Surgical Nursing

Learning Outcomes

• Outline pre-op stabilisation of a thoracic patient, describe thoracocentesis, chest drain placement (kit required, patient preparation, post op care).   

• Explain atelectasis and the importance of this process in the thoracotomy patient, outline how important positioning is to these patients.  

• Describe the process of V/Q mismatch and why this is more common in a patient undergoing a thoracotomy. Summarize the impact this may have on ventilation intra- and post-operatively.  

• Discuss the importance of having medical air available to thoracotomy patients undergoing general anaesthesia.  

• Discuss how to monitor effective ventilation and oxygen saturation intra- and post-operatively.  

• Outline options for multimodal analgesia approach to the thoracotomy patient.  

• Demonstrate knowledge of chest drain selection and justification depending on the disease process.  

• Describe the pathophysiology of pyothorax, chylothorax, pneumothorax, tension pneumothorax, flail chest, diaphragmatic hernia, peritoneopericardial diaphragmatic hernia and lung lobe torsion.    

• Discuss different types of drains used in thoracic surgery including wound drains and analgesic catheters. Compare and contrast passive and active drains.  

• Describe post operative care of patients with drains, including patient comfort, recognizing drain failure, minimising patient interference.  

• Discuss risks and complications associated with wound drains.  

• Explain the rationale of wound analgesic catheters. Discuss where they are suitable for use. Explain how these are used in conjunction with wound drains.   

• Compare and contrast the nature of fluid expected from drains, explain the different characteristics and describe how fluid can evolve over time.   

Learning Outcomes

• Outline pre-op assessment and stabilisation of the acute abdomen, including POCUS for abdominal trauma patients and abdominocentesis.  
• Explain intra-operative considerations such as positioning, ventilation, warming, vascular access.  
• Describe the technique of placing a jugular catheter. Discuss the rationale behind placement. Recognise patients that would benefit, as well as those who have contraindications for placement. 
• Define and discuss sepsis, including the pathophysiology of sepsis, the surgical approach and intra-operative patient requirements (lavage, temperature control).    
• Outline post-operative care of the ex-lap patient.   
• Compare and contrast feeding tube selection for the post operative surgical patient - discuss the importance of colloid oncotic pressure and the role nutrition has.   
• Discuss liver disease and the impact it has on drug selection, glucose, clotting and metabolism of proteins.   
• Discuss the pathophysiology of portosystemic shunts, including intra-hepatic and extra-hepatic shunts. Discuss the process of ligation- comparing full ligation to partial closure and the rationale for choosing such. Outline portal hypertension and post-ligation neurological syndrome.   
• Explain the post-operative care requirements for liver disease patients, including glucose monitoring, seizure control and analgesia.   
• Describe the pre-operative tests on surgical patients including PT APTT, BMBT, Bile Acid Stim test, ammonia. Understand abnormal results and their impact on the patient and surgical approach.  
• Briefly describe the role of auto-transfusion in surgery, where it is contra-indicated and where it may be appropriate to consider. Discuss the method and equipment required.   
• Discuss the pathophysiology of laryngeal paralysis. Describe the stabilisation of these patients including airway exam and how the diagnosis is reached. Describe the surgical approach of a laryngeal tieback as well as patient preparation for said procedure.  
• List the post-operative requirements for airway recoveries such as tieback or BOAS patients. Explain the importance of sedation, oxygen delivery and analgesia as well as regurgitation/vomiting prevention in these patients.   
• Discuss the mechanism of regurgitation and compare this to vomiting. Identify the patient profiles more likely to regurgitate under anaesthesia. Explain the potential consequences of regurgitation under GA. Describe the treatment for regurgitation under anaesthesia including treatment and pharmacological support.  

Learning Outcomes

• Discuss the mechanism of nerve blocks.  

• Explain the use of a nerve stimulator, including the mechanism of action and the difference between the needle used with a stimulator vs a hypodermic needle.   

• Describe the technique of ultrasound guided nerve blocks.   

• Discuss the advantages and disadvantages of nerve blocks.  

• Compare and contrast local anaesthetic agents, including Bupivacaine, Lidocaine, Ropivacaine and explain rationale on their selection.   

• Describe common nerve block techniques including the femoral and sciatic nerve block, the RUMM block..   

• Describe epidural anaesthesia including indications and contra-indications, patient preparation, drug selection, risks, and complications.      

• Describe the pathophysiology of IVDD. Compare and contrast the different types of discs, (Hansen type 1, Hansen type 2 and Hansen type 3/ANNPE) and their treatment. Understand the spinal grading system from 1-5 and describe each of these grades accordingly   

• Explain the difference between disc disease and FCE, outlining diagnoses and treatment differentiations  

• Describe the limitations of CT vs MRI for diagnosing disc disease.   

• Outline post-operative care for the neurological patient including recumbent patient care, urinary catheter placement and maintenance and rehabilitation/physio  

• Describe a post-surgical neurological exam to determine the patient’s status and monitoring for signs of improvement or deterioration  

• Explain the development of myelomalacia, the pathophysiology and progression of the condition  

• Describe the different types of wound drains and their applications in the post surgical patient and the use of diffusion catheters for analgesia.