Adult Health Nursing 1 (Unit-2) - Intraoperative Care Complete Notes

Adult Health Nursing–I

UNIT 2 – INTRAOPERATIVE CARE

Learning Objectives

• Explain the organization and physical setup of an operation theatre.
• Describe OT classification, design and staffing.
• Identify members of the surgical team and their responsibilities.
• Explain the duties of the OT nurse.
• Describe common surgical positions and draping principles.
• Identify common surgical instruments, sutures and equipment.
• Explain disinfection and sterilization.
• Describe preparation of surgical sets.
• Explain surgical scrubbing, gowning, masking and gloving.
• Describe intraoperative patient monitoring.
• Explain maintenance of the therapeutic OT environment.
• Describe specimen handling and surgical counts.
• Identify common OT hazards and preventive measures.
• Explain types, methods, effects and stages of anaesthesia.
• Discuss legal and ethical responsibilities of the OT nurse.

1. Introduction to Intraoperative Care

Definition

• Intraoperative care is the nursing care provided during the surgical procedure.
• It begins when the patient enters the operating room and continues until transfer to the recovery/PACU area.
• The intraoperative phase requires close coordination among surgery, anaesthesia and nursing personnel.

Major Goals

• Maintain patient safety.
• Maintain physiological stability.
• Prevent infection.
• Maintain surgical asepsis.
• Prevent positioning injuries.
• Maintain accurate surgical counts.
• Ensure correct specimen handling.
• Assist the surgical team.
• Maintain patient dignity and confidentiality.
• Recognize and communicate changes in patient condition.

High-Yield Point:

The OT nurse acts as an important patient advocate, especially because an anaesthetized patient may be unable to communicate or protect their own interests.

2. Organization and Physical Setup of the Operation Theatre

2.1 Objectives of OT Organization

• Provide a safe environment for surgery.
• Reduce contamination and infection risk.
• Control movement of people and materials.
• Maintain appropriate sterile and non-sterile areas.
• Provide adequate space for surgical equipment.
• Provide appropriate lighting and ventilation.
• Ensure emergency equipment is readily accessible.
• Facilitate efficient teamwork.
• Allow safe patient transfer.

2.2 Classification of OT Areas

Operating departments are commonly divided into controlled zones. Exact terminology and access requirements may vary according to hospital policy and applicable standards.

OT zoning concept: movement becomes progressively controlled from unrestricted to restricted areas.

2.3 Common OT Areas

• Reception/entry area
• Changing rooms
• Pre-operative holding area
• Operating rooms
• Scrub areas
• Clean utility area
• Dirty utility/decontamination area
• Instrument preparation area
• Sterile storage area
• Equipment storage
• Post-Anaesthesia Care Unit (PACU)
• Waste-management area

3. OT Design

Important Design Principles

• Controlled entry and exit.
• Logical separation of clean and contaminated traffic.
• Smooth, easily cleanable surfaces.
• Adequate space around the operating table.
• Adequate lighting.
• Appropriate ventilation and air-handling systems.
• Safe electrical outlets and equipment.
• Accessible oxygen and medical gases.
• Accessible suction.
• Emergency access.
• Appropriate storage facilities.
• Hand-hygiene facilities.
• Fire-safety provisions.

3.1 Important OT Environmental Requirements

Factor	Importance
Lighting	Provides adequate illumination of the operative field and surrounding area.
Ventilation	Helps maintain appropriate air quality and environmental control.
Temperature	Should be controlled according to patient, procedure and facility requirements.
Humidity	Should remain within facility-approved environmental limits.
Noise	Excessive noise can interfere with communication and concentration.
Traffic	Unnecessary movement and door opening should be minimized.

4. OT Staffing

Factors Affecting Staffing

• Number of operating rooms.
• Number of procedures.
• Type of surgery.
• Complexity of surgery.
• Emergency surgery requirements.
• Patient acuity.
• Specialized procedures.
• Available staff competencies.
• Institutional policies.

