🏥🩺 Perioperative Nursing Care
✅ I. Introduction / Definition:
Perioperative nursing care refers to the comprehensive care provided by nurses to patients before (preoperative), during (intraoperative), and after (postoperative) surgery. It includes assessment, preparation, monitoring, and evaluation of the patient to ensure safe and effective surgical outcomes.
🟢 II. Phases of Perioperative Nursing:
🔹 1. Preoperative Phase
Care provided from the time the decision for surgery is made until the patient is transferred to the operating room.
🔹 2. Intraoperative Phase
Care provided during the actual surgical procedure, from patient transfer into the OR until transfer to the recovery unit.
🔹 3. Postoperative Phase
Care provided from admission to the Post Anesthesia Care Unit (PACU) until full recovery.
🧾 III. Objectives of Perioperative Nursing:
🔸 Ensure patient safety before, during, and after surgery
🔸 Provide emotional and psychological support
🔸 Minimize risk of surgical complications
🔸 Promote optimal recovery and rehabilitation
🔸 Educate the patient and family about surgical procedures
📖 IV. Preoperative Nursing Care:
✅ Take informed consent
✅ Assess vital signs, allergies, and medical history
✅ Ensure NPO status (Nil Per Oral for 6–8 hrs)
✅ Provide psychological support and answer queries
✅ Shave/clean surgical site as per protocol
✅ Remove prosthetics, dentures, jewelry, nail polish
✅ Administer prescribed pre-op medications (e.g., antibiotics, sedatives)
✅ Label patient and ensure correct identification
🏥 V. Intraoperative Nursing Care:
✅ Ensure sterile environment and surgical asepsis
✅ Assist in positioning the patient properly
✅ Count surgical instruments, sponges, needles (before and after)
✅ Monitor vital signs continuously
✅ Document surgical procedures and interventions
✅ Support the surgical team (scrub nurse/circulating nurse role)
🛌 VI. Postoperative Nursing Care:
✅ Receive and assess patient in PACU (Airway, Breathing, Circulation – ABC)
✅ Monitor for postoperative complications (bleeding, shock, infection)
✅ Manage pain and administer analgesics
✅ Observe for nausea, vomiting, urinary retention
✅ Record intake-output, monitor drainage
✅ Encourage early ambulation to prevent DVT
✅ Educate on wound care and discharge instructions
⚠️ VII. Postoperative Complications:
🔺 Hemorrhage
🔺 Infection or sepsis
🔺 Deep vein thrombosis (DVT)
🔺 Pulmonary embolism
🔺 Urinary retention
🔺 Delayed wound healing
🔺 Respiratory distress (atelectasis, aspiration)
👩⚕️ VIII. Nursing Responsibilities Summary:
🟩 Preoperative
• Educate patient, check ID, consent, NPO status, skin prep
🟨 Intraoperative
• Maintain asepsis, assist surgical team, monitor vitals
🟧 Postoperative
• ABC assessment, pain management, wound care, early ambulation
📚 Golden One-Liners for Quick Revision:
🟡 Perioperative care includes pre, intra, and post-op phases
🟡 Consent must be signed before administering sedatives
🟡 NPO status prevents aspiration during anesthesia
🟡 Early ambulation prevents postoperative DVT
🟡 Airway is the first priority in postoperative care
✅ Top 5 MCQs for Practice:
Q1. What is the main purpose of keeping a patient NPO before surgery?
🅰️ Prevent weight gain
🅱️ Avoid bleeding
✅ 🅲️ Prevent aspiration
🅳️ Induce vomiting
Correct Answer: 🅲️ Prevent aspiration
📘 Rationale: NPO prevents gastric contents from entering the lungs during anesthesia.
Q2. What is the first priority in post-anesthesia recovery?
🅰️ Pain relief
✅ 🅱️ Maintain airway
🅲️ Wound assessment
🅳️ Vital signs monitoring
Correct Answer: 🅱️ Maintain airway
📘 Rationale: Airway obstruction is a critical concern post-anesthesia.
Q3. What is the role of the circulating nurse in the OR?
🅰️ Scrubs in and passes instruments
✅ 🅱️ Maintains the sterile field and manages documentation
🅲️ Sutures the incision
🅳️ Administers anesthesia
Correct Answer: 🅱️ Maintains the sterile field and manages documentation
📘 Rationale: Circulating nurse handles patient safety, sterility, and records.
Q4. Which is a common postoperative complication?
🅰️ Hypoglycemia
✅ 🅱️ Deep vein thrombosis
🅲️ Hypercalcemia
🅳️ Cataract
Correct Answer: 🅱️ Deep vein thrombosis
📘 Rationale: Immobility post-surgery can lead to clot formation in deep veins.
Q5. Which medication is commonly used for preoperative sedation?
✅ 🅰️ Midazolam
🅱️ Furosemide
🅲️ Acetaminophen
🅳️ Metronidazole
Correct Answer: 🅰️ Midazolam
📘 Rationale: Midazolam is a benzodiazepine used to reduce anxiety preoperatively.
📝👩⚕️ Preoperative Nursing Care
📘 Highly Important for Medical-Surgical Nursing, OT Nursing & Staff Nurse Competitive Exams
✅ I. Introduction / Definition:
Preoperative nursing care refers to the comprehensive physical, emotional, and psychological preparation of the patient before undergoing surgery.
It begins when the decision for surgery is made and continues until the patient is transferred to the operating room.
