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    Ch. 18. Intra-Operative Nursing Care

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    محمد الحواجرة
    Assist with airway management, suctioning, ventilation, and oxygenation as directed by anesthesia provider.  Hypothermia • Loss of body heat during surgery • Nursing actions: - Monitor temperature - Use warming blankets - Warm IV fluids

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    Ch. 18. Intra-Operative Nursing Care

    Uploaded by

    محمد الحواجرة
    17 views49 pages
    Assist with airway management, suctioning, ventilation, and oxygenation as directed by anesthesia provider.  Hypothermia • Loss of body heat during surgery • Nursing actions: - Monitor temperature - Use warming blankets - Warm IV fluids

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    Ch. 18. Intra-operative Nursing Care

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    Assist with airway management, suctioning, ventilation, and oxygenation as directed by anesthesia provider.  Hypothermia • Loss of body heat during surgery • Nursing actions: - Monitor temperature - Use warming blankets - Warm IV fluids

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    17 views49 pages

    Ch. 18. Intra-Operative Nursing Care

    Uploaded by

    محمد الحواجرة
    Assist with airway management, suctioning, ventilation, and oxygenation as directed by anesthesia provider.  Hypothermia • Loss of body heat during surgery • Nursing actions: - Monitor temperature - Use warming blankets - Warm IV fluids

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 49

    Nursing care of patients undergoing

    surgery
    (Intraoperative Care)

    Dr. Mohammad Alhawajreh


     Intended Learning Outcomes
    • S.E.E.1: Distinguish various areas of perioperative department and
    appropriate attire.
    • S.E.E.2.1: Outline the roles and responsibilities of interprofessional
    surgical team members.
    • S.E.E.2.2: Analyze role of a perioperative nurse in the management
    of patients undergoing surgery.
    • H.P.M.2: Prioritize needs of patients undergoing surgery
    • S.E.E.1: Identify intraoperative positions.
     Intended Learning Outcomes
    • S.E.E.2.1: Apply basic principles of infection prevention and aseptic
    technique in the operating room.
    • S.E.E.2.2: Recognize operating room safety measures related to
    patients, equipment, and anesthesia.
    • PH.I.2: Distinguish various anesthesia techniques and common
    anesthesia drugs
    • P.H.I.1: Identify adverse effect of surgery and anesthesia
    • G.H.E.2: Introduce to the updated operating room safety
    measures related to patients, equipment, and anesthesia
    • G.H.E.2: Discuss the latest measures for infection prevention and
    aseptic techniques used in the OR.
     Intraoperative period

    • Period of time from when pt is transferred to


    operating room table to when pt is admitted to post
    anesthesia care unit (recovery room)
     Surgical Team

    • Patient
    • Circulating Nurse
    • Scrub nurse
    • Surgeon
    • Assistant Surgeon
    • Anesthesiologist and anesthetist
     Surgical Team

    Circulating Nurse (Runner nurse)


    • Main responsibilities include:
    • Assist with patient positioning
    • Preparing patient skin for surgery
    • Managing surgical specimens
    • Documenting intraoperative events
    • Verifying consent
    • Coordinating team
    • Ensure proper lighting, cleanliness,
    temperature &humidity , safe function of
    equipment, and availability of supplies
    and materials.
    • Monitor scrubbed team for breaks in
    sterile fields
    • Not scrubbed, gowned, or gloved
    • Remains in unsterile field
     Surgical Team
    • Scrub Nurse activities
    • Wear sterile gown and gloves . sterile attire
    “uniform”
    • Remain in sterile field
    • Perform surgical hand scrub
    • Set up sterile tables
    • Prepare supplies and equipment on sterile table
    • Assist surgeon during procedure
    • Count all needles, sponges, and instruments
    +circulating nurse
    • Label specimens & sent it to lab by circulating nurse
     Surgical Team

    Surgeon
    • Performs surgical procedure
    • Responsible for:
    • Preoperative medical history
    • obtaining informed consent
    • Physical assessment
    • Patient safety
    • Postoperative management
     Anesthesia care provider

    • Prescribes preoperative medicines


    • Administers anesthesia
    • Maintenance of physiologic homeostasis throughout
    intraoperative period
    • Monitors cardiac and respiratory status and vital signs
    throughout procedure
     Surgical environment
    • Operating room
    • Controlled area
    • Access limited to authorized personnel
    • Designed to minimize spread of infections