Common OT Personnel

• Surgeon
• Assistant surgeon
• Anaesthesiologist/anaesthesia provider
• Scrub nurse
• Circulating nurse
• Surgical technologist/OT technician
• Anaesthesia technician where applicable
• Radiology personnel when required
• Biomedical/equipment support personnel
• Environmental/housekeeping personnel

5. Members of the Operation Theatre Team

Simplified representation of the multidisciplinary surgical team.

5.1 Surgeon

• Performs the surgical procedure.
• Provides surgical leadership.
• Determines surgical technique.
• Communicates operative findings.
• Works with the multidisciplinary team.

5.2 Anaesthesia Provider

• Performs anaesthetic assessment.
• Administers and manages anaesthesia.
• Manages airway.
• Monitors cardiovascular and respiratory status.
• Manages physiological changes during surgery.

5.3 Scrub Nurse

• Works within the sterile field.
• Prepares sterile instruments.
• Maintains surgical asepsis.
• Passes instruments to the surgeon.
• Anticipates surgical requirements.
• Maintains sterile supplies.
• Participates in surgical counts.

5.4 Circulating Nurse

• Works outside the sterile field.
• Coordinates the operating room.
• Obtains additional supplies.
• Maintains documentation.
• Assists with patient positioning.
• Maintains patient safety.
• Participates in counts.
• Coordinates specimen handling.

6. Duties and Responsibilities of the OT Nurse

6.1 Before Surgery

• Verify patient identity.
• Verify planned procedure according to institutional safety protocol.
• Review allergies.
• Review relevant clinical information.
• Check availability of equipment.
• Check sterile supplies.
• Prepare surgical instruments.
• Check emergency equipment.
• Assist with safe patient transfer.
• Maintain privacy and dignity.

6.2 During Surgery

• Maintain surgical asepsis.
• Assist with positioning.
• Protect pressure points.
• Assist with draping.
• Provide instruments and supplies.
• Maintain surgical counts.
• Monitor patient safety.
• Observe physiological changes in coordination with the anaesthesia team.
• Handle specimens correctly.
• Document required information.

6.3 After Surgery

• Complete final counts.
• Assist with dressing application.
• Assist with transfer to PACU/recovery area.
• Provide handover.
• Send specimens appropriately.
• Ensure equipment is processed appropriately.
• Prepare OT for subsequent procedure.

7. Surgical Positions

Patient positioning should provide adequate surgical exposure while protecting the airway, circulation, nerves, skin, eyes and pressure points.

Simplified educational diagrams of common surgical positions.

7.1 Supine Position

• Patient lies flat on the back.
• Commonly used for many abdominal, thoracic and vascular procedures.
• Head and spine should be appropriately aligned.
• Pressure points should be protected.
• Arms should be positioned safely.

Potential complications:

• Pressure injury
• Nerve compression
• Reduced peripheral circulation
• Respiratory compromise in susceptible patients

7.2 Trendelenburg Position

• Patient is supine with the head lower than the feet.
• Used for selected pelvic and lower abdominal procedures.

Potential problems:

• Respiratory compromise
• Increased venous pressure
• Facial/airway edema
• Patient sliding
• Pressure injury

7.3 Reverse Trendelenburg

• Head is elevated relative to the feet.
• Used in selected upper abdominal and upper-body procedures.
• Requires appropriate patient support to prevent sliding.

7.4 Lithotomy Position

• Patient lies supine with hips and knees flexed.
• Legs are supported using appropriate stirrups.
• Commonly used for selected gynaecological, urological and perineal procedures.

Simplified diagram: legs are supported while protecting circulation, nerves and pressure points.

7.5 Prone Position

• Patient lies on the abdomen.
• Commonly used for spinal and selected posterior procedures.

Precautions:

• Protect eyes.
• Maintain airway access.
• Protect pressure points.
• Protect breasts and genitalia where applicable.
• Ensure appropriate chest and abdominal support.

7.6 Lateral Position

• Patient lies on one side.
• Used in selected thoracic, renal and orthopaedic procedures.

Precautions:

• Maintain spinal alignment.
• Protect dependent shoulder and hip.
• Protect peroneal nerve.
• Use appropriate supports.

7.7 Sitting / Beach Chair Position

• Patient is placed in a semi-upright position.
• Used for selected shoulder and neurosurgical procedures.

