procedure or action done

• Excision, incision, or replacement heal the patient

• Nursing responsibility maintains patient safety and quality of care

• Perioperative Nursing refers to events beginning from preparation for surgery to temporary recovery effects of anesthesia

• It has three phases that are preoperative, intraoperative, and postoperative

• Preoperative Nursing commences the decision for intervention, concluding with Operating Room client transfer

• Prepares the patient physically, mentally, and emotionally, includes assessments and health teaching prior

• Intraoperative Nursing is when the patient has been transferred into O.R. table finishing post anesthesia/recovery room

• Anesthesia giving, draping, skin prep, and patient positioning takes place, infection prevention is emphasized

• Postoperative Nursing commences with post anesthesia care and finishes with resolution of its temporary effects

• From PACU, discharges, 1st follow up checks, and health teaching is emphasized

• Requires monitoring vitals and input with output

• Conditions for requring surgery obstruction/blockage, perforation, erosion, tumor (benign or malignant)

• There are various types of surgery depending on the purpose

• Diagnostic for determine presenting signs and confirmation (tumors)

• Exploratory is for estimate disease/damage of organs and tissues (exploratory laparotomy)major surgery

• Curative removes damaged/diseased tissue or organs which has subtypes like ablative (removal), reconstructive (complete restoration), and constructive (improves function)

• Palliative relieves suffering with appearance

• Radiotherapy, Chemotherapy provides comfort (pain) or supportive measures

• Cosmetic improves aging appearances or trauma forms

• Procedure choice is the patient's decision

• Operations listed are; liposuction, botox, breast argumentation, breast reduction, chin argumentation

• Major operations may have serious risk and life threatening

• Procedure use general or regional for anesthesia such as hysterectomy, cabg, Angioplasy, Appendectomy, Amputation, Craniotomy, Cholonostomy or Organ transplant

• Minor are few complications, minimal blood loss use of local and can be performed in clinics or OPD

• Procedures are like cataract surgery, circumcision, teeth restoration, Conization

• Emergency must be performed immediately to maintain life, organ, remove things, stop something like GSW

• Imperative/urgent requires intervention within 24-48hrs after diagnosis (peritonitis )

• Planned/required are necessary for maintenance of well being (tonsillectomy or cataract)

• Elective have well being but has elective (circumcision)

• Optional is based to one individual’s preferences (mammoplasty, scar, rhinoplasty)

• There are procedures with inpatient admissions, they can be usually admitted a day before

• Ambulatory: Outpatient surgery and Conducted in emergency, doctor and clinic dept

Preoperative Nursing

• Psychological Preparation with Physiological Preparation

• Physical Preparation that involves common medications and Legal Aspects

• Psychological/Psychosocial reactions to surgery happens during the Fear of pain, fear of mutations, Fear of Death

• Therapeutic Communication (teachings and providing social support) is needed

• Physiological Preparation Assessment measures the goals such for health status like physicals, risk factors like high blood pressure, determining anesthetic settings,

• Baseline comparision, preoperative care with such health teachings

• Health status, age, and manage health condition

• Plan of care differ between geriatric and pedia

• Nutritional status (weight) helps to determine for candidates that can performed in operation

• Cardiovascular, Pulmory, Renal, and liver functions

• Drug therapy can be some the contradicted

• Routine Preoperative Screening Tests

Complete Blood Count (CBC) tells to oxygen-carrying capacity of the blood and an indicator of immune function Blood grouping and cross-matching to determine if blood transfusion is required Serum electrolytes (Na, K, Ca, Mg, CI, HCO3) to evaluate fluid and electrolyte status Fasting blood glucose to indicate undiagnosed diabetes mellitus Blood urea nitrogen (BUN) and creatinine to evaluate renal function ALT, AST, LDH, Bilirubin evaluate liver status and nutritional stats Urinalysis contains possible abnormal components Chest X-ray - evaluate respiratory status and heart size Electrocardiogram (ECG) identify preexisting cardiac problems

• The purpose of interoperative nursing is an individual for safety

• Preoperative visits check ups that helps recgonize to an individuals autonmy

• Checklists consists to make it easier to have quick review of all things

• In addition of verify the procedure and consent of the situation (check)

Interoperative Nursing

• Verifying allegations,limitations, mental state, hair, the OT team

• Intraperative phase transfers the team to care properly Preparing O.R for equipment and meds/pre anesthesia that nurse assists in

• Anesthesiologist also provides a time out

• Transfers provide oxygen, check temp

• Anesthesiologist takes control and the nurse takes time.

• Procedures used for spinal like surgeries and amputation for epidural meds

• In the event to determine site or something

• There are also nurses

• During a surgery (maintain the team and document)

Postoperative Nursing

• Post Anesthesia Care Unit has some features that are safe, accessible to staff, and medications

• The three phases are ( PACU, Self Phase, Discharge)

• The provider does head while the surgical does tail

• Considerations are surgical reasons

• The role is to respiratory/cardiovascu/nervousness functions

• Initial assessment is checked for at least 15 mins

• Patients need to breathe/have airway support

• O2 stats are something taken into account

• Side notes:

  • Turn to side
  • The head can also be elevated while secretions and cath is used
  • Vitals, Skin, and other things are taken into count, primary complications can be hemorrhage so pain meds are introduced as well

• Nursing promotes a caring state and self

• Home can not be driven unless 24-48 hours

• Recommmend it to restricted and don’t work under hard work

• Hospital can be multiple or short stay appenedectmies will be cared by patients in order

Anesthesia

• Key points are anesthetic agents, purposes, effects

• In giving age is an factor where pedia and geriatric have different affects to anesthesia

• Physical of patients

• Type and location

• The history to any reaction must be noted

• Two types: general and regional

• Levels Spinal Anesthesia in that order:

  • Inhalation
  • Intravenous -Low spinal -High spinal -Mid-Spinal

• Nerve Blocks -To local the sites

Skin Preparation

The process removes many microorganisms as possible from the operative site by mechanical washing and chemical antisepsis, prior to operation after the patient is anesthetized, the nurse must work for three cycles