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Purpose of Suture:
O to hold a wound together in good apposition until such time as the natural healing process
is suIIiciently well established to make the support Irom the suture material unnecessary
and redundant.
Ligature or Tie reIers to a suture material that is tied around a blood vessel to occlude the
lumen.
Two types of ligature or tie:
1. ree tie is a stand oI material that is handed or given the surgeon or assistant to ligate a
vessel. This stand is not threaded on a needle.
2. Stick tie or suture ligature the suture material is threaded either on a needle holder or
on a right angle clamp beIore occluding a deep or large vessel.
Atraumatic Suture a suture material prepared or manuIactured with a needle attached to it. It
is reIerred to as an eyeless needle or atraloc-swage on needle.
Strand suture material prepared or manuIactured without a needle attached to it.
Continuous Suture a suturing technique wherein a surgeon start suturing at one point and
ends at the other point without cutting the suture material. This may be reIerred to as a running
stitch and also used to close the peritoneum and vessels because it provide a leakprooI suture
line.
Interrupted Suture the suture is taken, tied and out separately. This technique is time
consuming.
Subcuticular Suture a continuous suture is placed beneath epithelial layer oI skin in short
lateral stitches. It leaves a minimal scar Iormation.
Buried Suture a suture placed under the skin, buried either continuous or interrupted suture.
Burse String or Inverting Stitch a continuous suture is used as a draw string method to invert
the loose ends or edges oI tissue and tied the close the lumen. (Ior example, stamp oI the
appendix.)
Traction Suture is used to hold tissue out oI the way during the operation.

I. Horizontal Recumbent
1. !lace patient Ilat on back with legs extended or slightly Ilexed.
2. !lace bath blanket over patient lengthwise. Fan bedding to Ioot oI bed
Purpose:
1. eneral examination.
2. Abdominal surgery.
3. Surgery on head and extremities.
II. Dorsal Recumbent
1. !lace patient Ilat on back with one pillow under head; have knees Ilexed and separated
and Ieet Ilat on bed.
2. Fold blanket in halI lengthwise. Lay center oI blanket over abdomen and ends over each
Ioot. Fan leading to Ioot on bed. Arrange blanket to cover extremities and expose
perineum.
Purpose:
1. #ectal, vaginal and pelvic examinations and treatments.
2. Deliveries.
III. Sims or Left Lateral
1. !lace patient on leIt side somewhat obliquely across the bed with buttocks to edge oI
mattress. Incline the body Iorward, draw the leIt arm back under patient and place the
right arm Iree in Iront. The thighs should be Ilexed upon the bodythe right more than
the leIt.
2. !lace lengthwise bath blanket over patient, IanIold topsheet to Ioot oI bed. Fold blanket
back exposing the area to be examined.
IV. Knee-Chest or Genu-Pectoral
1. !lace patient in the prone position, then assist her to kneel so that her weight rests on her
chest and knees. Turn head to one side and Ilex her arms at the elbows extending, then to
the bed in Iront oI her. Be sure the thighs are perpendicular to the level oI the head.
Watch pulse and general condition oI the patient.
Purpose:
1. To obtain better exposure oI the vagina, cervix, and rectum.
2. To examine the bladder.
3. To help correct retroversion oI the uterus.
4. To administer caudal and sacral anesthesia.
. Vaginal and rectal examinations.
6. Operative procedures on the vagina, rectum and perineum. Operative deliveries
V. Dorsal Lithotomy or Dorso-sacral:
In bed:
1. !lace the patient on her back across bed with the buttocks slightly beyond the edge oI the
mattress, then Ilex knees over the abdomen and separate the knees. Support the knees by
means oI long sheet Iolded diagonally and passed under the knees and around the neck.
2. Draw up gown over abdomen. Drape as Ior dorsal recumbent.
Purpose:
1. Vaginal and rectal examination.
2. Operative procedures on the vagina, rectum and perineum.
3. Deliveries and operative deliveries
n Examining Tables: !lace patient on dorsal position with the knees Ilexed and Ieet in still-
ups. Buttocks are brought down to edge oI examining table.
VI. Standing or Erect
When used for vaginal examination:
1. ave the patient standing with the knees separated about ten inches with one Ioot on a
low stool. Instruct her to place one hand on the buck oI the chair Ior support and the other
hand on her hip.
2. Either remove skirts or Iold about waist. Wrap a Iolded sheet about the lower part oI the
body stimulating skirt, with the sides overlapping in Iront. !in it to hold in place.
When use for examination of spine and backs:
1. #emove patient`s slippers and have patient stand on towel.
2. Loosen gown, place bath blanket around shoulders with opening at the back. !in at nape.
Purpose:
1. Vaginal examination Ior determining the degree oI prolapse oI the uterus.
2. Examination oI hernia
VII. Prone
1. Let patient lie on his abdomen. Turn hand to one side. Allow pillow under the head and
another under the lower chest.
2. Draping same as in dorsal.
Purpose:
1. For treatment on the back.
2. To Iacilities drainage Irom wound.
3. To secure drainage oI pus to Iront oI abdomen.
4. To keep pus away Irom the spine.
VIII. 1ack knife or Kroaske or Bozeman
1. !lace patient on a prone position with the hips directly over the band oI the examining
table. Tip the table with the head lower than the hips. Lower the Ioot part oI the table so
that the patients Ieet are below the level oI his head. !lace pillow under the pelvis and
abdomen to relieve the strain.
2. Drainage
Purpose: Operation on the rectum and coccyx
IX. Walchers Position
1. !lace patient Ilat on her back with the sacrum resting on the edge oI the table. Lower the
legs slowly toward the Iloor. Elevate the buttocks slightly iI the table permits.
1.2.Draping is similar to that oI the lithotomy position.
Types of Anesthesia

