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THE SKIN

 Provides a protective barrier against mechanical, thermal and physical injury and hazardous substances.
 Prevents loss of moisture.
 Reduces harmful effects of UV radiation.
 Acts as a sensory organ (touch, detects temperature).
 Helps regulate temperature.
 An immune organ to detect infections
5 LAYERS OF THE SKIN
Epidermis - It protects your body from harm, keeps your body hydrated,
produces new skin cells and contains melanin, which determines the color of
your skin

Dermis – The dermis is a fibrous structure composed of collagen, elastic


tissue, and other extracellular components that includes vasculature, nerve
endings, hair follicles, and glands. The role of the dermis is to support and
protect the skin and deeper layers, assist in thermoregulation, and aid in
sensation.

Superficial Fascia – Superficial fascia is the outermost layer located


directly under your skin. Layers of membranes, loosely packed interwoven
collagen and elastic fibers make up this layer. Superficial fascia is thicker in
your chest and back (torso) and gets thinner in your arms and legs.

Deep Fascia – The main function of the deep fascia is to support and protect muscles and other soft tissue structures. It also provides a
barrier against the spread of infection from the skin and superficial fascia into muscle compartments.

Muscle - In the body, there are three types of muscle: skeletal (striated), smooth, and cardiac.

Peritoneum - is a membrane, a sheet of smooth tissue that lines your abdominopelvic cavity and surrounds your abdominal organs. It
pads and insulates your organs, helps hold them in place and secretes a lubricating fluid to reduce friction when they rub against each
other.
OPERATING ROOM + SURGICAL TEAM

OR STAFF
 Chief Nurse – Ma’am Marivic Napeñas
 Head Nurse – Ma’am Maritoni B. Racelis
 Charge Nurses – Ma’am Kaypee Eballa; Sir Maynard Arceo
 OR Nurses - Ma’am Eloisa Palma
 Surgical Tech – Ma’am Nitz Abustan
 OR Orderly – Sir Edwin & Sir Mamu

AREAS IN THE OR
 Receiving Area + OPD
 Recovery Room – Post-Op clean cases, Labor <10 cm dilation
 Labor & Delivery – In labor 10 cm dilation, normal delivery
 OR #1 – Minor - Biopsies, Repairs of cuts or small wounds, Removal of warts, benign skin lesions, hemorrhoids or
abscesses, Excision of mass
 OR #2 – Major – CS, Mastectomy, Appendectomy, Laparoscopic Cholecystectomy
 OR #3 – Endoscopy – Gastroscopy, Colonoscopy
 OR #4 – Dirty Cases – Debridement, Amputation, Covid-19, MRSA, PTB
 OR #5 – Eye Surgeries – ECCE, PHACO

THE SURGICAL TEAM


 Surgeon – Dr Frondoza
 Assistant Surgeon – Dr. Reyes
 Anesthesiologist – Dr. Ilagan; administers anesthesia, post-op meds and monitoring of patient, meds for breakthrough pain;
Breakthrough pain is severe or excruciating pain of rapid onset that can disable or even immobilize the patient. Patients with
BTP should be assessed after baseline persistent pain has been stabilized with around-the-clock (ATC) analgesics.
 Scrub Nurse
 Circulating Nurse
 Surgical Tech

ACCS
1. Anesthesia
2. Cutting
3. Closing; Initial counting
4. Specimen Out

CIRCULATING
 Receives the endorsement
o Allergy - food, medication and other materials like latex
o Medications - maintenance medication, when was the last dose taken
o Present Illness - other existing conditions like diabetes, hypertension
o Last meal - must be on NPO for at least 6-8 hours
o Event – what is the procedure?
 Identifying the patient, and verifying consent
 Assist patient in gowns, linens and slippers
 Verifies surgical procedure and site of incision
 Coordinates with the surgical team
 Drops instruments and materials in the back table
 Anticipates needs of the team
 Ensuring cleanliness, proper temperature, humidity, lighting, safe function of equipment, availability of supplies and
materials
 Monitors aseptic practice
 Monitoring of the patient’s condition
 Documents specific activity during operation
 Send labeled specimen to the laboratory

