FUNDAMENTALS OF NURSING Lesson #19 INTRAOPERATIVE TECHNIQUES

DEFINE TERMS/SUFFIX ostomy: opening for passage pexy: fixation or suspension otomy: opening into orrhaphy: repair of plasty: plastic surgery oscopy: direct visualization of ectomy: surgical removal of lysis: destruction or dissolution of anostomosis: joining of 2 ducts or blood vessels

INTRAOPERATIVE PHASE INTRAOPERATIVE PHASE: Starts when pt enters the OR Ends when pt enters post-anesthesia unit (PACU) or recovery room

ROLE OF CIRCULATING NURSE Always an RN Considered the charge nurse of the OR suite Assists scrubbed or sterile personnel Responsible for quality of pt care

ROLE OF CIRCULATING NURSE ROLES DEFINED: Prepares room and equipment Gathers supplies and maintains the sterility Counts supplies pre-op and post-op Gets patient at the right time

ROLE OF CIRCULATING NURSE ROLES DEFINED: Assesses pt preoperatively Identifies pt Verifies teaching received Ensures consent form accurate Confirms allergies and lab results Assures safe pt transfers Applies EKG equipment Assists team with maintaining sterility and provides supplies Documents on operative record, nurses notes Assists anesthesiologist, surgeon Performs sponge count

ROLE OF SCRUB NURSE SCRUB NURSE: Can be RN, LPN, or scrub tech Passes instruments & supplies to surgeon or assistants Maintains strict asepsis Sterile fields must be maintained Takes knowledge & experience to do efficiently ANY question about sterility = contaminated Sterility must be maintained to prevent or decrease infection

ROLE OF SCRUB NURSE ROLES DEFINED: Assists circulating nurse Is sterile Sets up sterile fields Performs sponge/instrument count at start/finish Assists surgeons with gowning and gloving Assists with sterile draping of pt Monitors for breaks in sterile field Handles specimens

USING STERILE TECHIQUE IN OR SURGICAL HAND SCRUB: Cannot sterile the skin Can decrease the number of microbes by Chemical (soap) Physical (friction) Mechanical (brush) means Special soaps (Betadine, Hibiclens) can help Fingernails must be short and polish free No jewelry Put on shoe covers, cap, mask before scrubbing in

USING STERILE TECHIQUE IN OR SURGICAL HAND SCRUB: 5-10 minute scrub: Scrub from hands to elbows Keep hands above elbows Rinse from fingertips to elbows Do not tough anything once scrubbed Water controls are at your feet Remember sterile field… From hands to 2 inches past elbow

USING STERILE TECHIQUE IN OR APPLYING STERILE GOWN & CLOSED GLOVING: Hand scrub Put on sterile gown keeping hands inside

APPLYING STERILE GOWN & CLOSED GLOVING: ROLE OF SCRUB NURSE APPLYING STERILE GOWN & CLOSED GLOVING:

FUNDAMENTALS OF NURSING Lesson #20 INTRAOPERATIVE TECHNIQUES

POSTANESTHESIA CARE 2 PHASES: Immediate post anesthesia Convalescent state PHASE I Post anesthesia: Pt is leaving the OR and before admit to general nursing unit Takes place in RR or PACU

POSTANESTHESIA CARE PHASE I: POST ANESTHESIA Anesthesia provider gives verbal report Orders from surgeon or admitting provider are received

POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: First 1-2 hours post op most critical Constant assessment vital Remember ABCs: Airway Breathing Circulation

POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: REACT: Respiration Energy Alertness Circulation Temperature

POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: DRAINAGE: Should know what kind of drainage to expect Don’t be afraid to ask… Risk of hemorrhage post op Arterial bleeding Venous bleeding Capillary bleeding

POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: Types… Urine DRAINAGE: Types… Urine NG tube Wound, Hemovac, Jackson Pratt Report bloody drainage > 100-200 cc/h

POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: DRESSINGS: Check and document when receiving pt from OR Drainage should go from sanguineous to serous If other way around…report to MD Note content of drainage in tubes NG placement IV fluids: rate, site, fluid

POSTANESTHESIA CARE NURSING INTERVENTIONS: Report from OR On immediate arrival Airway Breathing Circulation Spinal anesthesia Drainage

POSTANESTHESIA CARE NURSING INTERVENTIONS: Pain Unique interventions Temperature Dressings Edema

POSTANESTHESIA CARE 2 PHASES: Immediate post anesthesia Convalescent state PHASE II Convalescent period: From dc from PACU/RR to dc to home/nursing unit

POSTANESTHESIA CARE PHASE II: Assessment includes… VS Temperature LOC NPO status Complications Incision site

POSTANESTHESIA CARE PHASE II: Assessment includes… Ventilation Post-op shock Pain Urinary function Venous stasis

POSTANESTHESIA CARE PHASE II: Assessment includes… Ambulation GI Fluids & electrolytes

POSTANESTHESIA CARE PHASE II: Parenteral fluids/IV therapy Assessment IV fluids Isotonic, hypertonic, hypotonic

POSTANESTHESIA CARE PHASE II: Parenteral fluids/IV therapy IV fluids Hyperalimentation Infusion site

POSTANESTHESIA CARE IV fluids Site Rate Interventions PHASE II: Parenteral fluids/IV therapy IV fluids Site Rate Interventions

POSTANESTHESIA CARE Assessment VS Reaction indicators Nursing actions PHASE II: Blood transfusion interventions: Assessment VS Reaction indicators Nursing actions

POSTANESTHESIA CARE PHASE II: DC planning for post-op patient: Incision care Drainage Dressing changes Comfort Side effects Safety

THE END!!!!!