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HEALTH – state of complete physical, mental and social well being and not merely the
absence of a disease or infirmity (WHO 1948)
- viewed as a dynamic, ever changing condition that enables people to function at
an optimal potential at any given time
- ideal health status is one in which people are successful in achieving their full
potential, regardless of any limitations they might have
- represents successful adaptation to stress – ability to adapt to internal and external
environment
ETIOLOGIC AGENTS
• biologic – bacteria, viruses
• physical – trauma, burns, radiation
• chemical – poison, alcohol
• nutritional excesses or deficits – under/over nourishment
PATHOGENESIS – sequence of cellular and tissue events that take place from the time
of initial contact with an etiologic agent till the ultimate expression of diseases
- time of contact until the time that signs and symptoms are evident
- describes how the disease process evolves
*you always go back to the cell because it is the smallest unit in the body
PHYSIOLOGY – deals with the normal functions of the body
• everything boils down to the immune system or how your body responds to stress
STRESS – defined as a state resulting from a change in the environment that is perceived
as threatening to homeostasis
- stimulus is known as “stressor”
EFFECTS OF STRESS
1. adaptive – adaptation or adjustment to change or coping with change
- you are able to overcome and have a positive results
- lead to positive effective/effective – health
agents causing injury acts at the cellular level by damaging or destroying the following:
1. integrity of the cell membrane necessary for ionic balance
2. the ability of the cell to transform energy – e.g. stressor will make you lose your
confidence. Therefore if you lose confidence, you would stay “mumoy” in one
side.
3. the ability of the cell to synthesize enzymes and other necessary proteins
4. the ability of the cell to grow and reproduce (genetic integrity) – can be related to
ABT
CILIA – hair-like structures lining the upper respiratory tract mucous membrane
- protect lungs by trapping mucus, pus, dust, and foreign particles
- push trapped particles up the pharynx with wavelike movements
GASTRIC JUICES – found in the stomach’s highly acidic (pH of 1-5) acidic
environment destroys most organisms that enter the stomach
LYZOSYMES – bactericidal enzymes present in WBC and most body fluids (tears,
saliva, and sweat)
- dissolve the walls of bacteria
PHAGOCYTES – cells that ingest and destroy bacteria, damaged or dead cells, cellular
debris, and foreign substances
DIFFERENT PHAGOCYTES:
• LEUKOCYTES (WBC) – primary cells, protect against infection and tissue
damage
- 5 types:
o neutrophils – bacteria and small particles
o monocytes – become macrophages ; tissue debris and large particles
o lymphocytes – functions: antigen recognition and antibody production
o basophils – respond to inflammation from injury
o eosinophils – destroys parasites and response in allergic reactions
- increased during allergic reactions or infestation
• MACROPHAGES – mature monocytes
2. LYMPHOID ORGANS
a. Thymus – vital to the development of the immune system
b. Bone marrow – produces leukocytes, which is one of the products of
blood
- problems in bone marrow can, later on, cause leukemia
c. Spleen
d. Tonsils
e. Intestinal lymphoid tissue
f. Lymph Nodes
IMMUNITY – resistance to a disease that is provided by the immune system
- ability of the body to protect itself from disease
IMMUNE RESPONSE – involves a complex series of interactions between the
components of the immune system and the antigens of foreign pathogen
TYPES OF IMMUNITY
1. INNATE IMMUNITY – immunity you are born with involving barriers
that keep harmful materials form entering the body
- forms the first line of defense in the immune response
- e.g. cough reflex, enzymes in the tears, mucus, skin stomach acid
CONCEPT OF PAIN
“Pain is whatever the experiencing person says it is, existing whenever the
experiencing person says it does.” By Margo McCaffery, a well-known pain consultant
PAIN
- fifth vital sign
- most important protective mechanism
- strong motivator for action
- one of the body’s most important adaptive mechanisms
- protective mechanism or a warning
o congenital analgesia – rare genetic disorder where the individual is unable
to feel pain
TYPES OF PAIN:
I. PHASIC
A. Acute Pain – has identifiable cause and occurs soon after and injury
- temporary and subsides as healing takes place as chemical
mediators causing pain are removed
- onset: sudden and slow
- intensity: varies from mild to severe
- severe acute pain activates sympathetic nervous system causing
diaphoresis, increased RR, PR and BP
- usually lasts until 6 months
- classifications:
o SOMATIC – superficial (comes form the skin or close to
the surface of the body)
o VISCERAL – pain in the internal organs, abdomen or
skeleton; radiates or referred
o REFERRED – pain present in an area removed or distant
form point of origin
- supplied by the same spinal segment as actual site since
skin has more receptors, pain is felt
B. CHRONIC PAIN – persistent, lasts beyond expected healing phase
- non-protective; related to tissue damage, inflammation or injury of
the NS
- lasts for more than 6 months
NEUROPHYSIOLOGICAL TRANSMISSION OF PAIN
“ Pain is the result of transduction, transmission, perception and modulation of
painful (nociceptive) impulses.”
