Intraoperative Nursing Flashcards
Operating Room Personnel
- Surgeon
- 2nd Surgeon or Assistant if necessary
- Anesthesiologist or Nurse Anesthetist
- Circulating Nurse (non-sterile activities)
- Scrub Nurse
- RN First Assistant
- Manager
- Educator
Duties of the circulating nurse:
- Must be an RN
- Responsible for non-sterile activities
- Advocate for pt, concerned with safety
- Coordinates OR experience for pt, delegates and is cost compliant
- Does not wear sterile clothing (scrubs)
- Checks equipment, positioning, skin preps
- Does all documentation
- Assists scrub nurse with counts
Scrubbing intraoperatively:
- 3 to 5 min scrub for all essential personnel (contact with the sterile field, or sterile instruments and equipment)
- Hands and forearms up to 2 inches above elbow
- Use of long acting, powerful, antimicrobial soap
Duties of the scrub nurse:
- Can be RN or LPN
- Responsible for all sterile activities
- Gathers equipment for sterile procedure
- Hands surgeon equipment
- Responsible for accurate count
Specialty Nurses:
1) RN FA (RN First Assistant)
advance practice nurse with specialty training, assists surgeon
2) Manager
Responsible for staffing, all activities/experiences in the OR
(OR educator)
Surgical suite divisions:
1) Unrestricted
2) Semi-restricted
3) Restricted
Unrestricted Areas
- Central point of OR (holding area, nurses station)
- Monitoring pt, personnel & materials
- Scrubs not needed
- Traffic unlimited
Semi-restricted areas
- Peripheral areas outside of surgical suites (storage, hallways)
- Only available to authorized personnel and patients
- Must be in scrubs (top, bottom, foot coverings)
Restricted Areas
- OR Procedure Areas, Center wells (clean core) found in between 2 surgical suites (sinks, warmers, IV Solutions
- Full scrubs, masks, hair and foot coverings, and dedicated shoes specifically for the OR
4 Stages of General Anesthesia
1) Preinduction (Onset)
2) Induction (Excitement)
3) Maintenance (Surgical Anesthesia)
4) Emergence (Danger)
Preinduction
- Analgesics, sedative meds brought on board
- Pt free of pain, mildly sedated & relaxed
- Anesthesiologist applies monitors
- Pt is drowsy, dizzy, and has a reduced sensation to pain
Induction
- Continual loss of consiousness
- Irregular breathing
- Increased autonomic responses
- Anesthesiologist inserts airway
Maintenance
- Surgery can begin
- Loss of eyelid reflex
- Vitals dip
- Pt is unconscious
- No gag reflex
- Pt usually can not hear
Emergence
- Dangerous if stages 3-4 are maintained
- All functions are depressed
- Pt is not breathing
- If not emerged from nesthesia, will go into cardiac arrest
General Anesthesia is best used for:
- Pt’s that are anxious
- Uncooperative
- Contraindication to local or regional anesthesia
- Depending on length of procedure
- Conditions where breathing is an issue
General Anesthesia: IV
- Rapid Induction: within 30 seconds
- Can be used alone because of sedative effect in small procedures (dental work)
- Can be a supplement to inhalation
Most commonly used IV agents:
- Pentathol: weak analgesic, used in combination
- Ketalar: disassociative state, analgesic (makes pt unconscious), eyes stay open but pt is unaware of surroundings
- Versed: shortacting, hypnotic, slower induction anesthetic, has an amnesia quality
General Anesthesia: Inhalation
- Most controllable method
- Few side effects
- Liquids or gas & O2 used
- Eliminated through respiratory system
- Used to maintain induction
- Given through mask or endotrach tube, laryngeal mask airway, or tracheostomy
Most commonly used inhalation agents:
- Nitrous Oxide: most commonly used (gas), weak analgesic (must be used with other agents). Little effect on pulse and respiration.
