Ch 18 intraoperative Flashcards
which allow for MIS, such as endovascular procedures, and the traditional open incision approach within the same room, are becoming more common.
Hybrid ORs
(1) unrestricted, (2) semirestricted, and (3) restricted
Surgery department is divided into 3 distinct zones:
is where people in street clothes interact with those in scrub attire. These areas typically include the points of entry for patients (e.g., holding area), staff (e.g., locker rooms), and information (e.g., nursing station or control desk)
unrestricted zone
includes the surrounding support areas and corridors. Only authorized staff are allowed access to semirestricted areas. All staff in the semirestricted area should wear clean surgical attire. This includes scrub attire that was laundered in an accredited laundry facility, long-sleeved jacket, shoes dedicated for surgery use or shoe covers, surgical head cover and mask that covers all head and facial hair, and any appropriate personal protective equipment (e.g., face shield)
semirestricted zone
is found within the semirestricted area. It includes the surgical suite (OR) where the invasive procedure takes place and the sterile core
restricted zone
, is an unrestricted zone where patient identification and assessment take place.
holding area, often called the preoperative holding area
called the admission, observation, and discharge (AOD) unit
holding area is aka
allow early morning admission for outpatient surgery, same-day admission, and inpatient holding before surgery
AOD (admission, observation, discharge) unit is designed to
is controlled geographically, environmentally, and aseptically
restricted zone (description)
Filters and controlled airflow in the ventilating systems provide dust control. Positive air pressure in the rooms prevents air from entering the OR from the halls and corridors. ORs are kept within a narrow range of temperature and humidity to prevent bacteria growth. ORs follow strict protocols for cleaning between cases and terminal cleaning at the end of the day. The use of ultraviolet lighting reduces the number of microorganisms in the air.2
methods to prevent the transmission of infection in the OR
offers a way to deliver routine and emergency messages
communication system (OR)
is a registered nurse (RN) who collaborates with the rest of the surgical team and implements the patient’s plan of care during perioperative period
perioperative nurse
Depending on the size of the OR department
(1) preoperative RN, (2) OR RN, and (3) PACU RN.
Preoperative RN role may include three domains: (vary upon size)
(1) maintaining the patient’s safety, dignity, and confidentiality; (2) communicating with the patient, the surgical team, and other departments (e.g., CPD, PACU, laboratory); and (3) providing nursing care discussed in the Nursing Management section of this chapter.
OR RN, you are the patient’s advocate during surgery. This includes
follows the designated surgical hand antisepsis and glove and gown sterile attire and prepares and manages the sterile field and instrumentation
scrub nurse (sterile)
assumes functions that involve either sterile or unsterile activities
OR RN
stays in the unsterile field, facilitates the progress of the procedure, and keeps documentation
circulating nurse
may fill the role of the circulating or scrub nurse
LPN/VN or a surgical technologist
performing delegated nursing tasks.7
As an OR RN, you take on responsibility for supervising an LPN/VN or surgical technologist
• Preoperative medical history and physical assessment, directing preoperative testing, and postoperative management Obtaining informed consent
• Leading the surgical team and directing the course of a procedure
surgeon is primarily responsible for
another physician, registered nurse first assistant (RNFA), physician’s assistant, surgical resident or fellow, medical student, or a certified surgical first assistant.
surgeon’s assistant can be
usually holds retractors to expose surgical areas and helps with hemostasis and suturing. In some agencies, especially in educational settings, the assistant may perform some portions of the surgery under the surgeon’s direct supervision.
surgeons assistant scope
to achieve an optimal surgical outcome for the patient.
registered nurse first assistant (RNFA) works with the surgeon
CNOR nurses or nurse practitioners can complete RNFA program to assume this expanded role. RNFAs can obtain
certification (C-RNFA). (to work collaboratively with surgeon
is a medical specialty that focuses on clinical management of the patient in the perioperative period, pain management, critical care, trauma, airway management, and cardiopulmonary resuscitation.