• STAGE 2 – TRANSMISSION
- transfer electrical impulses to the CNS
• STAGE 3 – PERCEPTION
- awareness of pain that is dynamic, changing in response to person’s
development, environment, disease or injury
- can be brief, prolonged, or even permanent
• STAGE 4 – MODULATION
- also called adjustment
- refers to internal and external ways of reducing/increasing the pain
Receptor molecules at the tip of nociceptive primary afferent neurons (free nerve
endings)
Electrical energy (action potential) travels (progresses form the injury site) to the
spinal cord
Thalamus – acts as relay station sending pain impulses to different areas in the brain
for processing
Perception of pain
Somatosensory cortex – identifies location and intensity
Associated cortex – determines how an individual interprets the meaning
PAIN TOLERANCE – the duration and intensity of pain that a person tolerates
before openly expressing
PAIN THEORIES:
1. SPECIFICITY THEORY – intensity of pain is directly
related to the amount of associated injury – DesCartes, 17th century
- finger prick against cutting off on one hand
- more tissue injury, more painful
- useful in specific injuries or acute pain, but not with chronic or cognitive and
psychologic contributions to pain
JCAHO
- a private sector US-based not-for-profit organization that sets standards for
accreditation of health institutions.
- helps to improve the quality of patient care by assisting international health care
organizations, public health agencies, health ministries and others evaluate,
improve and demonstrate the quality of patient care and enhance patient safety
and to demonstrate quality.
ASSESS:
Ia. History
Ia1. Pain characteristics
• onset and duration
• location
• intensity
• quality
• relieveing factors
• aggravating factors
II. PLAN/IMPLEMENTATION
1. Establish therapeutic relationship
2. teach patient about pain relief
3. reduce anxiety and fears
4. provide comfort measures
5. manage pain
II. PHARMACOLOGIC
A. ANALGESIS
a. Nonopioid (nonnarcotic) – used to treat pain that’s either nociceptive
(injury receptors) or neuropathic (nerves)
• effective in somatic pain like joints and muscle pain
• controls pain, decreased inflammation and fever
• e.g. acetaminophen, NSAID’s, salicylates
b. opioids (narcotics) – w/ primary effects in the CNS
i. opioid agoinist – treat moderate pain w/o loss of consciousness
• e.g. Codeine, Fentanyl
ii. mixed agonist – antagonist – decrease risk of toxic effect and
dependency
• e.g. nalbuphine
iii. opioid antagonist – blocks opioid effect
B. METHODS OF ADMINISTRATION
a. Topical
b. Oral
c. IM
d. IV
e. PCA - Patient Controlled Analgesia
f. Conscious Sedation
g. Intranasal
h. Epidural
C. SURGICAL INTERVENTIONS
1. RHIZOTOMY – selective destruction of the dorsal root of the spinal nerve
2. NERVE BLOCK OR CORDOTOMY – unilateral or bilateral severe nerve fibers
in the spinal cord
3. NEURECTOMY – resection of one or more peripheral branches of the cranial or
spinal
4. SYMPATHECTOMY – destroys nerves in the SNS
• performed to increase blood flow and decrease long-term
pain in certain diseased that cause narrowed blood vessels
• can also be used to decrease excessive sweating
• this surgical procedure cuts or destroys the sympathetic
ganglia, which are collections of nerve cell bodies in clusters along the
thoracic or lumbar spinal cord
PERIOPERATIVE NURSING
• the scrub nurse is always in front of the surgeon
DISADVANTAGES OF OUTPATIENT
a. less time for rapport
b. less time to assess, evaluate, teach risk of potential complications
ADVANTAGES OF OUTPATIENT
a. low cost
b. low risk of infection
c. less interruption of routine
d. less stress
PREOPERATIVE PHASE
- begins when the decision for surgical intervention is made and ends with the
transfer of the patient to the operating table
2. PRESENCE OF PAIN
