MedSurg Ch 19 – Flashcards
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What are characteristics of the surgical suite?
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Controlled environment Minimize the spread of infectious organisms
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What are the three areas of the surgical suite?
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Unrestricted Semirestricted Restricted
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What are characteristics of the Unrestricted area?
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People in street clothes interacting with those in scrub clothing Typically points of entry
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What are characteristics of the Semirestricted area?
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Surrounding support areas and corridors Only authorized staff Surgical attire with hair coverings
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What are characteristics of the Restricted area?
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Surgical attire with hair coverings and masks Can include ORs, scrub sink areas, and clean core
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What is the holding area (preoperative holding area) used for?
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Special waiting area Used to identify patient, assess patient before transfer to OR Patient warming Prophylactic antibiotic administration Application of sequential compression devices In some institutions caregivers can wait with the patient until transfer to OR to reduce anxiety
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What are some characteristics of the OR?
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Filters and controlled airflow Positive air pressure UV lighting Equipment/furniture that is adjustable, easy to clean, and easy to move
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What does the preoperative nurse do?
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Implements patient care during the perioperative period. Prepares the OR for patients before they arrive First member of the surgical team encountered Patient's advocate Protect the patient and communicate with the patient Physical and emotional comfort Patient and caregiver education
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What does the circulating nurse do?
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Not scrubbed, gowned, or gloved Remain in unsterile field Assist with room preparation Checks mechanical and electrical equipment Identifies and admits patient Monitors draping procedure Insertion and application of monitoring devises Assists with induction of anesthesia Documents intraoperative care Reports information to PACU nurses
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What does the scrub nurse do?
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Follows scrub procedure Remains in sterile field Assists with room preparation Scrubs, gowns, and gloves self and other surgical team members Prepares instrument table and organizes sterile equipment Assists with draping procedure Passes instruments to surgeon Reports amounts of meds used by ACP and/or surgeon
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What does the nurse do before surgery?
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Assment Plans & implements teaching Verifies surgical site Determine a plan of care Ensures all supplies and equipment needed for surgery are available and functioning
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What does the nurse do during surgery?
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Maintains safety Ensures integrity of sterile field Positions patient Monitors physical status (vitals, blood loss, urine output) Monitors psychological status (comforts, touches, communicates)
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What does the nurse do after surgery?
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Determines patient's immediate response to surgery Monitors ABCs, vitals, LOC Safely administers meds Determines patient's level of satisfaction Assists with discharge planning
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What is the surgeon responsible for?
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Preoperative medical history and physical assessment Patient safety and management in the OR Postoperative management of the patient
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What is a Registered Nurse First Assistant?
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Works in collaboration with the surgeon Must have formal education Handling tissue Using instruments Providing exposure to surgical site Assisting with hemostasis Suturing
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What is the anesthesiologist responsible for?
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Medical management of patient rendered unconscious Protection of life functions and vital organs Management of pain Management of CPR Management of problems in pulmonary care Management of critically ill patients
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What is a nurse anesthetist?
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RN who graduated from an accredited nurse anesthesia program (master's degree) Performs and documents a preanesthetic assessment Develops and implements a plan for delivering anesthesia Selects, obtains, and administers anesthesia, adjuvant drugs, and fluids Managing patient's airway and pulmonary status Managing emergence and recover from anesthesia Ordering, initiating, or modifying pain relief therapy
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What is involved with the preoperative assessment?
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Psychosocial assessment Physical assessment (provides baseline) Chart review (required tests present) Admitting the patient Reassessment of patient and last-minute question answering
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What alternative therapies can be done during preoperative period?
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Therapeutic touch Aromatherapy Music therapy Guided imagery Movies
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What is worn by scrubbed team members in the OR?
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Surgical gowns 2 pairs of gloves Hair covers Shoe covers Masks
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When scrubbing in, should you wash from hands to elbows or elbows to hands?
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Hands to elbows Always keep hands above elbows to prevent unsterile fluid dripping onto hands
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What is the Universal Protocol?
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Preventing wrong site, wrong procedure, and wrong surgery
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What is the cornerstone to making surgery safer and included in the Universal Protocol?
