NUR 1213: MSN- Pain And Surgery PDF

NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS First professor of clinical surgery within the University of Leeds...

NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS First professor of clinical surgery within the University of Leeds OUTLINE Book: Abdominal Operations earned him an 1 Surgery international operation 2 Perioperative Care *Surgery has been made safe for the patient; 3 Operating Room Attire, Surgical Hand we must now make the patient safe Scrubbing, Gowning, Closed Gloving, and for surgery. * Instrumentation Improvement in Perioperative Patient Care 4 Pre, Intra, Post Operative Care Technology is attributed to the following: 5 Pain and Pain Management Surgical specialization of surgeon and team Sophisticated diagnostic and intraoperative imaging techniques MODULE 1 - SURGERY Minimally invasive equipment and Definition technology Surgery, as a discipline, combines On-going research and technological physiologic management with an advancements interventional aspect of treatment SURGERY RELATED Total care of illness with an extra modality of TERMINOLOGIES treatment, the surgical procedure Operating Room/ Operating Theatre- room Branch of medicine that comprises pre- in health care facility in which patients are operative, intraoperative, and post operative prepared for surgery, undergo surgical Surgery as a Science procedures, and recover from the anesthetic Surgery as an Art procedures required for surgery EVOLUTION OF SURGERY Perioperative- term used to describe entire Historical Background span of surgery including before and after the Code of Hammurabi (1955-1913BC) - if actual operation patient died after surgical procedure, Perioperative nursing- includes activities surgeons will be retribution in the form of performed by the RN that encompasses pre- amputation of his right hand operative, intraoperative, and post-operative Persians rule on surgery- successful phases of patient’s care procedure on 3 infidels before being OR nurse- duly licensed nurse legally pronounced as competent to practice surgery responsible for the nature and quality of the Galen of Pergamum (130-200AD) nursing care patients Caludius Galen - a Greek physician who Surgical Conscience- awareness which performed animal dissections and fallen into develops a knowledge based on the disrepute; stressed the importance of human importance of strict adherence to principles of dissections; aseptic and sterile techniques Studied the muscles, spinal cord, heart, Breach in sterility: stop and tell what urinary system, and proved that the arteries happened (surgical team) are full of blood. What will happen: Infection, poor wound Believed that blood originated in the liver, and healing, financial burden sloshed back and forth through the body, Be a patient-advocate passing through the heart, where it was mixed Asepsis- free from infection or absence with air, by pores in the septum microorganism Also introduced the spirit system consisting of Aseptic Technique- methods by which natural spirit or “pneuma” (air he thought was contamination of microorganism is prevented found in the veins), vital spirit (blood mixed Disinfection- process of destroying all with air he believed to found in the animals) pathogenic microorganisms except spore bearing ones Sterilization- killing all microorganisms including spores; by heat using autoclave; by chemical using EO gas, plasma sterilization Lord Berkeley George Moynihan (1865 – 1936)- formal education GUMAPAC, E., SOLIS, L. 1  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Surgical Intervention- therapeutic process Incision- open tissue of structure by sharp rendered to restore or maintain health (i.e. the dissection; using scalpel ability to function) Excision- removal of tissue or structure by Surgical Procedure- invasive incision into sharp dissection the body tissues or a minimally Diagnostics- biopsy tissue sample; common invasive entrance into a body cavity for either example: lumps (benign or malignant) therapeutic or diagnostic purpose during Repair- e.g. closing of hernia which protective reflexes or self-care abilities Removal- FBE are potentially compromised Reconstruction- creation of new breast Antiseptic- substances which combat sepsis and cause bacteriostasis Termination- abortion of pregnancy Anesthesia- insensibility to pain and trauma Palliation- relief on an obstruction with or without loss of consciousness Aesthetics- facelift Informed consent- the patient’s autonomous Harvest- skin grafting decision about whether to undergo a surgical Procurement- donor organ procedure, based on the nature of the Transplant- placement of a donor organ condition, the treatment options, and the risks Bypass/ shunt- vascular rerouting and benefits involved Drainage/ evacuation- incision of abscess Abdomin (o)- abdomen Stabilization- repair of fracture Aden (o)- gland Angi (o)- vessel Staging- checking of cancer progression Arthr (o)- joint Parturition- C-section Broncho- bronchus Extraction- removal of tooth Card, Cardi (o)- heart Exploration- invasive examination Cephal (o)- head Diversion- creation of stoma Chole, Chol (o)- bile Four Major Pathologic Conditions Requiring Chondr (o)- cartilage Surgical Intervention Colo- colon Obstruction- impairment to the flow of vital Cost (o)- rib fluids e.g. blood, urine, CSF, bile Crani (o)- skull Cele- tumor, hernia Perforation- rupture of an organ Centhesis - puncture Erosion- wearing off a surface or Ectomy- surgical excision/ removal membrane Itis- inflammation Tumor- abnormal new growth Litho - stone/ calculus Reasons for Surgical Intervention Ostomy- creation of new opening To preserve life Rhapy- repair To Maintain dynamic body equilibrium Oscopy- examination w/a lighted instrument To undergo diagnostic procedures Plasty- surgical repair or reshaping Pexy- suture in place To prevent infection and promote healing To obtain comfort SURGERY Ensure the ability to earn a living Surgery is performed for the purpose of structurally To restore or reconstruct a part of the body altering the human body by incision or destruction of that is congenitally malformed or damaged tissues and is part of the practice of medicine. by trauma or disease Objectives of Surgery To alter cosmetic appearance Repair of injuries Conditions treated by Surgery Alter form or structure Congenital- inborn deformity Correction of deformities and defects Acquired- resulting from trauma or injury Relief of suffering Three (3) Categories of Surgical Procedure Diagnosis and cure of disease process Invasive surgery- major surgeries; open Prolongation of life Minimally Invasive surgery- surgical Common Indications of Surgery procedures that use specialized instruments GUMAPAC, E., SOLIS, L. 2  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS inserted into the body either through natural Elective- client will not be harmed if surgery orifices or through small incision is not performed but will benefit if it is less risky; laparoscopic surgeries performed; revision of scars, vaginal repairs Non-Invasive surgery- unrisky Optional- personal preference usually Classifications of Surgical Procedure aesthetic purposes; cosmetic surgery According to Purpose: Risks: Diagnostic surgery- to establish the Preoperative: body disturbance presence of a disease condition; enables the Intraoperative: