intraoperative nursing

Question 1

describe document review

Answer 1

-nurse at each phase adds to checklist and verifies previous info
-pt safety
-communication and continuity of care

Question 2

what is the goal of universal protocol (UP)

Answer 2

prevent:
-wrong person
-wrong procedure
-wrong site
-foreign objects left behind
-intra/postoperative death

Question 3

what are the three main compenents of UP

Answer 3

1) preop pt identification
2) marking operative site
3) time out

Question 4

describe time out

Answer 4

-involves anyone and everyone in the OR
-go through everything with the pt awake
-get shit straight

also used outside the OR

Question 5

why are people NPO before surgery

Answer 5

prevent pneumonia and aspiration

Question 6

describe general anesthesia

Answer 6

-inhalation and IV (involves skeletal muscle reactions, produces pain relief, induces sleep like state)
-requires close monitoring and must be administered by CRNA or anesthesiologist
-involves induction, maintenance, emergence

Question 7

general anesthesia

describe induction

Answer 7

time from first administration until ready for incision

Question 8

general anesthesia

describe maintenance

Answer 8

what happens during surgery

Question 9

general anesthesia

describe emergence

Answer 9

reversing anesthesia

Question 10

describe moderate sedation/analgesia

Answer 10

-conscious sedation
-nurses can adminster, as well as others
-used for short term, minimally invasive procedures
-amnesic meds
-unless procedure requires it, pt doesnt have to be NPO

Question 11

what are some examples of regional anesthesias

Answer 11

-nerve blocks
-spinal
-epidural

Question 12

describe regional anesthesias

Answer 12

-effects regions of the body
-injected near nerve/nerve pathway that innervates OP site
-no change in level of consciousness
-blocks autonomic nerves (decreased BP)
-less side effects, can be used for post op pain

Question 13

describe topical and local anesthesia

Answer 13

-solution is used to bathe tissues
-used in conjunction with other forms
-“caine”

Question 14

name some intraoperative nursing roles

Answer 14

-circulator
-scrub
-RNFA
-CRNA

Question 15

who counts the surgical supplies together

Answer 15

circulator and scrub

Question 16

nursing roles

describe circulator roles

Answer 16

-manages everything, controls environment, coordinates activities, monitor aspesis
-oversees safety (advocating, ensures pts rights are protected)
-does not scrub in

Question 17

nursing roles

describe scrub nursing

Answer 17

-can be nurse or tech
-scrubs in
-provides instruments and supplies
-anatomy, tissue repair
-prepares sterile fields

Question 18

nursing roles

RNFA

Answer 18

-registered nurse first assist
-can assist with surgery

Question 19

what is a CRNA

Answer 19

nurse anesthetist

Question 20

what are intraoperative nursing responsibilities

Answer 20

-safety
-communication
-positioning
-site prep
-draping
-observation/assessment
-documentation
-device placement (foley, scds, grounding pad, suction)
-“runner”
-counts
-prep for transfer to PACU

Question 21

what assessments indicate malignant hyperthermia (MH)

Answer 21

-first sign is muscle rigidity (jaw early)
-increased end tidal CO2
-tachycardia/dysrhythmias
-tachypnea/cyanosis
-increase temp
-mottled skin
-sweating
-DIC

Question 22

describe interventions for malignant hyperthermia (MH)

Answer 22

-ice packs
-cooling blanket
-dantrolene (reversal med)
-reversal of anesthesia
-monitor UOP

Question 23

describe MH

Answer 23

-uncontrolled increase in skeletal muscle metabolism overhwlems body’s ability to regulate O2, CO2, and temp
-can lead to circulatory collapse and death
-result of general anesthesia, can be inherited, males are more susceptible

Question 24

if a person experiences MH, what are they at risk for?

Answer 24

rhabdomyolysis

Question 25

describe rhabdomyolysis

Answer 25

-result of excessive skeletal muscle breakdown -> kidney breakdown
-can result from long surgeries
-brown urine is a sx