    Surgical area
    • Holding (waiting) area
    • Operating room (OR)
    • Postanesthsia care unit (recovery room)
     Surgical environment
    Methods used to prevent transmission of infection
    • Filters
    • Controlled airflow
    • Positive air pressure [When intake fans’ combined
    airflow is greater than exhaust (Dust reduction)
    • Traffic control
    • Adhering to principles of surgical asepsis
    • Sterility of equipment and surfaces
    • Processes of scrubbing, gowning, and gloving
    • OR attire
    • Cleanliness of rooms
     Surgical environment

    Surgical area divided into :


    • Unrestricted areas/zone
    • Semi restricted areas/zone
    • Restricted areas
    Unrestricted areas/zone
    • street clothes allowed
    • Includes
    • Holding area (point of entry of patient : Waiting
    area )
    • Staff locker rooms
    • Nursing station
     Surgical environment

    • Holding area
    • Final identification and assessment before pt is
    transferred to OR
    • Minor procedures performed (e.g. insert IV
    catheter, remove cast, drug administration)
    • Friends/family allowed
     Surgical environment

    • Semirestricted area/zone
    • Peripheral support areas and corridors with only
    authorized people
    • Must wear surgical attire and cover all head and
    facial hair.
     Surgical environment

    • Restricted areas
    • Operating rooms and Scrub sink areas
    • Attire consists of
    • Scrub cloths
    • Gloves
    • Head covers (caps)
    • Masks
    • Shoes covers\caps
    • In trauma and some types of surgery
    • Double gloves
    • Waterproof apron
    • Eye protector
     Principles of surgical asepsis

    • Aim to : Prevent contamination of wound


    • All staff should adhere to these principles
    • All equipment that comes in direct contact with pt
    must be sterile
    • Basic guideline for maintaining surgical asepsis
    p507
     Basic Guidelines for Surgical Asepsis

    • All materials in contact with wound, within sterile field


    must be sterile
    • Gowns sterile in front from chest to level of sterile field
    Movements of surgical team: from sterile to sterile, from
    unsterile to unsterile
    • Movement around sterile field must not cause
    contamination of field
    • Items of doubtful sterility considered unsterile
    Health Hazards

    • Health Hazards associated with surgical


    environment
    • Exposure to blood and body fluids, radiation, and
    toxic agents
    • Laser risks
    • Latex allergy (latex-free products)
    • Unintentional leaving of an object in a person
    • Policies and procedures to minimize exposure to
    these hazards
     Nursing Management
    Before surgery
    • Room preparation (done before transfer pt to OR )
    • Surgical attire worn by all persons entering OR suite
    • Electrical and mechanical equipment checked for
    proper function
    • Psychosocial assessment
    • Physical assessment
    • Chart review : ensure that all required blood and other
    studies are available.
     Nursing Management

    • Diagnostic tests (i.e., Chest x-ray, CT scan)


    • Pregnancy testing
    • Surgical and blood transfusion consent
    • Allergies
    • Blood type and crossmatch
    • Admitting patient
    • Proper identification (ask pt to state his or her name,
    name of surgeon procedure), ID BAND,
     Nursing Management

    • Admitting patient
    • Reassessment
    • Last-minute questions
    • Questioning about valuables, prostheses,
    contacts, last intake of food/fluid
     Nursing Management

    • Assist with anesthesia care provider


    • NURSE SHOULD
    • Understand mechanism of anesthetic administration
    and pharmacologic effects of the agents
    • Know location of emergency equipment and drugs in
    the OR
    • May place monitoring devices on patient
    • Remain at patient’s side to ensure safety
     Types of Anesthesia and sedation

    • General anesthesia
    • Local anesthesia
    • Regional anesthesia
     General anesthesia

    • Anesthesia: state of narcosis (severe CNS depression


    produced by pharmacologic agents) , analgesia,
    relaxation, and reflex loss
    • Loss of sensation
    • loss of consciousness
    • Skeletal muscle relaxation
    • Possible impaired ventilatory and Cardiovascular
     Methods of GA agents administration

    1. Intravenous agents
    • Used during initial period of anesthesia
    • Rapid action
    • Induce pleasant sleep
    • Insert endotracheal tube (ET) and start inhalation agent
    • Table 19-2
    • barbiturates, benzodiazepines, non-barbiturate
    hypnotics, and opioid agents Morphine sulfate
     Methods of GA agents administration

