Ch 18 Intraoperative Nursing Management

Front 1

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?

Back 1

report the infection to an immediate supervisor

Front 2

During a procedure, a client’s temperature begins to rise rapidly. This is likely the result of which of the following complications?

Back 2

malignant hyperthermia

Front 3

There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements.

Back 3

Stage II;excitement

Front 4

After teaching a patient scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements?

Back 4

"ill be sleepy but able to respond to your questions"

Front 5

A patient is scheduled to have a heart valve replacement with a porcine valve. Which patient does the nurse understand may refuse the use of any porcine-based product?

Back 5

a patient of jewish faith

Front 6

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:

Back 6

circulating nurse

Front 7

How would the operating room nurse place a patient in the Trendelenburg position?

Back 7

on his back with his head lowered so that the plane of his body meets the horizontal on an angle

Front 8

The nurse caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia would assess for the most common early sign of:

Back 8

tachycardia (HR>150bpm)

Front 9

You are working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks you why these medications are needed. What would be your best answer?

Back 9

" These medications decrease gastric acidity and volume"

Front 10

Which of the following is the appropriate response to the statement, “I'm so nervous about my surgery”?

Back 10

"you seen nervous about your surgery"

Front 11

An example of an intravenous anesthetic that is a hypnotic and produces excellent amnesia is:

Back 11

versed

Front 12

The nurse is caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia. What is the most common early sign that the nurse should assess for?

Back 12

tahycardia

Front 13

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately?

Back 13

temperature of 102.5 degrees F

Front 14

As a circulating nurse, what task are you solely responsible for?

Back 14

keeping records

Front 15

The client asks the nurse about possible ill effects from general anesthesia. Which of the following is the best response by the nurse?

Back 15

"some possible negative effects include oversedation and bradycardia"

Front 16

The anesthesiologist administered a transsacral conduction block. Which of the following documentation by the nurse is consistent with the anesthesia being administered?

Back 16

denies sensation to perineum and lower abdomen

Front 17

The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system?

Back 17

cardiovascular system

Front 18

The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching?

Back 18

headache

Front 19

A patient undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The patient is ready for rewarming procedures. Which of the following actions by the nurse is appropriate?

Back 19

apply a warm air blanket, gradually increasing body temperature

Front 20

A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role?

Back 20

scrub role

Front 21

Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic?

Back 21

halothane

Front 22

During a procedure, a client’s temperature begins to rise rapidly. This is likely the result of which of the following complications?

Back 22

malignant hyperthermia

Front 23

What medication should the nurse prepare to administer in the event the patient has malignant hyperthermia?

Back 23

dantrolene sodium (Dantrium)

Front 24

A patient is having a surgical procedure that requires the patient to be in the prone position. What is an expected patient outcome?

Back 24

the patient remains free of perioperative posistioning injury

Front 25

The nurse recognizes that the older adult is at risk for surgical complications due to:

Back 25

decreased renal function

Front 26

A patient is to receive general anesthesia with sevoflurane. The nurse anticipates the need for which of the following?

Back 26

oxygen

Front 27

When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the following would the nurse include?

Back 27

"you shouldnt experience a headache after this type of anesthesia"

Front 28

What is the priority action by the scrub nurse when the surgeon is starting to close the surgical wound?

Back 28

obtain sponge count

Front 29

During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following?

Back 29

metabolic acidosis

Front 30

What intravenous anesthetic administered by the anesthesiologist has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression?

Back 30

pentothal

Front 31

Which stage of anesthesia is termed surgical anesthesia?

Back 31

III

Front 32

Which intervention should the nurse plan to implement to decrease the client’s risk for injury during the intraoperative period?

Back 32

assess the client for allergies

Front 33

A patient is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?

Back 33

verify consent

Front 34

The circulating nurse is preparing a patient for a surgical procedure. What primary responsibility does the circulating nurse have in the perioperative experience?

Back 34

discussing the complications of the surgical procedure with the patient

Front 35

The client who had spinal anesthesia complains of a headache. Which of the following is an inappropriate action by the nurse?

Back 35

administer morphine sulfate

Front 36

(see full question)Which of the following medications would the nurse expect to be used to facilitate intubation of the client?

Back 36

attacurium (Tracrium)

Front 37

A patient is to undergo surgery on his kidney. The patient would be placed in which position for the surgery?

Back 37

sims or lateral position

Front 38

(see full question)The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury?

Back 38

peripheral pulses palpable

Front 39

Which nursing diagnosis should the nurse plan to address first in the client upon arrival in the intraoperative setting?