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Patient safety checklist for OR's
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What is a "Surgical Time-Out"?
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Done just before the procedure starts to verify patient ID, surgical procedure, and surgical site. All team members stop and participate Patient ID'd by band Operative procedure and location ID'd Compare the hospital ID number w/patient's ID band and chart
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Why is skin preparation or "prepping" done?
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Reduce the number of microorganisms available to migrate to the surgical site.
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How is skin prepping done?
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Mechanically scrubbing or cleansing around surgical site w/antimicrobial agent Liberal area scrubbed in a circular motion
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What happens after skin prepping?
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Sterile drape is placed
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Who will accompany patient to PACU?
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The ACP and you or another team member A report of patient's status and procedure is communicated
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What is awareness monitoring?
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When the ACP tracks level of patient awareness during surgery
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What is the Bispectral Index monitor?
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Introduced in the 1990's Allows ACPs to track the level of patient awareness (awareness monitoring) during surgery
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What is the American Society of Anesthesiologists (ASA) physical status classification used for?
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Assigns the patient an anesthesia classification Scale of 1 - 6 Higher the score = More likely to develop intraoperative complications Based on physiological status of patient with no regard to the surgical procedure to be performed Status is dynamic and represents the status of the patient immediately before the operative procedure.
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What does an ASA P1 rating mean?
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Normal healthy person
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What does an ASA P2 rating mean?
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Patient with mild systemic disease
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What does an ASA P3 rating mean?
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Patient with sever systemic disease
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What does an ASA P4 rating mean?
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Patient with severe systemic disease that is a constant threat to life
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What does an ASA P5 rating mean?
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Moribund patient who is not expected to survive without surgery
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What does an ASA P6 rating mean?
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Declared brain-dead patient whose organs are being removed for donor purposes
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What does an "E" added to the ASA rating mean?
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Designates an emergent or newly needed procedure
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What are the characteristics of General Anesthesia?
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Loss of sensation with loss of consciousness Combination of hypnosis, analgesia, and amnesia Skeletal muscle relaxation Elimination of coughing, gagging, vomiting, and sympathetic nervous system responsiveness
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What are the characteristics of Regional Anesthesia?
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Loss of sensation to a region of body w/o loss of consciousness Blocking a specific nerve or group of nerves with injection of local anesthetic
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What are the characteristics of Local Anesthesia?
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Loss of sensation w/o loss of consciousness Induced topically, via infiltration, intracutaneously, or subcutaneously Interrupts the generation of nerve impulses by altering the flow of sodium into nerve cells
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What is Monitored Anesthesia Care (MAC)?
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Similar to general anesthesia w/o loss of consciousness Benzo's and opioids are used at lower doses No inhalation agents Relieves anxiety, provides analgesia and amnesia Patient breathes w/o assistance Can be used in conjunction w/regional or local anesthesia Used in minor surgical procedures and diagnostic procedures (colonoscopy)
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What is general anesthesia used for?
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Procedures that are of significant duration Those that require uncomfortable position because of the operation site Those that require control of respiration For those patients who refuse local or regional anesthesia Uncooperative patients (age, mental status, etc)
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What is a "balanced technique"?
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Using adjunctive drugs to complement induction in general anesthesia
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What is an absolute contraindication for any anesthetic technique or agent?
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Patient refusal
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What are some characteristics of intravenous anesthetic agents?
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Induce a pleasant sleep Rapid onset of action that patients find desirable
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What is TIVA?
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Total intravenous anesthesia No use of inhalation gasses Fast onset Fast elimination Fewer untoward side effects
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What are some characteristics of inhalation agents?
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Cornerstone of general anesthesia
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What are some desirable traits of inhalation agents?
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Ease of administration Rapid excretion by ventilation
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What are some drawbacks of inhalation agents?
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Irritating effect on the resp tract Coughing Laryngospasm Bronchospasm Increased secretions Respiratory depression
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What are adjunct drugs?
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Used in general anesthesia Drugs added to an inhalation anesthetic (other than an IV induction agent)
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What are adjunct drugs used for?
