INTRAOPERATIVE Flashcards
Surgical environment (3)
Unrestricted Area
Semi-restricted Area
Restricted Area
provides an entrance and exit from the
surgical suite for personnel, equipment
and patient street clothes are permitted
in this area,
- and the area provides access to
communication with personnel within
the suite and with personnel and
patient’s families outside the suit
Unrestricted area
provides access to the procedure
rooms and peripheral support areas
within the surgical suite. personnel
entering this area must be in proper
operating room attire and traffic control
must be designed to prevent violation
of this area by unauthorized persons
- peripheral support areas consists of:
storage areas for clean and sterile
supplies, sterilization equipment and
corridors leading to procedure room
Semi restricted
includes the procedure room where
surgery is performed and adjacent
substerile areas where the scrub sinks
and autoclaves are located personnel
working in this area must be in proper
operating room attire
Restricted Area
The size of the procedure room
Usually
rectangular or square in shape
- 20 x 20 x 10 with a minimum floor
space of 360 square feet
Temperature and humidity control. The temperature in the procedure room
should maintained between
68 F -75 F
( 20-24 degrees C) Humidity level
between 50 - 55 % at all times
Air exchange in each procedure room, should be atleast
25 air exchanges
every hour, and five of that should be
fresh air. A high filtration particulate filter,
working at 95% efficiency is
recommended.
THE SURGICAL TEAM
Surgeon
Assistant surgeon
Scrub nurse
Circulating nurse
Anesthesiologist
The primary decision maker regarding
surgical technique to use during the
procedure.
SURGEON
Primary responsible for the
preoperative medical history and
physical assessment
SURGEON
Performance of the operative
procedure according to the needs of
the patients.
SURGEON
May assist with positioning and
prepping the patient or may delegate
this task to other members of the team
SURGEON
May be a resident, intern, physician’s
assistant or a perioperative nurse.
ASSISTANT SURGEON
Assists with retracting, hemostasis,
suturing and any other tasks requested
by the surgeon to facilitate speed while
maintaining quality during the
procedure.
ASSISTANT SURGEON
Selects the anesthesia, administers it,
intubates the client if necessary,
manages technical problems related to
the administration of anesthetic agents,
and supervises the client’s condition
throughout the surgical procedure
ANESTHESIOLOGIST
A physician who specializes in the
administration and monitoring of
anesthesia while maintaining the
overall well-being of the patient.
ANESTHESIOLOGIST
May be either a nurse or a surgical
technician.
SCRUB NURSE
Reviews anatomy, physiology and the
surgical procedures.
SCRUB NURSE
Assists with the preparation of the
room. Scrubs, gowns and gloves and
other members of the surgical team
SCRUB NURSE
Prepares the instrument table and
organizes sterile equipment for
functional use.
SCRUB NURSE
Assists with the draping procedure.
Passes instruments to the surgeon and
assistants by anticipating their needs.
SCRUB NURSE
Counts sponges, needles and
instruments. Monitor practices of
aseptic technique in self and others.
SCRUB NURSE
Keeps track of irrigations used for
calculations of blood loss
SCRUB NURSE
CIRCULATING NURSE
Initial to final counting
SCRUB NURSE
Double check counting
CIRCULATING NURSE
Must be a registered nurse who, after
additional education and training,
specializes in perioperative nursing
practice
CIRCULATING NURSE
Responsible and accountable for all
activities occurring during a surgical
procedure including the management
of personnel equipment, supplies and
the environment during a surgical
procedure.
CIRCULATING NURSE
Patient advocate, teacher, research
consumer, leader and a role model.
CIRCULATING NURSE
May be responsible for monitoring the
patient during local procedures if a
second perioperative nurse is not
available.
CIRCULATING NURSE
Craniotomy
Butterfly
Eye surgeries
Limbal
Breast surgeries
Halstead/Elliptical
Gallbladder and biliary
tract surgery
Subcostal
Right side - gallbladder,
biliary tract Left side -
splenectomy
Paramedian
Gastrectomy
Transverse
Right side - small bowel
resection Left side -
sigmoid colon resection
Rectus
Appendectomy
Mcburney
Gynecologic surgery
Pfannenstiel
Kidney surgery
Lumbotomy
position where an individual lies on their back with the knees bent, legs separated, and feet flat on the surface, often used during, Hernia repair, mastectomy, bowel
resection
Dorsal Recumbent
variation of supine in which the head of the bed is tilted down such that the pubic symphysis is the highest point of the trunk, Pelvic Surgeries
Trendelenburg
supine position of the body when the patient is face-up, arms to the sides, but the legs are separated, raised, and supported in a boot-style leg holder or stirrup-style position. Vaginal repair, D&C,
rectal surgery, APR
Lithotomy
lying flat on your stomach, Spinal surgery,
laminectomy
Prone
when a surgical patient is positioned with the non-operative side placed on the operating room table, Kidney, chest, hip
surgery
Lateral
the patient lays on the side (either right or left) with the operative side up. Kidney, chest, hip surgery
Lateral
wherein the patient’s abdomen lies flat on the bed. The bed is scissored, so the hip is lifted, and the legs and head are low. Rectal procedures, sigmoidoscopy and colonoscopy
Jack Knife Position
This variation of supine in which the head of the bed is tilted upward so that the head is the highest point of the trunk facilitates upper abdominal surgery. Upper abdominal, head, neck and facial surgery
Reverse Trendelenburg
Position
State of Narcosis. Anesthetics can produce
muscle relaxation, block transmission of pain
nerve impulses and suppress reflexes. It can also temporarily decrease memory
retrieval and recall.
