Week 3 : Preoperative IntraOp Care

Question 1

what does intraop mean ?

Answer 1

this is area when they left the pre op area and go to the operating room ( surgical room ) or OR

Question 2

what is operating room often called

Answer 2

surgical theatre

Question 3

what is the whole focus on perioperative intra op care?

Answer 3

the whole focus here is pt safety
- being safe and pt coming out fine and recover with no infection

Question 4

what is a surgical suite

Answer 4

another word for operating room

Question 5

why is it important to know the different type of anesthesia ?

Answer 5

since the pts are waking up from the anaesthetic and you’ll be reliable , so it is crucial to know

Question 6

True or false. the physical environment of the OR is a very controlled environment.

Answer 6

true

Question 7

what is the key in the physical environment of the OR

Answer 7

made to minimize infection and equipments are easy to clean

Question 8

describe what physical environment of the OR is

Answer 8

OR rooms/theatres and the OR “ area/wing” of the hospital

Question 9

when you think of the people an supplies is it a clean technique or sterile technique ( physical environment of the OR )

Answer 9

it is sterile and try to make this pattern to help be efficient an safe and free of contamination

Question 10

true or false. * Controlled environment design/physical space – minimize infection & have equipment easy to “clean” fits in the description of the physical environment of the OR

Answer 10

true

Question 11

how are the air and temp in the OR ?

Answer 11

the air is under positive pressure, so that prevents air from going into the OR ( we want to keep the dirty air outside so its positive pressure )

the temp is kept cool , it’s between 20 to 24 degrees and its kept cool because that decreases bacteria growth

Question 12

how are the ventilation inside of the OR

Answer 12

ventilation system- they use filters its high efficiency, particular air
these filters are used to control and eliminate things like dust and airborne transmission of micro organism

Question 12

furniture and lighting inside the OR are east to clean? how is it easy to clean?

Answer 12

yes this is true . this can be moved around and its on wheels and can be adjusted, its made like that so it easier after to clean

Question 13

how is the humidity inside of the OR

Answer 13

kept at 30% to 60% and that also helps with decreasing bacteria growth, and somehwhat for physical comfort, because surgeons and anesthesiologist can get hot

Question 14

true or false. in the ventilation system. ventilation system - they use filters its high efficiency particular air
- these filters are used to control and eliminate things like dust and airborne transmission of micro organisms also helps remove the anaesthetic gas and helps remove toxic fumes.

Answer 14

true

Question 15

are the lighting adjustable as well inside the OR?

Answer 15

yes no shat

Question 16

what is the materials of the intruments inside the OR made of ? and why is it good?

Answer 16

stainless steel
this is good
- effects of disinfectant because it will be cleaned often during and the supplies are all spread out on a sterile field

Question 17

what are the 3 main areas in the OR : controlled Access

Answer 17

unrestricted area
semi restricted area
restricted area

Question 17

describe unrestricted area

Answer 17

1) can be in street clothes
- this would usually be where the perso would be when they just go in their care, the bus into the hospital, going to work
example : front desk, locker room, pt admission area

Question 18

Areas of the OR : Controlled Access
what is the biggest take way here ?

Answer 18

maximum infection control : in an environment that makes sense for the work that need to hapen

Question 19

describe what restricted area

Answer 19

surgical attire, cover all hair & surgical mask

no personal belongings
big thing is to derease cross contamination - clean and sterile supplies to be seperated from contaminated supplies and waste

Question 19

describe semi restricted area

Answer 19

1) must wear surgical attire anf cover all hair
- this includes on the head or bear, peripheral support areas, like a work or storage area for clean and sterile supplies
example : semi restricted is like the cord between the operating room rooms

Question 20

how do they manage restricted area? name and example

Answer 20

they do this by oragnizing of the layout and flow
so think of space and time and traffic patterns
example. sterile surgical supplies

Question 21

would this be considered as an example of restricted area : would move from the med device reprocessing department through the clean core area
and into the restricted
supplies that are used in the OR and then contaminated they would covered and transport through the peripheral area back to the med processing room to be decontaminated clean re sterilized

Answer 21

true

Question 22

who are the surgeons ?