🟢 II. Objectives of Preoperative Nursing Care:
🔸 Ensure patient safety and physical readiness
🔸 Minimize surgical and anesthetic risks
🔸 Relieve anxiety and build confidence
🔸 Prevent complications like infection or aspiration
🔸 Educate patient and obtain informed consent
📖 III. Key Components of Preoperative Nursing Care:
🔹 1. Physical Preparation:
🧼 Skin Preparation:
• Bath with antiseptic soap
• Shaving of operative site as per protocol
🥣 Gastrointestinal Prep:
• NPO (Nil Per Oral) 6–8 hrs before surgery
• Enemas or laxatives if required
💉 Preoperative Medications:
• Sedatives (e.g., Diazepam)
• Antibiotics (to prevent infection)
• Anticholinergics (e.g., Atropine to reduce secretions)
👚 Clothing and Accessories:
• Remove jewelry, dentures, contact lenses, nail polish
• Provide hospital gown and ID band
🔹 2. Psychological Preparation:
🗨️ Provide clear explanation of surgery and expected outcome
🧘 Encourage questions and address fears
👪 Allow family involvement
📖 Educate on postoperative pain and breathing exercises
🔹 3. Assessment and Documentation:
📋 Collect medical/surgical history and allergies
🩺 Check vital signs (BP, HR, Temp, RR)
💊 Review current medications
🧪 Verify lab reports (CBC, electrolytes, blood glucose, etc.)
🧾 Ensure informed written consent is signed
🔹 4. Safety Measures:
🔐 Correct patient ID and surgical site marking
🚫 NPO compliance to prevent aspiration
💼 Safe transfer to OT with complete documentation
📁 Communicate special needs (e.g., prosthetics, pacemaker)
👩⚕️ IV. Nursing Responsibilities:
🟩 Before Surgery:
🔹 Verify identity, consent, and surgery site
🔹 Ensure NPO status and vital signs stability
🔹 Administer premedication as prescribed
🔹 Provide emotional support and clear instructions
🟨 Immediate Pre-Op (1–2 hours before):
🔹 Ensure bladder emptying
🔹 Secure IV access
🔹 Check that all investigations and consents are complete
🔹 Transport safely to OT
🟥 Documentation:
🔹 Allergies, last meal time, premedication given
🔹 Patient education provided
🔹 Informed consent availability
📚 Golden One-Liners for Quick Revision:
🟡 NPO prevents aspiration during anesthesia
🟡 Shaving is done only if needed and just before surgery
🟡 Consent must be obtained before administering sedatives
🟡 Emotional support is key in reducing pre-op anxiety
🟡 Pre-op medications include sedatives, anticholinergics, antibiotics
✅ Top 5 MCQs for Practice:
Q1. What is the minimum recommended NPO period before surgery?
🅰️ 2 hours
🅱️ 4 hours
✅ 🅲️ 6–8 hours
🅳️ 10–12 hours
Correct Answer: 🅲️ 6–8 hours
📘 Rationale: Ensures empty stomach to reduce aspiration risk during anesthesia.
Q2. Which medication is commonly used to reduce respiratory secretions before surgery?
🅰️ Diazepam
✅ 🅱️ Atropine
🅲️ Furosemide
🅳️ Paracetamol
Correct Answer: 🅱️ Atropine
📘 Rationale: Atropine is an anticholinergic that reduces salivary and bronchial secretions.
Q3. What should be removed from a patient before surgery?
🅰️ Jewelry
🅱️ Nail polish
🅲️ Dentures
✅ 🅳️ All of the above
Correct Answer: 🅳️ All of the above
📘 Rationale: To prevent interference with surgery and reduce risk of injury.
Q4. What is the nurse’s first responsibility after giving a pre-op sedative?
🅰️ Allow the patient to walk
✅ 🅱️ Ensure patient safety and bed rest
🅲️ Take blood pressure
🅳️ Call the surgeon
Correct Answer: 🅱️ Ensure patient safety and bed rest
📘 Rationale: Sedatives may cause drowsiness, so fall precautions are necessary.
Q5. Which document must be verified before surgery begins?
🅰️ Discharge summary
🅱️ Nursing care plan
✅ 🅲️ Informed consent
🅳️ Diet chart
Correct Answer: 🅲️ Informed consent
📘 Rationale: Legal and ethical requirement before any surgical procedure.
🔪🧼 Intraoperative Nursing Care
📘 Important for Operation Theatre Nursing, Medical-Surgical Nursing & Staff Nurse Exams
✅ I. Introduction / Definition:
Intraoperative nursing care refers to the specialized nursing care provided during the actual surgical procedure, starting from the time the patient is transferred to the operating room until they are moved to the recovery room (PACU).
