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Chapter 3 - The Surgical Patient - Surgical Technology

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Primary role of the surgical technologist

assist surgeon, establish the sterile field, handle and care for surgical instrumentation, assist with technical tasks


Physical need of the patient

any need or activity related to genetics, physiology, or anatomy


Psychological need of the patient

any need or activity related to the identification and understanding of oneself.


social need of the patient

Any need or activity related to one's identification or interaction with another individual or group.


spiritual need of the patient

any need or activity related to the identification and understanding of one's place in an organized universe.


Maslow's hierarchy of needs

establishes a means of prioritizing needs effective for basic understanding of individuals and for quick recognition of patient concerns - A model that expresses human development using developmental stages


how we should treat patients

we do not call patients by their surgery - they are human beings. implementation of moral and ethical obligations is required. Sensitive to feelings,


factors that result in surgery

genetic malformation, trauma, nonmalignant neoplasm, disease, a condition, psychological state


factors that apply to a patient's reaction to health, illness, and hospitalization

adaptation and stress


Sister Callista Roy - Roy Adaptation Model

A viewpoint of the patient as a biopsychosocial individual that is constantly interacting with the environment with the ability to adapt by using coping skills in dealing with internal and external stressors.


adaptive process

involves both physiological and psychological changes that indicate the person's attempt to adapt to the illness or trauma.



occurs in a rapid or slow fashion based on the nature and type of illness or trauma



nonspecific response of the body to a demand - Dr. Hans Selye either physical, chemical, or emotional



most common - type that has negative implications usually physiological and psychosocial.



"good" "well" - positive desirable - marriage, new baby, etc..


types of stressors for Surg. Tech to be aware of

type of illness, trauma, or disease, previous experience with surgery, age of patient(child/adult), environmental differences (not home), family role (breadwinner), economic factors(cost of surgery), religious beliefs


types of coping mechanisms

denial-not accepting truth


regression-exhibits behavior of earlier stages in life

repression- holds back feelings by not discussing


cardiac death

irreversible loss of cardiac and respiratory function. Permanent absence of heartbeat.


higher-brain death

lower brain stem continues to provide respiration, blood pressure, and a heartbeat without the assistance of a respirator


whole-brain death

irreversible loss of all functions of the entire brain. This is the current law as to what defines death in most jurisdiction of the world and reflects the standard set by the Harvard School of Medicine. A flat EEG, unresponsive, lack of pupil reflexes, low body temp.


Elizabeth Kubler-Ross

Five Stages of Grief



initial stage of grief, a temporary defense to cope

"cannot believe it's happening to them"



when first stage of grief can't be continued, this stage is replaced with rage, envy, resentment.

"Why me?"



after going through the second stage of grief, patient wants to postpone the inevitable.

-unable to face reality



all stages prior to this stage turn to a sense of great loss as the illness progresses

"Please don't take me away from my family"



after all four stages of grief have been passed, the patient reaches a sense of resolution.

"I know I will be in a better place"



category of death that is caused by nature or humans. May engender wrongful death suits.



category of death that is progressive and incurable. palliative treatment is often prescribed.


prolonged (chronic)

category of death that is long-lasting and needs to be managed on a long-term basis, managed by lifelong medical treatment



category of death that occurs without warning.


palliative procedures

intended to provide the patient with symptom relief, the avoidance of symptoms, or relief from conditions secondary to the progressive local disease


therapeutic procedures

used to treat or manage a disease. These include elective and nonelective surgeries.

elective=stent, pacemaker

nonelective=live organ donor transplant


life support

a set of therapies that preserve a patient's life when body systems are not functioning sufficiently to sustain life.


"ordinary" life-support therapies

used to illustrate care given to prolong life that the physician is morally obligated to provide


"extraordinary" life-support therapies

include those therapies that may pose an undue burden on the patient and may be costly or futile. Not only futile, but the burdens will be disproportionate to the benefits



"good death" "easy death" "painless inducement of quick death"


passive euthanasia

when the physician does nothing to preserve life


active euthanasia

requires actions that speed the process of dying. (administration of morphine) This euthanasia is divided into voluntary and involuntary euthanasia


voluntary euthanasia

patient initiates facilitation of his own death


involuntary euthanasia

patient's autonomous rights are violated


Patient Self-Determiniation Act 1990

requires medical facilities to inform patients of their right to choose the type and extent of their medical care and to provide patients with information concerning living wills and powers of attorney.


advance directives

one of two legal documents used to speak for patients in the event that they cannot make decisions for themselves


living will

an advance directive that allows patients to state in writing exactly what medical interventions they are willing to endure to sustain life.


power of attorney

legal way to appoint a health care proxy who will make medical decisions for the patient in the event that he or she cannot do so.



do no resuscitate/do not intubate - many hospitals rescind the DNR/DNI during surgery


patient death in the operating room

*notify surgery dept. and implementation of postmortem patient care

*family is notified by surgeon

*patient's religious leader is notified if not done so by family

*procedures for death that involves law enforcement will be carefully followed and evidence preserved, autopsy

*preparation of the body for family to view

*postmortem care of the body for transportation


Title XI fo the Omnibus Budget Reconciliation Act of 1986

hospitals are required to establish organ procurement protocols or lose Medicare and Medicaid funding


Donation After Cardiac Death (DCD)

the decision to discontinue mechanical support will allow a patient to donate organs - A patient is considered a candidate only if it is predicted that the heart will cease functioning within 90 minutes of removal from mechanical support


steps to organ donation

*after death discussion with physician, nurse, clergy, and social worker

*next of kin must consent by signing documents

*Gift of Life Coordinator determines the patient's suitability

*Gift of Life Coordinator and medical team coordinate the donation process, review of medical/social history, OR scheduled


tissue donation from patients who were not on life support

corneas, skin, bone


physiological needs

Maslow's 1968,1971 model - most basis needs are biological, such as the need for water, oxygen, food, and temperature regulation


safety needs

Maslow's 1968,1971 model - refer to the perception on the part of the individual that his or her environment is safe


love and belonging needs

Maslow's 1968,1971 model - basic social needs - to be known and cared for as an individual and to care for another


esteem needs

Maslow's 1968,1971 model - refers to a positive evaluation of oneself and others, a need to be respected and to respect others



Maslow's 1968,1971 model - to fulfill what one believes is one's purpose


Maslow's 1968,1971 model

1. survival or physiological needs

2. safety needs

3. belonging and love

4. prestige & esteem

5. self-actualization

****all the requisite needs of each prior level must be met in order to achieve the next level (upward)

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