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Exam 3 > Intraoperative Nursing > Flashcards

Intraoperative Nursing Flashcards

1
Q

Charge Nurse

A

In charge of all the scheduling, admissions, etc. Very stressful job

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2
Q

Manager

A

Make sure everyone has supplies

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3
Q

Educator

A

Make sure you have a good foundation of the operating room

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4
Q

RNFA

A

Registered Nurse first assist

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5
Q

Nurse Anesthetist

A

Administers and reverses effects of anesthesia

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6
Q

Scrub

A

Don’t have a degree but have to certified- Sterile Person who passes sterile instruments to surgical team

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7
Q

Circulator

A

RN- identifies the physiological, psychological, and cultural needs of the OR patient in order to restore or maintain the health and welfare of that patient before, during, and after surgical intervention
*SAFETY

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8
Q

ULP

A

*Unlicensed personnel
1. Individuals who are trained in the job to function in an assistive role to the RN
(ex-OR aides, orderlies, ortho-techs & central processing techs)
2. RN may delegate but must also supervise the work
3. Alignment of pt., make sure pressure points are padded

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9
Q

Central Processing Techs

A

In charge of cleaning equipment (4 step process)

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10
Q

Scrub Roles in OR

A
  1. May be an RN, Surg tech, LPN
  2. Assists in gathering supplies, equipment & helping set up OR room
  3. Set-up and maintain sterile field, hands supplies and instruments to surgeons, keeps count of sponges, sharps, supplies & instruments, & monitors sterile technique
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11
Q

Circulator Roles in OR

A
  1. Collects pre-op patient information
  2. Verifies consent
  3. Sets up OR room, gathers supplies & equipment
  4. Opens instruments and supplies
  5. Anticipates and meets needs of surgeon, anesthesia, and scrub
  6. Monitors blood loss
  7. Plans and coordinates care in OR
  8. Supports patient and acts as pt. advocate
  9. Monitors and controls OR environment
  10. Documents nursing care and counts
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12
Q

Initial Intra-op assessment

A
  • Chart Check
  • Physical Assessment
  • Variables assessment
  • Assess for any jewelry, screws, plates, etc in patient
  • Low platelet count. low potassium, etc (patient wouldn’t get procedure
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13
Q

Psychological Assessment

A
  1. Reviewing critical patient data first
  2. Identifying and addressing anxiety and fear
  3. Teaching about OR activities, clarifying misunderstandings
  4. Asking questions that are about facts & feelings
  5. Providing privacy when performing the interview
  6. Discussing expectations
  7. Maintaining an attitude of hope
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14
Q

Sociocultural and Spiritual Assessment

A
  • Personal Space and Modesty
  • Eye contact and touch
  • Pain management
  • Birth and Death Rituals
  • Family relationships
  • Religious Orientation
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15
Q

Developmental Assessment

A
  • Fluid and Electrolyte balance
  • Body temp
  • Pain
  • Anxiety
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16
Q

Pre-Op Nursing Diagnoses

A
  • Anxiety

- Knowledge Deficit

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17
Q

OR Nursing Diagnoses

A
  • Risk for injury
  • Risk for infection
  • Altered Protection
  • Risk for impaired skin integrity
  • Altered body temperature
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18
Q

Assist Anesthesia With: (Nursing Diagnoses)

A
  1. Ineffective breathing pattern
  2. Ineffective Airway clearance
  3. Altered tissue perfusion
  4. Risk for aspiration
  5. Risk for fluid volume imbalance
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19
Q

Dress Code

A

Unrestricted, Semi-restricted, Restricted

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20
Q

Unrestricted dress code

A

Can wear street clothes

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21
Q

Semi-Restricted

A

Scrubs and hats required, staff and patients only (red line will start semi-restricted area

22
Q

Restricted

A

Where surgical procedures are performed, scrubs, hats, and masks are required (once first item is popped open
*Don’t pull mask below nose

