Handout on Surgery and Surgical Nursing I (RGN 215)

Contents

Introduction to Surgery and Surgical Nursing

Surgical nursing plays a critical role in patient care, particularly in the management of patients undergoing surgery. This course introduces student nurses to the operating room environment, infection prevention, and the roles of the theatre team. It also covers the comprehensive care of patients before, during, and after surgery, wound management, and care for patients with gynecological conditions, neoplasms, and terminal illnesses.

This handout aligns with the Ghana Nurses and Midwifery Council (NMC) Curriculum and provides in-depth knowledge and skills necessary for surgical nursing.

1. Theatre Nursing

Theatre nursing focuses on ensuring a sterile environment for surgical procedures and assisting the surgical team during operations. Nurses must be proficient in infection prevention, handling surgical instruments, and providing patient care throughout the surgical process.

a. Introduction to the Theatre Environment, Infection Prevention, and Control

The theatre environment is a highly controlled area designed to prevent infections and maintain sterility during surgical procedures. Nurses must ensure that all surfaces, equipment, and instruments are sterilized, and that strict protocols are followed to minimize the risk of infection.

  • Infection Prevention in the Theatre:
    • Sterilization of Instruments: All surgical tools must be properly sterilized using autoclaves or chemical disinfectants.
    • Use of Personal Protective Equipment (PPE): Gloves, masks, gowns, and eye protection must be worn by all theatre staff to maintain a sterile environment.
    • Hand Hygiene: Thorough scrubbing and handwashing techniques are essential before donning gloves and gowns.
    • Aseptic Techniques: Nurses must use aseptic techniques when handling sterile equipment to prevent contamination.

b. Theatre Team Members and Their Roles

The theatre team is composed of various healthcare professionals, each with specific responsibilities. Effective teamwork is crucial for the success of surgical procedures.

  • Surgeon: The lead member of the team who performs the surgery.
  • Scrub Nurse: Responsible for handling sterile instruments, assisting the surgeon during the operation, and maintaining the sterile field.
  • Circulating Nurse: Manages non-sterile activities in the operating room, including obtaining supplies and assisting with patient positioning.
  • Anesthetist/Anesthesiologist: Administers anesthesia and monitors the patient’s vital signs during surgery.
  • Surgical Technician: Assists with setting up equipment and preparing the operating room.

c. General Pre, Intra, and Post-Operative Management of Surgical Conditions

i. Theatre Techniques: Scrubbing, Gowning, and Gloving
  • Scrubbing: Nurses must follow strict scrubbing techniques to disinfect their hands and arms before entering the sterile area.
    • Procedure: Scrub from fingertips to elbows with antiseptic soap for a minimum of 5 minutes.
  • Gowning: Nurses wear sterile gowns to protect themselves and maintain the sterile field.
  • Gloving: After gowning, sterile gloves are donned to prevent contamination.
ii. Identification, Functions, and Handling of Surgical Instruments

Nurses must be familiar with various surgical instruments used in different procedures. Proper handling and passing of instruments to the surgeon are essential to maintaining efficiency and safety during surgery.

  • Examples of Surgical Instruments:
    • Scalpel: Used for making incisions.
    • Forceps: Used for grasping tissues.
    • Hemostats: Used to clamp blood vessels to control bleeding.
iii. Setting of Trolleys and Mayo’s Table for Surgery

Nurses are responsible for organizing surgical instruments on trolleys and the Mayo’s table. Instruments must be arranged in a logical order to facilitate smooth operations.

iv. Receiving, Positioning, Skin Preparation, and Draping of the Patient for Operation
  • Receiving the Patient: Nurses verify the patient’s identity and ensure consent forms are signed.
  • Positioning: Proper positioning of the patient is crucial for the success of the surgery and to prevent complications like nerve damage. Common positions include the supine position and lateral position.
  • Skin Preparation: The patient’s skin is cleaned and disinfected to reduce the risk of infection.
  • Draping: Sterile drapes are placed around the surgical site to maintain a sterile field.
v. Assisting the Surgeon During Operations

The scrub nurse assists the surgeon by passing instruments, maintaining sterility, and anticipating the needs of the surgical team.

vi. Handling of Surgical Specimens

After surgery, any tissues or specimens removed from the patient are handled with care and sent for further analysis. Nurses must label and document the specimens correctly.

d. Infection Prevention and Control in the Theatre

Maintaining a sterile environment is essential to prevent surgical site infections (SSI). This involves:

  • Sterilization of Instruments and Equipment.
  • Proper Disposal of Waste: All contaminated materials must be disposed of according to infection control protocols.
  • Monitoring of the Operating Room Environment: Ensuring air filtration systems are working and that staff adhere to hand hygiene and gowning procedures.

2. Inflammation, Management of Wounds, and Healing Processes

a. Inflammation

Inflammation is the body’s response to injury or infection, characterized by redness, swelling, heat, and pain. Nurses play a vital role in managing inflammation to promote healing and prevent complications.

