FAR EASTERN UNIVERSITY

Institute of Nursing
First Semester SY 2020-2021

HAND OUT – MODULE 1.1

NUR 1213 – PAIN AND SURGERY

COURSE TITLE: Care of Clients with Problems in Oxygenation, Fluid & Electrolytes,
Infectious, Inflammatory and Immunologic Response, Cellular Aberrations, Acute and Chronic.

COURSE CODE: NCM 112

COURSE DESCRIPTION:
This course deals with concepts, principles, theories and techniques of
nursing care management of at risk and sick adult clients in any setting with alterations / problems in
oxygenation, fluid and electrolytes, infectious, inflammatory and immunologic response, cellular
aberrations, acute and chronic. The learners are expected to provide nursing care to at risk and sick adult
clients utilizing the nursing process.

COURSE CREDIT: 8 Units Theory (144 hours)

6 Units RLE (306 hours)
1 unit Skills Lab (51 hours)
5 units RLE (255 hours)

TOTAL LEARNING TIME: 20 Hours

CONCEPTS of NUR 1213:

a. Pain and Surgery - 20 hours (11 %)
b. Fluid & Electrolytes - 24 hours (21 %)
c. Oxy / Respi - 20 hours
(28%)
d. Cardio / Hema - 20 hours
e. Communicable Diseases – 28 hours (20 %)
f. Cellular Aberrations - 28 hours 20 %)
Comprehensive Exam - 4 hours
--------------------------------------------------
144 hours (100%)

COURSE PLACEMENT: Third Year, First Semester

PRE REQUISITE: NCM 109

COURSE OUTCOMES:
1. Apply knowledge of physical, social, natural and health sciences,
and humanities in the nursing care of at risk and sick adult clients with
problems in oxygenation, fluid and electrolytes, infectious,
inflammatory and immunologic response, cellular aberrations, acute and
chronic.
2. Provide safe, appropriate and holistic nursing care to at risk and sick
adult clients with problems in oxygenation, fluid and electrolytes,
infectious, inflammatory and immunologic response, cellular
aberrations, acute and chronic, utilizing the nursing process.
3. Apply guidelines and principles of evidence-based practice in the
delivery of care.
4. Practice nursing in accordance with existing laws, legal ethical and
moral principles and standards.
5. Communicate effectively in speaking, writing and presenting using
culturally-appropriate language.
6. Document to include reporting up-to-date client care accurately and
comprehensively.
7. Work effectively in collaboration with inter-, intra- and multi-
disciplinary and multi-cultural teams.
8. Practice beginning management and leadership skills in delivery of
client care using systems approach.
9. Conduct research with an experienced researcher.
10. Engage in lifelong learning with a passion to keep current with local,
national and global developments in general, and nursing and health
developments in particular.
11. Demonstrate responsible citizenship and prided in being a Filipino.
12. Apply techno-intelligent care systems and processes in health care
delivery.
13. Adopt the nursing core values in the practice of the profession.

LEVEL OUTCOMES:
At the end of the third year, given individuals, families, population
groups, and communities with physiologic and psychosocial health
problems and maladaptive patterns of behavior in varied healthcare
settings, the learners demonstrate safe, appropriate and holistic care
utilizing the nursing process, evidence based practice and research
process.

INTENDED CONCEPT LEARNING OUTCOMES:

At the end of the concept, the students will be able to:

1. Understand the concept of surgery and apply correctly in the clinical
setting.
2. Develop an understanding of the principles of sterile and aseptic
technique and the necessity of their application in all operative
procedures or phases.
 3. Acquire basic knowledge and skills about OR nursing in order to
provide better and efficient care to surgical patients.
4. Develop confidence, alertness and competence among students in
meeting the patient’s needs – physical or psychological.
5. Apply the nursing process in the care and management of patient
undergoing preoperative, intra operative and post-operative phase.

HOUSE RULES :
1. There are five modules in Pain and Surgery. Study each module provided
thru canvas religiously.
2. Consultation hours regarding the topics is every lecture hour.
3. For formative assessment (Quizzes), it will be open on the day it is
intended to answer by the students and are given 48 hours to answer and send
it back thru canvas.
4. For Summative assessment (Unit Exam) which will be open on the third
and last week of lecture, it is expected to be submitted prior to the start of the
second concept.
5. Students are expected to read and study the module ahead of time and
have the initiative to gain an additional knowledge about the concept by
reading other references.