Back 39

anxiety related to ineffective coping with surgical concerns

Front 40

Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic?

Back 40

halothane

Front 41

The physician, concerned about aspiration during a surgical procedure, orders a medication to increase gastric pH. Which of the following medications would the nurse document as given?

Back 41

sodium citrate (Bicitria)

Front 42

A medical student, scheduled to observe surgery, enters the unrestricted surgical zone wearing jeans, a t-shirt, and tennis shoes. What is the best action by the nurse?

Back 42

educate the medical student on required attire for each surgical zone

Front 43

A nurse who works in the OR is required to assess the patient continuously and protect the patient from potential complications. Which of the following would not be included as a symptom of malignant hyperthermia?

Back 43

increased urine output

Front 44

A patient who has undergone surgery and received spinal anesthesia is reporting a headache. Which of the following would be most appropriate?

Back 44

encourage increased fluid intake

Front 45

Which zone of the surgical area only allows for attire in the form of scrub clothes and caps?

Back 45

semirestricted zone

Front 46

a state of narcosis, analgesia, relaxation, and loss of reflexes

Back 46

anesthesia

Front 47

physician trained to deliver anesthesia and to monitor the patient’s condition during surgery; assesses the patient before surgery, selects the anesthesia, administers it, intubates the patient if necessary, manages any technical problems related to the administration of the anesthetic agent, and supervises the patient’s condition throughout the surgical procedure

Back 47

anesthesiologist

Front 48

the substance, such as a chemical or gas, used to induce anesthesia

Back 48

anesthetic agent

Front 49

health care professional, often a certified registered nurse anesthetist, who is trained to deliver anesthesia and to monitor the patient’s condition during surgery; assesses the patient before surgery, selects the anesthesia, administers it, intubates the patient if necessary, manages any technical problems related to the administration of the anesthetic agent, and supervises the patient’s condition throughout the surgical procedure

Back 49

anesthetist

Front 50

registered nurse who coordinates and documents patient care in the operating room; manages the OR and protects the patient’s safety and health by monitoring the activities of the surgical team, checking the OR conditions, and continually assessing the patient for signs of injury and implementing appropriate interventions ; verifies consent; ensures cleanliness, proper temperature, humidity, appropriate lighting, safe function of equipment, and the availability of supplies and materials. ; monitors aseptic practices to avoid breaks in technique while coordinating the movement of related personnel (medical, x-ray, and laboratory), as well as implementing fire safety precautions ; ensuring that the second verification of the surgical procedure and site takes place and is documented; sends specimens to lab

Back 50

circulating nurse (or circulator)

Front 51

state of narcosis, analgesia, relaxation, and loss of reflexes at and below the level where the spine is accessed, achieved by injecting an anesthetic agent into the epidural space of the spinal cord

Back 51

epidural anesthesia

Front 52

state of narcosis, analgesia, relaxation, and loss of reflexes produced by pharmacologic agents; not arousable, not even to painful stimuli; lose ability to maintain ventilatory function and require assistance in maintaining patent airway-intubated

Back 52

general anesthesia

Front 53

a thin endoscope inserted through a small incision into a cavity or joint using fiber-optic technology to project live images of structures onto a video monitor; other small incisions allow additional instruments to be inserted to facilitate laparoscopic surgery

Back 53

laparoscope

Front 54

injection of a solution containing the anesthetic agent into the tissues at the planned incision site, affecting only the local area

Back 54

local anesthesia

Front 55

a rare life-threatening condition triggered by exposure to most anesthetic agents inducing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the body’s capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if untreated; often inherited as an autosomal dominant disorder; can be triggered by myopathies, emotional stress, heatstroke, neuroleptic malignant syndrome, strenuous exercise exertion, and trauma; inherited commonly, bulky muscles more susceptible,

Back 55

malignant hyperthermia

Front 56

previously referred to as conscious sedation, involves the use of sedation to depress the level of consciousness without altering the patient’s ability to maintain a patent airway and to respond to physical stimuli and verbal commands; do not remember, Important to have: heart monitor, crash cart, O2 available

Back 56

moderate sedation

Front 57

moderate sedation administered by an anesthesiologist or anesthetist

Back 57

monitored anesthesia care

Front 58

an anesthetic agent is injected around nerves so that the area supplied by these nerves is anesthetized; awake and aware of his or her surroundings unless medications are given to produce mild sedation or to relieve anxiety

Back 58

regional anesthesia

Front 59

a member of the operating room team whose responsibilities may include handling tissue, providing exposure at the operative field, suturing, and maintaining hemostasis; practices under the direct supervision of surgeon