23
Q

Surgical Asepsis

A
  1. Always face sterile field
  2. If sterile items fall on the floor, it is considered contaminated
  3. Keep 12 inches from sterile field
  4. Check package integrity
  5. Pop open away from you if opening sterile package into sterile field
  6. Do not lean over field when opening packages
  7. Do not splash fluids when dispensing
  8. Everyone in room monitors each other for the maintenance of the sterile field
    * Do NOT touch tech
24
Q

Patient OR positioning

A
  • Main purpose is to provide optimum exposure and access to the operative site
  • Should sustain body alignment, circulatory and respiratory function
  • Must provide access to IV and airway
  • Should not compromise neuromuscular structures and skin intergrity
25
Q

OR skin Prep

A
  • Main purpose is to make the operative site as free from microorganisms and dirt as possible
  • Hair removal should be done in pre-op (clippers-no shaving)
  • Start in area where incision will be made and move out in circular motion
  • Move from clean to dirty
  • Scrubbing/soapy solution may be used first, followed by a paint solution
  • Prep should last 5 min (10 min for CV and Ortho preps)
  • After reaching the prep area edges, a new sponge dipped in the antiseptic should be used beginning at the proposed incision site (repeat 3x atleast)
26
Q

Electrosurgical Unit (ESU) - (Bovie)

A

Created in 1920’s by Dr. Cushing and Dr. Bovie

  • Uses electric current to cut and coagulate fat, fascia, muscle, internal organs & small blood vessels
  • Decreases amount of diffuse bleeding during surgery
  • Patient could get burned so bovie pad is places on big muscles and they have to have good skin contact (no hair)
27
Q

AICD- Automatic Implantable Cardioverter Defibrillators

A

-Has to be turned off if pt. has this device (shocks patient)-Monitors heart rate

28
Q

General Anesthesia

A

reversible, unconscious state characterized by amnesia, analgesia, depression/loss of reflexes, muscle relaxation, & homeostasis or manipulation of physiological functions(BP and HR)

  • As close to death as you can bring anybody
  • Put on a ventilator to breathe for pt.
29
Q

Regional Anesthesia

A

reversible loss of sensation &/or movement when a local anesthetic is injected to block or anesthetize nerve fibers (Spinals, epidurals, caudals or major peripheral blocks such as brachial nerve block)

30
Q

Local Anesthesia

A

The surgical site is injected with a anesthetic, such as lidocaine, into the SQ tissue in order to depress the superficial peripheral nerves
* when med ends in -caine, it is a local anesthetic.

31
Q

Epidural

A 
Dose Dependent; Caudal block
Negative Effects:
1. vBP
2. urinary retention and cause bladder damage 
3. Could lose sensation
32
Q

Spinal

A

Dose Dependent; Dangerous.
Negative Effects
1. vBP
2. urinary retention and cause bladder damage
3. Could lose sensation
4. Anesthetic traveling up and causing respiratory depression
5. Could hit spinal cord and CFS leaks (causing an awful headache ^ to two weeks)

33
Q

Conscious Sedation

A
  • State of reduced consciousness which allows performance of unpleasant procedures while preserving protective airway reflexes & ability to respond to verbal commands
  • Amnesic, analgesic, & sedative pharmacological agents are given (Morphine & Midazolam-versed)-IV Push (could overdose)
34
Q

Stages of Anesthesia

A

Induction, Maintenance, Emergence

*Induction and Emergence should be very quiet because hearing is the last to go

35
Q

Induction

A

Begins with administration of anesthetic agents to the positioning of the patient

36
Q

Maintenance

A

From the position until the surgical incision is closed

37
Q

Emergence

A

From the time the patient begins to “wake up” until the patient is transferred to the PACU

38
Q

Balances Anesthesia

A
  • Current techniques used to administer anesthesia
  • The use of combining IV anesthetics, analgesics, amnesics & inhalation drugs to achieve unconsciousness, skeletal muscle relaxation, pain relief & physiological homeostasis
  • Give sedative & pain med WITH paralyzing agents (could hear and feel but CANT move- causes a lot of stress
39
Q