PRESENTATION OF COURSE OUTLINE: Please see uploaded files in Canvas

CONCEPT REQUIREMENT: 2 Formative Assessment

1 Summative Assessment

FEU VISION STATEMENT

Guided by the core values of Fortitude, Excellence and Uprightness, Far Eastern University aims to be a
university of choice in Asia.

FEU MISSION STATEMENT

Far Eastern University provides quality higher education through industry-responsive and outcome-
based curricular programs.
Far Eastern University produces globally competitive graduates who exhibit the core values of
fortitude, excellence and uprightness.
Far Eastern University promotes sustainable and responsive research, extension, heritage and
environment stewardship towards national and global development.
 MODULE 1.1 - SURGERY

Surgery as a Science – branch of medicine concerned with disease or conditions requiring or amenable
to operative or manual procedures.
It is a total care of illness with an extra modality of treatment, the surgical procedure.
Surgery as an Art - comprises perioperative patient care encompassing such activities as
preoperative preparation, intra operative judgment & management, and post-operative care of patients.

Surgery as a discipline, combines physiologic management with an interventional aspect of

treatment.

Evolution of Surgery:
a. Historical Background
Code of Hammurabi (1955-1913BC) – if a patient died after a surgical procedure, retribution would
be reflected on the surgeon in the form of amputation of his right hand.

Persians rule on surgery – successful procedures on 3 infidels before being pronounced as competent
to practice surgery.

Galen of Pergamum (130-200AD) - Claudius Galen is a Greek physician performing extensive

dissections in
animals. Although human dissections had fallen into disrepute, he also performed and stressed to his
students the importance of human dissections. He recommended that students practice dissection as
often as possible. He studied the muscles, spinal cord, heart, urinary system, and proved that the arteries
are full of blood. He believed that blood originated in the liver, and sloshed back and forth through the
body, passing through the heart, where it was mixed with air, by pores in the septum.

Lord Berkeley George Moynihan (1865 – 1936) - was born in Malta, where his father was an ensign in
the army. He enrolled at the Leeds School of Medicine in 1883, graduating in 1887 with a degree from
London and the conjoint diploma. He became House Surgeon to McGill and obtained 5 years practical
experience before being elected an Assistant Surgeon and Lecturer in Surgery in 1896.

By 1910 he was nationally known and became the first Professor of Clinical Surgery within the
University of

Leeds. His book ‘Abdominal Operations’ earned him an international reputation. In 1925 he became
Professor of
Surgery. Between 1926 and 1931 he was President of the

Royal College of Surgeons of England.

He believed that “Surgery has been made safe for the patient; we must now make the patient safe for
surgery.”

b. Improvement in Perioperative Patient Care Technology is attributed to the following:

 Surgical specialization of surgeons and team;
 Sophisticated diagnostic and intra-operative imaging techniques;
 Minimally invasive equipment and technology;
 Ongoing research and technologic advancements
Surgery related Terminologies
a. Operating Room / Operating Theatre – room in a health care facility in which patients are
prepared for surgery, undergo surgical procedures and recover from anesthetic procedures required for
surgery.
b. Perioperative - is a term used to describe the entire span of surgery, including before and after the
actual operation.
c. Perioperative nursing – includes activities performed by the registered nurse during the pre
operative, intra operative, and post-operative phases of patient’s care.
- Total surgical experience that encompasses pre-operative, intra-operative and post
operative phases of patient care.
d. OR nurse - duly licensed registered nurse legally responsible for the nature and quality of the
nursing care patients.
e. Surgical Conscience - awareness which develops from a knowledge based on the importance of
strict adherence to principles of aseptic and sterile techniques.
f. Asepsis – freedom from infection or absence of microorganism.
g. Aseptic Technique – methods by which contamination of microorganisms is prevented.
h. Disinfection - process of destroying all pathogenic microorganisms except spore bearing ones.
i. Sterilization - process of killing all micro-organisms including spores.
j. Surgical Intervention - therapeutic process rendered to restore or maintain health (i.e. the ability
to function).
k. Surgical Procedure - invasive incision into the body tissues or a minimally invasive entrance into
a body cavity for either therapeutic or diagnostic purpose during which protective reflexes or self-care
abilities are potentially compromised.
l. Antiseptic - substance which combat sepsis and cause bacteriostasis.
m. Anesthesia - insensibility to pain and trauma with or without loss of consciousness.
n. Informed consent - is a legal document that provides evidence of patient’s agreement to allow a
procedure to be performed on him/her ;
- a signed consent is legally regarded as VALID for a period of about 6 months or for
as long as the patient consents to the same procedure. Institutional policy may vary.

