Chapter 18 - Intraoperative Care Flashcards
OR
operating room
3 Zones in Surgery Department
1 unrestricted (street clothes interact w scrubs) 2 semirestricted (clean surgical attire, authorized staff) 3 restricted (w/in semirestricted area - surgical suite + sterile core)
scrub nurse vs circulating nurse
scrub is sterile;
circ clean unsterile field
Anesthesiology
medical specialty that focuses on clinical mgmt of patients in perioperative period: pain mgmt, critical care, trauma, airway mgmt, \+ cardiopulmo resuscitation
anesthesia care provider [ACP]
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}
one the patient is on the OR bed ensure that there is always _______
someone on both sides of the patient until safety strap is secured to prevent falls
anesthesia preparation
always understand the effect of the drugs + location of all emergency drugs + equipment
Hypovolemia + cardiovasc disease can worsen effects of improper positioning in patients. Improper positioning can cause…
-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
[SCIP]
Surgical Care Improvement Project
-focused on improving surgical care + reducing number of complications
SCIP measures
1 prophylactic antibiotic started 30-60 min before incision
2 apply warming blanket (prevent hypothermia)
3 intermittent pneumatic compression device [ICPs] (prevent DVT)
NPSG requires PREprocedure verification process. Their universal protocol is followed to prevent____
- wrong site
- wrong procedure
- wrong surgery
ACP must be present for….
- MAC (monitored anesthesia care)
- general anesthesia
ACP does not have to be present for ____
moderate to deep sedation
- procedures done outside of OR
- –ex) reduction of dislocated joints in emergency dept
what is mod to deep sedation used for?
procedures outside of OR
MAC
for procedures done in or outside of OR
-used for diagnostic + therapeutic procedures
general anesthesia are for___
patients having surgical procedures w long duration
- unsconsious
- needs for skeletal muscle relaxation
- require uncomfortable operating positions
- require control of ventilation
___ is preferred during the initial portion of anesthesia c it induces sleep w rapid onset
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
complications/side effects of inhalation agents
- irritates resp tract
- coughing
- laryngospasm
- incr secretion
inhalation of agents is usually through what devices?
LMA (laryngeal mask airway)
ET (endotracheal tube)
ET vs LMA
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
adjuncts
drugs added to an inhalation anesthetic (other than IV induction
include opioids, benzo, neuromusc blocking agents (muscle relaxant), antiemetics
general vs local anesthesia
general = unconscious, inhale/IV local/regional = numbs the pain, conscious
opiods
fentanyl, morphine
-cause resp depress, bradycardia
opiod antagonist
naloxone
