OR Notes 1

I. CNHS Core Values

 Love of God
 Caring as Core of Nursing
 Compassion
 Competence
 Confidence
 Commitment

II. PSU Institutional Outcomes

 Agent of Change
 Creative & critical thinker
 Effective Communicator
 Research-oriented learner
 Value-laden individual

III. Surgical Hand Washing (See the separate sheet)

IV. Principles of Sterility

A sterile field is a microorganism-free area. Nurses often establish a sterile field by using the
innermost side of a sterile wrapper or by using a sterile drape. When the field is established, sterile
supplies and sterile solutions can be placed on it. Sterile forceps are used in many instances to
handle and transfer sterile supplies. So that sterility can be maintained, supplies may be wrapped in
a variety of materials. Commercially prepared items are frequently wrapped in plastic, paper, or
glass. Sterile liquids (e.g., sterile water for irrigations) are preferably packaged in amounts
adequate for one use only because once a container has been opened, there is no assurance that it
will remain sterile. Any leftover liquid is discarded.

Principles and Practices of Surgical Asepsis

1. All objects used in a sterile field must be sterile.
2. Sterile objects become unsterile when touched by unsterile objects.
3. Sterile objects that are out of sight or below the waist or table level are considered
unsterile.
4. Sterile objects can become unsterile by prolonged exposure to airborne microorganisms.
5. Fluids flow in the direction of gravity.
6. Moisture that passes through a sterile object draws microorganisms from unsterile surfaces
above or below to the sterile surface by capillary action.
7. The edges of a sterile field are considered unsterile.
8. The skin cannot be sterilized and is unsterile.
9. Conscientiousness, alertness, and honesty are essential qualities in maintaining surgical
asepsis.
V. Preoperative Consent

Before performing surgery, it is the physician’s responsibility to obtain voluntary, written,

informed consent from the patient. The consent gives legal permission for the surgery and has two
purposes: It protects the patient from unauthorized procedures, and it protects the physician,
anesthesiologist, hospital, and hospital employees from claims of performance of unauthorized
procedures. A signed consent is needed for all invasive procedures, surgery, anesthesia, blood
administration, and radiation or cobalt therapy. It is typically valid for 30 days after signing.

Informed consent involves three elements:

1. The physician must explain in terms the patient understands about the diagnosis, the proposed
treatment and who will perform it, the likely outcome, possible risks and complications of
treatment, alternative treatments, and the prognosis without treatment. If the patient has questions
before signing the consent, the physician must be contacted to provide further explanation to the
patient. It is not within the nurse’s scope of practice to provide this information.

2. The consent must be signed before analgesics or sedatives are given because patients must
demonstrate to the witness that they are informed and understand the surgery.

3. Consent must be given voluntarily. No persuasion or threats can be used to influence the patient.
The patient can withdraw consent at any time, even after the consent form has been signed.

Witnessing a Consent

Your signature as a witness on a consent form indicates that you observed the informed
patient or patient’s authorized representative voluntarily sign the consent form. It does not mean
that you informed the patient about the surgical procedure; that is the responsibility of the
physician. In a medical emergency, the patient may not be able to give consent. In this case, the next
of kin or legal guardian may give telephone consent, or a court order can be obtained. If time does
not permit this, the physician documents the need for treatment in the chart as necessary to save
the patient’s life or avoid serious harm, according to state law and institutional policy.

VI. Preoperative Preparation Checklist

A preoperative checklist is usually completed and signed by the nurse (per agency policy)
before the patient is transported from the surgical unit to surgery. The checklist provides guidance
for preoperative preparation of the patient:

• An identification band is placed on the patient. A hospital gown is given to the patient to
wear. Underwear is removed, depending on the type of surgery.
• Vital signs are taken and recorded as baseline information and to assess patient status.
• Makeup, nail polish, and artificial nails (if applicable) are removed to allow assessment of
natural color and pulse oximetry for oxygenation status during surgery.
• Removal of hair pins, wigs, and jewelry prevents loss or injury. Rings, such as wedding rings,
are taped in place if the patient does not want to take them off, except if the ring is on the
operative side (arm or chest surgery), because edema may occur.
 • Dentures, contact lenses, and prostheses are removed to prevent injury. Some patients are
concerned about body image and do not want family members to see them without dentures
or makeup. Remove dentures after the family goes to the waiting room and insert them before
the family sees the patient postoperatively.
• Glasses and hearing aids go with patients to surgery if they are unable to communicate
without them. Label them with the patient’s name and document where they go.
• All orders, diagnostic test results, consents, and history and physical (required on the chart)
are reviewed for completion and documented on the checklist.
• Patient valuables are recorded and given to a family member or locked up per institutional
policy by the nurse.
• Antiembolism devices are applied if ordered.
 History of Allergy
• Patients are asked to void before sedating preoperative medications are given, unless a
urinary catheter is present, to prevent injury to the bladder during surgery.

VII. Pre-Operative Medications

VIII. Surgical Safety Checklist