SCRUB
 Perform surgical hand scrub
o Fingers  interdigital spaces  palm  back of hand  arms
o 1st – 30-20-20-20; up to 3-inches above the elbows
o 2nd – 15-10-10-10
o 3rd – 8-5-5  no need to scrub arms
 Setting up the sterile table
 Preparing sutures, ligatures, and specific equipment
 Anticipates the needs of the surgeon
 Assisting the surgeon and surgical assistant during operation
 Share the circulating nurse in counting all needles, sponges and instruments
 The obtained tissue sample during surgery is poured with formalin and is labeled

RECOVRERY
 Monitoring of patient
 VS q15
 Wound care – must be dry and intact before endorsing to ward
 Aldrete Score - the Aldrete's score is used to determine when a patient can safely leave the Post-Anaesthesia Care Unit
(PACU) and be transferred to the surgical ward. The Aldrete score is based on the evaluation of vital signs and
consciousness.

MEDICAL ABBREVIATIONS

 MRM – Modified Radical Mastectomy


 ECCE – Extracapsular Cataract Extraction
 PHACO - Phacoemulsification
 TAHBSO - Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy
 PHRA + BC – Partial Hip Replacement Arthroplasty with Bone Cement
 Polymethyl methacrylate (PMMA) or Bone Cement
 AVF - Arteriovenous Fistula
 GA – General Anesthesia
 GA-LMA – General Anesthesia - Laryngeal Mask Airway
 ET – Endotracheal Tube
 CS – Cesarean Section
 MRSA - Methicillin-resistant Staphylococcus aureus
 PTB - Pulmonary tuberculosis
 GATT - Gonioscopy-Assisted Transluminal Trabeculotomy
SURGICAL PROCEDURES

 MRM – Modified Radical Mastectomy - Surgery to remove the whole breast, which may include the nipple, areola (the dark-colored skin
around the nipple), and skin over the breast. Most of the lymph nodes under the arm are also removed.

 ECCE – Extracapsular Cataract Extraction - The term ECCE refers to the technique in which a portion of anterior capsule of the lens is
removed, allowing extraction of the lens nucleus and cortex, leaving the remainder of anterior capsule, the posterior capsule, and the
zonular support intact.

 PHACO - Phacoemulsification - is a modern-day cataract surgery that employs ultrasound energy to emulsify the nucleus, vacuum to catch
the nuclear material, and irrigation and aspiration for cortex and viscoelastic removal. A typical phaco machine consists of a handpiece,
foot pedal, irrigation, and aspiration system.

 TAHBSO - Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy - This surgery will remove the uterus, cervix, ovaries,
and fallopian tubes.

 PHRA + BC – Partial Hip Replacement Arthroplasty with Bone Cement - During partial hip replacement, your doctor replaces the ball of
your hip joint, but not the socket. The artificial part is made of metal, ceramic, or plastic. This type of surgery is done to repair certain types
of hip fractures.

o Polymethyl methacrylate (PMMA), is commonly known as bone cement, and is widely used for implant fixation in various
Orthopaedic and trauma surgery.

 AVF - Arteriovenous Fistula - An arteriovenous (AV) fistula is an irregular connection between an artery and a vein. Blood flow avoids
tiny blood vessels (capillaries) and moves directly from an artery into a vein. An arteriovenous (AV) fistula is an irregular connection
between an artery and a vein.

 Laparoscopic Cholecystectomy – A cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical
tools through four small incisions to see inside your abdomen and remove the gallbladder. Doctors call this a laparoscopic
cholecystectomy. In some cases, one large incision may be used to remove the gallbladder.

o Hydrops - Mucocele (hydrops) of the gallbladder is a term denoting an overdistended gallbladder filled with mucoid or clear and
watery content. The condition can result from gallstone disease, the most common affliction of the biliary system.

 Appendectomy is surgery to remove the appendix when it is infected. This condition is called appendicitis. Appendectomy is a common
emergency surgery. The appendix is a thin pouch that is attached to the large intestine. It sits in the lower right part of your belly.

 Cholecystectomy is a surgical procedure to remove your gallbladder — a pear-shaped organ that sits just below your liver on the upper
right side of your abdomen. Your gallbladder collects and stores bile — a digestive fluid produced in your liver.

