ROT - 6

Presented by:
Bazan, Neriel
Yasin, Sharif Haden
Patient E
Age: 34 years old
Sex: Female
DX: ASA SEEC TO ( Acute
Superficial Abdomen
Secondary to) RUPTURED
APPENDICITIS
 append (appendix)
-ectomy (the surgical
removal of something)

An appendectomy is the
surgical removal of the
appendix. It’s a common
emergency surgery that’s
performed to treat appendicitis,
an inflammatory condition of
the appendix. What is Appendectomy
Why is it Performed?
The easiest and quickest way to treat
appendicitis is to remove the appendix.
Your appendix could burst if
appendicitis isn’t treated immediately
and effectively. If the appendix
ruptures, the bacteria and fecal
particles within the organ can spread
into your abdomen.
 An appendectomy is a fairly
simple and common procedure.
However, there are some risks
associated with the surgery,
including:

bleeding
infection
injury to nearby organs
blocked bowels

Risk Factors
Open
Appendectomy
During an open appendectomy, a surgeon makes one
incision in the lower right side of your abdomen. Your
appendix is removed and the wound is closed with
stiches. This procedure allows your doctor to clean the
abdominal cavity if your appendix has burst.
Your doctor may choose an open appendectomy if your
appendix has ruptured and the infection has spread to
other organs. It’s also the preferred option for people
who have had abdominal surgery in the past.
APPENDECTOMY PROCEDURE
Step-by-Step
INSTRUMENTS UTILIZED

DURING APPENDECTOMY
 Malleable

Category: Retractors

A malleable or ribbon retractor (manual) is used to retract deep

wounds. May be bent to various shapes
 Deaver

Category: Retractors

A Deaver retractor (manual) is used to retract deep abdominal or chest

incisions. Available in various widths.
 Richardson

Category: Retractors

A Richardson retractor (manual) is used to retract deep abdominal or

chest incisions
 Army Navy Category: Retractors

The Army Navy Retractor, sometimes called US or USA Army Retractor,

is used for shallow or superficial wounds.
Tissue Forceps (Toothed)

Category:
Grasping/Holding
Instrument

A toothed forcep is a grasping instrument used to hold, reposition, or

remove tissue, organs, and sutures during many medical procedures.
Tissue Forceps (Toothless)

Category:
Grasping/Holding
Instrument

Non-toothed forceps used for fine handling of tissue and traction

during dissection.
 Towel Clips

Category:
Grasping/Holding
Instrument

A Backhaus towel clip is used to hold towels and drapes in place

 Debakey

Category:
Grasping/Holding
Instrument

DeBakey forceps are used to grasp delicate tissue, particularly in

cardiovascular surgery
 Needle Holder

Category:
Grasping/Holding
Instrument

Mayo-Hegar needle holders are used to hold needles when suturing.

They may also be placed in the sewing category.
 Allis Forceps

Category:
Grasping/Holding
Instrument

An Allis is used to grasp tissue. Available in short and long sizes. A

"Judd-Allis" holds intestinal tissue; a "heavy allis" holds breast tissue.
 Curved Forceps

Category:
Grasping/Holding
Instrument

Used to hold delicate tissue Used to compress bleeding vessels Jaws are
fully serrated
 Bobcock

Category:
Grasping/Holding
Instrument

A Babcock is used to grasp delicate tissue (intestine, fallopian tube,

ovary). Available in short and long sizes.
 Straight Forceps

Category:
Grasping/Holding
Instrument

Used to clamp small vessels or hold tissue Jaws are partially serrated
Curved and Straight Metzenbaum

Category: Cutting and

Dissecting Instruments

Used to cut delicate tissue. Available in regular and long sizes.

 Scalpel/Blade

Category: Cutting and Dissecting Instruments

A scalpel, or lancet, or bistoury, is a small and extremely sharp bladed

instrument used for surgery and anatomical dissection.
 Bowl

Used to clamp small vessels or hold tissue Jaws are partially serrated
 Cautery Pen

is often used in surgery to remove unwanted or harmful tissue. It can

also be used to burn and seal blood vessels. This helps reduce or stop
bleeding during surgery or after an injury
 Asepto Syringe

a syringe designed to fit directly into large lumen tubing; also used for
intraoperative irrigation and a vacuum for gentle suction of small
amounts of bodily drainage.
 Light Handles

The sterile controls also provide adjustment of the pattern size and
positioning of lights in the sterile field and allow for increasing and
decreasing illumination in the operating table.
 Kidney Basin

used in medical and surgical wards to receive soiled dressings and other
medical waste.
 Operating Sponge

They are ordinarily made of gauze and are used to absorb blood and
other fluids as well as clean wounds.
 Abdominal Pack

used for temporary control of severe injury and it is used in damage control surgery
schedule. Technically bleeding from abdominal cavity can generally be achieved by
applying pressure with several large abdominal packs.
 Round Needles

needles penetrate and pass through tissues by stretching without

cutting. A sharp tip at the point flattens to an oval or rectangular shape.
The point cuts a pathway through tissue and is ideal for skin sutures
 Cutting Needles

The point cuts a pathway through tissue and is ideal for skin sutures
 Free Ties

A suture without a needle is often called a “free tie”. Free ties are useful
when ligating vessels and pedicles.
 Atraumatic Needle

