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107 Cards in this Set
- Front
- Back
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The differences between ambulatory setting and the traditional in patient surgery setting are:
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healthier patient populations
shorter procedures quicker patient turnovers less time available for perioperative teaching and family |
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Unrestricted part of surgical suite is where personnel in _________ ________ can interact with those in _______ ________.
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street clothes
scrub clothing |
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Where are the unrestricted parts of the surgical suite?
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Holding area
Staff locker area Nursing station Control desk |
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Semirestricted part of surgical suite includes the peripheral support areas and corridors. Only __________ _________ are allowed in this area and must wear surgical attire and cover all ______ and __________ hair.
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authorized personnel
head and facial |
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Restricted area requires that __________ be worn in addition to surgical attire. These areas include the ______, ________ ______ _____, and _____ _____.
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masks
OR, scrub sink area, and clean core |
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The RN makes the final identification and assessment in the _________ area.
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holding
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In the AOD holding area, the nurse can _______________ the patient for preoperative data, _________ the patient both before and after surgery, and allow ________ for a sufficient length of time before discharge to home or IP room.
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assess
observe recovery |
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The AOD area significantly affects the patient's stay throughout the OP surgery and prevents unnecessary _____________ ________ in the IP setting.
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overnight stays
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The nurse is the patient's advocate throughout the intraoperative experience. This encompasses what four things?
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protecting the patient
communicating with the patient doing things for the patient comforting and caring for the patient |
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In the holding area, the nurse provides preoperative _________ regarding the upcoming experience and physical comfort measures. The nurse also works with patients family/sig others, keeping them informed and answering questions.
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education
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What are the methods used to prevent transmission of infection in the OR?
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Filters and controlled airflow
Positive air pressure (prevents air from entering) No dust collecting surfaces |
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The perioperative nurse who cares for the patients in the OR is knowledgeable about the activities that occur when a patient is transferred into the _____________ _________.
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surgical suite.
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General questions about surgery and anesthesia can usually be answered by the ______________ nurse.
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perioperative
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Data that are especially important to the intraoperative nursing care include baseline data such as:
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Vital signs, height, weight, age, allergies to food, drug and latex, condition and cleanliness of skin, skeletal/muscle impairments, perceptual difficulties, LOC, NPO status, any source of pain and discomfort.
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What are data that can be collected from chart review during preoperative assessment?
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H&P, Allergies, UA, CBC, Serum electrolyte values, CXR, EKG, Diagnostic tests, Pregnancy testing, surgical and blood transfusion consent, blood type and cross match.
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What are the roles of the perioperative nurse?
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Circulator
OR Director Scrub Nurse Registered First Nurse Assistant (RFNA) Patient Educator |
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The scrub nurse is can be a _______, ______, ______, or _________ ________ and performs ______________ activities such as handing surgeon instruments and ________ supplies.
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RN, LVN, PA or surgical tech
sterile sterile |
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The scrub nurse follows designated scrub procedure and is gowned and gloved in sterile attire. The scrub tech is the only completely __________ team member.
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sterile
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Who in the surgical team scrubs, gowns and gloves self and other members of the surgical team, prepares the instrument table, and organizes sterile equipment for functional use.
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Scrub nurse
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Who in the surgical team monitors practices of aseptic technique in self and others, keeps track of irrigation solutions used for calculation of blood loss, and reports amounts of local anesthesia and epinephrine solutions used by ACP and/or surgeon.
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Scrub nurse
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The circulating nurse must be a ________ and handles all ___________ activities, such as documenting the nursing care and assessment/ID of patient, manages the needs of the client and coordinates needs of the surgical team.
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RN
unsterile |
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Who in the surgical team creates and maintains a safe, comfortable environment in the OR and provides assistance to any team member as well as maintains communication?
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Circulating nurse
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How does the circulating nurse maintain a safe environment in the OR?
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Being very diligent in observing for breaks in aseptic techniques and initiate appropriate measures to correct the situation. Also by ID of potential dangers involving the client or team and correct them as well.
