PERIOPERATIVE NURSING

Ritche D. Vidal, M.D.

 PERI-OPERATIVE NURSING

Nursing care provided to surgery patients

during the entire inpatient period from
admission to date of discharge. It
comprised with preoperative,
intraoperative and postoperative phase.
SURGERY
The branch of medicine concerned with
diseases and trauma requiring operative
procedures.
PREOPERATIVE PHASE
- the preparation and management of a
patient before surgery.
 FACTORS TO CONSIDER IN
PREOPERATIVE PHASE
Anxiety
I. GENERAL INFORMATION
a. Feeling of apprehension,uncertainty, and fear
without apparent reasons
A. Predisposing factors
1. Fear of unknown
2. Fear of death
3. Fear of anesthesia
4. Fear of disfigurement
5. Financial difficulties
 B. Signs and symptoms
1. Inability to concentrate, follow conversation
2. Inability to verbalize fears
3. Pacing, inability to rest, insomnia
4. Anger, depression, confusion, or no emotional
response
5. Increase in pulse and respiratory rates

II. Planning/goals
A. Client will verbalize fears/anxieties
B. Client will demonstrate decreased signs of anxiety
III.Implementations
A. Allow for verbalization of fears, concerns
B. Patient teaching
1. Explain Preoperative test
2. Explain preoperative routine
3. Discuss what to expect postoperatively*
*a. Recovery room b. Use analgesia c. Use of special
equipment
4. Postoperative activities
a. Turning, coughing, deep breathing
b. Incisional splinting
c. Leg exercises
C. Include family/significant other in preoperative care and teaching
D. Assess need for spiritual advisor prior to surgery
E. Call surgeon if patient demonstrates unrelieved, elevated anxiety
DIAGNOSTIC TEST - certain base-line diagnostic tests
performed to evaluate client’s overall physical status

PREOPERATIVE DIAGNOSTIC TESTS

Diagnostic Test Rationale

Chest x-ray Check for pulmonary

disease and cardiac enlargement
Urinalysis Check for presence of UTI,
renal disease, diabetes
Blood profile:
RBC, Hgb, HCT, WBC Check for anemia,presence of
differential infection, immune deficiency
PT/PTT Monitor for bleeding tendencies
Fasting blood sugar (FBS) Presence of diabetes
Blood urea nitrogen (BUN) Check for renal disease
EKG Presence of cardiac disease
or electrolyte abnormalities
 INFORMED CONSENT
statement indicating consent has been given to have operative
procedure performed

GENERAL INFORMATION
A. Assess of client understanding and competence
II.PLANNING/GOALS
A. Client will be able to verbalize understanding of surgery
B. Client will sign consent
III.IMPLEMENTATION
A. Assess client’s level of understanding about surgery
B. Act as client advocate in witnessing consent;answer and
clarify client questions
C. Contact surgeon if client has major questions or
misunderstanding about surgery
D. Assess language used,level of consciousness,use of drugs
that may alter sensorium prior to patient signing consent
 IV.EVALUATION
A. Client verbalizes understanding of surgery
B. Client signs informed operative consent

AGE
GENERAL INFORMATION
- elderly at higher risk to undergo surgery, as well as development of
postoperative complications

A. Predisposing factors
1.Presence of chronic diseases
a..Pulmonary disease(COPD)
b..Cardiovascular diseases (MI,CHF)
c..Liver and Renal disease
d..Endocrine disease
 2.Frequently dehydrated 3.Poor nutritional status
4.Stress response diminished

II. PLANNING/GOALS
A.Elderly clients will have risk factors identified
B.Elderly clients will experience minimal postoperative complications

III. IMPLEMENTATIONS

A. Carefully evaluate intake and output postoperatively

B.Reduce pain medications postoperatively;assess effectiveness

C.Assess and initiate preventive measures for the following frequently

seen postoperative complications
 COMMON POSTOPERATIVE
COMPLICATIONS
Shock
a. Assess vital signs, level of consciousness (LOC)
b. Assess urine output

Atelectasis pneumonia
a. Assess respiratory status b. Good pulmonary hygiene
Thrombophlebitis
a. Early ambulation b. Assess Homans’ sign

