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AH3- Ch. 19
IntraOperative Care
| Question | Answer |
|---|---|
| What has altered where and how surgery is preformed? | advancements in technology, administration of anesthesia, and changes in the healrth care environment |
| What are the differences in the ambulatory surgery setting compared with the traditional sugery? | healthier pt populations, shorter procedures, quicker pt tunrovers, and less time available for perioperative eaching of the pt and family |
| What is the surgical suite? | a controlled environment designed to minimize the spread of infections and allow a smooth flow of pt, personnel, and the instruments needed to provide safe pt care |
| What are the 3 areas of the surgical suite? | unrestriced, semirestricted, and restricted |
| What can be worn in the unrestricted area? | street clothed people can interact with people in scrub clothes |
| What is the semirestricted area? | peripheral support areas and corridors |
| Who are only allowed in semirestricted areas? | authorized personnel |
| What is worn in the semirestricted area? | Sergical attire, and cover hair |
| What is required in the restricted area? | mask |
| Restriced area includes? | OR's, Scrub sink, and clean core |
| The layout of the surgical suite is designed to reduce? | cross contaminiation |
| What is the holding area? | special waiting area inside or adjacent to the surgical suite |
| What does the nurse do in the holding area? | makes the final identification and assessment before transfer to the OR |
| What is the AOD area? | Another area for holding (admission, observation and discharge) |
| What is the operating room? | unique care setting removed from other hospital clinical units |
| The OR is usually adjacent to the? | PACU |
| Filters and controlled airflow in the ventilating systems provide? | dust control |
| Postitive air pressure in the rooms prevents? | air from entering the OR from the halls and corridors |
| OR furniture is? | adjustable, easy to clean and easy to move |
| The privacy of the pt is achieved by? | restricting the influx of hospital personnel and visitors |
| The is the perioperative nurse? | a RN who implements pt care during the perioperative period based on the nursing process |
| The nurse is the pt's? | advocate throughout the intraOp experience |
| If the nurse is not scurbbed, gowned and gloved the nurse is in what role? | function of circulating |
| If the nurse is gowned gloved, in surgical attire and remains in the sterile field what is the function? | function of scrubbing |
| The perioperative nurse must respond to changes and revise? | the plan of care as needed |
| What does the nurse in the circulating role do? | documents the nursing care of the pt |
| In many institution who performs the scrubbed function? | sergical technologist or licensed practical nurse |
| What is the associated of surgical techonologists? | sets standards for education and provides continuing education opportunities to advance knowledge and skill |
| The person in the scrubbed functions assists? | the sergoen by passing instruments and implementing other technical functions during surgery |
| What is a surgeon? | physicial who performs the surgery |
| What 3 things is the surgeon responsible for? | preop med hx and physical assesment, pt safety and management in the OR, postop management of the pt |
| What does the surgeons assistant usually do? | holds retractors to expose surgical area and assists with hemostasis and surturing |
| Who can the surgeons assistant be? | RN or a nonphysicial who functions in the role of the assistant under supervision |
| What is the registered nurse first assistant? | works in collaboration with the sergeon to produce an optimal surgical outcome for the pt |
| What do the registered nurse first assistant do? | handles tissues, use instruments, provides exposure to the surgical site, assist with hemostasis and suturing |
| What is the anesthesia care provider? | one who administers anesthesia and can be an anesthesiologist or a nurse anesthetist |
| What does anesthesiology specialize in? | medical managment of pt, protection of life and vital organs under stress of anesthetic, managmagment of prob with pain, management of cardiopulmonary resusitation, managment with prob with pulmonary care, and management of critically ill pt |
| What is the anesthesiologist responsible for? | on site medical direction of any nonphysician who participates in the delivery of anesthesia care to the pt |
| What is a nurse anesthetist? | RN who has graduated from an accredited nurse anesthesia progam and completes a national certification exam |
| What are all the members of the surgical team? | circulating nurse, scrub assistant, surgeon, surgeon's assistant and ACP |
| Cultural assessment is essential to understanding the pt's? | response to the surgical experience |
| What is assessment data that is specifically important to the intraoperative nurse? | VS, height, weight, and age, allergic reactions, condition and cleanliness of skin, skeletal and muslce impairments, level of consciousness, and any sources of pain or discomfort |
| What is data obtained during the preop assessment? | hx, physical exam, allergies, urinalysis, blood cell count, serum electrolyte valuse, chest x ray, ECG, pregnancy test, consent, blood type |
| What is the general routine for admitting a pt? | initial greeting, human contact and proper identification |
