intraop ppt

Question 1

Surgical Suite

Answer 1

Controlled environment, designated to minimize spread of infections, allows smooth flow of patients, personnel, and instruments/equipment.

Question 2

Unrestricted Areas

Answer 2

Personnel in street cloths interact with those in scrubs. Holding and information areas.

Question 3

Semirestricted Areas

Answer 3

Peripheral support areas and corridors with only authorized people can go. Must wear surgical attire and cover all head and facial hair.

Question 4

Restricted Areas

Answer 4

Operating rooms, scrub sink areas and clean core, Surgical attire, head coveres, and masks required.
Holding Areas: Waiting areas inside or adjacent to surgical area. Final identification and assessment. Minor procedures performed. Friends/family allowed.

Question 5

Operating room:

Answer 5

Geographically, environmentally, bacteriologically controlled. Restricted inflow and outflow of personnel, Preferred location is next to postanesthesia care unit.
There are filters, controlled airflow, positive air pressure, materials resistant to corroding
Equipments are adjustable, easy to clean, and easy to move. Equipments are checked for electrical safety. Lighting provides low to high intensity for precise view of surgical site.
The temperature is controlled.
The room is private because the influx of personnel and visitors are restricted.

Question 6

Perioperative Nurse

Answer 6

: prepares room with the team and serves as the patient advocate throughout the surgical experience

Question 7

Circulating Nurse:

Answer 7

: Not scrubbed, gowned, or gloved. Remains in unsterile field. Documents. Pt advocate, transfers/positions

Question 8

Scrub Nurse

Answer 8

Follows designated scrub procedure. Gowned and gloved in sterile attire. Remains in sterile field

Question 9

Surgical Technician

Answer 9

Performs scrubbed function. Passes instruments and implements other technical functions during procedure. Supervised by RN

Question 10

Surgeon:

Answer 10

Physician who performs the procedure. Responsible for preoperative medical history, physical assessment, patient safety

Question 11

Surgeon Assistant

Answer 11

can be a physician or an RN, who functions in an assisting role. Holds retractors, assists with homeostasis and suturing, may perform portions of procedure under direct supervision
RN as the first assistant: Must have formal education, handles tissue, uses instruments, provides exposure to surgical site, assists homeostasis, suturing

Question 12

Anesthesia care provider

Answer 12

Adminsters anesthesia, Can be anesthesiologist or nurse anesthetist, Maintenance of physiologic homeostasis throughout introperative period, Prescribes preoperative and adjunctive medicines, Monitors cardiac and respiratory status and vital signs throughout the procedure.

Question 13

surgical time out

Answer 13

identify patient, surgery, body part

Question 14

how are pt positioned?

Answer 14

Prevent occlusion of arteries and veins
Provide modesty in exposure
Prevent injury
Secure extremities
Provide adequate padding and support

Question 15

circulating nurse

Answer 15

Counts and documents countable items with scrub
Responds to needs of sterile team members throughout procedure
Transport to recovery with anesthesia and report to recovery room nurse

Question 16

scrub nurse

Answer 16

A sterile team member

Helps gather needed supplies and equipment
Creates sterile field, enters it, prepares it for use
Primary: maintain the sterile field
Also counts(with circulating nurse) instruments and sponges used in surgery

Question 17

first assistant

Answer 17

sterile May be another MD, a nurse with special training or certification of First Assistant, a PA, or a surgical technician with advanced training

Question 18

Anesthesia Provider

Answer 18

not sterile Evaluates patient preoperatively, administers anesthesia, blood and IV fluids, and supervises recovery in PACU

Question 19

pre-op

Answer 19

ID Patient
Last minute questions
Chart review-SIGNATURES!
NPO status
Baseline VS, Ht & Wt.
Recent Lab work
Chest X-ray
Hx of Cardiac, or Respiratory issues (co-morbidities)
Drugs – Anticoagulants (aspirin, nsaids, or herbal supplements)

Question 20

surgical risk factors

Answer 20

Advanced age
Obesity
Malnutrition
Dehydration
Cardiovascular disorders
Respiratory disorders
Diabetes mellitus
Renal and liver dysfunction
Alcoholism
Nicotine use
Medications

Question 21

3 phases of anesthesia

Answer 21

Preoperative evaluation
Intraoperative anesthetic care and management
Postoperative care and evaluation

Question 22

general anesthesia

Answer 22

Loss of sensation with loss of consciousness
Elimination of somatic, autonomic, and endocrine responses (i.e., cough, vomiting)
Produces hypnosis, analgesia, amnesia
Can impair respiratory and cardiovascular function

Question 23

general anesthesia

Answer 23

Loss of sensation with loss of consciousness

Elimination of somatic, autonomic, and endocrine responses (i.e., cough, vomiting)
Produces hypnosis, analgesia, amnesia