3. NUTRITIONAL STATUS – client who is well nourished is better prepared to
handle surgical stress
4. FLUID AND ELECTROLYTE BALANCE – dehydration and hypovolemia
(fluid volume deficit) predispose a client to complications during and after
surgery
- electrolyte imbalance also increased operative risk
5. PRESENCE OF INFECTION
6. CARDIOVASCULAR FUNCTION – client should be assessed for elevated BP;
slow, rapid or irregular pulse; edema; cold cyanotic extremities; weakness; and
shortness of breath
ANTICOAGULANTS
Heparin sodium • cause clotting abnormalities which
Warfarin sodium results to hemorrhage
Aspirin
NSAIDS
ANTIBIOTICS w/c is combined with other • increase postoperative respiratory
muscle relaxants depression
TRANQUILIZERS • decrease blood pressure thus
increase the risk of shock
• potentiates the effects of
narcotics and barbiturates
THIAZIDE DIURETICS • can create potassium depletion
STEROIDS • cause hypofunction of the adrenal
cortex thus impair physiologic
response to stress of anesthesia and
surgery
• anti-inflammatory effect delay
wound healing and increase risk of
infection
MONOAMINE (MOA) INHIBITORS • can cause hypertensive crisis when
combined with anesthetic agents
ANTIPARKINSON DRUGS • cause hypotension or hypertension
when combined with anesthetic
agents
STREET DRUGS AND ALCOHOL • increase tolerance to narcotics
ABUSE
HYPOGLYCEMICS • require dosage alteration and close
monitoring of blood sugar
HERBS
GARLIC • inhibits platelet aggregation
• may potentiate warfarin
• increase INR and PT
• cause GI upset
• decrease blood glucose level
GINGER • anticoagulant action
• large doses – increase risk of
bleeding and dysrhythmias
GINSENG • tachycardia and hypertension, esp.
w/ the use of cardiac stimulants
• inhibit platelet aggregation
• decrease warfarin effectiveness
• lowers blood glucose
• potentiate effects of digoxin
• assess ginseng abuse syndrome:
hypotension, hypotonia and edema
GINGKO BILOBA • prolongs bleeding time
• increase anticoagulant effect
• subconjunctival hemorrhage and
spontaneous subdural hemorrhage
9. ALLERGIC REACTIONS
PSYCHOLOGIC RESPONSE
1. ANXIETY
POTENTIAL SOURCE OF ANXIETY
a. anticipation of impending surgery
b. pain and discomfort
c. changes in body image or function
d. role changes
e. loss of control
f. family concerns
g. potential alterations in lifestyles
2. FEAR
- client’s respond differently to fear – some respond by becoming silent and
withdrawn, childish, belligerent, evasive, tearful and clinging
SPECIFIC FEARS
a. diagnosis of malignancy
b. anesthesia
c. dying
d. pain
e. disfigurement
f. permanent limitations
ASSESSMENT OF PREOPERATIVE ANXIETY
SUBJECTIVE DATA
1. understanding of proposed surgery
a. site
b. type of surgery
c. information from surgeon regarding extent of hospitalization,
postoperative limitations
d. preoperative routines – what will happen postoperatively?
- let px. know that after surgery, px. will be staying in RR
e. postoperative routines
f. tests
2. previous surgical experience
a. type, nature
b. time interval
3. any specific concerns or feelings about present surgery
4. religion, meaning for patient
5. significant others
a. geographic distance
b. perception as source of support
6. changes in sleep pattern
OBJECTIVE DATA
1. speech patterns
a. repetition of themes
b. change topic
c. avoidance of topics related to feelings
2. degree of interaction with others
3. physical
a. pulse and respiratory rates
b. hand movement and perspiration
c. activity level
d. voiding frequency
PREOPERATIVE ASSESSMENT
• HISTORY TAKING - plays a large part in determining the degree of preoperative
and postoperative anxiety the client experiences
- allows the nurse to:
o Establish rapport with client
o Begin psychosocial assessment
o Reassure client and significant others and answer general questions about
surgery, the health-care facility etc.
