Wk 3 Intraoperative Care

Question 1

When does the intraoperative phase end?

Answer 1

When they are transferred to PACU

Question 2

What does the circulating nurse in the OR do?

Answer 2

Not scrubbed, gowned, or gloved
Remains in unsterile field
Records all nursing care

Question 3

What does the scrub nurse do in the OR?

Answer 3

Follows designated scrub procedure
Gowned, gloved
Remains in sterile field

Question 4

When is site identification especially important?

Answer 4

Extremities
Laterality (right versus left)
Multiple structures
Levels of the body need surgical site markings by the surgeon

Question 5

What will be used as the surgical site marking?

Answer 5

The surgeons initials

Question 6

Where should the initials be?

Answer 6

As close to the actual incision site as possible

Question 7

What is a time out?

Answer 7

The entire surgical team will stop, verify and agree to a list of things before an incision is made

Question 8

What is verified during the time out?

Answer 8

Patient identity 
Surgical site
Level, laterality, or structure
Correct procedure
Patient position 
Availability of correct implants, special equipment of other requirements

Question 9

4 potential complications of improper patient positioning during surgery

Answer 9

Muscle strain
Joint damage
Pressure ulcers
Nerve damage

Question 10

What is also important during patient positioning?

Answer 10

Secure extremities

Add packing/support

Question 11

What is general anesthesia?

Answer 11

Inhalation or injection of anesthetic drugs that results in loss of all sensation and consciousness

Question 12

What are the 4 phases of general anesthesia?

Answer 12

Pre induction
Induction
Maintenance
Emergence

Question 13

What is regional anesthesia?

Answer 13

Medication instilled into or around a nerve to block transmission of nerve impulses in a specific region

Question 14

What are 4 examples of region anesthesia?

Answer 14

Nerve block
Bier black
Spinal
Epidural

Question 15

What is local anesthesia?

Answer 15

temporary loss of feeling as result of inhibition of nerve endings in part of body

Question 16

What is monitored anesthesia care?

Answer 16

Similar to general anesthesia, but it doesn’t involve inhaled agents. So they are conscious but sedated

Question 17

What is another term that is commonly used instead of monitored anesthesia care?

Answer 17

Conscious sedation

Question 18

4 intraoperative nursing considerations

Answer 18

Risk for infection
Risk for perioperative positioning injury
Risk for injury
Risk for imbalanced body temperature (hypothermia)

Question 19

What is malignant hyperthermia?

Answer 19

Inherited muscle disorder that is triggered by certain types of anesthesia that may cause a fast acting life-threatening crisis

Question 20

What is the incidence of malignant hyperthermia?

Answer 20

Incidence is low but if it goes untreated mortality is high

Question 21

What do you not see initially with malignant hyperthermia?

Answer 21

You don’t initially see a high fever

Question 22

The trigger for malignant hyperthermia results in what?

Answer 22

unregulated calcium accumulation

Question 23

What is the first thing you will see in a patient experiencing malignant hyperthermia?

Answer 23

Sustained muscle contraction in the masseter muscle

Question 24

Where is the masseter muscle?

Answer 24

Lateral sides of the mandible

Question 25

You might see breakdown of the masseter muscle which is called…

Answer 25

rhabdomyolysis

Question 26

What else will you see with malignant hyperthermia?

Answer 26

Anaerobic metabolism and metabolic acidosis

Question 27

What is the most common initial sign of malignant hyperthermia?

Answer 27

Unexpected increase in end-tidal CO2

Question 28

What are the early presentations of malignant hyperthermia?

Answer 28

Hypercarbia
Sinus tachycardia
Masseter or generalized muscle rigidity

Question 29

What is not a presenting sign of malignant hyperthermia?

Answer 29

Hyperthermia

Question 30

What is unique about patients who do experience malignant hyperthermia?

Answer 30

90% of them do not have a family history of malignant hyperthermia

Question 31

About 50% of patients who experience malignant hyperthermia under anesthesia had had….

Answer 31

uneventful general anesthesia in the past

Question 32

What is the antidote for malignant hyperthermia?

Answer 32

dantrolene IV