lecture four--perioperative nursing (preoperative)

Question 1

GOALS

Answer 1

PATIENT SAFETY
collaborative teaching of perioperative personnel
maintain surgical standards of care

Question 2

surgical team

Answer 2

perioperative nurse
circulating nurse
scrub tech or RN
anesthesia
PACU nurse

Question 3

preoperative nurse

Answer 3

begins surgical experience with pt./family
confirms all surgical orders
VERIFIES informed consent
checks lab work and informs surgeon of any discrepancies
starts IV, all prep work prior to surgery

Question 4

circulating nurse

Answer 4

pt. assessment before and during procedure
collaboration with surgeon, anesthesia, and other OR personnel (anticipate needs)
management of OR–or conditions, asepsis, equipment, coordinating OR team, surgical count, positioning pt.
verify consent completion, lab work, documentation
review pre-op checklist
initiate “time out”
ensure pt. safety and a caring environment

Question 5

surgical tech

Answer 5

performs hand scrub and sets up the sterile field
prepares supplies and equipment
assists with draping of patient
passes instruments to surgeon and assists with procedure
tracks instruments, sponges and sharps
confirms specimens with circulating RN
assists with tracking irrigation fluids and blood loss

Question 6

anesthesia

Answer 6

MD or CRNA
assesses medical readiness for surgery
maintain airway
monitor and control pts. vital life functions (HR, BP, temp, fluid balance)
controls pain and LOC

Question 7

PACU nurse

Answer 7

monitor airway and loc
monitor pain level and administer pain meds to reach a comfortable goal
monitor vital signs

Question 8

patient SAFETY

Answer 8

patient identification
verify informed consent (correct?)
verify records of health hx and physical
results of diagnostic test
allergies
assessing special needs of pt.

Question 9

what is a time out and why is it important

Answer 9

a time out occurs immediately before starting the invasive procedure and is another way to check that you have the right patient for the right procedure. The patient is awake to give yet another verbal consent

Question 10

patient safety–SCIP

Answer 10

give antibiotics 1 hr before
hair removal immediately prior to cut (clip not shave)
prevent hypothermia–ideally at 36C within 15 mins of arrival to PACU
blood glucose less than 200 mg/dL on POD1 and POD2 cardiac patients (high blood sugar =high infection risk)
VTE prophylaxis (SCDs, TED Hose, heparin therapy)
beta blocker Tx

Question 11

principles of surgical asepsis

Answer 11

sterile field
opening sterile items
sterile items/tables
NEVER turn your BACK on the sterile field

surgical scrub
daily 5-10 minutes
fluids fall in direction of gravity (hands always above elbows)

Question 12

ALCOHOL BASED HAND RUBS

Answer 12

3 MINUTE dry time
no one wants a fire

Question 13

guidelines for positioning

Answer 13

preserve dignity
pad all bony prominences and restraints
maintain adequate respiratory exchange and circulation
avoid hyperextension or strain on joints and muscles
ensure perfusion to extremities
don’t allow extremities to dangle
don’t position pt. on extremity