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					Operating Room Technique
              OBJECTIVES
At the end of orientation, the student is
    expected to:
1. Recall the implications of legal and ethical
    issues in operating room.
2. Explain the functions of nurses during
    perioperative patient care.
3. Discuss methods of sterilization.
4. Discuss the principles of asepsis and
    sterile technique.
5. Recall the different methods of anesthesia
  and the nursing responsibilities.
6. Return demonstrate the opening of a sterile
  pack, wearing of gown and gloves.
8. Return demonstrate the serving of the gown
  and gloves to the partner.
9. Return demonstrate the insertion of the
  blade and needle into its holders.
              Clinical Focus
• Care of a client from all stages of
  development encompassing nursing activities
  that assist the surgical client in a conscious or
  unconscious state following the International
  Standards in Patient Care and Safety by the
  Joint Commission International.These
  activities are directed toward providing
  continuity of care through preoperative,
  intraoperative and postoperative evaluation
taking into consideration the different phases
of the nursing process and core competencies
such as:
legal responsibilities, collaboration with other
health teams, ethico-moral responsibility,
research, quality improvement, safe and
quality nursing care, management of
environment and resources, communication,
health education, personal/professional
growth and development.
 Legal and Ethical Issues in O.R.
1. Liability
    a. Negligence
    b. Malpractice
2. Borrowed Servant Rule
    the surgeon is liable for acts of team
    members only when he or she has the right
    to control and supervise the way in which
    a perioperative caregiver performs the
    specific acts
3. Doctrine of a Reasonable Man
4. Doctrine of Res Ipsa Loquitor
5. Doctrine of Respondeat Superior
6. Assault and Battery
7. Invasion of Privacy
8. Abandonment
9. Consent
     International Standards in Patient
        Care & Safety Goals By JCI

Goal I        Identify Patients Correctly
Goal II       Improve Effective Communication
Goal III      Improve the Safety of High-alert
              Medications
Goal IV       Eliminate wrong-site, wrong
              patient, wrong-procedure surgery
Goal V        Reduce the risk of health care-
              associated infections
Goal VI   Reduce the risk of patient
          harm resulting from falls
    Effective Communication

I   Introduction
S   Situation
B   Background
A   Assessment
R   Recommendation
       Recommended Practices
1.   Identification of patient.
2.   Identification of surgical site.
3.   Protection of personal property.
4.   Observation of patient.
5.   Positioning of the patient.
6.   Aseptic and sterile techniques.
7.   Accountability of accurate counts.
8.   Use of equipment.
9. Prevention of skin injury.
10. Administration of drugs.
11. Monitoring of patient.
12. Preparation of specimens.
13. Patient teaching.
Perioperative Patient Care Team
      and their functions
1. Nonsterile team
  – Anesthesiologist
  – Circulator
  – Others
2. Sterile Team
  – Surgeon
  – First, second assistant
  – Scrub person
Arrangement of sterile field, team
members and unsterile equipment
   Anesthesia     Anesthesio
    machine         logist

       Intern
                               1st Assist
                                 Surg

       Main       Draped
                   patient
      Surgeon
                    and         2nd Assist
                 operating
                   table
       Scrub                    Student
       Nurse     Mayo
                 table


          Instrument or Back table
Operating Room set-up
          Types of Anesthesia

1.   General anesthesia
2.   Balanced anesthesia
3.   Local and regional block anesthesia
4.   Spinal or epidural anesthesia
        Methods of general anesthesia
1. Inhalation – facemask,
     laryngeal mask or
     endotracheal tube
   –   Nitrous oxide, halothane
       (Fluothane), Enflurane
       (Ethrane), Isoflurane
       (Forane), Desflurane
       (Suprane), Sevoflurane
       (Ultane)
2. Endotracheal
   administration
2. Intravenous
   –   Propofol (Diprivan),
       Ketamine
       Hydrochloride
       (Ketalar, ketaject)
       Local and Regional Anesthesia
1. Local anesthesia
   1.1. Topical application
   1.2. Topical infiltration
2. Nerve block
3. Epidural anesthesia
Stages of anesthesia
     Narcotic reversal (Narcotic
            Antagonist)

