OPERATING ROOM

 a room in a hospital specially equipped for surgical operations.

 Perioperative nursing
is a nursing specialty that works with patients
who are having operative or other invasive
procedures.
Perioperative nurses work closely with
surgeons, anesthesiologists,
nurse anesthetists, surgical technologists and
nurse practitioners.
Three phases of perioperative Nursing.
1. Preoperative phase- begins when the decision to
have surgery is made and ends when the client is transferred
to the operating table
2. Intraoperative- begins when the client is transferred
to the operating table and ends when the client is admitted
to the PACU (Post anesthesia Care Unit )
3. postoperative phase-begins with the admission of
the client to the PACU and ends when the healing is
complete.
WHO Checklist
• Principles of sterile technique
help control and prevent infection,
prevent the transmission of all microorganisms in a given
area, and include all techniques that are practiced to
maintain sterility.
Principles of Sterile Technique
1.All articles used in an operation have been sterilized
previously.
2.Persons who are sterile touch only sterile articles,
persons who are not sterile touch only unsterile articles.
3.Sterile persons avoid leaning over an unsterile area
non-sterile persons avoid reaching over a sterile field
Unsterile persons do not get closer than 12 inches from a
sterile field.
 4. IF IN DOUBT ABOUT THE STERILITY OF ANYTHING CONSIDER IT NOT STERILE. IF
A NON-STERILE PERSON BRUSHES CLOSE CONSIDER YOU’RE CONTAMINATED.
5. GOWNS ARE CONSIDERED STERILE ONLY FROM THE WAIST TO SHOULDER
LEVEL IN FRONT AND THE SLEEVES TO 2 INCHES ABOVE THE ELBOWS.
A. KEEP HANDS IN SIGHT OR ABOVE WAIST LEVEL AWAY FROM THE FACE.
B. ARMS SHOULD NEVER BE FOLDED.
C. ARTICLES DROPPED BELOW WAIST LEVEL ARE DISCARDED.
6. STERILE PERSONS KEEP WELL WITHIN THE STERILE AREA AND FOLLOW THOSE
RULES FROM PASSING:
1.FACE TO FACE OR BACK TO BACK.
2.TURN BACK TO A NON-STERILE PERSON OR WHEN PASSING.
3.FACE A STERILE AREA WHEN PASSING THE AREA.
4. ASK A NON-STERILE PERSON TO STEP ASIDE RATHER THAN TRYING TO
CROWD PAST HIM.
 5. Step back away from the sterile field to sneeze or cough.
6. Turn head away from sterile field to have perspiration mopped from brow.
7. Stand back at a safe distance from the operating table when draping the
patient.
8. Members of the sterile team remain in the operating room if waiting for the
case.
9. Do not wander around the room or go out in the corridors.

7. Sterile persons keep contact with sterile areas to a minimum.

a. Do not lean on the sterile tables or on the draped patient.
b. Do not lean on the nurse’s mayo tray.
8. NON-STERILE PERSONS — WHEN YOU ARE OBSERVING A CASE, PLEASE STAY
IN THE ROOM UNTIL THE CASE IS COMPLETED.
DO NOT WANDER FROM ROOM TO ROOM AS TRAFFIC IN THE OPERATING
ROOM SHOULD BE KEPT AS A MINIMUM. PATIENT PRIVACY NEEDS TO BE
RESPECTED.
9. KEEP NON-ESSENTIAL CONVERSATION TO A MINIMUM.
10. THE CIRCULATING NURSE IS IN CHARGE OF THE ROOM — IF YOU HAVE ANY
QUESTIONS, PLEASE REFER THEM TO HER, THE SUPERVISOR OR YOUR
INSTRUCTOR. ASK CIRCULATING NURSE WHEN IT IS AN APPROPRIATE TIME
TO ASK QUESTIONS SO THAT
EXPLANATIONS/RATIONALE CAN BE GIVEN.
Infection Control Practices:
Personnel and students should:
 Will become familiar with and adhere to the policies set forth in
the Infection Control Manual.
 Will wear approved OR attire
 Will be free from active infection
 Will report promptly suspected communicable diseases
 Will adhere to good hygiene practices such as daily bathing
and wearing a clean scrub uniform daily
 Will practice frequent and thorough handwashing w/
appropriate soap.
 Will follow hospital policy on Universal/ Standard precautions
 against bloodborne pathogens
 Will report suspected trends and problems to the Infection
 Control Department
 Dress Code- Surgical Attire ( OR Setting )
1. All persons who enter the semi-restricted and restricted areas of the
surgical area should be in hospital laundered surgical attire
intended for use only within the surgical area.
2. All possible had and facial hair including sideburns and neckline
should be covered when in the surgical area.
All persons entering an Operating Room area should wear a mask.
All personnel entering the area should have all jewelry confined or
removed. Watches and plain wedding bands are acceptable.
Earrings must be covered by the scrub cap.
 5. Nail polish and artificial nails should not be worn within the area.
 6. Protective barriers(gloves, masks, protective eyewear and face
shields) are provided by the hospital and should be utilized to
reduce the risk of exposure to potentially infective agents.
 7. Shoes should be dedicated to the OR and shoe covers are not
required. If shoe covers are necessary, the wearer should remove
them before leaving the Operating Room to avoid tracking blood
and debris through the department.
.
 Aseptic technique - means using practices and
procedures to prevent contamination from pathogens.
 It involves applying the strictest rules to minimize the risk
of infection. Healthcare workers use aseptic technique in
surgery rooms, clinics, outpatient care centers, and other
health care settings.
 Points to Remember About Aseptic Technique
 ADHERENCE TO THE PRINCIPLES OF ASEPTIC TECHNIQUE
REFLECTS ONE’S SURGICL CONSCIENCE.

