GENERAL SURGERY

WHAT IS GERNERAL
SURGERY
 This is a surgical specialty that focuses
on abdominal contents including and
often the thyroid gland (depending on
local referral patterns). They also deal
with diseases involving the skin, breast
and soft tissue, trauma, peripheral
vascular surgery and hernias and
perform endoscopic procedures
SURGICAL PROCUDURES DONE
UNDER GERNERAL SURGERY
 Exploratory  Appendectomy
laparotomy  Excision Biopsy/FB
 Lap  Debridment
cholectstectomy  Mastectomy
 Open  Thyroidectomy
cholectstectomy  Lumpectomy
 Toe amputation  Gastroscopy
 TMA  Colonscopy
 BKA  Wound exploration
 AKA
 SURGICAL PROCUDURES
DONE UNDER GERNERAL

SURGERY
 Colostomy take down
Revision of stump
 Skin graft  Fistulectomy
  Ovchiodopexy
Chest tube
placement  Ovchidectomy
  Paracentensis
Gastrostomy
placement  Hydrocelectomy
  Abdominoplasty
Repair of Jac
  Vagotomy
Circumcision
 PD catherter
 Splenectomy
placement
 Gastrectomy
 SURGICAL PROCUDURES
DONE UNDER GERNERAL
SURGERY
 EUA  Hemicolectomy
 Installation of  Adhesivolysis
peritoneal drain  Fverulectomy
superpubic  Traction to keloids
 Juenelum release  Wound closure
 Tivachest tube
placement
Fistulectomy
 This is a surgical
procedure that
involves the
removal of the
fistulous tract
and is caused
when an
abnormal
connection
between two
hollow
intestines and
 POST OPERATIVE CARE
 Pain Management. After all surgery
pain is expected and must be
monitored to know is medication is
effective
 Monitor discharge, for small or large
amount which an indicate abnormal or
expected
 Sitz bath each morning and after bowel
action, to promote healing to sit
Haemorrhoidectomy

 This is the

removal of

hemorrhoid
 POST OPERATIVE CARE
 Pain Management, to ensure medication
is working and patient is feeling little or
no pain
 Antibiotic (Metronidazole), to fight
against bacteria and infection prevention
 NPO, as food can cause aspiration in
cases
 Monitor for aspiration
 Monitor for air-way clearance (Oxygen
therapy)
Examination Under
Anesthetic
 This is done
sometimes if an
individual has a
condition where
they are feeling
severe pain and
cannot be examine
properly in the out-
patient clinic and is
suggested that the
exam can be
performed under
anesthesia.
 POST OPERATIVE CARE

 Monitor Vital signs especially Blood

pressure
 Monitor for aspiration, patient body is
shut down and under anesthesia he or
she can aspirate
 Keep airway patent, this is to ensure
patient can breathe, Oxygen therapy is
normally given
 Instillation of
Peritoneal Drain
 This procedure is
done under strict
aseptic techniques
and when caring
for the peritoneal
catheter. This is
the installment of
an abdominal
drainage catheter
to drain
accumulated fluids
from the peritoneal
cavity.
 POST OPERATIVE CARE
 Orthostatic blood pressure
 Monitor for leak, as if
monitoring, this is to set
base for any changes there is a leak the catheter
which can indicate
complication has to be replaced

 Daily dressing, then

 Maintain fluids as ordered,
this is because patient alternate dressing the
might be NPO and
electrolyte and hydration weekly, to promote healing
levels must be maintain
and prevent contamination
 Avoid and monitor for and bacteria
kinks in the catheter line,
 Monitor vital signs
this is to prevent blockage
of the line and bacterial
development
Wound Closure
 This is the
stitching of the
edges together
after a procedure,
chop wound to
promote healing.
 POST OPERATIVE CARE
 Monitor pain status.  Monitor for
This is because the swelling, This can
patient is expected
be minimized by
to have discomfort
and generally once ice packs once
there is a breakage allowed by
in the skin barrier surgeon

 Monitor bleeding,  Follow in

This is normal after instruction given
surgery and for wound care as
depending it can be to prevent
controlled with a
infection
little pressure
Hydrocelectomy
Surgery that is done
to remove or repair
a hydrocele. A
hydrocele is a fluid-
filled sac
surrounding a
testicle that causes
swelling in the
scrotum
 POST OPERATIVE CARE
 An ice pack is placed  Patient must avoid
over the area of swimming, bathing,
surgery, to aid in the using a hot tub, and
reduction of swelling. other activities that
The ice pack should not cause the incision to be
be left there for more covered with water
than 15 mins. until doctor says it’s ok

 Take prescribed pain  Don't lift anything

 medicine as directed. heavy. Exercise as
directed.
 Care for your incision as
instructed.  Don't drive until you
are no longer taking
 Don't have sex for 4 pain medicine and your
weeks, or as directed doctor says it’s OK.
Abdominoplasty
 This is often
called a “tummy
tuck.” During this
procedure, excess
fat and skin can
be removed from
your belly. And
certain muscles
can be
repositioned to
improve
abdominal
weakness.
 POST OPERATIVE CARE
 An ice pack is placed over the area of surgery, to aid in the
reduction of swelling. The ice pack should not be left there
for more than 15 mins.

