Notes Flashcards
What marks the beginning and end of the intraoperative nursing phase?
Begins with the client’s arrival in the operating room and ends with the client’s transfer to the recovery room.
What are the nursing goals during the intraoperative phase?
To ensure patient safety, comfort, and effective communication.
Who are the members of the scrubbed surgical team?
- Surgeon
- Assistant to the surgeon
- Scrub Nurse
Who constitutes the unscrubbed surgical team?
- Anesthesiologist/Anesthetist
- Circulating Nurse
- Pathologist
- Others
What are the primary responsibilities of the surgeon?
- Preoperative medical history and physical assessment
- Perform the operative procedure according to patient needs
- Primary decision maker regarding surgical technique
What are the responsibilities of the assistant surgeon?
- Assists the surgeon as requested
- Holds retractors in the wound
- Places clamps on blood vessels
- Assists in suturing and ligating bleeders
What is the role of the anesthesiologist during surgery?
- Administers and controls anesthetic
- Ensures availability of necessary equipment
- Monitors vital signs
- Keeps the surgeon informed of the client’s condition
What are the key responsibilities of the scrub nurse?
- Sets up sterile supplies
- Assists in gowning and gloving
- Maintains the sterile field
- Keeps accurate counts of instruments and sponges
What are the functions of the circulating nurse?
- Greets and identifies the patient
- Coordinates the operating room
- Maintains sterility
- Assists in patient positioning
What are the three zones of the surgical area?
- Unrestricted
- Semi-restricted
- Restricted
What is the required temperature range for the procedure room?
68 F - 75 F (20 - 24 degrees C)
What is the humidity level that should be maintained in the procedure room?
30 - 60%
How many air exchanges per hour are required in each procedure room?
At least 15, with at least 3 being fresh air.
What is the purpose of surgical attire?
To minimize risk of contamination and maintain sterility.
What is the definition of surgical scrub?
Process of minimizing microorganisms on hands and arms through mechanical and chemical means.
Name three common antimicrobial skin agents used for surgical scrub.
- Chlorhexidine Gluconate
- Povidone iodine
- Triclosan
What is the time scrub method?
Scrubbing each surface of hands and fingers for a specified time of 1 ½ minutes.
What is the principle of surgical asepsis?
Only sterile items are used within the sterile field.
What is the dorsal recumbent position used for?
Abdominal, extremity, vascular, chest, neck, facial, ear, breast surgeries.
What is the prone position used for?
Surgeries involving the posterior surface of the body.
What is the Trendelenburg position used for?
Surgeries involving the lower abdomen and pelvic organs.
What is the reverse Trendelenburg position used for?
Upper abdominal, head, neck, and facial surgery.
What is the lithotomy position used for?
Perineal, vaginal, rectal surgeries; combined abdominal vaginal procedures.
What is the jackknife position used for?
Rectal procedures, sigmoidoscopy, and colonoscopy.
What is narcosis?
A state of profound unconsciousness produced by a drug.
What is induction in anesthesia?
The period from the beginning of anesthetic administration until the client loses consciousness.
What are the stages of general anesthesia?
- Beginning anesthesia or induction
- Excitement or delirium
- Surgical/operative anesthesia
What parameters are monitored during anesthesia?
- Respiration
- O2 saturation
- CO2 levels
- Heart rate and blood pressure
- Urine output
What characterizes surgical/operative anesthesia?
Begins with generalized muscle relaxation and ends with loss of reflexes and depression of vital functions.
What occurs during medullary paralysis?
Begins with depression of vital functions and ends with respiratory failure, cardiac arrest, and possible death.
What are the methods of administration of general anesthesia?
- Inhalation
- Intravenous
How is inhalation anesthesia delivered?
Gases and vapors can be delivered via face mask or endotracheal tube.
What is the purpose of the laryngeal mask airway (LMA)?
A device for maintaining a patient’s airway without tracheal intubation.
What is regional/local anesthesia?
Briefly disrupts sensory nerve impulse transmission from a specific body area or region, without impairing consciousness.
What is topical application in regional anesthesia?
Anesthetic agent applied directly into the mucosal membrane or an open wound.
What defines local infiltration anesthesia?
The agent is injected into the tissue around the incisional area, producing temporary loss of sensation.
What is a peripheral nerve block?
Anesthetic agents are administered directly into or around one nerve or group of nerves.
What is caudal anesthesia?
Produced by injection of the local anesthetic into the caudal or sacral canal.
What is spinal anesthesia?
Anesthetic agent is introduced into the cerebrospinal fluid in the subarachnoid space.
What is epidural anesthesia?