- Specific information to obtain during reoperative history concerns:
o Previous surgery and experience with anesthesia
o Responses of significant others to previous surgery and anesthesia
o Whether the client had any serious illness
o Previous and current medication (prescribed/over-the-counter)
o Allergies and reactions and dietary restrictions
o Alcohol, nicotine or recreational drug use
o Current symptoms and discomforts
o Occupation
o Religious affiliation
o Significant others
o Whether client has question about the surgery
o Chronic illnesses such as arthritis, migraines, backpains
• PHYSICAL EXAMINATION
PREOPERATIVE DIAGNOSTIC TESTS
1. Serum potassium
2. Hemoglobin
3. Serum sodium
4. Hematocrit
5. Serum chloride
6. Prothrombin time
7. Glucose
8. Partial thrombo-plastin time
9. Blood Urea
10. Nitrogen
11. Chest X-ray
12. Electrocardiogram
13. Creatinine
PREOPERATIVE TEACHING
Basic areas that must be covered:
1. deep breathing and coughing exercise
2. turning and extremity exercises
3. pain control methods that will be offered – splinting, DBE, medications
4. postoperative equipment
• teach coughing and breathing exercise, splinting of incision, turning side to side
on bed and leg exercises: explain the importance in preventing complications;
provide for opportunity for return demonstration
COUGHING EXERCISE
• may be done sitting or lying down
• splinting the incision minimizes pressure and helps control pain when coughing
• client is instructed to interlace fingers across the incision to and hold them when
coughing
• a small pillow or folded towel may be held over the incision to facilitate splinting
LEG AND ANKLE EXERCISES – prevent deep vein thrombosis and embolism
POSTOPERATIVE EQUIPMENT
a. wound drain and suction devices
b. penrose drain – used for post AP, ruptures where there are discharges
- acts as a route for all discharges to pass through so that it will be
absorbed by the gauze
- tied to the skin
c. Jackson-Pratt drain or reservoir
d. T-tube drain
e. Hemovac drainage system
PHYSICAL PREPARATION
1. Preparing the Skin
2. Preparing the GIT – some surgery require special bowel preparation (enema)
3. Preparing for anesthesia
4. Promoting rest and sleep
• And adult sign their own consent unless they are unconscious or mentally
incompetent. A parent or legal guardian usually provides consent for a minor
• Emancipated minors, that is, minors who are married or earning their own
livelihood and retaining the earnings can sign their own consent
• If no legal guardian can be contacted, two phsycians who are not associated with
the procedure amy make the decision for surgical intervention
• Illiterate patients must understand the verbal explanation of the consent process
and may sign the form with an X_ . This process must be witnessed by two
persons.
• The patient has the right to refuse surgical intervention
• Px. has the right to withdraw consent at anytime before the procedure is that
decision is reached voluntarily
SITE MARKINGS
Site verification is required for all procedures that involve laterality, multiple structures
or multiple level.
Site is marked with a permanent marker that is visible after the
skin is prepped and draped
Operating surgeon should mark the site with his or her initials
before the patient enters the OR suites
Site is marked with patient participation (verbal confirmation or
pointing)
A patient has the right to refuse to mark the site. Each institution
will determine policy for these situation
INTRAOPERATIVE PHASE
Intraoperative Nursing
- 2nd Phase of the Perioperative Period
- OR Nursing
- OR table to PACU
NURSING ACTIVITIES
• Psychological Support – emotional well-being
• Physiologic support - assessment of patient status
• Maintenance of patient safety - positioning, maintain asepsis, & control of
surgical environment
PERIOPERATIVE TEAM
a. Preoperative team
Pre-op nurse
Physician, nurse practitioner or physician assistant
Clinical nurse specialist – Advanced Practice Nurse, a MSN holder
w/ Major in their field of specialty
b. Surgical/Operating Team
Sterile
Unsterile
STERILE MEMBERS
1. SURGEON
• The team leader & main decision maker
• Performs the operative procedure safely and correctly
• Performed draping of the patient and checks all other needed for
the produre
• Secures dressing In place
• Assist in moving the patient to PACU
• Do the post operative orders
2. ASSISTANT TO THE SURGEON
• Assist to the surgeon in operative procedure
• Assist in positioning the patient and draping
• Assist in closing the incision and dressing
• Assist in moving patient to pacu
• MAY DO POST OPERATIVE ORDERS.
