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Intra Operative Nursing Care

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by

Candice Kiskadden

on 8 September 2016

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Transcript of Intra Operative Nursing Care

Foundation
The Operating Room
Nursing Management
of the surgical client

The Nursing Process
Nursing Responsibility
The Process
IntraOperative Nursing
Related to the Intraoperative Client
at surgical closure
NURSING 230
*Construct nursing responsibilities to ensure patient safety during the intraoperative period.

*Identify the interdisciplinary approach to the care of the patient during surgery.

*Compare the types of anesthesia with regard to uses, advantages, and disadvantages.

*Summarize the members of the surgical team.

*Identify the risk factors related to surgery & the intraoperative nursing measures that will reduce those risks.
Student Learning Outcomes:
*Prioritize nursing responsibilities for clients undergoing the various types of anesthesia.
*Identify the manifestations of and explain interventions for a client experiencing Malignant Hyperthermia.
*Discuss nursing responsibilities at the close of surgery.
*Summarize the transfer process of the client from surgery.
As well as.....
Introduction
An area that provides observation and comprehensive care to clients waiting for surgery. Staffed by RNs and LPNs.
The Holding Area
IV site

Observe for s/s of anxiety

Check chart for completeness

Review physician progress record

Review lab results

Make sure history and physical are on the chart
Positively identify client

Clarify procedure

Ask about allergies

Ask about past medical/surgical history
Clarify height, weight

Take VS

Clarify medications

NPO since?
Nursing Assessment
Surgical Care Improvement Project

*Antibiotics (if indicated) are administered within 1 hour of incision
*Certain procedures require certain antibiotics
*These antibiotics should then be D/C'd within 24 hours of surgery
*Control of blood glucose levels
*Appropriate hair removal
*Removal of urinary catheter postoperatively
*Temperature management
*Beta blocker therapy
*Venous thromboembolism prophylaxis therapy



Perioperative nurses act as a client advocate!
SCIP Measures
*Notify anesthesia provider if previous negative anesthesia experience, abnormal labs, patient did not maintain NPO status.

*Explain any delays to patient.

*Notify surgeon if necessary
More Nursing Interventions
A unique, aseptic, environmentally controlled setting that is geographically separate, and has restricted flow.
The Operating Room

RN or trained OR tech.
Scrubs, gowns self & others
Sets up sterile field
Assists the surgeon during the surgical procedure
Monitors the practices of aseptic technique of self and others
Counts
The Surgical Team
The Scrub Nurse
Must be an RN

Manages the OR and protects the safety
and health needs of the client.

Puts client on OR table
Identification of client
Helps with induction
Positions the client

Preps skin

Completes the intraop. documentation

Counts
Accompanies client to PACU
The Surgical Team Continued
The Circulating Nurse
Surgeon, Assistant Surgeon

First Assistant
RN, PA, CRNP
Surgeon maintains responsibility
More of The Surgical Team
Anesthesiologist, CRNA
Administers anesthesia
Maintains airway
Maintains homeostasis
Surgical Attire
Surgical Scrub
Chlorahexidine
Betadine
Waterless scrubs
Nail care
Fingertips to above elbow
Absence of sensation
Anesthesia
Conscious & Deep Sedation
General Anesthesia
Local/Regional Anesthesia
Types of Anesthesia
Nursing Responsibilities of Conscious Sedation
A controlled state of unconsciousness from which the client cannot be immediately aroused.
General Anesthesia
Stage I – Analgesia
Stage II – Excitement
Stage III – Surgical anesthesia
Stage IV - Overdose
Stages of General Anesthesia
Conscious & Deep Sedation
General Anesthesia
Local/Regional Anesthesia
Types of Anesthesia
Nursing Responsibilities of Conscious Sedation
General Anesthesia
Stage I – Analgesia
Stage II – Excitement
Stage III – Surgical anesthesia
Stage IV - Overdose
Stages of General Anesthesia
Intubation
Induction
Considerations for Children
Reversal of Anesthesia
Neuromuscular Blocking Agents
Purposeful Hypotension
Hypothermia
Adjuncts to General Anesthesia
Risk for Aspiration
Risk Factors: ?
Risk for Hypothermia
Risk Factors: ?
Malignant
Hyper
thermia –
An inherited muscle disorder chemically induced by anesthetic agents.
Potentially lethal.
Symptoms:

Tachycardia Tachypnea
Decreased BP Muscle rigidity
Low or absent urinary output
Hyperpyrexia
Eventually: cardiac arrest



Potential Intraoperative Complications
Cardiac Arrhythmias
Respiratory Depression
Hemorrhage
Lack of Response to Pain
Burns
Additional Potential Complications
Closure
Anesthesia Reversal
Documentation
Client Transfer to PACU

Nursing Responsibilities at the Close of Surgery
Questions?
Considerations for the Elderly Client
A controlled state of unconsciousness from which the client cannot be immediately aroused.
Full transcript