Intraoperative patient care and safety pt. 3 Flashcards
1
Q
What are the 4 different types of anesthesia?
A
- minimal or light station (anxiolysis)
- moderate sedation or analgesia
- deep sedation or analgesia
- full anesthetic
2
Q
What are the broad terms for anesthesia?
A
- local
- regional (nerve blocks, spinal, epidural)
- managed anesthesia care
- general
3
Q
What are 6 medications use to supplement general inhalation anesthetics?
A
- benzodiazepine reversal agents (flumazenil)
- benzos (midazolam)
- muscle relaxant reversal agents (cholinergic)
- muscle relaxants (depolarizing verus nondepolarizing)
- narcotic reversal agents (naloxone)
- narcotics (opioids, synthetic opioids)
4
Q
How does the RN assist the anesthesia provider?
A
- transferring the patient to the operative or procedure table
- application of monitors
- safe patient positioning
- intubation (handing tube, cricoid pressure)
- extubation while anticipating any potential for airway obstruction
5
Q
How does an RN help an anesthesia provider when a patient is receiving spinal or epidural regional anesthesia?
A
proper positioning of the patient’s spine in either the sitting or lateral position allows the anesthesia professional to successfully access the spinal level appropriate for the procedure
6
Q
What might happen if there is increased blood loss during a procedure?
A
RN may be called on to retrieve volume expansion infusions or blood products
7
Q
What is crucial to preventing hypervolemia or hypovolemia?
A
accurate monitoring of a patient’s input and output
8
Q
What is a scrubs job when it comes to completing accurate blood loss volume totals?
A
calculating the amount of irrigation fluid used through the procedure to assist with accurate blood loss volume totals
9
Q
What is RN and anesthesia professional’s role during hysteroscopy and TURP procedures?
A
monitor intake and output to prevent fluid overload or electrolyte shifts
10
Q
How is cricoid pressure performed?
A
gently pressing the thyroid cartilage downward to close the upper esophagus
11
Q
What does cricoid pressure decrease?
A
the possibility of regurgitated stomach contents entering the airway during intubation
12
Q
What are the 2 used of nitrous oxide? (anesthestic agent)
A
- when rapid induction and recovery are desired
- for short procedures when muscle relaxation is not important
13
Q
What are 3 uses of desflurane? (anesthestic agent)
A
- can be used for maintenance in adults and children
- when rapid elimination is desired
13
Q
What is 1 nursing implication for nitrous oxide?
A
high levels of nitrous oxide can accelerate the burning of combustible materials in the OR
14
Q
What should the RN have basic understanding of when it comes to hemodynamic needs? (2 things)
A
an understanding of…
1. of the principles of hemodynamics as they relate to blood circulation.
2. patient’s medical history that could affect the patient undergoing a surgical procedure
15
Q
What are the 2 methods of supporting anticipated blood loss?
A
- autotransfusion
- admin of blood products
16
Q
What 2 things may determine the method of blood administration?
A
- patient’s religious beliefs - Jehovah’s Witness
- emergent procedures with significant blood loss
17
Q
If an accurate calculation of blood loss is necessary, how can this be performed?
A
weighing the used sponges discarded from the surgical field can provide an accurate means to determine blood loss
18
Q
A
19
Q
What is important to remember for desflurane? (anesthestic agent)
A
not for induction in children
20
Q
What is a nursing implication for desflurane?
A
halogenated anesthetic agents are triggers for MH
21
Q
What are 2 uses of sevoflurane? (anesthestic agent)
A
- for induction and maintenance of adults and children
- when rapid elimination is desired
22
Q
what is 1 nursing implication for sevoflurane?
A
halogenated anesthetic agents are triggers for MH
23
Q
What are 3 uses of propofol? (anesthestic agent)
A
- when rapid induction is desired
- when short procedures are performed alone
- for prolonged anesthesia in combination with inhalation agents or opioids
24
What are 2 nursing implications for propofol?
1. there is no known reversal agent
2. it is not used for procedural sedation by nurses in most states
25
What is 1 use of fentanyl? (anesthestic agent)
1. for high dose narcotic anesthesia in combination with oxygen
26
What is 1 nursing implication for fentanyl?
the reversal agent is naloxone
27
What are 3 uses of diazepam? (anesthestic agent)
1. for premedication
2. for awake intubation
3. for induction
28
What is 1 nursing implication for diazepam?
the reversal agent is romazicon
29
What are 3 uses of midazolam? (anesthestic agent)
1. for premedication
2. for moderate sedation
3. for induction in children
30
What is 1 nursing implication for midazolam?
the reversal agent is romazicon
31
What is the process of collecting the patient's blood intraoperatively and administering the blood back to the patient?
autotransfusion
32
Is auto transfusion an acceptable method of preventing complications with bleeding in a patient whose religion or personal belief system permits receiving blood transfusions?
yes; if the circuit from blood collection and infusing units remain connected to the patient
33
What is required when doing auto transfusion?
proper labeling of all the units of blood processed by a cell salvage unit is required
34
What should proper labeling include?