Potential risks:

• Hypotension
• Reduced cerebral perfusion
• Pressure injury
• Nerve injury
• Patient sliding

8. Surgical Draping

Purpose

• Creates a sterile barrier.
• Exposes only the operative area.
• Reduces contamination.
• Maintains patient dignity.
• Protects surrounding areas from contamination.

Principles

• Use sterile drapes.
• Handle drapes carefully.
• Avoid touching non-sterile surfaces.
• Do not unnecessarily reposition a sterile drape.
• Maintain appropriate sterile boundaries.
• Follow hospital sterile-technique policy.

9. Surgical Instruments

Simplified educational illustration of common surgical instrument categories.

Category	Examples	Purpose
Cutting	Scalpel, scissors	Incision and cutting tissue/material.
Grasping	Forceps	Holding tissue or materials.
Clamping	Hemostatic forceps	Clamping vessels or tissue.
Retracting	Retractors	Holding tissue away from the operative field.
Suturing	Needle holder	Holding the suture needle.
Suction	Suction tips	Removing blood and fluids.

10. Sutures and Suture Materials

Definition

• Sutures are materials used to approximate tissue edges and support wound closure.

Classification

Basis	Types
Absorption	Absorbable / Non-absorbable
Structure	Monofilament / Multifilament
Origin	Natural / Synthetic

Examples

• Absorbable: Polyglactin, poliglecaprone and other appropriate absorbable materials.
• Non-absorbable: Nylon, polypropylene and polyester.

Exam Point:

Suture selection depends on tissue type, required tensile strength, healing characteristics, contamination risk, surgeon preference and institutional practice.

11. Equipment Used for Common Surgical Procedures

• Operating table
• Operating lights
• Anaesthesia workstation
• Patient monitor
• Suction apparatus
• Electrosurgical unit
• Infusion pumps
• Tourniquet equipment where indicated
• Diathermy equipment
• Instrument tables
• Emergency/crash cart
• Defibrillator
• Oxygen supply
• Airway equipment
• Procedure-specific equipment

12. Disinfection and Sterilization

12.1 Cleaning

• Removal of visible soil and organic/inorganic material from an item.
• Cleaning is an essential step before high-level disinfection or sterilization.

12.2 Disinfection

• Process that eliminates many or most pathogenic microorganisms from objects or surfaces.
• It does not necessarily destroy bacterial spores.

12.3 Sterilization

• A validated process designed to render an item free from viable microorganisms.
• Method depends on the item and manufacturer's instructions.

12.4 Common Sterilization Methods

Method	General Application
Steam sterilization	Heat- and moisture-resistant instruments.
Hydrogen peroxide-based low-temperature systems	Selected heat-sensitive devices compatible with the system.
Ethylene oxide	Selected heat- and moisture-sensitive devices.
Dry heat	Selected materials when compatible with validated processes.

Important Sterilization Principles

• Clean instruments before sterilization.
• Follow manufacturer instructions.
• Use appropriate packaging.
• Use sterilization indicators as required.
• Inspect packages before use.
• Do not use wet or damaged sterile packs.
• Store sterile items appropriately.
• Maintain traceability according to facility policy.

13. Preparation of Surgical Sets

General Procedure

1. Identify the planned procedure.
2. Review the required instrument list.
3. Check cleanliness of instruments.
4. Inspect instruments for damage.
5. Check instrument function.
6. Arrange instruments systematically.
7. Prepare required sutures and needles.
8. Prepare blades and other consumables.
9. Check sterile packaging.
10. Check sterilization indicators.
11. Perform required counts.
12. Keep emergency equipment accessible.

Examples

Surgical Set	Possible Components
Suturing Set	Needle holder, forceps, scissors, suture material, needles and other required items.
Dressing Set	Forceps, scissors, sterile gauze and procedure-specific materials.
Abdominal Set	Procedure-specific clamps, forceps, retractors, scissors, suction and other instruments.
Gynaecological Set	Procedure-specific speculum, forceps, retractors and other instruments.

14. Surgical Scrubbing

Purpose

• Reduce microorganisms on hands and forearms.
• Reduce contamination of the sterile field.
• Prepare the healthcare professional for sterile gowning and gloving.