Anesthetic agent is administered into the epidural space, sometimes using a catheter for more medications.
What is continuous lumbar epidural anesthesia (CLEA)?
Continuous injection of an anesthesia solution into the sacral and lumbar plexuses.
What is the purpose of draping during surgery?
To create and maintain an adequate sterile field during operation.
What is the counting method used during surgery?
Accounting for items placed on the sterile table during the surgical procedure.
What are the three main counts in the counting method?
- Baseline count
- 1st closing count
- 2nd closing count
What is an anaphylactic shock during anesthesia?
Caused by idiosyncrasy of the anesthetic.
What is malignant hyperthermia?
A rare reaction to anesthetic inhalants and muscle relaxants characterized by hypermetabolism and elevated body temperature.
What is the nursing diagnosis for a patient undergoing anesthesia?
- Risk for fluid volume deficit or excess
- Risk for hypothermia or hyperthermia
- Risk for infection
- Risk for altered tissue perfusion
- Risk for injury
What is the major goal during the intraoperative period?
Maintenance of fluid balance, normothermia, prevention of infection, adequate tissue perfusion, and absence of injury.
What is the role of the circulator during the counting process?
Documents the count for each type of item and informs the surgeon of incorrect counts.
What is the purpose of continuous thoracic epidural anesthesia (CTEA)?
Effective for reducing pain after thoracic and abdominal surgery, and rib fractures.
Fill in the blank: The higher the number on surgical sutures, the _______.
[smaller the size]
What is the time frame for removing sutures used on the abdomen?
7-10 days.
What are the common surgical incisions?
- Butterfly incision
- Limbal incision
- Halstead/elliptical incision
- Abdominal incision
- McBurney’s incision
- Pfannenstiel incision
- Lumbotomy or transverse incision
What are the five main layers of the abdominal cavity?
- Skin
- Subcutaneous
- Fascia
- Muscle
- Peritoneum
What is a suture?
Any material used to sew, stitch, or hold tissue together until healing occurs.
What is the purpose of a ligature?
A material that is tied around a blood vessel or hollow organ to occlude its lumen.
What are the types of suture needles?
- Cutting needles
- Non-traumatic needles
What is the risk associated with fast movement of an unconscious patient during anesthesia?
Circulatory depression or shock.
What is the purpose of the safety strap in the operating room?
To secure the client during the procedure
Ensures safety and prevents movement.
What should be verified regarding client positioning?
To protect nerves, circulation, respiration, & skin integrity
Proper positioning is crucial for patient safety.
What action should be taken for pressure areas during surgery?
Always pad pressure areas
Padding helps prevent pressure ulcers.
Who is responsible for quickly supplying newly requested items to the anesthesia or scrub team?
The circulating nurse
The circulating nurse plays a key role in maintaining workflow.
What role does the surgical nurse act in relation to the client?
Client advocate
This includes providing privacy & protection from harm.
What must be documented in the operating room?
All OR care
Documentation is essential for legal and safety reasons.
What should be maintained during the procedure for the client’s comfort?
A quiet, relaxing atmosphere
The client can hear during anesthesia.
What is the ‘TIME OUT’ in surgical procedures?
An immediate pause by the entire surgical team to confirm the correct patient, procedure, and site
Introduced in 2003 as part of the Universal Protocol.
What does the ‘TIME OUT’ represent?
The final recapitulation and reassurance of accurate patient identity, surgical site, and planned procedure
Ensures that all team members agree on the details.
What is required from the surgical team during the ‘TIME OUT’?
100% oral or visible agreement following the time-out statement
This can be a nod or gesture.
What is an electrosurgical pencil used for?
Basic surgical instrument for cutting and coagulating tissue
It utilizes electrical current.
What is the function of a harmonic scalpel?
To cut and coagulate tissue using ultrasonic vibrations
Minimizes thermal damage to surrounding tissues.
Name a type of surgical instrument used for holding tissue.
Tissue forceps
Essential for grasping and manipulating tissues during surgery.
Fill in the blank: The _______ is used to hold needles during suturing.
needle holder
Key tool for suturing techniques.
What is the purpose of a towel clip in surgery?
To secure drapes in place
Prevents movement of sterile drapes during procedures.
True or False: The surgical homestic forceps set is used for grasping and manipulating tissues.
True
These forceps are specifically designed for surgical applications.
What is a retractor used for during surgery?
To hold back tissues and provide visibility at the surgical site
Essential for accessing deeper areas during surgery.
What is the role of suction in the operating room?
To remove blood, fluids, and debris from the surgical site
Maintains a clear view and reduces the risk of infection.