IV.EVALUATION
A. Risk factors minimized during elderly client’s postoperative course
B. Elderly client free of complications postoperatively
 USUAL PREOPERATIVE
MEDICATIONS
CLASS EXAMPLE USE AND COMMON EFFECT

Sedatives sodium pentobarbital cause drowsiness and

nembutal relaxation; facilitate and
decrease amount of anesthesia
Tranquilizers: Diazepam(valium) reduce anxiety, fear; facilitate
Antianxiety Hydroxyzine (vistaril) anesthesia induction;
agents (minor antiemetic; potentiate narcotics
tranquilizers) and sedatives
Narcotics Morphine, meperidine Facilitate anesthesia induction;
produce drowsiness
Anticholinergics: Atropine, Robinul Decrease secretions; keep
respiratory passages clear and dry
 INTRAOPERATIVE PHASE
- pertaining to the period during a surgical procedure
ASEPSIS
- Absence of any infectious agents
I. GENERAL INFORMATION
A.Etiology/incidence
1. Asepsis practiced in operating room to prevent entrance of microorganism into
surgical wound
2. Asepsis practiced to maintain client safety and decrease postoperative
infections
II.PLANNING/GOALS; EXPECTED OUTCOME
Client will not be exposed to infection during surgery
III.IMPLEMENTATION
• A.Principles of sterile technique must be followed to ensure a sterile environment
for client
IV.EVALUATION:
• No infection occurs.Asepsis maintained
PRINCIPLES OF ASEPTIC TECHNIQUE IN THE
OPERATING ROOM

• All materials that enter the sterile field must be sterile

• Sterilization is the only means by which an item can be
considered sterile. If anything comes in contact with an unsterile
item it becomes contaminated
• Contaminated items should be removed immediately from the
sterile field.
• Sterile team members must wear sterile gowns
• Team members should move from sterile to sterile or from
unsterile to unsterile
• Tables are considered sterile only at table-top level and items
extending beneath this level are considered contaminated
• The edges of a sterile package are considered contaminated
once the package has been opened
 POSITIONING
I. GENERAL INFORMATION
PURPOSE:
1. Provide functional alignment
2. Prevent pressure on bony prominence
3. Provide adequate respiratory expansion
4. Avoid compression of nerve tissue,veins and arteries
II.PLANNING/GOALS/EXPECTED OUTCOME
Client will be properly positioned during surgical procedure
III.IMPLEMENTATION
A. Transfer cart is securely locked while moving client
B. All bony prominences,muscles,and nerves padded
C. Asses the straps that do not constrict circulation
D. Return from operative to supine position slowly to avoid hypotension
E. Move both legs simultaneously
IV EVALUATION
Client sustains no injuries as a result of positioning during surgery
 ANESTHESIA
- Absence of consciousness
TYPES:
GENERAL: cause total loss of sensation and loss of consciousness
REGIONAL: reduces all painful sensation to one area of body
without loss of consciousness
COMPLICATIONS:
GENERAL
1. Respiratory and cardiac depression
REGIONAL
1. Cannot be used for lengthy surgeries
2. hypotension secondary to peripheral vasodilation.
 ANESTHESIA
General Anesthesia:
1. Inhalational agents:
a. Gas anesthetics
- nitrous oxide: induction agent, given in combination with O2
- cyclopropane: obstetric anesthesia, highly flammable and explosive
b. liquid anesthetics
- halothane, enflurane, methoxyflurane, isoflurane and sevoflurane
2. IV anesthetics: used primarily as induction agents
- methohexital, sodium thiopenthal
3. Dissociative agents: lack of awareness w/o loss of consciousness
- Ketamine
4. Neuroleptics: produce state of neuroleptic analgesia char. By
reduced motor activity, decreased anxiety and analgesia
- fentanyl citrate with droperidol (Innovar)
 ANESTHESIA
Adjuncts to general anesthesia:
Neuromuscular blocking agents: used with general anesthetics to
enhance skeletal muscle relaxation.
- Gallamine, Pancuronium, Succinylcholine, tubocurarine,
Atracurium besylate, Vecuronium bromide
- Monitor client’s respirations for at least 1 hour after drug's effect
has worn off.

