Perioperative Nursing 2

1. Identifying the surgical client

2. Assess the Emotional and Physical status

3. Verify information in the Preoperative checklist

Intraoperative Nursing Management:

I. ASSESSMENT

• SAFETY

• POSITIONING

• MAINTAINING ASEPSIS

• CONTROLLING THE ENVIRONMENT

III. PLANNING & IMPLEMENTATION

Focus:

1. Reducing Anxiety

2. Protecting patient’s safety

3. Preventing Intraoperative positioning injury

4. Serving as patient advocate

Caring for the Patient During Surgery:

Surgeon

concentrates on performing the procedure

Anesthesiologist/Anesthetist

administers the anesthetic agent and monitor’s the client’s physiologic stability

Intra-operative nurse

responsible for the safety and well-being of the patient; the coordination of the OR personnel and the performance of the scrub and circulating nurse activities.

✓ Circulating nurse

✓ Scrub nurse

✓ RN first assistant

Anesthesia

a state of narcosis, analgesia, relaxation and reflex loss.

artificially induced state of partial or total loss of sensation with or without loss of consciousness.

General Anesthesia

• Blocks pain stimulus at the cerebral cortex & induce depression of the CNS that is reversed by metabolic changes and elimination from the body or by pharmacologic means.

• Produce analgesia, amnesia, unconsciousness and loss of reflex.

ONSET/BEGINNING (analgesia)

EXCITEMENT (Delirium)

SURGICAL ANESTHESIA

DANGER/MEDULLARY DEPRESSION/Respiratory arres

4 STAGES OF GENERAL ANESTHESIA

ONSET/BEGINNING (Analgesia)

• From anesthetic administration to loss of pain sensation.

• Physical reaction: warmth, dizziness and a feeling of detachment, ringing of ears, aware of being unable to move exaggerated.

EXCITEMENT (Delirium

• From consciousness to loss of eyelid reflex.

• Physical reaction: struggling, shouting, laughing, or crying; pupils become dilated, pulse rate is rapid and respirations irregular

SURGICAL ANESTHESIA

• From loss of eyelid reflex to loss of most reflex

• Physical reaction: clients are unconscious, muscles are relaxed, respirations are regular, normal pulse rate, absence of blink or gag reflex.

DANGER/MEDULLARY DEPRESSION/Respiratory arrest

• Functions are excessively depressed to respiratory and circulatory failure.

• Physical Reaction: respirations become shallow, pulse is weak & thready, pupils become widely dilated and no longer constrict when exposed to light, cyanosis may develop.

INHALATION ANESTHESIA

INTRAVENOUS ANESTHETIC

CONSCIOUS SEDATION

REGIONAL ANESTHESIA

SPINAL ANESTHESIA

CONDUCTION BLOCKS

LOCAL INFILTRATION ANESTHESIA

METHODS OF ADMINISTRATION

Nitrous Oxide (blue cylinder)

potent analgesic, used frequently for dental surgery, weakest of the gas anesthetic and the least toxic.

Cyclopropane (orange cylinder)

rapid action & rapid recovery, it causes muscle relaxation

Ethylene (red cylinder)

less toxic than most other gas anesthetic, not associated with bronchospasm, less post-anesthetic vomiting

INTRAVENOUS ANESTHETIC

• Include: benzodiazepines, barbiturates, opioids, dissociative agents

• These medications: may be administered for induction or maintenance of anesthesia

• Often used along with inhalation anesthetics but may be used alone.

• Can be used to produce CONSCIOUS SEDATION.

CONSCIOUS SEDATION

• Depressed level of consciousness without impairment of client’s ability to maintain a patent airway and to respond appropriately to physical stimulation and verbal command.

REGIONAL ANESTHESIA

• Agent is injected around the nerves so that the area supplied by these nerves is anesthetized.

• Effects depend on the type of nerve involved; local anesthetics block motor nerves least readily and sympathetic nerves most readily.

SPINAL ANESTHESIA

• involves introducing a local anesthetic into the subarachnoid space at the lumbar area between L4 and L5.

• Produce anesthesia of the lower extremities, perineum and lower abdomen.

• Spread of anesthetic agent and the level of anesthesia depends upon the amount of the fluid injected, the speed at which it is injected, the positioning of the patient after injection.

• Nausea, vomiting, pain and incidence of headache are common side-effects.

Epidural Anesthesia

o Achieved by injecting a local anesthetic into the spinal canal in the space surrounding the dura mater.

o Blocks sensory, motor and autonomic function.

o Advantage: absence of headache that results from spinal anesthesia.

o Disadvantage: greater technical challenge of introducing the anesthetic into the epidural space

LOCAL INFILTRATION ANESTHESIA

• Injection of a solution containing the local anesthetic into the tissue at the planned incision site.

• Often administered with epinephrine which causes vasoconstriction agent thus prolongs its local action.

• Advantages:

o Simple, economical, and non-explosive

o Equipment is minimal

o Post operative recovery is shortened

o Undesireable effects of general anesthesia is avoided

self-adhering sheets

sterile, waterproof and antistatic and transparent or translucent plastic sheeting may be applied to dry skin.

Incise drape

the entire clear plastic drape has an adherent backing that is applied to the skin. This maybe applied separately or the sheeting may be incorporated into the drape sheet. The skin incision is made through the plastic.

Towel drape

o Towel sheeting has a band of adhesive along one edge.

o Used as a draping towel, it will remain on the skin without towel clips.

Aperture drape

adhesive surrounds fenestration in the plastic sheeting. This secures the skin around the surgical site.

Non-woven fabric disposable drapes

are compressed layers of synthetic fibers combined with cellulose and bonded together chemically or mechanically without knitting, tufting or weaving. May either be absorbent or non absorbent.

o Laser resistant drapes o Thermal drape

Woven textile fabrics

Tightly woven textile fabric may inhibits the migration of microorganisms.

towels

o Disposable or reusable sterile towels may be used to outline the surgical site after prepping the skin.

o Usually packaged in groups of 4 and can be secured with non perforating clips. Some disposable types have adhesive strips to hold them in place.

Fenestrated sheets

Drape sheet has an opening that is placed to expose the anatomic area where the incision will be made.

Laparatomy sheet

Thyroid sheet

Chest sheet

Hip sheet

Perineal sheet

Laparascopy sheet

Fenestrated sheets

Laparatomy sheet

the longitudinal fenestration is placed over the surgical site on the abdomen, back or comparable area.

Thyroid sheet

fenestration Is transverse or diamond shaped and is positioned closer to the top of the sheet over the neck area.

Chest sheet

similar to a laparotomy sheet except that the fenestration provides a larger exposure. It is used for chest and breast procedures.

Hip sheet

covers the orthopedic fracture table, similar to laparotomy sheet but somewhat longer.

Perineal sheet

is of adequate size to create a sterile field over the patient in the lithotomy position, has 1 or 2 openings to accommodate the perineum and/or rectum.

Laparascopy sheet

a combination of laparotomy and perineal sheet. It is used for gynecologic laparoscopy in lithotomy or combined abdomino eprineal resection with patient in the lithotomy position.

Separate sheets

with smaller opening used for small incisions, such as taking specimens for biopsies, or procedures in the hands or feet.

Split sheet

Minor sheet

Medium sheet

Single sheet

Leggings

Stockinette

Separate sheets