Intraoperative - Postoperative Nursing Care Management

Surgeon

Head of the Surgical Team

First/Second Assistant Surgeon

Assists in retracting, hemostasis, suturing, etc. May be a resident, intern, physician's assistant, or a perioperative nurse

Registered Nurse First Assistant

Under the direct supervision of the surgeon. Handles tissue, provides exposure at the operative field, sutures and maintain hemostasis.

Scrub Nurse

Selects instruments, equipment and other supplies appropriate for the surgery. Prepares the sterile field and sets-up sterile tables

Surgical counts

The counting of sponges, sharps and instruments that are opened and delivered to the sterile field for use during surgery

Anesthesiologist

A physician specifically trained in the art and science of anesthesiology.

CRNA

A qualified health care professional who administers anesthetics. Administers anesthesia under the direct supervision of the anesthesiologist

Circulating Nurse

Completes a preoperative assessment. Monitors sterile technique of all members of the team and a safe OR environment. Maintains accurate and complete documentation

Unrestricted zone

Surgical zone in which street clothes are allowed and are usually designated at entrance and exit for personnel and patients, dressing room, PACU, offices, holding area, lounges, storage for supplies

Semi Restricted zone

Surgical zone in which attire consists of scrub suits and caps. Usually designated at storage areas for clean and sterile supplies, sterilization processing and preparation area for equipment.

Restricted zone

Surgical zone in which attire consists of scrub suits, caps, shoe covers and masks are worn. Surgery is performed in this zone

Endogenous

Source of infection that arises from within the body

Exogenous

Source of infection that arises from outside the body

Asepsis

It refers to the absence of pathogenic organisms

Aseptic technique

It refers to the practices by which contamination with microorganisms in the surgical environment is prevented.

Surgical conscience

It is an inner commitment to adhere to aseptic practice, to report any break in the aseptic practice, and to correct any violation, whether or not anyone else is present or observes the violation.

To lower the bacteria on the skin prior to surgery

What is the purpose of patient skin prep?

Draping

It serves as a barrier to prevent the passage of microorganisms between sterile and non-sterile areas.

Sterile drapes

It is used to create a sterile surface around the incision site that may be used for sterile supplies and equipment.

Flat sheets

It is used to drape instrument table and areas of the patient

Towels

It is used to drape the operative site

Fenestrated drapes

Drapes with openings of various sizes.

Stockinet drapes

It is used to drape feet and hands

Leggings

It is a part of the drape intended for surgery with the patient for lithotomy position.

Dorsal Recumbent/Supine

It is the most common surgical position. Used in abdominal surgeries ;anterior approach, head, neck and most extremity surgery.

Trendelenburg

Positioning used for surgeries in the lower abdomen and pelvis

Reverse Trendelenburg

Positioning used for surgeries in the head and neck procedures

Lithotomy

Positioning used for surgeries in the perineum, pelvic organs, and genitalia.

Sims/Lateral

Positioning used for surgeries in access to the thorax, kidney, retroperitoneal space, and hip

Sitting

Positioning used for surgeries in cranial surgeries

Prone

Positioning used for surgeries in the spine, back, rectum, and posterior aspects of the extremities.

Jackknife or Kraske's

Positioning used in proctologic procedures and rectal surgeries

Anesthesia

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

Regional anesthesia

It is an anesthetic agent that is injected around the nerves so that the area supplied by these nerves is anesthetized.

Spinal anesthesia

It is obtained when the anesthetic agent is injected into the CSF in the subarachnoid space.

between L2 & L3 or below

Spinal anesthesia is injected through what vertebral interspace?

bupivacaine and tetracaine

What are the most frequently used agents for spinal anesthesia

Epidural anesthesia

Injection of the anesthetic agent into the epidural space that surrounds the Dura mater of the spinal cord.

It is useful for pain management in the post-operative period

In epidural anesthesia, why can the catheter be left in place for continuous infusion?

Caudal anesthesia

Anesthetic that is injected into the epidural space through the caudal canal in the sacrum.

Nerve block

It is injected into and around a nerve or nerve group that supplies sensation to a small area of the body. Commonly used for sustained relief in patient with chronic pain.

Major nerve block

Nerve block that involves multiple nerves or a plexus

Minor nerve block

Nerve block that involves a single nerve

Local anesthesia

It involves injection of the anesthetic agent into subcutaneous tissue at, or close to, the anticipated site. Useful for minor and superficial procedures

Toxic reaction

A nurse must be alert when giving local anesthesia due to the possibility of this reaction

Topical anesthesia

It is applied directly to a mucous membrane or an open wound.

pontocaine

Commonly used topical anesthetic for eye procedures

cocaine

Commonly used topical anesthetic for nasal procedures

lidocaine

Commonly used topical anesthetic for procedures in the throat, nose, esophagus, and genitourinary tract.

General anesthesia

A drug induced loss of consciousness during which patients cannot be aroused, even by painful stimulation. It is either inhaled or administered through IV

Amnesia, analgesia and skeletal muscle relaxation

Effective general anesthesia includes?

Aspiration

It is the entry of gastric, oropharyngeal, or other substance into the lungs.

Suctioning of the oropharynx and the tracheobronchial tree

What is the primary nursing care management for aspiration?

Laryngospasm

It is the closure of the vocal cords as an involuntary reflex action.

Bronchospasm

It is the contraction of smooth muscle in the walls of the bronchi.

Pulmonary embolism

It is the obstruction of the pulmonary artery or one of its branches by an embolus. It is the major cause of death

Cardiac arrest

It is the cessation of circulatory action

Hypovolemia

It is the decreased circulating blood volume from loss of blood and plasma

elevate the patient's legs

What is the primary nursing care management for hypovolemia?

Hemorrhage

It is an abnormal internal or external loss of blood from an arterial, venous or capillary source

weigh sponges

How would you estimate blood loss from a hemorrhage?

Malignant hyperthermia

It is a rare inherited muscle disorder that is chemically induced by anesthetic agents. It can occur 10 to 20 minutes after induction of anesthesia or during the first 24 hours after surgery

Dantrolene sodium

It is a a skeletal muscle relaxant and along with sodium bicarbonate are administered immediately for patients with malignant hyperthermia

Shock

It is a state of inadequate blood perfusion to parts of the body.

Hypovolemic shock

It is fluid loss greater than compensatory absorption of interstitial fluid into the circulation.

Hemorrhagic shock

Shock that results from hemorrhage or inadequate blood volume replacement

Neurogenic shock

It is the loss of vasomotor tone in peripheral blood vessels leads to sudden vasodilation and pooling of blood.

prevention

What is the best treatment for shock?

To critically evaluate and stabilize the patient postoperatively, anticipate and prevent potential complications and safeguard the patient's well-being until they are stable to do so themselves.

What are the main objectives of RR care?

post op pain

It can delay a return to normal function, impair wound healing and predispose the patient to infection.

pre-empt pain before it starts

What is the objective of effective pain management?

Aldrete score

A scoring system used to assess the physical status of clients recovering from anesthesia and serves as a basis for discharge from PACU.

8

It is the minimum Aldrete score for discharge

30 mL/hour

What is the normal urine output

temperature, pulses and sensations, surgical site, casts and pressure areas

In the PACU/RR, the nurse must monitor what?