Regional Anesthesia:
- produces loss of painful sensation in one area of the body; does
not produce loss of consciousness
- used for biopsies, excision of moles and cysts, endoscopies,
surgery on extremities, childbirth
- topical, local infiltration block, field block, nerve block, spinal,
epidural
 ANESTHESIA
MEDICATION SIDE EFFECTS NURSING CONSIDERATION
GENERAL Respiratory depression, circulatory Check history of sensitization.
ANESTHESIA via depression .Delirium during Maintain airway. Protect and orient
inhalation induction and recovery. Nausea and client. Monitor v/s, labs. Prevent
(halothane) vomiting, aspiration during induction, aspiration postop by elevating head
myocardial depression, hepatic of bed, turning head to side (unless
toxicity contraindicated), suctioning
Nitrous oxide Hypotension,postop nausea and Monitor v/s. Adequate oxygenation
vomiting is essential, especially during
emergence
IV thiopental Na Respiratory depression, low BP, Monitor v/s, especially airway,
laryngospasm. Poor muscle breathing. Straps for operative table,
relaxation, hypotension, irritating to proper positioning. Protect IV site.
skin and subcutaneous tissue check for placement periodically
Spinal anesthesia Hypotension, headache Monitor V/S. Encourage oral fluids

Epidural, Caudal Hypotension, respiratory depression Headache not experienced

Monitor V/S
Local anesthesia Excitability, toxic reactions such as Monitor patient, Do not use local
respiratory difficulties, anesthesia with epinephrine on
vasoconstriction if substance fingers (circulation is less optimal)
contains epinephrine
GENERAL POINTS REGARDING ANESTHETIC
AGENTS
TYPE DEFINITION MAJOR COMPLICATION

General Inhalation Gases and vapors Cardiac dysfunction

administered through mask (dysrhythmias, arrest)
or endotracheal (ET) tube; respiratory dysfunction
block pathways to brain and (bronchospasm and
render client unconscious; laryngospasm, aspiration
used for major operations of
thorax, abdomen and neck
Intravenous Drugs given directly into vein; Respiratory dysfunction
used for induction and as (arrest, bronchospasm)
adjuncts to inhalation agents Cardiac dysfunction
(hypotension, depression)
Regional Drugs injected into the Hypotension,anaphylactic
nerve track/endings to block shock Respiratory paralysis can
some of the nerve fibers; occur headache.
maybe given topically or
locally (spinal, epidural)
Client must be cooperative
 STAGES OF GENERAL ANESTHESIA

Stage Duration Manifestations

I Beginning of induction to Loss of judgment
loss of consciousness Hearing acute
II Loss of consciousness to Cerebral or voluntary
loss of eyelid reflex control lost
Hypersensitive to incoming
impulse
Hearing acute
III Extends from loss of Functions of medulla retained
eyelid reflex to cessation
of respiratory effort;
surgery performed in this
stage; reflexes absent and
muscles relaxed
IV Respiratory paralysis
Cardiac failure
Death
 POST- OPERATIVE
CARE
- pertains to the period after surgery.
- the management of the patient after surgery.
- it begins with patient’s emergence from anesthesia
and continues through the time required for the acute
effects of the anesthetic and surgical procedures to
abate.
 POST- OPERATIVE
COMPLICATIONS
RESPIRATORY COMPLICATIONS
GENERAL INFORMATION

- respiratory problems may develop post-operatively as a

result of airway obstruction, laryngospasms,
bronchospasms, and hypoventilation.
 PULMONARY
COMPLICATIONS
RISK FACTORS
• Smoking
• History of COPD
• Obesity
SIGNS AND SYMPTOMS
• Restlessness
• Fast and thready pulse
• Rapid, shallow respirations
• Decreased breath sounds
• Asymmetrical chest wall expansion
• Use of accessory muscles
• Cyanosis
 PULMONARY
COMPLICATIONS
PLANNING/GOALS/EXPECTED OUTCOMES
• Client will not develop respiratory complications post-op
IMPLEMENTATIONS
• Position client on one side with chin extended to prevent
occlusion of airway, or in semi-prone position.
• Suction as needed.
• Leave airway in until removed by client.
• Deep breathing and coughing exercises.
• Oxygen therapy; usually 60% (6 L/min)
• Assess breath sounds, depth and rate of respirations,
chest symmetry, use of accessory muscles
EVALUATION
- Breath sounds clear post-op.
SHOCK AND HEMORRHAGE
GENERAL INFORMATION
• Shock can develop post-op as a result of
hemorrhage, effects of anesthesia, sepsis, cardiac
arrest and pulmonary emboli

SIGNS AND SYMPTOMS

• Lowered BP
• Tachycardia
• Rapid, difficult respirations
• Dusky, pail, cold skin, pale lips and nail beds
SHOCK AND HEMORRHAGE
PLANNING/GOALS/EXPECTED OUTCOMES
• Client will have adequate tissue perfusion post-op.