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Who provides assistance by assisting anesthesia care provider throughout the process, directs and anticipates the need of the scrub nurse, and provides extra supplies and equipment?
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Circulating nurse
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Who maintains communication among team members and any necessary contact with other health care professionals and the client's family? This person serves as the patient's advocate while patient is unable to care for themselves.
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Circulating nurse
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Who admits the patient to the OR suite, checks mechanical and electrical equipment prior to surgery, records, labels and sends to proper locations the tissue specimens and cultures, and ensures safety of transferring and positioning the patient on the OR bed?
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Circulating RN
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Who accompanies the patient to the post op anesthesia recovery area and reports info relevant to the care of the patient to the recovery area nurses?
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Circulating RN
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Who is responsible for gathering the information for the H&P assessment preoperatively, the decision for the need for surgical intervention, choice of procedure, management of preop workup, and discussion of risks as well as alternatives to surg. procedures?
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The surgeon and assistant
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Who is responsible for patient safety and management in the OR and postop management of the patient?
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The surgeon and assistant
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This perioperative nurse must have formal education for this role and works collaboratively with the surgeon, patient, and surgical team by handling tissue, using instruments, providing exposure to the surgical site, assisting with homeostasis, and suturing.
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RNFA - registered nurse first assistant
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One who administers anesthesia and can be an anesthesiologist or a nurse anesthetist.
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Anesthesia Care Provider (ACP)
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Discipline within the practice of medicine specializing in the following: Medical management of patients who are rendered unconscious and/or insensible to pain and emotional stresses during surgical, OB, and certain other medical procedures; protection of life functions and vital organs under the stress of anesthetic, surgical, or other medical procedures; management of problems in pain relief; management of CPR; management of problems in pulmonary care; management of critically ill patients in special care units.
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Anesthesiology
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Nursing Management during surgery consists of nine steps:
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room prep, transferring the client, scrubbing gowning and gloving, basic aseptic technique, assisting ACP, safety considerations, positioning the client, preparing the surgical site, and managing the patient after surgery.
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The scrub nurse will scrub in and only touch _______ items.
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Sterile
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Circulating nurse stays in the ____________ field and assists with touching _____________ items and the patient.
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unsterile, unsterile.
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Before the patient is sutured or stapled up, what is done?
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Sponges, needles and instruments are counted.
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Each time the patient is transferred from one bed to another, the wheels should be _______.
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locked
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Once patient is on OR bed, what should be done?
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safety straps should be placed across patient's thighs.
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Surgical hand antisepsis is required of all sterile members of the surgical team. Who are they?
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Scrub assistant, surgeon and surgeon's assistant.
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Waterless, alcohol based agents are replacing traditional soap and water. What do you need to do first prior to using the alcohol based agents in surgery?
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Wash hands with soap and water.
(In outline) |
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When performing correct technique for surgical hand antisepsis, you start washing fingers and hands, then progress to ___________________ and __________________.
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Forearms and elbows.
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After the surgical hand antisepsis, sterile surgical team enters the ____________ to don gown and gloves.
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OR
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Center of sterile field is the site of what?
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Surgical incision.
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What does the universal protocol TIME OUT prevent?
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Wrong site, wrong procedure/surgery, wrong client,.
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When is time out performed?
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Prior to patient being anesthetized
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What is the universal protocol?
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Conduct a pre-procedure verification process.
Mark procedure site. Time out prior to starting procedure. |
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What are common surgical positions?
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Supine, Trendelenburg, Prone, Lateral, Lithotomy, Jackknife, Kidney, and Sitting.
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Improper positioning could potentially result in what problems?
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Muscle strain, Joint damage, Pressure ulcers, Nerve Damage, and Other Untoward Effects.
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Whose responsibility is it to prepare the surgical site?
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Circulating nurse.
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How to you prep the surgical site?
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Mechanical scrubbing/cleansing with antimicrobial agents, hair removed that will interfere with the surgery, area scrubbed in a circular motion from clean to dirty, large area cleansed. After cleaning, the sterile members of the team drape area and only the site to be incised is left exposed.
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At minimal sedation the patient responds ________.
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normally.
