Ch. 18. Intra-Operative Nursing Care
Ch. 18. Intra-Operative Nursing Care
Ch. 18. Intra-Operative Nursing Care
surgery
(Intraoperative Care)
• Patient
• Circulating Nurse
• Scrub nurse
• Surgeon
• Assistant Surgeon
• Anesthesiologist and anesthetist
Surgical Team
Surgeon
• Performs surgical procedure
• Responsible for:
• Preoperative medical history
• obtaining informed consent
• Physical assessment
• Patient safety
• Postoperative management
Anesthesia care provider
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
• 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
• Admitting patient
• Reassessment
• Last-minute questions
• Questioning about valuables, prostheses,
contacts, last intake of food/fluid
Nursing Management
• General anesthesia
• Local anesthesia
• Regional anesthesia
General anesthesia
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) :
• 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
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 ?