Surgical Nursing
Surgical nursing tests asepsis, patient preparation, instrument and suture knowledge, and your ability to protect the sterile field while monitoring the patient. Expect questions that combine technique with judgment about contamination.
Asepsis and patient preparation
- Clip hair away from the incision and vacuum loose hair before the final prep. Chlorhexidine gluconate 2-4% or povidone-iodine are standard; chlorhexidine must not enter the eye or middle ear.
- Scrub with friction for 3-5 minutes, alternating scrub and rinse; start at the intended incision and work outward. Alcohol alone is not a substitute for a surgical scrub.
- Wear a sterile gown and gloves; keep the sterile field in view; never reach over an open wound.
- Count instruments, needles, and sponges before and after the procedure.
Instruments and closure
- Absorbable sutures include polydioxanone, polyglactin 910, and poliglecaprone; nylon and silk are nonabsorbable.
- Suture size decreases as the number increases: 3-0 is larger than 5-0. Choose the smallest size that holds the tissue.
- Common closures: simple interrupted, cruciate, continuous, and subcuticular patterns.
Worked example
A needle is dropped during an ovariohysterectomy. It is not retrieved with a bare hand. The surgeon replaces it with a sterile needle, and the nurse documents the original as contaminated and accounts for it at the final count. If a sponge count is short, radiograph the patient before recovery.
Traps that cost marks
Prepping the site after draping; scrubbing in a circular motion that returns to contaminated skin; using chlorhexidine near the cornea; forgetting active warming; and removing a bandage without checking for swelling or strike-through.