Post Anesthesia Recovery unit (PACU)

A
  • Initial assessment is focused on respiratory status, CV status, pain level, type of anesthesia given, temperature, control of N/V
  • *AIRWAY
  • Vitals are done Q 15 min
  • LOC, O2 Sat
  • Side position is recovery position if breathing on own until LOC comes back
40
Q

PACU nursing diagnoses

A
  1. Pain
  2. Ineffective Breathing Pattern
  3. Ineffective Airway Clearance (snoring, etc)
  4. Altered tissue perfusion
  5. Risk for aspiration
  6. Nausea
  7. Risk for fluid volume balance
  8. Risk for altered body temperature
  9. Alteration in sensory perception
  10. Fear, Anxiety
41
Q

Ineffective Airway Clearance

A

S&S- snoring, nasal flaring, use of accessory muscles, intercostal retractions
Causes- tongue occluding the pharynx
Treatment- chin lift/jaw thrust, stimulate pt. to cough & DB, insert oral airway, intubation
**Intervene before airway blockage gets bad or will have to trach.

42
Q

Ineffective Breathing Pattern (S&S & Causes)

A

S&S- CO2 >45 mmHg, extreme sedation, v RR, shallow respirations, HR & BP elevated or depressed
Causes- residual effects of anesthesia, pain, obesity, supine positioning, H/O poor circulatory perfusion

43
Q

Ineffective Breathing Pattern (Treatment)

A

Treatment- stimulate patient to take deep breaths, O2, elevate HOB, place in lateral position, provide pain relief

  • Assess for hypovolemia & replace with appropriate fluid
  • Listen for rales (adolectasis)
  • Adolectasis- collapsing of alveoli (secretions in lungs)
44
Q

Alteration in Tissue Perfusion (Hypotension)

A
  • BP s
45
Q

Alteration in Tissue Perfusion (Hypertension)

A
  • BP >160/90
    -Causes- pain, anxiety, full bladder, pulmonary edema, hypervolemia, hypothermia, hypoxia
    Treatment- treat cause & give quick acting antihypertensives
46
Q

Acute Pain

A
  • Must know what anesthetics & analgesics were given in the OR
  • Need to adjust pain med dose & assess RR frequently
  • Get pt. body temp to normal
  • Touch and repositioning may help
47
Q

Top Pain Meds- Sublimaze

A

AKA Fentanyl

-Severe Pain- Major CNS depression, used as supplement to general anesthesia

48
Q

Top Pain Meds- Hydromorphone

A

AKA Dilaudid *Stronger than morphine

-CNS depression, used for moderate to severe pain

49
Q

Top Pain Meds- Naloxone

A

AKA Narcan- *Reverse effects of fentanyl and dilaudid

Adult dose- 0.2-0.4 mg of IV push

50
Q

Alteration in Body temperature

A
  • Body temp < 95
  • Elderly and children very suseptible
  • More of a problem in big cases where large cavity is opened
  • Goal is temp >97
  • Caises bradycardia & shallow respirations
  • Shivering increases O2 demand
  • May lead to hypotension, metabolic acidosis & cardiac dysrhythmias
51
Q

Comfort and Safety

A
  • Must know what anesthetics & analgesics were given in the OR
  • Need to adjust pain med dose & assess RR frequently
  • Get pt. body temp to normal
  • Touch and repositioning may help
  • Stay at bedside if pt. is fearful
  • v fear/anxiety by making simple explanations of where the pt. is, what is going to happen, how they are doing
  • Reunite pt. and family ASAP
52
Q

Emergence Delirium

A

S&S- strong, non-purposeful movements, crying, verbalizing and moaning & unable to follow commands
Causes- Certain anesthetic agents, H/O anxiety, substance abuse, hypoxemia, children
Treatment- stay with pt., reassure pt, pull curtains around bed, dim lights
**If patient seems confused after being alert, the first thing you check is 02 sats

Exam 3 (6 decks)

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