intra op pp Flashcards
Members of the Surgical Team
Surgeon and surgical assistantAnesthesia providersHolding area nurseCirculating nurseScrub nurseSurgical technologist Specialty nursesORTs/surgical technologists may be used in addition to nursing staff
Minimally Invasive and Robotic Surgery (MIS)
Now common practice Preferred technique for many surgery types, including Cholecystectomy Joint surgery Cardiac surgery Splenectomy Spinal surgery
Environment of the Operating Room
Preparation of surgical suite, team safety
Layout
Health and hygiene of surgical team
Surgical attire and scrub
Remember
People are a source of bacteria in the surgical setting!
Special health care standards, dress are needed
Watch for nosocomial infections, identify source of pathogens
Surgical Scrubbing
Surgical ScrubbingBroad-spectrum, surgical antimicrobial solution Vigorous rubbing that creates friction used from fingertips to elbowScrub continues for 3 to 5 min
Anesthesia
know kinds
Induced state of partial or total loss of sensation, occurring with or without loss of consciousness
Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, achieve controlled level of unconsciousness (in some cases)
General Anesthesia
Reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of central nervous system (CNS)
Involves single or combination of agents
Depresses CNS, resulting in analgesia, amnesia, and unconsciousness with loss of muscle tone and reflexes
Administered via
Inhalation
IV injection
Balanced anesthesia
Four Stages of General Anesthesia–dont need to know
Stage 1—Analgesia and sedation, relaxation
Stage 2—Excitement, delirium
Stage 3—Operative anesthesia, surgical anesthesia
Stage 4—Danger
Emergence—Recovery from anesthesia
Balanced Anesthesia
Combination of IV drugs and inhalation agents used to obtain specific effectsExample: Thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, pancuronium(paralyzing agent) for muscle relaxation- (on ventilator needs to be paralyzed-so wont fight breathing) (dont want to be conscious)
examples of intra-operative medications–look at
know meds
know what catagorys they are-anxietys, etc…
https://nursing.com/lesson/pharm-01-02-54-common-medication-prefixes-and-suffixes/
on slides
sevoflurane–Sevoflurane is administered in a mixture with nitrous and oxygen for induction and maintenance of general anaesthesia. It has a pleasant smell.
midazolam fentanyl propofol lidocaine pancuronium ondanestron examethasone neostigmine glycopyrrolate cefotetan hydromorphone famotodine 0.9%NaCl phenyephrine
MAC-monitored anesthesia care(breathe on own-conscious sedation)might still fal asleep
GA- general anesthesia-not breathing on own
Complications from General Anesthesia
Malignant hyperthermia Overdose Unrecognized hypoventilation Problems with specific anesthetic agents Intubation problems
Malignant Hyperthermia
Acute, life-threatening complication
rare-
med they give?
worst complication
May be genetic
Begins with skeletal muscle exposed to specific agent
Causes increased metabolism, calcium levels in muscle cells
Leads to acidosis, high temperatures, dysrhythmias
Clinical Manifestations of Malignant Hyperthermia
Tachycardia Skin mottling Cyanosis Myoglobinuria(moscle in urine?) Rise in end tidal carbon dioxide Elevated temperature
Local Anesthesia
Briefly disrupts sensory nerve impulse transmission from specific body area/region
Delivered topically and by local infiltration
Patient remainsconscious, able to follow instructions
Regional Anesthesia
Blocks multiple peripheral nerves in specific body region Field Nerve Spinal Epidural
Spinal and Epidural Anesthesia
pics on slides
Complications of Local or Regional Anesthesia
Anaphylaxis Incorrect delivery technique Systemic absorption Overdose Local complications
Treatment of Complications
Establish open airway Give oxygen Notify surgeon Fast-acting barbiturate is usual treatment Epinephrine for unexplained bradycardia
Moderate Sedation
IV delivery of sedative, hypnotic, opioid drugs to reduce level of consciousness
Patient maintains patent airway, can respond to verbal commands
Amnesia action is short
Interprofessional Collaborative Care
Assessment: Noticing
Electronic health record review
Advanced directives
Allergies and previous reactions to anesthesia or transfusions
Autologous blood transfusion
Laboratory and diagnostic test results
Medical history and physical examination findings
Analysis: Interpreting
The priority collaborative problems for patients during surgery are
Potential for injury related to improper perioperative positioning
Potential for infection related to invasive procedures Compromised GASEXCHANGErelated to anesthesia, pain, reduced respiratory effort
Preventing Injury
Interventions
Proper body position
Prevent pressure ulcer formation
Prevent obstruction of circulation, respiration, nerve conduction
common surgical positions-dont need to know
supine, trendelenburg lithotomy lateral jacknife prone
Preventing Infection
Interventions
Plastic adhesive drape
Skin closures, sutures and staples, nonabsorbable sutures
Insertion of drains
Application of dressing
Patient transfer from OR table to stretcher
common skin closures-dont need to know
interrupted sutures continuous sutures(interlocking stitch, staples, tapes, retention bridge stay(retention) sutures
Preventing Hypoventilation–anesthesia monitors
Continuous monitoring ofBreathingCirculationCardiac rhythmsBlood pressure and heart rateContinuous presence of anesthesia provider
Evaluation: Reflecting
The nurse evaluates the care of the patient during surgery based on the identified priority patient problems. The expected outcomes include Safe anesthesia care provided without complicationsRemains injury free related to surgical positioning or equipmentRemains free of skin or tissue contamination and infection during surgery Maintains normal body temperature
A nursing student is assessing a student upon entry to the surgical suite. Which statement by the nurse would cause the nurse to intervene?A.“Are you Mr. Green?”B.“What kind of operation are you having today?”C.“Do you have any allergies?”D.”Have you donated blood for this surgery?”
A.“Are you Mr. Green?”B.“What kind of operation are you having today?”C.“Do you have any allergies?”D.”Have you donated blood for this surgery?”
A..
During a surgical procedure, the nurse notices the sponge count is incorrect. One sponge is missing. What is the priority nursing intervention?A.Communicate the discrepancy to the surgical team immediately.B.Complete appropriate documentation concerning the error in sponge count.C.Examine the environmental distractions, refocus, and count the sponges again.D.Anticipate that the surgeon will order an x-ray to look for the sponge postoperatively.
A.Communicate the discrepancy to the surgical team immediately.B.Complete appropriate documentation concerning the error in sponge count.C.Examine the environmental distractions, refocus, and count the sponges again.D.Anticipate that the surgeon will order an x-ray to look for the sponge postoperatively.
A,
The nurse is aware that a patient having surgery is at risk for infection if which additional factor is present?A.Diabetes mellitusB.Age greater than 65C.Impaired liver functionD.Insertion of a surgical drain
A.Diabetes mellitusB.Age greater than 65C.Impaired liver functionD.Insertion of a surgical drain
A biggest one-keep CBG in normal range
