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1510 Intra-Operative

1-4 points of Surgical Asepsis Contact with wound must be sterile; Fronts of gowns are considered sterile from chest to level of sterile field; Sleeves of gowns 2 inches above elbow to cuff; Only top of sterile drape is considered sterile, positioned front to back
5-9 points of Surgical Asepsis Sterile to sterile, unsterile to unsterile;Movement around sterile field must be restricted to at least one (1) foot away;If sterile barrier is breached, consider contaminated; Prepare sterile field as close as possible to procedure
Difference in medical and surgical asespsis? Medical asepsis is clean technique whereas surgical asepsis is sterile technique
Types of General Anesthesia Inhalation-Vapors are inhaledPatient is intubated, anesthesiologist administers with oxygenIntravenous-Barbiturates, benzodiazepines, hypnotics, analgesics, muscle relaxantsCan be used with inhalation anesthesia or alone
Stages of General Anesthesia Stage 1- Beginning anesthesiaStage 2- ExcitementStage 3- Surgical anesthesiaStage 4- Medullary depression
Attributes of Stage 1 Anesthesia Pt hears noise in animation-amplification. Try to reduce noise
Attributes of Stage 2 Anesthesia pt may be restrained to prevent injury
Attributes of Stage 3 Anesthesia pt should be unconscious and unresponsive
Attributes of Stage 4 Anesthesia CNS is to far depressed. Can be fatal
Types of Regional Anesthesia TopicalLocalEpiduralSpinalLocal Conduction Block (Nerve Block)
Moderate Sedation airway intervention not required; self ventilation; CV function usually maintained; purposeful response to repeated or painful verbaal or tactile stimuli; RN
Monitored Anesthesia Care Airway intervention may be required; self ventilation may be inadequate; CV function usually maintained; purposeful response after stimulation; CRNA
Versed (midazolam) Benzodiazepine; sedative/hypnoticUsed to reduce anxiety and induce amnesia/sedation for procedure/testUsual dose IV: 1 mg initially, titrated to patient’s sedation required, total dosage > 4 mg rare; PO 5-10 mg
Versed AE Can cause respiratory depression!Side Effects: drowsiness, dizziness, headaches, dry mouth, blurred vision
Demerol (meperidine hcl) Opioid analgesicUsed as anesthesia adjunct or for sedationUsual dose IV: 25 mg given in increments
Demerol AE Can cause respiratory depressionSide Effects: drowsiness, dizziness, headaches, dry mouth, blurred vision
Narcan (naloxone Opioid antagonistUse: Reversal of CNS depression because of suspected opioid overdosageRoutes: Usually IVUsual dose IV: 0.4mg q2-3min, up to 2mg
Narcan AE Side Effects: hypertension, hypotension, tachycardia, N&VMonitor vital signs frequently (every 5-15 minutes) for 3-4 hours after administration
Circulating Nurse Duties 1 Universal Protocol (Time-Out) PRIORITY!Two patient identifiers;Question the patient to determine if he/she understands the procedure;Ensure that site is CLEARLY marked
Circulating Nurse Duties 2 Signed Informed Consent should be in prominent area of chart – MUST be witnessed by pre-op nurse;Consent should clearly state what procedure is to be done, what site, and what side;Is there an Advance Directive/Living Will/DNR on the chart; Allergies
Circulating Nurse Duties 3 Check IV, NG Tube, Foley CatheterPatient should be wearing cap and gown that allows easy access to surgical siteIf ordered, are TED hose or SCDs in place?Make sure any special equipment needed is available and functioning properly
Circulating Nurse Duties 4 Check patient’s response to pre-op medsReduced anxietyDry mouthIf administering Moderate Sedation, must assess the patient continuouslyB/P, Pulse, Resp, anxiety level, pain level q5min or more as neededContinuous pulse oxEthical Concerns
Patient Safety Precautions Proper Patient PositioningMonitor and maintain aseptic environmentMaintain catheters, tubes, drains, and specimensPerform sponge, sharps, and instrument counts
