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NURS 3512 - Class 7-12 > Week 12 - Intra-op Care > Flashcards

Week 12 - Intra-op Care Flashcards

1
Q

how is the physical enviro of the OR designed

A
  • for max infection control in an enviro that makes sense for the work that needs to happen
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2
Q

describe the temp & humidity of the OR: why?

A
  • temp = 20-24*
  • humidity = 30-60%

= decrease bacterial growth, keep HCP cool in PPE

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3
Q

what factors help maximize infection control in the OR (6)

A
  • strict personnel rules
  • temp & humidity control
  • particulate air filters
  • ventilation system
  • positive pressure system
  • ways to make it easier to clean
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4
Q

what is included in strict personnel entrance rules

A

controls:

  • who comes in
  • what is worn
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5
Q

what particulate air filter is used to maximize infection control ? why>

A
  • HEPA

- controls and eliminates dust, toxic fumes, genes, microorganisms from the air

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6
Q

why is a positive pressure system in the OR used

A
  • keep air out from the hallway
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7
Q

describe the items in the OR to maximize infection control & make it easier to clean (6)

A
  • space
  • stainless steel
  • wheels
  • plug ins
  • lighting
  • minimal items of floor
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8
Q

what are 3 main areas of the surgical suite

A
  • unrestricted area
  • semi-restricted area
  • restricted area
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9
Q

what is included in the unrestricted area? describe clothing in this area

A
  • ex. front desk, locker rooms, pt admin area

- can be in street clothes

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10
Q

what are examples of semi-restricted areas? describe clothing in this area

A
  • ex. corridors between OR rooms, peripheral storage area for sterile supplies
  • must wear surgical attire, cover all hair
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11
Q

what are examples of restricted areas? describe attire/rules in this area (5)

A
  • ex. OR rooms, scrub sinks
  • surgical attire
  • cover all hair
  • surgical mask
  • no personal belongings
  • no food/drink
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12
Q

what is a consideration to reduce cross contam.

A
  • seperate clean & dirty areas –> even when they are leaving the room to be cleaned , cover & contain until they are delivered into decontaminated space
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13
Q

describe the roles of the surgeon on the surgical team member (4)

A
  • determines need for surgical procedure
  • determines type of surgery
  • responsible for doing the surgery
  • post-op mngmt (on unit)
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14
Q

describe the roles of the anasthesiologist on the surgical team (3)

A
  • physician responsible for pts physiologic homeostasis during and shortly after surgery
  • ensure anesthesia is maintained throughout the surgery
  • ensure pt is stable while in recovery room (RR or PACU)
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15
Q

what are 2 types of nursing in the OR (2)

A
  • circulating nurse

- scrub nurse

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16
Q

describe the sterility of the circulating nurse

A
  • unsterile field
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17
Q

what are the roles of the circulating nurse in the OR (10)

A
  • asssess pt
  • position pt
  • pt advocate (ensure pt dignity, privacy, confidentiality)
  • ensure OR is running well
  • ensure adequate supplies
  • instigate surgical time outs (if something isnt going well, pause & refocus team)
  • assist scrub nurse to count sponges and instruments
  • communicat w “outside” –> phone calls, pages
  • document & give reports
  • greet pt on arrival to postop area
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18
Q

what are roles of the scrub nurse in the OR (4)

A
  • hands on
  • passes instruments to surgeon
  • advocate for aseptic technique
  • ensure there is efficient setup
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19
Q

describe the sterility of the scrub nurse in the OR

A
  • sterile field
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20
Q

what are the principle of aseptic technique (6)

A
  • hand washing before entering OR w surgical scrub
  • gowning and gloves put on once in OR (helped by circulating nurse)
  • once sterile, cannot touch anything non-sterile
  • must keep hands above waist
  • cannot reach over any non-sterile field
  • note breaches in sterility
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21
Q

what is anesthesia

A
  • an artifically induced state of partial/total loss of sensation with/without consciousness
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22
Q

what determines the type of anesthetic to be given (4)

A
  • length of procedure
  • invasivness of procedure
  • past health history
  • pt/surgeon/anesthetist preference
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23
Q

what are 3 classifications of anesthetics

A
  • general anasthesia
  • regional/local anesthesia
  • procedural sedation (conscious sedation)
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24
Q

what are differences between the types of anesthesias (3)