1. The patient is the center of the sterile field

2. Only the sterile items are used within the sterile field.
A. Examples of items used
B. How do we know they are sterile?(wrapping, label,storage)
3. Sterile persons are gowned and gloved.
A. Keep hands at waist level and in sight at all times.
 B. Keep hands away from the face.
 C. Never fold hands under arms.
 D. Gowns are considered sterile in front from chest to level of
sterile field and the sleeves from above the elbow to cuffs.
Gloves are sterile.
 E. Sit only if sitting for entire procedure.

 4. Tables are sterile only at table level

 A. Anything over the edge is considered unsterile,such as a
suture or the table drape.
 B. Use non-perforating device to secure tubings and cords
 To prevent them from sliding to the floor.
5. Sterile persons touch only sterile items or areas, unsterile
persons touch only unsterile items or areas.
A. Sterile team members maintain contact with the sterile field
by wearing gloves and gowns.
B. Supplies are brought to sterile team members by the
circulator, who opens wrapper of sterile packages. The
circulator ensures a sterile transfer to the sterile field. Only
sterile items touch sterile surfaces.
6. Unsterile persons avoid reaching over sterile field, sterile
persons avoid leaning over unsterile area.
7. Edges of anything that encloses sterile contents are
considered unsterile.
8. Sterile field is created as close as possible to time of use.
9. Sterile areas are continuously kept in view.
10. Sterile persons keep well within sterile area.
11. Unsterile persons avoid sterile areas.
12. Destruction of integrity of microbial barriers results in
contamination.
13. Microorganisms must be kept to irreducible minimum.
 Surgical Scrubbing, Gowning,Gloving
I. Gowning
1. Gowning: To don the gown, the scrub person:

a. Lifts the folded gown directly upward from the sterile package.
b. Steps back from the table into an unobstructed area;
c. Carefully locates the neckband and holds the inside front of the gown
just below the neckband with both hands;
d. Lets the gown unfold while keeping the inside of the gown toward the
body without touching the sterile exterior of the gown with bare hands
******: IF the gown does not unfold completely, then the circulating nurse
may
assist by pulling down the unfolded bottom inside the gown);
e. Holds the hands at shoulder level and slips both arms into the armhole
simultaneously.
 Roles of the Scrub and Circulating Nurse In Operating
Room
Types of Anesthesia
 There
are three main types of anesthesia: local, regional,
and general. The type of anesthesia used for a surgical
procedure is determined by several factors:
Type and length of the surgery
Patient health
Preference of the patient and physician
1. Local Anesthesia - blocks the nerves in a small, specific area of the
body. For example, if a surgical procedure is performed on the
right hand, local anesthetic is used to numb that hand without
affecting any other part of the body.(e.g., breast biopsies,
vasectomies) and to stitch small wounds.
2. Regional Anesthesia- numbs a large area, or region, of the body
and is used for more extensive and invasive surgery, often used for
procedures involving the lower part of the body, such as
caesarian sections, prostate surgery, and operations on the legs.
For example, if regional anesthesia is used for prostate surgery, the
patient is numb from his navel to his toes.
Types of regional anesthesia are :
1. Spinal anesthesia- is injected into the spinal fluid with a
special needle that penetrates the spinal column through
the back.
2. Epidural anesthesia is injected into an area outside the
spinal column called the epidural space
3. General Anesthesia
renders the patient completely unconscious and with no memory of the
surgical procedure upon awakening.
-given intravenously or inhaled through a breathing mask, and sometimes
both methods are used. ( Ex. Craniotomy,Cholecystectomy)

