CHAPTER I

INTRODUCTION

1.1 Background
Medical-surgical nursing is the single largest nursing specialty in the United
States. Registered nurses in this specialty practice primarily on hospital units and
care for adult patients who are acutely ill with a wide variety of medical problems
and diseases or are recovering from surgery.Surgery are all acts of treatment use
invasive methods by opening or displaying body parts will be handled. The opening
of this body part is generally done with making an incision, after which parts to be
handled are displayed, done. Acts of repairs ending with the closing and suturing
of the wound.
The surgery is performed by a surgeon. There are various kinds of
specialists who perform surgery. Generally the same division of specialization in
almost all parts of the world. Usually that includes surgeons is doctors, dentists, and
veterinarians who have specialists in the field of surgery. Surgical science is a side
of medical sciences which return the normal anatomy function with surgical doing.
The surgeon should know why are needs to be significant actions, about known the
patients will be surgery, and many experiences have decided to determine the
attitude to surgical will be done. Patients should know that he will be dissected and
treated, the patient is also entitled to a clear illumination about the course of surgery
that will be undergoing, in conducting surgery is necessary openness surgeon,
personality and sufferer background is also known.

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 CHAPTER II
DISCUSSION

2.1 Definition and Part of Basic Surgical

Basic surgical skills is defined as cornerstone course for all traines. In this
lesson, the students will learn a range of essential basic surgical skills and technique
in a controlled workshop environment. In routes of HIV transmission, injury with
needles are contaminated with blood, body fluids. In preventing transmission of
infection, we are not allowed to recap needles. It is important to set up sharps
containers where sharps are used.
Every hospital need to give clear guidelines for management of injury.
There are some steps which need to do in preventing infections universal
precautions. The first is to protect areas of broken skin, open wounds with
watertight dressings. It is important to treat all body substances. Nurses need to
wear protective glasses where blood splashes may occur. Infection is defined as the
most important and preventable causes of impaired wound healing. Tissues can be
reached by microorganism during surgery or manipulation. It can be transmitted by
air around wounds which can be contaminated by dust.
Aseptic treatment wound functions to prevent bacterial contamination from
these sources, during surgery, and phase of healing. In operating theatre, the doors
must be closed except as needed for passage equipment, personal, patients. Staffs
need to minimize people who want to enter operating theatre. In preventing
infection, the most important measure is to do hand washing. Plain soap and water
can be used to remove visible cintaminations.
The greatest contaminations areas is nails. Surgical gloves function to
prevent transmission of other infections through contact with blood. There are many
types of instruments such as forceps used for holding tissue, needle horders,
scissors, and retractors. In wound management, we are not allowed to leave the
infected wounds open. A contaminated wound delays healing. Patients need to close
wounds with sutures at 2 days. The factors that prevent wound healing is the age,
and underlying illness.

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2.2 Hecting
2.2.1 Definition
Wound dressing is an action to close the wound edge with the thread
until it is healed and sufficient to withstand physiological burden.

2.2.2 Indication
Any injury where for healing needs to close the wound edges.

2.2.3 Sharp trauma causes:

a. Wound iris: vulnus scissum / incicivum
b. Puncture wounds: vulnus ictum
c. Bite wounds: vulnus morsum
Blunt trauma causes:
a. Open wounds: vulnus apertum
b. Closed wounds: vulnus occlusum (excoriation and hematoma)
c. Shot wounds cause: vulnus sclopetorum.
Clashing wounds based on the presence or absence of germs:
a. Sterile wound: wound made operation time
b. Contamination wound: wound containing germs but less than 8
hours. (golden period)
c. Wound infections that contain germs and have multiplied and have
arising local symptoms as well as common symptoms. (rubor, dolor,
calor, tumor, lechee function).

2.2.4 Tools and materials needed for wound suturing.

a. Tools (Instruments)
b. Tissue forceps (tweezers) consists of two forms of tissue forceps
scalloped tip (surgical forceps) and without teeth at the tip ie
atraumatic tissue forceps and dressing forceps.
c. Scalpel handles and scalpel blades
d. Dissecting scissors (Metzen baum)

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 e. Suture scissors
f. Needleholders
g. Suture needles (needles) of 2/3 circle shape, Vi circle, shape triangle
and round shape
h. Sponge forceps (Cotton-swab forceps)
i. Hemostatic forceps the toothless tip (Pean) and tip toothed (Kocher)
j. Retractors, double ended
k. Towel clamps

2.2.5 Material
a. Yarn (type and indication explained later)
b. Desifectant Liquids: Povidon-iodidine 10% (Bethadine)
c. 0.9% Na Cl fluid and 5% per day to wash the wound.
d. Local anesthesia lidocain 2%.
e. Gloves.
f. Sterile gauze.