| What does the identification process include? | pt name, surgeons name, and operative procedure and location |
| What is counted before a surgery? | all sponges, needles and instruments |
| What kinds of agent should be used for hand washing? | nonirritating, broad spectum and fast acting |
| If they use a waterless hand rub what should be done first? | hands waches with soap and water |
| What is the cneter of the sterile field? | the site of the incision |
| SMoke evacuators are used for what? | to get rid of smoke particles produced during laster procedures |
| What is the universal protocol? | prevents wrong site, wrong procedure and wrong surgery |
| What is a surgical time out? | where everyone stops to verify pt, surgical procedure and surgical site |
| What are the positions that a pt could be placed in during surgery? | supine, prone, trendelenburg, later, kidney, lithotomoy, jackknife and sittings |
| What is the most common position during surgery? | supine |
| What is the purpose of skin prep? | reduce the number or organims availiable to migrate to the surgical wound |
| Who usually does skin prep? | circulating nurse |
| Who accompanies the pt to the PACU? | perioperative nurse or another member of surgical team |
| What are factors that contribute to the choice of anesthetic chosen by the ACP? | pt health and hx, emotion stability and factors relating to the op procedure |
| anesthesia is classified according to the effect that is? | has on the pt's sensorium and pain perception |
| What are the 4 levels of sedation? | 1. minimal, the pt still responds 2. moderate, airway and heart function 3. deep sadation, pt not easily aroused 4. anesthesia level the pt required assisted ventilation |
| What is conscious sedation? | drug induced depression of consciousness that retains the pt's ability to maintian his or her airway and respond appropriately to verbal commands |
| What drugs are often used to provide anelgesia? | combination of anxiolytic |
| What are the 3 types of anesthesia? | general, local and regional |
| What is general anesthesia? | loss of sensation with loss of consciouness, skeletal muscle relaxation |
| What is local anesthesia? | loss of sensation without loss of consciousness |
| What is regional anesthesia? | loss of sensation to a region of the body without loss of consciousness when a specific nerve or group of nerves is blocked with the administration of local anesthetic |
| General anesthesia is uaually the technique of choice for pt's who? | are having surgeries that need great skeletal muscle relaxant, last for long periods of time, require awkeard positions because of the location, are extremely anxious, refuse or can't have local or regional anesthetic, are uncooperative |
| How may genreal ensthesia be administered? | IV, inhalation or rectally |
| What is a new types of general anesthesia? | Total IV anesthesia |
| What is total IV anesthesia? | all meds are giving iv, thus eliminating the need for inhalation agents |
| What is the foundation of general anesthesia? | inhalation agents |
| What are volatile liquids? | drugs administerd through a vaporizer that are being mixed with oxygen |
| What are adjuncts? | drugs assed to an inhalation anesthetic |
| What are types of adjuncts? | opioids, benzodiazepines, NMBA, and antiemetics |
| Opioids are used preoperativly for? | sedation and analgesia |
| Opioids are used intraOp for? | induction and maintenance of anesthesia and analgesia |
| Opioids are used postOp for? | pain mangament |
| All opioids produce? | resp. depression |
| What is a lte sign of resp. depression? | decreased SaO2 by pulse ox |
| What can reverse opioid causing resp depression? | narcan |
| Benzodiazepines are used widely for? | premedication before srugery for their amnesic effects, maintenance of anesthesia, for conscious sedation and for postOp anxiety and agitation |
| What is the most frequency used benzo? | versed |
| What can reverse benzo resp depression? | flumazenil |
| Neuromuscular blocking agents are used as? | adjuncts to general anesthesia to facilitate endotracheal intubation and to optimize surgical working condition |
| How do NMBA work? | interrupt the transmission of nerve impulses at the neurmuscular junction |
| What reverses NMBA? | anticholinesterase |
| What do antiemetics do? | prevent and treat N |
| What does dissociative anesthesia do? | interupts associative brain pathways while blocking sensory pathways |
| What is commonly administered doissociative anesthetic? | ketamine |
| What does ketamine do for pt with asthma? | promotes bronchodilation, increase heart rate and maintain CO |
| Ketamine can cause? | hallucinations and nightmares, particularly in adult pt |
| What do local anesthetics block? | the initiation and transmission of electrical impulses along nerve fibers |
| Local anesthetics produce? | autonomic nervous system blockade, anesthesia and skeletal muscle paralysis in the area of the affected nerve |
| Local anesthesia allows an operative procedure to to be? | performed on a particular part of the body without loss of consciousness or sedation |
| With local anesthesia there is little? | systemic absorption of the drug |
| Many pt report what to local anesthetics? | allergies |
| What are the 2 classes of local anesthetia? | ether and amides |
| regional nerve block is achieved by? | injection of local anesthetic into or around a specific nerve or group of nerces |
