Intra operative Nursing Management 25 April 2017

Myocardial depression and cardiac arrhythmia The patient may experience variety of complications once entered the OR that include: Allergic reaction Myocardial depression and cardiac arrhythmia Central nervous system(CNS) agitation Hypoxemia and hypercarpia Hypotension, hypothermia, hyperthermia 25 April 2017

Main role is to manage the OR and protect patient safety There is 2 types of nurses in the OR the circulating nurses and the scrub nurse. The circulating nurse Must be RN Main role is to manage the OR and protect patient safety Monitor environment inside the OR: lighting, humidity, temperature, cleanliness Verify consent 25 April 2017

Perform surgical handscrub Set up the sterile table Prepare suture The scrub nurse Perform surgical handscrub Set up the sterile table Prepare suture Assist the surgeon during surgery At the end of the surgery both the circulating nurse and the scrub nurse count all eqipments and ensure that nothing retained inside patient body 25 April 2017

Principles of surgical asepsis All material in contact with the surgical wound must be sterile Gowns of the surgical team are considered from the chest to the level of setrile filed The top of surgical drapes is considered sterile Movement of sterile to sterile and from unsterile to unsterile Items is dispensed to the sterile filed by method that preserve sterility 25 April 2017

The Surgical Experience Anesthesia : a state of narcosis ( svere central nervous system depression) , relaxation, and reflex loss that is induced by pharamcologic agent. Pharmacologic agents include inhaled gases such as nitrous oxide and IV agents such as fentanyl, and morphine Types of anesthesia General anesthesia : consists of 4 stages with clinical manifestations for each 25 April 2017

Stages of general anesthesia Stage 1: beginning anesthesia: once patient breath in the anesthetic mixture warmth, dizziness, and feeling of detachment may be experienced , noise is exaggerated Stage 11: the excitement : patient may sing, shout, talk, laugh, cry, patient may have uncontrolled movement and needs strap. Stage 111: surgical anesthesia: the patient in this stage is quite and unconscious Stage 1V: medullary depression:in case of anesthesia overdose the patient respiration become shallow, pulse thready and weak, pupils dilated and cyanosis may develop 25 April 2017

Regional anesthesia Regional anesthesia : Anesthetic agents is injected around a nerve so that the area supplied by the nerve is anesthized. Includes 3 types epidural anesthesia, spinal and local conduction block Epidural anesthesia: injecting local anethetic agent inside the epidural space that surround the dura matter Spinal anesthesia: inject the anesthetic agent inside the subarachnoid space 25 April 2017

Local anesthesia: injection of the anesthetic agent in the tissue at the planned site. 25 April 2017

Potential Intraoperative Complications Nausea and vomiting Anaphylaxis: sever allergic reaction cause mostly by medications Hypoxia and hypercarpia hypothermia. Malignant hyperthermia Dissiminated Intravascular coagulopathy (DIC) 25 April 2017

NURSING PROCESS Assessment : VS, physichological status, nutrition….. Diagnosis Anxiety,risk for injury Disturbed sensory perception Planning : to reduce anxiety, and prevent injury and complications Intervintion Reduce anxiety, prevent injury, Evaluation : expected outcomes include low level of anxiety, remain free of injury, free of complications 25 April 2017

Post operative nursing management Post anesthesia care unite ( Recovery room) is located near the OR. Patient who still under anesthesia are placed in this unite The nursing role in the recovery room is to provide care until the patient recover from anesthesia Main nursing activities include Assess the patient Maintain patent airway( head tilt chin left or jaw thrust) Maintain cardiovasular stability : prevent and manage hypovolemic shock , hemorrhage, hypertension and arrhytmia. Relieving anxiety and fear Control nausea and vomiting 25 April 2017

The classic signs of hypovolemic shock Pallor Cool moist skin Rapid breathing Cyanosis Narrowing pulse pressure Low blod pressure Concentrated urine 25 April 2017

NURSING PROCESS FOR HOSPITALZIED PATIENT RECOVERING FROM SURGERY Assessment : VS, respiratory and cardiac status, complications Diagnosis : risk for ineffective airway clearence, decrease cardiac output, impaired skin integrity, risk for imbalanced nutrition. Planning : main goals is to obtian clear airway, no pain, unimpaired wound healing, increased activite tolerance… Intervention : relieve pain,encourage activity, monitor and manage bleeding and hypotension , promote wound healing, maintain normal body temperature, promote bowel function and manage voiding Evaluation: expected outcomes include optimal respiratory function, no pain, wound heal with no complications, normal body temperature, normal voiding pattern 25 April 2017