🟢 II. Objectives of Intraoperative Nursing Care:
🔸 Maintain sterile technique and asepsis
🔸 Ensure patient safety and correct positioning
🔸 Support the surgical team and procedure
🔸 Monitor patient’s physiological status
🔸 Prevent surgical site infections and complications
🏥 III. Types of Intraoperative Nurses:
🔹 1. Scrub Nurse (Sterile Role):
👩⚕️ Works within the sterile field
🛠️ Handles sterile instruments and supplies
📌 Key Responsibilities:
✅ Prepare and organize sterile field
✅ Count instruments and sponges (before, during, after)
✅ Pass instruments to surgeon
✅ Maintain sterility throughout procedure
✅ Assist in draping, suction, suturing, retraction
🧪 Works directly with: Surgeon, First Assistant, Anesthetist
🔹 2. Circulating Nurse (Non-Sterile Role):
🚶♀️ Functions outside the sterile field
🔎 Ensures patient safety and supports surgical environment
📌 Key Responsibilities:
✅ Verify patient ID, consent, surgical site
✅ Monitor environment (lighting, temperature, equipment)
✅ Open sterile packs without contamination
✅ Document surgical procedures
✅ Handle specimens (label, transport to lab)
✅ Provide emotional reassurance to patient before anesthesia
🧪 Works closely with: Scrub nurse, Anesthesiologist, OT technician
📖 IV. Other Key Intraoperative Nursing Tasks:
🔹 Assist with positioning (pad pressure points to prevent nerve injury)
🔹 Perform skin prep with antiseptics (betadine, chlorhexidine)
🔹 Observe patient for changes in vitals (under anesthesia)
🔹 Communicate with surgical team about equipment or patient needs
🔹 Count instruments and materials (initial, closing, and final count)
🔹 Report any breaks in aseptic technique immediately
⚠️ V. Common Intraoperative Risks:
❌ Hypothermia
❌ Bleeding and hemorrhage
❌ Pressure injuries from positioning
❌ Anesthesia-related complications (e.g., malignant hyperthermia)
❌ Retained surgical items (sponges, needles)
👩⚕️ VI. Nursing Responsibilities: (Scrub + Circulating)
🟩 Scrub Nurse:
🔹 Sterile field management
🔹 Instrument and suture handling
🔹 Maintaining count of sponges and tools
🔹 Handing over instruments during surgery
🔹 Assisting with dressing and closure
🟨 Circulating Nurse:
🔹 Room preparation and documentation
🔹 Equipment and patient verification
🔹 Ensuring sterility from outside the field
🔹 Specimen handling and communication
🔹 Ensuring safety and emotional comfort
📚 Golden One-Liners for Quick Revision:
🟡 Scrub nurse works in the sterile field — passes instruments
🟡 Circulating nurse works outside the sterile field — manages documentation
🟡 Sponge and instrument counts are done thrice: before, during, after
🟡 Skin preparation reduces surgical site infection
🟡 Breaks in asepsis must be reported immediately
✅ Top 5 MCQs for Practice:
Q1. What is the primary role of the scrub nurse during surgery?
🅰️ Monitoring ECG
🅱️ Administering anesthesia
✅ 🅲️ Passing sterile instruments to the surgeon
🅳️ Recording I&O
Correct Answer: 🅲️ Passing sterile instruments to the surgeon
📘 Rationale: The scrub nurse works in the sterile field and assists the surgeon directly.
Q2. The circulating nurse is responsible for:
🅰️ Suturing the wound
✅ 🅱️ Verifying patient identity and consent
🅲️ Passing sutures inside the field
🅳️ Holding retractor
Correct Answer: 🅱️ Verifying patient identity and consent
📘 Rationale: The circulating nurse ensures safety checks and documentation outside the sterile zone.
Q3. What is done to prevent retained surgical items?
🅰️ Use of blunt needles
✅ 🅱️ Counting instruments before and after surgery
🅲️ Use of continuous suture
🅳️ Elevating the wound
Correct Answer: 🅱️ Counting instruments before and after surgery
📘 Rationale: Surgical counts reduce the risk of items being left inside the patient.
Q4. During surgery, who is responsible for opening sterile packs?
🅰️ Surgeon
✅ 🅱️ Circulating Nurse
🅲️ Scrub Nurse
🅳️ Anesthesiologist
Correct Answer: 🅱️ Circulating Nurse
📘 Rationale: The circulating nurse opens sterile supplies while maintaining sterility.
Q5. A scrub nurse notices a contaminated instrument. What should they do?
🅰️ Ignore and continue
🅱️ Clean it and reuse
✅ 🅲️ Discard and inform surgeon
🅳️ Pass it quickly to finish surgery
Correct Answer: 🅲️ Discard and inform surgeon
📘 Rationale: Any breach in sterility must be addressed immediately to prevent infection.
🔪🩺 Surgery and Its Types
📘 Important for Medical-Surgical Nursing, Operation Theatre Nursing & Staff Nurse Exams
✅ I. Introduction / Definition:
Surgery is a branch of medical practice that treats injuries, deformities, diseases, or abnormalities by manual and instrumental operations.
✅ It involves incision, excision, suturing, manipulation, or alteration of body tissues for diagnostic or therapeutic purposes.
🟢 II. Objectives of Surgery:
🔹 Remove diseased tissue or organs (e.g., appendectomy)
🔹 Repair or reconstruct damaged structures (e.g., hernia repair)
🔹 Relieve symptoms (e.g., palliative cancer surgery)
🔹 Restore normal function (e.g., joint replacement)
🔹 Diagnose disease (e.g., biopsy, laparoscopy)
📖 III. Classification of Surgery:
🔹 1. Based on Purpose:
🩺 Curative Surgery:
✅ Removes the cause of the disease
👉 E.g., Tumor excision, Appendectomy
🩺 Diagnostic Surgery:
✅ Confirms or identifies disease
👉 E.g., Biopsy, Laparoscopy
🩺 Palliative Surgery:
✅ Reduces symptoms but not a cure
👉 E.g., Debulking tumor to relieve pressure
🩺 Reconstructive Surgery:
✅ Restores appearance or function
👉 E.g., Cleft lip repair, Skin grafting
🩺 Transplant Surgery:
✅ Replaces diseased organ with donor organ
👉 E.g., Kidney transplant, Liver transplant
🩺 Preventive (Prophylactic) Surgery:
✅ Prevents occurrence of disease
👉 E.g., Mastectomy in BRCA-positive women
🔹 2. Based on Urgency:
🚨 Emergency Surgery:
✅ Performed immediately to save life
👉 E.g., Trauma repair, Ectopic pregnancy rupture
🕑 Urgent Surgery:
✅ Required within 24–48 hours
👉 E.g., Fracture repair, Appendicitis
📅 Elective Surgery:
✅ Planned in advance, not life-threatening
👉 E.g., Cataract removal, Hernia repair
🔹 3. Based on Procedure:
🔹 Open Surgery:
✅ Involves large incisions
👉 E.g., Laparotomy, Open-heart surgery
🔹 Minimally Invasive Surgery (MIS):
✅ Uses small incisions + camera (laparoscopy, endoscopy)
👉 Benefits: Less pain, faster recovery
🔹 Robotic Surgery:
✅ Performed via robotic systems, guided by surgeon
👉 E.g., Robotic prostatectomy
👩⚕️ IV. Nursing Responsibilities (Pre, Intra, Post):
🟩 Preoperative:
🔹 Obtain informed consent
🔹 Provide education and psychological support
🔹 Maintain NPO status
🔹 Administer pre-op meds and prep site
🟨 Intraoperative:
🔹 Maintain aseptic technique
🔹 Position patient correctly
🔹 Assist surgeon and anesthetist
🔹 Count instruments/sponges
🟥 Postoperative:
🔹 Monitor ABCs (Airway, Breathing, Circulation)
🔹 Manage pain and monitor for complications
🔹 Encourage early ambulation
🔹 Educate on wound care and discharge plan
📚 Golden One-Liners for Quick Revision:
🟡 Curative surgery removes the root cause
🟡 Diagnostic surgery helps confirm a diagnosis
🟡 Palliative surgery relieves symptoms without curing
🟡 Elective surgeries are planned and non-emergent
🟡 Laparoscopy is a type of minimally invasive surgery
✅ Top 5 MCQs for Practice:
Q1. Which surgery type is performed to relieve symptoms, not to cure?
