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acute > exam 1 intraoperative > Flashcards

exam 1 intraoperative Flashcards

1
Q

surgical team

A 
patient
surgeon
anesthesiologist
circulating nurse
RN first assist
scrub nurse/tech
assistants
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2
Q

nurses in the OR

A

CRNA
***Circulating nurse
Scrub (nurse)
may be a technician

Important OR nursing role: patient advocacy

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3
Q

role of circulating nurse

A

An RN
Leadership role
Protects safety
OR conditions, continually assessing patient for injury
Verifies consent
Coordinates the team and environment
Monitors surgical aseptic practices
Documents activities occurring
Ensuring second verification—time out
Right patient, right procedure, right site—marked and signed
Site should be marked and signed prior to time out

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4
Q

patient OR considerations

A

Emotional
Relaxed, anxious, fearful, stressed
Importance of pre op education, discussion
Potential Complications
**Anesthesia and Surgery disrupt all major body systems
See list, Chart 18-2 in text

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5
Q

the surgical suite environment

A 
Safety and infection control are paramount
Safety considerations
Risk for fire
Risk for injury
Infection control
Designated zones
Specific clothing
Specific grooming requirements
Surgical asepsis
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6
Q

safety measures of OR staff personnel

A 
Body mechanics
Fatigue
Radiation safety
Exposure to body blood & fluids
Latex allergy
Chemical waste
Noxious vapors
Fire hazards
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7
Q

infection prevention in the OR

A

zones in the or
environmental controls
surgical asepsis

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8
Q

unrestricted zone in the OR

A

Persons with street clothing allowed

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9
Q

semi-restricted zone in the OR

A

Requires scrub attire

AORN: OK for home laundered scrubs if not worn in

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10
Q

restricted zone in the OR

A

Mask, gown, gloves and appropriate scrub suit

Maintain 12 inch parameter within

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11
Q

the sterile field restricted zone in the OR

A

1 foot perimeter around field maintained and if breached or thought breached is contaminated
Only sterile materials can be used within the sterile field
Gowns of scrubbed team are considered sterile from chest to field and sleeves from two inches above the elbow to cuff—sterile gloves over
Sterile objects handed or disbursed into sterile field must not violate sterile field
Only personnel scrubbed in can directly contact sterile field
Sterile field must be kept in view
If field is breached or considered breach it is deamed contaminated

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12
Q

surgical infection prevention by all OR staff

A

No communicable diseases or illnesses, no open wounds
Good personal hygiene
Some agencies require routine cultures 3-6 months
No artificial nails

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13
Q

surgical attire for all (not in restricted zone)

A 
All must wear scrub attire
Clean and not sterile
Provided for and changed into at the surgery site
Top, bottom, cap, cover for facial hair
Masks
Changed between patients
Should be on or off and not hanging on neck
Shoes
Not from home or shoe covers
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14
Q

scrub personnel or surgical scrub

A

5-10 minute scrub

hands and arms are dried with a sterile towel

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15
Q

surgical asepsis control principles

A 
surgical asepsis control principles Prevents the contamination of surgical wounds
Head and hair covers
Mask
Instrument sterilization
Patient skin preparation
Draping
Equipment/floor cleansing
Ventilation control and traffic control
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16
Q

the surgical scrub of the patient

A

Skin cannot be sterilized but can be surgically clean
Skin prep
Prior to arrival to the OR and in the OR
Clipping of hair if necessary just prior to incision

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17
Q

patient preparation

A

Positioning:
- Exposes the operative site - Provides access for anesthesia - Safety alert: prevent injury
• Pressure, rubbing, shearing, joint and bony prominence protection, circulation & oxygenation concerns