infection, safety surgeon to verify a suspected diagnosis; e.g. Post-operative: pain breast biopsy, biopsy of skin lesion According to Location Exploratory surgery- to determine the External- outside the body; e.g. extent of the disease condition and at times hysterectomy to make or confirm a diagnosis; e.g. exploration of abdomen for unexplained pain, Internal- inside the body; e.g. hysterectomy exploratory laparotomy According to Extent or Risk Involved (Magnitude) Curative Major- life-threatening - High risk, extensive prolong, large amount of Ablative- removal of blood loss, major or vital vital organs are deceased organ (suffix used is involved, great risk of complications “ectomy”); e.g cholecystectomy/ - Heart surgery, colorectal appendectomy Minor- non-life threatening, less Constructive- repair of serious generally not prolong, few congenitally defective organs serious complications; e.g. biopsy, (suffixes used are “plasty,” excision “orrhaphy,” “pexy,”); e.g. total Surgical Risks Patients hip replacement, orchiopexy (surgery for undescended Obesity- increased incidence of morbidity testes) and mortality; degree of morbidity varies with the severity of the obese condition Reconstructive- involves repair of damaged organ; e.g. Fluid, electrolyte, and nutritional problems: plastic surgery after burns will cause delay and poor wound healing Palliative surgery- to relieve distressing Difficult to close up; larger structures, more signs and symptoms, not necessarily to cure difficult the disease; e.g. resection of tumor to relieve Comorbidities, complications due to existing pressure and pain problems (HPN, DM) Cosmetic surgery- correction of defects, Undernourished- slow poor healing and improvement of appearance or change to a recovery due physical feature; e.g. rhinoplasty, cleft lip Extremely young- underdeveloped repair, mammoplasty structures and immunity Extremely old- physical changes; According to Urgency: comorbidities Emergency- Immediate; life-threatening Person with disability conditions requiring surgery; e.g gunshot Presence of Disease/ Illness- has wound, severe bleeding, small bowel comorbidity; DM patients have poor wound obstruction; patient may deteriorate healing immediately Concurrent or prior pharmacotherapy- ask Urgent or Imperative- within 24-30 hours- what meds are taken by the patient; some client requires prompt attention; kidney meds may alter physiologic functions that stones, acute gallbladder infection, fractured may affect the surgery (anticoagulants- hip bleeding) Planned or required: planned for a few Other factors weeks or months after decision; client Nature and location of requires surgery at some point condition GUMAPAC, E., SOLIS, L. 3  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Magnitude and urgency of To assist the surgeon by functioning the surgical procedure effectively as a member of the surgical team Mental attitude of the To create and maintain an aseptic/ sterile person toward surgery- e.g. environment at all times anxiety Objectives of Operating Room Nursing Caliber of the professional To help the patient return as rapidly as staff and health care facilities possible to the best physical and mental Potential Effects of surgery to the Patient health attainable Stress response is elicited In case the patient did not return to his heath, Vascular system is disrupted pain and discomfort should b eased and s/he Defense against infection is lowered should be allowed to die with dignity PERIOPERATIVE NURSE Organ functions are disturbed Definition Body image may be disturbed Perioperative Nurse is a nurse who provides patient Lifestyle may be changed care, manages, teaches, and studies the care of Legal Liability, Accountability & Ethical Issues patients undergoing invasive or non-invasive Safeguard the patient in the OR against hazards. procedures. S/he possesses a depth and breadth of Protect the nurse, technologist, surgeons, knowledge that allows for the coordination of care of anesthesiologist, and the hospital. Prevention focuses the surgical patient. on the quality assurance Responsibilities of a Perioperative Nurse Prioritizes interventions based on a Quality improvement as an ongoing process comprehensive body of scientific knowledge Understanding regulations, standards, policies, and and variation in patient’s responses procedures Uses critical thinking skills in applying the Accountability for one’s own actions nursing process, acting as a patient advocate, Legal rights of the patients and exercising judgment in a professionally Individualized patient care accountable manner Technical competency Your surgical and ethical conscience. Provides specialized nursing care to patients before, during, and after their surgical and To be liable is to be legally bounded, responsible, and invasive procedure answerable. Works closely with all members of the surgical PERIOPERATIVE NURSING team Definition Helps plan, implement, and evaluate Perioperative Nursing Practice- includes activities treatment of the patient performed by the professional registered nurse during Designs, coordinates, and delivers care to the preoperative (before), intraoperative (during), and meet the identified postoperative (after) phases of the patient’s surgical physiological, psychological, and spiritual; experience. needs of the patients Key Elements of Perioperative Nursing Practice Expected Attributes of a Perioperative Nurse Caring Considerate Conscience Informative and sincere Discipline Versatile Technique Analytical Concept of Surgical Conscience Creative resourceful “Do unto the patient as you would have others do unto Humanistic and Ethical you.” Personal Attributes of a Perioperative Nurse Philosophy of Operating Room Nursing To give service that aims to provide comprehensive With sense of humor support physically, morally, psychologically, spiritually, Objective and socially to a patient undergoing surgery. Enduring Goals of Operating Room Nursing Impartial, nonjudgmental, open-minded To provide a safe, supportive, and Manual and intellectual comprehensive care to patient Curious to lean GUMAPAC, E., SOLIS, L. 4  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Empathic, conscientious, efficient DDS (Doctor of Dental Surgery) or Oral Well-organized surgeon MODULE 2 – PERIOPERATIVE CARE DMD (Doctor of Dental Medicine) Three Phases of Perioperative Care DPM (Doctor of Podiatric Medicine) Preoperative Phase Attributes of a surgeon Begins with the decision to perform surgery Compassionate interpersonal behavior and continues until the client reaches the Accountability operating area Humanistic concern During this phase, the perioperative nurse Appropriate clinical skills in data gathering performs the assessment and planning Good decision making & problem-solving components of the nursing process. skills Questions to ask: Critical thinking ability Allergies Major responsibilities of a surgeon Medications/ Diet (NPO) Preoperative diagnosis and care Practices (smoking, alcohol/ drug intake) Selection and performance of the surgical Location (left, right, bilateral) procedure Intraoperative Phase Post-operative management Begins with placement of patient on the Assistants to Surgeon (First Assistant/ Second operating table, including the entire surgical Assistant)- qualified surgeon or a resident in an procedure and extends