intraop ppt Flashcards
Surgical Suite
Controlled environment, designated to minimize spread of infections, allows smooth flow of patients, personnel, and instruments/equipment.
Unrestricted Areas
Personnel in street cloths interact with those in scrubs. Holding and information areas.
Semirestricted Areas
Peripheral support areas and corridors with only authorized people can go. Must wear surgical attire and cover all head and facial hair.
Restricted Areas
Operating rooms, scrub sink areas and clean core, Surgical attire, head coveres, and masks required.
Holding Areas: Waiting areas inside or adjacent to surgical area. Final identification and assessment. Minor procedures performed. Friends/family allowed.
Operating room:
Geographically, environmentally, bacteriologically controlled. Restricted inflow and outflow of personnel, Preferred location is next to postanesthesia care unit.
There are filters, controlled airflow, positive air pressure, materials resistant to corroding
Equipments are adjustable, easy to clean, and easy to move. Equipments are checked for electrical safety. Lighting provides low to high intensity for precise view of surgical site.
The temperature is controlled.
The room is private because the influx of personnel and visitors are restricted.
Perioperative Nurse
: prepares room with the team and serves as the patient advocate throughout the surgical experience
Circulating Nurse:
: Not scrubbed, gowned, or gloved. Remains in unsterile field. Documents. Pt advocate, transfers/positions
Scrub Nurse
Follows designated scrub procedure. Gowned and gloved in sterile attire. Remains in sterile field
Surgical Technician
Performs scrubbed function. Passes instruments and implements other technical functions during procedure. Supervised by RN
Surgeon:
Physician who performs the procedure. Responsible for preoperative medical history, physical assessment, patient safety
Surgeon Assistant
can be a physician or an RN, who functions in an assisting role. Holds retractors, assists with homeostasis and suturing, may perform portions of procedure under direct supervision
RN as the first assistant: Must have formal education, handles tissue, uses instruments, provides exposure to surgical site, assists homeostasis, suturing
Anesthesia care provider
Adminsters anesthesia, Can be anesthesiologist or nurse anesthetist, Maintenance of physiologic homeostasis throughout introperative period, Prescribes preoperative and adjunctive medicines, Monitors cardiac and respiratory status and vital signs throughout the procedure.
surgical time out
identify patient, surgery, body part
how are pt positioned?
Prevent occlusion of arteries and veins Provide modesty in exposure Prevent injury Secure extremities Provide adequate padding and support
circulating nurse
Counts and documents countable items with scrub
Responds to needs of sterile team members throughout procedure
Transport to recovery with anesthesia and report to recovery room nurse
scrub nurse
A sterile team member
Helps gather needed supplies and equipment
Creates sterile field, enters it, prepares it for use
Primary: maintain the sterile field
Also counts(with circulating nurse) instruments and sponges used in surgery
first assistant
sterile May be another MD, a nurse with special training or certification of First Assistant, a PA, or a surgical technician with advanced training
Anesthesia Provider
not sterile Evaluates patient preoperatively, administers anesthesia, blood and IV fluids, and supervises recovery in PACU
pre-op
ID Patient Last minute questions Chart review-SIGNATURES! NPO status Baseline VS, Ht & Wt. Recent Lab work Chest X-ray Hx of Cardiac, or Respiratory issues (co-morbidities) Drugs – Anticoagulants (aspirin, nsaids, or herbal supplements)
surgical risk factors
Advanced age Obesity Malnutrition Dehydration Cardiovascular disorders Respiratory disorders Diabetes mellitus Renal and liver dysfunction Alcoholism Nicotine use Medications
3 phases of anesthesia
Preoperative evaluation
Intraoperative anesthetic care and management
Postoperative care and evaluation
general anesthesia
Loss of sensation with loss of consciousness
Elimination of somatic, autonomic, and endocrine responses (i.e., cough, vomiting)
Produces hypnosis, analgesia, amnesia
Can impair respiratory and cardiovascular function
general anesthesia
Loss of sensation with loss of consciousness
Elimination of somatic, autonomic, and endocrine responses (i.e., cough, vomiting)