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18
Q

position considerations in the OR

A 
Surgical site
Age, size and weight of the patient
Type of anesthesia and delivery method
Comfort---Pain with movement?
Protection of the nerves, circulation
Surgeon's request
Physical limitations—pulmonary, musculoskeletal considerations
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19
Q

positioning complications- brachial plexus

A

Loss of sensation to the arm and shoulder

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20
Q

positioning complications- radial nerve

A

wrist drop

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21
Q

positioning complications- medial or ulnar nerve

A

hand weakness or claw hand

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22
Q

positioning complications- peroneal nerve

A

foot drop

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23
Q

positioning complications- tibial nerve

A

loss of plantar surface sensation

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24
Q

positioning complications- articulating joints

A

stiffness, pan, inflammation, limited ROM

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25
Q

Anesthesia and Sedation

A

• Means negative sensation by pharmacologic means
• Partial or total sensation loss with or without loss of consciousness • Purpose:
- Blocks nerve impulse transmission - Suppresses reflexes - Controls level of consciousness - Provides relaxation and analgesia

26
Q

Anesthesia types- general

A

Nerve impulse block, suppresses reflexes, loss of consciousness, muscle relaxation, analgesia, amnesia

27
Q

Anesthesia types- regional or local

A

Analgesia, reflex loss, muscle relaxation - Patient maintains consciousness

28
Q

Anesthesia types- conscious sedation

A

(text calls it moderate sedation or monitored anesthesia care (MAC)
- Analgesia, amnesia and moderate sedation

29
Q

selection of types of anesthesia

A 
Type and duration of procedure
Area of body
Safety---mostly airway issues
Urgency of surgery
Pain management
Last oral food intake
Positioning
Alert enough to follow directions
Previous response to surgery
30
Q

general anesthesia

A

Not arousable
• Not reactive to painful stimuli • Lose ability to ventilate on their own • CV may also be impaired
• Induced by IV or inhalation agents

31
Q

general anesthesia cont

A

• Role
- depress CNS= loss of consciousness - analgesia - amnesia - muscle relaxation
- elimination of somatic, autonomic, and endocrine response ( ie, cough, vomiting, SNS response)
• One of the most common forms of anesthesia for major surgery.

32
Q

Inhalation Anesthesia Agents

A
  • Volatile liquids or gasses - Enter body through alveoli - Rapid excretion by ventilation
33
Q

IV Induction Anesthesia Agents

A
  • Used to induce or maintain anesthesia - Induce pleasant sleep - Rapid onset - Reduces incidence of post op nausea & vomiting
34
Q

General Anesthesia Delivery Methods when using Inhalation

A

Laryngeal Mask Airway
IntraNasal Intubation
Endotracheal intubation (most common)

35
Q

Risks associated with General Anesthesia

A 
Suppresses all physiologic functions to some degree
Depresses CV and resp. function
Slows peristalsis
Decreases renal function
Depresses neurological function
Hoarseness
Sore or stiff extremity
36
Q

anesthesiologist main concerns to prevent complications- oxygenation

A

O2 saturation

37
Q

anesthesiologist main concerns to prevent complications- ventilation

A

chest excursion, end tide CO2

38
Q

anesthesiologist main concerns to prevent complications- circulation

A

EKG ,BP, HR, skin color

39
Q

anesthesiologist main concerns to prevent complications- Body temperature

A

too high or too low

40
Q

anesthesiologist main concerns to prevent complications- silent regurgitation

A

Use H2 blockers and PPIs

41
Q

anesthesiologist main concerns to prevent complications- unexpected patient awareness

A

Use Bispectral Index Monitoring or End Tidal Anesthetic Gas measure

42
Q

regional anesthesia

A
  • Loss of sensation to a limited area of the body
  • Agent injected in close proximity to nerves
  • Medications interrupt nerve impulse for pain sensation - Local anesthetics
  • Does not usually affect the brain
  • Often sedatives/tranquilizers IV are adm.
  • Named according to where administered
  • Patient is awake so staff must be aware of conversation, noises, etc.
43
Q

central nerve block

A

Neuroaxial • Spinal, epidural, caudal

44
Q

peripheral nerve block

A

Plexus—a large group of nerves

Single—single smaller nerve • Local

45
Q

Distinguishing Spinal from Epidural Nerve Blocks- spinal

A

Injection of agent into CSF of subarachnoid space
Autonomic, sensory, and motor blockade
Dosage is lower
**Can travel up to the CSF to the thoracic or cervical level on specific gravity compared to the CSF, speed of adm., and patient positioning—can produce resp. paralysis
Increased risk for nausea, vomiting