1.   Naloxone hydrochloride (Narcan)
2.   Flumazenil (Romazicon)
3.   Prostigmin
4.   Atropine Sulfate
                          Sterility
Methods of Sterilization
1. Thermal (physical)
   –   Steam under pressure/moist heat
   –   Hot air / dry heat
2. Chemical
   –   Ethylene oxide
   –   Formaldehyde gas and solution
   –   Hydrogen peroxide plasma/vapor
3. Radiation (physical)
   –   Microwave (nonionizing)
   –   X-ray (ionizing)
     Principles of Sterile Technique
1. Only sterile items are used
   within the sterile field.
2. Sterile persons are gowned and
   gloved.
3. Tables are sterile only at table
   level.
4. Sterile persons touch only
   sterile items or areas, while
   unsterile persons touch only
   unsterile items or areas.
5. Unsterile persons avoid reaching over the
  sterile field, while sterile persons avoid
  leaning over an unsterile area.
6. The edges of anything that encloses sterile
  contents are considered unsterile.
7. The sterile field is created as close as
  possible to the time of use.
8. Sterile areas are continuously kept in view.
9. Sterile persons keep well within the sterile
  area.
10. Sterile persons keep contact with sterile
      areas to a minimum.
11. Unsterile persons avoid sterile areas.
12. Destruction of the integrity of microbial
      barriers results in contamination.
13. Microorganisms must be kept to an
      irreducible minimum.
Organizational Chart
     Medical Director
    Dr Bejamin Alimurong

                                Nursing Director
                               (Dr. Furio, Malou)

   Asst. Nsg Director
   Mr. Gabriel, Tonette

                               Operative Department
                                 (Ms. Lamasan)

      Unit Manager
   (Ms. Manolo, Marian )

                           Staff Nurses

Nursing Aid, Orderlies, etc.
                  Policies
1. Schedule = 1st Shift 6:00 am ; 2nd Shift 12:00 PM-
    8:00pm
2. Attire (Ladies and Gentlemen)
    a. Before and after duty = CHN uniform
       and black shoes
    b. Washable shoes
    c. OR uniform
3. Requirements:
    a. Paraphernalia – except sphymo
    b. Completion form/ small notebook
4. Signing of cases.
  a. Before your C.I. will sign your OR cases,
    let your scrub nurse sign your case. NO
     SIGNATURE OF SCRUB NURSE NO
     CASE.
  b. Make sure you have several photo copies
       of your completion form to avoid
       losses.
5. Before you assist the operation, assess first
   your patient by knowing the data from the
   chart.
6. Operational definition of OR cases:
    a. Major
       = any case that requires opening of
         the cavity example: thoracic,
         abdominal.
       = operating an eye ball, middle and inner ear
       = amputation/ removal of body part/s
         example: breast, thyroid, three or
         more fingers or toes.
       = wound dressing of more than 50%
         body surface
       = Grafting ex. A.V.
b. Minor
   = excision of small tumors
   = wound dressing of less than 50%
   = amputation of less than 2 fingers /toes
   = operating eyelids
   = breast augmentation
   = making a fistula
   = vein stripping
        Course Requirement

Ward Class regarding cases assisted.
  Format:
  a. Definition of Medical diagnosis of the
    case assisted.
  b. Pathogenesis of the medical diagnosis.
  c. Complications of the medical diagnosis.
d. Problems brought about by the medical
   diagnosis.
e. Surgical intervention
   Care of the patient: Pre, intra and post
Pre Operation
 From time the patient was received from
 Ward nurse up to the time the patient was
 transferred to Operating table
Intra Operation
 From the time the patient was inducted with
 anesthesia up to the time patient was
 endorsed to RR
Post Operation
 From endorsement of OR nurse to RR nurse
              Evaluation

1. Observation of performance
2. Quiz
3. Ward Class
     Evaluation of Ward Class
1. Content (50%)
  – Description of the disease
  – Pathophysiological/ Physiological discussion
    of patient’s needs and/ problems.
  – Surgical interventions – ante, intra and post
    care
2. Presentation (50%)
  – Mastery of Subject Matter
  – Critical Perception

				
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posted:4/24/2010
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