1. the patient's name
2. the patient's hospital identification number
3. the time of collection
4. the time rein fusion started
5. the time of expiration
6. a label that specifically states for autologous use only
35
How does auto transfusion work?
patient's own blood is captured through a suction tip and fed directly to a reservoir on a cell salvage unit, the blood is washed and reinfused to the patient
36
What does preoperative prep include for blood products?
1. identifying whether blood products are needed by confirming physician orders
2. completing a type and screen or crossmatch for products
37
What is a really important role for the nurse when it comes to blood products
to confirm that the patient is given consent for the use of blood products
38
Blood transport and storage are based on what and not what?
temperature based and not time based
39
Because blood transport and storage are temperature based, what should the RN do?
should maintain units of blood in the storage device from the blood bank until they are ready to transfuse
40
After a unit of blood is removed from storage, that unit of blood must be completely transfused within how much time?
4 hours
41
true or false; a blood products consent may be an independent consent or part of the surgical consent form obtained by the surgeon or anesthesia professional
true
42
before the patient is anesthetized the nurse should do what?
confirm the availability of the prepared products
43
What are 5 responsibilities of the RN for blood products?
1. obtaining the required products from the blood bank
2. maintaining the products while in the OR according to the AABB guidelines for storage
3. confirming the correct patient and product type with the anesthesia professional
4. maintaining awareness of potential reactions to the products being administered
5. anticipating the potential need for additional products
44
What is the RN guided by in the delivery of care to the surgical patient?
using the perioperative patient focused model
45
What is the RN's responsibility when it comes to physiologic response?
the responsibility to observe and anticipate the potential physiologic responses to the anesthetic, positioning, and procedure being performed
46
What are fail points for management of medications?
1. high-alert medications available in multiple concentrations
2. inconsistent labeling of medications, both on and off the sterile field
3. look-alike, sound-alike medications stored near each other
4. limited medication knowledge of allied health professionals in sterile attire
5. medications prepared without pharmacist oversight
6, medications removed from their original packaging for aseptic transfer to the sterile field
7. inconsistent methods for communicating physician orders - verbal orders, handwritten orders, standing surgeon preferences, electronic order transmission
8. multiple patient hand-overs during long procedures or breaks
9. perioperative interventions often requiring rapid response
10. fatigued workers or insufficient staff
47
What should the RN use whenever possible to avoid cross-contamination between patients/
single-dose medications
48
What are 3 other safety concerns associated with the use of multiple dose vials?
1. the risk of administering too much medication
2. confusion in labeling and expiration dates with opened vials
3. issues of proper disposal of unused pharmaceutical wastes
49
What are the 3 most problematic medications identified?
1. anticoagulants
2. antibiotics
3. steroidal compounds
50
What are the 8 rights of medication administration?
1. right patient using at least 2 identifiers
2. right medication
3. right does
4. right toute
5. right time
6. right strength or concentration
7. right medication administration ate
8. infusion pump settings
51
When have errors with narcotic overdosing occurred?
when fentanyl patches are not identified before initiation of anesthesia or postoperative narcotic pain management
52
if the preference card is the only documentation of a medication order for intraoperative administration, what should happen with that preference card?
should be placed in the patient's chart as a physician medical order
53
After receiving the medication from the RN, what should the scrub tech do?
label all meds with...
1. med name
2. strength or concentration of the med
3. dilution and diluent name
4. amount, if not apparent by markings on the container
5. date and time transferred to the sterile field
54
What kind of meds are used primarily during the operative and postoperative phase of care?
opioid analgesic medications
55
what is the medication of choice for sedation, MAC, and general anesthesia?
fentanyl
56
Why is IV fentanyl the first-line medication for treating acute pain in monitored settings?
fast onset of pain relief
57
What is the other most common pain meds used in the OR?
local anesthetics
58
What are the 2 most common local anesthetics?
1. lidocaine (1%, 2%,
2. bupivicaine (.25%, 2%)
59
Why is epi put into local anesthetics?
used to extend the anesthetizing effect by vasoconstriction of nearby venues
60
Local anesthetics are classified as either what or what?
aminoaide or aminoester formulations
61
What are examples of aminoaide medications?
lidocaine and bupiv
62
What are 3 characteristics of aminoaide meds?
