Chapter 18 - Intraoperative Care

Question 1

OR

Answer 1

operating room

Question 2

3 Zones in Surgery Department

Answer 2

1 unrestricted (street clothes interact w scrubs)
2 semirestricted (clean surgical attire, authorized staff)
3 restricted (w/in semirestricted area - surgical suite + sterile core)

Question 3

scrub nurse vs circulating nurse

Answer 3

scrub is sterile;

circ clean unsterile field

Question 4

Anesthesiology

Answer 4

medical specialty that focuses on clinical mgmt of patients in perioperative period: 
pain mgmt, 
critical care, 
trauma, 
airway mgmt, 
\+ cardiopulmo resuscitation

Question 5

anesthesia care provider [ACP]

Answer 5

person responsible for admin of anesthetic agents + managing vital life functions
-ultimate responsibility for CHOICE of anesthesia

-can be anesthesiologist, nurse anesthetist, anesthesiologist assistant [AA}

Question 6

one the patient is on the OR bed ensure that there is always _______

Answer 6

someone on both sides of the patient until safety strap is secured to prevent falls

Question 7

anesthesia preparation

Answer 7

always understand the effect of the drugs + location of all emergency drugs + equipment

Question 8

Hypovolemia + cardiovasc disease can worsen effects of improper positioning in patients. Improper positioning can cause…

Answer 8

-muscle strain
-joint damage
-pressure injuries
-nerve damage
-pooling of blood away from parts of bodies
+++hypovolemia + cardiovasc disease can worsen effects of improper pooling

Question 9

[SCIP]

Answer 9

Surgical Care Improvement Project

-focused on improving surgical care + reducing number of complications

Question 10

SCIP measures

Answer 10

1 prophylactic antibiotic started 30-60 min before incision
2 apply warming blanket (prevent hypothermia)
3 intermittent pneumatic compression device [ICPs] (prevent DVT)

Question 11

NPSG requires PREprocedure verification process. Their universal protocol is followed to prevent____

Answer 11

• wrong site
• wrong procedure
• wrong surgery

Question 12

ACP must be present for….

Answer 12

• MAC (monitored anesthesia care)

- general anesthesia

Question 13

ACP does not have to be present for ____

Answer 13

moderate to deep sedation

• procedures done outside of OR
• –ex) reduction of dislocated joints in emergency dept

Question 14

what is mod to deep sedation used for?

Answer 14

procedures outside of OR

Question 15

MAC

Answer 15

for procedures done in or outside of OR

-used for diagnostic + therapeutic procedures

Question 16

general anesthesia are for___

Answer 16

patients having surgical procedures w long duration

• unsconsious
• needs for skeletal muscle relaxation
• require uncomfortable operating positions
• require control of ventilation

Question 17

___ is preferred during the initial portion of anesthesia c it induces sleep w rapid onset

Answer 17

IV induction agents.

• single dose last few minutes - long enough for placement of laryngeal mask airway or endotracheal tube.
• once done, ACP give inhalation + IV agents

Question 18

complications/side effects of inhalation agents

Answer 18

• irritates resp tract
• coughing
• laryngospasm
• incr secretion

Question 19

inhalation of agents is usually through what devices?

Answer 19

LMA (laryngeal mask airway)

ET (endotracheal tube)

Question 20

ET vs LMA

Answer 20

ET- allows control of ventilation
—protects airway fr aspiration

LMA- option for patients w difficult airways
—does not provide access to trachea, does not protect airway

Question 21

adjuncts

Answer 21

drugs added to an inhalation anesthetic (other than IV induction

include opioids, benzo, neuromusc blocking agents (muscle relaxant), antiemetics

Question 22

general vs local anesthesia

Answer 22

general = unconscious, inhale/IV
local/regional = numbs the pain, conscious

Question 23

opiods

Answer 23

fentanyl, morphine

-cause resp depress, bradycardia

Question 24

opiod antagonist

Answer 24

naloxone

Question 25

dissociative anesthesia

Answer 25

interrupts associative brain pathways while blocking sensory pathway
-ketamine

Question 26

malignant hyperthermia

Answer 26

• genetic
• common s/s high temp (w no infections/complications) + muscle spasms
• cool them down
• administer dantrolene

Question 27

ketamine in surgery

Answer 27

• given to asthma patients (promotes bronchodilation)

- incr heart rate to maintain CO

Question 28

midazolam (Versed) for ketamine

Answer 28

reduces hallucination + nightmares

Question 29

incentive spirometer

Answer 29

10x w/in 1 hour

-inhale

Question 30

malignant hyperthermia is commonly induced by _____

Answer 30

succinylcholine

Question 31

patient controlled analgesia [PCA]

Answer 31

self admin of predetermined doses of analgesia by patient

• goal is immediate analgesia and acceptable level of pain control
• IV, oral, epidural, transdermal

Question 32

opiod tolerant patients may need ____

Answer 32

patient administered boluses

Question 33

which PCA is for short term pain mgmt

Answer 33

transdermal

Question 34

benefits of transdermal

Answer 34

• needle-less
• low infection risk
• decr drug error assoc w pump malfunction or inaccurate programming

Question 35

PCA may lead to _____

hint: positive outcomes

Answer 35

• early ambulation
• better pain mgmt
• greater patient satisfaction

Question 36

hemorrhage is seen as

Answer 36

fluid loss