Detailed Study Guide on Pre-operative and Intra-operative Nursing Processes

Pre-operative Checklist

• Purpose of the Pre-op Checklist: Ensures all necessary preparations are completed before surgery.

  • Includes getting labs, inserting an ID, completing all necessary questions, and confirming patient consent.

• Surgeon's Role: The surgeon will meet with the patient to discuss the procedure and obtain consent if it hasn't already been signed.

• Anesthesia Consultation: Anesthesia staff will also meet with the patient, confirming details and asking several questions.

  • Sign the Site: Both the patient and surgeon, along with sometimes the anesthesia staff, will sign the operative site to confirm the correct location for surgery.

Pre-operative Medications

• Common Pre-op Medications: Administered for specific reasons, including:

  • Antibiotics:

  • Purpose: Prophylactic use to prevent infections during surgery even in sterile Operating Rooms (OR).

  • Administration Timing: Ideally, should be given 30 minutes to an hour prior to surgery, before entering the OR.

  • Anticholinergics:

  • Purpose: To dry secretions and prevent issues during general anesthesia, especially when a breathing tube is involved.

  • Examples: Atropine and scopolamine are commonly used.

  • Antiemetics:

  • Purpose: To control nausea and vomiting, reducing aspiration risk.

  • Example: Ondansetron, given prior to waking the patient from anesthesia.

  • Sedatives and Analgesics:

  • Benzodiazepines: Used for sedation and anxiety relief.

    • Examples include midazolam and lorazepam.

    • Midazolam: More sedating and has an amnesic effect.

    • Lorazepam: Focus on reducing anxiety.

    • Reversal Agent: Flumazenil is used to reverse the effects of benzodiazepines in case of over sedation.

  • Opioids: Used for pain management.

    • Example: Fentanyl.

    • Reversal Agent: Meperidine or Naloxone can be used to reverse opioid effects.

Monitoring Patient Safety

• Important Monitoring Concerns: Benzodiazepines and opioids can cause respiratory depression.

  • Signs include shallow respiratory rate and low oxygen saturation (O2 sat).

  • Continuous monitoring of the patient’s airway and breathing is crucial during sedation and anesthesia.

Safety and Positioning in the OR

• Preparing for Surgery: Before surgery begins, it's essential to position the patient correctly:

  • Ensure Comfort: Use padding for bony prominences to prevent pressure sores, and maintain proper alignment for the surgical approach.

  • Prevent DVTs: Apply Sequential Compression Devices (SCDs).

  • Grounding Measures: Use grounding pads to prevent fires caused by surgical tools such as cautery devices.

Surgical Site Preparation

• Chlorhexidine Scrubs:

  • Used for cleaning the surgical site effectively prior to surgery.

  • Patients may be instructed to use chlorhexidine soap at home or pre-operatively in the hospital.

• Draping: After cleaning, sterilize the area with chlorhexidine iodine scrub, ensuring a sterile field and draping appropriately for the surgical procedure.

• Latex Allergies: Check for potential latex allergies. Food allergies such as to bananas and kiwis could signify a latex allergy.

Anaphylaxis Signs and Screening

• Signs of Anaphylaxis include:

  • Swelling of neck and tongue, hypotension, tachycardia, and bronchospasms.

  • Ensure to monitor ventilation changes in intubated patients since signs like stridor may not be audible.

  • If only one vital sign change is observed, other causes must be explored before concluding an allergic reaction.

Malignant Hyperthermia

• Definition: A rapid rise in temperature due to an adverse reaction to anesthesia.

  • At-Risk Populations: Higher incidence in individuals with red hair and certain genetic predispositions.

  • Management: Immediate administration of dantrolene can reverse symptoms.

  • Timing: Can occur any time from initiation of anesthesia to several hours post-op.

Hypothermia in the OR

• Environmental Factors: The OR is cold to reduce infection risk, leading to potential hypothermia in sedated patients.

  • Risk of temperatures falling to around 34°C, which could lead to complications such as cardiac arrest or blood flow issues.

• Preventive Measures: Use warm blankets, hot packs, and devices like Bear Huggers to maintain body warmth post-surgery.

Time-Out Procedure

• Importance of Time-Out: Conducting a time-out is vital before any invasive procedure, ensuring safety and accuracy.

  • Procedure for Time-Out:

  • Announce the patient's name, date of birth, known allergies, procedures to be performed, and the involved medical personnel.

  • Example: “I have patient Tori Merrick, DOB 07/03/1997, no known allergies, procedure: right sided chest tube insertion.”

• Documentation: Ensure all time-out information is documented meticulously in the patient's records.

Roles of Operating Room Nurses

• Roles in the OR:

  • Scrub Nurse: Maintains sterile field and assists directly during the surgery, handling instruments and aiding the surgeon.

  • Circulating Nurse: Monitors room conditions, patient status, and manages supplies.

  • Example: If a specific retractor is requested mid-surgery, the circulating nurse fetches it promptly.

  • Interoperative Care: The circulating nurse is responsible for tracking estimated blood loss and urine output, and communicating pre-and post-operative reports.