Answer 22

determines the need for & type of surgery
does surgery, got consent
care ( orders ) on unit

Question 23

who is writing medical orders after the pt is transferred tot he unit

Answer 23

the surgeons and they’ll probably have
1 or 2 physician with them ( residency or something )

Question 24

who is not doing the surgery at all but keeping the pt alive, monitoring the vitals, fluid intake, and output may have to give blood and meds

Answer 24

anesthesiologist

Question 25

name the role of anesthesiologist

Answer 25

keeps pt alive & ensures the anesthesia is maintained
care in RR/PACU

Question 26

who is the one that meet the pt in the pre op and look in their mouth and decide if what type of anesthetic

Answer 26

anesthesiologist

Question 27

what are the nursing role in the OR ?

Answer 27

circulating nurse and scrub nurse

Question 28

name the rundown of circulating nurse

Answer 28

• unsterile field
• deals with pt
• “runs the ship”
• contact with outside world!

Question 29

what is the description of circulating nurse

Answer 29

not scrubbed in
assess the pt ( help position and meet in the pre op )
serve pt advocate
follows if everyone is doing aseptic technique
they follow and listen
they can instigate surgical time out if a question has timed out
assistant scrub nurse to count the sponges

they have has to take phone calls, take equipment in, report, and documents

Question 30

true or false. circulating nurse still has to report and document. Anesthetist documents all the vs meds and fluid oxygenation but they also have to make notes why the time is given

Answer 30

true

Question 31

who helps prep the pt for surgical ? in terms of their skin

Answer 31

circulating nurse

Question 32

what is the run down of scrub nurse

Answer 32

sterile field
in there

Question 33

what is the description of scrub nurse

Answer 33

• Sterile scrub ( everyhting sterile )
• Handling and passing tot he surgeons
• Watching aseptic technique counting equipments with circulating nurse

Question 34

just read : don’t answer, just go through the statement : more about what advocacy means when we talk about the circulating nurse, being a strong patient advocate, they need to make sure that everyone is acting.
And does as they should in their rule that everyone’s following the rules, they need to identify if something is wrong or something missing, they maintain patient, privacy, confidentiality, and dignity. They have a big role in the physical care and comfort.

Question 35

why is patient positioning important ?

Answer 35

prevent injury to the skin and any breakdown we also don’t want them to have really sore joints or muscles

Question 36

what are the patient positioning for goals :

Answer 36

do the surgery
monitor - safety
can give meds
dont injure the pt
- alignment
-secure extremities
-padding and supoort

Question 37

what do we make sure the pt is ?

Answer 37

make sure the pt is comfortable, so we strapped them down so they wont fall over the oeprating room table and we also have to think abt the pressure points

Question 38

can table be tilted a bit to take the pressure off

Answer 38

yes true

Question 39

look at the slide 11 for more info for patient positioning

Question 40

what is the definition of anesthesia or anesthethic given

Answer 40

an artificially induced state state of partial/total loss of sensation with/without consiousness

Question 41

type of anesthethic to be given is determined by

Answer 41

procedure
past health hx
preference

Question 42

what are the classifications of anesthethics given

Answer 42

general ( GA )
regional/local
procedural sedation ( conscious sedation ) - fentanyl & versed ( midazolam)

Question 43

can the pt be awake during regional/local anesthetics when it’s given?

Answer 43

yes

Question 44

What is the difference – what is the expected way & time the pt would recover from the anesthetic they received? How/what do we monitor? What could go wrong?

Answer 44

the difference between them is basically how awake the patient is thinking of what is their level of consciousness and then the amount that the pt can remember after

another difference is the patient’s ability to feel and the pt ability to move, so they can be given meds that paralyze them and block all receptors of pain & sensation

Question 45

true or false. another difference is can the patient breathe on their own or not can they protect their airway , if the pt cant breathe on their own because of the med that were given they would have to be a breathing tube, so that the pt would be intubated and on ventilator so the whole classifications of anesthetics

Answer 45

true

Question 46

what is general anesthesia?