🅰️ Curative
✅ 🅱️ Palliative
🅲️ Diagnostic
🅳️ Preventive
Correct Answer: 🅱️ Palliative
📘 Rationale: Palliative surgery is done to relieve discomfort or improve quality of life.
Q2. An appendectomy is an example of which type of surgery?
🅰️ Diagnostic
✅ 🅱️ Curative
🅲️ Reconstructive
🅳️ Emergency only
Correct Answer: 🅱️ Curative
📘 Rationale: It removes the inflamed appendix, curing the condition.
Q3. Which type of surgery is scheduled and not urgent?
🅰️ Emergency
🅱️ Urgent
✅ 🅲️ Elective
🅳️ Palliative
Correct Answer: 🅲️ Elective
📘 Rationale: Elective surgeries are pre-planned and not life-threatening.
Q4. What is a key advantage of minimally invasive surgery?
🅰️ Longer recovery
🅱️ Higher pain levels
✅ 🅲️ Smaller incisions and quicker recovery
🅳️ Open access to organs
Correct Answer: 🅲️ Smaller incisions and quicker recovery
📘 Rationale: MIS reduces tissue trauma and speeds up healing.
Q5. Which surgery is done to replace a diseased organ?
🅰️ Palliative
🅱️ Diagnostic
🅲️ Preventive
✅ 🅳️ Transplant
Correct Answer: 🅳️ Transplant
📘 Rationale: Transplant surgery replaces malfunctioning organs with healthy ones.
🩺😖 Pain
✅ I. Introduction / Definition:
Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” (IASP)
It is a subjective feeling, and the patient’s report is the most reliable indicator of pain.
🟢 II. Classification of Pain:
🔹 Based on Duration:
🔸 Acute Pain – Sudden onset, lasts <6 months (e.g., injury, surgery)
🔸 Chronic Pain – Lasts >6 months, persistent (e.g., arthritis, cancer)
🔹 Based on Cause:
🔸 Nociceptive Pain – Caused by tissue injury
• Somatic: Skin, muscles, bones (sharp, localized)
• Visceral: Organs (dull, cramping)
🔸 Neuropathic Pain – Damage to nerves (e.g., diabetic neuropathy, phantom limb)
• Burning, shooting, tingling sensation
🔹 Based on Source:
🔸 Referred Pain – Felt at a site other than the source (e.g., shoulder pain in MI)
🔸 Radiating Pain – Spreads from origin (e.g., sciatica)
📖 III. Characteristics of Pain:
🔸 Onset: When did it begin?
🔸 Location: Where is the pain?
🔸 Duration: Continuous or intermittent?
🔸 Intensity: Mild, moderate, severe (0–10 scale)
🔸 Quality: Sharp, dull, throbbing, burning
🔸 Aggravating/Relieving Factors: What worsens/improves it?
🔸 Impact on ADLs: Sleep, mobility, appetite
📏 IV. Pain Assessment Tools:
🟦 Numeric Rating Scale (NRS): 0 (no pain) to 10 (worst pain)
🟦 Visual Analogue Scale (VAS): Line from “no pain” to “worst pain”
🟦 Wong-Baker FACES Pain Rating Scale: Used in children or cognitively impaired
🟦 FLACC Scale: For infants and nonverbal (Face, Legs, Activity, Cry, Consolability)
💊 V. Medical Management of Pain:
🔹 Pharmacologic:
✅ Non-opioid analgesics: Paracetamol, NSAIDs
✅ Opioids: Morphine, Tramadol, Fentanyl
✅ Adjuvants: Antidepressants, anticonvulsants (for neuropathic pain)
✅ Local anesthetics: Lidocaine patches
🔹 Non-Pharmacologic:
✅ Relaxation techniques
✅ Guided imagery and distraction
✅ TENS (Transcutaneous Electrical Nerve Stimulation)
✅ Cold and heat applications
✅ Positioning and massage
👩⚕️ VI. Nursing Management:
🟩 Assessment:
🔹 Use standardized pain scales
🔹 Observe for non-verbal signs (grimace, restlessness)
🔹 Assess the effect of pain on daily life and emotional well-being
🟨 Implementation:
🔹 Administer prescribed analgesics safely
🔹 Monitor for side effects (e.g., respiratory depression with opioids)
🔹 Apply non-pharmacological techniques
🔹 Educate the patient on pain control methods
🟥 Evaluation:
🔹 Reassess pain 30–60 minutes after intervention
🔹 Adjust care plan based on response
🔹 Promote comfort and rest
⚠️ VII. Complications of Unrelieved Pain:
❌ Sleep disturbance
❌ Depression and anxiety
❌ Increased heart rate and BP
❌ Poor wound healing
❌ Impaired immune function
❌ Reduced quality of life
📚 Golden One-Liners for Quick Revision:
🟡 Pain is a subjective experience – always trust the patient
🟡 Numeric Pain Scale ranges from 0–10
🟡 Neuropathic pain feels like burning or tingling
🟡 FLACC is used for infants or non-verbal patients
🟡 Opioids can cause respiratory depression – monitor closely
✅ Top 5 MCQs for Practice:
Q1. Which pain scale is most appropriate for a 3-year-old child?
