Wk 3 Intraoperative Care Flashcards
When does the intraoperative phase end?
When they are transferred to PACU
What does the circulating nurse in the OR do?
Not scrubbed, gowned, or gloved
Remains in unsterile field
Records all nursing care
What does the scrub nurse do in the OR?
Follows designated scrub procedure
Gowned, gloved
Remains in sterile field
When is site identification especially important?
Extremities
Laterality (right versus left)
Multiple structures
Levels of the body need surgical site markings by the surgeon
What will be used as the surgical site marking?
The surgeons initials
Where should the initials be?
As close to the actual incision site as possible
What is a time out?
The entire surgical team will stop, verify and agree to a list of things before an incision is made
What is verified during the time out?
Patient identity Surgical site Level, laterality, or structure Correct procedure Patient position Availability of correct implants, special equipment of other requirements
4 potential complications of improper patient positioning during surgery
Muscle strain
Joint damage
Pressure ulcers
Nerve damage
What is also important during patient positioning?
Secure extremities
Add packing/support
What is general anesthesia?
Inhalation or injection of anesthetic drugs that results in loss of all sensation and consciousness
What are the 4 phases of general anesthesia?
Pre induction
Induction
Maintenance
Emergence
What is regional anesthesia?
Medication instilled into or around a nerve to block transmission of nerve impulses in a specific region
What are 4 examples of region anesthesia?
Nerve block
Bier black
Spinal
Epidural
What is local anesthesia?
temporary loss of feeling as result of inhibition of nerve endings in part of body
What is monitored anesthesia care?
Similar to general anesthesia, but it doesn’t involve inhaled agents. So they are conscious but sedated
What is another term that is commonly used instead of monitored anesthesia care?
Conscious sedation
4 intraoperative nursing considerations
Risk for infection
Risk for perioperative positioning injury
Risk for injury
Risk for imbalanced body temperature (hypothermia)
What is malignant hyperthermia?
Inherited muscle disorder that is triggered by certain types of anesthesia that may cause a fast acting life-threatening crisis
What is the incidence of malignant hyperthermia?
Incidence is low but if it goes untreated mortality is high
What do you not see initially with malignant hyperthermia?
You don’t initially see a high fever
The trigger for malignant hyperthermia results in what?
unregulated calcium accumulation
What is the first thing you will see in a patient experiencing malignant hyperthermia?
Sustained muscle contraction in the masseter muscle
Where is the masseter muscle?
Lateral sides of the mandible
You might see breakdown of the masseter muscle which is called…
rhabdomyolysis
What else will you see with malignant hyperthermia?
Anaerobic metabolism and metabolic acidosis
What is the most common initial sign of malignant hyperthermia?
Unexpected increase in end-tidal CO2
What are the early presentations of malignant hyperthermia?
Hypercarbia
Sinus tachycardia
Masseter or generalized muscle rigidity
What is not a presenting sign of malignant hyperthermia?
Hyperthermia
What is unique about patients who do experience malignant hyperthermia?
90% of them do not have a family history of malignant hyperthermia
About 50% of patients who experience malignant hyperthermia under anesthesia had had….
uneventful general anesthesia in the past
What is the antidote for malignant hyperthermia?
dantrolene IV
