Intraoperative

Question 1

What are the 3 basic types of anesthesia and what do they do?

Answer 1

• General- patient is rendered unconscious
• Local- patient conscious, area of surgery is numb
• —> Local Infiltration
• —> Epidural
• —> Spinal or Regional Block
• Conscious Sedation- Twilight Sleep (moderate to deep sedation but awake)

Question 2

What are the types of nurses in the intraoperative setting? Describe them

Answer 2

• Perioperative Nurse
• Circulating Nurse
• Scrub Nurse

Question 3

What are the duties of a perioperative nurse?

Answer 3

• Perioperative Nurse
• –> Prepares room with team
• –> Patient advocate throughout surgical experience

Question 4

What are the duties of a circulating nurse?

Answer 4

• Circulating Nurse
• –> Not scrubbed, gowned, or gloved
• –> Remains in “unsterile field”
• –> Documents

Question 5

What are the duties of a scrub nurse?

Answer 5

• Scrub Nurse
• –> Follows designated scrub procedure
• –> Gowned and gloved in sterile attire
• –> Remains in Sterile Field
• –> Holds retractors
• –> Assists with hemostasis and suturing

Question 6

What are the duties of a surgeon’s assistant (who could be either a physician or RN)?

Answer 6

• –> Holds retractors
• –> Assists with hemostasis and suturing
• –> May perform portions of procedure under direct supervision

Question 7

What should you ASSESS during PACU Care?

Answer 7

• Assess Physiological Status
• Assess Surgical Site
• Assess Influence of Anesthesia at Admission

Question 8

What are some important things to know when assessing physiological status?

Answer 8

• Breathing gets rid of anesthetic agents
• High HR, Heart Beats Stronger, Higher Respiratory Rate are expected but stabilize them
• Get patient to DEEP BREATH and COUGH while holding something against chest and abdomen because intraabdominal pressure might cause wound to reopen

Question 9

What “abnormal” sign is normal immediate post op?

What is the goal to get them to baseline?

Answer 9

• Decreased LOC

- Goal is to get them to be AROUSABLE

Question 10

Why is checking on a patient’s increased respiratory rate in the PACU important?

What level does your O2 Sat. need to fall to for you to be concerned?

Answer 10

• Might indicate atelectasis (partial or full collapsed of the lung due to alveoli becomes deflated or filled with alveolar fluid)
• Less than or equal to 84%

Question 11

What should you do to clear obstruction caused by patient’s tongue?

Answer 11

Manually elevate the jaw (such as putting pillow under the neck) while tilting the head back

Question 12

What position should you lay a patient to avoid aspiration and/or you’re not sure if they can protect their airway?

What should you do once you find out that they can protect their airway and why?

Answer 12

Lateral Position (on side) specifically the Sim’s position

Sit them upright into SEMI-FOWLERS Position so the diaphragm has more room to move

Question 13

What should you do to check if a patient can protect their airway?

Answer 13

Test their gag reflex

Question 14

What are the postanesthesia discharge criteria?

Answer 14

• Patient awake or at baseline
• Vital signs stable
• No EXCESS bleeding or drianage
• O2 Sat. >90%
• Report given to the floor

Question 15

What are the ambulatory surgery discharge criteria?

Answer 15

• All PACU discharge criteria met
• No IV narcotics for last 30 minutes
• Voided (if appropriate to surgical procedure & orders)
• Able to ambulate if age appropriate and not contraindicated
• Responsible adult present to accompany patient
• Discharge instructions given and understood