🅰️ Numeric scale
🅱️ Visual analogue scale
✅ 🅲️ Wong-Baker FACES scale
🅳️ FLACC
Correct Answer: 🅲️ Wong-Baker FACES scale
📘 Rationale: It uses facial expressions that are easy for young children to understand.
Q2. Neuropathic pain is best described as:
🅰️ Sharp and stabbing
✅ 🅱️ Burning or tingling
🅲️ Dull and aching
🅳️ Throbbing
Correct Answer: 🅱️ Burning or tingling
📘 Rationale: It is associated with nerve damage or irritation.
Q3. What is the priority action after administering opioid analgesia?
🅰️ Check blood sugar
🅱️ Encourage fluid intake
✅ 🅲️ Monitor respiratory rate
🅳️ Assess skin turgor
Correct Answer: 🅲️ Monitor respiratory rate
📘 Rationale: Opioids depress the respiratory center, requiring close observation.
Q4. Which is a non-pharmacological method of pain control?
🅰️ Morphine
🅱️ Tramadol
🅲️ Ibuprofen
✅ 🅳️ Guided imagery
Correct Answer: 🅳️ Guided imagery
📘 Rationale: It helps distract and relax the mind, reducing pain perception.
Q5. A patient reports pain as 8/10 on the numeric scale. What should the nurse do first?
✅ 🅰️ Administer prescribed analgesic
🅱️ Tell patient to ignore it
🅲️ Wait until next dose time
🅳️ Apply cold compress without order
Correct Answer: 🅰️ Administer prescribed analgesic
📘 Rationale: Severe pain should be treated promptly according to orders.
💉😷 Anesthesia
✅ I. Introduction / Definition:
Anesthesia is a medical procedure that induces loss of sensation with or without loss of consciousness, to facilitate painless surgical or diagnostic interventions.
It can be administered via inhalation, intravenous, topical, or regional routes depending on the type and duration of procedure.
🟢 II. Classification of Anesthesia:
🔹 1. General Anesthesia (GA)
🔸 Causes complete unconsciousness and absence of all sensations
🔸 Administered via IV or inhalation
🔸 Requires airway support (endotracheal tube)
🧪 Agents: Propofol, Thiopentone, Halothane, Isoflurane
🧪 Adjuncts: Fentanyl (opioid), Midazolam (benzodiazepine), Succinylcholine (muscle relaxant)
🩺 Used for: Major surgeries (abdominal, brain, thoracic)
🔹 2. Regional Anesthesia
🔸 Loss of sensation in a specific region of the body
🔸 Patient remains conscious
Types:
🟦 Spinal Anesthesia – Injected into subarachnoid space (L3–L4)
🟦 Epidural Anesthesia – Injected into epidural space (can be continuous)
🟦 Nerve Block – Targets specific nerve or plexus (e.g., brachial block)
🩺 Used for: Cesarean section, lower limb, abdominal surgeries
🔹 3. Local Anesthesia
🔸 Loss of sensation in a small, specific area
🔸 Patient is fully conscious
🔸 No systemic effect
🧪 Agents: Lidocaine, Bupivacaine, Procaine
🩺 Used for: Dental procedures, suturing wounds, skin biopsy
🔹 4. Conscious Sedation / Monitored Anesthesia Care (MAC)
🔸 Patient is drowsy but can respond to verbal commands
🔸 Maintains airway independently
🔸 Combination of sedatives and analgesics
🧪 Agents: Midazolam, Fentanyl, Propofol (low dose)
🩺 Used for: Endoscopy, minor orthopedic procedures
📖 III. Phases of General Anesthesia:
🟡 1. Induction: From awake to unconsciousness
🟡 2. Maintenance: Maintains anesthesia throughout surgery
🟡 3. Emergence: Reversal of anesthesia and regaining consciousness
🟡 4. Recovery: Full restoration of protective reflexes
⚠️ IV. Side Effects / Complications:
🔺 Respiratory depression
🔺 Hypotension
🔺 Nausea & vomiting
🔺 Aspiration pneumonia
🔺 Headache (commonly after spinal anesthesia)
🔺 Nerve injury (rare)
🔺 Malignant hyperthermia (genetic reaction to anesthetics)
👩⚕️ V. Nursing Responsibilities in Anesthesia Care:
🟩 Pre-Anesthesia:
🔹 Obtain informed consent
🔹 Ensure NPO status for at least 6–8 hours
🔹 Review allergy and drug history
🔹 Prepare and check equipment (airway, suction, oxygen)
🔹 Provide psychological support and explain procedure
🟨 Intra-Anesthesia:
🔹 Assist anesthesiologist with equipment and positioning
🔹 Monitor vitals: HR, BP, SpO₂, ECG
🔹 Maintain sterile environment
🔹 Document drugs and interventions
🟥 Post-Anesthesia:
🔹 Assess airway, breathing, consciousness
🔹 Monitor for hypoxia, bleeding, pain
🔹 Check IV line, urinary output
🔹 Provide warm environment and emotional support
🔹 Report complications promptly
📚 Golden One-Liners for Quick Revision:
🟡 General anesthesia causes complete unconsciousness
🟡 Spinal anesthesia is injected in subarachnoid space
🟡 Epidural anesthesia can be given continuously via catheter
🟡 Local anesthesia affects a small area with intact consciousness
🟡 Conscious sedation allows response to commands without full awareness
✅ Top 5 MCQs for Practice:
Q1. Which type of anesthesia causes complete unconsciousness?