2.3 Preventuring Maintenance Procedures

How to treat the wound should be Right and Right, so that the impact is not
more severe or even cause infection that would be dangerous. The wound is the
disruption of normal integrity to the skin and underlying tissues that occur for any
intentional or intentional, closed or open, clean or contaminated cause
2.3.1 The mechanism of the occurrence of injuries that often occur
because:
a. An incision injury, caused by a sharp instrument (surgery or
exposure to other sharp objects due to intentional or unintentional).
b. Bruises, caused by impact or pressure and characterized by injury to
soft tissue, bleeding and swelling of the skin tissue and underlying
tissue.
c. The blisters, which occur because the skin rubs against other objects
that are usually visible and objects that are not sharp.

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 d. Stab wounds, caused by the presence of taper objects (bullets,
knives, etc.) that enter into the skin and usually with a small
diameter.
e. Scratch, caused by sharp objects such as glass or wire ends.
f. Injured wound, is a wound that penetrates the organs of the body,
usually at the beginning of the wound entering a small diameter but
the other end will be wider

2.3.2 Aim
a. Prevent, limit, or control infection
b. Lifting necrotic tissue to improve wound healing
c. Absorb drainage (exudate)
d. Maintaining a humid wound environment
e. Compressing the eyes

2.3.3 Indication
a. Chronic wounds and many drainage / pussy
b. Wounds that lose a lot of skin tissue

2.3.4 Tools preparation

a. A sterile set as needed
b. Plaster
c. Sterile gauze in place, bandage if necessary
d. Clean gloves
e. Sterile gloves
f. The normal solution of sterile saline (NaCl 0.9%)
g. Infectious garbage bags
h. Perlak and its base
i. Storage of sterile goods, such as bent (kidney cup) and sterile bowl
(kopyes) above the trolley

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2.3.5 Procedure
a. Check doctor's instructions and treatment plan
b. Prepare the tools, including sterile equipment on the table / trolley
c. Identify the patient, explain the goals and procedures
d. Provide privacy
e. Elevate the bed and lower the bed barrier to work on the side of the
patient
f. Place the bag to put a dirty bandage near the patient
g. Wash hands
h. Spread perlak under the area to be replaced bandage
i. Wear clean gloves (not sterile)
j. Remove the plaster towards the wound or open the bandage bandage
k. Pour saline normal solution in dressing
l. Remove the gauze one by one, then throw it into a plastic bag
m. Remove the gloves
n. Open the sterile set while maintaining the sterility of the tool
o. Pour the normal saline solution into kopyes and place a few pieces
of gauze in the sterile area
p. Wear sterile gloves
q. Clean the wound area using gauze, press gauze on the depression or
hole area
r. Assess wounds, measure, type identification and determine if there
are any signs of infection
s. Extend a damp and alkaline gauze in a single layer and place it at
the top covering the entire area
t. Then cover with a dry gauze on a bandage to hold it
u. Remove the gloves and insert them into infectious waste bags
v. Plaster only at the ends of the bandages, montgomery plaster can be
used to prevent excessive skin irritation and damage caused by
frequent dressing changes. For certain areas, can be added bandage
rolls to strengthen the fixation

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 w. Return the patient to its original position. Lower the bed and re-raise
the bed barrier
x. Dispose of dirty material into the right container (infectious waste)
y. Wash hands
z. Clean up the tools
aa. Record in medical record

2.4 Dialog Practice

Emergency Room Visit
Rita : Dont be panic, please. You just have a terrible accident. Now, you
are in emergency room in Wangaya Hospital.
Kana : Sorry, but I dont remember anything. Who are you?
Rita : I am doctor Rita who is incharge now.
Kana : Whats happening to me ? Why Iam here?
Rita : You had an accident with your bike and crashed into tree and you
broke your arm. But you dont have to worry abaut it. I will take
care of you.
Kana : What are you doing now ?
Rita : You just need to relax. We will give some medicines to help you
feel better.
Kana : Pain? What pain ? But I dont feel anything in my arm.
Rita : It does not sound good. We need to start operating immediately.
Please be quit and dont move. You need to do fasting before
surgery. Before the surgery, please dont take any drink or food.
Kana : Thank you docter. I will do my best.
Three Hours Later
Nata : Hello, Are you awake ?
Kana : Yes, I am. And I can see you. Whats happening? Where am I now?
Nata : Im an ortopaedic surgeon who did operation to you. Do you have
pain in your am ?
Kana : Yes, it hurts.

