intraoperative Flashcards
unrestricted area
- street clothes permissible
- holding area staff lounge, nurses station
semi-restricted area
- some hallways going in and around surgical suite
- scrubs on, hair covered
restricted area
- scrubs on, hair covered, mask on
- operating room, scrub sink, supply areas that go into OR
surgical handwash
- fingers to hands to elbows
- 5 minutes
- hands held upwards afterwards
- then surgical attire
RN roles
scrub nurse and circulating nurse
scrub nurse
- prepares instruments on table
- maintains counts of things
- verifies and reports drugs used
circulating nurse
- assess pt
- checks OR equipment/supplies
- document care
- measuring output
- dispensing and recording drugs used
- goes with pt to PACU
surgeons assistant can be….
MD, PA, or RNFA
what can a RNFA do
manage incision/wound
hemostasis
sutures
types of ACPs
anesthesiologist
CRNA
AA
what does the ACP manage
anesthesia
airway
pain
CPR
what does the timeout procedure verify
pt identification
surgical procedure
surgical site
NANDA risk for positioning
risk for perioperative positioning injury
skin prep for surgery
cleansing surgical site with iodine in a circular mortion, drape placed to only expose surgical site
what must be grounded in case of an electrical shock
electrosurgical devices and the patient
what is key for retained surgical equipment
counts are KEY
local anesthesia
no loss of consciousness
loss of sensation to a local area
injection or applied topically
4 types of regional anesthesia
local
spinal
epidural
caudal
spinal anesthesia
injected into CSF in subarachnoid space (below L2)
- cant move or feel
epidural
epidural space between L2-L5
- wont be able to feel, may be able to move
caudal
epidural space near tip of tailbone used for kids as an alternative to spinal
moderate sedation
- conscious sedation
- used for minor procedures like setting a bone
- sedative, anxiolytic, analgesic meds (IV)
- pts are responsive and breathe on their own
monitored anesthesia care (MAC)
- sedative, anxiolytic, analgesic meds
- possible airway management
- usually IV
- not given by RN
IV agents for general anesthesia
TIVA
induction with hypnotic, anxiolytic, or dissociative agent
inhalation agents
- volatile liquid/gas
- requires advanced airway
adjunct meds (table 19-7)
- opioids
- neuromuscular blockade
- antiemetics
balanced approach anesthesia
combo of inhalation and IV agents
3 phases of general anesthesia
induction
maintenance
emergence space
how to check if a ETT was successfully inserted
listen to lung sounds on the left side
pt may have a sore what after surgery?
sore throat from the ETT
laryngeal mask airway
doesnt go as far down as an ETT
three big anaphylaxis agents
antibiotics
latex
blood products
anaphylaxis causes…
hypotension
tachycardia
bronchospasm
tx for anaphylaxis
epinephrine
how is malignant hyperthermia passed down
autosomal dominant trait
genetic mutations lead to excessive Ca2+ release
what does malignant hyperthermia cause
hypermetabolism in skeletal muscles (rigidity)
primary trigger for malignant hyperthermia
succinylcholine PLUS inhaled anesthetics
malignant hyperthermia results in…
hypoxemia
muscle contractures
lactic acidosis
fatal hyperthermia
geriatric considerations
watch response to anesthesia and narcotics