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At moderate sedation, (aka conscious sedation), __________ and _____________ function are maintained.
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airway, cardiovascular
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At deep sedation/analgesia, the patient is not easily _________.
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aroused
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At anesthesia level, the patient requires what?
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Assisted ventilation.
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With general anesthesia, patient has a loss of sensation with loss of __________. The skeletal muscles relax. There is a possible impaired ventilatory and CV function, and elimination of ______, _____ and ______ responses.
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consciousness
somatic, autonomic, endocrine |
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Local anesthesia is loss of ________ without loss of _______.
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sensation, conciousness
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Regional sedation is the loss of sensation to a region of the _______ without loss of consciousness when a specific _______ or _____ ___ _____ are blocked with administration of local anesthetic (spinal, epidural).
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body
nerve, group of nerves |
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Which type of anesthesia is the technique of choice for surgical procedures that require significant skeletal muscle relaxation, last a long period of time, require awkward positions, or for those who are uncooperative, extremely anxious or who have contraindications to local or regional anesthesia?
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General anesthesia
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How is anesthesia administered?
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IV, inhalation or rectally.
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What are the four phases of general anesthesia?
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Preinduction
Induction Maintenance Emergence |
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Preinduction anesthesia phase
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Time period starting with the preop medication, initiation of appropriate IV/arterial access, application of monitors.
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Induction anesthesia phase
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Initiation of sequence of medications that render the patient unconscious, securing the airway.
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Maintenance anesthesia phase
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Time period which the surgical procedure is performed. Patient remains in an unconscious state with appropriate measures to ensure safety of the airway.
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Emergence anesthesia phase
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Time period during which the surgical procedure is completed and the patient is prepared for return to consciousness and removal of airway assist device.
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IV agents induce pleasant ______ with _______ onset. A single dose lasts a few minutes (long enough to insert what)?
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sleep, rapid
endotracheal tube |
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TIVA (total IV anesthesia) means that all meds are delivered IV which eliminates need for _________ agents.
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inhalation
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Inhalation Agents are the foundation of _________ anesthesia. Can be ______ liquids or gases. Enters the body via __________ in the ______. Can be administered via ______, _______, _________. Ease of administration and rapid excretion.
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general
volatile alveoli, lungs mask, tube, tracheostomy |
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Drugs added to an inhalation anesthetic (other than IV induction agent) is termed ________.
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adjuncts
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Adjuncts to general anesthesia (four types)
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opioids
benzodiazepines neuromuscular blocking agents antiemetics |
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It is important for the nurse to know that adjunct agents are often given in combination and may have ____________ or ________ effects.
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synergistic or additive
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Opioids (Fentanyl, Sufentanil, Morphine Sulfate, and Demerol) can be used in surgery for
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preop sedation and analgesia
intraop for induction and maintenance of anesthesia post op for pain management |
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What are opioids adverse effects?
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Respiratory depression
Stimulation of vomiting center Possible bradycardia and peripheral vasodilation High incidence of pruritis |
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What are the nursing interventions for opioids?
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Assess resp status, monitor pulse ox findings, protect airway in anticipation of vomiting, use standing orders for antipuritics.
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Benzodiazepines (Versed, Valium, Ativan) are used in surgery for
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Inducing and maintaining anesthesia
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What are the adverse effects of Benzodiazepines?
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Potentiating of the effects of opioids, increasing the potential for respiratory depression, hypotension, and tachycardia.
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What are the nursing interventions for Benzodiazepines?
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Monitor C/P status and LOC
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NM Blocking Agents (Succinylcholine) is used in surgery for
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Facilitating endotracheal intubation
Promoting skeletal muscle relaxation (paralysis) to enhance access to surgical sites. |
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What are the adverse effects of NM Blocking Agents?
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Apnea r/t paralysis of resp muscles
Prolonged muscle relaxation |
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What are the nursing interventions for NM blocking agents?
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Monitor resp rate and pattern until pt able to cough and return to previous levels of muscle strength; maintain patent airway; make sure the reversal agents and resp support equipment are available; monitor temp and levels of muscle strength with temp change; as client gets warmer, weakness induced by the action of NM blocking drugs may reoccur.
