Week 3 : Preoperative IntraOp Care Flashcards
what does intraop mean ?
this is area when they left the pre op area and go to the operating room ( surgical room ) or OR
what is operating room often called
surgical theatre
what is the whole focus on perioperative intra op care?
the whole focus here is pt safety
- being safe and pt coming out fine and recover with no infection
what is a surgical suite
another word for operating room
why is it important to know the different type of anesthesia ?
since the pts are waking up from the anaesthetic and you’ll be reliable , so it is crucial to know
True or false. the physical environment of the OR is a very controlled environment.
true
what is the key in the physical environment of the OR
made to minimize infection and equipments are easy to clean
describe what physical environment of the OR is
OR rooms/theatres and the OR “ area/wing” of the hospital
when you think of the people an supplies is it a clean technique or sterile technique ( physical environment of the OR )
it is sterile and try to make this pattern to help be efficient an safe and free of contamination
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
true
how are the air and temp in the OR ?
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
how are the ventilation inside of the OR
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
furniture and lighting inside the OR are east to clean? how is it easy to clean?
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
how is the humidity inside of the OR
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
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.
true
are the lighting adjustable as well inside the OR?
yes no shat
what is the materials of the intruments inside the OR made of ? and why is it good?
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
what are the 3 main areas in the OR : controlled Access
unrestricted area
semi restricted area
restricted area
describe unrestricted area
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
Areas of the OR : Controlled Access
what is the biggest take way here ?
maximum infection control : in an environment that makes sense for the work that need to hapen
describe what restricted area
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
describe semi restricted area
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
how do they manage restricted area? name and example
they do this by oragnizing of the layout and flow
so think of space and time and traffic patterns
example. sterile surgical supplies
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
true
who are the surgeons ?
determines the need for & type of surgery
does surgery, got consent
care ( orders ) on unit
who is writing medical orders after the pt is transferred tot he unit
the surgeons and they’ll probably have
1 or 2 physician with them ( residency or something )
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
anesthesiologist
name the role of anesthesiologist
keeps pt alive & ensures the anesthesia is maintained
care in RR/PACU
who is the one that meet the pt in the pre op and look in their mouth and decide if what type of anesthetic
anesthesiologist
what are the nursing role in the OR ?
circulating nurse and scrub nurse
name the rundown of circulating nurse
- unsterile field
- deals with pt
- “runs the ship”
- contact with outside world!
what is the description of circulating nurse
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
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
true
who helps prep the pt for surgical ? in terms of their skin
circulating nurse
what is the run down of scrub nurse
sterile field
in there
what is the description of scrub nurse
- Sterile scrub ( everyhting sterile )
- Handling and passing tot he surgeons
- Watching aseptic technique counting equipments with circulating nurse
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.
why is patient positioning important ?
prevent injury to the skin and any breakdown we also don’t want them to have really sore joints or muscles
what are the patient positioning for goals :
do the surgery
monitor - safety
can give meds
dont injure the pt
- alignment
-secure extremities
-padding and supoort
what do we make sure the pt is ?
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
can table be tilted a bit to take the pressure off
yes true
look at the slide 11 for more info for patient positioning
what is the definition of anesthesia or anesthethic given
an artificially induced state state of partial/total loss of sensation with/without consiousness
type of anesthethic to be given is determined by
procedure
past health hx
preference
what are the classifications of anesthethics given
general ( GA )
regional/local
procedural sedation ( conscious sedation ) - fentanyl & versed ( midazolam)
can the pt be awake during regional/local anesthetics when it’s given?
yes
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?
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
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
true
what is general anesthesia?
heavy big medication that puts the pt right after, so they’re unconcious
the patient can be mouth intubated or nasally intubated when it comes to general anesthesia ?
yes this is true
why are the eyes shut during general anesthesia
they shut the eyes so that it doesn’t dry out or that there aren’t any abrasion on their eye
true or false. there is an anesthetic that is given through the vaporized, which can go into the lungs and works an anesthetic.
true
what equipment are needed for an anesthethic thats given through vaporized ?
patient monitor, anesthetic agent vaporizers, mechanical ventilators, breathing tubes, carbon dioxide absorber
General anesthethis ( gas ) : how is it given
what do the anesthesiologist do ?
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
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
iv induction med ( propofol )
General Anesthesia (GA): How is it Given? Anesthesiologist
inhalation agents- “ foundation to anesthesia”
describe what it is
gas” to breath
given face mask then likely endotracheal tube
(placed once IV induction agent given)
what is this describing : gas” to breath
given face mask then likely endotracheal tube
(placed once IV induction agent given)
inhalation agents - foundation to anesthesia
adjuncts to general anesthesia
IV drugs given to achieve, what ?
unconsciousness
amnesia
muscle relaxation
ANS control
what is occurring during when adjuncts to general anesthesia is given
no movement, no reflexes , no coughing
no vomiting, no sympathetic nervous system response
during adjuncts to general anesthesia : they are toally unaware/no feeling, explain
the body is controlled by the meds that are given
what is a purple tube in the slides
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
what does the local anesthesia do
?
