Role of the peri-operative nurse

Question 1

What does the peri-operative nurse role involve?

Answer 1

• Patient advocacy
• Scientific nursing interventions
  – Critical thinking
  – Clinical reasoning
  – Caring
  – Comfort

Question 2

What is the environment of the operating room?

Answer 2

Restricted area-accessed through semi restricted area masks and other
PPE required to supplement perioperative attire during surgery or procedure

Lighting – low to high intensity range for a precise view of the surgical
site. Ultraviolet UV lighting/UV radiation reduces the number of microrganisms in the air

Temperature -20-22 degrees celsius can inhibit bacterial growth

Humidity- 50%-60% inhibits bacterial growth decreases potential risks
with static electricity

Positive Air Pressure-prevents airflow from entering from halls and corridors. Filters and controlled airflow in the ventilating systems provide dust control and a role in reducing postoperative infection in complex surgical procedures

AS/NZ Standards indicate air conditioners ultraclean air systems minimum 20
air changes per hour

Electrical equipment – checked frequently by biomedical engineers/functioning/ electrical safety

Communication System- delivery routine emergency messages throughout the
perioperative environment

The Australian College of Perioperative Nurses (ACORN) outlines standards for
the planning and design of operating
rooms

Question 3

Describe the Anaesthetic nurses role?

Answer 3

• Functions accordance with the ANZCA Guidelines
  – Prepares and checks the anaesthetic machine
  – Prepares and checks anaesthetic equipment and intravenous
  – and arterial lines as required
  – Acts as a patient advocate at all times
  – Participates in time- out
  – Assists the anaesthetist in the induction and maintenance of the anaesthetic
  – Understands and prepares for any anaesthetic emergency and assists in any anaesthetic emergency
  – Assists the anaesthetist in safe extubation on completion of surgery

Question 4

What is the scrub nurses role?

Answer 4

• Reviews anatomy and physiology and surgical procedure
  – Completes surgical hand and arm scrub gowns /gloves self
  – Prepares instrument table and organises sterile equipment
  – Assists with skin preparation and draping of the surgical site
  – Participates in time-out
• Passes instruments to surgeon and assistant by anticipating their needs
• Maintains an accurate account of sponges needles instruments and other medical devices that may be retained in the patient
• Maintains practice of aseptic techniques in self and others
• Reports medications used by the surgeon and monitors irrigation fluids used for calculation of blood loss

Question 5

What is the circulating nurses role?

Answer 5

• Plans and coordinates intraoperative nursing care
• Assists in preparing the operating room ensuring supplies and equipment are available and in working order and sterile
• Maintain aseptic technique in all required activities
• Monitors self /others in practices of aseptic technique
• Identifies and admits the patient to the operating room
  – Participates in time-out
  – Maintains an accurate count of sponges needles instruments and other medical devices that may be retained in the patient
  – Documents intraoperative care/ Surginet

Question 6

What is the Postanaesthesia Care Unit PACU Nurse Role?

Answer 6

Stage 1 recovery patient unconscious
– Require one to one nursing care
– Close monitoring of vital signs
- ABC
– Temperature
– Assessment of possible postoperative complications
– Medications for pain and postoperative nausea and vomiting (PONV) intravenously faster onset than intramuscular and oral
medication.
- Patients transferred to Stage 2 recovery or a postsurgical ward area when appropriate discharge criteria has been met
- Requires minimum of a 1:4 nurse to patient ratio for lowacuity uncomplicated patients
- Higher staffing ratio to be considered when higher- acuity
patients are admitted to the area

Question 7

What does the initial PACU assessment involve?

Answer 7

initial PACU assessment:

Airway- patency/ oral or nasal airway/supraglottic airway LMA

Breathing –respiratory rate and quality/ auscultated breath sounds/ pulse oximetry/ supplemental oxygen

Circulation-ECG monitoring/ rate and rhythm / blood pressure/ temperature / capillary refill (peripheral return) / colour and temperature of the skin/ peripheral pulses

Neurological- level of consciousness/ orientation/ sensory and motor status/ pupil size and reaction

Gastrointestinal –nausea/ vomiting/intake/ fluids/ irrigations
– Genitourinary –output/ urine/ drains
– Surgical site -dressings and drainage/ per vagina loss/ fundal height/ pain/ incision

– Other- other surgery-specific assessments or observations/
pedal pulses/ vascular observations / Glasgow Coma Scale