3. 2ND ASSISTANT TO THE SURGEON
• Assist the surgeon and the assistant surgeon
-suctioning and retracting
-cutting sutures
-may do suturing
• Assist in positioning, draping and dressing
• Assist in moving patient to pacu.
4. SCRUB NURSE/SURGICAL TECHNICIAN
• Gathers all equipment for the procedure
• Prepares supplies & instruments using sterile technique
• Maintain sterility w/in the sterile field
• Set up back table, mayo tray and prep tray
• Handles instruments & supplies during surgery
• Do the sponge count and instrument count with the circulating
nurse before & after surgery
• Maintain accurate count
• Assist the surgeon through out the operation with proper
anticipation
• Assist in draping and securing the suction and the cautery machine
• Responsible for cleaning patient before transferring to the pacu
• Responsible in cleaning up the back table and instrument
• Anticipates the needs of the sterile team
• Establishes baseline counts with circulating nurse
5. CERTIFIED REGISTERED NURSE 1ST ASSISTANT
UNSTERILE MEMBERS
- work outside the sterile area
SENSE OF HEARING – last sense lost and first sense gained in anesthesia
CLOTHING ATTIRE
• basic scrub suit
• shoes with shoe cover
4. RESTRICTED AREA
• operating rooms
• sub-sterile areas connected to the OR’s (typically houses the
autoclave, scrub sinks and blanket warmers)
• where a sterile area/field is open
CLOTHING ATTIRE
• sterile gown and sterile gloves
• mask
SURGICAL SUITE ENVIRONMENTAL HAZARDS
1. PHYSICAL – back injury, fall, noise, pollutions, radiations, electricity fire
2. CHEMICAL – anesthetic gases, toxic fumess antineoplastic drugs and cleaning
agents
3. BIOLOGIC – patients as a host for or source of pathogenic microorganism,
infectious waste, surgical plumes, latex sensitive, cuts and needle prick
SURGICAL ATTIRE
• provide effective barrier that prevent dissemination of microorganism to patient
• prohibits contamination of surgical wound and sterile field by direct contact
• protects personnel from infected persons
PROTECTIVE ATTIRE
• objective follows the principles of the “UNIVERSAL PRECAUTION”
- precaution that protects health care workers form contact with blood and
body fluids of all patients not just those diagnosed or suspected of being
infected by Hepa B, HIV or other blood borne pathogens
- minimum precaution for all invasive procedures
INVASIVE PROCEDURES – entry into the tissue, organs or body cavities in the OR,
DR, ER physician or dentist office, radiologist department, clinal laboratory
- attire:
1. APRON – should be fluid resistant
2. EYE WEAR/FACE SHIELD
3. GLOVES
a. STERILE GLOVES – used on a sterile procedure
b. CLEAN GLOVES – only used for unsterile
procedures (e.g. washing instruments, MIO,
handling specimens)
STERILE TECHNIQUE
- required in the ff:
• all surgical procedures
• all procedures that invade the blood stream
• complex dressing and wound care
• tube insertions
• care of the high risk groups of patients
SEPSIS –
TYPES OF ANTISEPTIC
A. CHLORHEXIDINE GLUCONATE
• antimicrobial effects against gram (+) and gram (-) microorganisms
• residual effect is more than 6 hours
B. IODOPHORES
• rapid against gram (+) and gram (-) microorganism
• can’t sustain for a prolonged period of time – at least two hours only
• skin irritant
C. TRICLOSAN
• non toxic, non irritating that inhibits growth of a wider range of both gram (+) and
gram (-) microorganism
• good for sensitive skin
• develops prolonged cumulative suppressive action if used routinely
D. ALCOHOL
• ethyl or isopropyl
• rapid acting anti-microbial
• non toxic but has a drying effect
E. HEXACHLOROPHENE
• available by prescription only
• has a high potential for toxicity
PRINCIPLES OF COUNTING
1. All item are counted initially by the circulating nurse and the scrub nurse together
(aloud) as the scrub person touches each item.