 Take any prescribed medications exactly as directed.

 Walk slightly bent at the waist, if suggested by your

doctor. This helps protect the abdominal wall as it heals.

 Care for your incisions and the bandage over them as

instructed by your doctor.

 Don’t shower for 72 hours after surgery, or as instructed

by your doctor. Avoid swimming, bathing, using a hot tub,
and other activities that cause the incisions to be covered
with water until your doctor says it’s OK.
Exploratory Laparotomy
Ex- Lap is a surgical
operation where
the abdomen is
opened and the
abdominal organs
examined for
injury or disease.
 POST OPERATIVE CARE
 Your temperature, pulse, respiration, blood
pressure and wound site are carefully
monitored.
 You may have a drain inserted at the wound
site.
 A small tube may have been passed through
your nose and into your stomach to help
drain stomach secretions for a day or two.
This rests your digestive tract as it heals.
 A urinary catheter may be inserted to drain
off urine.
 You are given intravenous fluids (directly into
the vein), as you may not be allowed to eat
for a few days.
 Pain relief should be given regularly, as
ordered by your doctor, to keep you
comfortable.
 As soon as possible, you are
encouraged to do your deep breathing
and leg exercises.
 You are assisted out of bed the day
after the operation (all going well).
Early walking is important, as it reduces
the risks of blood clots and chest
infections.
 You are given daily wound care and
observation, along with advice on
caring for your wound at home.
 Medication is given to you on discharge.
PD Catheter Placement
 A small incision is
made above the
entrance site,
usually in the
midline with blunt
dissection of the
abdominal rectus
sheath. An 18-gauge
needle is placed into
the peritoneal cavity
POST OPERATIVE CARE
 After the operation the
 The fluid is a reddish
person’s blood
pressure and pulse will
pink colour to begin
be checked, and the
wound site examined at with because some
regular intervals to
ensure that there is no blood is mixed with the
undue bleeding from
the operation site. The fluid. On the day after
PD nurse will flush
the operation the
small volumes of fluid
through the catheter person or their care
until the fluid that
comes out is clear taker will be shown
(Some Units do this,
others do not flush the how to care for the exit
catheter). site.
Cholecystectomy
 A surgical
procedure to
remove the
gallbladder
 POST OPERATIVE CARE
 Monitor vital signs  Administer pain
every 15 minutes medication as ordered

 Maintain a supine  Administer antibiotics

position as prescribed

 Educate patient on  Monitor the surgical

early ambulation, site for signs of
turning, splinting and infection (redness,
active and passive swelling, purulent
range of motion discharge etc.)

  Observe patient for

Maintain IV fluids as
ordered nausea and vomiting
Amputation ( TMA,
BKA, AKA)
 It is the
removal of an
injured or
diseased body
part.
POST OPERATIVE CARE
› Administer oxygen therapy via face
mask.
› Monitor vital signs q15 minutes to 1
hourly until stable.
› Elevate bed rails.
› Assess the wound dressing and
drainage q2hrs for excessive bleeding.
› A tourniquet is kept available at the
bedside in case of acute bleeding.
› Observe for tachycardia, hypotension,
and indications for bleeding and shock.
› Maintain and monitor input and output.
› Continue IV fluids therapy as ordered by
doctor.
› Administer pain medication as ordered by
the doctor.
› Encourage deep breathing and coughing
exercises
› Encourage early ambulation
› Encourage active and passive range of
motion exercises
› Teach patient about wound care (keeping
site, clean and dry etc)
› Teach patient to avoid lifting heavy
objects (no more than 8 pounds)
› Teach patient how to cluster activities and
to take short frequent breaks in between
them
Appendectomy
 A surgical
procedure done
to remove the
appendix, the
procedure is
performed as an
emergency
procedure when
the patient is
suffering from
acute
appendicitis.
 POST OPERATIVE CARE
 Administer oxygen therapy via face mask.
 Elevate bed rails.
 Monitor vital signs q 15 minutes to 1
hourly.
 Assess the respiratory status.
 Monitor and maintain IV fluids.
 Monitor pain status.
 Administer pain medication as ordered by
doctor.
 Place patient in semi-fowlers position to
reduce the tension and pulling of tissues
on the wound area
 Encourage deep breathing and
coughing exercises
 Encourage early ambulation
 Encourage active and passive
range of motion exercises
 Teach patient about wound care
(keeping site, clean and dry etc)
 teach patient to avoid lifting
heavy objects (no more than 8
pounds)
 teach patient how to cluster
activities and to take short
frequent breaks in between them
Gastroscopy
 The procedure will
usually be carried
out by an
endoscopist and
assisted by a nurse.
 After the procedure,
is taken to the
recovery room and is
monitored for blood
loss or bleeding.
Colonoscopy
 The patient is
monitored for bleeding
in the recovery room
because sometimes
polyps are removed
and may cause
bleeding profuse
bleeding can lead to
shock or death

