Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Intraoperative Nursing - Lecture Slides |, Study notes of Nursing

Intraoperative Material Type: Notes; Class: Nursing Science 2 - Intermediate; Subject: Nursing; University: Santa Fe Community College; Term: Forever 1989;

Typology: Study notes

2010/2011

Uploaded on 01/29/2011

kelcuddihy
kelcuddihy 🇺🇸

3 documents

1 / 14

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
1
Intraoperative Nursing
Presented By
Jean Hutton, RN, MSN, CNS, CNE
History of OR Nursing
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
Members of the Surgical Team
Charge Nurse
Manager
Educator
RNFA
Nurse Anesthetist
Scrub
Circulator
ULP
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe

Partial preview of the text

Download Intraoperative Nursing - Lecture Slides | and more Study notes Nursing in PDF only on Docsity!

Intraoperative Nursing

Presented By

Jean Hutton, RN, MSN, CNS, CNE

History of OR Nursing

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

Members of the Surgical Team

Charge Nurse Manager Educator RNFA Nurse Anesthetist Scrub Circulator ULP

Definition of RN in the OR

A nurse who identifies the physiological,

psychological & sociological needs of the

OR patient in order to restore or maintain

the health & welfare of that patient before,

during & after surgical intervention

Circulator

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

Circulator

Plans & coordinates care in OR Supports patient & acts as patient advocate Monitors & controls OR environment Documents nursing care & counts

Psychological Assessment

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

Sociocultural & Spiritual

Assessment

Be aware of: Personal space & modesty Eye contact & touch Pain management Birth & death rituals Family relationships Religious orientation

Developmental Assessment

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

Perioperative Nursing Diagnosis

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

Traffic Patterns

Unrestricted- can wear street clothes Semi-restricted- scrubs & hats required, staff & patients only Restricted- where surgical procedures are performed, scrubs, hats & masks required

Surgical Asepsis

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

OR Skin Preparation

A Scrubbing/soapy solution may be used

first, followed by a paint solution

The prep should last 5 minutes, CV &

Orthopedic preps should last 10 minutes

After reaching the prep area edges, a new

sponge dipped in the antiseptic should be

used beginning at the proposed incision site

& working to the edges again, repeat atleast

three times

Electrosurgical Unit (ESU)

Created in the 1920’s by Dr. Cushing & Dr.

Bovie

Uses electric current to cut & coagulate fat,

fascia, muscle, internal organs & small

blood vessels

Decreases amount of diffuse bleeding

during surgery

Electrical burn through the patient’s skin is

the greatest hazard of electrosurgery

Clinical Education Department, Valleylab Inc, 9/

Clinical Education Department, Valleylab Inc, 9/

Anesthesia

General, Regional, Local, Conscious

Sedation

General- reversible, unconscious state

characterized by amnesia, analgesia,

depression/loss of reflexes, muscle

relaxation, & homeostasis or manipulation

of physiological functions

Regional & Local Anesthesia

Regional- reversible loss of sensation &/or

movement when a local anesthetic is

injected to block or anesthetize nerve fibers

(Spinals, Epidurals, Caudals or Major

peripheral blocks such as a brachial nerve

block)

Local- the surgical site is injected with a

anesthetic, such as lidocaine, into the SQ

tissue in order to depress the superficial

peripheral nerves

Balanced Anesthesia

Current techniques used to administer

anesthesia

The use of combining IV anesthetics,

analgesics, amnesics & inhalation drugs to

achieve unconsciousness, skeletal muscle

relaxation, pain relief & physiological

homeostasis

Complications of Anesthesia

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

Malignant Hyperthermia

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

Malignant Hyperthermia

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

Post Anesthesia Recovery Unit

Initial assessment is focused on respiratory status, CV status, pain level, & type of anesthesia given, temperature, control of N/V

Nursing Diagnosis in the PACU

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

Alteration in Tissue perfusion

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

Acute Pain

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!

Alteration in Body Temperature

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

Comfort & Safety

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

Emergence Delirium

S & S - strong, non-purposeful movements,

crying, verbalizing or moaning & unable to

follow commands

Causes- certain anesthetic agents, H/O

anxiety, substance abuse, hypoxemia,

children

Treatment- stay with pt, reassure pt, pull

curtains around bed, dim lights