Surgical Nursing
The Surgical Nursing domain tests operating-room discipline and postoperative judgment: asepsis, patient preparation, instrument identification and handling, suture selection, wound classification, hemostasis, and recovery monitoring. Questions often describe a procedure and ask what should happen next.
Core rules
- Classify wounds before closure: clean, clean-contaminated, contaminated, or dirty/infected. Closure of a contaminated wound may require debridement, lavage, and delayed closure rather than immediate primary closure.
- Clip hair away from the incision before antiseptic scrub; scrub from the incision outward, not back and forth.
- Maintain the sterile field: gowns are sterile front chest to waist, gloves above the elbows; never turn your back to the field.
- Choose suture by tissue and tension. Absorbable monofilament such as poliglecaprone or polyglyconate suits many soft-tissue closures; nonabsorbable nylon suits skin. Use the smallest size that holds tension.
- Count instruments and sponges before and after surgery.
Worked example
A dog has a 3 cm laceration contaminated with dirt, seen 6 hours after injury. The wound is lavaged, debrided, and left open with a wet-to-dry bandage; closure is planned in 48 hours. Reasoning: bacterial load and devitalized tissue make immediate primary closure risky; delayed primary closure after granulation reduces infection.
Traps
Scrubbing the incision last instead of first, clipping after the scrub, breaking sterile technique by reaching over the field, and choosing a braided suture in an infected wound. Also, forgetting to record sponge counts.