🅰️ Local
🅱️ Spinal
✅ 🅲️ General
🅳️ Regional
Correct Answer: 🅲️ General
📘 Rationale: General anesthesia induces total loss of consciousness and sensation.
Q2. Which agent is commonly used in local anesthesia?
🅰️ Isoflurane
🅱️ Propofol
✅ 🅲️ Lidocaine
🅳️ Halothane
Correct Answer: 🅲️ Lidocaine
📘 Rationale: Lidocaine is a local anesthetic used for minor procedures.
Q3. What is the most common complication of spinal anesthesia?
🅰️ Hypoxia
✅ 🅱️ Headache
🅲️ Nausea
🅳️ Seizures
Correct Answer: 🅱️ Headache
📘 Rationale: Leakage of CSF after spinal puncture causes post-spinal headache.
Q4. In which space is spinal anesthesia administered?
🅰️ Epidural space
✅ 🅱️ Subarachnoid space
🅲️ Subdural space
🅳️ Peritoneal cavity
Correct Answer: 🅱️ Subarachnoid space
📘 Rationale: Spinal anesthesia is given into the cerebrospinal fluid of subarachnoid space.
Q5. Conscious sedation allows:
✅ 🅰️ Response to verbal commands
🅱️ Complete paralysis
🅲️ No awareness
🅳️ Full anesthesia
Correct Answer: 🅰️ Response to verbal commands
📘 Rationale: In conscious sedation, the patient remains relaxed but alert enough to respond.
🛌⚕️ Common Surgical Positions
✅ I. Introduction / Definition:
Surgical positions are specific body placements of patients maintained during surgery to:
🔹 Provide optimal exposure of the operative site
🔹 Ensure patient comfort and safety
🔹 Prevent complications like nerve damage or pressure sores
Selection of position depends on:
🔸 Type and site of surgery
🔸 Anesthesia used
🔸 Patient’s age, body condition, and comorbidities
🟢 II. Common Positions Used During Surgeries:
🔹 1. Supine Position (Dorsal Recumbent):
🛏️ Lying flat on the back with arms at side or on arm boards
🩺 Used For:
• Abdominal surgery
• Cardiac surgery
• Hernia repair
• Appendectomy
⚠️ Nursing Care:
• Support bony prominences
• Avoid hyperextension of arms
• Pad heels and elbows
🔹 2. Prone Position:
🛏️ Lying on the abdomen with head turned to one side
🩺 Used For:
• Spinal surgery
• Rectal surgery
• Posterior neck surgery
⚠️ Nursing Care:
• Protect face and eyes
• Use chest rolls to prevent respiratory compression
• Pad knees and toes
🔹 3. Lithotomy Position:
🛏️ Supine with hips and knees flexed, legs held in stirrups
🩺 Used For:
• Gynecological procedures
• Vaginal delivery
• Perineal and rectal surgeries
• Urological procedures
⚠️ Nursing Care:
• Check stirrup alignment
• Prevent nerve damage (peroneal)
• Watch for venous return issues
🔹 4. Trendelenburg Position:
🛏️ Supine with head lower than feet (15–30° tilt)
🩺 Used For:
• Lower abdominal or pelvic surgeries
• Shock management (temporarily)
⚠️ Nursing Care:
• Monitor for increased intracranial pressure
• Avoid in patients with breathing difficulties
🔹 5. Reverse Trendelenburg:
🛏️ Supine with head elevated above the feet
🩺 Used For:
• Upper abdominal surgery (gallbladder, liver)
• Head and neck surgeries
⚠️ Nursing Care:
• Secure the patient to prevent sliding
• Monitor BP
🔹 6. Lateral (Sims’) Position:
🛏️ Side-lying with one leg flexed
🩺 Used For:
• Thoracic surgery
• Renal surgery
• Hip surgeries
⚠️ Nursing Care:
• Support upper arm and leg
• Pad under dependent areas
• Maintain spinal alignment
🔹 7. Fowler’s / Semi-Fowler’s Position:
🛏️ Head of bed raised 45–60° (semi = 30–45°)
🩺 Used For:
• Neurosurgery
• ENT surgeries
• Shoulder surgeries
• Postoperative recovery
⚠️ Nursing Care:
• Ensure good back support
• Monitor for hypotension
🔹 8. Jackknife (Kraske) Position:
🛏️ Prone with table bent at hips forming a “V” shape
🩺 Used For:
• Hemorrhoidectomy
• Rectal surgeries
⚠️ Nursing Care:
• Protect airway and chest
• Use padding to reduce pressure on knees and shoulders
👩⚕️ III. Nursing Responsibilities in Positioning:
🟩 Before Surgery:
🔹 Verify patient identity and consent
🔹 Assist anesthesiologist in patient comfort
🔹 Confirm surgical site and planned position
🟨 During Surgery:
🔹 Maintain correct alignment
🔹 Use positioning aids (pads, rolls, straps)
🔹 Protect pressure points
🔹 Monitor circulation and respiration
🟥 After Surgery:
🔹 Assess for numbness, tingling, or pressure sores
🔹 Monitor mobility and sensation
🔹 Document position used and patient’s response
📚 Golden One-Liners for Quick Revision:
🟡 Supine position is most commonly used in surgery
🟡 Lithotomy position is used in gynecological procedures
🟡 Prone position provides access to the spine
🟡 Trendelenburg increases venous return temporarily
🟡 Padding is essential to prevent pressure sores and nerve damage
✅ Top 5 MCQs for Practice:
Q1. Which surgical position is commonly used for spinal surgery?