Anesthesia, or anaesthesia has traditionally meant the
condition oI having sensation (including the Ieeling oI
pain) blocked. This allows patients to undergo surgery
and other procedures without the distress and pain they
would otherwise experience. The word was coined by
Oliver Wendell olmes, Sr. in 1846. Another deIinition
is a 'reversible lack oI awareness, whether this is a
total lack oI awareness (e.g. a general anaesthestic) or a
lack oI awareness oI a part oI a the body such as a
spinal anaesthetic or another nerve block would cause.
Anesthesia diIIers Irom analgesia in blocking all
sensation, not only pain.
Classification:
A. General Anesthesia - is the loss oI all sensation and consciousness. !rotective reIlexes such
as cough and gag reIlexes are lost. A general anesthetic acts by blocking awareness centers in the
brain so that amnesia (loss oI memory), analgesia (insensibility to pain), hypnosis (artiIicial
sleep), and relaxation (rendering a part oI the body less tense) occur. eneral anesthetics are
usually administered by intravenous inIusion or by inhalation oI gases through a mask or through
an endotracheal tube inserted into the trachea.
Advantages:
1. Because the client is unconscious rather then awake and anxious, respiration and
cardiac Iunction are readily regulated.
2. The anesthesia can be adjusted to the length oI the operation and the client`s age
and physical status.
Disadvantage:
1. It depresses the respiratory and circulatory systems.
2. Some clients become more anxious about a general anesthetic that about the
surgery itselI. OIten this is because they Iear losing the capacity to control their
own bodies.
B. Regional Anesthesia - is the temporary interruption oI the transmission oI nerve impulses to
and Irom a speciIic area or region oI the body. The client loss sensation in an area oI the body
but remains conscious. Several techniques are used:
Topical (surface) Anesthesia Is applied directly to the skin and mucous
membranes, open skin surIaces, wounds, and burns.
The most common used topical agents are lidocaine
(Xylocaine) and benzocaine. Topical anesthetics are
readily absorbed and act rapidly.
Local Anesthesia (InIiltration)is injected into a speciIic area and is
used Ior minor surgical procedures such as suturing
a small wound or perIormng a biopsy. Lidocaine or
tetracaine 0.1 may be used.
Nerve Block Is a technique in which the anesthetic agent is
injected into and around a nerve or small nerve
group that supplies sensation to a small area oI the
body. Major blocks involve multiple nerves or a
plexus (e.g. the brachial plexus anesthetizes the
arm); minor blocks involve a single nerve (e.g. a
Iacial nerve)
Intravenous block (Bier
block)
Is used most oIten Ior procedures involving the arm,
wrist and hand. An occlusion tourniquet is applied to
the extremity to prevent inIiltration and absorption
oI the injected intravenous agent beyond the
involved extremity.
Spinal anesthesia
(Subarachnoid block)
It requires a lumbar puncture through one oI the
interspaces between lumbar disc 2 (L2) and the
sacrum (S1). An anesthetic agent is injected into the
subarachnoid space surrounding the spinal cord.
Categorized into Low Spinals (saddle or caudal
blocks) are primarily used Ior surgeries involving the
perineal or rectal areas. Mild Spinals (below the
level oI the umbilicus T10) can be used Ior hernia
repairs or appendectomies. High Spinals (reaching
the nipple line T4) can be used Ior surgeries such
as cesarean sections.
Epidural (peridural)
anesthesia
Is an injection oI an anesthetic agent into the
epidural space, the area inside the spinal column but
outside the dura mater.

