Surgical Nursing
Surgical nursing tests asepsis, operating-room readiness, patient preparation, instrument and suture knowledge, intraoperative monitoring, and postoperative care. The exam expects practical judgment about preventing infection and recognizing complications early.
Core rules and concepts
- Follow Halsted principles: gentle tissue handling, asepsis, hemostasis, preservation of blood supply, and accurate tissue apposition.
- Clip hair before the surgical scrub, then scrub the skin with chlorhexidine or povidone-iodine in concentric circles from the incision outward. Avoid scrubbing the eyes or mucous membranes with chlorhexidine.
- Sterile gowns and gloves are contaminated by moisture, so keep the field dry. Do not reach across an unsterile area.
- Know common instruments: Mayo scissors for heavy tissue, Metzenbaum for delicate dissection, needle holders, tissue forceps, and hemostats.
- Suture selection: absorbable materials include poliglecaprone, polyglactin 910, and polydioxanone; nonabsorbable include nylon and polypropylene. Monofilament sutures reduce wicking.
- Count sponges and instruments before closure and again at the end; a retained sponge is a preventable emergency.
Worked example
A cystotomy is planned. The bladder mucosa heals quickly and is exposed to urine, so a monofilament absorbable suture such as poliglecaprone 25 or polydioxanone at 3-0 or 4-0 is a reasonable choice. Multifilament sutures can harbor bacteria, and nonabsorbable suture in the bladder can act as a nidus for calculus formation. Confirm the surgeon's preference and document the lot and size.
Traps that cost marks
- Clipping after the scrub, which recontaminates skin.
- Letting the sterile field become wet or touching nonsterile equipment with gloved hands.
- Forgetting the final sponge and instrument count.
- Describing suture as "strong" without matching absorbability and tissue type.