until transfer of the accredited surgical education program. client to the recovery room. The - The resident is maybe an associate with implementation component of the nursing whom surgical practice is shared and to whom process is performed here part of the patient’s care maybe delegated. Postoperative Phase - In hospital with accredited postgrad surgical Begins with admission to the RR recovery residency training programs, the surgical room/ PACU (Post Anesthesia Care Unit) and resident in the third or later year usually acts continues until the client receives a follow up as 1st assistant. The resident is given evaluation at home or is discharged to a increasing responsibilities under supervision rehabilitation unit evaluation component of at the operating table to acquire skill and the nursing process is completed in this judgement. phase. NURSE is free to refuse to perform as first Discharge plan, complications, wound care assist out of concern for the well-being of the PERIOPERATIVE PATIENT CARE TEAM (OR patient and for his/her professional TEAM) accountability. Major Responsibilities of Assistants to Surgeon Operating Room Team Help maintain visibility of the surgical site, Each member of the operating room team is control bleeding, close wounds, apply an integral entity in unison and harmony with dressings, handle tissues, and uses his/her colleagues for the successful instruments accomplishment of the expected outcomes. OR Team is subdivided according to the functions of its members: sterile and unsterile team Scrub nurse - Instrument and Suture Sterile team (Surgeon, Assistant Surgeon, and Nurse - Nursing staff member of the sterile team Scrub Nurse) - RN, LPN (licensed practical nurse) or LVN Surgeon- Must have the knowledge, skill, and (licensed vocational nurse), ST (surgical judgement required to successfully perform the technologist) intended surgical procedure. Major Responsibilities of a Scrub Nurse Who can be the head surgeon: Responsible for maintaining the integrity, safety, and efficiency of the sterile field Licensed MD throughout the procedure. DO (osteopath) GUMAPAC, E., SOLIS, L. 5  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Responsible for preparing and arranging the through implementing the principles of sterile instruments and supplies for the asepsis, demonstrate a strong sense of surgical procedure. surgical conscience. Anticipates, plan for, and respond to the Constant flexibility in identifying needs of the surgeon by constantly watching environmental danger stressful, situations, the sterile field. and meet the unexpected act in an efficient, Should have knowledge, skills, and rational manner at all times. experience with aseptic and sterile Maintenance of the communication link techniques. between events and team members at the Should have manual dexterity, physical sterile field and stamina, stable temperament, able to work Provision of assistance to any member of the under pressure, with keen sense of OR team and any manner in which the responsibility and concern for accuracy in circulator is qualified. performing all duties. Direction of the activities of all learners. The Nonsterile Team CN must have the supervisory capability and Anesthesiologist - is an MD or DO, certified by the teaching skills needed to ensure maintenance Philippine Board of Anesthesiology, specializes in of a safe and therapeutic environment for the administering anesthetics to produce various states of patient. anesthesia. Nurse anesthetist- refers to a qualified RN, Major Responsibilities of an Anesthesiologist anesthesiologist assistant (AA), dentist, our physician Choice and application of appropriate who administers anesthetics. anesthetic agents and suitable techniques of PERIOPERATIVE ENVIRONMENT administration and monitoring of physiologic Physical Facilities functions. Location- located accessible to the critical care Maintenance of fluid and electrolyte balance surgical patient areas and the supporting service and blood replacement during the surgical department-CSR, radiology, pathology, etc. procedure. Many OR suites are UNDERGROUND or Minimize the hazards of shock, electrocution, have solid walls without windows. and fire. Ventilation - Must ensure a controlled supply of filtered Responsible for overseeing the positioning air. Air conditioning is ideal and valuable; it controls and movement of patients. humidity Able to use and correctly interpret a wide Door - Ideally, sliding doors should be used. variety of monitoring devices. Floor - Must be suitably hard, suitable for heavy Oversee the PACU to provide resuscitative equipment specially during transport from one room to provide care until each patient has regained another and easy to clean. control vital functions. Lighting- General illumination is furnished by ceiling Participate in the hospital’s program of CPR lights in white fluorescence bulbs which are evenly as teachers and team members. As well as distributed throughout the room. consultants and managers for problems of Should be shadowless o Be freely adjustable acute and chronic respiratory insufficiency to any position or angle by vertical or requiring inhalation therapy and other fluid, horizontal range of motion electrolyte and metabolic disturbances Produce minimum heat to prevent injuring requiring IV therapy. exposed tissues o Be easily cleaned They are integral staff member of Pain Two Principles in designing an Operating Room Therapy clinics. a. Exclusion of contamination from outside the Circulating nurse - A RN or ST (surgical suite technologist) who functions under the supervision of b. Separation of clean areas from contaminated an RN. areas Major Responsibilities of a Circulating nurse Types of OR Designs Nursing judgement and decision-making skill Central Corridor are requisites to assessing, planning, Central Core implementing, and evaluating the plan of care Peripheral corridor before, during, and after surgical operation. Combination central core & peripheral Creation and maintenance of a safe and corridor comfortable environment for the patient Three corridor layouts GUMAPAC, E., SOLIS, L. 6  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Grouping or cluster plan Desirable if all have the same size, so they can be used interchangeably to The OR suite should be large enough to allow accommodate elective and emergency for correct technique yet small enough to cases. minimize the movement of patients, personnel Must accommodate equipment like laser, and supplies. Provision must be made for traffic microscope, video equipment, c-arm, portable control. The type of design will predetermine light, etc. traffic patterns. Signage should be posted Adequate size is at least 20x20x10 feet (400 properly. sq ft or 37 m2) of floor space or maximum of 20x30x10 feet (600 sq ft or 60 m2). Three Areas/Division of Operating Room Suite Sub sterile Room Unrestricted / Unsterile Area Work Area This area is isolated by doors from the main hospital corridor or elevators and from other Steam Sterilizing Room areas of the OR suite. Washer Serves as an OUTSIDE-to-INSIDE access Storage Room for Supplies area Record Room Street clothes are permitted Peripheral Support Areas Vestibular / Exchange Areas (Transition Zone) - Central Administrative control inside the entrance to the OR suite, separates the OR Sterile supply