Follow the approved surgical hand-antisepsis method and the product manufacturer's instructions.

Important Principles

• Remove jewellery as required.
• Inspect hands and forearms.
• Use approved surgical hand antisepsis.
• Follow the manufacturer's recommended technique and duration.
• Avoid touching contaminated surfaces.
• Keep hands positioned according to the selected technique and institutional policy.
• Allow hands and forearms to dry appropriately.

15. Surgical Gowning

• Perform surgical hand antisepsis.
• Dry hands appropriately.
• Pick up the sterile gown without contaminating it.
• Allow the gown to unfold without touching non-sterile surfaces.
• Insert arms into sleeves.
• Secure gown using the approved sterile technique.
• Proceed to sterile gloving.

16. Surgical Masking

• Perform hand hygiene before handling the mask.
• Use an approved surgical mask.
• Cover nose and mouth completely.
• Secure appropriately.
• Avoid unnecessary touching.
• Replace when contaminated or compromised according to policy.

17. Surgical Gloving

Closed Gloving

• Usually performed after surgical gowning.
• Hands remain inside gown cuffs during application.
• Helps reduce contamination of bare hands.

Open Gloving

• Used when appropriate without a sterile gown or according to procedure requirements.
• Requires careful handling to maintain sterility.

Important:

If a sterile glove becomes contaminated, it should be replaced using the appropriate sterile technique.

18. Monitoring the Patient During Surgery

Simplified representation of intraoperative physiological monitoring.

Parameters

• Heart rate
• ECG rhythm
• Blood pressure
• Respiratory rate
• Oxygen saturation
• End-tidal carbon dioxide when indicated
• Temperature when indicated
• Urine output when monitored
• Blood loss
• Fluid input and output
• Neuromuscular monitoring when indicated

Nursing Responsibilities

• Ensure monitoring equipment is functional.
• Apply appropriate monitoring devices.
• Observe trends.
• Recognize abnormal changes.
• Immediately communicate significant deterioration.
• Assist with emergency management.
• Document required observations.

19. Maintenance of the Therapeutic Environment in OT

Physical Environment

• Appropriate temperature.
• Appropriate humidity according to facility requirements.
• Adequate lighting.
• Effective ventilation.
• Clean environment.
• Controlled traffic.
• Minimal unnecessary door opening.
• Minimal unnecessary noise.

Psychological Environment

• Maintain dignity.
• Maintain privacy.
• Communicate respectfully.
• Reduce unnecessary anxiety.
• Avoid inappropriate conversation about the patient.
• Protect confidentiality.
• Provide reassurance without making unrealistic promises.

20. Assisting in Major and Minor Operations

Minor Operations

• Wound suturing
• Incision and drainage
• Biopsy
• Minor excision procedures
• Removal of selected superficial lesions

Major Operations

• Major abdominal surgery
• Major orthopaedic surgery
• Thoracic surgery
• Neurosurgery
• Major vascular procedures
• Major gynaecological procedures

Role of Nurse

• Prepare the OT.
• Prepare surgical sets.
• Check equipment.
• Assist with positioning.
• Maintain sterile technique.
• Pass instruments if functioning as scrub nurse.
• Coordinate room activities if functioning as circulating nurse.
• Maintain counts.
• Handle specimens.
• Monitor patient safety.
• Document care.

21. Handling Surgical Specimens

Examples

• Biopsy tissue
• Tumour specimens
• Organ specimens
• Fluid specimens
• Foreign bodies

Principles

1. Identify the specimen.
2. Use the correct container.
3. Use appropriate preservative when required.
4. Label according to institutional protocol.
5. Verify patient identifiers.
6. Maintain specimen integrity.
7. Complete documentation.
8. Transport promptly through the approved process.

Clinical Case – Specimen Error

A tissue specimen has been removed during surgery but has not yet been labelled.

What should the nurse do?

• Do not guess the specimen identity.
• Do not send an unidentified specimen.
• Follow the institutional specimen-verification procedure.
• Verify patient and specimen information with the appropriate team members.
• Use the correct container/preservative where required.
• Document according to policy.