🅰️ Supine
🅱️ Lithotomy
✅ 🅲️ Prone
🅳️ Fowler’s
Correct Answer: 🅲️ Prone
📘 Rationale: The prone position gives optimal access to the posterior spine.
Q2. Which position is best for gynecologic procedures like hysterectomy?
🅰️ Prone
✅ 🅱️ Lithotomy
🅲️ Trendelenburg
🅳️ Fowler’s
Correct Answer: 🅱️ Lithotomy
📘 Rationale: Lithotomy provides access to the perineum and pelvic organs.
Q3. In Trendelenburg position:
🅰️ Feet are higher than head
✅ 🅱️ Head is lower than feet
🅲️ Patient lies on the side
🅳️ Legs are flexed in stirrups
Correct Answer: 🅱️ Head is lower than feet
📘 Rationale: Trendelenburg tilts the body to improve pelvic access and venous return.
Q4. Which position requires careful protection of peroneal nerves?
🅰️ Supine
✅ 🅱️ Lithotomy
🅲️ Prone
🅳️ Lateral
Correct Answer: 🅱️ Lithotomy
📘 Rationale: Incorrect placement in stirrups can damage the peroneal nerve.
Q5. Which of the following positions is ideal for shoulder surgery?
🅰️ Supine
🅱️ Trendelenburg
🅲️ Lithotomy
✅ 🅳️ Fowler’s
Correct Answer: 🅳️ Fowler’s
📘 Rationale: Fowler’s position provides access to upper chest and shoulders.
🧵🩺 Sutures
✅ I. Introduction / Definition:
Sutures are sterile threads or materials used to hold body tissues together after injury or surgery. They aid in healing, prevent wound dehiscence, and control bleeding.
It is a type of wound closure technique performed using a needle and thread-like material.
🟢 II. Classification of Sutures:
🔹 1. Based on Material:
🔸 Absorbable Sutures
• Get broken down naturally by the body over time
• No removal required
🧪 Examples: Catgut, Vicryl, Polyglycolic acid (Dexon)
🔸 Non-Absorbable Sutures
• Do not dissolve — need manual removal
🧪 Examples: Silk, Nylon, Prolene, Polyester, Stainless steel
🔹 2. Based on Structure:
🔸 Monofilament:
• Single smooth strand
• Less infection risk
🧪 Examples: Nylon, Prolene
🔸 Multifilament (Braided):
• Several fibers twisted or braided
• Strong but more infection risk
🧪 Examples: Silk, Vicryl
🔹 3. Based on Origin:
🔸 Natural Sutures:
• Derived from animal products
🧪 Examples: Catgut, Silk
🔸 Synthetic Sutures:
• Made from polymers or plastics
🧪 Examples: Vicryl, Nylon, Prolene
📖 III. Types of Surgical Needles:
🟦 Cutting Needle: For tough tissues like skin
🟦 Reverse Cutting Needle: Less traumatic, for skin
🟦 Taper Point Needle: For soft tissues (e.g., intestine, peritoneum)
🟦 Blunt Needle: For friable tissues like liver
🏥 IV. Common Types of Suturing Techniques:
🔸 1. Interrupted Sutures:
• Individual stitches with knots
• High strength, easy removal
🔸 2. Continuous Sutures:
• One long thread without cutting
• Quick, even tension but risk of unraveling
🔸 3. Mattress Sutures:
• Horizontal/Vertical styles
• Good for everting wound edges
🔸 4. Subcuticular Sutures:
• Placed just under the skin
• Cosmetic and minimal scarring
👩⚕️ V. Nursing Responsibilities:
🟩 Before Suturing:
🔹 Prepare sterile tray
🔹 Explain procedure to patient
🔹 Assist doctor with local anesthesia
🔹 Maintain aseptic technique
🟨 During Suturing:
🔹 Hand instruments properly
🔹 Control bleeding
🔹 Monitor patient response
🟥 After Suturing:
🔹 Clean wound and apply dressing
🔹 Educate patient on suture site care
🔹 Monitor for signs of infection (redness, swelling, discharge)
🔹 Record date and type of suture material used
🔹 Schedule suture removal if non-absorbable (5–14 days depending on site)
📚 Golden One-Liners for Quick Revision:
🟡 Catgut is absorbable and made from animal intestines
🟡 Vicryl is synthetic, absorbable, and braided
🟡 Nylon and Prolene are non-absorbable and synthetic
🟡 Interrupted sutures have better strength and prevent complete failure
🟡 Taper needle is used for internal soft tissues
✅ Top 5 MCQs for Practice:
Q1. Which of the following is an absorbable suture?
🅰️ Nylon
✅ 🅱️ Vicryl
🅲️ Silk
🅳️ Prolene
Correct Answer: 🅱️ Vicryl
📘 Rationale: Vicryl is a synthetic, braided, absorbable suture.
Q2. Which type of needle is best for suturing skin?
