Intraoperative Nursing Management

Question 1

do older adults have high risk than younger people when it comes to analgesics?

Answer 1

YES

Question 2

when do preoperative risks increase?

Answer 2

each decade after the age of 60

Question 3

why are older adults at greater risk?

Answer 3

due to co-morbidities, more advanced disease, and increased susceptibility to nosocomial illnesses

Question 4

why do older adults need a lower dose of anesthetic agents?

Answer 4

due to the decreased tissue elasticity and reduced lead tissue mass

Question 5

how is the liver affected as older adults?

Answer 5

liver size decreases the rate at which the liver can inactivate many anesthetic agents

Question 6

how is kidney function affected in older adults?

Answer 6

the function decreases so it slows the elimination of waste products and anesthetic agents

Question 7

what does the inability to increase metabolic rate put older adults at risk for?

Answer 7

hypothermia

Question 8

what is a registered nurse first assistant (RNFA)?

Answer 8

they practice under direct supervision of a surgeon

- handle tissue, provide exposure to the operative field, suturing, and maintaining hemostasis

Question 9

what is the role of the circulating nurse?

Answer 9

verifies consent, coordinates the team, and ensuring cleanliness, proper temperature, humidity, lighting, safe function of equipment, and the availability of supplies and materials

Question 10

what is the anesthesiologist?

Answer 10

a physician specifically trained in the art and science of anesthesiology

Question 11

what is the role of the anesthesiologist?

Answer 11

-assess patient before surgery, selects anesthesia, administers, intubates patient if necessary, manages technical problems

Question 12

what are the three zones what help decrease microbes?

Answer 12

• unrestricted
• semi-restrictive
• restrictive

Question 13

what is the unrestrictive zone?

Answer 13

street clothes are allowed

Question 14

what is the semi-restrictive zone?

Answer 14

where attire consists of scrub clothes and caps

Question 15

what is the restrictive zone?

Answer 15

where scrub clothes, shoe covers, caps, and masks

Question 16

when is double gloving routine?

Answer 16

when sharp bone fragments are present

Question 17

what are the 5 types of anesthesia?

Answer 17

• general anesthesia
• local anesthesia
• moderate sedation
• monitored anesthesia care (MAC)
• local anesthesia

Question 18

what is anesthesia a state of?

Answer 18

narcosis, analgesia, relaxation and reflex loss

Question 19

what is narcosis?

Answer 19

severe nervous system depression produced by pharmacological agents

Question 20

are patients arousable while under general anesthesia (GA)?

Answer 20

no - not even to pain

Question 21

what is anesthesia awareness?

Answer 21

partially waking while under general anesthesia

Question 22

who are the patients at risk for anesthesia awareness?

Answer 22

cardiac, obstetric, and major trauma patients

Question 23

what are the 4 stages of GA?

Answer 23

• beginning anesthesia
• excitement
• surgical anesthesia
• medullar depression

Question 24

what is beginning anesthesia?

Answer 24

pt breathes it in, dizziness, warmth and a feeling of detachment may be experience

Question 25

what is excitement?

Answer 25

struggling, shouting, talking, singing, laughing, or crying - often avoided if the anesthetic agent is administered smoothly and quckly

Question 26

what is surgical anesthesia?

Answer 26

continued administration of anesthetic vapour or gas

Question 27

what is medullary depression?

Answer 27

reached if too much anesthetic has been administered

Question 28

is there a sharp division between the stages?

Answer 28

not during smooth administration of anesthetic agent

Question 29

what are the most reliable guide to a patient's condition?

Answer 29

- pupil response - BP - resp and cardiac rate

Question 30

what is the most common anesthetic agent?

Answer 30

nitrous oxide

Question 31

where is regional anesthesia injected?

Answer 31

around nerves so that region is supplied by these nerves is anesthetized

Question 32

when is an anesthetic agent considered "worn off"?

Answer 32

not until all three systems (motor, sensory, and autonomic) are no longer in affect

Question 33

where is an epidural anesthetic injected?

Answer 33

a local anesthetic into the epidural space that surrounds the dura mater of the spinal cord

Question 34

why are epidural doses higher than spinal doses?

Answer 34

because they do not come into direct contact with the spinal cord or nerve roots

Question 35

what is spinal anesthesia?

Answer 35

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)

Question 36

what areas of the body are affected with spinal anesthesia?

Answer 36

lower extremities and lower abdomen

Question 37

what are the local conduction blocks with spinals?

Answer 37

- brachial plexus block - paravertebral anesthesia - transsacral (caudal) block

Question 38

what is moderate sedation used for?

Answer 38

reducing patient anxiety and control pain during diagnostic or therapeutic procedures

Question 39

what is the goal of moderate sedation?

Answer 39

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

Question 40

what does the professional monitoring the patient in charge of?

Answer 40

monitoring for dysrhythmias, administering oxygen, and performing resuscitation

Question 41

what is monitored anesthesia care (MAC) used for?

Answer 41

healthy patients undergoing minor surgical procedures and some critically ill patients who may be unable to tolerate anesthesia without invasive monitoring

Question 42

where is local anesthesia injected (LA)?

Answer 42

into the tissues where the incision will be

Question 43

what are the 5 advantages of LA?

Answer 43

- simple, economical and nonexplosive - minimal equipment - postoperative recovery is brief - undesirable effects of GA are avoided - ideal for short and minor procedures

Question 44

what may happen to the patients temperature during anesthesia?

Answer 44

may drop

Question 45

what is considered hypothermia?

Answer 45

36.6 or less

Question 46

what might happen to glucose during anesthesia?

Answer 46

glucose metabolism is reduced - might result in metabolic acidosis

Question 47

what causes a drop in temp while under anesthesia?

Answer 47

- 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

Question 48

should warming be rapid?

Answer 48

no! - gradual

Question 49

what is malignant hypothermia?

Answer 49

rare inherited muscle disorder that is chemically induced by anesthetic agents

Question 50

what is the earliest sign of malignant hypothermia?

Answer 50

tachycardia