22. Surgical Counts

Items Commonly Counted

• Sponges
• Gauze
• Needles
• Sharps
• Instruments
• Other countable items according to institutional policy

Purpose

• Prevent retained surgical items.
• Improve patient safety.
• Provide systematic verification.

Clinical Case – Missing Sponge

At the end of an abdominal procedure, the surgical count shows one sponge is missing.

Immediate actions:

• Inform the surgical team immediately.
• Repeat the count according to policy.
• Search the sterile field.
• Check appropriate waste/receptacle areas.
• Follow the institutional retained-item protocol.
• Do not assume that the sponge was discarded.
• Escalate and document appropriately.

23. Prevention of Accidents and Hazards in OT

Hazard	Examples	Prevention
Sharps injury	Needles, blades	Safe handling and approved sharps disposal.
Electrical hazard	Damaged cables, faulty equipment	Equipment inspection and maintenance.
Fire	Ignition source + fuel + oxidizer	Fire prevention and equipment checks.
Positioning injury	Nerve or pressure injury	Correct positioning and padding.
Infection	Break in asepsis	Hand hygiene, sterilization and traffic control.
Falls	Unsafe patient transfer	Safe transfer and adequate assistance.
Radiation	Fluoroscopy	Time, distance and shielding principles.
Chemical exposure	Disinfectants and other chemicals	PPE and safe handling.

23.1 Surgical Fire

Surgical fire prevention requires control of ignition sources, fuels and oxidizer-rich environments.

Potential Ignition Sources

• Electrosurgical units.
• Lasers.
• Other heat-producing devices.

Potential Fuels

• Alcohol-based skin preparations.
• Drapes.
• Gauze and sponges.
• Other combustible materials.

Oxidizers

• Oxygen-enriched environments.
• Other oxidizing gases.

Fire Prevention:

• Allow alcohol-based preparations to dry completely.
• Follow facility fire-safety policies.
• Keep unnecessary combustible materials away from ignition sources.
• Communicate clearly before activating heat-producing equipment.

24. Anaesthesia

Definition

• Anaesthesia is a medically controlled state used to reduce or eliminate pain and, depending on technique, awareness and movement during procedures.

Major Types

Type	Description	Examples
General Anaesthesia	Controlled unconsciousness with suppression of protective responses.	Major surgical procedures.
Regional Anaesthesia	Blocks sensation over a larger region of the body.	Spinal, epidural, selected nerve blocks.
Local Anaesthesia	Numbs a limited area.	Minor procedures.
Sedation	Produces varying levels of reduced anxiety and consciousness.	Selected diagnostic and procedural settings.

25. Methods of Anaesthesia Administration

• Intravenous administration
• Inhalational administration
• Local infiltration
• Regional injection
• Nerve block
• Other specialized techniques

26. General Anaesthesia – Traditional Stages

Traditional nursing textbooks describe four stages of general anaesthesia. Modern anaesthesia is carefully titrated with monitoring, so these classical stages may not always appear as clearly defined phases.

Stage	Traditional Features
Stage I – Analgesia	Beginning of anaesthetic effect; pain perception decreases and consciousness may be maintained.
Stage II – Excitement	May involve irregular respiration, involuntary movements and increased reflex activity.
Stage III – Surgical Anaesthesia	Progressive loss of consciousness and reflexes; desired depth for many surgical procedures.
Stage IV – Medullary Depression	Excessive anaesthetic depth with severe respiratory and cardiovascular depression; life-threatening emergency.

Exam Point:

Stage IV is associated with severe depression of vital centres and is a dangerous state requiring immediate management.

27. Effects of Anaesthesia

• Reduced consciousness.
• Reduced airway protective reflexes.
• Respiratory depression.
• Changes in blood pressure.
• Changes in heart rate.
• Altered thermoregulation.
• Nausea and vomiting.
• Delayed recovery.
• Urinary retention.
• Post-operative confusion in susceptible patients.

28. Anaesthesia Equipment

Simplified educational illustration of an anaesthesia workstation and related monitoring.

