intraoperative nursing (important notes)

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Intraoperative Phase - is the time when the person is transferred to the operating room -anesthesia is administered and the person undergoes the scheduled surgical procedure. -the emphasis is on the asepsis, homeostasis and safe administration of anesthesia The Surgical Team 1. Surgeon -is the head of the surgical team and makes the major decision - Surgeons have medical degrees, specialized surgical training of up to seven years, and in most cases have passed national board certification exams. 2. Scrub Nurse -participates directly during the procedure, setting up the operating room and making certain that the environment for surgery is sterile. -during the surgery, she maintains an accurate count of sponges, sharps ad instruments on the sterile field and count the same materials together with the circulating nurse. 3. Anesthesiologist/ Nurse Anesthetist - anesthesiologists are physicians with at least four years of advanced training in anesthesia. - anesthetists are qualified health care professionals who administer anesthesia. - their functions include: a. maintain the person airway b. ensure that the person has an adequate oxygen and carbon dioxide exchange c. infuse blood, medications and fluids as necessary d. alert the surgeon immediately for signs of complication 4. Circulating Nurse - act as the manager of the operating room - the functions include: a. check that all equipments are working properly before the surgery b. prepares and autoclave instrument for surgery c. alert team members of any break in the sterile technique d. contacts the x-ray and pathologic departments if requested by the surgeon e. do skin preparation f. document the specific activity throughout the operation g. verify consent and coordinate with the team Aseptic Technique 1. Sterilize all supplies used for sterile procedures. When in doubt, consider an object unsterile 2. When putting on sterile gloves, do not touch the outside of bare hands. When wearing sterile gloves, only touch sterile articles. If a glove is punctured, remove the damaged glove, wash hands, and put

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Page 1: INTRAOPERATIVE NURSING (IMPORTANT NOTES)

Intraoperative Phase

- is the time when the person is transferred to the operating room

-anesthesia is administered and the person undergoes the scheduled surgical procedure. -the emphasis is on the asepsis, homeostasis and safe administration of anesthesia

The Surgical Team

1. Surgeon -is the head of the surgical team and makes the major decision - Surgeons have medical degrees, specialized surgical training of up to seven years, and in most cases have passed national board certification exams.

2. Scrub Nurse -participates directly during theprocedure, setting up the operating room and making certain that the environment for surgery is sterile.-during the surgery, she maintains an accurate count of sponges, sharps ad instruments on the sterile field and count the same materials together with the circulating nurse.

3. Anesthesiologist/ Nurse Anesthetist

- anesthesiologists are physicians with at least four years of advanced training in anesthesia. - anesthetists are qualified health care professionals who administer anesthesia. - their functions include:a. maintain the person airwayb. ensure that the person has an adequate oxygen and carbon dioxide exchange c. infuse blood, medications and fluids as necessary d. alert the surgeon immediately for signs of complication

4. Circulating Nurse

- act as the manager of the operating room - the functions include: a. check that all equipments are working properly before the surgery b. prepares and autoclave instrument for surgery c. alert team members of any break in the sterile technique d. contacts the x-ray and pathologic departments if requested by the surgeone. do skin preparationf. document the specific activity throughout the operation g. verify consent and coordinate with the team

Aseptic Technique

1. Sterilize all supplies used for sterileprocedures. When in doubt, consider anobject unsterile

2. When putting on sterile gloves, do nottouch the outside of bare hands. Whenwearing sterile gloves, only touch sterilearticles. If a glove is punctured, removethe damaged glove, wash hands, and puton a new glove as promptly as patientsafety permits.3. The outer wrappings and edges of packsthat contain sterile items are not sterile.They should be opened or handled by theperson who is not wearing sterile gloves.Open sterile packages with the edges ofthe wrapper directed away from yourbody to avoid touching your uniform or

reaching over a sterile field. Touch onlythe outside of a sterile wrapper. Once asterile pack has been opened, use it; if itis not used, rewrap and resterilize it.4. Avoid sneezing, coughing or talking directly over a sterile field or object. 5. Do not reach across or above a sterile field or wound.6. Avoid spilling solutions on a sterile setup.7. A sterile field should be away from drafts,fans, and windows. 8. Store sterile packages in dry areas.Frequently wash hands using correcttechnique.9. Be constantly aware of need for clean surroundings. 10. Hold sterile objects and gloved handsabove waist level or level to the sterilefield. Since it cannot be sterilized, anyobject that touches it is consideredcontaminated. Have a special receptacleor waxed paper or plastic bag to receivecontaminated materials.