o. Abdomin (o) – abdomen

p. Aden (o) – gland
q. Angi (o) – vessel
r. Arthr (o) – joint
s. Broncho – bronchus
t. Card, Cardi (o) – heart
u. Cephal (o) - head
v. Chole, Chol (o) - bile
w. Chondr (o) - cartilage
x. Colo - colon
y. Cost (o) - rib
z. Crani (o) - skull
aa. Cele - tumor, hernia
ab. Centhesis - puncture
ac. Ectomy - surgical excision
ad. Itis - inflammation
ae. Litho - stone / calculus
 af. Ostomy - creation of a new opening
ag. Rhapy - repair
ah..Oscopy - examination using a lighted instrument
ai. Plasty - plastic repair
aj. Pexy - to fix or suture in place

Surgery
a. Definition of Surgery - branch of medicine concerned with disease or conditions requiring or
amenable to operative or manual procedures. The discipline of surgery is both an art and a science.

b. Objectives of Surgery
a. Correction of deformity and defects;
b. Repair of injuries;
c. Alter form or structure;
d. Diagnosis & Cure of disease process;
e. Relief of suffering;
f. Prolongation of life.

c. Common Indications of Surgery

 Incision – open tissue or structure by sharp dissection
 Excision – remove tissue or structure by sharp dissection
 Diagnostics – biopsy tissue sample
 Repair – closing of a hernia
 Removal – FBE
 Reconstruction – creation of new breast
 Termination – abortion of a pregnancy
 Palliation – relief of an obstruction
 Aesthetics – facelift
 Harvest – skin grafting
 Procurement – donor organ
 Transplant – placement of a donor organ
 Bypass / shunt – vascular rerouting
 Drainage / evacuation – incision of abscess
 Stabilization – repair of a fracture
 Staging – checking of cancer progression
 Parturition - caesarean section
 Extraction – removal of a tooth
 Exploration – invasive examination
 Diversion – creation of a stoma

d. Pathologic conditions requiring Surgical Intervention

a. Obstruction – impairment on the flow of vital fluids
b. Perforation – rupture of an organ
c. Erosion – wearing off of a surface or membrane
d. Tumor – abnormal growth
e. Reasons for Surgical Intervention
 To preserve life
 To maintain dynamic body equilibrium
 To undergo diagnostic procedures
 To prevent infection and to promote healing
 To obtain comfort
 To ensure the ability to earn a living
 To alter cosmetic appearance
 To restore or reconstruct a part of the body that is congenitally malformed or damaged by
trauma or disease.

f. Conditions treated by Surgery

 Congenital – inborn deformity
 Acquired – conditions resulting from trauma or injury.

g. Three (3) Categories of Surgical Procedure

 Invasive surgery
 Minimally Invasive surgery
 Non Invasive surgery

h. Classifications of Surgical Procedure

a. According to Purpose
a.1. Diagnostic surgery – to establish the presence of a disease condition. It enables the surgeon to
verify a suspected diagnosis.
Ex. Breast biopsy

a.2. Exploratory surgery – to determine the extent of the disease condition and at times to make or
confirm a diagnosis.
Ex. Exploratory Laparotomy

a.3. Curative / Reparative / Restorative surgery

 Ablative – involves removal of deceased organ
Ex. AP ; Cholecystectomy
 Constructive – involves repair of congenitally defective organ
Ex. Orchidopexy ; THRA
 Reconstructive – involves repair of a damaged
organ
Ex. Plastic surgery after burns

a.4. Palliative surgery – to relieve distressing signs and symptoms, not necessarily to cure the
disease.
Ex. Resection of a tumor to relieve pressure and pain

a.5. Cosmetic surgery – correction of defects, improvement of appearance or change to a new

physical feature.
Ex. Rhinoplasty ; Cleft lip repair
 b. According to Urgency
b.1. Emergency – immediate ; condition is life threatening requiring surgery at once.
Ex. GSW

b.2. Urgent or Imperative – client requires prompt attention within 24 to 30 hours.

