Intra Op. Flashcards
What is intraoperative?
Caring for the pt. while they’re undergoing surgery
Who makes up the surgical team?
The patient: the center of our care…as pt enters OR they may feel anxious stressed, or relaxed…due to sedation of anesthesia pt. looses biological protective mechanisms (loss of reflexes and sensation) and cognitive function…loss of biological protective mechanisms & communication poses pt at increase risk for injury
Surgeon
Scrub tech
Anesthesiologist
Circulating nurse
Scrub nurse
Intraoperative Safety: Time out
We call a time out prior to when the surgery begins when EVERYONE is in the OR…during the time out we are identifying the pt., the surgical site, the side of the body the procedure is taking place
Surgical Enviornment: Main Goal
Main goal is to prevent infection; we’d administer prophylactic antibiotics to PREVENT infection…these would be our on call meds
Sterile Fields
sterile fields can only touch sterile, other wise it become contaminated; if its wet then UNSTERILE…if you’re unsure if something is sterile then UNSTERILE
Patient Positioning in the OR
Pt. positioning in the OR is dependent on the procedure and the physical condition of the pt
Factors Influencing Positioning:
-operative site must be well exposed
-no undue pressure on nerves of operative site
-adequate vascular supply
-maintain pt. safety
-gentle use of restraints
Dorsal Recumbent
Pt is in supine position with pillows under them near pressure points to prevent from pressure injuries
Trendelenburg Position
Feet elevated above and head low
- Techs use this to reposition pts, but want to be careful because some pts. may not be able to tolerate this…ex. pts with COPD may not be able to breathe properly
- Residents use this position to get a central line in
Lithotomy Position
Seen in L&D to give birth
Sims/Lateral Position
Pt is on their side with one leg straight one leg bent and may have pillows under them
-Use this position to administer enemas. Always want to administer the enemas in Sims position lying on the left side
General Nursing Care
-Reduce anxiety
-Verify information
-Prevent positioning injury
-Provide for the safety of the pt
-Coordinate the OR personnel
-Perform circulating and scrub duties
-Act as the pt advocate
Scrub Nurse Duties
Hands the surgeon tools and counts sponges for the surgeon
Circulating Nurse
Circulates the sterile field ensuring sterility is being maintained and advocating for the pt
Types of anesthesia
Local, general, & epidural/nerve blocks
Local anesthesia
Blocks pain on a small area of the body/treats only the location of pain
-ex. lidocaine given in the dental office for the mouth
Epidural & Nerve Block
Covers the affected limbs; typically from the waist down
General anesthesia
Covers the complete body; pt is completely knocked out
Goal of anesthesia
-Block sensation
-Unconsciousness
-Analgesia
-Relax the muscles
-Loss of reflexes
Intraperative Complications: Nausea and Vomiting
If this occur turn the head and suction as needed; suction should be at the bedside
Intraperative Complications: Hypoxia
-Poor perfusion to the tissues
-Peripheral perfusion & pulse oximetry is monitored continuously by anesthesia
Intraperative Complications: Hypothermia
-OR is kept cold pt’s temp. may fall which can result into decreased glucose metabolism which can result in metabolic acidosis
-Warmed IV & irrigating fluids may be administered to 98.6 F
-if drapes or gowns on pt. get wet replace them with dry ones to prevent hypothermia
Intraperative Complications: Hyper/Hyponatremia
Low sodium/high potassium; find the cause potassium treat it
Intraperative Complications: Hyper/Hyponatremia
Low sodiu/high sodium; find the cause and treat it
Intraperative Complications: Hypovalemia
Can cause low circulating BV which can lead to shock…#1 priority is to stop the bleeding
Intraoperative Complications: Anaphylactic Reaction
-Could be due to anesthesia
- Manifests with pulmonary and circulatory reactions (antibiotics and latex are common offenders)
-Symptoms may be masked by anesthesia due to everything being relaxed and pt is non-coherent
-Attempt to find the cause and discontinue it
-Antidote is epinepherine
Malignant Hyperthermia
rare hereditary disease that can be triggered by some types of general anesthesia and is life threatening
Risk factors for malignant hyperthermia
PMH or family PMH (due to the fact that it is hereditary) of reactions to anesthesia OR recent eposure to heat stroke
Diagnosis of malignant hyperthermia
muscle biopsy
Pathophysiology of malignant hyperthermia
triggering agent (general anesthesia ) causes a disruption in muscle relaxation…because calcium isn’t returning to cells calcium accumulates which results in HYPERmetabolism in the the muslce, increased muscle contraction, hypothermia, & CNS damage
Early S/S of malignant hyperthermia
muscle rigidity, tachycardia
S/S of malignant hyperthermia
-tachypnea
-hypertension
-dysrthmias
-hyperkalemia
-metabolic and respiratory acidosis
-hyperthermia
What to do if pt. develops malignant hyperthermia?
-Stop anesthesia (may be a problem if anesthesia is administering more than 1 anesthesia agent)
-Stop surgery
-Administer oxygen
-IV therapy; quick cooling techniques to restore/bring down body temps (ice or infusions of ice solutions)
-Administer DANTROLENE IV (antidote)