Answer 46

heavy big medication that puts the pt right after, so they’re unconcious

Question 47

the patient can be mouth intubated or nasally intubated when it comes to general anesthesia ?

Answer 47

yes this is true

Question 48

why are the eyes shut during general anesthesia

Answer 48

they shut the eyes so that it doesn’t dry out or that there aren’t any abrasion on their eye

Question 49

true or false. there is an anesthetic that is given through the vaporized, which can go into the lungs and works an anesthetic.

Answer 49

true

Question 50

what equipment are needed for an anesthethic thats given through vaporized ?

Answer 50

patient monitor, anesthetic agent vaporizers, mechanical ventilators, breathing tubes, carbon dioxide absorber

Question 51

General anesthethis ( gas ) : how is it given
what do the anesthesiologist do ?

Answer 51

first they give iv induction med ( propofol )
they use is balanced technique
they’re using different drugs from different classes to kind of combined effect on the pt

Question 52

what is this describing : it induces a pleasant sleep and it has a rapid on set of action often this is when they say count backwards from 10 and the pt is asleep by 7 or 6

Answer 52

iv induction med ( propofol )

Question 53

General Anesthesia (GA): How is it Given? Anesthesiologist

inhalation agents- “ foundation to anesthesia”
describe what it is

Answer 53

gas” to breath

given face mask then likely endotracheal tube
(placed once IV induction agent given)

Question 54

what is this describing : gas” to breath

given face mask then likely endotracheal tube
(placed once IV induction agent given)

Answer 54

inhalation agents - foundation to anesthesia

Question 55

adjuncts to general anesthesia
IV drugs given to achieve, what ?

Answer 55

unconsciousness
amnesia
muscle relaxation
ANS control

Question 56

what is occurring during when adjuncts to general anesthesia is given

Answer 56

no movement, no reflexes , no coughing
no vomiting, no sympathetic nervous system response

Question 57

during adjuncts to general anesthesia : they are toally unaware/no feeling, explain

Answer 57

the body is controlled by the meds that are given

Question 58

what is a purple tube in the slides

Answer 58

purple here and this tubing it basically is a safety thing, this is a gas
so they give them some breaths there, and then what they do is they would pull that mask away
and they would intubate the patient. then they’d put up the gas to the tube here then they start to give adjuncts

Question 59

what does the local anesthesia do
?

Answer 59

block electrical impulses along nerve fibers to specific part of body

Question 60

would the recover be fast during local anesthesia

Answer 60

yes this would be fast

Question 61

true or false. no NPO preop during local anesthesia.

Answer 61

true

Question 62

local anesthesia
topical

Answer 62

apply to skin, mucous membranes

Question 63

what other kind of local anesthesia is there ?

Answer 63

regional
this is an injection of local anesthetic
- in or around nerve group

Question 64

where else can regional anesthesia go ?

Answer 64

into CSF in subarachnoid space ( spinal anesthetic ) or nerve roots around the spine ( epidural anesthetic ) to achieve anesthesia for surgery of lower extremities

Question 65

recall we know that regional anesthesia go into CSF in subarachnoid space ( spinal anesthetic ) : what else

Answer 65

nerve roots around the spine ( epidural anesthetic ) to achieve anesthesia for surgery of lower extremities

Question 66

what would be a good example of general anesthesia

Answer 66

surgery to remove a tumor from the bowel and were giving a pt a colostomy or maybe there doing a brain surgery , and they’re treating the brain bleed like an epidural hematoma

Question 67

true or false. the pt is weak and they’re talking and breathing when it comes to local anesthesia.