🅰️ Taper
🅱️ Blunt
✅ 🅲️ Cutting
🅳️ Round-bodied
Correct Answer: 🅲️ Cutting
📘 Rationale: Cutting needles are sharp and ideal for tough tissues like skin.
Q3. What is the main advantage of interrupted sutures?
🅰️ Fast application
✅ 🅱️ High strength and better wound approximation
🅲️ Low cost
🅳️ Cosmetic appearance
Correct Answer: 🅱️ High strength and better wound approximation
📘 Rationale: If one suture breaks, others still hold the wound together.
Q4. Which suture material does NOT require removal?
🅰️ Silk
🅱️ Nylon
✅ 🅲️ Catgut
🅳️ Prolene
Correct Answer: 🅲️ Catgut
📘 Rationale: Catgut is absorbed naturally by the body.
Q5. Which suture type is preferred for minimal scarring?
🅰️ Mattress suture
🅱️ Interrupted suture
✅ 🅲️ Subcuticular suture
🅳️ Continuous suture
Correct Answer: 🅲️ Subcuticular suture
📘 Rationale: Subcuticular sutures are buried beneath the skin, offering a cosmetic result.
🪡 Surgical Needle
✅ I. Introduction / Definition:
A surgical needle is a medical instrument used to carry suture material through tissue during wound closure, surgical procedures, or tissue approximation.
It consists of three main parts:
🔹 Swage – End where suture is attached
🔹 Body – Middle portion, held by needle holder
🔹 Point – Tip that penetrates the tissue
🟢 II. Types of Surgical Needles (Based on Point Shape):
🔹 1. Cutting Needle
🩸 Triangular tip with sharp edges
📌 Used For: Skin, tough tissues like scalp
🧪 Example: Conventional Cutting Needle
⚠️ Higher risk of tissue trauma
🔹 2. Reverse Cutting Needle
🔸 Similar to cutting needle but the cutting edge is on the outside
📌 Used For: Skin, subcutaneous tissue, oral mucosa
✅ Less risk of tearing delicate tissues
✅ Stronger than conventional cutting
🔹 3. Taper Point Needle
🔸 Rounded body that tapers to a point
📌 Used For: Internal soft tissues like GI tract, peritoneum, bladder
🧪 Does not cut but spreads tissue apart
🔹 4. Blunt Point Needle
🔸 Rounded tip, does not cut
📌 Used For: Friable tissues like liver, kidney
✅ Reduces risk of laceration
✅ Often used in patients with coagulopathy
🔹 5. Taper Cutting Needle
🔸 Combines features of taper and cutting needle
📌 Used For: Tough but delicate tissues like tendon, cardiovascular, fascia
📦 III. Types Based on Shape of Body:
🔸 Straight Needle – Used in easily accessible areas (skin, surface)
🔸 Curved Needle – Common in deep or confined areas
• 1/4, 3/8, 1/2, 5/8 circle types
🔸 Compound Curve Needle – Combination of straight and curved sections
🛠️ IV. Parts of a Surgical Needle:
🔹 Swage – Part where suture thread is attached (eyed or eyeless)
🔹 Body (Shaft) – Main grip area for instruments
🔹 Point – Determines penetration type and shape
👩⚕️ V. Nursing Responsibilities:
🟩 Pre-Procedure:
🔹 Ensure correct needle type is selected per tissue type
🔹 Maintain sterile field
🔹 Check for integrity of suture-needle attachment
🟨 During Procedure:
🔹 Pass needles safely to the surgeon using needle holder
🔹 Use needle counters to avoid retained surgical items
🔹 Avoid hand-to-hand passing – use neutral zone
🟥 Post-Procedure:
🔹 Dispose used needles in sharps container
🔹 Count all needles before and after the procedure
🔹 Document type, number, and any breakage if occurred
📚 Golden One-Liners for Quick Revision:
🟡 Cutting needle is used for tough skin
🟡 Taper point needles are best for soft tissues
🟡 Reverse cutting needles reduce risk of tissue tearing
🟡 Blunt needles are safest for friable organs like liver
🟡 Surgical needles are classified by point, body shape, and function
✅ Top 5 MCQs for Practice:
Q1. Which needle type is most suitable for suturing skin?
🅰️ Taper
🅱️ Blunt
✅ 🅲️ Cutting
🅳️ Round-bodied
Correct Answer: 🅲️ Cutting
📘 Rationale: Cutting needles penetrate tough tissues like skin efficiently.
Q2. A needle with cutting edge on the outer curve is called:
🅰️ Taper point
🅱️ Conventional cutting
✅ 🅲️ Reverse cutting
🅳️ Blunt
Correct Answer: 🅲️ Reverse cutting
📘 Rationale: Reverse cutting needles reduce risk of tearing delicate tissues.
Q3. Which surgical needle is best suited for liver tissue?
🅰️ Cutting
🅱️ Reverse cutting
🅲️ Taper
✅ 🅳️ Blunt point
Correct Answer: 🅳️ Blunt point
📘 Rationale: Blunt needles minimize trauma to friable organs like liver.
Q4. What is the function of the swage in a surgical needle?
✅ 🅰️ To attach the suture
🅱️ To cut the tissue
🅲️ To hold the needle
🅳️ To form the point
Correct Answer: 🅰️ To attach the suture
📘 Rationale: Swage is the end of the needle where the suture thread is attached.
Q5. A needle that spreads tissue rather than cuts is called:
🅰️ Cutting
✅ 🅱️ Taper point
🅲️ Reverse cutting
🅳️ Blunt
Correct Answer: 🅱️ Taper point
📘 Rationale: Taper needles push tissues apart gently without slicing them.