Surgical Nursing
Asepsis is the theme
Surgical nursing questions usually hinge on asepsis: what is sterile, what is clean, and where the break in technique occurred. Know the surgical hand scrub (chlorhexidine gluconate or povidone-iodine, scrub to the elbows, hands held above elbows, dry, then gown and closed-glove), and patient preparation (clip a wide margin, remove loose hair, scrub skin, avoid alcohol on mucous membranes or open wounds). Draped patients are never re-prepped through the drape.
Instruments and materials
Match instruments to purpose: hemostats and Kelly forceps for vessels, Mayo scissors for fascia, Metzenbaum scissors for fine tissue, needle holders, thumb forceps, retractors, towel clamps. Know absorbable suture (polyglactin 910, poliglecaprone, catgut) versus nonabsorbable (nylon, polypropylene, silk), and patterns: simple interrupted, continuous, cruciate, mattress, subcuticular. Understand the steps of instrument counts and sponge counts.
Sterilization and the operative period
Steam autoclaving typically runs at 121 °C (250 °F) and 15 psi for 15–30 minutes, or higher temperature for shorter cycles; chemical and ethylene oxide methods exist. Position the patient to maximize ventilation and access, monitor vital signs and anesthetic depth, and keep the patient warm.
Postoperative care
Monitor temperature, pulse, respiration, pain, incision, drains, and bandages. Educate the owner about restriction of activity and monitoring for swelling or discharge.
Worked example
A pack is autoclaved and the internal chemical indicator has not changed color. That pack is not sterile and must not be used, regardless of the external tape.
Traps
Scrubbing the patient in the wrong order, using alcohol in the ear canal or mucosa, forgetting to count sponges, and choosing a nonabsorbable suture for a contaminated wound.