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Achieve unconsciousness Analgesia Amnesia Muscle relaxation Autonomic nervous system control I.E. - opioids, benzo's, muscle relaxants, antiemetics
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What is dissociative anesthesia?
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Interrupts associate brain pathways while blocking sensory pathways Patient may appear catatonic, is amnesic, and experiences profound analgesia I.E. - Ketamine
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What are some drawbacks of the dissociative anesthesia drug Ketamine?
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Hallucinations Nightmares
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What is it important to do with patients in PACU who have received dissociate anesthesia?
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Provide a quiet, unhurried environment
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For which population is Ketamine the preferred dissociative anesthesia drug?
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Asthmatics - promotes bronchodilation Trauma patients - increases heart rate & helps maintain cardiac output
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What are some characteristics of spinal anesthesia?
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Injection of a local anesthetic into the cerebrospinal fluid Autonomic, sensory, and motor blockade Vasodilation --> hypotensive Unable to move Feel no pain
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What procedures would spinal anesthesia be appropriate for?
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Those involving the extremities, lower GI, prostate, and gynecologic
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What are some characteristics of an epidural block?
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Injection of a local anesthetic into the epidural (extradural) space Does not enter the cerebrospinal fluid Sensory pathways are blocked but motor fibers remain intact
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What procedures would an epidural be appropriate for?
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Obstetrics Vascular procedures involving lower extremities Lung resections Renal + midabdominal surgeries
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What are some complications of spinal and epidural anesthesia?
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Autonomic nervous system blockade --> hypotension, bradycardia, nausea, vomiting Inadequate breathing + apnea Postdural puncture headache Back pain Isolated nerve injury Meningitis
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What differences exist for older adults receiving anesthesia?
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Onset, peak, and duration of medications are greatly altered Perioperative hypothermia
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What are some signs of anaphylactic reactions for patients under anesthesia?
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Hypotension Tachycardia Bronchospasm Pulmonary edema
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What are some characteristics of malignant hyperthermia?
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Rare disorder Hyperthermia with rigidity of skeletal muscles Can result in death Primary trigger --> succinylcholine (anectine) Usually occurs during general anesthesia, but may present in recovery period as well Autosomal dominant trait
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What causes malignant hyperthermia?
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Caused by hypermetabolism of skeletal muscle from altered control of intracellular calcium
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What are some signs of malignant hyperthermia?
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Muscle contracture Hyperthermia Hypoxemia Lactic acidosis Hemodynamic and cardiac alterations Tachycardia Tachypnea Hypercarbia Ventricular dysrhythmias
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What happens if malignant hyperthermia is not promptly detected?
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Cardiac arrest and death
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What is given to treat malignant hyperthermia?
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Dantrolene (Dantrium) --> slows metabolism, reduces muscle contraction, and mediates the catabolic process
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Why would 'hypothermia" be used for surgery procedures?
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Decreases metabolism --> reduces demand for oxygen and anesthetic requirements
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What is transesophageal echocardiography?
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Assess ventricular function and competency of heart valves Recognize venous air embolism Quickly replacing use of pulmonary artery catheter during surgery
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What is ultrasonic-guided regional anesthesia?
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Visualizing a nerve or plexus of nerves via ultrasound to place a regional block with more accuracy
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Proper attire for the semirestricted area of the surgery department is:
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Surgical attire and head cover
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Activities the nurse might perform in the role of a scrub nurse during surgery include:
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Preparing the instrument table Passing instruments to the surgeon and assistants Assisting the ACP with monitoring of patient during surgery
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The nurse is caring for a patient undergoing surgery for a knee replacement. What is critical to the safety of the patient's surgery:
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Universal protocol is followed The patient's allergies are communicated to the surgical team
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The nurse's primary responsibility for the care of the patient undergoing surgery is:
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Developing an individualized plan of nursing care for the patient.
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When scrubbing at the scrub sink, the nurse should:
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Hold the hands higher than the elbows.
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When positioning a patient in preparation for surgery, the nurse understand that injury to the patient is most likely to occur as a result of:
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Incorrect musculoskeletal alignment.
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Intravenous induction for general anesthesia is the method of choice for most patients because:
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Induction is rapid and pleasant.
