Intraoperative Nursing Management Flashcards
do older adults have high risk than younger people when it comes to analgesics?
YES
when do preoperative risks increase?
each decade after the age of 60
why are older adults at greater risk?
due to co-morbidities, more advanced disease, and increased susceptibility to nosocomial illnesses
why do older adults need a lower dose of anesthetic agents?
due to the decreased tissue elasticity and reduced lead tissue mass
how is the liver affected as older adults?
liver size decreases the rate at which the liver can inactivate many anesthetic agents
how is kidney function affected in older adults?
the function decreases so it slows the elimination of waste products and anesthetic agents
what does the inability to increase metabolic rate put older adults at risk for?
hypothermia
what is a registered nurse first assistant (RNFA)?
they practice under direct supervision of a surgeon
- handle tissue, provide exposure to the operative field, suturing, and maintaining hemostasis
what is the role of the circulating nurse?
verifies consent, coordinates the team, and ensuring cleanliness, proper temperature, humidity, lighting, safe function of equipment, and the availability of supplies and materials
what is the anesthesiologist?
a physician specifically trained in the art and science of anesthesiology
what is the role of the anesthesiologist?
-assess patient before surgery, selects anesthesia, administers, intubates patient if necessary, manages technical problems
what are the three zones what help decrease microbes?
- unrestricted
- semi-restrictive
- restrictive
what is the unrestrictive zone?
street clothes are allowed
what is the semi-restrictive zone?
where attire consists of scrub clothes and caps
what is the restrictive zone?
where scrub clothes, shoe covers, caps, and masks
when is double gloving routine?
when sharp bone fragments are present
what are the 5 types of anesthesia?
- general anesthesia
- local anesthesia
- moderate sedation
- monitored anesthesia care (MAC)
- local anesthesia
what is anesthesia a state of?
narcosis, analgesia, relaxation and reflex loss
what is narcosis?
severe nervous system depression produced by pharmacological agents
are patients arousable while under general anesthesia (GA)?
no - not even to pain
what is anesthesia awareness?
partially waking while under general anesthesia
who are the patients at risk for anesthesia awareness?
cardiac, obstetric, and major trauma patients
what are the 4 stages of GA?
- beginning anesthesia
- excitement
- surgical anesthesia
- medullar depression
what is beginning anesthesia?
pt breathes it in, dizziness, warmth and a feeling of detachment may be experience
what is excitement?
struggling, shouting, talking, singing, laughing, or crying - often avoided if the anesthetic agent is administered smoothly and quckly
what is surgical anesthesia?
continued administration of anesthetic vapour or gas
what is medullary depression?
reached if too much anesthetic has been administered
is there a sharp division between the stages?
not during smooth administration of anesthetic agent
what are the most reliable guide to a patient’s condition?
- pupil response
- BP
- resp and cardiac rate
what is the most common anesthetic agent?
nitrous oxide
where is regional anesthesia injected?
around nerves so that region is supplied by these nerves is anesthetized
when is an anesthetic agent considered “worn off”?
not until all three systems (motor, sensory, and autonomic) are no longer in affect
where is an epidural anesthetic injected?
a local anesthetic into the epidural space that surrounds the dura mater of the spinal cord
why are epidural doses higher than spinal doses?
because they do not come into direct contact with the spinal cord or nerve roots
what is spinal anesthesia?
an extensive conduction nerve blocker that is produced when a local anesthetic agent is introduced into the subarachnoid space at the lumbar level (between L4/L5)
what areas of the body are affected with spinal anesthesia?
lower extremities and lower abdomen
what are the local conduction blocks with spinals?
- brachial plexus block
- paravertebral anesthesia
- transsacral (caudal) block
what is moderate sedation used for?
reducing patient anxiety and control pain during diagnostic or therapeutic procedures
what is the goal of moderate sedation?
to depress a patient’s level of consciousness to a moderate level to enable surgical, diagnostic, or therapeutic procedures to take place while ensuring comfort
what does the professional monitoring the patient in charge of?
monitoring for dysrhythmias, administering oxygen, and performing resuscitation
what is monitored anesthesia care (MAC) used for?
healthy patients undergoing minor surgical procedures and some critically ill patients who may be unable to tolerate anesthesia without invasive monitoring
where is local anesthesia injected (LA)?
into the tissues where the incision will be
what are the 5 advantages of LA?
- simple, economical and nonexplosive
- minimal equipment
- postoperative recovery is brief
- undesirable effects of GA are avoided
- ideal for short and minor procedures
what may happen to the patients temperature during anesthesia?
may drop
what is considered hypothermia?
36.6 or less
what might happen to glucose during anesthesia?
glucose metabolism is reduced - might result in metabolic acidosis
what causes a drop in temp while under anesthesia?
- low temp in OR
- infusion of cold fluids
- inhalation of cold gases
- open body wounds or cavities
- decreased muscle activity
- advanced age
- pharmaceutical agents used
should warming be rapid?
no! - gradual
what is malignant hypothermia?
rare inherited muscle disorder that is chemically induced by anesthetic agents
what is the earliest sign of malignant hypothermia?
tachycardia