Conscious Sedation may be used alone or in conjuction with regional anesthesia Ior some
diagnostic tests and surgical procedures. Conscious sedation reIers to minimal depression oI the
level oI consciousness in which the client retains the ability to maintain a patent airway and
respond appropriately to commands.
Intravenous narcotics such as morphine or Ientanyl (Sublimaze) and antianxiety agents such as
diazepam (Valium) or midazolam (Versed) are commonly used to induce and maintain conscious
sedation. Conscious sedation increases the client`s pain threshold and induces a degree oI
amnesia but allows Ior prompt reversal oI its eIIects and a rapid return to normal activities oI
daily living. !rocedures such as endoscopies, incision and drainage oI abcesses, and even balloon
angioplasty may be perIormed under conscious sedation.
#isk Factors Ior Complications During the !rocedure:
O Current or past health problems
O Taking medications, supplements, or herbal remedies, blood thinners
O Allergies (eg, Iood allergies, medication allergies, latex allergies)
O Smoking
O Drinking alcohol
O Taking recreational drugs
O !ersonal or Iamily history oI adverse reactions to anesthesia
!ossible Complications:
O !ain and tenderness around the injection site
O Bruising, inIection, or bleeding oI the injection site
O ematoma (a mass oI clotted blood that Iorms in a tissue, organ, or body space as a result
oI a broken blood vessel)
O Spinal headache (a severe headache that may occur aIter spinal or epidural anesthesia)
O Decrease in blood pressure
O erve damage
O Medication mistakenly injected into a vein; symptoms include dizziness, rapid heartbeat,
and Iunny taste or numbness around the mouth
O orner`s syndrome (change oI pupil size on one side)
O !tosis (drooping oI the eyelid)
O !neumothorax (air trapped between the lung and rib cage)
Call Your Doctor II Any oI the Following Occurs:
O Signs oI inIection, including Iever and chills
O #edness, swelling, increasing pain, or discharge Irom the injection site
O Tingling, numbness, or trouble moving around the aIIected area
O eadache
O !ersistent coughing
O Chest pain
O Trouble breathing or shortness oI breath
O Dizziness
O eartbeat abnormalities
O Funny taste or numbness oI the mouth
O Other worrisome symptoms
Digestive System
Share1hls

Llvlng organlsms need food

a) ln order Lo keep allve and Lo carry on Lhelr varlous llfe acLlvlLles such as lngesLlon dlgesLlon
absorpLlon resplraLlon movemenL clrculaLlon coordlnaLlon secreLlon excreLlon and reproducLlon

b) lor bulldlng and malnLalnlng Lhelr cellular and meLabollc machlnery (growLh malnLenance and repalr
of Lhe organlsm)

c) lor regulaLlng meLabollc processes

d) lor bulldlng up Lhe reslsLance agalnsL dlsease

lood Lhus can be deflned as any essenLlal subsLance LhaL when absorbed lnLo Lhe body Llssues ylelds
maLerlals for Lhe producLlon of energy Lhe growLh and regulaLlon of llfe processes wlLhouL harmlng Lhe
organlsm