A blunt, curved needle with an eye in the tip used for passing a suture
around a vessel.
 Laparotomy Sheet

A large non woven disposable drape with an incise drape in the centre, surrounded by an
absorbent area. Is used to cover the patient and expose only the operative site.
 Sterile Towels

surgical towel is a sterile drape used to cover the body while surgery is being performed.
Being they are low lint they make a great wipe to clean sterilized surgical instruments. They
can also be used in surgery to cover certain areas of the patient
PERIOPERATIVE ROLES

SCRUB & CIRCULATING NURSE

Pre-operative Roles of SN & CN
From the time of arrival up to the time before the incision, either of the nurses; or both of them can
perform these activities:
Receive the endorsement (client, chart, and supplies) and note the time;
Counter-check the client’s identity and procedure/operation to be done;
Recheck the operating room checklist, it must be completely carried out;
Review laboratory results for any that has significant impact on the operation;
Recheck the consent form for completeness;
Remind/check the schedule of the assigned surgeon and other members of the surgical team for
availability;
Prepares the operating room table (bed), tables, materials, equipment, and needed machines;
Ensures functionality of everything to be used;
Prepares emergency kit;
Reinforce knowledge on what to expect during and after the procedure/operation.
Pre-operative Roles of the Scrub Nurse
After these/at this time, the scrub nurse can now perform surgical hand-washing,
gowning, and gloving while having strict adherence to the operating room
technique;
He/she can now serve gloves and other sterile materials to the surgeon and other
members of the sterile team;
He/she can now also prepare sterile materials and equipment on the mayo table, in
an arrangement he/she is comfortable and facilitate speedy performance;
He/she may or may not start initial and tentative counting of sponges, needles,
sharps, and other tiny materials that will be used;
Pre-operative Roles of the Circulating Nurse
As the scrub nurse moves to perform his/her role, the circulating nurse will continue
handling the client by establishing or re-checking vital signs;
Recheck administration (time, dosage, by whom) and effects of the pre-anesthesia agents;
Ensures safety while transporting a patient from the lobby to the OR table/bed;
Assists in positioning the client in the induction of anesthesia, note the time of induction;
Assists in positioning the client in the desired position for operation/procedure;
Place straps, restraints, and other protective materials for safety;
Assists in dressing (gowning) of the sterile nurse;
Calls for any other request and corrections among surgical team members;
Prepares/put anticipated additional materials within accessible areas.
Intraoperative Roles of the Scrub Nurse
Assembles the mayo table in an arrangement that both holds accessibility and
comfort while it could maintain sterility (an example is making “pillow” to
maximize space within the table);
Charges parts of instruments and materials like a blade to blade holder to make a
“knife” or scalpel;
Serves additional antiseptics to further cleanse the incision site (if requested);
Serves sterile draping materials like towels, clips, eye sheets, and others;
Serves the “knife” or scalpel and note the time of incision (formal start of the
operation);
Serves sponges and other ligating materials to stop or minimize bleeding;
Anticipates needed materials to be used next;
Intraoperative Roles of the Scrub Nurse
Anticipates physical help that can be rendered like retractions and positioning of “tied”
materials;
Keep on organizing the mayo table to prevent dropping and contaminating
instruments and materials;
Continuously monitoring the number of tiny materials that may be left inside the body
or misplaced;
Monitors dropped materials for tallying and possible replacements;
Collects the specimen tissue and put it in container for possible laboratory workouts;
Serves suturing instruments and materials;
Notes the closing time which marks the ending of the operation;
Collects all instruments, materials, and equipment that are exposed to body secretions
and fluids.
Intraoperative Roles of the Circulating Nurse
Notes the incision time;
Records the quantity of every material to used or prepared;
Anticipates the serving of additional materials;
Assists the anesthesiologist and other unsterile team members;
Maintains communication among members of the surgical team, and surgical team to other
offices like the laboratory and surgical ward;
Continuously monitors dropped materials and document it, prepares possible replacements;
Does the documentation of everything done and happened during the operation/procedure in
chronological order;
Assists in the final counting of sponges, needles, blades, and tiny materials used;
Notes the time of closure;
Assists in transferring the client from OR table/bed to the stretcher;
Ensures safety of transport from the operating room to PACU.
Post-operative Roles of the SN & CN
After the closure of the operative site, the roles of the scrub nurse and the circulating nurse will
gradually meet to a common point. They will both focus on the synonymous concept, the
“aftercare”.
The scrub nurse’s contribution to the aftercare focuses on handling used materials that are
exposed to body secretions and fluids. The circulating nurse is on unused materials together with
putting the machines back in place;
Another is the scrub nurse returns used materials to the central supply for re-sterilization while
the circulating nurse assists the client to the PACU for endorsement;
After their role performance, both will go back to the vacated operating room to final check the
arrangement of every details; returning it back to their original places, keeping it ready to cater to
the next operation.
THANK YOU!

References
https://www.healthline.com/health/appendectomy
http://www.southsudanmedicaljournal.com/archive/may-
2016/open-appendicectomy.how-i-do-it.html
https://www.mayoclinic.org/diseases-
conditions/appendicitis/symptoms-causes/syc-20369543