    2. Inhalation agents
    • Volatile liquids (liquid at room temp) mixed with O2 as
    carrier gas. E.G Halothane
    • Gases agents (gas at room temp) (nitrous oxide(N2O)
    with O2)
    Given by:
    Endotracheal tube
    Mask
    Tracheostomy
    • Muscle relaxants (neuromuscular blockers IV) :

    relax muscles in abdominal and thoracic surgery


    relax eye muscles in certain types of eye surgery
    facilitate ET intubation
    treat laryngospasm
    assist in mechanical ventilation
     Local Anesthesia
     Local Anesthesia

    Advantages of local anesthesia


    • Simple and economical .
    • Minimal Equipment needed
    • Brief Postoperative recovery
    • Avoid Undesirable effects of general anesthesia
    • Ideal for short and superficial surgical procedures.
     Regional anesthesia

    • local anesthetic
    • Injection of anesthetic agent into or around specific
    nerve or group of nerves
    • Loss of sensation in body region without loss of
    consciousness
    • Epidural anesthesia
    • Spinal anesthesia
     Regional anesthesia

    • Spinal anesthesia
    • Injection of local anesthetic agent into CSF of
    subarachnoid space at lumbar level
    • Usually below L2 (between L4-L5)
    • Used for surgical procedures in lower abdomen,
    groin, perineum, lower extremity
    • Patient can remain fully conscious
     Regional anesthesia

    Epidural anesthesia
    • Injection of local anesthetic agent into epidural
    space that surrounds dura matter of spinal cord
    • Does not enter CSF
    • Patient can remain fully conscious
    • Commonly used for obstetrics, lower
    extremities surgeries
    • A=epidural catheter
    • B=single injection
    epidural
    • C=spinal
     Potential Intraoperative Complications

    • Nausea, vomiting
    • Anaphylaxis
    • Hypoxia and respiratory complications
    • Hypothermia
    • Malignant hyperthermia
     Nausea and Vomiting
    side effect of anesthesia
    • Nursing actions
    • Turn Patient to side
    • Lower head of table
    • Provide basin to collect vomitus
    • Suctioning
     Anaphylaxis/Allergic reactions

    • Reaction to medication, latex, or other substances


    • Nurse should alert to possibility and observe for
    changes in vital signs and symptoms of anaphylaxis
    • Hypotension
    • Bronchial constriction
     Hypoxia and other Resp. complications
    • Due to inadequate ventilation, anesthetic agent ..etc
    • Nursing actions:
    • Monitoring oxygenation
    • Monitoring peripheral perfusion
    • Pulse oximetry
     Hypothermia

    core body temp lower than 36.6C or less


    Metabolic acidosis
    • Causes : low OR temperature, cold fluids gases, open
    wound…etc
    • Nursing actions
    • Reset OR temperature 25-26.6 C
    • Warm IV and irrigating fluids to 37 C
    • Replace wet gowns by dry materials
    • Re-warm patient gradually
     Malignant Hyperthermia
    Uncontrolled increase in oxidative
    metabolism in skeletal muscle, which reduces the
    body's capacity to supply oxygen, remove carbon
    dioxide, and regulate body temperature, eventually
    leading to circulatory collapse and death if not
    immediately treated.
    Uncommon
    Rare inherited muscle disorder
    induced by anesthesia agents
    Hyperthermia with rigidity of skeletal muscles.
    Can result in death.
    causes
    Anesthetic agents
    Stress
     Malignant Hyperthermia

    S&S
    • Tachycardia (early sign)
    • Ventricular dysrhythmia
    • Hypotension
    • Oliguria and decrease cardiac output
    • Cardiac arrest
    • Rise in temperature (late sign developed rapidly)
     Malignant Hyperthermia

    Management
    • Identification of patients at risk
    • If occur
    • Stop surgery
    • Hyperventilation 100% O2
    • Muscle relaxant agents
    • Monitoring
     Intraoperative Positions

    positions depend on
    • surgical procedure to be performed
    • physical conditions of patient
    • Factors to be considered includes:-
    Comfortable position
    Operative area must be exposed
    No interference with respiration and vascular
    supplies
    Nerves must be protected
     Intraoperative Positions

    • Positions
    • Supine (suited for abdomen, heart, breast
    surgeries.
    • Dorsal Recumbent Position
    • Trendelenburg Position
    • Lithotomy Position
    • Lateral Position
    • Prone (back surgeries)
    Intraoperative Positions
    Trendelenburg position
    Thank you
    Any Questions ?

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