3.2 Intraoperative Care Flashcards
1
Q
Intra-Operative Care
A
- Begins when patient is transferred onto the OR bed and ends with admission to PACU
- Surgery is done at hospitals, ambulatory care centers, outpatient surgical centers, physicians offices.
2
Q
Open Surgery
A
- Incisions large enough to allow surgeon to see areas necessary for the surgery.
3
Q
Minimally Invasive Surgery (MIS)
A
- This and robotic surgery are now common practice
- MIS is preferred method
4
Q
INTRAOPERATIVE AREAS
A
5
Q
Unrestricted
A
- Street clothes allowed (clean scrubs for nurses)
- Holding area for patient, locker room, nursing station, family visitation
- IV’s are often started here
- Pre-Op medications are given
- Assessment of pre-op data and confirmations
6
Q
Semi-Restricted
A
- Only authorized personnel are permitted
- Scrub clothes and Caps are required
7
Q
Restricted
A
- Scrub Sink Area
- Operating Room
- Infection control is a priority here
- Scrub clothes, shoe covers, caps, masks are all required
- Filters to control airflow ventilation systems
- Positive air pressure to prevent air from entering the OR
- Aseptic Practice
- Temperature is 68-73 degrees F (20-24C) which is unfavorable for bacteria growth.
8
Q
Members of Surgical Team
A
Patient Anesthesiologist (physician) or CRNA (nurse anesthesiologist) Surgeon Certified Surgical Technologists Nurses
9
Q
Perioperative Nurse
A
- Communication with patient and inpatient unit nurses
- Prepares OR team for patient
- Patient Advocate
- Patient Education
- Documentation Care
10
Q
Circulating Nurse
A
- Leadership
- Manages OR functions, ring equipment, supplies to sterile area, delivery of blood and tissue samples to the lab, surgical safety checklist
11
Q
Scrub Nurse
A
- Manages OR functions within sterile field
12
Q
Registered Nurse First Assistant (RNFA)
A
- Requires formal education
- Collaborates with surgeon and handles tissue, uses instruments, manages homeostasis, does suturing.
13
Q
Surgical Technician
A
- May be filled by LPN, Tech, or RN
- Passes instruments to the surgeon
14
Q
Certified RN Anesthesiologist (CRNA)
A
- Masters Degree
- National certification
- Administers anesthesia and intubates patient
- Monitor patient continuously throughout surgery
15
Q
“Time Out” Second Time
A
- Done in the OR
- Verify patient ID, informed consent, health history, diagnostic tests, allergies, surgical site
16
Q
Safety Measures of OR
A
- Grounding of equipment (fire safety)
- Proper patient positioning
- Restraints
- Do not leave sedated patient unattended
- Blood type verification
- Blood type verification
17
Q
Protection from Infection
A
- First line of defense is environmental controls
18
Q
Surgical Asepsis
A
- At least 1 foot away from sterile field must be maintained
- When sterile area is breached it is contaminated
- Sterile field is constantly monitored
- Items of doubtful sterility are unsterile
- Sterile field prepared as close to surgery time as possible
- All contact with surgical wounds must be sterile
- Edges of sterile packages are contaminated once opened
- Do not reach across sterile field
- Sleeves from 2 inches above elbow to cuff are sterile
- Hair and skin must be covered with proper attire
- Bacteria can travel through moist fabrics
- Movement of surgical team are from sterile to sterile or unsterile to unsterile only.
19
Q
Hyperoxia
A
- Administration of high levels of oxygen
- Not recommended to reduce surgical site infections
20
Q
NURSING MANGEMENT DURING SURGERY
A
21
Q
Positioning of Patient
A
- Done after anesthesia
- Provide correct position to avoid pressure injuries
- Padding and grounding of patient are important
- Most important is comfort, operation field is exposed, position does not obstruct breathing/vascular supply/nerves.
- Extra precautions for thin/obese, physical deformities.
- Light restraints before induction of anesthesia
22
Q
Preparing Surgical Site
A
- Purpose is to reduce organisms that may migrate into wound
- Scrubbing/cleaning of skin around surgical site with antimicrobials
- Clipping hair that may be in site range
- Liberal areas are cleaned then draped
23
Q
Additional Safety Concerns
A
- Use of lasers increase fire risk
- Laser generated airborne contaminants (LGAC) such as dust, metallic fumes, chemical fumes, aerosols
- Appropriate use of respirators, eye protection, gloves during laser procedures is essential.
24
Q
Older Adults
A
- Higher risk for anesthesia complications
- This is due to cardiovascular and pulmonary changes, decreased tissue elasticity, reduced lean body mass, decreased liver metabolism of anesthesia, decreased kidney function, impaired thermoregulation