A
  • can the pt feel
  • can the pt remember
  • can pt protect their airway
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25
Q

what effects does general anasthesia have on the CNS (6)

A
  • loss of consciousness
  • loss of sensation
  • loss of reflexes
  • analgesia
  • amnesia
  • paralysis
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26
Q

what impact does GA have on the pt’s airway

A
  • cannot move or protect airway
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27
Q

what are 2 routes of admin for GA

A
  • IV induction

- inhalation agents

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28
Q

describe IV induction for GA

A
  • all routine GA procedures usually start w an IV induction
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29
Q

what is an example of GA given IV

A
  • propofol
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30
Q

what is the foundation to anesthesia

A
  • inhalation agents
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31
Q

how do GA inhalation agents enter the body (2)

A
  • enter the body through the alveoli of the lungs

- most commonly admin via an endotracheal tube (placed once IV induction given)

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32
Q

what are 2 examples of inhalation agents for GA

A
  • nitrous oxide

- flourine gas

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33
Q

what is given prior to intubation and insertion of endotracheal tube

A
  • succinylcholine (muscle relaxant)
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34
Q

when does extubation occur

A
  • after adjucts wear off
35
Q

what are adjuncts to general anasthesia

A
  • drugs added to IV regimen to achieve unconsciousness amnesia and muscle relaxation and ANS control
36
Q

what are examples of adjuncts to general anesthesia (2)

A
  • narcotics

- rocuronium (paralytic)

37
Q

what impact does local anesthesia have on the body

A
  • blocks electrical impulses along nerve fibers to specific part of body so that the procedure can be performed
38
Q

what impact does LA have on the pt’s consciousness (2)`

A
  • no loss of consciousness

- rapid recovery w little residual drug hangover

39
Q

describe nutrition status prior to LA

A
  • does not require pt to be NPO postop
40
Q

what are 2 types of LA

A
  • topical

- regional

41
Q

describe topical LA

A
  • application of anesthetic to skin or mucous membrane
42
Q

what are types of regional LA (3)

A
  • injection of a LA in or around nerve group such as brachial plexus
  • spinal anasthetic
  • epidural anesthetic
43
Q

where is spinal anesthesia inserted into (3)

A
  • infection of a local anesthetic into CSF in subarachnoid space
  • one time injection of anesthetic and analgesia to subarachnoid space
  • usually below L2
44
Q

what does spinal anesthesia mix with

A
  • CSF
45
Q

what does spinal anesthesia block (3)

A
  • autonomic
  • sensory
  • motor
    = anything below lvl of spinal feels no pain, no motor response
46
Q

what might a pt w spinal anesthesia experience

A
  • vasodilation (d/t autonomic block)
47
Q

what is an epidural (2)

A
  • injection of anesthetic/analgesia in the epidural space

- drug binds to nerve roots entering/exiting spinal cord

48
Q

what does an epidural block

A
  • sensory fibers blocked

- motor fibers intact (pt can move)

49
Q

describe use of an epidural

A
  • can be a one-time dose for surgery

- can be left in to continue as analgesia for post-op (up to 3 days )

50
Q

what is a spinal and epidural anesthetic often ysed for

A
  • anesthesia for surgery of lower extremities
51
Q

describe the impact of LA on resp system.

A
  • pt can breath on own (no intubation needed)
52
Q

what is required after a surgery w LA

A
  • pain meds
53
Q

what postop monitor for potential complications should be competed r/t spinal/epidural anesthesia (8)

A
  • hypotension
  • pruritis
  • urinary retention
  • NV
  • infection/septicemia
  • epidural hematoma
  • spinal headache (w spinal)
  • ensure epidural blocks arent too strong (can impact VS)
54
Q

what does a spinal HA indicate

A
  • CSF leakage
55
Q

what is procedural (conscious) sedation

A
  • mild or heavy deep IV sedation for minor surgical procedures or diagnostic procedures
56
Q

what are examples of procedures that use procedural sedation (3)