IMPLEMENTATIONS
• Assess V/S frequently post-op.
• Assess skin color and temperature.
• Assess capillary refill.
• Assess urine output hourly.
• Assess blood loss from incision and drains.
EVALUATION
• Client does not develop post-op complications from
shock and hemorrhage.
 WOUND INFECTION
ETIOLOGIC ORGANISMS
• Staphylococcus organisms
• Streptococcus organisms
PREDISPOSING FACTORS
• Poor nutrition prior to surgery
• Age (elderly)
• Obesity
• Use of steroids, radiation, or chemotherapeutic drugs
• Presence of other diseases such as DM and cancer
 WOUND INFECTION
SIGNS AND SYMPTOMS
• Wound dehiscence
- separation of wound edges
• Wound evisceration
- protrusion of loops of bowel through incision

PLANNING/ GOALS/ EXPECTED

OUTCOMES
• Client will not develop wound infection post-op.
 WOUND INFECTION
IMPLEMENTATIONS
• Assess for redness, increase drainage or tenderness
around wound.
• Assess temperature.
• Use aseptic technique with dressing changes.
• Change dressings with drainage immediately.
• Provide for good pulmonary hygiene, ambulation,
splinting of incision for clients at high risk for
developing wound dehiscence/evisceration.
EVALUATION
• Clients does not develop post-op wound infection.
 FLUID AND ELECTROLYTE
IMBALANCE
GENERAL INFORMATION
• Fluid imbalances can develop post-op from blood loss,
insensible fluid, physiologic response to surgery and
improper IV fluid replacement
• Electrolyte imbalances can occur post-op from body fluids
lost during surgery or GI secretions loss through vomiting,
NGT, or diarrhea.

PREDISPOSING FACTORS
• Elderly at high risk to develop F&E imbalances
- small elderly individual at very high risk
FLUID AND ELECTROLYTE
IMBALANCE
COMPLICATIONS
• Pulmonary edema
• Water intoxication
• Cardiac arrhythmias
• Hyponatremia
• Hypokalemia
• Acidosis/Alkalosis

PLANNING/GOALS/EXPECTED OUTCOMES
• Client will have normal fluid electrolyte balance in
post-op care
 FLUID AND ELECTROLYTE
IMBALANCE
IMPLEMENTATIONS
• Assess I& O; Assess serum electrolytes.
• Administer IV fluids properly; irrigate NGT with normal saline.
• Assess for signs of pulmonary edema
- dyspnea, cough with large amounts of blood-tinged sputum,
tachycardia, wheezing, rales, diaphoresis, restlessness, jugular vein
distension
• Administer anti-emetic if client is experiencing unrelieved vomiting.

EVALUATION
• Client has normal F&E function post-op.
PREDISPOSING FACTORS

• Decrease peristalsis may occur post-op because of

anesthetics, narcotics, hypokalemia, decrease oral
intake, or immobility

PLANNING/GOALS/EXPECTED OUTCOMES

• Client will have normal bowel function post-op.

 AMBULATION
GENERAL INFORMATION
• Early post-op ambulation has been proven to hasten
client’s recovery and decrease post-op complications.

PLANNING/GOALS/EXPECTED OUTCOMES
• Client will successfully ambulate in early post-op.
 AMBULATION
IMPLEMENTATIONS
• Encourage client to cough and deep breathe and
perform leg exercises in immediate post-op period.
• Encourage client’s ability to safely ambulate.
- begin with dangling, assist to stand/walk, increase
distance of ambulation daily.