Post-op Nausea and Vomiting Anticholinergics usually given PreOp to prevent aspiration:Atropine RobinulFirst action is to turn patient to side to prevent aspiration May also receive antiemetics:Promethazine (Phenergan)Hydroxyzine Pamoate (Vistaril)Ondansetron (Zofran)
Phenergan (promethazine hcl) Antiemetic; sedative/hypnoticUse: Prevention or tx of N/V, pre-op sedation, adjunct to anesthesia and analgesiaRoutes: PR, PO, IM, *IVDoes not mix with some meds Usual dose: 12.5 – 50 mg
Phenergan (promethazine hcl)AE Side effects: Dizziness, drowsiness, sedation, burning & pain at IV site
Vistaril (hydroxyzine pamoate) Antiemetic; anti-anxiety; sedative/hypnoticUse: May be given pre-op as anti-anxiety, but often during surgery as anti-emeticRoutes: PO, usually IMAdminister ONLY deep IM into well-developed muscle with Z-track methodUsual dose: 25-100 mg
Vistaril (hydroxyzine pamoate)AE Side effects: drowsiness, agitation, ataxia, dizziness, pain/abscess at IM site
Zofran (ondansetron) AntiemeticUse: Prevention/tx of N/VRoutes: PO, IM, usually IVUse no more than 8 mg/day in hepatic impairmentUsual dose: 4mg
Zofran (ondansetron)AE Side effects: dizziness, drowsinessBe sure to check IV compatibility
Symptoms of Anaphylaxis Peripheral tinglingFullness in mouth and throatFlushing, warmth, anxietyBronchospasms, edema of airways or larynxDyspnea, cough, wheezingAbdominal cramping, vomiting, diarrhea, seizuresCardiac arrest, coma
Ineffective Airway Clearance Individual experiences a threat to respiratory status related to inability to cough ineffectively
Ineffective Breathing Pattern Individual experiences an actual or potential loss of adequate ventilation related to an altered breathing pattern
Ineffective Tissue Perfusion (Peripheral) Individual experiences a decrease in oxygenation at the capillary level
Deficient Fluid Volume Individual experiences dehydration
Hypothermia Individual has a sustained reduction of body temperature of < 98°F rectally due to external factors
Risk for Aspiration Risk for entry of secretions, solids, or fluids into the tracheobronchial passages
Risk for Imbalanced Body Temperature At risk for hyperthermia, hypothermia, or ineffective thermoregulation
Risk for Fluid Volume Imbalance At risk for a decrease, increase, or rapid shift of fluids (intravascular, interstitial, and/or intracellular)
Risk for Perioperative Positioning Injury At risk for harm as a result of positioning requirement during surgery, unable to protect self due to anesthesia
Risk for Infection At risk for invasion by microorganism (virus, fungus, bacterium, protozoan, or other parasite)
Unintentional Hypothermia Indicated by core body temperature of less than 98 degrees (36.6 degrees C)Often give warmed IV fluids (98.6F)Increase room temp temporarily to 78-80F Warming must be done gradually, not rapidly
Malignant Hyperthermia Rare inherited muscle disorderWas a 80% mortality rate, now 10%Tachycardia earliest symptom Rise in temperature is a late sign and can reach above 104 degrees
Disseminated intravascular coagulation.DIC Cause: thrombus formation in the microcirculationDepletion of select coagulation proteinsThese processes lead to hemorrhaging
Infection/Sepsis May become septic during procedureCan occur when the surgery involves infected tissues – infection spreads rapidly within the blood stream
Signs of shock Increased heart rateRapidly decreasing blood pressureDiaphoresisPatient’s temperature will be elevated, and will continue to rise
Hypoxia/Other Respiratory Complications Brain damage from hypoxia occurs within minutesCapillary refill < 3 secs, nail beds pinkCheck peripheral pulses to check perfusion, esp. in vascular surgery
Causes of Anaphylaxis MedicationsMost common cause of anaphylaxisLatexAdhesivesFibrin sealantsCyanoacrylate tissue adhesives
Created by: Vipdesigner