Roles and Responsibilities; Aseptic technique; Cholecystectomy and Appendectomy(1).pdf

ROLES AND RESPONSIBILITIES OF THE SURGICAL TEAM PREPARED BY: Angel Rose C. Garanganao BSN 4-A Group 2; PCI  THE SURGICAL TEAM -Personnel performing direct patient care during a surgical procedure in both the sterile and non-steril...

ROLES AND RESPONSIBILITIES OF THE SURGICAL TEAM PREPARED BY: Angel Rose C. Garanganao BSN 4-A Group 2; PCI  THE SURGICAL TEAM -Personnel performing direct patient care during a surgical procedure in both the sterile and non-sterile positions. STERILE 1. THE Surgeon MEMBERS First Assistant 2. to the Surgeon The Scrub 3. Assistant  THE Surgeon He/she is a licensed physician (MD), osteopath (DO), Oral surgeons (DDS or DDM) Responsible for determining the pre- operative diagnosis Performs the surgical procedure & heads the surgical team. The primary decision maker regarding surgical technique to use during the procedure Explanation of the risks and benefits Obtains informed consent and the postoperative management of the patient’s care.  First Assistant to the Surgeon May be a resident, intern, physician’s assistant or a perioperative nurse Practice under the direct supervision of the surgeon Responsible for handling tissue, providing exposure at the operating field, suturing, providing homeostasis & other tasks requested by the surgeon to facilitate speed while maintaining quality during the procedure. Needs to be aware of the objectives of the surgery, needs to have the knowledge & ability to anticipate needs & to work as a skilled team member, and needs to be able to handle any emergency in the OR.  The Scrub Assistant may either a nurse or a surgical technician Activities include: – performing a surgical hand scrub, – setting up the sterile tables, – preparing sutures, ligatures, sponges & special equipment – maintaining the sterility of the surgical field through aseptic practices. The Scrub Assistant Assist the surgeon & surgical assistants during the procedure by anticipating the instruments that will be required As the operation is about to close, the scrub person & the circulator counts all needles, sponges, & instruments to be sure all are accounted for & not retained as foreign body in the patient. Tissue specimen obtained during the surgery must be labeled by the scrub nurse/person & sent to the laboratory by the circulator  Anesthesiologist UNSTERILE 1. and Anesthetist MEMBERS 2. Circulating Nurse  Anesthesiologist and Anesthetist ANESTHESIOLOGIST – is a physician who specializes in the administration & monitoring of anesthesia while maintaining the overall well being of the patient. ANESTHETIST-a qualified healthcare professional who administers anesthetics Interview & assess the patient before surgery, selects the anesthesia, administers it, intubates the patient if necessary, manages any technical problems related to the administration of the anesthetic agent. Supervises the patient's condition throughout the surgical procedure; Reassess. –During surgery: monitors the patient’s blood pressure, pulse & respirations as well as the ECG, blood oxygen saturation level, tidal volume, Blood Gas level, Blood pH, alveolar gas concentrations & body temperature.  CIRCULATING NURSE Ensures patient consent, safety and comfort throughout the procedure. Manages the operating room setup and supplies, coordinating with the surgical team. Records all aspects of the surgical procedure, including patient information and equipment used. Monitors aseptic practices to avoid breaks in technique while coordinating the movement of related personnel, as well as implementing fire safety precautions. In charge of the instrument and sharps count and communicating relevant information to individual outside of the OR, such as family members. CIRCULATING NURSE INITIAL COUNTING: “Excuse me surgical team, initial count complete.” FINAL COUNTING: “Excuse me surgical team, all instruments, sharps, and sponges are all counted, checked, and complete.” REPEAT IT IF THE DOCTOR DID NOT ACKNOWLEDGE  Paraprofessional / Ancillary Positions 1. Sterilization, processing & distribution (S.P.D.) technicians (instrument room aids) 2. Orderlies/nursing assistants 3. Environmental services personnel 4. Clerical personnel Provide effective barrier that prevent dissemination of microorganisms to patient; Prohibits contamination of surgical wound & sterile field by direct contact; Protects personnel from infected persons ASEPTIC TECHNIQUE -Practice that restricts microorganism in the environment, equipment and supplies. Controls the environment. Goals 1. Each aseptic practice is to optimize primary wound healing 2. Prevent surgical infection 3. Minimize length of recovery from surgery  PRINCIPLES OF ASEPTIC TECHNIQUE 1. All objects used in a sterile field must be sterile. 