EVALUATION
• Client ambulates post-op without difficulty or
complications.
 PAIN
GENERAL INFORMATION
• Normal post-op pain experience may be caused by the
following factors:
- incision
- organ manipulation
- edema
- muscle spasms
- infection
- distention
- anxiety

PLANNING/GOALS/EXPECTED OUTCOMES
• Client’s post-op pain will be reduced.
 PAIN
IMPLEMENTATIONS
• Assess client’s complaint of pain and possible causes.
- urinary retention, anxiety, abdominal distension
• Utilize nursing comfort measures for pain control.
- backrub, allowing client time to verbalize
• Medicate with analgesic before pain becomes severe.
• Assess respiration and pulse prior to administration of
analgesic.

EVALUATION
• Client is comfortable post-op.
 PEDIATRIC PREOPERATIVE
PREPARATION
PSYCHOSOCIAL
• Obtain written consent from parent or legal guardian
• Explain all preparatory tests and surgical procedures in terms
that child will understand
1. Pictures
2. Stories
3. Play Therapy
• Prior to surgery, give child a tour and explanation of operating
room (OR)/recovery room (RR), if possible
• Encourage parents to stay with child until entrance to OR suite
• Allow the child to take security object to OR, if possible
• Have parents at recovery room when child brought in.
 FEARS OF SURGERY AT DIFFERENT
DEVELOPMENTAL STAGES
NURSING
AGE-GROUP SPECIFIC FEARS CONSIDERATION
Teach parents to expect
regression e.g. in toilet
Toddler Separation
training, and difficult
separations
Allow child to play with
models of equipment.
Preschooler Mutilation
Encourage expression
of feelings. e.g. anger
Explain procedures in
School-age Loss of control simple terms. Allow
choices when possible
Involve adolescent in
Loss of
procedures and
Adolescence independence,being
therapies. Expect
different from peers
resistance
 AGE-APPROPRIATE PREPARATION FOR HEALTH
CARE PROCEDURES
NURSING
AGE TYPICAL FEARS
CONSIDERATION
Include parents Loud noises
Newborn
Mummy restraint Sudden movements

6-12 months Model desired behavior Strangers, heights

Separation from parents

Simple explanations
Toddler Animals, stranger.
Use distractions. Allow choices
Change in environment
Encourage understanding by Separation from parents
playing with puppets, dolls.
Preschool Ghosts
Demonstrate equipment. Talk
at child’s eye level Scary people

Allow questions. Explain why. Dark, injury. Being alone

School-Age
Allow to handle equipment Death

Explain long-term benefit.

Social incompetence
Adolescent Accept regression. Provide
War,accidents Death
privacy
 PHYSICAL PREPARATION
• Urinalysis
• CBC, type and cross match,as applicable
• X-rays, EKG, if applicable
• Anesthesia check
• Assess for signs and symptoms of infections that would delay
surgery
• NPO 8 to 12 hours before surgery; give liquids liberally prior to this
time
• Void prior to sedation
• Check for loose teeth
• Side rails up at all times,especially after sedation
• Do not leave child unattended after sedation
 PEDIATRIC
INTRAOPERATIVE CARE

• Monitor effects of anesthesia post induction

• Continuously monitor vital signs
• Aseptic technique
• Perform sponge/instrument count
• Fluid balance
 PEDIATRIC
POSTOPERATIVE CARE
A. Psychosocial preparation

a. Communicate caring and security through touch

b. Emphasize “things” child did right
c. Use play therapy to allow child to express feelings, frustration,
autonomy
d. Encourage normal routines, activities, school work as
tolerated
e. Encourage “exploration” of hospital, surgical experience
through stories, collections, scrapbooks
f. Allow child to participate in as much of care as possible within
age and disease process limitations
B. PHYSICAL PREPARATION

A. Vital signs as ordered

B. Evaluate effects of anesthesia
C. Assess operative site
D. Monitor signs/symptoms of complication
E. Administer and monitor IV Fluids
F. Advance diet as tolerated
G. Assess voiding patterns; catheterize if unable to void eight hours post op
H. Assess respiratory patterns; turn, cough and deep breath every two hours
I. Medicate for pain as needed
J. Allow parents to participate as much as possible in care
 COMMON SURGICAL PROCEDURES