2. The number (count) of each type of item is immediately recorded in the sponge
count form by the circulating nurse
3. If there is any uncertainty regarding the initial count, it is repeated.
4. As additional items are added to the sterile field during the procedure, the scrub
nurses counts the items with the circulator who adds the count to the records form
and initial it.
5. If possible there should be no interruptions while counting
6. After the final sponge and instrument count, the circulating nurse and the scrub
nurse will inform the surgeon by saying aloud “sponge count, instruments count
and needle count complete.”
7. The circulating nurse signed the sponge count form with the time and term
correct.
POSITIONING
• essential that each patient be considered as an individual.
- A good position must provide maximum safety for the duration of the operative
procedure. Maximum safety includes:
a. Maintaining good respiratory function.
b. Maintaining good circulation
c. Preventing pressure on muscles and nerves.
d. Good exposure and accessibility of the operative field – maximum
visualization
e. Good access for the administration of anesthetic and observation of effects
SKIN PREPARATION
decreases the number of bacteria on the patient’s skin, thus decreasing the
chance of the patient acquiring a post operative wound infection.
duration usually is 5 min depending on the size of the area to be prepped.
always start the prep at the incision site, working to the outer boundaries.
Boundaries are Bedside to bedside; nipple line to mid thigh
new sponges should be used when returning to incision site ( cleanest to dirtiest )
should be done with firm but not rough movements. Observe for skin reactions.
skin prep is institutional. Latest practice is the 12 ball technique.
Nurse must not reach over the prepped area.
Draping of the operative area is done immediately after the skin preparation is
completed.
Sterilization by Heat
1. Autoclaving (moist heat) or steam under pressure
- most effective means of sterilization
- Steam kills organism by coagulations of the cell protein.
- suitable for fabrics e.g. gowns, towels, dressings, and instruments
- A process by which there is a direct steam contact with specific
temperature and time contained in a chamber with a saturated steam
pressure.
PRINCIPLES OF AUTOCLAVING
• Temperature – 250f to 270f
• Timing – depending upon the loads and the type of autoclave but usually 15-30
minutes.
• Loading – all articles must be properly wrapped with indicators
• Drying the load- all articles should be dry at the end of the sterilization process.
2. Dry Heat
- kills micro-organisms by oxidation (exposed at 160 C or 320 F for 1 hr.)
- suitable for all types of glassware and some instruments.
- Timing – the recommended time is 2 minutes or longer from the start of boiling
point
6. Chemical disinfectant
• A process by which chemical agents is used to prevent and to kill the growth of
bacteria.
A. Cidex - a 2% activated aqueous glutaraldehyde soln
B. Alcohol solution – 70% isopropyl or ethyl alcohol solution
C. Providone iodine (betadine) – anaqueous solution that
coagulates albuminous substance
D. Phenols (Lysol) – effective in the presence of organic
matter
DRAPE – provide sterile environment
1. Laparotomy sheet/lap sheet - a large sheet with longitudinal
opening which is place over the operative site on the abdomen, or
comparable area.
2. towels - A small sheet used to outline the operative
site(green towel) also used for drying of hands (blue towel)
3. large sheet - a plain large sheet used to drape under legs as
in added protection above or below the operative area or for draping areas
in which a sheet with an opening cannot used.
4. towel with hole -a small sheet with a circular hole used to
drape or cover a small operation such as excision of cyst or mass.
5. eye sheet -a small sheet with an openning like a shape of an
eye used to drape a very small operation and eye operations.
6. thyroid sheet -a large sheet with an opening fitted in the
neck area to drape in the neck operation.
7. single sheet/sterilizing sheet/ss -a regular size sheet without
opening which is folded lengthwise and placed above operative field.
8. perineal sheet - A special design large sheet with an
opening and used to create an adequate sterile field with the patient in
lithotomy position such as d & c, hemorroidectomy and others.
9. cystoscopy sheet -a special design large sheet with an
opening and pockets used to drape patient in a lithotomy position such as
cystoscopy operation and others.