2. A sterile object becomes non-sterile when touched by a non-sterile object. 3. Sterile items that are below the waist level, or items held below waist level, are considered to be non-sterile. 4. Sterile fields must always be kept in sight to be considered sterile. 5. When opening sterile equipment and adding supplies to a sterile field, take care to avoid contamination.  PRINCIPLES OF ASEPTIC TECHNIQUE 6. Any puncture, moisture, or tear that passes through a sterile barrier must be considered contaminated. 7. Once a sterile field is set up, the border of one inch at the edge of the sterile drape is considered non-sterile. 8. If there is any doubt about the sterility of an object, it is considered non-sterile. 9. Sterile persons or sterile objects may only contact sterile areas; non-sterile persons or items contact only non-sterile areas. 10. Movement around and in the sterile field must not compromise or contaminate the sterile field.  Hand washing with soap  HAND WASHING WITH STERILIUM  HAND SCRUBBING  HAND SCRUBBING  APPENDECTOMY and CHOLECYSTECTOMY  APPENDECTOMY - a surgical procedure to remove the appendix, typically performed when the appendix is inflamed or infected, a condition known as appendicitis. Purpose: This surgery is often an emergency procedure to prevent complications such as a ruptured appendix, which can lead to peritonitis (infection of the abdominal cavity)  APPENDICITIS Inflammation of the appendix that prevents mucus from passing into the cecum. Appendix- A narrow, finger-like pouch that projects from the cecum; located at the right lower abdomen Causes: > Obstruction of the appendix by fecalith, foreign bodies or infection >Other causes are low fiber diet and high intake of refined carbohydrates.  APPENDICITIS Signs and Symptoms: -Sudden pain starting around the navel and shifting to the lower right abdomen (abdominal pain), nausea, vomiting, fever, and loss of appetite; rebound tenderness; rigid abdomen. Diagnostic Test -Complete Physical Exam; Laboratory & X-ray findings. - CBC demonstrates an elevated WBC Ò - Leukocyte count may exceed 10,000 cells/mm3 - Neutrophil count exceed 75% ;Abdominal X-ray films; Ultrasound studies & CT scan may reveal a lower quadrant density or localized distention of the bowel  APPENDICITIS Management: 1. Bed rest 2. NPO 3. Relieve pain (cold application over the abdomen) 4. Avoid factors that increase peristalsis, thereby rupture: >Heat application over the abdomen >Laxative >Enema 5. IVF therapy to maintain fluid – electrolyte balance 6. Antibiotic therapy 7. Analgesic can be administered after diagnosis is made. 8. Surgery (Appendectomy) spinal or general anesthesia  CHOLECYSTECTOMY a surgical procedure to remove the gallbladder. The gallbladder is a small organ located under the liver that stores bile, a digestive fluid produced by the liver. Purpose: This surgery is commonly performed to treat gallstones that cause pain, infection, or other complications such as cholecystitis (inflammation of the gallbladder) and cholelithiasis.  CHOLELITHIASIS - the formation of gallstones within the gallbladder. These stones can vary in size and number and may or may not cause symptoms. Gallbladder is located at the upper right part of the abdomen, beneath the liver. Causes: Gallstones form when there is an imbalance in the substances that make up bile, such as cholesterol or bilirubin. Symptoms: Often asymptomatic, but can cause biliary colic (sudden, severe pain in the upper right abdomen), nausea, vomiting, and jaundice if a stone obstructs the bile duct.  CHOLELITHIASIS Diagnostic tests: Ultrasound: First-line imaging to detect gallstones and inflammation. HIDA (hepatobiliary iminodiacetic acid) Scan: Assesses gallbladder function by tracking the flow of bile. MRCP (magnetic resonance cholangiopancreatography): Detailed imaging of the bile ducts. Blood Tests: Check for infection, inflammation, and liver function abnormalities³.  CHOLECYSTITIS Management: 1. Analgesics to relieve pain. 2. Antibiotics: For infection control. 3. Dietary Adjustments: Low-fat diet to reduce symptoms⁴. Nursing Management -1. Monitor Vital Signs: Especially for signs of infection or complications. 2. Pain Assessment: Regularly assess and manage pain. 3. Patient Education: Inform about dietary changes and signs of complications⁴. THANK YOU!