3. Traffic control

Surgical Environment: - a surgical suite is designed to promote safe therapeutic environment for the patient. - The in and out of the operating room is kept to minimum

-3 zones: a. unrestricted area

Page 2: INTRAOPERATIVE NURSING (IMPORTANT NOTES)

-provide entrance to and exit from the operating room-people may wear street clothes.-it includes the holding area,lounges, dressing room and offices.

b. semirestricted area

-provide access to the restricted zone and peripheral support areas within the surgical suite - scrub attire is required with caps

c. restricted area

-includes the individual OR’s, scrub areas, sub sterile room, and clean core areas. -in this area, scrub attire, hair covering and masks must be worn

2. Operating Room Attirea. masksb. headgear- should cover completely the hair, neckline and beardc. gownd. gloves

Sedation and Anesthesia: 4 Levels

Minimal sedation -is a drug induced state during which the patient can respond normally to verbal command -cognitive functioning and coordinationmaybe impaired but ventilatory andcardiovascular functioning is notimpaired

2. Moderate sedation -is a form of anesthesia that maybe produced intravenously. -there is a depressed level of consciousness that does not impaired the patient’s ability to maintain a patent airway and to respond appropriately to physical stimulation and verbal command

3. Deep sedation -is a drug induced state that client cannot be easily aroused but can respond purposely after repeated stimulation.

-usually achieved when anesthetic agent is inhaled or administered intravenously -the commonly use are the volatile liquids and gas anesthetics

VOLATILE LIQUIDS

1.Enflurane 2. Halothane 3. Methoxyflurane 4. Volatile liquids: 5. Isoflurane 6. Sevoflurane 7. Desflurane

Gases

1. Nitrous oxide

4. Anesthesia - is the state of narcosis, analgesia and relaxation and reflex loss - the client is not arousable even to painful stimuli

Page 3: INTRAOPERATIVE NURSING (IMPORTANT NOTES)

2. -Types of Regional Anesthesia

Page 4: INTRAOPERATIVE NURSING (IMPORTANT NOTES)

Spinal Anesthesia

-A spinal anesthetic is often used forlower abdominal, pelvic, rectal, or lower extremity surgery. This type of anesthetic involves injecting a single dose of the anesthetic agent directly into the fluid(SUBARACHNOID SPACE) surrounding the spinal cord in the lower back, causing numbness in the lower body -autonomic fiber is affected first and are the last to recover, (1) touch, (2) pain, (3) motor, (4) pressure, (5) proprioceptive fiber

2. Epidural Anesthesia

-This anesthetic is similar to a spinal anesthetic and also is commonly used for surgery of the lower limbs and during labor and childbirth. This type of anesthesia involves continually infusing medication through a thin catheterthat has been placed into the epiduralspace of the spinal column in the lowerback, causing numbness in the lower-if the level of block is too high it may lead to depression or paralysis

3. Caudal Block

-is produced by injection of local anesthetic into caudal or sacral canal -commonly use for obstetric clients

4. Topical Anesthesia

-anesthetic agent maybe applied directly on the area to be desensitized. - it can be a solution, ointment, a gel a cream or a powder- this short acting anesthetic agent can block the peripheral nerve endings

5. Local Infiltration Anesthesia

-involves the injection of anesthetic agent into the skin or subcutaneous tissue of the area to be anesthetized. - aspirate before injecting

6. Field Block Anesthesia

-involves the injection of anestheticagent to the area proximal to theplanned incision site.- this block forms the barrier between the incision and the NS

7. Peripheral Nerve Block

- a nerve block anesthetizes individual nerve or nerve plexus rather than all the local nerves. - Nerve block can be obtained in a finger, entire upper arm or chest or abdomen

Complications and Discomforts of Spinal Anesthesia

Hypotension -due to paralysis of the vasomotor nerves shortly after the induction of anesthesia.

- Interventions:a. ephedrene, antiemeticb. oxygen and fluid

3. Headache - cerebrospinal fluid that is lost through dural hole or leakage of fluid due to use of large spinal needle or poor hydration

- Nursing Interventions:a. Apply tight abdominal binderb. fluids and analgesicc. inject client blood to plug the hole(10cc) d. flat on bed after the surgery

4. Respiratory Paralysis

-occurs when the drug reaches upper thoracic and cervical spinal level

-Intervention: a. artificial respiration

5. Neurological Complication

- maybe due to: a. unsterile needle, syringes or anesthetic agentb. per-existing disease of CNSc. transient response to anesthetics d. position during surgery

-Interventions:a. supportive care for transient formsb. antibiotic and steroid therapyc. rehabilitation for permanent paralysis