1. metabolized by the liver
2. longer duration of effects
3. may accumulate after repeated doses in patients with hepatic insufficiency
63
What are examples of amino ester formulations?
procaine and tetracaine
64
What are 2 characteristics of amino ester meds?
1. hydrolyzed rapidly by plasma cholinesterase
2. short half-lives
65
What are 2 delivery methods of solutions?
1. remove the cap and deliver the entire contents without splashing into a sterile receptacle on the sterile field
2. deliver IV solutions via a bag decanter
66
What are key points for aseptic delivery of solutions?
1. do not splash or create an aerosol
2. do not recap unused solution for later use
3. the above principles apply to unused solutions in IV bags
67
What can aerosolization potentially cause?
may cause anaphylaxis in susceptible people
68
Why should we not recap unused solution for later use?
the lip of the container is considered contaminated
69
What are 3 delivery methods for medications in vials?
1. withdraw medication using a needle and syringe
2. dispense medication directly from the syringe after removing the needle
3. use a sterile transfer jet to dispense liquid medication into a labeled container on the sterile field
69
What are 2 key points for medications in vials?
1. the needle entering the vial is considered contaminated
2. popping off the cap and removing the stopper contaminates the lip of the vial and introduces glass particles to the solution
70
What are the steps for delivering a glass ampule to the sterile field?
1. use a filter needle to remove the medication
2. remove the filter needle before dispensing the medication into a sterile medicine cup
71
Why is injecting medication with a filter needle attached onto the sterile field not ok?
filter needles are designed to capture small glass fragments; injecting the medication with the filter needle attached may result in shards of glass being injected into the patient
72
Dispensing medication with a filter needle can produce what?causing what?
produce an aerosol which can cause anaphylaxis
73
What should try to stick to when dispensing ointments and creams to the sterile field?
single-use medications
74
If you are dispensing multi dose tubes of ointments and creams to the sterile field what should you do first?
discard half an inch of ointment or cream into the trash before dispensing onto the sterile field
75
true or false; the sterility of multi dose tubes is fine
false; it is questionable
76
What are 4 methods an RN can use to decrease anxiety and promote comfort in patients?
1. introduce the patient to team members upon arrival in the operating room
2. provide for patient privacy
3. offer comfort and reassurance
4. encourage the use of complementary care interventions
77
What are 4 methods an RN can provide for patient privacy?
1. keeping the patient covered unless access to the patient is needed
2. closing window shades, especially for surgery exposing sensitive ares
3. restricting access to the operating room to only those personnel actively caring for the patients
4. providing privacy for the patient and personnel to converse about the patient and his or her surgery
78
How can RN offer comfort and reassurance?
1. providing warm blankets
2. staying at the patient's bedside from induction to final positioning
3. administering any anxiolytic medication according to physician orders
4. distracting the patient with conversation that focuses on the patient
5. explaining what processes the patient can expect as he or she comes out of anesthesia
79
What are examples of complementary care interventions?
1. music therapy
2. aromatherapy and essential oil
3. hypnosis by trained individual or self-hypnosis
4. reiki therapy
5. guided imagery
6. relaxation tapes
80
What is a medication that is routinely used as a preoperative anxiolytic?
midazolam
81
Midazolam has a what effect?
dose dependent effect
82
When given IV, what is the onset of action for midazolam?
1 to 3 minutes
83
What is an important nursing consideration for midazolam in the elderly?
they can achieve anxiolytic effects of the medication with one half of the ordered dose
84
Besides having an anxiolytic effect, what other effect does midazolam have?
an amnesic effect
85
What does the amnesic properties of midazolam help with?
this property contributes to overall increase in satisfaction with operative procedures because the patient cannot recall perceived unpleasant activities associated with operative procedures
86
How can midazolam be given in pediatric populations?
it can be given orally in a syrup formation
87
Dosing of midazolam in pediatric populations can be difficult because...
child may develop respiratory depression and arrest
88
Dosing of midazolam in pediatric populations should be in where?
a controlled environment that is equipped with a pediatric emergency respiratory and cardiac support and an anesthesia professional is there
89
What will Jehovah's witnesses accept as far as fluids?
colloid or crystalloid replacement fluids
90
What kind of infusions will Jehovah's witnesses accept?
hetastarch as volume expanders
91
What are 5 situations in which ethical issues may arise with an RN?
1. when RN has personal beliefs that are not in agreement with patient desires, so the nurse may need to arrange for another nurse to care for the patient
2. when the RN is uncomfortable with the patient's cultural beliefs, so the nurse may need to gain further education
3. when the RN must advocate for the patient to protect him or her from incompetent, unethical, or illegal practices
4. when the RN questions care that appears inappropriate or substandard
5. when the RN observes behavioral, verbal, or physical abuse
92