room corridors from the rest of the facility Work and storage areas Preoperative check-in unit - this is an General work room unrestricted area of the OR for patient to change from street clothes to gown. Utility room Dressing rooms and lounges - clothes Housekeeping Storage area hanging areas must be provided for both Anesthesia work & storage areas males and females. Shoe rack is advisable for Furnitures and other Equipment Inside the the OR scrub suit. Operating Room Post-operative holding area - A designated 1. OR Table - divided into head, body, and leg room for patients to wait in the OR suite that sections. Attachment includes knee strap, shields them from distressing sights and arm strap, arm board, anesthesia screen, sounds. metal foot board, etc PACU - may be outside the OR or adjacent to 2. Instrument table or Back table the OR suite. o Part of unrestricted area with 3. Mayo table - placed above and across the access from both semi restricted areas. patient and contains instruments which are in Semi-restricted / Semi sterile Area constant use during operation. Personnel should be wearing OR scrub suit 4. Small table for patient’s preparation with cap. equipment (skin prep table) This area includes peripheral support areas 5. Ring stand for basin (s). and access corridors to the OR like PACU, 6. Anesthesia table and machine SICU, offices for anesthesia department and 7. Sitting stools and footstools/standing administrative OR nursing personnel, etc. platforms Work area or packing area 8. IV stands and hangers for IV solutions Steam sterilizing room 9. Suction machine, bottles, and tubing Washer-sterilizer area 10. Cautery machine 11. Kick buckets in wheeled bases Storage room for supplies o Record room 12. Basin in wheeled bases for soiled sponges Restricted / Sterile Area and gloves Personnel should be wearing complete OR 13. Communication system / Intercom scrub suit including mask. 14. Defibrillator This area performs sterile procedures o 15. Negatoscope- obsolete device for displaying Includes OR suite room, scrub sink areas, sub Xray films sterile rooms where unwrapped supplies are 16. Wall Clock with second hand sterilized. 17. White board for recording 18. Blood warmer machine attached to IV pole GUMAPAC, E., SOLIS, L. 7  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS 19. monitoring machines the team and mayo were photographed operating in Cabinets / carts surgical gowns, caps, and masks MODULE 3 - OR Attire, Surgical Hand 1930- 1940 - Scrub dresses began to replace nurses’ regular uniforms heretofore worn Scrubbing, Gowning, Closed Gloving, under the sterile gown, observers in the OR and Instrumentation were gowned, capped, and masked. Operating Room Attire 1958 - Disposable latex Description: gloves were introduced Consists of body covers, such as a two- Most efficient masks are disposable ones piece pantsuit, head cover or cap/turban, containing a high efficiency filter mask. shoe cover, or booties, googles, and 1960 - Full skirts were replaced by close apron fitting scrub dresses and pantsuits that Protects us from blood and body substance of reduces the hazard of brushing against a patient sterile table when near or passing by it 1950 - OR personnel were required to change Purpose: shoes when entering the OR suite and to wear To provide effective barriers that prevent the only those shoes when within the suite. dissemination of microorganisms to the px Currently, disposable shoe covers are Protects personnel from infected patients and commonly worn. against exposure to communicable disease CRITERIA FOR OR ROOM ATTIRE Has been shown to reduce particle count OR attire should be: from the body from over 10,000 particles per An effective barrier to microorganisms. Both min to 3000 per min, or from 50, 000 reusable woven and disposable nonwoven microorganisms per cubic foot to 500 materials are used. Design and composition microorganisms per cubic foot. should minimize microbial shedding. Historical Background: Closely woven material void of dangerous OR nurse take a bathe before a surgical electrostatic properties. The garment must procedure, to take a carbolic bath (anti- meet the fire protection standards, including microbial soap) before laparotomy and to resistance to flame. wear long sleeves and clean apron for the Nylon and other static spark-producing surgical procedure materials are forbidden as outer garments. Resistant to blood, aqueous fluids, and Gustav Neuber (1883)- He insisted on wearing of abrasions. caps by OR personnel Designed for maximal skin coverage. Hunter Robb - A gynecologist at Johns Hopkins hosp Hypoallergenic, cool, and comfortable Baltimore, insisted on OR cleanliness and on the Non generative wearing of caps and sterile gowns Easily to don and remove Dr. William Halsted (1897) - He designed a Effective barrier to microorganisms semicircular instrument table to separate himself, in Made of pliable material to permit freedom of sterile gown and gloves, from observers in street movement for the practice of sterile clothes who watched him operate. technique Johann von Mikuliez (1896) - A pioneering german Colored to reduce glare under lights surgeon, advocated the wearing of cotton gloves in 1896 but these were soon found to lack the qualities of DRESS CODE impermeable rubber gloves for infection control. He also advocated the use of gauze masks in 1897. These are written policies and procedures for Joseph Lister- Fist use of caps and sterile gowns proper attire to be worn within the semi- occurred in Germany while the value of joseph lister’s restricted and restricted areas of the OR suite principle of antiseptic surgery to exclude putrefactive Should include personal hygiene bacteria from wounds was still Protocols must be abided From 1908 to 1930, various styles of turbans Location of the dressing room and shower cap-style head covering were worn. Street clothes are never worn beyond the Charles Mayo (1913) unrestricted area GUMAPAC, E., SOLIS, L. 8  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Only approved, clean, and/or freshly Must be don a scrub suit before entering a laundered or attire worn within the semi- semi restricted area restricted area. Shirt and waistline drawstrings are tucked This applies to all, both professional, non- inside pants to avoid their touching sterile professional and visitors alike. areas and to reduce fallout of skin debris from OR attire should not be worn outside the or thoracic and abdominal areas suite. Scrub suit should be changed as soon as Before leaving the or suite, everyone should possible whenever it becomes wet or visibly change to street clothes soiled § *lab gowns and smock Person who will not be sterile team members gowns should wear long-sleeved jackets A clean, fresh scrub suit should be put on after Headcover/ Cap/ Turban return for reentry to the suite. All facial and head hair must be completely OR attire should be hung or put in a locker covered. for wearing a second time. If disposable, Cap or hood is put on before a scrub suit to discard in the trash one use. protect the garment from contamination by Personal hygiene must be re-emphasized hair. - A person with an acute infection Types include disposable, lint-free, - Persons with cuts, burns or skin lesions nonporous, nonwoven fabrics. A reusable cap should not scrub or handle sterile supplies should