 Debridement is a procedure for treating a wound in the skin. It involves thoroughly cleaning the wound and removing all hyperkeratotic
(thickened skin or callus), infected, and nonviable (necrotic or dead) tissue, foreign debris, and residual material from dressings.
 Surgical excision is a simple procedure that your doctor can use to remove growths, such as moles, lesions, and tumors, from your skin.
The primary tool used in this procedure is a sharp razor. Doctor may use also use an electrode to feather the edges of the excision site to
make the scar less noticeable.

DRUGS

TYPES OF ANESTHESIA
 General anesthesia - A patient who gets general anesthesia is completely unconscious (or "asleep"). They can’t feel any pain, are not aware
of the surgery as it happens, and don’t remember anything from when they are “asleep.” Patients can get general anesthesia through an IV
(into a vein) or inhale it through their nose and mouth. A tube placed in their throat helps the person breathe while they are under general
anesthesia; someone may feel groggy and a little confused when waking up after surgery. Other common side effects can include nausea or
vomiting, chills or shakiness, or a dry throat (from the breathing tube).

 Local anesthesia - numbs a small part of the body (for example, a hand or patch of skin). It can be given as a shot, spray, or ointment. It
may be used for dental work, stitches, or to lessen the pain of getting a needle.

 Spinal/ Regional Anesthesia - This type of anesthesia is injected near a cluster of nerves in the spine. This makes a large area of the body
numb and unable to feel pain. Common types of regional anesthesia include epidurals (often used in childbirth), spinal blocks, and
peripheral nerve blocks (when the medicine is injected near a nerve or group of nerves to block feelings of pain in a specific area of the
body); waist down – example: appendectomy, CS, wound debridement

SIDE EFFECTS OF ANESTHESIA


 Nausea  Muscle aches
 Vomiting  Itching
 Dry mouth  Shivering
 Sore throat  Sleepiness

WOF – Falls  Side rails must be up

MEDICATIONS

> Propofol - marketed as Diprivan, among other names, is a short-acting medication that results in a decreased level of consciousness and a
lack of memory for events. Its uses include the starting and maintenance of general anesthesia, sedation for mechanically ventilated adults,
and procedural sedation.

> Sevoplurane - is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anaesthetic for
induction and maintenance of general anesthesia. After desflurane, it is the volatile anesthetic with the fastest onset.

> Nicardipine - is a medication used to treat high blood pressure and angina. It belongs to the dihydropyridine class of calcium channel
blockers. It is also used for Raynaud's phenomenon. It is available in by mouth and intravenous formulations. It has been used in
percutaneous coronary intervention.

> Epidrine - Ephedrine is a central nervous system stimulant that is often used to prevent low blood pressure during anesthesia. It has also
been used for asthma, narcolepsy, and obesity but is not the preferred treatment. It is of unclear benefit in nasal congestion – 1mL is given

> Nubain - is an opioid analgesic which is used in the treatment of pain. It is given by injection into a vein, muscle, or fat. Side effects of
nalbuphine include sedation, sweatiness, clamminess, nausea, vomiting, dizziness, vertigo, dry mouth, and headache.

> Mydriacyl - This medication is used to widen (dilate) the pupil of the eye in preparation for certain eye examinations. It belongs to a class
of drugs known as anticholinergics. Tropicamide works by relaxing certain eye muscles.
INSTRUMENTS

COUNTING OF INSTRUMENTS
1. Baseline – before incision
2. Initial – before closing
3. Final - closing

MAJOR SET

 Kelly – Curved or Straight


 Mayo – Sutures
 Metz - Tissues
 Blade Holder + Blade = Scalpel
 Tissue – with teeth
 Thumb – no teeth

Oschner Oschner
Mixter Richardson Deaver Balfourt Set Weitlaner D’backey Adison
Curved Straight

DRAINS
Chest Tube/ Thoracotomy (a surgical procedure in which a cut is made between
Jackson Pratt Drain
the ribs to see and reach the lungs or other organs in the chest or thorax)

LAPAROSCOPIC INSTRUMENTS

Maryland Grasper Shears Suction Irrigation

SUTURES & NEEDLES

 Silk 2-0 – non absorbable  Suture ligature - return thread


 Vicryl 1 - absorbable  Suture – with needle
 Tie on a clamp  OB Procedures – Suture with mosquito
 Free tie – no needle  Silk duo strands – black

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