Intraoperative Care

Question 1

Anesthesia

Answer 1

a state of narcosis, analgesia, relaxation, and loss of reflexes

Question 2

Anesthesiologist

Answer 2

physician trained to deliver anesthesia and to monitor the patient’s condition during surgery

Question 3

Anesthetic

Answer 3

the substance, such as a chemical or gas used to induce anesthesia

Question 4

Surgical Asepsis

Answer 4

absence of micro-organisms in the surgical environment to reduce the risk of infection

Question 5

Physical environment of Surgical Suite: Surgical suite is divided into 3 distinct areas

Answer 5

Unrestricted: all people in street clothes
Semi-restricted: work and storage areas for clean & sterile supplies
Restricted: OR

Question 6

Pre-Operative holding areas

Answer 6

Admission & waiting area, either inside or adjacent to surgical suite
Pre-op nurse identifies, assesses, and gives pre-op meds

Question 7

Operating Room

Answer 7

Surgical attire and Masks
Sterile surgical supplies kept separate from contaminated

Question 8

Circulating Nurse

Answer 8

Manage the OR not scrubbed in gloved or gowned and remains in the unsterile field. Protects the patient, verify consent, coordinate the team, ensure cleanliness, proper temperature, safe functioning of equipment
Monitors: aseptic practices, the patient
Nursing activities directly relate to preventing complications and achieving optimal pt outcomes

Question 9

Scrub Nurse

Answer 9

• Activities include performing a surgical hand scrub, setting up sterile tables, preparing sutures, ligatures and special equipment assisting the surgeon
• As the incision is closed, the scrub and circulating nurses count all needles, sponges and instruments
• Tissue specimens must be labeled by the scrub nurse

Question 10

Surgeon

Answer 10

Heads the surgical team, performs the surgical procedure

Question 11

RN/First Assistant

Answer 11

Varies by institution, assists the surgeon

Question 12

Anesthesiologist

Answer 12

Interview and assesses pt prior to surgery, selects and administers anesthesia, intubates if necessary

Question 13

Principles of surgical asepsis

Answer 13

Prevents the contamination of surgical wounds
All surgical supplies must be sterilized
Team wears long sleeved sterile gowns, masks, and gloves

Question 14

Classifications of Anesthesia (4)

Answer 14

1. General anesthesia
2. Local anesthesia
3. Regional anesthesia
4. Conscious sedation

Question 15

General anesthesia

Answer 15

choice for lengthy surgical procedures that require relaxation of skeletal muscles
An altered physiological state
- reversible loss of consciousness
- skeletal muscle relaxation
- amnesia
- analgesia
Not rousable even to painful stimuli
Require assistance in maintaining a patent airway

Question 16

How is general anesthesia acheived

Answer 16

IV or inhalation, or both
IV: midazolam, propofol, ketamine
Inhalation: Nitrous oxide, Isoflurane
In todays health care, 1 or 2 inhalation drugs in conjunction with IV meds are used
usually the sedative is given first

Question 17

General anesthesia is usually more than one agent: (4)

Answer 17

• IV opioids
• Benzodiazepines
• Neuro-muscular blocking drugs
• Antiemetics

Question 18

Inhalation general anesthesia

Answer 18

• Mixed vapours with oxygen, many used are volatile liquids
• Inhaled through a mask, ETT, or tracheostomy
• Most commonly admin via an endotracheal tube

Question 19

Local Anaesthesia

Answer 19

Blocks the initiation and transmission of electric impulses along nerve fibres
Allows surgery to be performed on certain areas of the body without loss of consciousness
Topical application (directly on skin, mucous membranes, or open surface)
Injection of the agent into tissues

Question 20

Regional Anaesthesia (peripheral nerve block)

Answer 20

Injection of local anesthetic into or around a specific nerve or group of nerves

Question 21

Two types of regional anesthesia

Answer 21

1. Spinal anesthesia
2. Epidural anesthesia

Question 22

Spinal anesthesia

Answer 22

lumbar area in the subarachnoid space
between the arachnoid mater and the pia mater

Question 23

Epidural anesthesia

Answer 23

goes into the epidural space at the thoracic or lumbar area of the spine

Question 24

Spinal Anesthesia

Answer 24

Blocks the initiation and transmission of electric impulses along nerve fibres
Allows surgery to be performed on certain areas of the body without loss of consciousness
Alternative to GA in a physiologically compromised patient
Local anesthetic is injected into cerebro-spinal fluid (CSF) in subarachnoid space

Question 25

Epidural Anesthesia

Answer 25

Local anesthetic is injected into epidural (extradural) space
Does not enter the CSF but works by binding to nerve roots as they enter and exit the spinal cord
At low does: sensory pathways are blocked but motor fibers are intact
At higher dose: both sensory and motor fibers are blocked
For C-section: lower extremity vascular procedures, hip and knee replacements

Question 26

Advantage of Epidural anesthesia over spinal anesthesia

Answer 26

decreased incidence of post-spinal anesthesia headache

Question 27

Procedural (conscious) sedation

Answer 27

Administration of sedatives, with or without analgesics
Decreased anxiety and discomfort during non-invasive or minimally invasive procedure
e.g., enoscopy, interventional radiology, central line & chest tube placements

Question 28

Complications During Surgery: Major Blood Loss

Answer 28

-Maybe they didn’t stop taking their anticoagulants
-Monitor and record all fluid accumulation in suction container
-It is the circulating nurses responsibility along with the anaesthesiologists to replace blood loss

Question 29

Complications During Surgery: Anaphylactic Reactions

Answer 29

A reaction can occur in response to many medications, latex, or other substances. Anaphylaxis is a life threatening acute allergic reaction that causes vasodilation, hypotension

Question 30

Complications During Surgery: Hypothermia

Answer 30

• During anesthesia, pts temperature may fall. if you add a cooler OR room, cool IV fluids, cool gases, open body wounds, decreased muscle activity - the drop in temperature below 36.6 degrees is serious
• Often, IVs and irrigating fluids are warmed, wet gowns, drapes are removed and replaced ASAP and warm blankets are often utilized

Question 31

Malignant Hyperthermia

Answer 31

Is an inherited muscle disorder chemically induced by anesthetic agents. Susceptible people include those with strong bulky muscles, a hx of muscle cramps, unexplained temperature elevations, and unexplained deaths of family members during surgery
Increased HR, tachypnea, muscle rigidity and increase in temp

Question 32

Complications During Surgery: Nausea and Vomiting

Answer 32

• may affect pts during the intraoperative period
• if gagging occurs, turn pt on their side, suction mouth prn
• antiemetics are often administered
• if the pt aspirates, a number of pulmonary complications can occur an lead to extreme hypoxia