be made of a dense woven material because serum may seep from the eroded and laundered daily. (after use put it in the area hamper and send it to the department) - Sterile team members who are known to carry Net caps are not acceptable are pathogens. Hair should not be combed while wearing a - Fingernails should be kept short. Nail polish is scrub suit not allowed. Persons with scalp infection should be - Pierced-ear studs must be confined within excluded from the OR and treated first headcover If the hair is long, a helmet or hood must be - Jewelry (rings and watches) should be worn to cover the neck area. It should be well removed before entering the semi-restricted fitted to confine and prevent escape of any and restricted areas. hair. - Necklaces and chains can grate on the skin, Caps of different colors are helpful to increasing desquamating differentiate personnel - Facial makeup should be minimal Shoe cover - Eyeglasses should wiped with a cleaning Should be clean, washable and soft-soled solution before each surgical procedure and Protect the wearer from spilled into or onto properly secured shoes during procedures - Hands must be washed frequently and Maybe worn in semi-restricted and restricted thoroughly. Hand cream may be used after to areas prevent chapping and drying of hands. Shoes restricted to wear in the OR or shoe Comfortable, supportive shoes should be cover overshoes are preferable in reducing worn to minimize fatigue and for personal microbial transfer from the outside into the OR safety, shoes should have enclosed toes and suite. heels; clogs, slippers Can inadvertently become solid and harbor External apparel that doesn't serve any microorganisms should be removed from functional purpose should not be worn in the entering the dressing room and after leaving OR. the OR COMPONENTS OF OPERATING ROOM Protective gloves should be worn to change Body cover or Scrub suit shoe covers whenever they become wet, One piece overall with attached hoods and soiled, or torn. boots are convenient garb for visitor whose Mask presence in the OR will be brief like the Worn in the operating room pathologist Should be worn at all times in the restricted Pantsuits are preferred than the one-piece areas where sterile supplies are exposed overall. 90% of bacteria GUMAPAC, E., SOLIS, L. 9  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Reusable cotton masks are obsolete because Latex - polymeric membrane of natural rubber with an they filter ineffectively as soon they biome infinite number of holes between lattices moist Better barrier than vinyl tape At least 95% efficient in filtering miscorebed Contains protein antigen & is cured with from droplet particles agents that may cause an allergic dermatitis Disposable mask made of soft, cloth-like or systemic anaphylaxis material in very fine synthetic. Vary in thickness (minimum 0.1mm) A fluid-resistant mask is advantageous Petroleum-based lotions or lubricants should Cool, comfortable, and nonobstructive to not be used on the hands before dining latex respiration gloves. Hydrocarbons will penetrate latex, Non-irritating to the skin because of its causing a change in its physical polypropylene, polyester, or rayon fibers. characteristics, including tear resistance. Should be worn over both nose and mouth Surgical Gloves- clean objects and sterile packages and should conform to facial contours to should not be handled with contaminated; worn in prevent leakage of expired air surgical procedures Double masking is NOT recommended Hands must be washed thoroughly after because the extra thickness can cause removing the gloves venting from the effort to breathe through it. Lead gloves To prevent cross-infection, masks should be Thick gloves- should be worn for skin protection from handled by the strings. DO NOT handle the ethylene oxide exposure if sterilized packages must be mask excessively; handled before operation Never be lowered to hang loosely around the Working Gloves- utility gloves are worn for cleaning neck, on top of the cap, or put in a pocket. and housekeeping. Avoid disseminating microorganisms Sterile and non-sterile single-use disposable Be promptly discarded into proper receptor latex and vinyl gloves are discarded after use. Changed frequently. Do not permit the mask They should not be washed or reused to become wet. Talking should be kept at a Sterile Gown minimum. Is worn over the scrub suit to permit the Eyewear/Goggles wearer to come within the sterile field. Worn to reduce risk of blood or body fluids Differentiates sterile from unsterile members. from the px splashing into the eyes of sterile Although the entire gown is sterilized, the team members, or bone chips or splatter back is not sterile, nor any area below table alike. level, once the gown is donned With side shields, anti-fog goggles, Wrap around sterile gowns that provide combination surgical mask with a visor eye coverage shield. If the gown is close by ties along the back, a Eyewear or face shield that becomes sterile vest should be put on to cover the contaminated should be decontaminated or back discarded promptly. The cuffs of the gowns are stockinette (rib- Laser eye must be worn for eye protection knit) to tightly fit the wrists. Sterile gloves from laser beams cover the cuffs of the gown (close method Eyewear with a face shield should be worn gowning) when handling or washing the instruments Should be resistant to penetration by fluids when the activity could result in a splash, and blood spray or splatter to the eye or face. Should be comfortable without producing excessive heat build-up. Sterile Gloves Reusable gowns must be made of densely Non-sterile latex or vinyl gloves should be woven material. worn when handling contaminated materials Pima cotton with a 270-280 thread count per Surgical gloves are made of natural latex sq inch treated with a moisture-repellant rubber, synthetic rubber, vinyl, or finish polyethylene Some reusable are cotton-polyester blend. Seams of the gown should be constructed to prevent penetration of fluids. GUMAPAC, E., SOLIS, L. 10  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Woven textile gowns withstand about 75 launderings and sterilizing cycles before discarding them. If punctured or torn, gown should be changed Purpose of Surgical Hand Scrub during the procedure. To help prevent the possibility of All woven and some non-woven gowns are contamination of the operative wound by not flame retardants. Fire-resistant gowns bacteria on the hands and arms. should be worn for laser surgery and when To remove soil, debris, natural skin oils, hand electrosurgery is used lotions and transient microorganisms from the Gowning hands & forearms of sterile members. The circulator brings the gown over the To decrease the number of resident shoulder by reaching inside to the shoulder microorganisms on skin to an irreducible and arms seams. The gown is pulled on, minimum. leaving the cuffs of the the sleeves extended To keep the microorganisms to minimum over the hands. The back of the gown is during the surgical procedure by suppression securely tied or fastened at the neck and of growth. waist; touching the outside of the gown at the To reduce the hazard of microbial line of ties or fasteners, in the back only. contamination of the surgical wound by skin The scrub nurse, putting down, gently shakes