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Nata : Great, I did the operation well. We reattached the nerves which
were injured during your accident. You have to take a rest for three
month. You are not allowed to play sports and use your mobile
phone for the next three months. You may leave now. Good bye.
Kana : Thanks you docter.
Nata : I just do my best. Take care Anton. Good bye.

Dialog Practice
Doctor : Well, Mr. Kana. What seems to be the problem ?
Patient : I cant sleep last night, doctor.
Doctor : May I know, how long have you got this problem ?
Patient : Hmmmmmm, its about two weeks.
Doctor : Have you got headache ?
Patient : Sometimes
Doctor : Have you get fever ?
Patient : No I havent
Doctor : Do you have problem in your family ?
Patient : No, I dont. my wife and I get well together.
Doctor : How about your works ?
Patient : Well, I usually work late 10 to 12 hours a day.
Doctor : Maybe youd better have vacation for a while.
Patient : I am afraid I cannot do it now. I have some important businesses to
do.
Doctor : Is your business going well
Patient : It is not running so good at the momenut.
Doctor : Are you worried about your business ?
Patient : I guess so.
Doctor : Maybe, you should consider changing your job to be less stressful.
Patient : Well, its pretty had finding new jobat my age.
Patient : Thank you doctor

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2.5 Grammar Focus
Present Continous
The present continuous tense is formed from the present tense of the
verb be and the present participle (-ing form) of a verb:
a. Positif :
Subject + to be (is, am are) + verb-ing + object
Example: She is following the principles of antiseptic surgery

b. Negative
Subject + to be (is, am, are) + not + verb-ing + object
Example: He is not going to the surgery later

c. Intterogative
To be (is, am, are) + subject + verv-ing + object?
Example: Are you going to make a good recovery after surgery?

subject auxiliary verb main verb

+ I Am speaking to you.
+ You Are reading this.
- She Is not staying in London.
- We Are not playing football.
? Is He watching TV?
? Are They waiting for John?

Use
1. We use the present continuous tense to talk about the present:
a. For something that is happening at the moment of speaking:
Im just leaving work. Ill be home in an hour.
Please be quiet. The children are sleeping.
b. For something which is happening before and after a given time:

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 At eight oclock we are usually having breakfast.
When i get home the children are doing their homework.
c. For something which we think is temporary:
Michael is at university. Hes studying history.
Im working in london for the next two weeks.
d. For something which is new and contrasts with a previous state:
These days most people are using email instead of writing letters.
What sort of clothes are teenagers wearing nowadays?
What sort of music are they listening to?
e. To show that something is changing, growing or developing:
The children are growing quickly.
The climate is changing rapidly.
Your english is improving.
f. For something which happens again and again:
Its always raining in london.
They are always arguing.
George is great. Hes always laughing.
Note: We normally use always with this use.

2. We use the present continuous tense to talk about the future:

a. For something which has been arranged or planned:
Mary is going to a new school next term.
What are you doing next week?

3. We can use the present continuous to talk about the past:

a. When we are telling a story:
b. When we are summarising the story from a book, film or play etc.:

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 CHAPTER III
CONCLUSION

Medical-surgical nursing is the single largest nursing specialty in the United

States. Basic surgical skills is defined as cornerstone corse for all tarines, the
students will learn a range of essential basic surgical skills and technique in a
contrelled workshop environment. In rutes of AIV transmission injury with needles
are contaminated with blood, body fluids. In preventing transmision of infektion,we
are not allowed to recap nidles. It is important to set up sharps containers where
sharps are used. Every hospital needs to give clear guidelines for manegement of
injury. There are some steps which need to do in preventing infections universal
precautions. In the hospital, preventuring maintenance procedures and hecting is
very important it is how we can treat the wound should be right and right, so that
the impact is not more severe or even cause infection that would be dangerous.

11
 CHAPTER IV
BIBLIOGRAPHY

Juliarta, I Made.2017.Module Theory English for Nursing.Denpasar

http://www.esbase.com/grammar/present-continous

https://googleweblight.com/?lite.url=https://en.m.wikipedia.org/wiki/surgery&ei.g
oogle.co.id

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