Intraop Flashcards
Surgical team
Surgeon
Assistant or RN First assistant: med student or RN
Circuating Nurse : big role
Scrub nurse or tech
Anesthesia Care provider (MD or CRNA)
Circulating Nurse
Manager of OR
Unsterile
Document(start, vitals), label specimens, prepare room
Document count of instruments/supplies
Monitors and maintains pt safety
Scrub nurse or tech
Sterile
Assists with gowns/gloves for members of surgical team
Assists with draping
Passes instruments to surgeon
Performs surgical count
Surgical count
Sponges, needles blades, other surgical instruments
Scrub nurse/tech counts out loud, circulating nurse documents
Done 2-3 times
What if counts off: count again then look until you find it
Anesthesia care provider
Manages vital functions during the case:
-maintains IV access
-manages pain
-monitors VS, UOP, blood gases
-administers intraop meds
Operative areas/zones
Unrestricted
Semirestricted
Restricted
Unrestricted
Nursing station
Locker room
Holding areas
Clothes:
Street clothes/scrubs
Semirestricted
Hallways
Support areas
Restricted access (authorized staff)
Cloths:
Surgical scrubs, head covering
Restricted
OR
Cloths:
Surgical scrubs
Head covering
Mask
Shoe covers
Intraop safety ***
Prevent hypothermia
Falls/injury: transfering pt and position during surgery
Electrosurgery equipment carrier fire risk:
Use grounding pad to prevent fire
Positioning
Supine most common
Prevent pressure on nerves, boney prominences, earlobes, eyes
Correct MS alignment
Positions: Dorsal recumbent, Lithotomy, Trendelenburg
Time-Out
Every member will stop
Ensure correct, Pt, site, procedure
Pt should participate if possible (before anesthesia)
Anesthesia
Inhaled agents: nitrous oxide
Intravenous agents:
-opioids (morphine, fentanyl)
-muscle relaxers (paralyze) succinylcholine, vecuronium
*never without an airway in place
*never without pain/anxiety meds
Anxiolytic (induce amnesia): benzodiazepines
What to never do with muscle relaxers (paralyze) ***
succinylcholine
vecuronium
*never give without an airway in place
*never give without pain/anxiety meds
General Anesthesia
Loss of consciousness
Loss of sensation
No cough/gag reflex
Causes Resp depression/paralysis (requires airway management)
Meds and monitoring done by ACP
Can cause delirium, N/V, hypotension
Moderate/deep sedation
Procedure outside OR
RN can administer meds (directly supervised by physician)
ACP not required
Pt is responsive, able to breathe on own
Ex: reduction of dislocated joint, dental surgery
Regional anesthesia
Spinal: numbing agent injected into subarachnoid space
Epidural: numbing agent into the epidural space
*fewer SEs than spinal
*used for labor and delivery
Nerve blocks
Local anesthesia
Topical, ophthalmic, injection
No sedation or LOC
Often combined with epinephrine to reduce bleeding
*no epi on fingers, toes, nose, ears, geneitalia
Ex: sutures for laceration
Special considerations for older adults ***
SEs risk higher with meds
Hypothermia
Injury to skin/joints
Communication issues
Pulmonary edema (crackles, dyspnea, swelling, tachycardia, decreased o2)
Perioperative emergencies ***
Anaphylaxis
Malignant hyperthermia
Anaphylaxis ***
Severe allergic reaction
Causes:
Antibiotics
Blood products
Anesthesia
Latex
Anesthesia may mask symptoms: slow HR so you dont know their having it
S/s of anaphylaxis ***
Hypotension
Tachycardia
Bronchospasm (stridor)
Pulmonary edema
Malignant hyperthermia ***
R/t exposure to certain anesthetics
Genetic link
Life threatening condition
Tx: Dantrolene (KNOW)
Usually occurs in the OR but can present up to 24 hours postop
Malignant hyperthermia s/s ***
Tachycardia (Early)
Muscle rigidity (Early)
Hyperthermia (Late sign)