flora. out folds, then slips both arms into the Materials needed for Surgical Hand Scrub armholes of the sleeves simultaneously Scrub Sink without touching the sterile outside of the is adjacent to the OR for safety and gown with bare hands. convenience After drying your hands, pick up the sterile automatic control or foot or knee operated gown, lift it directly upward and step away to faucets; - sink is deep & wide enough avoid touching the edge of the wrapper. Should be used only for scrubbing or hand Drying Hands and Arms washing only. After scrubbing, hands and arms must be thoroughly Should not be used to clean or rinse dried before the sterile gown is donned to prevent contaminated/ soiled instruments and contamination of the gown by strike-through of equipment. microorganisms from wet skin. Scrub Brush Apron reusable scrub brushes Fluid proof aprons disposable sponges Lead aprons single use disposable brush-sponge A decontamination apron should be worn over combination with impregnated antiseptic the scrub suit to protect against liquids and detergent agents. cleaning agents during cleaning procedures. Brush should not cause skin abrasion This should be a full front barrier reusable brush may be wrapped to provide Lead Apron sterile individual packages. Protects against radiations exposure or when Reusable nail cleaners should be used to handling radioactive implants (x-rays,C-arms, clean under the nail. coronary angiogram) Orangewood sticks are not used because the REVIEW OF SURGICAL HAND SCRUBBING wood may splinter & harbor Pseudomonas Description: Antiseptic Agents Surgical hand scrubbing is the process of removing Antiseptic agents are approved by FDA as many microorganisms as possible from the hands Different agent has different specific microbial and arms by mechanical washing & chemical agent. antisepsis before participating in surgery. Agents alter the physical or chemical - Mechanical washing with friction properties of the cell membrane of removes transient organisms. microorganisms, thus destroying or inhibiting - Chemical antisepsis reduces resident cellular functions. flora & inactivates microorganisms with antiseptic agents. Should be a broad spectrum antimicrobial - Done before gowning & gloving for each agent; surgical procedure. Should be fast acting and effective; GUMAPAC, E., SOLIS, L. 11  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Should be nonirritating and non sensitizing; 30 strokes method Should be prolonged-acting; 15 strokes method Should be independent of cumulative action Steps in 5-minute time scrub method 4% Chlorhexidine Gluconate- produces effective, 1. Wet hands and forearms. Apply 2 to 3 ml (6 immediate, and cumulative reductions of resident & gtts) of antiseptic agents to the hands transient flora. The effect is maintained for more 2. Lather & Wash hands several times up to 2 than 6 hours. Nonirritating to the skin but highly inches above the elbow. Then rinse irritating if splashed in the eye. thoroughly under running water with hands Iodophors- is a povidone-iodine complex against upward. gram positive & gram-negative microorganisms; 3. Take the sterile brush, apply antiseptic agent irritating to the skin; not sustained for a prolonged & scrub following the time allotted per part: * period (6hrs). 30 seconds each nail, *30 seconds each 1% Triclosan- nontoxic, non-irritating, & develops finger, *30 seconds each hand a prolonged cumulative suppressive action when 4. With brush in hand, clean under fingernails used routinely. Less effective than Chlorhexidine with nail cleaner on running water then Gluconate and Iodophors discard after use the cleaner 60% / 90% Alcohol- nontoxic, does not have 5. Again scrub each individual finger, nail and residual activity, has drying effect on skin. hands with the brush a half minute for each 5. 3% Hexachlorophene - most effective after 1. hand, maintaining lather buildup of cumulative suppressive action. Available 6. Rinse hands and arms and by prescription only discard brush; Reapply the Preparation for Surgical Scrub antiseptic agent and wash the hands & arms Skin & nails should be kept clean and in good with friction up to the elbow for 3 minutes. condition and cuticles should be uncut. Interlace the fingers to cleanse between Fingernails should not reach beyond the them fingertip to avoid glove puncture. 7. Rinse the hands and arms thoroughly. Fingernail polish should not be worn. Artificial 8. Stay for a few seconds at the scrub sink for devices must not cover natural fingernails. the dripping of water, then proceed to the Remove all jewelries from fingers, wrists and assigned OR suite. DO NOT neck. INTERLACE THE FINGERS. Ensure to fold the sleeves of the scrub suit at Steps in Brushstroke method (15 Strokes Method) least 2 to 3 inches above the elbow. 1. Wet hands and arms up to 2 inches above Before proceeding to the scrub sink the elbow Open out the sterile gown pack onto a clean 2. Lather with antiseptic agent. back table, only grabbing the outermost 3. With the hands held under running water, edges to maximize the sterile field. clean under the fingernails of both hands Open the sterile glove packet and let it drop with nail cleaner & discard after use onto the open sterile gown pack 4. Rinse both hands and arms under running Preparations Immediately Before scrubbing water, keeping hands up Inspect the hands for cuts and abrasions. Skin 5. Take a sterile brush and apply an antiseptic integrity should be intact. agent and start doing the brush stroke All hair is covered properly by headgear method on ONE HAND first following: including the pierced ear studs. a. 15 strokes each nail b. 15 strokes all sides of each Adjust disposable mask snugly & comfortably over nose & mouth. finger c. 15 strokes each dorsum Clean eyeglasses if worn. d. 15 strokes each palm Adjust comfortably in relation to the mask. e. 15 strokes for each third of Adjust water to a comfortable temperature the arm up to 2 inches above and amount. the elbow. Types of Surgical Scrub Procedure 6. Repeat the above steps for the other Time Method hand and arm Complete scrub (5-7 minutes) 7. Rinse the hands and arms Short scrub (3 minutes) thoroughly Brush-stroke Method or counted Method GUMAPAC, E., SOLIS, L. 12  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS 8. Stay at the scrub sink for a few 3. Release the gown. The surgeon holds arms seconds for the dripping of water while outstretched while the circulator pulls the gown onto maintaining the hands up. the shoulders and adjusts the sleeves, so the cuffs are GOWNING AND DONNING OF SURGICAL properly placed. In doing so, only the inside of the gown GLOVES is touched at the seams. Purpose: Donning of sterile surgical gloves by Closed glove - Sterile gown is worn to exclude skin as a technique possible contaminant and to create a 1.Using the left hand and keeping it within the cuff of barrier between the sterile and unsterile sleeve, a gowned scrub person picks up the right glove. areas. Palm of glove is placed against palm of right hand, General Considerations grasping top edge of glove cuff above palm. A. The scrub person gowns & gloves CORRECT POSITION: Fingers of glove are self, then may gown and glove the pointing towards you and the thumb of the glove surgeon & assistants. is aligned with the thumb of the hand. The thumb B. Gown packages