• ABDOMINAL PROCEDURES
- Most abdominal incision have been devised for the
purpose of exposing specific regions with as little
disruption as possible of muscles, nerves and blood
vessels
- It may also be used during gynecological and
urological operation
A. LAPAROTOMY - opening of abdomen and abdominal wall
B. GASTROTOMY - An opening into the stomach usually for the
purpose of removing a foreign object.
C. GASTROSTOMY - Creation of an opening into the stomach,usually
for the purpose of feeding the patient when he/she is unable to
take food by mouth.
D. PYLOROMYOTOMY - Incision of the muscles surrounding the
pylorus in order to relieve stenosis in infants (Ramstedt’s
operation)
- e.g. Pyloric Stenosis
E. GASTROENTEROSTOMY - Creation of a passageway
(anastomosis) between the stomach and intestines in order to
bypass an obstruction at the pyloric end of the stomach
F. GASTRECTOMY (GASTRIC RESECTION) - Removal of various
amounts of the stomach for the treatment of ulcers and benign or
malignant tumors.
G. ILEOSTOMY - Creation of an opening from the ileum through the
abdominal wall
-This is done to allow the colon to rest or as a means
of elimination when the colon must be resected
H. COLOSTOMY OR SIGMOIDOSTOMY - Creation of an opening
proximal to an area of colon which is obstructed due to
inflammation,trauma,or tumor.
I. APPENDECTOMY - Removal of an acute or chronically inflamed
appendix to prevent the spread of infection in the peritoneal cavity
 CONSIDERATIONS DURING
GASTROINTESTINAL SURGERY