Can impair respiratory and cardiovascular function

Question 24

General Anesthesia USES

Answer 24

Significant skeletal muscle relaxation
Used when there are lengthy surgical procedures

Extremely anxious patients

Patients who refuse or have contraindications to local or regional anesthesia

Uncooperative patients

Question 25

Advantages of general anesthesia

Answer 25

Rapid excretion Can be used with all age groups and any type of procedure Produces amnesia

Question 26

Inhalation Agents/Gaseous

Answer 26

``` Enter body through alveoli Rapid excretion by ventilation Examples: isoflurane, Suprane, Ultane, halothane Complications Coughing Laryngospasm Bronchospasm Increase secretions Respiratory depression ```

Question 27

Dissociative Anesthesia

Answer 27

Interrupts associative brain pathways while blocking sensory pathways The patient Catatonic Potent analgesic and amnesic Experience profound analgesia that last into post-op period Example: Ketamine Uses: asthma patients – promotes bronchodilation PCP derivative: cause hallucinations

Question 28

Local Anesthesia

Answer 28

Loss of sensation without loss of consciousness Topical (EMLA cream) Local infiltration Inject agent into tissues through which incision will pass Lidocaine or tetracaine Patient does not have to be NPO

Question 29

Regional Anesthesia or blocks

Answer 29

Loss of sensation to a region of body without loss of consciousness Local anesthetic is injected to block a central nerve or a group of nerves Different types: Spinal, caudal, and epidural anesthesia and IV Peripheral Nerve block

Question 30

Epidural analgesia

Answer 30

Infusion of opioid analgesics through a catheter placed into the epidural space surrounding the spinal cord Observe closely for signs of autonomic nervous system (ANS) blockade – Bradycardia, hypotension, vomiting Complications may include headache and back pain post operatively Infusion of opioid analgesics through a catheter placed into the epidural space surrounding the spinal cord Observe closely for signs of autonomic nervous system (ANS) blockade – Bradycardia, hypotension, vomiting Complications may include headache and back pain post operatively

Question 31

PCA

Answer 31

Patient Controlled Analgesia Provide immediate analgesia Maintain constant, steady blood level of analgesic agent ``` Patient controlled Types of medications Morphine Sulfate Dilaudid Patient receive predetermined dose of analgesia Basal, Dose, Lockout, Max ```

Question 32

conscious sedation

Answer 32

Drug induced depression of consciousness. Patient maintains own airway but yet achieves pain control. Use of a sedative, hypnotic or narcotic in dosages that promotes “twilight” sleep. Patient is still arousable, with spontaneous ventilation but decreased awareness. Provides analgesia and amnesia and the client is conscious. Used for diagnostic and minor surgical procedures outside the OR Complications: airway obstruction, respiratory depression, hypoxia, and hypotension

Question 33

meds for conscious sedation

Answer 33

``` Combination of IV medications Versed is the most common Opioids Morphine, Demerol, Fentanyl Sedatives Valium, Versed Antagonist to opioids and benzodiazepines ```

Question 34

after surgery

Answer 34

Priority care includes monitoring and managing respiratory and circulatory function, pain, temp and the surgical site

Question 35

PACU

Answer 35

``` Responsibilities of the RN Monitoring Complications Hypo/Hypervolemia Hypothermia Emergence delirium ```

Question 36

PACU

Answer 36

``` Respiratory Status –(number 1!) Airway Suctioning Cough and deep breath O2 Mechanical support-if needed Prevent aspiration ``` Responsiveness/LOC

Question 37

Malignant Hyperthermia

Answer 37

rise in temp, tachycardia, hypertension, increased muscle contractions Dantrolene IV

Question 38

Anaphylactic Reactions

Answer 38

Manifestations Life-threatening pulmonary and circulatory complications Hypotension Tachycardia Bronchospasm Pulmonary edema May be masked by anesthesia Causes: any parenterally administered material Antibiotics and latex Vigilance and rapid interventions essential

Question 39

Malignant Hyperthermia

Answer 39

Manifestations Life-threatening pulmonary and circulatory complications Hypotension Tachycardia Bronchospasm Pulmonary edema May be masked by anesthesia Causes: any parenterally administered material Antibiotics and latex Vigilance and rapid interventions essential

Question 40

Malignant Hyperthermia

Answer 40

Triggering agents Succinylcholine (Anectine) used with volatile inhalation agents (desflurane, halothane, isoflurane) Prevention Careful Family history and be alert of its development

Question 41

Safe drugs for pt. with history of MH

Answer 41

Barbituates such as propofol or ketamine Nitrous Oxide Opiods and different class of muscle relaxants