Surgical Nursing – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management, and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.

Table of Contents

Surgical Nursing

Definition of Surgery:

Surgery is the branch of medicine that employs operations in the treatment of disease or injury. Surgery can involve cutting, abrading, suturing, or otherwise physically changing body tissues and organs.

Or,

Surgery is the branch of medicine that is concerned with the treatment of injuries, diseases, and other disorders by manual and instrumental means.

Types of Surgery:

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation.

1. Based on timing: Elective surgery is done to correct a non-life-threatening condition, and is carried out at the patient’s request, subject to the surgeon’s and the surgical facilities availability. A semi-elective surgery is one that must be done to avoid permanent disability or death, but can be postponed for a short time. Emergency surgery is surgery which must be done promptly to save life, limb, or functional capacity.

2. Based on purpose: Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition. Cosmetic surgery is done to subjectively improve the appearance of an otherwise normal structure.

3. By type of procedure: Amputation involves cutting off a body part, usually a limb or digit; castration is also an example. Resection is the removal of all of an internal organ or body part, or a key part (lung lobe; liver quadrant) of such an organ or body part that has its own name or code designation.

Replantation involves reattaching a severed body part. Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Excision is the cutting out or removal of only part of an organ, tissue, or other body part from the patient.

Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the patient. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery.

4. By body part: When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones or muscles).

5. By degree of invasiveness of surgical procedures: Minimally-invasive surgery involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, an open surgical procedure such as a laparotomy requires a large incision to access the area of interest.

6. By equipment used: Laser surgery involves use of a laser for cutting tissue instead of a scalpel or similar surgical instruments. Microsurgery involves the use of an operating microscope for the surgeon to see small structures. Robotic surgery makes use of a surgical robot, such as the Da Vinci or the ZEUS robotic surgical systems, to control the instrumentation under the direction of the surgeon.

Definition of Surgical Nursing:

Surgical nursing is a nursing specialty area concerned with the care of patients in a broad range of settings before, during and after surgery.

Definition of Surgical Nurse:

A surgical nurse, also referred to as a theatre nurse or scrub nurse, specializes in preoperative care, providing care to patients before, during and after surgery.

Duties and Responsibilities of a Surgical Nurse:

Preoperative Phase

This stage is undertaken when the patient decides to have surgery. Preoperative phase, which includes discussing to the patients about all the benefits of the procedure but also the dangers
that could occur.
By giving this information to the patients prior their operation, it’s a good chance for the patient to discuss any concerns they may have.
Also the theatre nurses must making sure that the patients are in good health, before going ahead with the surgery. While it is very important to prepare a patient physically it is also important to mentally prepare a patient prior to surgery.
A surgical nurse will help prepare the patient using various methods often including family members depending on the situation. The patient will normally express any concerns about the surgery to the nurse, this information will be passed on to other hospital staff including the surgeon, the appropriate actions will be taken dependent on the situation.

Intraoperative Phase

This stage begins when the ward nurse, who has prepared the patient for surgery, delivers the patient and their notes to the theatre and/or anaesthetic nurse.
Many checks are undertaken in this stage to ensure a safe environment for the patient and the theatre staff.
The theatre nurse carries out activities to maintain a sterile environment and to ensure the surgical equipment is working well.
The nurse also organizes all surgical instruments and ensures all supplies needed during the surgery are available.

Postoperative Phase

This phase begins when the theatre/anaesthetic nurse delivers the patients notes to the nurses and staff in the Post-Anaesthetic Care Unit (PACU). This can also be known as the recovery room.
Here the nurse’s immediate attention is on checking the patient’s airway and breathing.
In this phase nurses also attend to pain relief and any other complications following surgery. These nurses, often in day surgery cases, attend to provide patients and their caregivers with support and instructions and requirements needed for home care.
The first twenty-four hours post-surgery are critical, there are many procedures that should take place in order to monitor the patient.
Observations of the patient need to be taken and recorded every fifteen minutes.
General observations are inclusive of, heart rate, blood pressure, temperature, respiratory rate and oxygen saturation.
Further tasks taken out by a surgical nurse post operation include; urine output, assessment of wound sites, replacing intravenous requirements and reporting any abnormalities.
It is also a task of the nurse to collect information about the patient’s social history or issues, mobility restrictions, nutrition and education requirements prior to discharge from hospital.
When these tasks are taken out it is proven to improve recovery.

Physical and Psychological Preparation of the Client Who Has a Major Surgery:

	Provide adaptive exercise Prevention of infection Maintain nutrition according to condition Transfusion Maintain fluid & electrolyte balance
Physical preparation:	Maintain intake & output chart Gastrointestinal tract preparation Any acute & chronic inflammation information should be treated by the doctor before surgery Medical criteria such as DM, HTN & Ischemic heart disease should be controlled and anemia should be correction before surgery Before surgery shaving the surgical area of the body Stomach should be empty 6-8 hours before OT Some surgical operation procedure may need retentive catheterization before surgery Provide medication Monitoring vital signs – BP, temperature, pulse, respiratory rate & must be recorded Remove all jewelries & any metal & false teeth Patient clothing example-cap laggings gown Any allergies of the patient should be noted.
Psychological preparation:	Talk frankly & appropriately to patients Reassure the patient & their family or relatives about surgery Explain the patient about his/her surgery procedure Listen actively to verbal & nonverbal communication Establish trusting relationship Use of therapeutic communication Allow the patient to ask question related to his/her operation & post-operative period Spiritual aspect of the pt. should be considered Accompany to the patient while taking his/her OT Keep the patient warm specially during winter season.

Read more:

Medical and Surgical Nursing | Diploma in Nursing Science and Midwifery

Surgical Nursing | CHAPTER-1 | Medical and Surgical Nursing