10. instrument tray cover (ITC) - A fitted sheet used to drape or
cover the mayo stand.
SURGICAL INCISIONS
The choice of the incision is made by the surgeon with the following considerations:
Type of surgery (anatomical location)
Maximum exposure
Ease and speed of entering (for emergency surgery)
Possibility of extending the incision
Maximal postoperative wound strength
Minimum postoperative discomfort
Cosmetic surgery
LAYERS OF THE ABDOMINAL TISSUE
1. skin
2. subcuticular
3. subcutaneous
4. fascia
• superficial
• deep
5. muscle
6. peritoneum
ANESTHESIOLOGY
- a branch of Medicine concerned with the administration medications or
anesthetic agents to relieve pain and support physiologic function during a
surgical procedure
ANESTHESIA
- is an artificially induced state of partial or total loss of sensation, occurring
with or without loss of consciousness.
- Purpose:
• to block the transmission of nerve impulses, suppress
• reflexes, promote muscle relaxation and in some cases, achieve
• a controlled level of unconsciousness.
• formed from the Greek word meaning “negative sensation”
• loss of feeling or sensation; esp. loss of sensation of pain with
loss of protective reflexes
• Analgesia – lessening of or insensibility to pain
• Amnesia – loss of memory; indifference to pain
• Analgesic – drug that relieves pain by altering perception of painful stimuli w/o
producing loss of consciousness; acts on specific receptors in NS.
• Anesthetics – drug that produces local or general loss of sensibility
• Pain – perceptual phenomenon, a disturbed sensation causing suffering/distress
3 Types of Pain
1. Phasic – of short duration as a needlestick.
2. Acute – up to six months as postoperative pain from tissue trauma
3. Chronic – six months and above duration as a chronic disease.
TYPES OF ANESTHESIA
1. GENERAL ANESTHESIA / GENERAL
ENDOTRACHEAL ANESTHESIA / GETA
- block pain stimulus at the cerebral cortex
- induce depression of the CNS that is reversed either by metabolic change
and elimination from the body or by pharmacologic means
- produces analgesia, amnesia, unconsciousness and loss of reflexes and
muscle tone
- best suited for surgeries of the ff:
• head, neck, upper torso, back
• prolonged surgical procedure
• used in all clients who are unable to lie quietly for long periods
of time
- types:
• INTRAVENOUS ANESTHESIA – extremely rapid induction
- Uncosciousness occurs 30 sec. after administration
- Promotes rapid transition form the conscious to surgical
anesthesia stage
- Acts as calming agent
- Sufficiently potent to be used alone in some minor
procedures as dental extraction and pelvic exams
- Ex. Thiopental Sodium and Ketamine (has a great effect on
px. ; increases BP ; not given to px. with hx. Of
hypertension ; usually px. who have hx. Of low BP due to
depression of CNS which may be increased by Ketamine)
• INHALATION ANESTHESIA
- uses a mixture of volatile liquids or gas and oxygen
- advantage: ease in administration and elimination through
the respiratory system
- used ot maintain client in stage III anesthesia
- mixture is given through a mask or ET tube which is
inserted once the client is paralyzed and unconscious
(intubation)
- examples:
a. INHALATION ANESTHETICS (volatile agents)
- liquids vaporized for inhalation with O2 as
carrier
- cause post operative shivering –
hypothalamus effect
- halothane and isoflurane
b. GAS ANESTHETIC (gaseous agent)
- nitrous oxide- most commonly used
- odorless, colorless, non-irritating gas that
provides analgesia equivalrent to 10 mg of
morphine sulfate
2. REGIONAL ANESTHESIA – reversible loss of sensation in a specific area or
region of the body when local anesthetic is injected to purposely block or
anesthetize nerve fibers in and around the operative site
- agents blocks conduction of impulses in the nerve fibers
c. CAUDAL ANESTHESIA
h. MONITORED ANESTHESIA
- surgeon infiltrates surgical site with local anesthesthetics and the anesthesia
provider supplements local anesthetics w/ IV drugs to provide sedation and
systemic analgesia
i. ACUPUNCTURE
- Ancient chinese killing technique that works by insertion of long, thin needles
into specific acupuncture points
j. CRYOTHERMIA
- use of cold to induce anesthesia