Intraoperative Care Flashcards
Surgical Settings?
Operating Room (OR)
Ambulatory Surgery/ Day Surgery
Surgical Suite?
controlled environment designed to minimize the spread of infectious organisms.
the instruments and equipment needed to provide safe patient care.
3 areas of surgical suite?
Unrestricted
Semirestricted
Restricted
Unrestricted Areas?
personnel in street clothes can interact with those in scrub clothing.
Contains:
Holding Area (sometimes family is allowed)
Staff room/locker room
Nursing Station
Semirestricted Area?
The semirestricted area includes the peripheral support areas and corridors of the OR.
Only authorized personnel are allowed access
All personnel must wear surgical attire and cover all head and facial hair.
Restricted Area?
Operating Rooms – “THE THEATER” It is a controlled area Geographically (on same floor as PACU) Environmentally (filtered air, temperature control, lighting, washable material, humidity) Bacteriologically
surgical environment is medical asepsis
tools are surgical asepsis
Surgical Team?
Nurses
Circulating Nurse
Scrub Nurse
Surgeon and assistant(s)
Anesthesiologist and tech
Other health care team members
i.e. pathologist, radiology tech
Circulating Nurse?
Not scrubbed
Not gowned/gloved
Remains in the unsterile field
Reviews, identifies and assesses the physical status of the patient
Prioritizes, adjusts and documents the plan of care to meet the specific needs of the patient
Assists in maintaining and monitoring the integrity of the sterile field
Performs the count procedure concurrently with the scrub nurse and accurately documents
Scrub Nurse?
Gowned and gloved in sterile attire
Remains in the sterile field
Sets priorities and expedites an efficient aseptic set-up for each surgical procedure
Is vigilant and attentive and responds appropriately to complications and unexpected events during the surgical procedure
Monitors aseptic technique throughout the procedure
Patient advocate through out the surgical
KEY Role – Patient Advocate ?
Circulating Nurse: Acts as a patient advocate during the preoperative period
Scrub Nurse: Acts as the patient’s advocate during the surgical procedure
Surgeon(s) and assistant(s)?
The Staff surgeon performs the surgery
Assistants: Resident surgeons, medical students, Registered Nurse First Assistant
Some surgeries require the expertise of more than one surgeon i.e. plastic surgeon
Surgeon responsibilities?
Preoperative medical history and physical exam (H&P), including need for surgical intervention, choice of surgical procedure and management of preoperative workup
Obtaining consent and explaining all the risks and complications associated with surgery
Patient safety and management in the OR
Postoperative management of the patient
Anesthesiologist?
responsible for a patient’s medical care before, during, and shortly after surgery.
Preoperative assessment
Delivery , maintenance and reversal of the anesthesia
Care of the patient’s recovery until discharged from PACU
Positioning – post induction?
The positioning of the patient should allow for?
Accessibility to the operative site
Administration and monitoring of anesthetic agents
Maintenance of the patient’s airway
ensure pt is intubated properly
Positioning – SAFETY is key
Patient can not move or feel anything, so potential for injury is VERY HIGH
Air way is priority – provide for adequate thoracic expansion
Provide correct skeletal alignment
Prevent pressure on nerves, bony prominences, eyes
Prevent occlusion of blood vessels
Provide modesty
Recognize and respect individual needs
Types of Anesthesia; a balanced technique?
General
Regional
Conscious sedation
Local
General Anesthesia?
Balanced Technique → use of multiple medications/ classifications and routes (i.e. po, IV, IM) to obtain: Loss of consciousness Skeletal muscle relaxation Analgesia Amnesia
Phases of General Anesthesia?
Induction (initiation of medication)
Maintenance (pt remains in unconscious state)
Emergence (pt returned to conscious state)
Regional Anaesthesia?
The loss of sensation to a region of the body without loss of consciousness; a specific nerve or group of nerves is blocked with the administration of a local anaesthetic agent (i.e. Lidocaine, Bupivocaine)
Examples: spinal, epidural, or peripheral nerve block
Spinal anesthesia: the medication is injected into the cerebrospinal fluid in the subarachnoid space
Causes vasodilation and hypotension
Risk of systemic toxicity if absorbed into the general circulation
Starts to act immediately
Epidural anesthesia: injection of local anesthetic into epidural (extradural) space
Anaesthesia does not enter the cerebrospinal fluid, but binds to nerve routes
Starts to act within ~ 10 minutes
Conscious Sedation?
Pt is awake
Local Anaesthesia?
Local anaesthetics block the initiation and transmission of electrical impulses along nerve fibers. With progressive increases in local anaesthetic concentration, the transmission of autonomic, then somatic sensory, and finally somatic impulses is blocked → loss of sensation without loss of consciousness.
Local anaesthesia may in induced topically, intracutaneously (intradermal) or subcutaneously.
Examples: biopsy, dental
Post Anaesthesia Care Unit (PACU)?
Upon admission the patient is assessed for ABC’s
Airway
Breathing
Circulation
Level of consciousness Fluid status (I&O) i.e. Foley drainage, IV rate Ability to move Status of dressing /drain Pain
The following assessments most be done/met prior to DC to the unit/home:
Able to maintain airway and cough
Conscious and orientedx3
Vital signs stable (within baseline)
Able to move/follow commands (dependent on type of anesthesia)
Urinary output ≥ 30 mL/hr
Bleeding/wounds – exudate assessed
Safety in the OR?
Burns: Chemical Electric Fire Inhalation of smoke from cautery
Malignant Hyperthermia ?
Rare condition, genetically determined
Caused by succinylcholine and inhalation agents
Excessive, uncontrolled metabolic activity in the muscles
Leads to a very high temperature
Fatal if not treated
Treatment of M.H.?
Discontinue use of succinylcholine and inhalation agent(s)
Cool patient with ice, cold IV solution etc.
Administer Dantrolene
Skeletal muscle relaxant
