Intraoperative Nursing Flashcards
Explain the Intraoperative Care Phase
- Phase that begins when the patient is wheeled into the OR and ends when the patient is transferred to the immediate post-op recovery area
- This is a limited entry area due to its’ complexity and need for sterility/asepsis
- Surgical attire is to be worn by everyone entering the OR
The 4 Nursing roles involved during the intraoperative care phase are:
- Circulating Nurse
- Scrub Nurse
- RN First Assistant (RNFA)- possibly involved
- Nurse anesthetist (CRNA)- possibly involved
This OR nurse must follow designated scrub procedures, (sterile) gowned/gloved up, and maintain a sterile field:
Scrub Nurse
Registered Nurse First Assistant (RNFA) is responsible for running the show by recording all nursing care. They also do not scrub up, but they are gowned and gloved:
True or False
False
Circulating nurse is correct.
4 major concepts to consider during Intraoperative care:
Identification
Safety
Positioning
Asepsis
What is involved with Patient Identity & Safety?
- Patient identifiers (x2)
- Site(s) identification (surgical markings)
Examples of site identifiers (aka Surgical markings) include:
- Extremities
- Laterality (right vs left)
- Multiple structures (fingers, toes)
- Levels (spine)
The surgeon’s ___ are used as surgical site markings?
a) forceps
b) paperclips
c) initials
d) tweezers
c) initials
Where should the surgical site markings be located?
Over or as close as possible to the incision site
Must be visible after Pt has been draped
What is “Time Out”?
It is a patient safety procedure/concept where the entire surgical team verifies and agrees to several pieces of information before the incision begins
What must the entire surgical team agree to before the surgery/incision begins? (6)
- Correct identity of the patient.
- Correct surgical site.
- Correct level, laterality, or structure (if applicable).
- Correct procedure to be performed.
- Correct patient position.
- Availability of correct implants and any special equipment or requirements.
What are the risks for improper patient positioning?
- muscle strain
- joint damage
- pressure ulcers
- nerve damage
Ensuring correct _______ _______ is key in preventing injury.
Patient positioning
A sterile field set up is important before surgery:
True or False
True
Inhalation or injection of anesthetic drugs that results in the loss of all sensation and consciousness with amnesia is called:
General anesthesia
These two roles are certified and in charge of providing General anesthesia:
Anesthesiologist and CRNA (Certified RN Anesthetist)
The 4 classifications of Anesthesia include:
- General
- Regional
- Local
- Monitored anesthesia care
Match the classification with it’s definition:
- Regional ____
- Monitored anesthesia care ____
- General ____
- Local ____
a. produced by inhalation or injection of anesthetic drugs (or both); patient loses all sensation and consciousness
b. temporary loss of feeling as result of inhibition of nerve endings in part of body
c. similar to general anesthesia, but does not involve inhaled agents
d. medication is instilled into or around nerves to block transmission of nerve impulses in particular region
- Regional - d
- Monitored anesthesia- c
- General - a
- Local - b
The phases of General anesthesia:
Pre-induction
Induction
Maintenance
Emergence
Nerve blocks, Bier blocks, spinals, and epidurals are all types of:
Regional anesthesia
A patient is conscious, yet still sedated in General anesthesia:
True or False
False
Monitored anesthesia care (formerly “conscious sedation”) is where the patient is conscious, but sedated
Intraoperative risks for the nurse to consider:
- Risk for infection
- Risk for perioperative positioning injury
- Risk for injury
- Risk for imbalanced body temperature
- Hypothermia
- Malignant hyperthermia
This condition is unique to the intraoperative phase (& can also be a delayed reaction):
Malignant Hyperthermia
Malignant hyperthermia is:
An inherited muscle disorder triggered by certain types of anesthesia that may cause a fast-acting life-threatening crisis.
(Low incidence, but if left untreated, the mortality is high)
What triggers Malignant Hyperthermia?
triggering agents that are certain volatile anesthetics, which result in unregulated high calcium accumulations
Malignant Hyperthermia manifestations:
Sustained muscle contractions
Muscle breakdown
Anaerobic metabolism
Metabolic acidosis
Muscle breakdown in Malignant hyperthermia is called:
Rhabdomyolysis
Muscle location where the muscle contractions/spasms occur during Malignant hyperthermia:
Masseter Muscles
Early presentation of Malignant hyperthermia:
- hypercarbia
- sinus tachycardia
- masseter or generalized muscle rigidity**
- unexpected increase in end-tidal CO2 **
**Common initial signs
Hyperthermia is the presenting sign in Malignant hyperthermia:
True or False
False
Hyperthermia is not the initial sign. It is initially absent when the other s/s are occurring
Increased CO2 retention is called:
Hypercarbia
Is Malignant Hyperthermia predictable?
No. Though inherited, 90% of patients have a negative family history.
Name the antidote for Malignant Hyperthermia:
dantrolene IV