Ex. Acute GB infection

b.3. Planned or Required – planned for a few weeks or months after decision and the client
requires it at some point.
Ex. Cataract removal

b.4. Elective – client will not be harmed if surgery is not performed but will benefit if it is
performed.
Ex. Revisions of scar

b.5. Optional – personal preference and usually aesthetic purposes.

Ex. Liposuction

c. According to Location
c.1. External – outside the body
Ex. Skin grafting

c.2. Internal – inside the body

Ex. Hysterectomy

d. According to Extent or Risk Involved (Magnitude)

d.1. Major – life threatening
d.2. Minor – non life threatening

i. Surgical Risks Patients

a. Obesity – increase incidence of morbidity and mortality due to low recovery after surgery.
b. Fluid – electrolyte Imbalance & Nutritional problems – can cause delay and poor wound healing
c. Age – too young or too old
d. Person with disability
e. Patients with current disease or illness
f. Patients with concurrent or prior pharmacotherapy
g. Nature and location of condition
h. Magnitude and urgency of the surgical procedure
i. Mental attitude of the patient towards surgery
j. Caliber of the professional staff and health care facilities

j. Potential Effects of surgery to the Patient

a. Stress response is elicited;
b. Defense against infection is lowered;
c. Vascular system is disrupted;
d. Organ functions are disturbed;
e. Body image maybe altered;
f. Lifestyle is changed
k. Legal Liability, Accountability & Ethical Issues
Safeguard the patient in the OR against hazards. Protect the nurse, technologist, surgeons,
anesthesiologist and the hospital. Prevention focuses on Quality Assurance.
Q – quality improvement as an ongoing process.
U - understanding regulations, standards, policies
and procedure.
A - accountability for one’s own actions.
L - legal rights of the patients
I - individualized patient care
T - technical competency
Y - your surgical & ethical conscience

To be liable is to be legally bounded, responsible and answerable.

Perioperative Nursing
a. Definition of Perioperative Nursing - Perioperative nursing practice includes activities performed
by the professional registered nurse during the preoperative (before), intraoperative (during) and
postoperative (after) phases of the patient’s surgical experience.

b. Key Elements of Perioperative Nursing Practice

 Caring
 Conscience
 Discipline
 Technique

c. Concept of Surgical Conscience

(Surgical Golden Rule) - “ Do Unto The Patient As You Would Have Others Do Unto You.”

d. Philosophy of Operating Room Nursing

To give service that aims to provide comprehensive support physically, morally,
psychologically, spiritually and socially to a patient undergoing surgery.

e. Goals of Operating Room Nursing

 To provide a safe, supportive and comprehensive care to patient;
 To assist the surgeon by functioning effectively as a member of the surgical team;
 To create and maintain an aseptic / sterile environment all the times.

f. Objectives of Operating Room Nursing

 To help the patient return as rapidly as possible to the best physical and mental health
attainable.
 In case the patient did not return to his health, pain and discomfort should be eased and she/he
should be allowed to die in peace and with dignity
 Perioperative Nurse
a. Definition of Perioperative Nurse - is a nurse who provides patient care, manages, teaches and
studies the care of patients undergoing invasive or non-invasive procedures. He/she possesses a depth
and breadth of knowledge that allows for the coordination of care of the surgical patient.

b. Responsibilities of a Perioperative Nurse

* Prioritizes interventions based on a comprehensive body of scientific knowledge and variations in
patient’s responses;
* Uses critical thinking skills in applying the nursing process, acting as a patient advocate, and
exercising judgment in a professionally accountable manner;
* Provides specialized nursing care to patients before, during and after their surgical & invasive
procedure;
* Works closely with all members of the surgical team;
* Helps plan, implement and evaluate treatment of the patient;
* Designs, coordinates, and delivers care to meet the identified physiological, psychological,
sociocultural and
spiritual needs of the patients.

c. Expected Attributes of a Perioperative Nurse

 Considerate
 Informative & sincere
 Versatile
 Analytical
 Creative & resourceful
 Humanistic
 Ethical
 With sense of humor
 Objective
 Enduring
 Impartial, non-judgmental, open-minded
 Manual and intellectual dexterity
 Intellectually eager and curious to learn

d. Personal Attributes of a Perioperative Nurse

 Empathic
 Conscientious
 Efficient and well organized
 Flexible and adaptable
 Sensitive & Perceptive
 Understanding, reassuring, supportive
 Skilled listener, keen observer and abled communicator

Lecturers:

Ms. Julie C. Danofrata

Ms. Glenda T. Moraňo