• Anaesthesia workstation/machine
• Breathing circuits
• Oxygen supply
• Face masks
• Endotracheal tubes
• Supraglottic airway devices
• Suction apparatus
• Bag-valve-mask equipment
• Patient monitor
• Infusion pumps
• Emergency airway equipment
• Emergency medications

29. Common Anaesthesia-Related Drugs

Drug/Class	General Role
Propofol	Common intravenous induction agent.
Ketamine	Dissociative anaesthetic with analgesic properties.
Opioids	Analgesia.
Inhalational anaesthetics	Maintenance of general anaesthesia.
Neuromuscular blocking agents	Facilitate muscle relaxation and airway/surgical management.
Local anaesthetics	Local and regional anaesthesia.
Antiemetics	Prevention/treatment of nausea and vomiting.

Nursing Safety:

Anaesthetic medications can produce major respiratory and cardiovascular effects. Preparation, administration and monitoring must follow the authorized scope of practice, prescription and institutional protocols.

30. Intraoperative Patient Safety Checklist

• Correct patient identification
• Correct procedure
• Correct surgical site
• Allergy verification
• Relevant investigations reviewed
• Required equipment available
• Expected blood loss considered when appropriate
• Antibiotic prophylaxis verified when prescribed/indicated
• Patient positioning checked
• Pressure points protected
• Surgical counts completed according to policy
• Specimen identification verified
• Post-operative plan communicated

31. Legal Aspects of Intraoperative Nursing

31.1 Informed Consent

• The patient should receive appropriate information about the procedure from the responsible healthcare professional.
• The nurse verifies that required consent processes are completed according to institutional policy.
• The nurse should not force or coerce the patient.
• Questions regarding the surgical procedure should be communicated to the responsible clinician.

31.2 Patient Identification

• Use approved identifiers.
• Do not rely only on room or bed number.
• Follow the institution's patient-identification policy.

31.3 Confidentiality

• Protect patient information.
• Avoid unnecessary discussion of patient details.
• Protect written and electronic records.
• Share information only with authorized persons involved in care.

31.4 Documentation

• Document accurately.
• Document promptly.
• Use objective language.
• Record relevant observations.
• Record counts according to policy.
• Record specimen handling as required.
• Never falsify documentation.

31.5 Negligence

• Failure to provide expected standards of care may result in patient harm and professional/legal consequences.
• Examples may include:
  • Failure to identify the patient correctly.
  • Failure to report significant deterioration.
  • Failure to maintain required aseptic technique.
  • Failure to follow safety procedures.
  • Inadequate documentation.

31.6 Professional Accountability

• Work within scope of practice.
• Maintain competence.
• Follow institutional policies.
• Report unsafe practices.
• Protect patient rights.
• Maintain confidentiality.
• Participate in continuing education.

32. Integrated Clinical Cases

Case 1 – Wrong Patient in OT

Two patients are scheduled for surgery. A patient is transferred into the wrong operating room.

Priority:

• Stop the process.
• Do not proceed until identity and procedure are verified.
• Use approved patient identifiers.
• Inform the appropriate team members.
• Follow the surgical safety protocol.

Case 2 – Positioning Risk

A patient is placed in lithotomy position for a prolonged operation.

Nursing priorities:

• Protect pressure points.
• Maintain appropriate alignment.
• Avoid excessive hip flexion/abduction.
• Position both legs safely.
• Monitor circulation and pressure areas.
• Document positioning and protective measures as required.

Case 3 – Contaminated Instrument

A sterile instrument touches a non-sterile surface.

Correct response:

• Consider the instrument contaminated.
• Remove it from the sterile field.
• Replace it with an appropriately sterile instrument.
• Do not continue using a contaminated instrument.

Case 4 – Sudden Intraoperative Hypotension

During surgery, the patient's blood pressure suddenly falls and the heart rate changes.

Nursing priorities:

• Recognize the change.
• Check the monitoring equipment and patient connections.
• Immediately communicate the change to the anaesthesia/surgical team.
• Assist with interventions as directed.
• Continue monitoring.
• Document appropriately.

Case 5 – Surgical Count Discrepancy

At the end of surgery, one needle is missing from the count.

Priority actions:

• Immediately inform the surgical team.
• Repeat the count.
• Search the sterile field and appropriate areas.
• Follow institutional retained-item protocol.
• Document the discrepancy and actions according to policy.

