Surgery principles: antisepsis and asepsis

Surgical Study Guide

• The main goal of surgical hand washing is to reduce germs as much as possible.
• Surgical hand washing should take about 2 to 5 minutes.

Asepsis

• Performed on inanimate surfaces using disinfectants and sterilization.

Antisepsis

• Applied to living things on skin or tissues using antiseptics and detergents.

Principles of Asepsis

• From the center to the periphery
• From top to bottom
• From clean to dirty
• From distal to proximal
• From inwards to outwards
• From head to feet

International Goals

• Correct patient identification
• Improve communication
• Improve medication safety
• Correct procedures
• Reduce the risk of healthcare-related infections
• Reduce patient fall risk

Indicators

• Worthy touch
• Administering medications orally
• Monitoring IV drips
• Preventing infections from indwelling urinary catheters
• Preventing falls in hospitalized patients
• Preventing pressure ulcers in hospitalized patients
• Clinical nursing record
• Management of newborns weighing less than 1500g
• Monitoring newborns at risk for hyperbilirubinemia
• Providing care to adult patients with mental health issues
• Providing care to pediatric patients with mental health issues
• Monitoring newborns fed through nasogastric tubes
• Monitoring newborns with endotracheal tube secretions
• Monitoring newborns with intravascular catheters
• Care for hemodialysis patients
• Care for peritoneal dialysis patients

Standards

• NOM-067-SSA1-1993: Establishes health specifications for surgical sutures.
• NOM-087-ECOL-SSA1-2001: Covers environmentally safe handling of biohazardous waste.
• NOM-253-SSA1-2012: Concerns the disposal of human blood and its components for therapeutic purposes.
• NOM-017-SSA2-2012: Standards for epidemiological surveillance.
• NOM-022-SSA3-2012: Sets conditions for administering infusion therapy in Mexico.
• NOM-026-SSA3-2018: Deals with major outpatient surgery practices.
• NOM-005-SSA 32016: Establishes minimum infrastructure and equipment requirements for outpatient medical care facilities.
• NOM-006-SSA3-2017: Guidelines for anesthesiology practices.
• NOM-007-SSA2-2016: Care for women during pregnancy, childbirth, and postpartum, including newborn care.

Kidney Table Preparation

• Divided into 3 sections:
• Right: Surgical textiles for the patient.
• Central: Gauze, sutures, scalpel blades, probes, IV equipment, aspirators and so on.
• Left: Surgical instruments in order according to duration of use
• Note: Any scalpel placed under the back table is considered contaminated.

Surgical Times

• Cutting instruments used include scalpels, costotomes, and scissors.
• Scalpel handles #3 and #7 are for blades (10, 11, 12, 15).
• Scalpel handle #4 is for blades (20, 21, 22, 23, 24, 25).

Hemostasis

• Involves covering the wound with a sterile gauze or clean cloth
• Can be temporary or definitive
• Various hemostatic clamps:
• Halsted or mosquito: 12.5 cm
• Kelly 14-16 cm (crille)
• Pean: 12 to 14 cm
• Kocher: 14-16 cm

Dissection

• Releases anatomical structures from surrounding connective tissue
• Instruments used:
• Blunt dissectors
• Cutting instruments
• Separator (Farabeuf)
• Suction for aspiration
• Instruments for grasping or fixing (Backhaus, Campo, Erina clamps)

Fixation

• Allis clamp
• Babcock clamp
• Foerster Ring clamp

Exposure

• Separation:
• Active
• Passive
• Aspiration
• Traction

Circulating Nurse Functions

• Preparation and Coordination:
• Maintains the operating room
• Coordinates patient care
• Checks patient information and surgical materials
• Preoperative Assistance:
• Receives the patient
• Checks their health status
• Helps reduce anxiety
• During the Surgery:
• Keeps the operating room clean and organized
• Works with the surgical team and assists the anesthesiologist
• Administers medications and records everything in the clinical record
• Postoperative:
• Helps move the patient to recovery
• Collaborates in material counting and completion of the operation

Scrub Nurse Functions

• Operating Room Preparation:
• Makes sure instruments are ready
• Performs surgical scrub and attire
• Intraoperative Assistance:
• Assists the surgeon
• Maintains order in the operating field
• Efficiently hands instruments
• Sample Management:
• Protects and takes care of tissue samples
• Counts materials and prepares dressings

Summary

• The circulating nurse coordinates and cares for the patient before, during, and after surgery.
• The scrub nurse prepares the operating room and assists the surgeon during the operation.

Anesthesiology

• Medical field that alleviates pain and cares for patients during surgery.

Key Terms

• Anesthesia: Temporary loss of feeling.
• Sedation: Relaxation with medication.
• Analgesia: Pain relief.

Functioning

• Blocks pain signals to the brain.

Objectives

• Maintain vital functions
• Protect from pain during procedures
• Treat acute and chronic pain

Types of Anesthesia

• General: Patient is unconscious.
• Regional: Loss of sensation in one area.
• Local: Loss of sensation in a small area.

Specific Techniques

• Spinal: Injection into the subarachnoid space.
• Epidural: Injection outside the dura mater.

Complications

• Hematomas, infections, nerve damage.

Anesthesia Phases

• Induction, Maintenance, Awakening.

Common Medications

• Induction: Opioids, Benzodiazepines, Muscle Relaxants.
• Inhalation: Halothane, Isoflurane, Nitrous oxide.

Personnel Involved

• Anesthesiologist: Determines anesthesia.
• Nursing: Ensures surgical conditions.

Common Mistakes

• Asphyxia, tracheal damage, cardiovascular injuries.

Secondary Reactions

• Headache, nausea, confusion.

Topography

• Right Hypochondrium
• Right lobe of the liver
• Gallbladder
• Part of the transverse colon
• Hepatic flexure
• Superior pole of the right kidney
• Epigastrium
• Stomach
• Second and third parts of the duodenum
• Pancreas
• Solar Plexus
• Left Hypochondrium
• Tail of the Pancreas
• Spleen
• Splenic angle of the colon
• Superior pole of the left kidney
• Jejunum loops
• Right Flank
• Part of the small intestine
• Ascending colon
• Inferior pole of the right kidney
• Umbilical Region
• Greater omentum
• Mesentery
• Jejunum and ileum
• Left Flank
• Part of the small intestine
• Descending colon
• Inferior pole of the left kidney
• Right Iliac Fossa
• Cecum
• Appendix
• Ovary and spermatic cord right
• Hypogastrium
• Greater omentum
• Part of the small intestine
• Bladder
• Ureter
• Uterus
• Left Iliac Fossa
• Sigmoid colon
• Ovary and spermatic cord left

Abdominal Surgical Planes

• Steps or phases that a surgeon follows during surgery to access the organ to be operated on.

Types of surgical planes

• Skin
• Body's outermost layer.
• Protects internal tissues
• Sensory
• Variable thickness
• Thin under the eyes
• Thick on the back
• Sutures: dermalón, or prolene
• Subcutaneous Cellular Tissue
• Mostly fat
• Hypodermis
• Aids in healing and stores fat
• Sutures: Monofilament, vicryl
• Aponeurosis
• Flat, thick layers of tendons
• Few blood vessels and nerves
• Connects muscles to bones or other muscles
• Sutures: vicryl or catgut simple
• Muscle
• Soft tissue permits contractions
• Cardiac, skeletal, and smooth
• Sutures: chromic gut
• Peritoneum
• Membrane covering the abdominal cavity and internal organs
• Mesothelium and connective tissue.
• Parietal (abdominal wall) and visceral (organs) layers
• Sutures: chromic catgut