block electrical impulses along nerve fibers to specific part of body
would the recover be fast during local anesthesia
yes this would be fast
true or false. no NPO preop during local anesthesia.
true
local anesthesia
topical
apply to skin, mucous membranes
what other kind of local anesthesia is there ?
regional
this is an injection of local anesthetic
- in or around nerve group
where else can regional anesthesia go ?
into CSF in subarachnoid space ( spinal anesthetic ) or nerve roots around the spine ( epidural anesthetic ) to achieve anesthesia for surgery of lower extremities
recall we know that regional anesthesia go into CSF in subarachnoid space ( spinal anesthetic ) : what else
nerve roots around the spine ( epidural anesthetic ) to achieve anesthesia for surgery of lower extremities
what would be a good example of general anesthesia
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
true or false. the pt is weak and they’re talking and breathing when it comes to local anesthesia.
true
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
regional anesthetic
spinal/epidural anesthesia
what is a spinal anesthesia
spinal- one time injection of anesthetic and analgesia to subarachnoid space ( usually below L2 )
what can spinal anesthesia be used for ?
can be used with joint replacement for hip or knee fast onset also called a spinal block
this is mixes with csf and autonomic, sensory and motor blockade
spinal anesthesia
what is an epidural
injection of anesthetic/analgesia in epidural space ( lumbar or thoracic )
describe how epidural works ?
drug binds to nerve roots entering/exiting spinal cord
the sensory fibers are blocked, motor fibers intanct
true or false epidural can be a one time dose for surgery or left in to continue as analgesia for post op use ( pump)
this is true
spinal/epidural anesthesia helps with type of emotion?
anxious
what is this describing : they feel no pain, they cant move that area because of that motor block
spinal anesthesia
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
true
this is also called vehicle block , what is the commonly used in surgeries ( this type of anesthesia )
spinal anestehsia, commonly used in surgeries invovling the legs and surgeries below the umbilicus, like the knee or hip surgery maybe a c section
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
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
where is epidural common in
labour and delievery
spainl/epidural anesthesia
post op monitoring for potential complications of
hypotension
pruritis
urinary retension
n&v
epidural hematoma
spinal headache
infection/septicemia
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)
yes
we need to monitor the level of the block, what happens if the block is too high when it comes to epidural anesthesia?
cardiac or resp depression
what happens if the spinal anesthesia is too hgih?
it can go up and if its starting into the thorax area that can be way too high
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
true
refer to slide 17 for their back image
the catheter that is in
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
procedural “conscious” sedation
what undergoes this
Mild or heavy deep IV sedation for minor surgical procedures or diagnostic procedures (tooth extraction, endoscopy, wound debridement)
- pediatrics
what are common procedural “ conscious” sedation
fentanyl and versed ( midazolam )
what are we assessing as our assessment tool with procedural conscious sedation
ABCs, frequent VS, nurse- critical care or specialty training in concious sedation
scans are commonly used where ?
endoscopy or tooth extractions for peds ( make sure not overly sedated )
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)
the wrha surgical safety checklist
what is malignant hyperthermia?
this is rare by fatal, has NOTHING to do wit cancer , a real serious life threatening reaction by triggered by a certain gas
true or false. malignant hyperthermia is a genetic thing, and should be discovered pre op med history info.
true
this is triggered by certain drugs used for anaesthethic ( certain inhalation gases & ______)
succinylcholine
what happens with malignant hyperthermia
increased ca levels in muscle cells
increased muscle metabolism
myoglobinuria bc of rhabdomyolysis
what happens during malignant hyperthermia
hyper metabolic hyperthermia, tatchycardia
temp is up, and they get dyspnea and have dysrhtymias
what is the treatment for malignant hyperthermia
medication- dantrolene sodium ( skeletal muscle relaxant )
cool the pt
what is the goal for malignant hyperthermia?
get the temp down and slow metabolism
this is generally seen during surgery and even up to 24 to 72 hrs after surgery, so we need to be aware of this
malignant hyperthermia
what happens to the skeletal muscle during malignant hyperthermia
skeletal muscle goes rigid ( and contract ) hyper metabolism of skeletal muscles , genetic defect of the cell membrane wall
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
malignant hyperthermia
this is when u are done with operating room
recovery room/post anaesthesia care unit
what is pacu
post anaesthesia care unit
what are the rules or characteristics that undergoes recovery room/pacu
- No visitors
- Very close proximity to the OR
- Pt on stretcher
- Anesthesiologist brings pt & gives report to RN
what does open area mean during pacu
open area refers to no walls, no charting, not getting people up to bed or repositioning ( giving them time to wake up )
what is golden time in PACU
likely if they had problems show up in 2 hours thats why vitals are very important ( doing it more frequently)
discharge criteria- ready for the ward
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
what is the nurse’s role in pacu
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.
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!
PACU RN “ gives report “ to unit nurse
true or false. what surgery was perfomed, pt age and name, time frame
true
PACU RN “gives report” to unit nurse
what report are we giving them
anesthethic given ( allergies, latex or drugs )
past med hx
any intra op or rr problems and what was the treatment
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
yes
what is a big thing to know as a pacu rn giving a report
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.
