surgery lectures

What are intra-op nurses responsible for?

caring for a pt when placed on the OR table and continues until the pt is admitted to the PACU

Another name for intra-op nurses is ____.

circulator

What attire is required in sterile areas of the OR?

scrubs, hair cover, shoe covers. masks, and beard covers (if applicable)

Attire in semi-controlled areas include:

scrubs and PPE

What is the circulator is responsible for?

positioning, surgical prep, sterility, safety, advocacy, doc w/i the OR room

Who assists the surgeon with instruments during surgery?

scrub tech/nurse

OR preparation include:

sponge/sharp/instrument counts

What is used to identify correct surgical site?

biological/chemical indicators

Surgical site verification begins with the physician and ends prior to the surgical incision. What is marked?

“yes” "(“x” is discouraged)

When is time out perfomed?

immediately prior to surgical incision

What does timeout include/verify?

pt. , procedure, correct site, equipment (fire risk assess. & antibiotic admin. verification may vary)

What is the purpose of SCIP project?

to decrease infections related to surgical sites

How does temperature affect a personals condition?

increases bleeding, myocardial complications, pressure ulcers, prolonged recovery (or hospital stay), pain, anxiety

Malignant hyperthermia is a rare-life threatening condition triggered by what?

anesthetic agents

What does malignant hyperthermia do to the body?

drastic increase in skeletal muscle oxidative metabolism that can overwhelm the body

The body can no longer do what when malignant hyperthermia occurs?

supply oxygen, remove carbon dioxide, regulate body temp., eventually leading to circulatory collapse and death if untreated

Moderate sedation (conscious) involves the use of sedation to depress the level of consciousness without doing what?

altering the patient’s ability to maintain a patent airway and to respond to physical stimuli and verbal commands

What area in the OR is required to where scrub attire and surgical masks?

restricted zone

Area in the OR where scrub attire is required (may include areas where surgical instruments are processed)

semi-restricted zone

Unrestricted zones include:

patient reception and holding areas

General anesthesia consists a state of narcosis, which is also what?

severe CNS depression

When under general anesthesia, the patient cannot do what?

be aroused, not even to pain, cannot maintain ventilation function (requiring assistance to maintain patient airway)

Anesthesia can be given via what route?

Inhalation/Intravenous

Anesthesia given via inhalation can be delivered thru mask or endotracheal tube. What does it impact?

hypothalamus which can cause shivering after surgery

The advantages of inhalation include:

pt totally unconscious, less anxiety, prevention of pain

disadvantages of inhalation:

agents are highly flammable, cause circulatory/respiratory depression

Stage IV of anesthesia is also called Medullary depression but can be deadly due to…

too much anesthesia which leads to cessation of respiration & leads to death if not reversed

potential complications during extubation include:

laryngospasm, vomiting, slow spontaneous respirations, uncontrolled reflex movement

What type of anesthesia causes temporary loss of sensation in a particular portion of body use of local anesthetics?

regional anesthesia

Regional anesthetics include:

spinal & epidural

what are the advantages of regional anesthesia?

pt is alert, can be given when pt hasn’t been fasting, muscle relaxation, used with c-section, COPD pts, elderly

What position does the pt need to be in for spinal & epidural procedure initiation?

leaning over bedside table & pushing back out like cat to expose vertebrae or side lying position (fetal)

How is epidural different from spinal anesthesia?

anesthesia is in epidural space, though the dura into subarachnoid space surrounding spinal cord (goes to the dura but not thru it)

(T/F) Epidural requires greater dosing and has slower onset & is not dependent on pt positioning bc it doesnt penetrate the dura.

true

Complications of spinal anesthesia include:

paresthesias, paralysis, hypotension, bradycardia & spinal headache caused by leak of spinal fluid from dura needle puncture

What is the use of spinal anesthesia?

surgeries involving lower extremities, perineum, lower abdomen

What can occur if spinal medication reaches upper thorax & cervical areas?

partial or complete respiratory paralysis could result requiring ventilator assistance.

Nerve block achieved with injection of a local anesthetic into or around a nerve or group of nerves that innervates the operative site. Intercostal, axillary & digital blocks are examples.

Local conduction blocks

Moderate sedation is good for what type of surgeries?

eye surgeries where vomiting & coughing increase intraocular pressure which could endanger vision following surgery.

What reversal agent must be available at bedisde?

Narcan (or Versed, Valium, or Propofol)

Advantages of moderate sedation:

produces pleasant, rapid (within 30 seconds), relief of fear, maintenance of consciousness & protective reflexes, quick return to normal activities.

disadvantages of moderate sedation:

powerful depressant of breathing, poor muscle relaxant, wide variance of tolerance.

local anesthesia medications include:

the “caines” (procaine, lidocaine, xylocaine)

Local anesthesia can be prolonged and decrease bleeding at surgical site by ____.

adding epinephrine (causes vasoconstriction)

Local anesthesia is ideal for

minor surgical procedures (dental extraction)

Anesthesia awareness include what symptoms?

increase BP, HR, and pt movement

What helps preclude anesthesia awareness occurrence?

premedication with amnesic agents and avoidance of muscle paralytics

Risk factors that can increase the risk of nausea & vomiting are:

females, age less than 50 years, hx of PONV, opioids

What nursing interventions does the RN do if a pt begins to vomit during intra-op?

turn pt to the side, head of the table is lowered, offer basin, suction

Extreme hypoxia can occur due to …

a pt aspirating on vomit, leading to bronchial spasms and wheezing, that can develop pneumonitis and pulmonary edema

If a pt has a latex, fibrin, and/or cyanoacrylate allergy, what type of reaction can occur?

