intraoperative nursing Flashcards
describe document review
-nurse at each phase adds to checklist and verifies previous info
-pt safety
-communication and continuity of care
what is the goal of universal protocol (UP)
prevent:
-wrong person
-wrong procedure
-wrong site
-foreign objects left behind
-intra/postoperative death
what are the three main compenents of UP
1) preop pt identification
2) marking operative site
3) time out
describe time out
-involves anyone and everyone in the OR
-go through everything with the pt awake
-get shit straight
also used outside the OR
why are people NPO before surgery
prevent pneumonia and aspiration
describe general anesthesia
-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
general anesthesia
describe induction
time from first administration until ready for incision
general anesthesia
describe maintenance
what happens during surgery
general anesthesia
describe emergence
reversing anesthesia
describe moderate sedation/analgesia
-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
what are some examples of regional anesthesias
-nerve blocks
-spinal
-epidural
describe regional anesthesias
-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
describe topical and local anesthesia
-solution is used to bathe tissues
-used in conjunction with other forms
-“caine”
name some intraoperative nursing roles
-circulator
-scrub
-RNFA
-CRNA
who counts the surgical supplies together
circulator and scrub
nursing roles
describe circulator roles
-manages everything, controls environment, coordinates activities, monitor aspesis
-oversees safety (advocating, ensures pts rights are protected)
-does not scrub in
nursing roles
describe scrub nursing
-can be nurse or tech
-scrubs in
-provides instruments and supplies
-anatomy, tissue repair
-prepares sterile fields
nursing roles
RNFA
-registered nurse first assist
-can assist with surgery
what is a CRNA
nurse anesthetist
what are intraoperative nursing responsibilities
-safety
-communication
-positioning
-site prep
-draping
-observation/assessment
-documentation
-device placement (foley, scds, grounding pad, suction)
-“runner”
-counts
-prep for transfer to PACU
what assessments indicate malignant hyperthermia (MH)
-first sign is muscle rigidity (jaw early)
-increased end tidal CO2
-tachycardia/dysrhythmias
-tachypnea/cyanosis
-increase temp
-mottled skin
-sweating
-DIC
describe interventions for malignant hyperthermia (MH)
-ice packs
-cooling blanket
-dantrolene (reversal med)
-reversal of anesthesia
-monitor UOP
describe MH
-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
if a person experiences MH, what are they at risk for?
rhabdomyolysis
describe rhabdomyolysis
-result of excessive skeletal muscle breakdown -> kidney breakdown
-can result from long surgeries
-brown urine is a sx
