Intraoperative Nursing

Question 1

Explain the Intraoperative Care Phase

Answer 1

• 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

Question 2

The 4 Nursing roles involved during the intraoperative care phase are:

Answer 2

• Circulating Nurse
• Scrub Nurse
• RN First Assistant (RNFA)- possibly involved
• Nurse anesthetist (CRNA)- possibly involved

Question 3

This OR nurse must follow designated scrub procedures, (sterile) gowned/gloved up, and maintain a sterile field:

Answer 3

Scrub Nurse

Question 4

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

Answer 4

False

Circulating nurse is correct.

Question 5

4 major concepts to consider during Intraoperative care:

Answer 5

Identification
Safety
Positioning
Asepsis

Question 6

What is involved with Patient Identity & Safety?

Answer 6

• Patient identifiers (x2)

- Site(s) identification (surgical markings)

Question 7

Examples of site identifiers (aka Surgical markings) include:

Answer 7

• Extremities
• Laterality (right vs left)
• Multiple structures (fingers, toes)
• Levels (spine)

Question 8

The surgeon’s ___ are used as surgical site markings?

a) forceps
b) paperclips
c) initials
d) tweezers

Answer 8

c) initials

Question 9

Where should the surgical site markings be located?

Answer 9

Over or as close as possible to the incision site

Must be visible after Pt has been draped

Question 10

What is “Time Out”?

Answer 10

It is a patient safety procedure/concept where the entire surgical team verifies and agrees to several pieces of information before the incision begins

Question 11

What must the entire surgical team agree to before the surgery/incision begins? (6)

Answer 11

1. Correct identity of the patient.
2. Correct surgical site.
3. Correct level, laterality, or structure (if applicable).
4. Correct procedure to be performed.
5. Correct patient position.
6. Availability of correct implants and any special equipment or requirements.

Question 12

What are the risks for improper patient positioning?

Answer 12

• muscle strain
• joint damage
• pressure ulcers
• nerve damage

Question 13

Ensuring correct _______ _______ is key in preventing injury.

Answer 13

Patient positioning

Question 14

A sterile field set up is important before surgery:

True or False

Answer 14

True

Question 15

Inhalation or injection of anesthetic drugs that results in the loss of all sensation and consciousness with amnesia is called:

Answer 15

General anesthesia

Question 16

These two roles are certified and in charge of providing General anesthesia:

Answer 16

Anesthesiologist and CRNA (Certified RN Anesthetist)

Question 17

The 4 classifications of Anesthesia include:

Answer 17

• General
• Regional
• Local
• Monitored anesthesia care

Question 18

Match the classification with it’s definition:

1. Regional ____
2. Monitored anesthesia care ____
3. General ____
4. 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

Answer 18

1. Regional - d
2. Monitored anesthesia- c
3. General - a
4. Local - b

Question 19

The phases of General anesthesia:

Answer 19

Pre-induction
Induction
Maintenance
Emergence

Question 20

Nerve blocks, Bier blocks, spinals, and epidurals are all types of:

Answer 20

Regional anesthesia

Question 21

A patient is conscious, yet still sedated in General anesthesia:

True or False

Answer 21

False

Monitored anesthesia care (formerly “conscious sedation”) is where the patient is conscious, but sedated

Question 22

Intraoperative risks for the nurse to consider:

Answer 22

• Risk for infection
• Risk for perioperative positioning injury
• Risk for injury
• Risk for imbalanced body temperature
• Hypothermia
• Malignant hyperthermia

Question 23

This condition is unique to the intraoperative phase (& can also be a delayed reaction):

Answer 23

Malignant Hyperthermia

Question 24

Malignant hyperthermia is:

Answer 24

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)

Question 25

What triggers Malignant Hyperthermia?

Answer 25

triggering agents that are certain volatile anesthetics, which result in unregulated high calcium accumulations

Question 26

Malignant Hyperthermia manifestations:

Answer 26

Sustained muscle contractions
Muscle breakdown
Anaerobic metabolism
Metabolic acidosis

Question 27

Muscle breakdown in Malignant hyperthermia is called:

Answer 27

Rhabdomyolysis

Question 28

Muscle location where the muscle contractions/spasms occur during Malignant hyperthermia:

Answer 28

Masseter Muscles

Question 29

Early presentation of Malignant hyperthermia:

Answer 29

• hypercarbia
• sinus tachycardia
• masseter or generalized muscle rigidity**
• unexpected increase in end-tidal CO2 **

**Common initial signs

Question 30

Hyperthermia is the presenting sign in Malignant hyperthermia:

True or False

Answer 30

False

Hyperthermia is not the initial sign. It is initially absent when the other s/s are occurring

Question 31

Increased CO2 retention is called:

Answer 31

Hypercarbia

Question 32

Is Malignant Hyperthermia predictable?

Answer 32

No. Though inherited, 90% of patients have a negative family history.

Question 33

Name the antidote for Malignant Hyperthermia:

Answer 33

dantrolene IV