  • Types of Inflammation:
    • Acute Inflammation: Rapid onset, often associated with injuries or infections.
    • Chronic Inflammation: Long-lasting and can contribute to conditions like arthritis.

b. Management of Wounds and Healing Processes

i. Boils and Carbuncles
  • Boils are infections of hair follicles, while carbuncles are clusters of boils.
    • Management: Warm compresses, drainage, and antibiotics are commonly used treatments.
ii. Cellulitis
  • Cellulitis is a bacterial skin infection that spreads to deeper tissues.
    • Management: Antibiotic therapy, elevation of the affected area, and pain management.
iii. Wounds
  • Nurses manage different types of wounds, including surgical wounds, pressure ulcers, and traumatic wounds. Proper wound care promotes healing and reduces the risk of infection.
    • Wound Cleaning and Dressing: Use of sterile technique to clean the wound and apply appropriate dressings.
    • Monitoring for Infection: Signs of infection include increased redness, swelling, discharge, and fever.
iv. Ulcers (Tropical, Buruli)
  • Tropical ulcers are caused by bacterial infections in warm climates, while Buruli ulcers are chronic skin infections.
    • Management: Includes wound debridement, antibiotic therapy, and skin grafting in severe cases.

3. Gynecological Disorders

Nurses play a critical role in managing and providing care for women with gynecological disorders. This includes patient education, preparation for diagnostic tests, and post-procedure care.

a. Congenital Abnormalities

  • Imperforate Vagina/Hymen: A congenital condition where the vaginal opening is blocked.
  • Bicornuate Uterus: A malformation of the uterus that may cause pregnancy complications.
  • Hermaphroditism: A condition where an individual has both male and female reproductive organs.

b. Acquired Abnormalities

  • Obstetric Fistulae: Abnormal connections between the vagina and the bladder or rectum, often caused by childbirth trauma.
  • Hydatidiform Mole: A rare condition where a non-viable pregnancy forms a mass in the uterus.

c. Other Disorders

  • Disturbances of Menstruation: Conditions like amenorrhea (absence of menstruation) or menorrhagia (heavy periods) require nursing interventions for diagnosis and treatment.
  • Infertility: Nurses support patients undergoing fertility treatments.
  • Breast Cancer and Cervical Cancer: Nurses provide education, emotional support, and post-surgical care for women with cancer.
  • Menopause and Uterine Fibroids: Nurses manage symptoms like hot flashes, irregular periods, and fibroid complications.

4. Neoplasm (Tumors)

Neoplasms are abnormal growths of tissue, which can be benign (non-cancerous) or malignant (cancerous). Nursing care involves supporting patients through diagnosis, treatment, and recovery.

a. Benign and Malignant Tumors

  • Benign Tumors: Grow slowly and do not spread to other parts of the body.
  • Malignant Tumors: Grow rapidly and can spread to other organs (metastasis).

b. Chemotherapy, Radiotherapy, and Surgery

  • Chemotherapy: Nurses administer medications that destroy cancer cells.
  • Radiotherapy: Nurses prepare patients for radiation treatment and manage side effects like skin irritation.
  • Surgery: Nurses assist in tumor removal surgeries and provide post-operative care.

c. Counseling of Patients and Families

  • Counseling Techniques: Nurses use therapeutic communication to provide emotional support, explain treatment options, and help patients and families cope with the diagnosis.

d. Nursing of Patients Living with Cancer

  • Nurses provide symptom management (e.g., pain, nausea), psychological support, and assistance with daily living activities.

e. Care of Terminally Ill Patients

  • Nurses offer palliative care to manage symptoms and improve quality of life for patients nearing the end of life.

5. Pain Management

Pain management is critical for improving patient comfort and outcomes. Nurses must assess and manage pain effectively to prevent unnecessary suffering.

a. Pain Assessment

  • Assessment Tools: Use of scales like the Visual Analog Scale (VAS) or the Numeric Rating Scale (NRS) to evaluate pain intensity.
  • Pain History: Gathering information about the location, duration, and characteristics of the pain.

b. Management Strategies

  • Pharmacological Approaches: Use of analgesics (e.g., opioids, NSAIDs) to manage pain.
  • Non-Pharmacological Approaches: Includes methods like heat application, relaxation techniques, and massage.

c. Consequences of Unrelieved Pain

  • Physical Consequences: Includes increased heart rate, elevated blood pressure, and weakened immune response.
  • Emotional Consequences: Chronic pain can lead to anxiety, depression, and reduced quality of life.

6. Palliative Care

Palliative care focuses on improving the quality of life for patients with serious, life-limiting illnesses. Nurses play a key role in providing compassionate care and symptom relief.

a. Members of the Palliative Care Team and Their Roles

  • Palliative care team includes doctors, nurses, social workers, and chaplains, all working together to provide holistic care.

b. End of Life and Palliative Care Skills

  • Communication Skills: Nurses use empathetic communication to help patients and families navigate difficult decisions.
  • Symptom Management: Focus on alleviating pain, breathlessness, nausea, and other symptoms to improve patient comfort.

This Surgery and Surgical Nursing I (RGN 215) Handout provides a comprehensive overview of the key concepts and techniques necessary for managing surgical patients. From understanding the theatre environment to managing gynecological disorders and providing palliative care, this handout equips nursing students with the knowledge and skills required for effective surgical nursing.

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