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Intraoperative Material Type: Notes; Class: Nursing Science 2 - Intermediate; Subject: Nursing; University: Santa Fe Community College; Term: Forever 1989;
Typology: Study notes
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World’s first OR was in Germany in 1884
Heat sterilization was used in 1885
1902 first book published on OR nursing
Formal OR training was required for nursing licensure in 1905 Antibiotics developed during WW II After WW II corpsmen became OR technicians
Charge Nurse Manager Educator RNFA Nurse Anesthetist Scrub Circulator ULP
An RN that may work in pre-op, OR &/or PACU Collects pre-op patient information Verifies consent Sets up OR room, gathers supplies & equipment
Opens instruments & supplies Anticipates & meets needs of surgeon, anesthesia & Scrub Monitors blood loss with anesthesia
Plans & coordinates care in OR Supports patient & acts as patient advocate Monitors & controls OR environment Documents nursing care & counts
Build trust by:
Reviewing critical patient data first
Identifying & addressing anxiety & fear
Teaching about OR activities, clarifying misunderstandings
Asking questions that are about facts & feelings Providing privacy when performing the interview Discussing expectations Maintaining an attitude of hope
Be aware of: Personal space & modesty Eye contact & touch Pain management Birth & death rituals Family relationships Religious orientation
Fluid & electrolyte balance
Body temperature
Pain
Anxiety Give Pre-op OR tour Describe the roles of the OR team Allow children to play with OR medical equipment
Anxiety (continued) Allow child to bring a favorite security object Allow one parent to go back into the OR with the child Address fear of mutilation or punishment Address fear of being put to sleep
Pre-op: Anxiety
Knowledge deficit OR: Risk for injury
Risk for infection Altered protection
Risk for impaired skin integrity Altered body temperature
Assist Anesthesia with: Ineffective breathing pattern Ineffective airway clearance Altered tissue perfusion Risk for aspiration Risk for fluid volume imbalance
Unrestricted- can wear street clothes Semi-restricted- scrubs & hats required, staff & patients only Restricted- where surgical procedures are performed, scrubs, hats & masks required
See table 17-4 pg. 381
Always face sterile field
If sterile items falls on floor, its considered contaminated
Keep 12 inches from sterile field
Check package integrity
Clinical Education Department, Valleylab Inc, 9/
Clinical Education Department, Valleylab Inc, 9/
Anaphylactic reactions
Malignant hyperthermia
Hypotension
Fluid volume imbalance
Electrolyte imbalances
Hypothermia
Hypoventilation
Airway obstruction
Loss of sensation &/or movement from regional Hematoma, infection, tissue trauma from regional/local Inability to void from regional Drug toxicity N/V
Pharmacogenetic disease that effects the skeletal muscular system at the level of Ca transfer in the muscle cell
Precipitated by the administration of volatile inhalation agents &depolarizing muscle relaxants
Genetic
Associated with other Neuromuscular disorders
H/O cramps or muscle weakness
Results in muscle rigidity, tachycardia, hypermetabolic state & increased body temperature
Hypercarbia Usually occurs during general anesthesia but may occur 24 hours post-op Treatment includes Dantrolene, cold IVF, ice packs, & possibly ice NG lavages, ice rectal lavages
Initial assessment is focused on respiratory status, CV status, pain level, & type of anesthesia given, temperature, control of N/V
Pain
Ineffective breathing pattern
Ineffective airway clearance
Altered tissue perfusion
Risk for aspiration
Nausea Risk for fluid volume imbalance Risk for altered body temperature Alteration in sensory perceptual Fear Anxiety
Hypotension
B/P < 20% of baseline
Causes- hemorrhage, hypovolemia, MI, embolism or drugs
Treatment- Fluid replacement, vasoconstriction medications, elevate pt legs, monitor V/S & I & O
Hypertension B/P >160/ Causes- pain, anxiety, full bladder, Pulmonary edema, hypervolemia, hypothermia, hypoxemia Treatment- treat cause & give quick acting antihypertensives
Must know what anesthetics & analgesics were given in OR
Need to adjust pain med dose & assess RR frequently
Get pt body temp to normal
Touch & repositioning may help
Top pain meds used: Sublimaze (Fentanyl) Major CNS depression, used as supplement to general anesthesia Hydromorphone (Dilaudid) CNS depression, used for moderate to severe pain Have Naloxone (Narcan) ready!
Body temp< 95 F
Elderly & children very susceptible
More of a problem in big cases where large cavity is opened
Goal is to have Temp
97.0 F
Causes bradycardia & shallow respirations Shivering increases O2 demand May lead to hypotension, metabolic acidosis & cardiac dysrhythmias
Must know what anesthetics & analgesics were given in OR
Need to adjust pain med dose & assess RR frequently
Get pt body temp to normal
Touch & repositioning may help
Stay at bedside if pt is fearful Decrease fear/anxiety be making simple explanations of where the pt is, what is going to happen, how they are doing Reunite pt & family ASAP