Case 6 – Surgical Fire Risk

An alcohol-based skin preparation has been applied and an electrosurgical device is about to be activated.

Safety concern:

• The preparation must be allowed to dry according to product/facility requirements.
• Pooling of flammable preparation should be prevented.
• Communicate with the surgical team before activating ignition sources.
• Follow the OT fire-safety policy.

33. High-Yield Examination Points

• Intraoperative phase: Begins when the patient enters the OR and ends with transfer to the recovery/PACU area.
• Scrub nurse: Maintains the sterile field and manages sterile instruments and supplies.
• Circulating nurse: Works outside the sterile field and coordinates room activities and patient safety.
• Supine: Patient lies on the back.
• Prone: Patient lies on the abdomen.
• Lithotomy: Legs are supported in elevated flexed position.
• Trendelenburg: Head lower than feet.
• Reverse Trendelenburg: Head higher than feet.
• Medical asepsis: Clean technique.
• Surgical asepsis: Sterile technique.
• Surgical count: Helps prevent retained surgical items.
• Specimen: Correct identification, labelling, documentation and transport are essential.
• General anaesthesia: Requires continuous physiological monitoring and airway safety.
• Positioning: Must balance surgical exposure with protection from pressure, nerve, respiratory and circulatory complications.
• Legal responsibilities: Include patient identification, confidentiality, accurate documentation, safety and professional accountability.

34. Quick Revision Table

Topic	Key Point
OT	Controlled environment for safe surgical care.
Scrub Nurse	Sterile-field responsibilities.
Circulating Nurse	Room coordination, patient safety and non-sterile responsibilities.
Positioning	Surgical exposure + alignment + pressure protection + physiological safety.
Draping	Maintain sterile barriers and expose only the operative site.
Sterilization	Validated process designed to eliminate viable microorganisms.
Surgical Counts	Help prevent retained surgical items.
Specimen	Correct identification + container + label + documentation + transport.
Anaesthesia	Requires appropriate airway and cardiorespiratory monitoring.
Legal Aspects	Identification + confidentiality + documentation + accountability.

35. Nursing Student Clinical Competency Checklist

• Identify OT zones.
• Identify OT team members.
• Explain scrub nurse responsibilities.
• Explain circulating nurse responsibilities.
• Describe surgical hand antisepsis.
• Explain gowning and gloving.
• Identify common surgical instruments.
• Classify sutures.
• Describe common surgical positions.
• Identify positioning complications.
• Explain disinfection and sterilization.
• Describe surgical set preparation.
• Explain surgical counts.
• Describe specimen handling.
• Identify OT hazards.
• Explain fire prevention.
• Explain basic anaesthesia concepts.
• Describe intraoperative monitoring.
• Explain legal responsibilities.

36. One-Minute Revision – Unit 2

OT Controlled environment for surgical care.

Scrub Nurse Sterile field + instruments + counts.

Circulating Nurse Room coordination + patient advocacy.

Positioning Exposure + safety + pressure protection.

Sterilization Validated process for eliminating viable microorganisms.

Counts Prevent retained surgical items.

Specimen Identify + label + document + transport.

Anaesthesia Airway + breathing + circulation + monitoring.

Legal Identification + confidentiality + documentation + accountability.

UNIT 2 CORE CONCEPT

Intraoperative nursing = Patient Safety + Surgical Asepsis + Positioning + Monitoring + Instrument Management + Teamwork + Specimen Safety + Emergency Preparedness + Legal Accountability.

The OT nurse must continuously observe the patient, maintain a safe sterile environment, anticipate the needs of the surgical team, prevent avoidable complications and immediately communicate any significant change in the patient's condition.

37. Important Note for Students

• These notes are intended for academic learning and revision.
• Actual OT procedures must be learned under supervised clinical instruction.
• Always follow the hospital's current SOPs, infection-prevention policies and manufacturer's instructions.
• Exact sterilization, surgical-count, specimen-handling and anaesthesia practices may vary by institution.
• For examinations, learn both the conceptual principle and the terminology used in your prescribed nursing textbook.