1 1he parLlcles or pleces of food small or blg are Laken lnLo Lhe body 1hls ls called as eaLlng or
lngesLlon

2 1he lngesLed food ls Lhen dlgesLed where Lhe complex and large food parLlcles are broken down lnLo
slmpler smaller and soluble molecules

3 1hen Lhe slmpler subsLances obLalned from dlgesLlon are Lhen absorbed lnLo Lhe cells of Lhe body

4 1hen Lhe undlgesLed wasLe maLerlal ls removed and Lhrown ouL of Lhe body by excreLlon 1he process
of dlgesLlon lncludes mechanlcal and chemlcal breakdown of Lhe lngesLed food

1he chunks of food chewed by us are broken down lnLo small pleces and are acLed upon a varleLy of
enzymes secreLed lnLo Lhe mouLh 1hus lnslde Lhe mouLh sallva molsLens Lhe masLlcaLed food and
causes chemlcal dlgesLlon (of sLarch by Lhe amylase enzymes lnLo smaller molecules) 1he masLlcaLed
food and parLlally dlgesLed food Lhen passes Lhe esophagus or Lhe food plpe lnLo Lhe sLomach Pere lL ls
acLed upon by gasLrlc [ulce of Lhe sLomach whlch conLalns hydrochlorlc acld pepsln and oLher enzymes
1hese enzymes break down Lhe proLelns of Lhe food lnLo smaller molecules whlch pass onLo small
lnLesLlne



ln Lhe flrsL parL of Lhe small lnLesLlne called Lhe duodenum food (now called chyme) ls acLed upon Lhe
by blle [ulce from Lhe llver and pancreaLlc [ulce from Lhe pancreas 1he walls of a parL of small lnLesLlne
called lleum also pour some enzymes for food dlgesLlon



ll Lhe food whlch ls dlgesLed by Lhe mouLh sLomach duodenum and lleum ls ulLlmaLely absorbed by
Lhe vllll whlch are numerous mlnuLe flnger llke pro[ecLlons lnLo Lhe cavlLy of Lhe small lnLesLlne 1he
absorbed food ls Lhen senL Lhrough blood Lo dlfferenL parLs of Lhe body 1he absorbed food maLerlals
are uLlllzed by Lhe body ln varlous ways by a process called asslmllaLlon 1he undlgesLed food ls senL Lo
Lhe large lnLesLlne and removed Lhrough Lhe recLum and anus ln Lhe form of sLool or faeces 1hls
process ls called excreLlon













Abdominal regions
!osted on October 27th, 2008 in uman Anatomy
The abdomen is an important region oI a human body it contains many oI the vital organs oI the
body, so iI there is discomIort in this region then the cause can be linked to many organs so Iirst
a medical/dental student has to know the regions oI the abdomen to diagnose the present cause oI
the pain and to which organ it is related to.
ere in the image we can see the diIIrent regions oI the abdomen,

1. #ight ypochondrium
2. Epigastrum
3. LeIt ypochondrium
4. #ight Lumbar
. Umbilical
6. LeIt Lumbar
7. #ight Illiac
8. ypogastrium (or) Suprapubic
9. LeIt illeac
Below the Illeac region lies the !elvic region, knowing this regions oI te abdomen is or great
importance to a medical student to evaluate the cause oI the disease and to diagnose the cause oI
the disease.
THE FEMALE REPRODUCTIVE SYSTEM
1-1. GENERAL
The organs of the reproductive systems are concerned with the general process of reproduction, and
each is adapted for specialized tasks. These organs are unique in that their functions are not necessary
for the survival of each individual. nstead, their functions are vital to the continuation of the human
species. n providing maternity gynecologic health care to women, you will find that it is vital to your
career as a practical nurse and to the patient that you will require a greater depth and breadth of
knowledge of the female anatomy and physiology than usual. The female reproductive system consists of
internal organs and external organs. The internal organs are located in the pelvic cavity and are
supported by the pelvic floor. The external organs are located from the lower margin of the pubis to the
perineum. The appearance of the external genitals varies greatly from woman to woman, since age,
heredity, race, and the number of children a woman has borne determine the size, shape, and color. See
figure 1-1 for the female reproductive organs.