Answer 67

true

Question 68

what type of anesthesia is this descring : if you have had bad cut on your hand and they needed to do like 20 stitches
they would probably do a __________ so they would freeze your hand
you’d be awake and talking, you an look at it if you want but they do that anfdu shouldnt be able to feel stiches going in

Answer 68

regional anesthetic

Question 69

spinal/epidural anesthesia

what is a spinal anesthesia

Answer 69

spinal- one time injection of anesthetic and analgesia to subarachnoid space ( usually below L2 )

Question 70

what can spinal anesthesia be used for ?

Answer 70

can be used with joint replacement for hip or knee fast onset also called a spinal block

Question 71

this is mixes with csf and autonomic, sensory and motor blockade

Answer 71

spinal anesthesia

Question 72

what is an epidural

Answer 72

injection of anesthetic/analgesia in epidural space ( lumbar or thoracic )

Question 73

describe how epidural works ?

Answer 73

drug binds to nerve roots entering/exiting spinal cord
the sensory fibers are blocked, motor fibers intanct

Question 74

true or false epidural can be a one time dose for surgery or left in to continue as analgesia for post op use ( pump)

Answer 74

this is true

Question 75

spinal/epidural anesthesia helps with type of emotion?

Answer 75

anxious

Question 76

what is this describing : they feel no pain, they cant move that area because of that motor block

Answer 76

spinal anesthesia

Question 77

true or false.would be something like a knee or an ankle surgery
both of these have the pt consious and awake
now the dr may give a little bit of an iv sedative

Answer 77

true

Question 78

this is also called vehicle block , what is the commonly used in surgeries ( this type of anesthesia )

Answer 78

spinal anestehsia, commonly used in surgeries invovling the legs and surgeries below the umbilicus, like the knee or hip surgery maybe a c section

Question 79

they place a catheter in place and give some continous drug in there an binds to the roots and blocks sensory fibers since it is block no pain, but can work cause motor fibers at intact
what else can be seen with epidural

Answer 79

bad contractions- still can walk ( less chance of spinal headache ) due to leakage of spinal fluid at the side of the injection in an epidural block

Question 80

where is epidural common in

Answer 80

labour and delievery

Question 81

spainl/epidural anesthesia
post op monitoring for potential complications of

Answer 81

hypotension
pruritis
urinary retension
n&v
epidural hematoma
spinal headache
infection/septicemia

Question 82

can these all be seen as a potential complications for post op monitoring :

hypotension
pruritis
Urinary retention
N&V
Infection / Septicemia
Epidural hematoma
Spinal headache (with spinal)

Answer 82

yes

Question 83

we need to monitor the level of the block, what happens if the block is too high when it comes to epidural anesthesia?

Answer 83

cardiac or resp depression

Question 84

what happens if the spinal anesthesia is too hgih?

Answer 84

it can go up and if its starting into the thorax area that can be way too high

Question 85

true or false.again if the block is too high the pt can have resp and cardiac problems when ur caring for a pt on the unit theres a protocol

Answer 85

true

Question 86

refer to slide 17 for their back image

Question 87

the catheter that is in

Answer 87

they usually are used for less than 3 days
for post ip pain control, and usually not longer because of the risk of infection so we need to monitor the level of the block

Question 88

procedural “conscious” sedation

what undergoes this

Answer 88

Mild or heavy deep IV sedation for minor surgical procedures or diagnostic procedures (tooth extraction, endoscopy, wound debridement)
- pediatrics

Question 89

what are common procedural “ conscious” sedation

Answer 89

fentanyl and versed ( midazolam )

Question 90

what are we assessing as our assessment tool with procedural conscious sedation

Answer 90

ABCs, frequent VS, nurse- critical care or specialty training in concious sedation

Question 91

scans are commonly used where ?

Answer 91

endoscopy or tooth extractions for peds ( make sure not overly sedated )

Question 92

this is a checklist : getting on the tea focused they have different roles and duties making focus on the procedure ( who’s in the room, questions etc)

Answer 92

the wrha surgical safety checklist

Question 93

what is malignant hyperthermia?