preferably are side of the glove is down. opened on a separate table from 2, Back of the cuff is grasped in the left hand and turned other packages to avoid over the right sleeve and hand. Cuff of the glove is now contamination from dripping water. over the stockinette cuff of the sleeve, with the hand C. Avoid splashing water on scrub attire still inside the sleeve. during surgical scrub because 3.Top of the right glove & underlying sleeve of the gown moisture may contaminate the are grasped with the left hand. By pulling the sleeve up, sterile gown. the glove is pulled onto the hand. Wearing of Sterile gown by self 4.Using the gloved right hand, the left glove is picked After scrubbing, hands and arms must be up and placed with the palm of the glove against the thoroughly dried before the sterile gown is palm of the left hand. Back of the cuff is grasped, above donned to prevent contamination of the gown the palm in the right hand & turned over the left sleeve by strike-through of microorganisms from wet and hand. skin. 5.Cuff of the left glove is now over the stockinette cuff After drying of hands, pick up the sterile gown, of the sleeve, with the hand still inside the sleeve. Top lifts it directly upward and steps away to avoid of the left glove and underlying gown sleeve are touching the edge of wrapper. grasped with the right hand, and the sleeve is pulled The scrub nurse, putting on a gown, gently up, pulling the glove onto the hand. shakes out folds, then slips both arms into the Serving of Sterile gloves armholes of the sleeves simultaneously 1. Pick up the right glove, grasp it firmly, with without touching the sterile outside of the the fingers under the everted cuff. Hold the gown with bare hands. palm of the glove toward the surgeon. The Circulator brings the gown over the 2. Stretch the cuff sufficiently for the surgeon to shoulder by reaching inside to the shoulder introduce the hand. Avoid the touching the and arms seams. The gown is pulled on, hand by holding your thumbs out. leaving the cuffs of the sleeves extended 3. Exert upward pressure as the surgeon over the hands. plunges the hand into the glove The back of the gown is securely tied or 4. Unfold the everted glove cuff over the cuff of fastened at the neck and waist; touching the the sleeve; Repeat for the left hand. outside of the gown at the line of ties or 5. If a sterile vest is needed, hold it for the fasteners, in the back only. surgeon to slip the hands into the armholes. Serving of sterile gown Be careful not to contaminate gloves at the 1. Open the hand towel and lay it on the surgeon’s neck level. If the gown is a wraparound, hand, being careful not to touch the hand. assist the surgeon. *If no towel is available, the lower part of the Donning of sterile surgical gloves by Open glove gown may be used to dry the hands of the technique surgeon.* This method of gloving uses a skin-to-skin, glove- 2. Keeping your hands on the outside of the gown to-glove technique. The hand, although scrubbed, under a protective cuff of the neck and shoulder area, is not sterile and must not come in contact with the offer the inside of the gown to the surgeon. The exterior of the sterile gloves. The everted cuff on the surgeon slips the arms into the sleeves. gloves exposes the inner surface. GUMAPAC, E., SOLIS, L. 13  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS The first glove is put on with skin-to-skin technique, Glove removal bare hand to inside cuff. The sterile fingers of that The key to removing both sterile and non-sterile gloves gloved hand then may touch the sterile exterior of is "Dirty to Dirty - Clean to Clean" that is, contaminated the second glove, that is glove-to-glove technique surfaces only touch other contaminated surfaces: your Open Glove Method bare hand, which is clean, touches only clean areas 1. With the left hand, grasp the cuff of the right inside the other glove. glove on the fold. Pick up the glove and step 1. Take hold of the first glove at the back from the table. wrist. 2. Insert the right hand into the glove and pull it 2. Fold it over and peel it back, turning on, leaving the cuff turned well down over the it inside out as it goes. Once the glove is hand. off, hold it with your gloved hand. 3. Slip the fingers of the gloved right hand under To remove the other glove, place the everted cuff of the left glove. Pick up the your bare fingers inside the cuff without glove and step back. touching the glove exterior. Peel the 4. Insert the hand into the left glove and pull it glove off from the inside, turning it inside on, leaving the cuff turned down over the hand. out as it goes. Use it to envelope the 5. With the fingers of the right hand, pull the cuff other glove. of the left glove over the cuff of the left sleeve. If SURGICAL INSTRUMENTS the stockinette is not tight, fold a pleat, holding it Historical Background with the right thumb while pulling the glove over Code of Hammurabi (Circa 1900 BC)- describes a the cuff. Avoid touching the bare wrist. bronze lancet 6. Repeat step 5 for the right cuff, using the left Incas of Peru- use razor-sharp flint and animal teeth hand and thereby completely gloving the right Egyptians (1900 - 1200 BC) - blades made of flint, hand. reed, and bronze Reminders in Glove technique Hippocrates (460 -377 BC)- advocated the Avoid contact of sterile gloves with ungloved heating of tips of rounded and pointed blades hands during closed-gloving procedure. before using For close gloving method, never let the fingers Rome (1st century AD)- use of scalpel handles with extend beyond the stockinette cuff during the blunt dissecting ends, knives, saws, forceps, and procedure. Contact with ungloved fingers clamps with locking handles, probes, and hooks for constitutes contamination of the gloves. retraction. For open glove method, touch only the cuff of Ambroise Pare (1509-1590)- 1st person to grasp the glove with the ungloved hand, and then blood vessels with a pinching instrument that was the only glove to glove for the other hand. predecessor of the hemostat used today. If contamination occurs during either American Civil War (1861-1865) - trademark of this procedure, both gown and gloves must be period were amputations discarded and new gown and gloves must be - In some instances, amputations were added. performed on kitchen tables with heavy When removing gloves after a procedure is knives and instruments. Even tables forks finished, the gloves are removed using glove- were used as retractors. to glove, skin to skin technique, after the gown 18th-19th centuries is removed inside out technique. Surgical tools were made by skilled Removing of gown silversmiths, coppersmiths, and Grasp the right shoulder of the loosened gown with the woodworkers. Some instruments handles left hand and pull the gown downward from the were made of ivory, bone, or wood with velvet shoulder an off the right arm, turning the sleeve inside cases out; 20th Century: 1. Turn the outside of the gown away Instruments are made entirely of metals such from the body with flexed elbows; as carbon steel, silver, and brass, and the 2. Grasp the left shoulder with the right velvet case was replaced by sterilizer trays. hand and remove the gown entirely, 1900s pulling it off (inside Development of stainless steel from out); Germany, Sweden, France, England, 3. Discard in a