1. Mechanical cleansing of the intestinal tract and

administration of antibiotics preoperatively help reduce the
possibility of infection
2. The use of double set-up allows a clean set-up to be
used following the anastomosis.This reduces the transfer of
contamination
3. A single set-up can be used, but the materials used
during the resection and anastomosis are discarded as soon as
the anastomosis is completed
4. The used of closed technique with special instrument
(such as Payr clamps) helps prevent the escape of contents
from the tract.
 COMMON SURGICAL
PROCEDURES
• GALLBLADDER PROCEDURES
- It involves the biliary tract.
- The gallbladder serves as a storage pouch for bile after it is
manufactured by the liver.This greenish-yellow to brown viscous
digestive juice is secreted through the hepatic ducts and the
common bile duct to the duodenum.
- The tendency of these ducts to become obstructed leads to a
number of problems which are corrected by procedures which begin
with the root word “CHOLE”.
A. CHOLECYSTECTOMY - Removal of the gallbladder because of
acute and chronic inflammation,stones or tumors. (A penrose drain
is usually brought out through a stab wound.
B. CHOLECYSTOSTOMY - An opening into the gallbladder for the
purpose of drainage or removal of stones
C. CHOLEDOCHOSTOMY - Formation of an opening into the
common bile duct.
D. CHOLECYSTODUODENOSTOMY OR
CHOLECYSTOJEJUNOSTOMY - Formation of an anastomosis
between the gallbladder and the duodenum or the jejunum.
These procedures may be done to establish a route for the
flow of bile when there is an obstruction in the distal end of the
common duct.
 HERNIA REPAIRS
HERNIA - A protrusion of an organ or tissue through an abnormal opening
HERNIORRHAPPPHY OR HERNIOPLASTY - The surgical repair of a hernia. An
important feature of all hernia operations is the repair of the muscular defect
COMMON TYPE OF ABDOMINAL HERNIA
1. Inguinal, Direct or Indirect:
Inguinal
Inguinal hernia
hernia occurs in the groin where the lower abdominal muscles come
together
together to to form
form inguinal canal.
Indirect
Indirect inguinal
inguinal hernia - enters thethe inguinal canal through the internal ring and
emerges
emerges through
through the
the external
external ring
ring
Direct
Direct inguinal
inguinal hernia
hernia -- does
does not
not enter
enter the
the inguinal
inguinal canal
canal through
through the
the internal
internal ring.
ring.
ItIt bulges
bulges direct
direct through
through the
the muscles
muscles and emerges at external ring
2. Femoral Hernia - is located in the groin.It occurs more often in women than in men.
3. Umbilical Hernia - It occurs through the umbilical ring. ring. Ordinarily,
Ordinarily, this
this ring
ring closes
closes
soon
soon after
after birth,
birth, but
but a weakness
weakness maymay remain
remain
4. Epigastric Hernia - It occurs in the midline above the umbilicus. It is made up of a
peritoneal sac which protrudes through defects between the recti muscles
5. Incisional Hernia - is the protrusion of underlying tissues through a weakness in
the suture line following abdominal surgery
• BREAST PROCEDURES
1. Breast Biopsy - It involves the removal and
microscopic examination of tissues for the purpose
diagnosis. If the mass is located on the outer surface
of the breast, a small pillow or folded sheet can be
placed under the shoulder so the breast will rotate
inward.This allows easier access to the site of the
mass.
2. Simple Mastectomy - A palliative measure when
incurable cancer is encountered. It involves
subcutaneous removal of the mammary gland via an
incision below the breast.
Radical Mastectomy - is performed in the hope
of curing cancer that has not yet spread to other parts
of the body (metastasized).
• NECK OPERATIONS - It includes the thyroid
gland, parathyroid gland, parotid tumors.
1.Thyroidectomy - the removal of a thyroid gland to
reduce the hormone production (thyroxin) to a more
normal level. Care is taken,however, to leave enough
of the gland so hypothyroidism does not result.
2.Excision of parathyroid glands - The
parathyroid glands are located and carefully avoided
during thyroid surgery because their removal can
cause tetany (hypocalcemia)
• RECTAL OPERATION
A. PROCTOSCOPY - is an inspection of the rectum with a
speculum
B. SIGMOIDOSCOPY - is an inspection of the sigmoid flexure
with a long lighted speculum. The examination should be preceded
by cleansing of the lower gastrointestinal tract to permit visualization
• VEIN LIGATION AND STRIPPING
A. HEMORRHOIDECTOMY - is the removal of varicosities
(dilated veins) from lower rectum or anus. The operation involves
dilation of the anal canal and clamping, suturing and cutting of
hemorrhoid(s)
• OB/GYN OPERATIONS
1. HYSTERECTOMY- (TOTAL OR PANHYSTERECTOMY)-
removal of the uterus and cervix. This procedure should be
preceded by a vaginal prep as well as an abdominal prep.
2. SUBTOTAL HYSTERECTOMY - removal part of the uterus
3. OOPHORECTOMY - removal of an ovary
4. SALPINGECTOMY - removal of one or both fallopian tubes
5. SALPINGOPLASTY - plastic repair of a tube to correct an
obstruction.
OPERATIONS INVOLVING URINARY SYSTEM
1. NEPHRECTOMY - removal of a kidney
2. NEPHROTOMY - incision into the kidney for the purpose of
draining a cyst or abscess
3. NEPHROSTOMY - opening into the kidney for establishment of
temporary or permanent drainage when there is an obstruction in
the urinary tract
4. NEPHROLITHOTOMY - incision into and removal of a stone from a
kidney
5. PYELOTOMY - incision into the kidney pelvis
6. PYELOLITHOTOMY - incision into and removal of a stone from a
kidney pelvis
7. URETEROLITHOTOMY - incision into and removal of a stone from
ureter
8. URETEROTOMY - incision into a ureter
9. URETEROSTOMY - incision into ureter for establishment of
temporary or permanent drainage when there is an obstruction in a
lower portion of the urinary tract.
 10. ADRENALECTOMY - removal of one or both
adrenal glands to treat local tumors ,to reduce
hyperfunction, or to control tumors that are
affected by adrenal hormones.
11. CYSTOTOMY - opening into the bladder
12. CYSTOSTOMY - opening into the bladder for
the purpose of inserting a drain
13. CYSTOLITHOTOMY - opening into the
bladder for removal of stones
OPERATIONS ON THE REPRODUCTIVE ORGAN
1. SUPRAPUBIC PROSTATECTOMY - removal of the prostate
through a suprapubic incision through the bladder.
2. RETROPUBIC PROSTATECTOMY - removal of the prostate
through a suprapubic incision that does not enter the bladder.
3. PERINEAL PROSTATECTOMY - removal of the prostate through
a perineal incision
4. TRANSURETHRAL PROSTATECTOMY - resection of the prostate
through endoscopic instrument inserted via the urethra
5. VASECTOMY - excision of a portion of the vas deferens
6. EPIDIDYMECTOMY - removal of the epididymis from the testicle
7. ORCHIECTOMY - removal of one or both testes
8. ORCHIOPEXY - surgical transplant and fixation of undescended
testicle into the scrotum
THORACIC AND CARDIOVASCULAR
OPERATION
1.BRONCHOSCOPY-visualization of the bronchus
2.CLOSED THORACOTOMY-opening of the thorax

