Intraop

Question 1

Surgical team

Answer 1

Surgeon

Assistant or RN First assistant: med student or RN

Circuating Nurse : big role

Scrub nurse or tech

Anesthesia Care provider (MD or CRNA)

Question 2

Circulating Nurse

Answer 2

Manager of OR

Unsterile

Document(start, vitals), label specimens, prepare room

Document count of instruments/supplies

Monitors and maintains pt safety

Question 3

Scrub nurse or tech

Answer 3

Sterile

Assists with gowns/gloves for members of surgical team

Assists with draping

Passes instruments to surgeon

Performs surgical count

Question 4

Surgical count

Answer 4

Sponges, needles blades, other surgical instruments

Scrub nurse/tech counts out loud, circulating nurse documents

Done 2-3 times

What if counts off: count again then look until you find it

Question 5

Anesthesia care provider

Answer 5

Manages vital functions during the case:

-maintains IV access

-manages pain

-monitors VS, UOP, blood gases

-administers intraop meds

Question 6

Operative areas/zones

Answer 6

Unrestricted
Semirestricted
Restricted

Question 7

Unrestricted

Answer 7

Nursing station
Locker room
Holding areas

Clothes:
Street clothes/scrubs

Question 8

Semirestricted

Answer 8

Hallways
Support areas

Restricted access (authorized staff)

Cloths:
Surgical scrubs, head covering

Question 9

Restricted

Answer 9

OR

Cloths:
Surgical scrubs
Head covering
Mask
Shoe covers

Question 10

Intraop safety ***

Answer 10

Prevent hypothermia

Falls/injury: transfering pt and position during surgery

Electrosurgery equipment carrier fire risk:
Use grounding pad to prevent fire

Question 11

Positioning

Answer 11

Supine most common

Prevent pressure on nerves, boney prominences, earlobes, eyes

Correct MS alignment

Positions: Dorsal recumbent, Lithotomy, Trendelenburg

Question 12

Time-Out

Answer 12

Every member will stop

Ensure correct, Pt, site, procedure

Pt should participate if possible (before anesthesia)

Question 13

Anesthesia

Answer 13

Inhaled agents: nitrous oxide

Intravenous agents:
-opioids (morphine, fentanyl)

-muscle relaxers (paralyze) succinylcholine, vecuronium
*never without an airway in place
*never without pain/anxiety meds

Anxiolytic (induce amnesia): benzodiazepines

Question 14

What to never do with muscle relaxers (paralyze) ***

Answer 14

succinylcholine
vecuronium

*never give without an airway in place
*never give without pain/anxiety meds

Question 15

General Anesthesia

Answer 15

Loss of consciousness

Loss of sensation

No cough/gag reflex

Causes Resp depression/paralysis (requires airway management)

Meds and monitoring done by ACP

Can cause delirium, N/V, hypotension

Question 16

Moderate/deep sedation

Answer 16

Procedure outside OR

RN can administer meds (directly supervised by physician)

ACP not required

Pt is responsive, able to breathe on own

Ex: reduction of dislocated joint, dental surgery

Question 17

Regional anesthesia

Answer 17

Spinal: numbing agent injected into subarachnoid space

Epidural: numbing agent into the epidural space
*fewer SEs than spinal
*used for labor and delivery

Nerve blocks

Question 18

Local anesthesia

Answer 18

Topical, ophthalmic, injection

No sedation or LOC

Often combined with epinephrine to reduce bleeding
*no epi on fingers, toes, nose, ears, geneitalia

Ex: sutures for laceration

Question 19

Special considerations for older adults ***

Answer 19

SEs risk higher with meds

Hypothermia

Injury to skin/joints

Communication issues

Pulmonary edema (crackles, dyspnea, swelling, tachycardia, decreased o2)

Question 20

Perioperative emergencies ***

Answer 20

Anaphylaxis

Malignant hyperthermia

Question 21

Anaphylaxis ***

Answer 21

Severe allergic reaction

Causes:
Antibiotics
Blood products
Anesthesia
Latex

Anesthesia may mask symptoms: slow HR so you dont know their having it

Question 22

S/s of anaphylaxis ***

Answer 22

Hypotension
Tachycardia
Bronchospasm (stridor)
Pulmonary edema

Question 23

Malignant hyperthermia ***

Answer 23

R/t exposure to certain anesthetics

Genetic link
Life threatening condition

Tx: Dantrolene (KNOW)

Usually occurs in the OR but can present up to 24 hours postop

Question 24

Malignant hyperthermia s/s ***

Answer 24

Tachycardia (Early)

Muscle rigidity (Early)

Hyperthermia (Late sign)