 Vitals are also

monitored in order to
know if there is a
severe change in
patient condition so
these vitals will act as
a baseline
 WOUND EXPLORATION
Attention should be paid to the following:
 Warming the patient
 Continuing fluid and blood product
resuscitation
 Replacing electrolytes
 Monitoring drain outputs
 Patients with evidence of ongoing bleeding may
benefit from angiographic evaluation for
possible embolization; some require re-
exploration for control of hemorrhage
 Patients who have undergone damage-control
procedures or have temporary abdominal
closures must return to the operating room
within 24-48 hours for definitive repair
Chest Tube Placement
 The surgeon will
prepare a large
area on the side of
the patient's chest,
from your armpit
down to your
abdomen and
across to your
nipple.
 An ultrasound may
be used to identify
a good location for
inserting the tube.
 POST OPERATIVE CARE
 Monitoring of breathing the reason for this intervention
is because breathing difficulties are common with
placement of chest tube, sometimes the tube may not
have been inserted correctly or properly.

 Check for possible air leaks the reason for this

intervention is that if there is leakage air of fluid can be
accumulated into the lungs and cause further
complications.

 Monitoring for bleeding is a major intervention because

there is breakage in the skin barrier and a lot of blood is
loss during such procedure which if not monitored can
lead to shock and death.

 Monitoring of Vitals. Vitals serve as a baseline to ensure

whether or not a patient is stable or not.
Revision Of Stump
 Monitor for bleeding
major blood loss can
lead to complications
of shock and oxygen
deprivation to tissues
and cause further
complications.

 Monitor vitals to serve

as a baseline data

 Oxygen therapy
because of the blood
loss and anesthesia
that was given
Wound Debridement
 This is a procedure
used to remove
dead tissue and
contaminated
substances from a
wound. A wound
must be clean to
heal. It also must
get a good supply
of blood. Anything
that is stopping this
must be taken out
of the wound.
 POST OPERATIVE CARE
 If a local anesthetic is used, the patient will be
allowed to go home as soon as they are ready. If a
general anesthetic is used, they will be taken to a
recovery area until they are stable. The patients’
blood pressure and pulse will be checked often. They
may continue to get fluids through the IV tube for a
while.

 If pain is felt and the patient will likely be given

medicine for it.

 Before the patient goes home, make sure they know

how to care for the wound. This includes knowing
when the dressing should be changed and how to
change it and Set up a follow-up appointment before
the patient leaves.
Mastectomy

 This is a surgical

operation to

remove a

breast.
 POST OPERATIVE CARE
 Monitor vital signs until stable
 Position the patient with the affected
side elevated on a pillow above the
heart level.
 Suction drains will be place, so monitor
drainage for character and volume.
 Drains are move when volume
decreases to a minimal amount daily.
 Inspect dressings both anteriorly and
posteriorly for drainage.
 Monitor intake and output for 48hours,
if general anesthesia was employed.
 Active and passive exercise of the
arm is encouraged to prevent joint
contracture and muscle
shortening.
 Administer prescribed analgesics
for pain relief.
 Encourage patient to turn and
ambulate regularly to promote
circulation to the extremities and
prevent bed sores.
 Encourage patient to deep breath
and cough to help in breathing and
prevent lung complication
Thyroidectomy
 An operation that
involves the surgical
removal of all or part
of the thyroid gland.

Complications:
 Bleeding
 Injury to recurrent
laryngeal nerve
 POST OPERATIVE CARE
 Nursed patient in a semi-fowler’s
position, with head and neck well
supported to ease incision tension.

 A hemovac may be in place for the

first 24 to 48 hours.