- Halothane: (gas) High anesthetic potency, mild decrease in blood pressure and respiration, muscle relaxant, low post-op nausea
- Isoflurane: (liquid) Muscle relaxant, decreases respiratory rate
General Anesthesia: Adjunctive Agents
- Enhance analgesic properties
- Neuromuscular blockers: depolarizing or non-depolarizing
- Block the transmission of nerve impulses to the muscle fibers
- Administered in IV
- Facilitate intubation & provides skeletal muscle relaxation
Local Anesthesia
- Delivered topically (skin or mucous membranes) and by local infiltration
- SQ under skin with small needle
- Gel used for minor procedures
- EMLA patch
- Lidocaine
Regional Anesthesia
A type of local anesthesia that blocks multiple peripheral nerves in a certain region of the body
Regional Anesthesia Types:
- Field Block: area surrounding, barrier between incision & nerve
- Peripheral Nerve Block: group of nerves anesthesized
- Spinal (CSF and Subarachnoid Space)
- Epidural (Epidural Space): lower extremity surgeries
Regional Anesthesia is best:
Depending on the risk: adverse reactions to general anesthesia
- Pt’s preference
- Pain management is enhanced
- Pt is only mildly sedated in case food has been ingested
Moderate Sedation
- Conscious Sedation
- Altered level of consviousness that still allows the pt to respond to physical stimulation and verbal commands
- Pt maintains unassisted airway
- IV delivery of meds
- Produces amnesia
- O2, vital signs must be monitored
Commonly used meds for Moderate Sedation:
1) Amidate
2) Diazepam
3) Sublimaze
4) Versed
5) Propofol
Commonly used General Anesthesia Adjunctive Agents:
1) Succinylcholine (Succs): muscle relaxant
2) Pancuronium
3) Vecuronium
- Opioids (sedation, analgesic) and Benzodiazepenes (sedative, hypnotic property)
- Opioids reversed with Narcan
- Benzodiazepenes reversed with Romazicon
Positioning in the OR
1) Supine
2) Prone
3) Trendelenburg
4) Lithotomy
5) Lateral
Supine
On back, knees restrained 2 inches above.
ideal for: hernia, mastectomy, bowel resection
Prone
Face down
ideal for: spinal, back, craniotomy
Trendelenburg
Patient is placed head down on a table inclined at about 45 degrees from the floor with the knees uppermost and the legs hanging over the end of the table
Lithotomy
Feet in stirrups, exposes perineal and rectal areas
Lateral
- Pt positioned on the side
- Ideal for hip, kidney, possible chest surgery
- Restraints will be used to hold position
- Extremities are padded to the pressure points
Intraoperative complications
- Hypothermia
- Malignant hyperthermia
- Latex allergy
Hypothermia in relation to surgical procedures:
- The OR is maintained at 60 to 75°F
- Greatest temperature drop within the first 40 to 60 minutes of anesthesia
- Skin preparations and positioning and open tissue allow for greater heat loss
- Risks are myocardial ischemia, site infection, bleeding and client discomfort
- Precautions are warming blankets and warm infusions given by the anesthesiologist
Malignant hyperthermia in relation to surgical procedures:
- It is an inherited disorder that includes extreme elevation of body temperature as high as 111°
- Triggering agents are succinylcholine and inhalation agents (especially halothane)
- Complications include tachycardia, arrhythmias, increased CO2 concentrations, masseter spasm/rigidity
Latex allergies
- Screening is done prior to surgery preoperatively
- If there is an allergy to latex the patient is usually the first of the day
- There are latex free carts with equipment available
Transport to PACU
- Via stretcher or bed
- Accompanied by nurse and anesthesiologist
- Report is given to PACU nurse
- All documentation is completed which includes the procedure, type of anesthesia, intake and output, IV/meds and the last time given
Intraoperative nursing diagnoses
- Risk for anxiety
- Injury: improper positioning, restraints, pressure
- Impairment of skin integrity
- Alteration in normothermia
- Fluid volume deficit/excess
- Risk for infection
