Surgical Nursing, Perioperative Care and Wound Management
What the exam tests
This domain covers preoperative preparation, intraoperative safety, postoperative monitoring, and evidence-based wound care, including recognition of surgical-site infection.
Core rules
- Preoperative: verify identity, consent, fasting status, allergies, medications, dentures, jewellery, and site marking. Conduct a team time-out before incision.
- Maintain sterile technique: keep the field dry, never turn your back on it, and consider any contact with non-sterile surfaces contamination.
- Postoperative: prioritize airway, breathing, circulation, pain, nausea, urine output, drain output, and wound status. Monitor for bleeding and hypovolaemia.
- Assess wounds for size, depth, edges, exudate, odour, pain, and surrounding skin. Clean from clean to dirty and use the prescribed dressing.
- Support healing with nutrition, glycaemic control, pressure relief, early mobilization, and VTE prophylaxis.
- Label drains and lines with date and time; measure output and report sudden changes.
Worked example
On postoperative day 3, a laparotomy wound is red, warm, tender, and has purulent discharge; the patient has a temperature of 38.4 °C. The nurse does not simply apply a new dressing. She notes the wound findings, checks vital signs, informs the surgeon, obtains a wound culture as ordered, and ensures analgesia and hygiene. Reasoning: these are signs of surgical-site infection; early source control and antibiotics matter.
Traps
Touching the sterile field with ungloved hands; replacing a saturated dressing without assessing bleeding; ignoring a drain that suddenly stops; cleaning a clean wound with the same gauze used on a contaminated area; and calling wound pain “normal” when it is increasing.