ANESTHESIA
The effects of anesthesia are monitored by
considering the following parameters: (6)
Respiration
O2 saturation
CO2 level
HR and BP
Urine output.
reversible state consisting of complete loss of consciousness and sensation. Can cause respiratory depression as protective reflexes such as cough and gag are lost provides analgesia, muscle relaxation and
sedation. produces amnesia and hypnosis.
GENERAL ANESTHESIA
Two types of general anesthesia
Intravenous Anesthesia
Inhalation Anesthesia
This is being administered
intravenously and extremely rapidly.
- Its effect will immediately take place
after thirty minutes of introduction.
- It prepares the client for a smooth
transition to surgical anesthesia.
Intravenous Anesthesia
This comprises volatile liquids or gas
and oxygen.
- Administered through a mask or
endotracheal tube
- fastest
Inhalation Anesthesia
temporary interruption of the transmission of nerve impulses to and from specific areas or regions of the body.
REGIONAL ANESTHESIA
achieved by injecting local anesthetics in close proximity to appropriate nerves
REGIONAL ANESTHESIA
What agents used in regional anesthesia to reduce all painful sensation in one region of the body without inducing unconsciousness.
lidocaine and bupivacaine
applied directly to the skin and mucous
membrane, open skin surfaces,
wounds and burns.
- readily absorbed and rapidly used
topical agents are lidocaine and
benzocaine.
Topical Anesthesia
Local anesthetic is injected through
lumbar puncture, between L2 and S1
anesthetic agent is injected into
subarachoid space surrounding the
spinal cord.
Spinal Anesthesia
Spinal Anesthesia for perineal/rectal areas is called
Low spinal
Spinal Anesthesia T10 (below level of
umbilicus) for hernia repair and
appendectomy.
Mid spinal
Spinal Anesthesia T4 (nipple line ), for CS
anesthetic block conduction in spinal
nerve roots and dorsal ganglia;
paralysis and analgesia occur below
the level of injection
High spinal
Agents used in Spinal Anesthesia
procaine, tetracaine,
lidocaine and bupivacaine.
achieved by injecting local anesthetic
into epidural space by way of a lumbar
puncture.
- results similar to spinal analgesia
- agents used are chloroprocaine,
lidocaine bupivacaine.
Lower extremity anesthesia
Epidural Anesthesia
achieved by injecting a local anesthetic
to anesthetize the surgical site.
- agents used are chloroprocaine, lidocaine and bupivacaine.
Peripheral Nerve Block
7 types of regional anesthesia (TSEPICF)
Topical
Spinal
Epidural
Peripheral nerve block
Intravenous block
Caudal
Field block
Often used for arm,wrist and hand
procedure an occlusion tourniquet is
applied to the extremity to prevent
infiltration and absorption of the
injected IV
- agents beyond the involved extremity.
Intravenous Block
Is produced by injection of the local
anesthetic into the caudal or sacral
canal
Caudal Anesthesia
The area proximal to a planned incision
can be injected and infiltrated with local
anesthetic agents.
Field Block Anesthesia
4 STAGES OF ANESTHESIA (OESM)
Onset / Induction.
Excitement / Delirium
Surgical
Medullary / Stage of Danger
Extends from the administration of
anesthesia to the time of loss of
consciousness
Onset / induction
Extends from the time of loss of
consciousness to the time of loss of lid
reflex. Increase in autonomic activity
and irregular breathing. It may be
characterized by shouting, struggling
with the client
Excitement/ delirium
Extends from the loss of lid reflex to the
loss of most reflexes. surgical
procedure is started.
Surgical
It is characterized by respiratory and
cardiac depression or arrest. It is due
to an overdose of anesthesia.
Resuscitation must be done
Potential death
Medullary, stage of danger
inadequate ventilatory
support after paralysis of respiratory muscles
Hypoventilation
For Malignant Hyperthermia
Bantrolin sodium
due to preoperative
hypovolemia or untoward reactions to
anesthetic agents
Hypotension
due to preexisting
cardiovascular compromise, electrolyte
imbalance or untoward reaction to anesthesia
Cardiac Dysrhythmia
due to exposure to a cool
ambient OR environment and loss of thermoregulation capacity from anesthesia.
Hypothermia
due to improper
positioning of patients or use of restraints.
Peripheral Nerve Damage
