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H&C Ch 15 IntraOp
H&C Ch 15 Intraoperative
| Question | Answer |
|---|---|
| What are the main concerns for a geriatric patient undergoing surgery ? | age induced cardiovascular and pulmonary changes, withstanding endurance required for recovery (such as early ambulation) , adjusted doses for anesthesia, reduced renal function, possible impaired liver function |
| Some complications of surgery (think BIG ones) | Bleeding, allergic reactions, thrombosis, human error p. 357 for exhaustive list |
| True of False: When surgery is being done under local anesthesia and the patient does not speak English, because of the sterile environment a translator may not be utilized | false, translators will be utilized |
| the __________________________________ works in collaboration with surgeons, anesthesia providers, and other health care providers to plan the best course of action for each patient | circulating nurse |
| the ____________________monitors aseptic practices to avoid breaks in technique while coordinating the movement of related personnel | circulating nurse |
| When the circulating nurse observes a tech touch the back of another tech what should occur ? | the circulating nurse should announce the oversight so that it can be correct ? |
| Who is responsible for verifying the second check for correct procedure and site ? | circulating nurse |
| What is the purpose of the intraoperative checklist ? | to reduce errors, increase safety |
| True or false: the scrub role may be performed by an LPN | True p. 359 |
| If a surgical sponge cannot be located on final count what is the next course of action ? | notify the surgeon |
| what are the responsiblities of the RNFA? | handling tissue, providing exposure at the operative field, suturing, and maintaining hemostasis |
| What is the role of the CRNA ? | assesses the patient before surgery, selects the anesthesia, administers it, intubates the patient , manages technical problems r/t to the administration of the anesthetic agent, and supervises the patient’s condition throughout the surgical procedure |
| What approach is used to maintain the airway if the surgery is oral ? | intranasal intubation |
| Risk of hypothermia is related to what situation ? | the cool air in the environment, also compounded by patient condition/age |
| What are some fire prevention concerns in the OR? | alcohol based antiseptics, flammable solutoins, open oxygen, nitrous oxide, electrosurgical unit, laser or fiberoptic lights used, saws, burrs, drills (electric drills) |
| Does scrub entire protect the patient from microorganisms entirely ? | no, Upper respiratory tract infections, sore throats, and skin infections in staff and patients are sources of pathogens |
| What is the most common bacteria to cause surgical site infections ? | staph aureus |
| dry time is particularly important when applying what type of solutions (to prevent infection) | chlorhexidine, alcohol-based products |
| What part of the gown when worn in surgical suite is considered sterile ? | front from chest level to level of sterile field , sleeves from 5cm above the elbow to the stockinette cuff |
| What part of the draped table is considered sterile? | only the top |
| What distance from the sterile field must be maintained to prevent inadvernant contamination (think the entire OR set up, not for example glove packaging) | 1 foot around the sterile field in the OR |
| To avoid smoke (plume) inhalation during procedures what must be worn ? | N95 respirator |
| General anesthesia acts upon the __________ _________ _______ | Central nervous system |
| what are the 4 stages of general anesthesia ? | beginning anesthesia, excitement, surgical anesthesia, medullary depression |
| at what stage of general anesthesia is the patient likely to talk, sing or cry if anesthetic agents are not given smoothly or quickly | excitement (stage 2) |
| Gas anesthetics are always combined with what ? | oxygen |
| What is the advantage of IV anesthesia ? | there is none of the buzzing, roaring, or dizziness known to follow administration of an inhalation anesthetic agent. it is non explosive , low incidence of aspiration events |
| During __________________ anesthesia the patient is awake and aware of surroundings thorughout the procedures | regional |
| ______________anesthesia is achieved through injection in the space around the dura mater of the spinal cord | epidural |
| ________________anesthesia is achieved through injection into the dura mater | spinal |
| What is an after affect of spinal anesthesia? | headache |
| What are the influencing factors for headache during spinal anesthesia ? | sixe of needle, leakage at puncture site, hydration status |
| What is another name for moderate sedation ? | conscious sedation |
| What is the goal of moderate sedation ? | to depress a patient’s level of consciousness to a moderate level to enable surgical, diagnostic, or therapeutic procedures to be performed while ensuring the patient’s comfort during and cooperation with the procedures |
| ___________ is the injection of solution containing anesthetic into tissues at the planned incision site | local anesthesia |
| Why is epinephrine also given with local anesthesia ? | prevents rapid absorption of the agent systemically (keeps it local through vasoconstriction) |
| ___________________ is a potentially life-threatening event, it occurs when a bolus of LA is inadvertently injected into peripheral tissue or venous or arterial circulation during a PNB or spinal nerve block procedure | LAST - local anesthetic systemic toxicity |
| __________ ____________ refers to a patient unintentionally becoming cognizant of surgical interventions while under general anesthesia and then recalling the incident | anesthesia awareness |
| How might the anesthesiologist know anesthesia awareness is occurring ? | increase in BP, tachycardia, patient movement |
| patients may be given _______________ and ________________ to increase gastric pH | citric acid , sodium citrate |
| _____________________ __________________ is a rare inherited muscle disorder that is chemically induced by anesthetic agents | malignant hyperthermia |
| What are the sytmptoms of malignant hyperthermia ? | tachycardia, ventricular arrhythmia, hypotension, decreased cardiac output, oliguria p. 368 |
| What medication is used to treat malignant hyperthermia ? | dantrolene |
Created by:
Kelly Quijano
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