A
  • tooth extraction
  • endoscopy
  • wound debridement
57
Q

what are 2 examples of meds used for procedural sedation (2)

A
  • fentanyl

- versed (midazolam)

58
Q

describe the impact of procedural sedation on the pts airway

A
  • pt needs to maintain their own airway & breathing
59
Q

describe the impact of procedural sedation on CNS (2)

A
  • pt is awake

- pt may feel some discomfort

60
Q

what should be monitored in a pt w procedural sedation (2)

A
  • monitor VS (monitor for hypotension)

- monitor breathing

61
Q

describe the nurses role w procedural sedation

A
  • critical care or speciality training in conscious sedation
62
Q

what are the goals of pt positioning intraop (3)

A
  • optimize surgical exposure
  • optimize to monitor for safety, give meds
  • prevent injury and skin breakdown
63
Q

what are ways to prevent injury & skin breakdown w positioning (5)

A
  • provide good alignment
  • secure extremities (velcro, seat belts)
  • provide adequate padding and support (pstn may be for 8+ hrs)
  • keep in mind areas where joints dont work well
  • avoid straining self or pt when positioning
64
Q

what is done before induction of anesthesia? who is the lead for this?

A
  • briefing

- lead = circulator or anesthesiologist

65
Q

what is included in briefing before induction of anathesia (8)

A
  • pt verification (identity, consent, procedure, site)
  • site marked/NA
  • allergies & precautions
  • VTE prophylaxis
  • equipment/instrument/implant concerns
  • difficult airway/aspiration risk?
  • risk of >500 mL blood loss?
  • postop destination
66
Q

what is done before skin incision? who is the lead?

A
  • time out

- lead = surgeon

67
Q

what included in time out before skin incision (5)

A
  • team members identified
  • team verbally confirms pt, procedure, site
  • antibiotic prophylaxis given within approp timeframe?
  • team communicates anticipated complications
  • any questions from the team?
68
Q

what is done before the pt leaves the operating room

A
  • debriefing

- lead = circulatior

69
Q

what is done during debriefing (7)

A
  • confirm procedure performed
  • confirm ID and handling of specimen
  • confirm instrument, sponge, and needle counts are correct (or na)
  • any equipment problems
  • surgeon review any imp intraop events & mngmt plans
  • anesthesiologist any imp intraop events, recovery plans, normothermia maintained
  • is there anything that could have been done better?
70
Q

what is malignant hyperthermia

A
  • rare and life-threatening event triggered by anesthetic
71
Q

what anesthetic triggers malignant hyperthermia

A
  • succinylcholine
72
Q

what contributes to malignant hyperthermia

A
  • genetic
73
Q

when should risk of malignant hyperthermia be discovered

A
  • in preop –> medical history info

“ have you or your family even had issues during surgery

74
Q

what occurs w malignant hyperthermia

A
  • body unable to regulate intracellular Ca when given syccinylcholine
75
Q

what does malignant hyperthermia cause (8)

A
  • hyperthermia
  • hypermetabolism
  • hypoxemia
  • hypercarbia (increased CO2)
  • tachycardia
  • tachypnea
  • dysrhytmias
  • rigid skeletal muscles
76
Q

what is the treatment for malignant hyperthermia

A
  • dantrolene sodium (decreases metab)

- cool the pt

77
Q

what is included in prevention of malignant hyperthermia

A
  • family history
78
Q

when does malignant hyperthermia occur

A
  • within hour of induction
79
Q

what is the “golden time”

A
  • the time when postop problems are likely to show

- within 2 hr after surgery

80
Q

what is the recovery room/post anesthesia care unit (PACU) (2)

A
  • open area w stretchers, no walls, monitors, nurses charting at the bedside
  • where the anesthesiologist brings the pt and gives report to RN
81
Q

are visitors allowed in the PACU

A
  • no
82
Q

describe the location of the PACU; why is this beneficial

A
  • close to OR = go back if needed or call anesthesiologist if surgeon to come assess pt
83
Q

what is PACU discharge criteria (5)

A
  • neuro baseline
  • no resp depression
  • sats >90%
  • vitals stable
  • no uncontrolled bleeding

NURS 3512 - Class 7-12 (49 decks)

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