Surgical Nursing
What this domain tests
Surgical Nursing covers the entire perioperative period: preparing the patient, the suite, and the team; knowing instruments and suture materials; maintaining asepsis; and recognizing postoperative complications. The exam favors practical asepsis and wound-closure decision-making.
Asepsis and the surgical team
- The suite has three zones: unrestricted, semi-restricted, and restricted.
- Perform a timed surgical hand scrub with chlorhexidine or povidone-iodine, dry with a sterile towel, and gown and glove using closed-glove technique.
- Sterile team members keep hands above waist level, never turn their back on the sterile field, and replace any item that touches a non-sterile surface.
- Only sterile items enter the field; caps and masks are worn by everyone in the room.
Patient preparation
- Clip hair widely outside the prep area and vacuum or remove loose hair before skin antisepsis.
- Scrub from the incision site outward, alternating chlorhexidine scrub and rinse (or iodine), and avoid pooling of solution.
- Alcohol is flammable: allow it to dry and never use it near electrocautery.
- Place the drape once; do not reposition it after it contacts the patient.
Instruments and sutures
- Categories: cutting (scalpel, scissors), hemostatic (hemostats), grasping (thumb forceps), retractors, and needle holders.
- Absorbable sutures include polydioxanone, polyglactin 910, and catgut; nonabsorbable include nylon, polypropylene, and silk.
- Monofilament sutures harbor fewer bacteria than braided sutures. Suture size decreases as the number increases (3-0 is larger than 5-0).
- Common patterns: simple interrupted, simple continuous, Ford interlocking, mattress, and intradermal.
Worked example
A gastrotomy is planned in a 15 kg dog. Choose 3-0 or 4-0 monofilament absorbable suture such as polydioxanone with a swaged-on taper needle. Use an appositional simple interrupted or continuous pattern, taking bites that include submucosa for strength while avoiding excessive mucosal penetration and strangulating the tissue. Reasoning: this is a contaminated hollow-organ site, so an absorbable monofilament reduces the risk of suture-related infection, and a taper needle passes through soft tissue with less trauma.
Traps that cost marks
- Clipping after draping, which showers hair into the field.
- Losing track of instrument or sponge counts.
- Tying sutures so tightly that tissue becomes ischemic and dehisces.
- Using braided suture in a contaminated wound.
- Failing to monitor temperature, pain, and the incision during recovery.