Unit 5 - Intra Op Flashcards
Intraoperative Period
time enter OR until go to Post Anesthesia Care Unit (PACU)
Main concern for perioperative nurses
Patient Safety and Advocacy
physical environment of OR
4 fundamental purposes
geographic isolation
bacteriological isolation
centralize equipment
centralize trained personnel
geographic isolation of OR
restrict flow of people traffic and decrease contamination
3 Distinct Areas of OR
Unrestricted
Semi-restricted
Restricted
Unrestricted
street clothes-point of entry for patients
Semi-restricted
Authorized personnel must wear scrubs
Restricted
OR, scrub sink, clean core
biggest risk for contamination
PEOPLE
Bacteriological Isolation
Primary
special clothing & footwear, separate water supply, airflow system, laundry & disposal systems
Processing rooms
utility rooms for clean-up, instrument prep, storage
Part of Clean Core
Centralization of Equipment
contains all equipment to facilitate safe & effective surgery
clean core
Centralization of Trained Personnel
teamwork in an isolated, restricted environment
who recognize common goals & coordinate efforts to achieve them–>psychologically & physiological prepared pt to surgery
Scrubbed sterile team
enter sterile field
Scrubbed sterile team includes
operating surgeon
assisting surgeons
scrub nurses and technicians
Un-scrubbed, unsterile team:
Do NOT enter sterile field
anesthesiologist, circulating nurse, x-ray, patho
Surgeon’s Responsibilities
preop h & p assessment/management OR consent form patient safety & management in OR performing surgical procedure post-op management of patient
Surgeon assistant
(MD, PA or RNFA)
Sterile
assists surgeon during procedure
of gas exchanges per hour in OR
25
Anesthesiologist/ CRNA
Non-sterile
Admin agents during surgery
Mont. cardiac/respiratory function –>Alert Surgeon to any problems
Post anesthesia recovery in PACU & first 24h post-op
Supervises PCEA for duration of use
Three phases of anesthesia
Induction
Maintenance
Emergence
Induction
Administration of agent
RNFA
Registered Nurse, First Assistant
CRNA
Must work under supervision of anesthesiologist or surgeon
Scrub Nurse
sterile
Establish sterile field/ assist w/ room prep Scrub, gown, & glove self and others Assist with draping Pass instruments to surgeon & assistants Monitor aseptic technique
Holding Area Nurse
ensures patient ready for surgery
Ensures needed are available & sterile
Circulating Nurse
Receives and identifies pt
Circulating Nurse
Completes the intraoperative record
Circulating Nurse
Counts syringes, needles, instruments with scrub nurse
Circulating Nurse
Endogenous
from within the patient
Exogenous
from outside the patient
Essence of Aseptic Technique
eliminating all modes and sources of contamination to the extent that is possible
Two Types of Contamination
Endogenous
Exogenous
Modes of Transmission
Contact (Direct/ Indirect)
Vehicle (Food, Water, Drugs, Blood)
Airborne
Vector (Insect, rodent, etc)
Surgical hand scrub
length of Time determines effectiveness
AT LEAST 5 minutes
Rinse from cleanest area to less
If sterile item touches non-sterile
it becomes contaminated!!
Only Sterile can touch Sterile
Contact Contamination
surgeon’s back touching sterile basin
puncture of sterile glove
contact by circulating nurse to sterile field
surgical conscience
Specific principles of aseptic technique must be followed
Margin of safety between sterile and unsterile
at least 1 foot
Supine
On back, face UP
Prone
ON belly
Used for laminectomy, hemorrhoidectomy
Position used for total hip, femoral, chest surgeries
lateral
Lateral Kidney Position
- used fr=or nephrectomy/ nephrourectertomy
- can → eye, ear, ulner nerve damage, shoulder and neck pain, femoral head necrosis
Lithotomy
supine, feet in stirrup; used for vag. Hysterectomy, abdominal perineal resection, bladder procedures
Hematogenous
contaminated from pt blood
Jackknife
back and rectal procedures
high risk of skin breakdown
Time Out
Required on All procedures
Final verification of patient, procedure, site
Entire OR team
Correct pt, correct surgery, etc
First Stage of General Anesthesia
Analgesia, relaxation, sedation
Prepare instrument table & organize equipment
SCRUB NURSE
Count sponges, needles, and instruments
SCRUB NURSE
preop h & p
Surgeon’s
OR consent form
Surgeon’s