Common Medications Used In Anesthesia

1.Analgesics (Pain Relievers)
a. Acetaminophen (Tylenol) b.NSAIDs (ketorolac )
c. Narcotics (Demerol)
2. Anxiolytics (Sedatives) - are medications that help to reduce
or alleviate anxiety and relax the body.(midazolam (Versed )
3. Local Anesthetics- are medications that block the conduction
of impulses in nerves that relay pain signals. These are also
commonly known as “numbing agents”. (For EGD) ( lidocaine )
4. General Anesthetics- are medications that induce and
maintain a state of unconsciousness. They cause anterograde
amnesia, meaning that a patient does not remember the events
that follow their administration. given either by IV injection or
inhaled as a gas.
5. Inhalational Gases: Sevoflurane, Desflurane, Isoflurane
6. Intravenous Agents: Propofol (Diprivan®), Ketamine
EtomidatePropofol (Diprivan®) is the most commonly used IV
general anesthetic.
7. Paralytics (Muscle Relaxants) - are medications that induce
complete relaxation of the muscles and help to facilitate
intubation and surgery. Succinylcholine is a short acting
paralytic Cisatracurium (Nimbex®) are longer-acting paralytics
Four Stages of General Anesthesia
 Onset (Analgesia) – from anesthetic administration to
loss of consciousness
 Excitement – from loss of consciousness to loss of eyelid
reflexes
 Surgical Anesthesia – from loss of eyelid reflexes to loss
of most reflex and depression of vital functions
 Danger (death) (Medullary Paralysis) – vital functions are
too depressed causing respiratory and circulatory failure
Types of Surgery ( According to degree of Urgency)
1. EMERGENCY- performed immediately to preserve client’s
life, maintain organ or limb function, remove a damaged
organ or stop hemorrhage
2. IMPERATIVE - the patient requires surgical intervention
within 24-48 hours
3. ELECTIVE - performed to a patient whose condition is not
imminently life threatening or to improve client’s life or well-
being
4. OPTIONAL – surgery is performed for the individual’s
preference
Types of Surgery ( According to degree of Risk)
1. MAJOR - involves high degree of risk; may be
complicated or prolonged, large losses of blood
may occur, vital organs may be involved, or
postoperative complications may be likely
2. MINOR – involves a little risk produces few
complications and often performed in a “day
surgery”
Types of Surgery ( According to Purpose)
1. DIAGNOSTIC - confirms a diagnosis (Excision &
biopsy
2. PALLIATIVE - reduces pain or symptoms but does
not cure the disease(chordotomy)
3. CURATIVE
a. ABLATIVE - removes a diseased body part
(hysterectomy)
b. CONSTRUCTIVE - repair of congenital defects
(repair of cleft lip or palate)
C. RECONSTRUCTIVE- restoration of damaged
organ (episiorrhaphy)
 4. Exploratory- to estimate the extent of the disease and
confirm diagnosis as
well ( Exploratory Laparotomy)

5. TRANSPLANT - replaces malfunctioning structures

Potential postoperative complications
 Pneumonia
 Atelectasis
 Pulmonary embolism
 Hypovolemia
 Hemorrhage
 Thrombophlebitis
 Thrombus/embolus formation
 Urinary retention
 Urinary tract infection
 Nausea and vomiting
 Constipation
 Tympanitis
 Postoperative ileus
 Wound infection
 Wound dihiscence/
wound evisceration
 Postoperative depression
Five W’s of Post-operative Fever
1. Wind: Pneumonia – the primary cause of post-
operative fever during the first 48 hours
2. Water: UTI or dehydration
3. Wound: infection at surgical site
4. Walk: development of deep venous thrombosis
5. Wonderdrugs: drug-induced fever, usually
anesthesia