anaphylaxis

What should OR team do if a anaphylaxis reaction is suspected?

remove causative agents promptly (within 3 mins or less)

What are other significant potential complications associated with general anesthesia?

inadequate ventilation, occlusion of the airway, inadvertent intubation of the esophagus, and hypoxia

what triggers malignant hyopthermia?

myopathies, emotional stress, heatstroke, neuroleptic malignant syndrome, strenuous exercise exertion and trauma

Metabolic acidosis is also known as

hypothermia

Warm air blankets and thermal blankets should be used to rewarm a pt becuase…

warming must be accomplished gradually, not rapidly

What must be monitored during a hypothermia episode?

temperature, urine output, ECG, BP, ABGs. electrolytes

What is included in the pre-op phase?

includes Pre Admission Testing, Ambulatory (Outpatient) Surgery, and In Patient Surgery

____ increases a pt’s would healing at the incision site and infection.

obesity (10% over ideal body weight)

(T/F) Any signed form required is placed in a prominent place on the pt’s medical record and does not accompanies the pt’s to the OR.

False, must accompany pt

When must a written consent be obtained?

invasive procedures, requiring anesthesia/sedation, nonsurgical procedure, radiation, blood product administration

What does informed consent contain?

explanation of procedure/ risks, description of benefits/ alternatives, answer q’s, instructions that the pt may withdraw consent.

Informed consent checklist:

voluntary consent (18+), informed, comprehend language

Psychoactive premedication must be given before or after getting consent?

after

Who is responsible to provide a clear and simple explanation of what the surgery will entail prior to the pt giving consent?

surgeon , anesthesiologist

Preop checklist:

obesity, cardiac, renal, neuro, resp., endocrine, GI, hematological. family hx of malignant hyperthermia

Pre admission testing and teaching (PAT):

pre-op teaching, day of surgery instructions, informed consent, advanced directives, DNR, diagnostic testing, radiology, anesthesia decision

preop dx tests

CBC, basic metabolic panel, PT/INR, PTT, aPPT (coag.), UA, pregnancy, EKG, chest xray, pulmonary function test

What are some inhaled anesthetics?

Halothane, Isoflurane, Nitrous Oxide

What are some IV anesthetics?

•Benzodiazepines

•Etomidate

•Propofol

•Ketamine

•Thiopental

•Methohexital

Complications of general anesthesia include:

Respiratory Depression

Vomiting/Aspiration

Nerve Trauma/Paralysis

Intubation Difficulty

Malignant Hyperthermia

Anesthesia Awareness

LMA intubation reduces ___.

chance of aspiration

Intranasal intubation is used for what?

facial trauma, oral/dental surgery

Oral intubation can ____.

cause sore throat, irritate trachea

What is the tx for malignant hyperthermia?

terminate surgery, 100% o2, infuse iced 0.9% sodium chloride IV, apply cooling blanket

what medications tx malignant hyperthermia?

Dantrium (muscle relaxant), sodium bicarbonate to correct acidosis

clinical manifestations for malignant hyperthermia:

inherited muscle disorder, muscle rigidity, tachycardia, dysrhythmias, hypotension, cyanosis, oliguria, temp rises 2-4 degrees every 5 mins

What triggers malignant hyperthermia?

succinylcholine with halothane

complications of spinal anesthesia

resp, paralysis, cardiopulmonary arrest if level goes above T4, paralysis, meningitis, hypotension, bradycardia, spinal HA

An ___ has a catheter that may be left in the epidural space for future dosing.

Epidural

Epidural anesthesia has a higher risk of what?

infection due to catheter, failed anesthesia, dura puncture, resp. depression

moderate sedation medications consist of:

opioids, benzodiazepines

reversal agent for opiods

naloxone (narcan)

reversal agent for flumazenil

benzodiazepines

MAC (monitored anesthesia care)

starts with minimal sedation and can progress to other types as needed

day of surgery process

NPO status, orders/informed consent, assessment LOC, heart, lungs, pain, and site; SCIP, checklist

Hematological Disorders and Medications that affect coagulation:

 Anticoagulants

Nonsteroidal anti-inflammatory drugs

 Steroids

Antihypertensives

Diuretics

Insulin, oral diabetics

Analgesics

Antihistamines/decongestants

Monoamine oxidase (MAO) inhibitors

a diagnostic surgical procedure

biopsy, exploratory laparotomy, or laparoscopy

curative procedure

excision of a tumor or an inflamed appendix

repair procedure

multiple wound repair

reconstructive or cosmetic

mammoplasty or a facelift

palliative procedure

to relieve pain or correct a problem—such as debulking a tumor to achieve comfort, or removal of a dysfunctional gallbladder

total joint replacement surgery to correct crippling pain or progression of degenerative osteoarthritis

rehabilitative procedure

during pre admission testing (PAT) patients

learn what to expect on the day of surgery and receive answers to questions they may have.

what are nurses in the PAT responsible for communicating?

surgical procedure and the effect that the surgical procedure and anesthetic may have on the patient’s health status, functional status, and family dynamics

in the pre-op area, the nurses must assess:

emotional status, pain, pre-op medications

on the day of the surgery, nurse should verify

list of home medications with the patient; medications the patient discontinued and when they were last taken

medications should be stopped ___ weeks before surgery unless it is BP meds.

2 weeks

____ includes outpatient, same-day, or short-stay surgery not requiring admission for an overnight hospital stay but may entail observation in a hospital setting for 23 hours or less.

__**Ambulatory surgery**__

If at any point the patient requests additional information, or if the nurse feels that the patient may not understand, the nurse

notifies physician immediately