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AH3- Ch. 19

IntraOperative Care

QuestionAnswer
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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