Anesthesiology
is the person responsible for administering anesthetic agents and managing vital life functions (e.g., breathing, BP) during the perioperative period. This can be an anesthesiologist, nurse anesthetist, or anesthesiologist assistant (AA).
anesthesia care provider (ACP)
who has graduated from an accredited nurse anesthesia program and completed a national certification examination to become a certified registered nurse anesthetist (CRNA).
nurse anesthetist is a master’s or a doctorate prepared RN
is a master’s or a doctorate prepared RN who has graduated from an accredited nurse anesthesia program and completed a national certification examination to become a certified registered nurse anesthetist (CRNA).
nurse anesthetist
• Performing and documenting a preanesthetic assessment and evaluation
• Developing and implementing a plan for delivering anesthesia
• Choosing, obtaining, and administering anesthesia, adjuvant drugs, and fluids
• Choosing, applying, and inserting appropriate monitoring devices
• Managing a patient’s airway and pulmonary status
• Managing emergence and recovery from anesthesia
• Releasing or discharging patients from a PACU
• Ordering, starting, or modifying pain relief therapy
• Responding to emergency situations by providing airway management
CRNA’s scope of practice includes:
is a master’s-prepared health professional who serves under the direction of an anesthesiologist
AA (anaesthesia assistant)
is responsible for implementing the intraoperative plan of care and serving as the patient’s advocate. The circulating nurse focuses on the whole patient. This involves ongoing assessment, reassessment, and adjusting the care plan to promote the best surgical outcomes.
circulating nurse duty for intraoperative
Any retained surgical supplies, devices, or instruments are sentinel events (never events) or serious reportable events (SREs) that can result in negative outcomes for the patient.
sentinel events (never events)
in many agencies. When using an alcohol-based surgical hand-scrub product, prewash hands and forearms with soap and dry completely before applying the alcohol-based product. After applying the alcohol-based product, rub hands and forearms thoroughly until dry before donning sterile attire.1,4
Waterless, alcohol-based agents are replacing soap and water
is required of all sterile members of the surgical team (scrub nurse, surgeon, assistant)
Surgical hand antisepsis
your finger nails are cleaned first, followed by scrubbing each plane of individual fingers, palms, and forearms in the distal to proximal fashion. The hands should always be held away from surgical attire and higher than the elbows
wet scrubbing is the chosen method for surgical hand antisepsis,
(1) standard and transmission-based precautions, (2) engineering and work practice controls, and (3) the use of personal protective equipment, such as gloves, gowns, caps, face shields, masks, and protective eyewear. This is especially important in the OR because of the high potential for exposure to blood-borne pathogens.
OSHA guidelines for protection against blood-borne pathogens
are the front from chest to table level and sleeves to 2 inches above elbow.
only parts of the gown considered sterile
is used for various gynecological, genitourinary, and colon procedures.
lithotomy position (during surgery)
Positioning is a critical part of every procedure and usually follows induction of anesthesia. The
ACP says when to begin positioning
supine, prone, lateral, lithotomy, or sitting. The supine is the most common position
variety of surgical positions, including
Take care to (1) provide correct musculoskeletal alignment; (2) prevent undue pressure on nerves, skin over bony prominences, earlobes, and eyes; (3) provide for adequate thoracic excursion; (4) prevent occlusion of arteries and veins; (5) provide modesty in exposure; and (6) recognize and respect individual needs, such as previously assessed pains or deformities.
take great care to prevent injury to the patient
peripheral vessels to dilate
General anesthesia causes
Position changes affect where the pooling of blood occurs. If the head of the OR bed is raised, the lower torso will have increased blood volume and the upper torso may become compromised
General anesthesia causes dilation of vessels
Excess hair, adipose tissue, bony prominences, fluid (edema), adhesive failure, and scar tissue can compromise safety
electrosurgical unit is in use, the patient must be properly grounded to prevent unintended injury
reduce the number of microorganisms available to migrate to the surgical wound. The circulating nurse, surgeon, or surgical assistant completes the task of prepping before surgery.
purpose of skin preparation, or “prepping,” is to
there is strong research supporting that nontechnical skills (NTS) also have a high impact on outcomes
technical skills, such as operating equipment or proper instrument handling, are a critical part of OR RN competency,