 The patient is checked for dysphagia

and hoarseness, signs of laryngeal
nerve injury, and for bleeding or
infection.
 The patient is watched closely for
signs of respiratory distress, and in
both the recovery room and the
patient care setting, there should be
equipment for immediate
resuscitation: airway intubation,
tracheostomy tray, or both, as well as
various pharmacological agents

 Regular follow-up care is required to

manage hypothyroidism, which
develops 2 to 4 weeks after total
thyroidectomy, and to assess thyroid
size and status following subtotal
resection
Excisional Biopsy
 This is the
removal an entire
lump or an entire
area of abnormal
skin, including a
portion of normal
skin.
 POST OPERATIVE CARE
 Monitor heart rate, body
temperature, and blood pressure
to establish baseline data of any
abnormalities
 Administer pain medication to
relief pain
 Ensure dressing is done as ordered
to promote wound healing
 Patient should exercise arm to
prevent arm and shoulder stiffness
on the side where you had
 Patient should be taught about signs
and symptoms of infection (swelling,
redness, itching, fever and given
antibiotics to prevent any infections
 Patient should be given information on
caring for the incision and dressing,
recognizing signs of infection
 Prescriptions for pain medication and
possibly an antibiotic
 A follow-up appointment with your
doctor, usually seven to 14 days after
surgery
Orchiectomy /
Orchidectomy
 This is a surgical
removal of one or
both testicles. After
this procedure the
penis and scrotum
are usually left
intact. It is done via
an incision in the
front of the
scrotum and is used
to stop most of the
body’s production
of Testosterone.
 POST OPERATIVE CARE
 Monitor vitals per 15 minutes.

 Monitor for pain; patients may be sent

home with pain meds.

 Monitor surgical site for bleeding.

 Allow clear fluids immediately post op

and gradually progress to regular diet
as tolerated; Anesthesia can cause
stomach discomfort and nausea.
 Educate patient on incision care

 Educate patient on activity

restrictions; avoid any activity
that may affect the
healing/recovery process of the
incision.

 Administer antibiotics as
Vagotomy
 A surgical
procedure in
which one or
more branches of
the vagus nerve
are cut to reduce
the rate of gastric
secretion
(Example with
 POST OPERATIVE CARE
 Suction PRN.
 Monitor Vitals per 15 minutes.
 Monitor for pain.
 Maintain supine position
 Monitor IV Fluids.
 Administer antibiotics as
prescribed/ordered.
 Monitor airway.
 Administer Oxygen Therapy.
Frenectomy
 The removal of a
frenulum (A
muscular attachment
between 2 tissues
found inside the
cheeks, lips and
inside the mouth and
gums, 2 types: labial
and Lingual)
 POST OPERATIVE CARE
 Monitor airway.
 Monitor for pain.
 Suction PRN.
 Monitor vitals per 15 minutes.
 Administer Oxygen therapy
 Monitor for excessive swallowing
(an indication of bleeding)
Circumcision

 This is the
removal of the
foreskin of the
glans of the un-
erect penis.
 POST OPERATIVE CARE
 Daily cleaning or dressing for this
patient without forceful retraction of
the foreskin

 Topical corticosteroids is effective in

the patient management by separating
the loose adhesions found between the
glans and the foreskin.
Splenectomy

 This is the
surgical removal
of the spleen.
This procedure
is done under
general
anaesthesia.
 POST OPERATIVE CARE
 Pain medication is given after to patients
after surgical procedure is done to reduce
any pain that the patient would be in.

 Patients would not need to be on daily

antibiotics if he or she had received all
necessary immunizations at required at
childhood before the splenectomy.
 Second post operative day, you may remove
the gauze and clear plastic dressing placed
over patients incisions.
 Monitor for signs of elevated temperature
this can be a sign of infection.
Colostomy
 Colostomy is a
surgical procedure
that brings one end of
the large intestine out
through an opening
(stoma) made in the
abdominal wall. Stools
moving through the
intestine drain
through the stoma
into a bag attached to
the abdomen.
 POST OPERATIVE CARE
 The nurse should help the patient
accept the colostomy and teach
patient how to take care of it which
includes pouch management.

 For nutrition the patient starts off

on a low residue diet.

 Have the pouch be change

regularly as to reduce the odor.
Paracentesis
 This is a procedure in
which a needle or
catheter is inserted
into the peritoneal
cavity to obtain
ascitic fluid for
diagnostic or
therapeutic
purposes.
 POST OPERATIVE CARE

 Monitor patient vitals continuously,

 Monitor input and output chart

 Watch for any reaction for 24 hours,

SKIN GRAFT
 Skin grafting is a
surgical procedure
that involves
removing skin from
one area of the body
and moving it, or
transplanting it, to a
different area of the
body.
 POST OPERATIVE CARE

 Monitor Vital Signs

 Administer Analgesic

 Monitor for signs of infections