1-2. TERMS AND DEFINITIONS
These are only a few terms and definitions that will be used in this lesson. Other terms and definitions will
be dispersed throughout the lesson.
a. Broad Ligaments. Two wing-like structures that extend from the lateral margins of the uterus to the
pelvic walls and divide the pelvic cavity into an anterior and a posterior compartment.
b. Corpus Luteum. The yellow mass found in the graafian follicle after the ovum has been expelled.
c. Estrogen. The generic term for the female sex hormones. t is a steroid hormone produced primarily by
the ovaries but also by the adrenal cortex.
d. Fimbriae. Fringes; especially the finger-like ends of the fallopian tube.
e. FoIIicIe. A pouch like depression or cavity.
f. FoIIicIe StimuIating Hormone. The follicle stimulating hormone (FSH) is a hormone produced by the
anterior pituitary during the first half of the menstrual cycle. t stimulates development of the graafian
follicle.
g. Graafian FoIIicIe. A mature, fully developed ovarian cyst containing the ripe ovum.
h. Hormone. A chemical substance produced in an organ, which, being carried to an associated organ by
the bloodstream excites in the latter organ, a functional activity.
i. Lactation. The production of milk by the mammary glands.
j. Luteinizing Hormone. A hormone produced by the anterior pituitary that stimulates ovulation and the
development of the corpus luteum.
k. Oocyte. A developing egg in one of two stages.
l. Ovum. The female reproductive cell.
m. Progesterone. The pure hormone contained in the corpora lutea whose function is to prepare the
endometrium for the reception and development of the fertilized ovum.
n. Reproduction. The process by which an offspring is formed.

Somatic Pain
Somatic pain is caused by the activation oI pain receptors in either the body surIace or
musculoskeletal tissues. A common cause oI somatic pain in SCI persons is postsurgical pain
Irom the surgical incision. It is usually described as dull or aching. Somatic pain, that is a
complication oI SCI, occurs with increased Irequency in the shoulder, hip, and hand, although it
also occurs in the lower back and buttocks. Somatic pain is probably caused by a combination oI
Iactors, such as abnormalities that may have always been there, inIlammation, repetitive trauma,
excessive activity, vigorous stretching, and contractions due to paralysis, spasticity, Ilabbiness,
disuse and misuse. enerally speaking, somatic pain is usually aggravated by activity and
relieved by rest.

Visceral Pain
Visceral pain is the pain we Ieel when our internal organs are damaged or injured and is by
Iar the most common Iorm oI pain. Viscera reIers to the internal areas oI the body that are
enclosed in a cavity. Visceral pain is caused by the activation oI pain receptors in the chest,
abdomen or pelvic areas. Visceral pain is vague and not well localized and is usually described
as pressure-like, deep squeezing, dull or diIIuse. Visceral pain is caused by problems with
internal organs, such as the stomach, kidney, gallbladder, urinary bladder, and intestines. These
problems include distension, perIoration, inIlammation, and impaction or constipation, which
can cause associated symptoms, such as nausea, Iever, and malaise, and pain. Visceral pain is
also caused by problems with abdominal muscles and the abdominal wall, such as spasm.

Neuropathic Pain
europathic pain is caused by injury or malIunction to the spinal cord and peripheral nerves.
europathic pain is typically a burning, tingling, shooting, stinging, or "pins and needles"
sensation. Some people also complain oI a stabbing, piercing, cutting, and drilling pain. This
type oI pain usually occurs within days, weeks, or months oI the injury and tends to occur in
waves oI Irequency and intensity. europathic pain is diIIuse and occurs at the level or below
the level oI injury, most oIten in the legs, back, Ieet, thighs, and toes, although it can also occur
in the buttocks, hips, upper back, arms, Iingers, abdomen, and neck.
9-