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What is disassociative anesthesia
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Anesthesia that interrupts associative brain pathways while blocking sensory pathways. The pt appears catatonic, amnesic, and has profound analgesia. Ketamine is used IV or IM. It is a potent analgesic/amnesic.
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Which type of anesthesia is used for asthma (promoting bronchodilation) and trauma (increases HR and helps maintain CO) patients? It also may causes hallucinations or nightmares.
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Disassociative anesthesia.
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What are the ways in which local anesthesia is administered?
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Topical, Local infiltration
Regional (peripheral nerve block) IV Regional nerve block (Bier block) Spinal/Epidural Block |
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What is local infiltration?
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The injection of the agent into the tissues through which the surgical incision will pass.
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How is the regional (peripheral) nerve block achieved?
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By injection of a local anesthetic into or around a specific nerve or group of nerves.
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What is IV regional nerve block (Bier block)?
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IV injection of a local anesthetic into an extremity following mechanical exsanguination using a compression bandage and tourniquet.
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What is spinal anesthesia?
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Injection of a local anesthetic into the CSF, in the subarachnoid space, usually below the level of L2. It produces autonomic, sensory and motor blockade.
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What procedures would spinal anesthesia be used for?
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Procedures involving the lower abdomen, groin, perineum, or lower extremity.
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Epidural blocks do not enter into the _________, but work by binding the nerve roots as they enter and exit the spinal cord.
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CSF
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What procedures use epidural blocks?
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OB, vascular procedures involving the lower extremities, and hip and knee replacement surgeries.
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What is one advantage epidural block has over the spinal block?
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decreased incidence of HA
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What are some of the nursing considerations for gerontology?
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Anesthetic agents become greatly altered in them.
Decrease in ability to communicate/follow directions Higher risk of injury from tape, electrodes, warming and cooling blankets Care is needed in preparing and positioning them due to osteoarthritis and osteoparosis. Higher risk for hypothermia. |
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What are two catastrophic events that happen in the OR?
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Anaphylatic Reactions
Malignant Hyperthermia |
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What does an anaphylatic reaction cause in patients?
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hypotension
tachycardia bronchospasm possible pulmonary edema |
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What is malignant hyperthermia?
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Rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death. Occurs in affected people exposed to certain anesthetic agents (succinylcholine).
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How can you help prevent malignant hyperthermia?
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Obtain careful family history and be alert.
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What is the intervention for malignant hyperthermia?
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Prompt administration of Dantrolene (Dantrium), which slows metabolism, along with symptomatic support to correct hemodynamic instability, acidosis, hypoxemia, and elevated temp.
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Positive pressure has to change in OR how many times per hour?
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15
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In Texas, a scrub tech can be _________________.
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unlicensed.
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Anesthesiologist is an ________, where an anesthetist is a __________.
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MD
nurse |
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If someone says that are not sure if they are allergic to latex, ask them if they are allergic to ______ _____.
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tropical fruits.
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If someone is unsure if they are allergic to iodine, ask them if they are allergic to ___________.
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shellfish
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What do you do for someone who has started going into malignant hyperthermia?
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Iced Saline
Dentraline for muscle spasms and convulsions |
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What new NPO guidelines have been established?
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Water, apple juice, black tea and coffee, pulp free orange juice , and carbonated beverages can be ingested by non-obese adults that are healthy 2-3 hours prior to surgery.
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What are robotics?
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A new technology in the OR where robots are being used to assist in surgery.
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What is telesurgery?
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Where a surgeon with expertise assists via tele communication (satellite) with cases that are long distance.
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How do you prep a child for surgery?
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Prep surgical site after child is anesthetized.
Check child for loose teeth. Let kids go to surgery in PJ's then change them to hospital gown after anesthetized. May have same nurse pre and post op. |
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When inducing children with anesthesia, what guidelines are best to follow?
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use transparent mask
direct stream of gas towards child's face from bare tube allow child to sit up rather than lie down allow preop play with mask and doll or manikin |