-to provide aspiration and negative pressure in pleural

cavity
3.LOBECTOMY-removal of an entire lobe of a lung to
treat tuberculosis or cancer
4.PNEUMONECTOMY-removal the entire lung
CARDIAC OPERATION
1. VALVULOTOMY - cutting of one of the heart valves.
2. BLALOCK-TAUSSIG SHUNT - anastomosis of the right and left subclavian
artery to the pulmonary artery for the purpose to increase blood flow to the
lungs.
-surgical procedure of tetralogy of fallot
3. RASHKIND PROCEDURE - treatment includes surgical incision or balloon
septostomy to create in ASD
-surgical procedure of transposition of great vessel
4. MUSTARD PROCEDURE - this applied when child is old enough ,defect
will be corrected surgically to redirect blood flow
5. OPEN-HEART SURGERY (uses cardiopulmonary bypass): provides a
relatively blood free operative site;heart lung machine maintains gas exchange
during surgery
6. CLOSED HEART SURGERY - does not use cardiopulmonary bypass
machine;indicated for ligation of a patent ductus arteriosus or coarctation of the
aorta
CRANIAL
CRANIALOPERATION
OPERATION

1.1.CRANIECTOMY
CRANIECTOMY--removal
removal
of
ofaaportions
portionsofofthe
theskull
skullthat
thathave
have
been
beenfractured
fracturedand
andhave
havebecome
become
impacted
impactedor orfragmented
fragmented
2.CRANIOPLASTY
2.CRANIOPLASTY--repair repairof
of
the
thecranial
cranialdefect
defect
3.CRANIOTOMY
3.CRANIOTOMY--opening openinginin
the
theskull
skullfor
forthe
thepurpose
purposeofof
exposing
exposingandandcorrecting
correcting
intracranial
intracranialdisease.
disease.
• SPINAL OPERATION
1. CHORDOTOMY - this is the division of tracts
of the spinal cord to relieve pain in lower areas of the
body
2. RHIZOTOMY - is the interruption of roots of
the spinal nerves for the relief of pain or essential
hypertension
3. MENINGOCELE REPAIR - this the correction
of a hernia protrusion of the meninges through a
defect in the spinal column or the skull
• NERVE OPERATION
1. SYMPATHECTOMY - This is the interruption of a portion of the
sympathetic nervous pathways
• EYE, EAR, NOSE, THROAT SURGERY
EYES
1. IRIDECTOMY - removal of iris tissue to establish communication
between the anterior and posterior chambers for the flow of aqueous
EAR
1. MYRINGOTOMY - incising of the tympanic membrane (eardrum)
to relieve pressure due to pus or fluid in the middle ear
2. STAPEDECTOMY - the removal of stapes that is bound by
adhesion
• NASAL
1. RHINOPLASTY - revision of the shape of the nose by fracturing and
removing portions of the nasal septum and cartilage
2. CALDWELL-LUC - a radical sinus operation which involves an opening
above the upper molar teeth as well as intranasally. This allows a more
thorough removal of inflammatory material from sinus cavity
• THROAT
1. PAROTIDECTOMY - removal of the parotid tumor and gland
through an incision near the ear lobe
2. TRACHEOSTOMY - It is done for emergency procedure if the upper
respiratory tract becomes obstructed
3. TONSILLECTOMY AND ADENOIDECTOMY - This procedure is done
most often in children as adenoids usually atrophy by the time a person
reaches adulthood. It is the removal of the tonsils and the adenoids
4. HEMIGLOSSECTOMY - removal of the anterior portion of the tongue as
treatment for cancer.
5. RADICAL NECK DISSECTION - removal of the cervical nodes of the
neck in an effort to prevent metastasis of cancer from the head or neck.
6. LARYNGECTOMY - removal of the larynx and some surrounding
structures to treat cancer of the larynx.