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Care of the Surgical Patient > Intraoperative Nursing > Flashcards

Intraoperative Nursing Flashcards

1
Q

Operating Room Personnel

A
  • Surgeon
  • 2nd Surgeon or Assistant if necessary
  • Anesthesiologist or Nurse Anesthetist
  • Circulating Nurse (non-sterile activities)
  • Scrub Nurse
  • RN First Assistant
  • Manager
  • Educator
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2
Q

Duties of the circulating nurse:

A
  • 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
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3
Q

Scrubbing intraoperatively:

A
  • 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
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4
Q

Duties of the scrub nurse:

A
  • Can be RN or LPN
  • Responsible for all sterile activities
  • Gathers equipment for sterile procedure
  • Hands surgeon equipment
  • Responsible for accurate count
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5
Q

Specialty Nurses:

A

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)

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6
Q

Surgical suite divisions:

A

1) Unrestricted
2) Semi-restricted
3) Restricted

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7
Q

Unrestricted Areas

A
  • Central point of OR (holding area, nurses station)
  • Monitoring pt, personnel & materials
  • Scrubs not needed
  • Traffic unlimited
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8
Q

Semi-restricted areas

A
  • Peripheral areas outside of surgical suites (storage, hallways)
  • Only available to authorized personnel and patients
  • Must be in scrubs (top, bottom, foot coverings)
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9
Q

Restricted Areas

A
  • 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
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10
Q

4 Stages of General Anesthesia

A

1) Preinduction (Onset)
2) Induction (Excitement)
3) Maintenance (Surgical Anesthesia)
4) Emergence (Danger)

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11
Q

Preinduction

A
  • 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
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12
Q

Induction

A
  • Continual loss of consiousness
  • Irregular breathing
  • Increased autonomic responses
  • Anesthesiologist inserts airway
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13
Q

Maintenance

A
  • Surgery can begin
  • Loss of eyelid reflex
  • Vitals dip
  • Pt is unconscious
  • No gag reflex
  • Pt usually can not hear
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14
Q

Emergence

A
  • 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
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15
Q

General Anesthesia is best used for:

A
  • Pt’s that are anxious
  • Uncooperative
  • Contraindication to local or regional anesthesia
  • Depending on length of procedure
  • Conditions where breathing is an issue
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16
Q

General Anesthesia: IV

A
  • Rapid Induction: within 30 seconds
  • Can be used alone because of sedative effect in small procedures (dental work)
  • Can be a supplement to inhalation
17
Q

Most commonly used IV agents:

A
  • 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
18
Q

General Anesthesia: Inhalation

A
  • 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
19
Q

Most commonly used inhalation agents:

A
  • 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
20
Q

General Anesthesia: Adjunctive Agents

A
  • 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
21
Q

Local Anesthesia

A
  • Delivered topically (skin or mucous membranes) and by local infiltration
  • SQ under skin with small needle
  • Gel used for minor procedures
  • EMLA patch
  • Lidocaine
22
Q

Regional Anesthesia

A

A type of local anesthesia that blocks multiple peripheral nerves in a certain region of the body

23
Q

Regional Anesthesia Types:

A
  • 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
24
Q

Regional Anesthesia is best:

A

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
25
Q

Moderate Sedation

A
  • 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
26
Q

Commonly used meds for Moderate Sedation:

A

1) Amidate
2) Diazepam
3) Sublimaze
4) Versed
5) Propofol

27
Q

Commonly used General Anesthesia Adjunctive Agents:

A

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

28
Q

Positioning in the OR

A

1) Supine
2) Prone
3) Trendelenburg
4) Lithotomy
5) Lateral

29
Q

Supine

A

On back, knees restrained 2 inches above.

ideal for: hernia, mastectomy, bowel resection

30
Q

Prone

A

Face down

ideal for: spinal, back, craniotomy

31
Q

Trendelenburg

A

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

32
Q

Lithotomy

A

Feet in stirrups, exposes perineal and rectal areas

33
Q

Lateral

A
  • 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
34
Q

Intraoperative complications

A
  • Hypothermia
  • Malignant hyperthermia
  • Latex allergy
35
Q

Hypothermia in relation to surgical procedures:

A
  • 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
36
Q

Malignant hyperthermia in relation to surgical procedures:

A
  • 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
37
Q

Latex allergies

A
  • 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
38
Q

Transport to PACU

A
  • 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
39
Q

Intraoperative nursing diagnoses

A
  • Risk for anxiety
  • Injury: improper positioning, restraints, pressure
  • Impairment of skin integrity
  • Alteration in normothermia
  • Fluid volume deficit/excess
  • Risk for infection

Care of the Surgical Patient (3 decks)

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