Intraoperative Care Flashcards Preview

Nursing The Hospitalized Adult > Intraoperative Care > Flashcards

Flashcards in Intraoperative Care Deck (25):
1

Surgical Settings?

Operating Room (OR)

Ambulatory Surgery/ Day Surgery

2

Surgical Suite?

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

3

3 areas of surgical suite?

Unrestricted
Semirestricted
Restricted

4

Unrestricted Areas?

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

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

5

Semirestricted Area?

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.

6

Restricted Area?

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

7

Surgical Team?

Nurses
Circulating Nurse
Scrub Nurse

Surgeon and assistant(s)

Anesthesiologist and tech

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

8

Circulating Nurse?

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

9

Scrub Nurse?

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

10

KEY Role – Patient Advocate ?

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


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

11

Surgeon(s) and assistant(s)?

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

12

Surgeon responsibilities?

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

13

Anesthesiologist?

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

14

Positioning – post induction?

The positioning of the patient should allow for?

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

15

Positioning – SAFETY is key

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

16

Types of Anesthesia; a balanced technique?

General
Regional
Conscious sedation
Local

17

General Anesthesia?

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

18

Phases of General Anesthesia?

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

19

Regional Anaesthesia?

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

20

Conscious Sedation?

Pt is awake

21

Local Anaesthesia?

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

22

Post Anaesthesia Care Unit (PACU)?

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

23

Safety in the OR?

Burns:
Chemical
Electric
Fire
Inhalation of smoke from cautery

24

Malignant Hyperthermia ?

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

25

Treatment of M.H.?

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