Answer 93

this is rare by fatal, has NOTHING to do wit cancer , a real serious life threatening reaction by triggered by a certain gas

Question 94

true or false. malignant hyperthermia is a genetic thing, and should be discovered pre op med history info.

Answer 94

true

Question 95

this is triggered by certain drugs used for anaesthethic ( certain inhalation gases & ______)

Answer 95

succinylcholine

Question 96

what happens with malignant hyperthermia

Answer 96

increased ca levels in muscle cells
increased muscle metabolism
myoglobinuria bc of rhabdomyolysis

Question 97

what happens during malignant hyperthermia

Answer 97

hyper metabolic hyperthermia, tatchycardia
temp is up, and they get dyspnea and have dysrhtymias

Question 98

what is the treatment for malignant hyperthermia

Answer 98

medication- dantrolene sodium ( skeletal muscle relaxant )
cool the pt

Question 99

what is the goal for malignant hyperthermia?

Answer 99

get the temp down and slow metabolism

Question 100

this is generally seen during surgery and even up to 24 to 72 hrs after surgery, so we need to be aware of this

Answer 100

malignant hyperthermia

Question 101

what happens to the skeletal muscle during malignant hyperthermia

Answer 101

skeletal muscle goes rigid ( and contract ) hyper metabolism of skeletal muscles , genetic defect of the cell membrane wall

Question 102

shuold be wearing med alert bracelet
this would mean aneltholist and surgeon would think which medication or anethia would eb the ebest ( hwo do they do it without hat med ) this is comonly used
given iv and used intubation : what is this describing

Answer 102

malignant hyperthermia

Question 103

this is when u are done with operating room

Answer 103

recovery room/post anaesthesia care unit

Question 104

what is pacu

Answer 104

post anaesthesia care unit

Question 105

what are the rules or characteristics that undergoes recovery room/pacu

Answer 105

• No visitors
• Very close proximity to the OR
• Pt on stretcher
• Anesthesiologist brings pt & gives report to RN

Question 106

what does open area mean during pacu

Answer 106

open area refers to no walls, no charting, not getting people up to bed or repositioning ( giving them time to wake up )

Question 107

what is golden time in PACU

Answer 107

likely if they had problems show up in 2 hours thats why vitals are very important ( doing it more frequently)

Question 108

discharge criteria- ready for the ward

Answer 108

this is typically what happens in the recovery room from 1 to 4 hrs

• we also want them awake at their baseline, vs stables, no uncontrolled bleeding, no resp distress, sats above 90

Question 109

what is the nurse’s role in pacu

Answer 109

nurses that work here they would get report from the anesthelogist that they bring the pt to recovery room, give bedside report to the nurse chat abt procedure at he vital signs estimated blood loss urine output how it went etc.

Question 110

Patients who are excavated, who’ve been intubated for their operation are usually excavated right in the operating room. Even before they come to recovery room. If they can’t be activated for whatever reason that patient is probably going to be going right into. care unit

just read it!

Question 111

PACU RN “ gives report “ to unit nurse

true or false. what surgery was perfomed, pt age and name, time frame

Answer 111

true

Question 112

PACU RN “gives report” to unit nurse

what report are we giving them

Answer 112

anesthethic given ( allergies, latex or drugs )
past med hx
any intra op or rr problems and what was the treatment

Question 113

these are all the things we should look out for and give report to in pacu

• Fluids given in the OR (including blood pdcts), i&o balance, iv fluid
  now
• Lines, incision, dressings, drainage, O2 if on
• Last dose of analgesia, when next med is due (likely antibiotic)
• Current VS, temp, O2 sat%
• Family, surgeon communication

Answer 113

yes

Question 114

what is a big thing to know as a pacu rn giving a report

Answer 114

A big thing is to know the last dose of analgesia.
Also the last dose of an antibiotic, because nausea is so common and then when the next med is due the likely be due for an antibiotic soon. So, make sure that that nurse on the unit is aware of that.