Produces hypnosis, analgesia, amnesia
Can impair respiratory and cardiovascular function
General Anesthesia USES
Significant skeletal muscle relaxation
Used when there are lengthy surgical procedures
Extremely anxious patients
Patients who refuse or have contraindications to local or regional anesthesia
Uncooperative patients
Advantages of general anesthesia
Rapid excretion
Can be used with all age groups and any type of procedure
Produces amnesia
Inhalation Agents/Gaseous
Enter body through alveoli Rapid excretion by ventilation Examples: isoflurane, Suprane, Ultane, halothane Complications Coughing Laryngospasm Bronchospasm Increase secretions Respiratory depression
Dissociative Anesthesia
Interrupts associative brain pathways while blocking sensory pathways
The patient
Catatonic
Potent analgesic and amnesic
Experience profound analgesia that last into post-op period
Example: Ketamine
Uses: asthma patients – promotes bronchodilation
PCP derivative: cause hallucinations
Local Anesthesia
Loss of sensation without loss of consciousness
Topical (EMLA cream)
Local infiltration
Inject agent into tissues through which incision will pass
Lidocaine or tetracaine
Patient does not have to be NPO
Regional Anesthesia or blocks
Loss of sensation to a region of body without loss of consciousness
Local anesthetic is injected to block a central nerve or a group of nerves
Different types:
Spinal, caudal, and epidural
anesthesia and IV
Peripheral Nerve block
Epidural analgesia
Infusion of opioid analgesics through a catheter placed into the epidural space surrounding the spinal cord
Observe closely for signs of autonomic nervous system (ANS) blockade – Bradycardia, hypotension, vomiting
Complications may include headache and back pain post operatively
Infusion of opioid analgesics through a catheter placed into the epidural space surrounding the spinal cord
Observe closely for signs of autonomic nervous system (ANS) blockade – Bradycardia, hypotension, vomiting
Complications may include headache and back pain post operatively
PCA
Patient Controlled Analgesia
Provide immediate analgesia
Maintain constant, steady blood level of analgesic agent
Patient controlled Types of medications Morphine Sulfate Dilaudid Patient receive predetermined dose of analgesia Basal, Dose, Lockout, Max
conscious sedation
Drug induced depression of consciousness. Patient maintains own airway but yet achieves pain control.
Use of a sedative, hypnotic or narcotic in dosages that promotes “twilight” sleep. Patient is still arousable, with spontaneous ventilation but decreased awareness. Provides analgesia and amnesia and the client is conscious.
Used for diagnostic and minor surgical procedures outside the OR
Complications: airway obstruction, respiratory depression, hypoxia, and hypotension
meds for conscious sedation
Combination of IV medications Versed is the most common Opioids Morphine, Demerol, Fentanyl Sedatives Valium, Versed Antagonist to opioids and benzodiazepines
after surgery
Priority care includes monitoring and managing respiratory and circulatory function, pain, temp and the surgical site
PACU
Responsibilities of the RN Monitoring Complications Hypo/Hypervolemia Hypothermia Emergence delirium
PACU
Respiratory Status –(number 1!) Airway Suctioning Cough and deep breath O2 Mechanical support-if needed Prevent aspiration
Responsiveness/LOC
Malignant Hyperthermia
rise in temp, tachycardia, hypertension, increased muscle contractions
Dantrolene IV
Anaphylactic Reactions
Manifestations
Life-threatening pulmonary and circulatory complications
Hypotension
Tachycardia
Bronchospasm
Pulmonary edema
May be masked by anesthesia
Causes: any parenterally administered material
Antibiotics and latex
Vigilance and rapid interventions essential
Malignant Hyperthermia
Manifestations
Life-threatening pulmonary and circulatory complications
Hypotension
Tachycardia
Bronchospasm
Pulmonary edema
May be masked by anesthesia
Causes: any parenterally administered material
Antibiotics and latex
Vigilance and rapid interventions essential
Malignant Hyperthermia
Triggering agents
Succinylcholine (Anectine) used with volatile inhalation agents (desflurane, halothane, isoflurane)
Prevention
Careful Family history and be alert of its development
Safe drugs for pt. with history of MH
Barbituates such as propofol or ketamine
Nitrous Oxide
Opiods and different class of muscle relaxants