46
Q

Distinguishing Spinal from Epidural Nerve Blocks- epidural

A 
Injection of agent into epidural space
does not enter CSF
Autonomic: sensory and motor blockade 
binds to nerve roots as they enter and exit the spinal cord
dosage is higher
47
Q

spinal cord conus

A
  • End of the spinal cord at L2 (cauda equina)

* Inject epidural and spinal usually between L4-5 to avoid hitting the spinal cord

48
Q

advantages of peripheral nerve blocks

A

Quality of analgesia equivalent to epidural and superior to opioids

49
Q

disadvantages of peripheral nerve blocks

A 
Nerve injury
Post block paresthesia
Fall risk 
Local anesthetic allergy/toxicity risk
Risk for retroperitoneal hematoma formation
50
Q

local anesthesia

A
  • Role - creates loss of sensation at desired site - is used for minor procedures
  • Contraindicated if pt. very anxious
  • Fast acting, short duration
51
Q

new liposome injectables

A

Fat soluble amide local anesthetic
- ie: Exparel: Bupivicaine - Dispersed over time depending on the size of the vesicule - Can last up to 72 hours
• Can leak into the fat cells - Blocks sodium channels and therefore nerve impulses
• FDA approved for injection into the surgical site - Current use: Injected into the intra articular space, periosteum*,
incision edges

52
Q

moderate sedation

A

• Drug-induced depression (not loss) of consciousness
• IV administration of agent
• Patient maintains own airway but yet achieves pain control, many times amnesia
• Procedure examples
- Colonoscopy, halo traction application, bone marrow biopsy
• Combination of anxiolytic plus a narcotic - Versed + fentanyl often used
• provides analgesia
• relieves anxiety
• provides amnesia
• Must maintain calm environment b/c patient is aware

53
Q

anesthesia awareness

A

frequency: 0.1-0.2%
Signs: hypertension, tachycardia, movement
masked by anesthesia agents

54
Q

nausea and vomiting OR complication

A

may avoid with prophylactic antiemetics

must prevent aspiration

55
Q

OR complication- anaphylaxis

A

Prior to surgery
Check for latex, adhesive allergies
Monitor for shock

56
Q

OR complication- Hypoximia/Respiratory Complications

A

Inadequate ventilation or wrongly placed tubing
Allergic reactions, aspiration, positioning
Monitor O2 sats, peripheral circulation

57
Q

OR complication- Hypothermia

A

Core temp

58
Q

catastrophic reactions in the OR- anaphylactic reactions

A

Manifestation may be masked by anesthesia
Vigilance and rapid intervention essential
anesthesiologist is the #1 person to prevent this reaction and/or to catch it early

59
Q

catastrophic reactions in the OR- malignant hyperthermia

A
  • Rare metabolic, autosomal dominant disorder
  • Reaction to anesthetic agents
  • Hyperthermia with rigidity of skeletal muscles
  • Rise in CO2 that is not corrected with ventilation
  • May develop in the OR or in PACU
  • Can result in death—can be ≥70% if not recognized
  • Anesthetic agents may trigger hypermetabolic condition
  • Involves Ca++ function in skeletal muscle (Major release of intracellular calcium - Muscle rigidity - Increased body temp which damages CNS)
    • 2 -4 degrees F every 5 minutes up to 107 degrees F
  • Can occur 10-20 minutes post agent adm. but also during 1st 24 hours
60
Q

Clinical Manifestations of Malignant Hyperthermia

A

Tachycardia >150 (Often earliest sign)
Muscle rigidity (Also early sign)
Sympathetic stimulation (decreased BP, decreased CO, decreased urine output, irreg. HR)
increased temp is a later sign

acute (2 decks)

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