intraoperative nursing!!

when does the intraoperative period begin?

begins when the client enters the procedural area and continues until the client is admitted

what are procedural areas?

operating suite in surgery, cardiac catheter lab, special procedures lab, endoscopy suite, GI lab, labor and delivery

who is in the surgical care team?

RN first assistant, RN as a first assistant to the surgeon, CRNA, RN, and RN or scrub tech

who is the perfusionist?

heart-lung machine for cardiopulmonary bypass

for the floor plan what is important?

to know if the area is unrestricted, semi restricted, or restricted

example of unrestricted area?

2. • Surgical scheduling office

3. • Operating room supervisor's office

4. • Equipment store rooms

example of semi restricted area?

hallway before the surgical spot

example of restricted area?

operating room

temperature and humidity of OR?

Temperature should be between 68-73 degrees & the humidity should be 20-60%.

describe high efficiency air filters?

15 room air exchanges per hour in each OR suite

what are some infection control basic rules?

scrubbed persons function within a sterile field must wear sterile gown and gloves. sterile field is created with sterile drapes and drapes are at table levels. all items in the sterile field must be sterile

describe the surgical attire?

attire is clean, not sterile. staff changes in the unit lorckerrooms. hair and shoes are covered. mask, eyewear, gloves, and gown

when is surgical scrub performed and why?

performed after mask applied and before sterile gown and gloves so reduces organisms on skin

how to do the surgical scrub?

vigorous anti-microbial scrub finger tips to elbows 3-5 minutes

what are the basic rules for infection control?

introduction of supplies to sterile field must be under sterile manner. unattended sterile field is considered contaminated.

who can touch sterile area?

only scrubbed staff

what does sedation do?

reduces sensory perception. allows the client to maintain a patent airway. amnesia effects are short term

describe minimal sedation?

respond normally to verbal command, cognitive function may be impaired, respiratory/cardiac function affected

what are examples of moderate sedation?

sedatives, hypnotics, and opioid IV medications

what does moderate sedation allow for?

amnesia and sedation with a patent airway

when is moderate sedation utilized?

for short procedures so endoscopy, cardiac procedures, reduction

what is considered moderate sedation?

anytime medications are needed to relax a client for a procedure

what is important to monitor in moderate sedation?

monitor airway, breathing, and circulation so oxygen saturation, capnography, cardiac rhythm, and vital signs

describe the continuous monitoring to moderate sedation?

continuous monitoring during procedure then every 15-30 minutes until return to baseline

describe the modified aldrete score?

GO LOOK AT POWERPOINT

what is the ramsey sedation scale?

anxious, agitated, restless is level 1 and then goes to level 6 unarousable

what is the equipment and supplies needed for moderate sedation?

oxygen, suction, airway equipment, reversal agents for opioids or benzodiazepines, and crash card

what is topical application for anesthesia?

anesthetic agent applied directly to surface of area through ointment or spray

what can topical application anesthesia cause?

cardiovascular collapse/depression if applied to respiratory tract

what is local infiltration anesthesia?

injection of the anesthetic agent intracutaneously and subcutaneously into the tissue

what does local infiltration aesthetic block?

blocks the peripheral nerve stimulation

what is regional anesthesia?

local injection of medication to block the transmission of sensory impulses effectively blocking the sensation of pain

what are some usage/indications of regional anesthesia?

general anesthesia is contraindication, previous adverse reactions to general anesthesia, preference, postop pain management enhanced by regional anesthesia, emergency procedure & the client has been eaten

when is spinal anesthesia used?

in surgical procedures performed on the lower abdomen, inguinal region, perineum, and lower extremities

WHERE IS SPINAL ANESTHESIA INJECTED INTO?

cerebrospinal fluid in subarachnoid space

what can spinal anesthesia caused?

hypotension and common postop complain is headache

what is the treatment for the side effects of spinal anesthesia?

strict bed rest in supine position for 24-48 hours, hydration, analgesia, epidural blood patch

what is epidural anesthesia?

local anesthetic agent injected in the epidural space adjacent to the dura mater

what are the indication for epidural anesthesia?

anorectal, abdominal, vaginal, perineal procedures, genital urinary, lower extremity procedures, monitor for hypotension

what is a nerve block?

local anesthetic agent injected in to the individual nerve or nerve bundles that supply a specific area

what does the nerve block interrupt?

sensory, motor, and sympathetic transmission

describe the effect of a nerve block and how long it lasts?

effect begins within minutes and lasts longer than local

what is bier block?

peripheral nerve block administered intravenously

what do bier block do?

used to trap anesthetic in the local area

what are nursing interventions for a nerve block?

monitor signs of systemic absorption, sensitivity, and overdose

what are complications of a nerve block?

seizures, cardiac depression, dysrhythmias, respiratory depression

what are complications of general anesthesia?

sore throat, malignant hyperthermia, overdose, unrecognized hypoventilation, susceptible to specific anesthetic agents, intubation complications

what is malignant hyperthermia?

multifactorial disease genetically transmitted. life threatening clinical syndrome of hyper metabolism involving the skeletal muscle. inadequate thermoregulation

when may malignant hyperthermia occur?

during surgery or post op after surgery when the anesthetic has been terminated

what's the earliest sign of malignant hyperthermia?

tachycardia. ventricular dysrhythmias, decreased cardiac output, and hypotension

name more signs of malignant hyperthermia!

hyperkalemia, metabolic and respiratory acidosis, rapid elevation of the body temperature, muscle rigidity especially in jaw or upper chest, oliguria or myoglobinuria, and cardiac arrest

what is the emergency treatment for malignant hyperthermia?

stop anesthesia/stop surgery if possible. intubate and administer 100% oxygen, cooling measures, monitor and treat dysrhythmias, treat hyperkalemia, restore acid base balance

what to administer in malignant hyperthermia?

administer dantrolene sodium

how to minimize tissue injury?

maintain patient in a correct body alignment so the body weight is distributed equally

how to maintain electrical safety?

apply the grounding pad on a large body surface if using a unipolar cautery machine. implement appropriate protection for laser equipment

what is the joint commission national patient safety goals?

guidelines for implementation of the universal protocol for the prevention of wrong site, wrong procedure and wrong person surgery

what is the universal protocol?

pre-operative verification process, marking the operative site, time in immediately before starting the procedure, time out immediately following the procedure, and check list

what to do for the prevention of retention of foreign object?

surgical supplies and instrument count. must be done by two people: usually the circulating nurse and the scrub nurse/surgical technician

when are the counts performed?

before procedure, during as items are added, at first closure, and before final closure. final correct count is announced to the surgeon and documented

the client will not experience hypoventilation as evidenced by...

-pulse ox greater than 95%

-blood pH within normal limits 7.35-7.45

-vital signs are within established parameters

how to minimize the risk of hypothermia?

warm blanket, warm IV fluids or solution, air warming device (bair hugger)

what does hyperthermia result from?

dehydration, illness resulting in fever, thyroid disorder, side effect from medication, injury to the hypothalamus

what to do for hyperthermia to help?

remove excessive drapes, apply alcohol or cool water cooling blankets, cool IV fluids

what to do to minimize risk for impaired skin integrity?

pad joint/bony prominences, avoid over tightening support straps, avoid excessive external rotation

what is the final step!

I PASS THE BATON

what does I PASS THE BATON stand for?

Introduction

Patient

Assessment

Situation

Safety Concerns

Background

Actions

Timing

Ownership

Next