Back 59

registered nurse first assistant

Front 60

area in the operating room where scrub attire and surgical masks are required; includes operating room and sterile core areas

Back 60

restricted zone

Front 61

registered nurse, licensed practical nurse, or surgical technologist who scrubs and dons sterile surgical attire, prepares instruments and supplies, and hands instruments to the surgeon during the procedure; assisting the surgeon and the surgical assistants during the procedure by anticipating the instruments and supplies that will be required, such as sponges, drains, and other equipment; works with the circulating nurse for counts on equipment as the surgical incision is closed; labels specimens

Back 61

scrub role

Front 62

area in the operating room where scrub attire is required; may include areas where surgical instruments are processed

Back 62

semirestricted zone

Front 63

achieved when a local anesthetic agent is introduced into the subarachnoid space at lumbar level (L4-L5) of the spinal cord

Back 63

spinal anesthesia

Front 64

absence of microorganisms in the surgical environment to reduce the risk of infection

Back 64

surgical asepsis

Front 65

area in the operating room that interfaces with other departments; includes patient reception area and holding area

Back 65

unrestricted zone

Front 66

second verification of the surgical procedure and site takes place and is documented; takes place among the surgical team prior to induction of anesthesia with a briefing about anticipated problems, potential complications, allergies, and comorbidities; Every member of the surgical team verifies the patient’s name, procedure, and surgical site using objective documentation and data before beginning the surgery

Back 66

time out, surgical pause, or universal protocol

Front 67

Environmental Controls:

surgical asepsis

Floors and horizontal surfaces are cleaned between cases with detergent, soap, and water or detergent-germicide.

Sterilized linens, drapes, and solutions are used, Instruments are sterilized

-standard OR ventilation provides 14 air exchanges per hour

rm temp of 20-24 degrees Celsius (38-73 F)

humidity between 30-60%

Front 68

As the patient breathes in the anesthetic mixture, warmth, dizziness, and a feeling of detachment may be experienced. The patient may have a ringing, roaring, or buzzing in the ears and, although still conscious, may sense an inability to move the extremities easily. During this stage, noises are exaggerated; even low voices or minor sounds seem loud and unreal. For this reason, unnecessary noises and motions are avoided when anesthesia begins.

Back 68

Stage I: Beginning Anesthesia

(general)

Front 69

variously by struggling, shouting, talking, singing, laughing, or crying, is often avoided if IV anesthetic agents are administered smoothly and quickly. The pupils dilate, but they contract if exposed to light; the pulse rate is rapid, and respirations may be irregular. Because of the possibility of uncontrolled movements of the patient during this stage, the anesthesiologist or anesthetist must always be assisted by someone ready to help restrain the patient or to apply cricoid pressure in the case of vomiting to prevent aspiration. Manipulation increases circulation to the operative site and thereby increases the potential for bleeding.

Back 69

Stage II; Excitement

(General)

Front 70

administration of anesthetic vapor or gas and supported by IV agents as necessary. The patient is unconscious and lies quietly on the table. The pupils are small but contract when exposed to light. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed. With proper administration of the anesthetic agent, this stage may be maintained for hours in one of several planes, ranging from light (1) to deep (4), depending on the depth of anesthesia needed

Back 70

Stage III; Surgical Anesthesia

Front 71

This stage is reached if too much anesthesia has been administered. Respirations become shallow, the pulse is weak and thready, and the pupils become widely dilated and no longer contract when exposed to light. Cyanosis develops and, without prompt intervention, death rapidly follows. If this stage develops, the anesthetic agent is discontinued immediately and respiratory and circulatory support is initiated to prevent death. Stimulants, although rarely used, may be administered; narcotic antagonists can be used if the overdose is due to opioids.

Back 71

Stage IV: Medullary Depression

Front 72

pain control

Back 72

demerol

Front 73

forgetfulness

Back 73

Versed

Front 74

Intraoperative Complications

N & V: IV antinausea, roll to side, suction vomit

Anaphylaxis: stop med; latex allergies, tx latex free

Hypoxia: monitor O2, make sure tongue isnt occluding trachea / resp

Hypothermia: inc OR temp, IV and irrigating fluids warmed, wet gowns and drapes removed promptly and replaced with dry, warm air and thermal blankets; warming must be gradual!

Malignant Hyperthermia- 1st signs inc HR, dec BP, late signs rapidly increasing fever-1-2 degrees every 5 min; Tx with cold blanket, Tylenol, stop anesthesia

Back 74

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