1. Intra operative Nursing Management
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2. 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
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3. 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
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4. 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
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5. 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
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6. 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
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7. 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
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8. 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
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9. Local anesthesia: injection of the anesthetic agent in the tissue at the planned site.
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10. Potential Intraoperative Complications
Nausea and vomiting
Anaphylaxis: sever allergic reaction cause mostly by medications
Hypoxia and hypercarpia
hypothermia.
Malignant hyperthermia
Dissiminated Intravascular coagulopathy (DIC)
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11. 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
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12. 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
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13. The classic signs of hypovolemic shock Pallor Cool moist skin
Rapid breathing
Cyanosis
Narrowing pulse pressure
Low blod pressure
Concentrated urine
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14. 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
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