| What is a bier block? | IV regional nerve block, injection of a local anethetic into an extremity following mechanical exsanguination using a compression bandage and a tourniquet |
| What are two types of regional anesthesia? | spinal and epidural |
| Spinal anesthesia involves? | the injection of a local anesthetic into the cerebrospinal fluid found in the subarachnoid space |
| An epidural block involves? | injection of a local anesthetic into the epidural space via with a thoracic or lumbar approach |
| What does headache occur with? | spinal anesthesia |
| What is controlled hypotension? | technique used to decrease the amount of expected blood loss by lowering the BP duing the administraction of anesthesia |
| What is hypothermia? | delieberate lowering of body temp to decrease metabollism |
| What is cryoanesthesia? | cooling or freezing a localized area to block pain impulses |
| What are the nursing responsibilites intraop? | safety and well being of pt, coordination of operating room personnel, scrub and circulating activity, educator, pt advocate, psychosocial support |
| What is the job of the circulating nurse? | RN, manages OR, verifies consent, check equipment, monitor aseptic practices, monitor pt, take specimens to lab |
| What is the role of the scrub nurse? | scrubs for surgery, set up sterile table, prepares, assists surgeon, time manager, counts needles, sponges, etc. |
| What is an anesthetist? | administer anesthetics, graduate of a program |
| What is an anesthesiologist? | physician |
| Surgical Asepsis prevents? | contamination of surgical wound |
| What does surgical asepsis include? | sterilized material, scrubbing, gowning, clean OR, and ventilation |
| Any doubt that something is sterile? | its not sterile |
| Scrubbed personnel stay? | in area of sergical procedure |
| In from from chest level to sterile field is? | sterile |
| Sleeves to 2 inches above elbow is? | sterile |
| Circulating nurse and unscrubbed personnel stay at? | a safe distance |
| The draping for surgery is? | held above surface, and only top is sterile |
| Blood and body fluids, laser risk, latex allergy, radiation, and toxic agents are all what? | hazards for surgery |
| What is used for induction or maintenance? | IV anesthesia |
| With IV anesthesia? | onset is pleasant, duration is brief |
| What is the complication for IV anesthesia? | Respiratory Depression |
| What is conscious sedation? | Depressed level of consciousness without impairment of ability to maintian pt airway and to respond appropriate to physical stimulation and verbal command |
| What does conscious sedation cause? | amnesia, pain free but maintain protective reflexes |
| What are types of conscious sedation? | versed, diazepam, and morphine |
| What does general anesthesia cause? | loss of sensation and consciousness |
| General anesthesia causes? | skeletal muscle relaxation |
| What causes elimination of somatic, autonomic and endocrine responses? | general anesthesia |
| Regional anesthesia causes? | loss of sensation to a region of body without loss of consciousness |
| What are types of regional anesthesia? | spinal, epidural, peripheral |
| Local anesthesia causes? | loss of sensation without loss of consciousness |
| What blocks initiation and transmission of electrical impulses along nerve fibers? | local anesthesia |
| What are types of opioids? | morphine, demerol, and sublimaze |
| Opioids cause? | resp. depression |
| What do you give with opioid resp. depression? | Narcan |
| Benzodiazepine is a? | sedative hypnotic |
| What are types of benzos? | versed, valium, ativan |
| What do NMBD do? | block transmission of nerve impulses at neurmuscular junction of skeletal muscles |
| What is anectine? | NMBD |
| What are antiemetics for? | N |
| What are types of antiemetics? | Inapsine, Zofran, and phenergan |
| What interrupts associative brain pathways while blocking sensory pathways? | dissciative agents |
| what is a type of dissiative agent? | Ketalar |
| What are the reasons of positioning a client intraop? | procedure, condition of pt, comfort, exposure, safety |
| What should be done for N&V? | turn on side, head of table lowered, basin or suction |
| If hypoxia is suspected you should monitor pt's? | peripheral perfusion, pulse ox, administration of oxygen |
| What is hypothermia? | core body temp less than 98 |
| How do you prevent complications of hypothermia? | increase temp gradually, Warm IV fluids, wet gowns and drapes removed and replaced |
| What are anaphylatic reactions? | severe allergic reaction |
| What are s/s of anaphylatic reactions? | hypotension, tachycardia, bronchospasms, pulmonary edema |
| Malignant hyperthermia is an? | inherited muslce disorder |
| Malignant hyperthermia is chemically induced by? | anesthetic agents |
| What clients are susceptible to malignant hyperthermia? | bulky, strong muslces, hx of muscle cramps, unexplained temp elevation, unexplained death of family member during surgery |
| In malignant hyperthermia what is not returned to the muscle? | ca |
| What Ca accumulates it causes? | hypermetabolism |
| What are s/s of malignant hyperthermia? | increase heart rate (150), dysrhythmia, decrease BP and CO, oliguria, cardiac arrest, increased CO2, rigid movement, elevated temp |
| What is a late sign of MH? | elevated temp |
| What med reverse MH? | dantrium |
| What does dantrium do? | slows metabolism |
| What is becoming more a reality? | bloodless surgery |
Created by:
alicia.rennaker
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