laundry hamper or in a Pakistan, and United States trash receptacle (if disposable) GUMAPAC, E., SOLIS, L. 14  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Made of titanium, cobalt-based alloy (Vitallium), stainless steel or other metals Stainless steel: alloy of iron, chromium and carbon. It may also contain nickel, manganese, silicon, molybdenum, sulfur and Classification of instruments other elements to prevent corrosion or add Cutting and Dissecting tensile strength. Grasping and Holding Alloys make the instruments resistant to Clamping and Occluding corrosion when exposed to blood and body Exposing and Retracting fluids, cleaning solutions, sterilization, and atmosphere. Suturing and Retracing Parts of the Surgical Instrument Suturing and Stapling Tip Viewing Serrated Jaws Suctioning and Aspirating Boxlock Dilating and Probing Shank Accessory Instruments Ratchet CUTTING AND DISSECTING Finger ring or Ring Handle Have sharp edge Use to dissect, incise, separate, and excise tissues Should be protected during cleaning, sterilization, and storing; Should be kept separate from other instruments and demand careful handling at all times Scalpels Made of brass and the blade is made of carbon steel; Most frequently used has a reusable handle May also be available in disposable type Handle # 3, 7, 9 – Blade # 10, 11, 12, 15 GUMAPAC, E., SOLIS, L. 15  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS 8 O OO o Knives Comes in various sizes and configuration Usually have a blade at one end and the blade have one or two cutting edges Taceable Some have detachable Gadenotomedermatome Scissors Blades of the scissors maybe straight, angled or curved, pointed or blunt at the tips, and the Handles maybe long or short; Handle # 4 – Blade # 20, 21, 22, 23 Used only to cut or dissect tissues Blade # 10- most frequently use; Metzenbaum scissors (Metz)- used to cut 379 has a rounded cutting edge along one delicate tissue; also known as tissue side or operating scissor Blades # 20, 21, 22- have the same shape but larger i Blade # 11- straight edge that 379comes to a sharp point; known as the stab knife Blade # 12- shaped like a hook with 379the cutting 2 edge on the inside curvature Gmas Blade # 15- has a smaller and share 379shorter curved cutting edge than no. 10 Straight MAYO scissors (Suture blade cauterytipemachine scissors) used to cut sutures and supplies; Blade # 23- has a curved cutting electronicinstrument also known tocut as suture skintissuesvessels yellow scissor edge that comes to more of a point than nos. 20, 21, and 22 tocoagulatebleedingvesselsvianeatblue cauterypad attachedtopt'smuscle lower leg asgroundpadtopreventelectricshod GUMAPAC, E., SOLIS, L. 16  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Curved MAYO scissors - available in regular and long sizes. used to cut heavy and Blunt Sharp Dissectors - includes biopsy forceps and tough tissues (fascia, muscles, uterus, punches, curettes (has a sharp edge with loop, ring or breast) scoop on the end), snares (loop of wire may be put around a pedicle to dessert tissue such as a tonsil Wire scissors (stitch)- have short, heavy blades; used instead of suture scissors to GRASPING AND HOLDING cut stainless steel scissors; heavy wire Tissue Forceps cutters are used to cut bone fixation wires. - used often in pairs, to pick up or hold soft tissues and vessels O o teeth is Dressing / Bandage scissors - used to cut drains and dressings and to open items such as plastic packets - bandage is used to cut the uterus and umbilicus during CS operation Thumb Forceps/smooth, non- toothed forceps - used to hold delicate tissues; are tapered with serrations at the tip; maybe straight or angled, short or long and delicate or heavy. GUMAPAC, E., SOLIS, L. 17  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Toothed/ pick up/ Rat tooth Forceps- have a single tooth on one side that fits between two teeth on the opposing side; use to hold tough tissues Stone Forceps - Used to grasp calculi such as kidney stones or gallstones either curved or straight forceps have blunt loops or cups at the end of the jaw Allis Forceps- has a scissor action. Each jaw curves slightly inward with a row of teeth at the end; o holds tough tissue gently but securely Tenaculum - curved or angled points on the ends of the jaw penetrate tissue May have single tooth or multiple teeth (dilatation & curettage) Babcock Forceps- maybe used in fallopian tube The end of each jaw is rounded to fit around a structure or to grasp tissue without injury. GUMAPAC, E., SOLIS, L. 18  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS CLAMPING AND OCCLUDING Hemostatic forceps Usually have two opposing serrated jaws that are stabilized by a box lock and controlled by ringed handles When closed, the handles remain locked on ractchets most commonly used surgical instruments used primarily to clamp blood vessels either straight or curved slender Bone Holders - includes vice-grip, pliers and other types of heavy holding forceps use to stabilize the bone Crile / Stet / Tag Forceps- for shallow layers of tissues GUMAPAC, E., SOLIS, L. 19  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Kelly Forceps: for deep layers of tissues or cavity Kocher or Ochsner Forcep- usually used in colon surgery; for placing cardiac wires when performing sternotomy Crushing Clamps- used to crush tissues or clamp blood vessels; - fine tips are used for small vessels and structures while longer and sturdier jaws are needed for larger Non-crushing Vascular Clamps vessels, dense structures and thick tissues used to occlude peripheral or major blood vessels temporarily minimizes tissue trauma jaws, either straight curved or S shaped, have opposing rows of finely GUMAPAC, E., SOLIS, L. 20  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Deaver retractor -for deeper retraction EXPOSING AND RETRACTING Handheld or Non self-retaining Retractors usually used in pairs and held by the first or second assist; Some have blades on one end, either curved or angled, dull or sharp while some have blade on both ends used by the assistant surgeon used to pull soft tissue and muscle aside to expose surgical site Army-navy retractor - abdominal operation Harrington Retractor - to protect the organ; minimizes the trauma GUMAPAC, E., SOLIS, L. 21  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS Single end richardson retractor - used in cesarean keep the device open, while others section have wings to secure the blades; some holding devices have 2 or more blades that can be inserted to spread the edges of incision and hold them apart Balfour abdominal retractor - Bladder retractor Goulet retractor - intended for the abdominal procedure SUTURING AND STAPLING Needle Holder used to grasp and hold curved surgical needles Malleable ribbon retractor (straight, resembles hemostatic forceps but thin, bendable) the basic difference is the jaws has a short, sturdy jaws for grasping a needle without damaging it or the suture material. the size of the needle holder should match the size of the needle either long or short, with serrations on jaws, some are non Self – retaining Retractors May have shallow or deep blades, some have ratchets or spring locks to GUMAPAC, E., SOLIS, L. 22  NUR 1213: MSN- PAIN AND SURGERY NOVEMBER 2021 | FEU LECTURES, HANDOUTS 7 PPTs | GUMAPAC, SOLIS the higher the number, t