Intraoperative Care

Question 1

Surgical Settings?

Answer 1

Operating Room (OR)

Ambulatory Surgery/ Day Surgery

Question 2

Surgical Suite?

Answer 2

controlled environment designed to minimize the spread of infectious organisms.
the instruments and equipment needed to provide safe patient care.

Question 3

3 areas of surgical suite?

Answer 3

Unrestricted
Semirestricted
Restricted

Question 4

Unrestricted Areas?

Answer 4

personnel in street clothes can interact with those in scrub clothing.

Contains:
Holding Area (sometimes family is allowed)
Staff room/locker room
Nursing Station

Question 5

Semirestricted Area?

Answer 5

The semirestricted area includes the peripheral support areas and corridors of the OR.

Only authorized personnel are allowed access

All personnel must wear surgical attire and cover all head and facial hair.

Question 6

Restricted Area?

Answer 6

Operating Rooms – “THE THEATER”
It is a controlled area
Geographically (on same floor as PACU)
Environmentally (filtered air, temperature control, lighting, washable material, humidity)
Bacteriologically 

surgical environment is medical asepsis

tools are surgical asepsis

Question 7

Surgical Team?

Answer 7

Nurses
Circulating Nurse
Scrub Nurse

Surgeon and assistant(s)

Anesthesiologist and tech

Other health care team members
i.e. pathologist, radiology tech

Question 8

Circulating Nurse?

Answer 8

Not scrubbed
Not gowned/gloved
Remains in the unsterile field

Reviews, identifies and assesses the physical status of the patient
Prioritizes, adjusts and documents the plan of care to meet the specific needs of the patient
Assists in maintaining and monitoring the integrity of the sterile field
Performs the count procedure concurrently with the scrub nurse and accurately documents

Question 9

Scrub Nurse?

Answer 9

Gowned and gloved in sterile attire
Remains in the sterile field

Sets priorities and expedites an efficient aseptic set-up for each surgical procedure
Is vigilant and attentive and responds appropriately to complications and unexpected events during the surgical procedure
Monitors aseptic technique throughout the procedure
Patient advocate through out the surgical

Question 10

KEY Role – Patient Advocate ?

Answer 10

Circulating Nurse: Acts as a patient advocate during the preoperative period

Scrub Nurse: Acts as the patient’s advocate during the surgical procedure

Question 11

Surgeon(s) and assistant(s)?

Answer 11

The Staff surgeon performs the surgery
Assistants: Resident surgeons, medical students, Registered Nurse First Assistant

Some surgeries require the expertise of more than one surgeon i.e. plastic surgeon

Question 12

Surgeon responsibilities?

Answer 12

Preoperative medical history and physical exam (H&P), including need for surgical intervention, choice of surgical procedure and management of preoperative workup

Obtaining consent and explaining all the risks and complications associated with surgery

Patient safety and management in the OR

Postoperative management of the patient

Question 13

Anesthesiologist?

Answer 13

responsible for a patient’s medical care before, during, and shortly after surgery.

Preoperative assessment
Delivery , maintenance and reversal of the anesthesia
Care of the patient’s recovery until discharged from PACU

Question 14

Positioning – post induction?

The positioning of the patient should allow for?

Answer 14

Accessibility to the operative site
Administration and monitoring of anesthetic agents
Maintenance of the patient’s airway
ensure pt is intubated properly

Question 15

Positioning – SAFETY is key

Answer 15

Patient can not move or feel anything, so potential for injury is VERY HIGH
Air way is priority – provide for adequate thoracic expansion
Provide correct skeletal alignment
Prevent pressure on nerves, bony prominences, eyes
Prevent occlusion of blood vessels
Provide modesty
Recognize and respect individual needs

Question 16

Types of Anesthesia; a balanced technique?

Answer 16

General
Regional
Conscious sedation
Local

Question 17

General Anesthesia?

Answer 17

Balanced Technique → use of multiple medications/ classifications and routes 
	(i.e. po, IV, IM) to obtain:
Loss of consciousness
Skeletal muscle relaxation
Analgesia
Amnesia

Question 18

Phases of General Anesthesia?

Answer 18

Induction (initiation of medication)
Maintenance (pt remains in unconscious state)
Emergence (pt returned to conscious state)

Question 19

Regional Anaesthesia?

Answer 19

The loss of sensation to a region of the body without loss of consciousness; a specific nerve or group of nerves is blocked with the administration of a local anaesthetic agent (i.e. Lidocaine, Bupivocaine)
Examples: spinal, epidural, or peripheral nerve block

Spinal anesthesia: the medication is injected into the cerebrospinal fluid in the subarachnoid space
Causes vasodilation and hypotension
Risk of systemic toxicity if absorbed into the general circulation
Starts to act immediately

Epidural anesthesia: injection of local anesthetic into epidural (extradural) space
Anaesthesia does not enter the cerebrospinal fluid, but binds to nerve routes
Starts to act within ~ 10 minutes

Question 20

Conscious Sedation?

Answer 20

Pt is awake

Question 21

Local Anaesthesia?

Answer 21

Local anaesthetics block the initiation and transmission of electrical impulses along nerve fibers. With progressive increases in local anaesthetic concentration, the transmission of autonomic, then somatic sensory, and finally somatic impulses is blocked → loss of sensation without loss of consciousness.
Local anaesthesia may in induced topically, intracutaneously (intradermal) or subcutaneously.
Examples: biopsy, dental

Question 22

Post Anaesthesia Care Unit (PACU)?

Answer 22

Upon admission the patient is assessed for ABC’s
Airway
Breathing
Circulation

 Level of consciousness
 Fluid status (I&O)
i.e. Foley drainage, IV rate 
 Ability to move
 Status of dressing /drain
 Pain

The following assessments most be done/met prior to DC to the unit/home:
Able to maintain airway and cough
Conscious and orientedx3
Vital signs stable (within baseline)
Able to move/follow commands (dependent on type of anesthesia)
Urinary output ≥ 30 mL/hr
Bleeding/wounds – exudate assessed

Question 23

Safety in the OR?

Answer 23

Burns: 
Chemical
Electric
Fire
Inhalation of smoke from cautery

Question 24

Malignant Hyperthermia ?

Answer 24

Rare condition, genetically determined
Caused by succinylcholine and inhalation agents
Excessive, uncontrolled metabolic activity in the muscles
Leads to a very high temperature
Fatal if not treated

Question 25

Treatment of M.H.?

Answer 25

Discontinue use of succinylcholine and inhalation agent(s)
Cool patient with ice, cold IV solution etc.
Administer Dantrolene
Skeletal muscle relaxant