Operative Nursing Flashcards
Time Out/Pause for Cause
- Performed by patient & entire healthcare team (nurse, surgeon, anesthesiologist, resident, tech)
- Confirm pt identity, surgical procedure, surgical site
Time Out Elements
*Correct patient: state full name as printed on ID band + 2nd identifier (dob, SS, telephone, address, photo)
*Correct procedure: pt state
*Correct surgical site: pt state & signed by surgeon/pt
- Other things reported: positioning, medications, etc.
When are time outs done
- Preoperative period
- Entry into surgical suite prior to anesthesia
- Before incision
Informed consent for?
Surgery & anesthesia
- Communication between surgeon and pt
- Legal and ethical requirement
Role of surgeon/anesthesiologist in informed consent
Obtain informed consent
Role of nurse in informed consent
- Double check: clarify info, ensure pt understanding, correct misconceptions
- Emotional: ease concern of pt/family/support person
- Witness to process and sign form
Components of surgical informed consent
- Consent for procedure/anesthesia
- Name of surgeon/anesthesiologist
- Reason surgery/anesthesiology will benefit pt
- Alternative options for surgery/anesthesia
- Consent to administer blood products for surgery
Inability to consent
Cognitive impairment, Deaf/foreign language, Cannot physically sign, Minors, Emergencies
- Durable power of attorney signs eg. guardian
- Hospital interpret, can’t sign – mark an X
- Minors: parent/legal guardian, old enough
- Emergency: verbal consent or two providers sign
Nurse role before surgery for advanced directive
Document existence of AD/Living Will and place a copy of these documents in chart
Nursing management: preoperative history
- *Allergies/sensitivities (latex)
- *Last oral intake
- *Any medical implants or devices
- *Any piercings
- Previous anesthesia + response
- Surgical history, healing history
- Social history: alc, smoking, etc.
- History of mental illness/abuse
- Support systems
- Advanced directives
Preoperative nursing assessment
*Medications assessment: lab analysis or focused physical exam
- Anticoags: heparin, warfarin, lovenox –> bleeding risk
- Glucose metabolism altering meds: insulin, oral hypoglycemic agents, chronic steroid use –> hyperglycemia or hypoglycemia
- Antihypertensives: diuretics, beta blockers, ACE inhibitors –> hypotension in combo w other meds, hypertension without
- *Confirm skin and bowel prep completed
- Vital signs
- Head-to-toe physical exam
- Radiology tests
Nursing management: preoperative interventions
- *IV insertion
- *Ensure removal of jewelry and prosthetics
- Administer any preoperative meds, like anti-anxiety
- Foley catheter (usually done in OR)
- Skin prep (shaving usually done in OR)
- Inform anesthesia and surgical team of implants
- Time-out
Nursing management: preoperative teaching
- Anticipatory guidance (relieve anxiety)
- OR experience
- Recovery
- DVT prophylaxis: SCD, heparin, Ted hose, mobility
- Mobility prior to surgery
- Prevent pneumonia: cough + deep breathing
Sterile team members
Surgeon(s), Surgical assistants, Scrub nurses, Surgical techs, OR techs
Surgeon role
- Leader of surgical team
- May be more than one
Surgical assistant roles (NP, PA)
- Work interdependently w surgeon
- Provide preoperative and postoperative pt care
Scrub nurse, Surgical tech, OR tech roles
- Pass instruments, sponges & other items
- Prepare OR by setting up surgical instruments
- Help surgical team don sterile gowns and gloves
Non-Sterile team members
Anesthesia provider, Circulating RN
Anesthesia provider role (MD or CRNA)
- Constantly aware of surgeon’s actions
- Preoperative evaluation & postoperative care in PACU
Circulating RN role
- Observe procedure, assist surgical team, maintain pt safety
- Assess in preop arena and on admit to OR
- Assist anesthesia in monitor and line placement and pt positioning
- Anticipate supply and medication needs, label specimens
- Count number of needles, instruments, sponges
Surgical scrub procedure
- Prevent surgical infection
- Remove all jewelry and ensure clean nails (no gel or acrylic nails)
- Wash hands thoroughly
- Wash w disposable scrub sponge from clean (hand) to less clean area (arm), 3-5 mins
- Dry w sterile towel provided by scrub nurse
Surgical attire
- All OR roles: scrubs, caps, masks, designated OR shoes or covers
- Sterile field members: all the above + sterile gloves, gown and protective eyewear
Types of intraoperative anesthesia
General (GA), Regional (RA), Monitored-Anesthesia Care (MAC)
General anesthesia
Reversible unconscious states
- Variety of methods: volatile agents (gases), IV agents, muscle relaxants
- Anesthesia w muscle relaxant require endotracheal intubation for ventilation support
