Pre-Operative

1. The nursing responsibilities in the pre-operative phase of surgery

are to do a patient screening, this includes any blood and lab work,
history of surgery, any allergies to medications, history of chronic
illness, nutrition level including any dietary regimens the patient
should be on before and after surgery, as well as assessing all
medications the patient is on and if there are any contraindications to
surgery. To prepare the patient mentally physically and spiritually and
also to conduct a patient teaching to ensure the patient has all the
information that they have the right to know. The nurse also acts as a
witness to the signing of the informed consent.
2. The nurse must assess the needs of the patient pre-operatively this
can include the need for information, education, the need for comfort,
the need for spiritual guidance. The patient may need to use the
bathroom; the patient may feel ill or need some calming techniques
shown to them.
3. The nurse has the responsibility of ensuring the patient is ready for
surgery. The nurses duties usually include placing the patient on N!
status, starting an "# line, prepping the intestinal tract and skin and
administering the preoperative medicines. The nurse is usually
following orders from the surgeon or guidelines of the facility they
work in. The nurse also had the responsibility of ensuring that the
patient feels as though they have all the information that they have
rights to and that they have been well educated on the surgery. The
nurse also can mentally and spiritually as well as emotionally prepare
the patient for undergoing surgery.
4. The nurse administers patient teaching in regards to many things,
patients usually have fears when it comes to the effects of surgery and
anesthesia they may at times have questions about how the surgery
will affect their home lives negatively. The nurse can teach the patient
about the surgery to diminish some worry about the after effects. The
nurse can e$plain what anesthesia does to provide some knowledge
for the patient. %ome post op teaching like deep breathing and
coughing e$ercises are done pre op to ensure the patient understands
and can start them as soon as he or she is able. The nurse is there to
answer any questions and place the patient into a state of ease.
Intra-Operative
1. The average si&e of todays surgical suites is '(( square feet. They
are usually located near the intensive care units that speciali&e in the
surgery that was performed. )or e$ample, a heart surgery suite would
be located on the same floor as the cardiovascular intensive care unit.
*s to safety factors within surgical suites there are many; sterile
techniques are always used, the suites have great ventilation and
temperature control via +#*, units to prevent airborne infections and
they are very well lit.
2. *ssessment of the patient is happening at all times. -onitoring the
patients vitals continuously is especially important so the surgeons
know what condition the patient is in that they are receiving. The
patient is constantly with someone who is caring for them in different
ways. The patient is identified at many times and then when they are
in the !. they staff performs a /time-out0 this is used to identify the
patient as well as the surgery that is going to be performed and the
site to which they will be performing it.
3. The roles of the individual members of the surgical team are as
follows1
A. Surgeon: To perform the designated surgery in a surgically
aseptic and safe manner ensuring patient safety and well being
at all times.
B. Anesthesiologist or Nurse anesthetist 1 To monitor the patient
during surgery and identify the medications to be used with that
specific patient prior to surgery. To stay with the patient after
surgery until the airway is established.
C. Scrub Nurse 1 To don sterile 2 and ensure sterility at all
times to provide surgeon with instruments and all equipment for
the surgery. To prepare the sterile working field before surgery
and to anticipate the needs of the other members of staff to
provide them with their equipment and needs throughout the
surgery.
D. Circulating Nurse 1 To manage patient care in the !. and
protect patient safety and health needs. They control the
environment for cleanliness, temperature, lighting and humidity.
The circulating nurse ensures that the patients rights are being
protected. To monitor care and coordinate activities are also the
circulating nurses responsibilities. The circulating nurse and the
scrub nurse are responsible for accounting for all sponges and
instruments at the close of surgery.
E. OR Technician 1 ,reate an optimal environment for surgical
patients. There are scrub technicians who are overseen by the
scrub nurse and there are circulating technicians who are
overseen by the circulating nurse. Their 3ob is to assist to ensure
a sterile and safe surgical environment for patients and staff.
4. 4efore surgery the surgical team uses a surgical scrub technique of
washing their hands as well as how they don their 2. 5uring surgery
the team keeps all items within their sterile field, they inspect
packaging before opening to ensure sterility. The team is ensuring that
their gowns and gloves also remain sterile and are donned correctly.
.emember where their sterile field ends and how to ensure not to
contaminate your sterile field. %crubbed personnel pass one another
with backs away from each other and hands up to maintain sterility.
The team ensures that they do not stray from their working sterile
field and that they do not allow any unscrubbed personnel to enter
their sterile field.
5. 5epending on the surgery there are different types of anesthesia.
6eneral anesthesia is used for larger more serious surgery. .egional
anesthesia is used for a specific area of the body or if the patient
cannot receive general anesthesia. 7ocal anesthesia can also be used
for surgical procedures but is mostly a topical anesthetic and not used
for large or invasive surgery unless there are many implications that
the patient cannot receive general.
6. ,ommon surgical positions are1 %upine 8dorsal recumbent9 or
where the patient is laying on their back. Trendelenberg is where the
patient is on their back and their feet are in a higher position then
their head, .everse Trendelenberg is the opposite where the head is in
a higher position then the feet. 7ithotomy is where both feet are
placed in stirrups and the lower back is placed toward the end of the
surgical table. %itting and prone 8lying on your stomach9 are also used
and side lying positions as well.
7. %ome safety factors that were used are the instrument count before
and after the circulating nurse ensuring everyone within the surgical
space is practicing sterile technique. The /time-out0 is a very important
safety technique that is used to ensure the right patient and the
correct surgery.
Post-Operative
1. The purpose of the *,: unit is to provide an area where patients
are monitored closely directly after surgery. The goal of the *,: is to
get all vitals within one hour back to normal.
2. The role of the *,: nurse is to provide immediate care for the
patient, monitoring them at all times. The *,: nurse is to do an
immediate assessment of all of the patients vitals as well as a full
assessment of the patients systems, starting with the respiratory
system. The nurse is there also to provide mental emotional and
spiritual support, many patients will be scared and disoriented coming
out of surgery.
3. The immediate post-operative care of the patient is a full
assessment of all body systems as well as closely monitored vitals.