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Questions and Answers
What is a primary difference between spinal anaesthesia and epidural anaesthesia?
What is a primary difference between spinal anaesthesia and epidural anaesthesia?
In which surgical position is the risk of pressure injury to the sacrum heightened?
In which surgical position is the risk of pressure injury to the sacrum heightened?
Which of the following is NOT a role of the recovery room nurse in postoperative patient management?
Which of the following is NOT a role of the recovery room nurse in postoperative patient management?
What is the appropriate action to manage hazards like LASER plumes in the surgical environment?
What is the appropriate action to manage hazards like LASER plumes in the surgical environment?
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What should be communicated using the ISBAR format regarding a patient with an abdominal drain post-appendectomy?
What should be communicated using the ISBAR format regarding a patient with an abdominal drain post-appendectomy?
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Which surgical position requires careful attention to the ulnar nerve to prevent injury?
Which surgical position requires careful attention to the ulnar nerve to prevent injury?
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Which of the following conditions can be exacerbated by exposure to volatile anaesthetic gases?
Which of the following conditions can be exacerbated by exposure to volatile anaesthetic gases?
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Which of these drug categories is primarily used as reversal agents in the perioperative setting?
Which of these drug categories is primarily used as reversal agents in the perioperative setting?
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What is the primary purpose of the 'operating theatre'?
What is the primary purpose of the 'operating theatre'?
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Which of the following phases is NOT included in the perioperative period?
Which of the following phases is NOT included in the perioperative period?
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Why is pre-admission risk assessment essential in the perioperative process?
Why is pre-admission risk assessment essential in the perioperative process?
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What was a historical context for the term 'theatre' in relation to surgery?
What was a historical context for the term 'theatre' in relation to surgery?
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Which of the following is NOT part of the postoperative phase?
Which of the following is NOT part of the postoperative phase?
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What is an important aspect of patient education in the preoperative phase?
What is an important aspect of patient education in the preoperative phase?
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What kind of tools and equipment are typically found in an operating theatre?
What kind of tools and equipment are typically found in an operating theatre?
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What role does discharge planning play in the preoperative phase?
What role does discharge planning play in the preoperative phase?
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What is the recommended duration of a surgical scrub at the beginning of the day?
What is the recommended duration of a surgical scrub at the beginning of the day?
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What is the primary difference between a surgical hand scrub and a surgical hand rub?
What is the primary difference between a surgical hand scrub and a surgical hand rub?
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When can second and subsequent surgical scrubs be reduced to 3 minutes?
When can second and subsequent surgical scrubs be reduced to 3 minutes?
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What does the term 'strike-through' refer to in a surgical context?
What does the term 'strike-through' refer to in a surgical context?
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Which of the following is NOT one of the actions a scrub nurse should take to maintain a sterile field?
Which of the following is NOT one of the actions a scrub nurse should take to maintain a sterile field?
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What is a critical step in verifying patient identity before a surgical procedure?
What is a critical step in verifying patient identity before a surgical procedure?
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What is one reason for checking a patient's fasting status prior to anesthesia?
What is one reason for checking a patient's fasting status prior to anesthesia?
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During a surgical hand scrub, what technique is employed to ensure thorough cleaning?
During a surgical hand scrub, what technique is employed to ensure thorough cleaning?
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Why is strike-through considered a problematic occurrence in surgery?
Why is strike-through considered a problematic occurrence in surgery?
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Which type of environmental zone in an operating theatre allows the most access?
Which type of environmental zone in an operating theatre allows the most access?
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What is the role of a scrub nurse in handling instruments during surgery?
What is the role of a scrub nurse in handling instruments during surgery?
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What is the primary reason for maintaining a specific temperature range in the operating theatre?
What is the primary reason for maintaining a specific temperature range in the operating theatre?
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What mechanism is primarily responsible for air movement in an operating theatre?
What mechanism is primarily responsible for air movement in an operating theatre?
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Why is it important to document known allergies for patients undergoing surgery?
Why is it important to document known allergies for patients undergoing surgery?
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What vital sign is NOT typically assessed as part of the baseline vitals prior to anesthesia?
What vital sign is NOT typically assessed as part of the baseline vitals prior to anesthesia?
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Which of the following is a method to help maintain thermoregulation in an anaesthetized patient?
Which of the following is a method to help maintain thermoregulation in an anaesthetized patient?
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What phase of general anaesthesia involves the patient transitioning from unconsciousness to alertness?
What phase of general anaesthesia involves the patient transitioning from unconsciousness to alertness?
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Which of the following airway devices can provide positive pressure ventilation?
Which of the following airway devices can provide positive pressure ventilation?
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What is the purpose of Cricoid Pressure during Rapid Sequence Induction?
What is the purpose of Cricoid Pressure during Rapid Sequence Induction?
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What does the 'gold standard' indicate for confirming an Endotracheal Tube (ETT) placement?
What does the 'gold standard' indicate for confirming an Endotracheal Tube (ETT) placement?
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Which method is used to achieve surgical haemostasis artificially?
Which method is used to achieve surgical haemostasis artificially?
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Who is primarily responsible for the surgical count in the operating room?
Who is primarily responsible for the surgical count in the operating room?
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What distinguishes monopolar diathermy from bipolar diathermy?
What distinguishes monopolar diathermy from bipolar diathermy?
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What key element should a scrub nurse check when setting up instrument trolleys for surgery?
What key element should a scrub nurse check when setting up instrument trolleys for surgery?
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Study Notes
Skin Preparation and Surgical Procedures
- Skin preparation encompasses a series of steps to prepare the surgical site, including: removal of hair, cleaning with antiseptic solutions, and draping the patient.
- Surgical shave is the removal of hair from the surgical site to ensure a sterile field and avoid contamination.
- LMA removal is the process of taking out the laryngeal mask airway (LMA) after surgery, typically when the patient is regaining consciousness.
- Draping the patient involves covering the patient's body with sterile drapes to create a barrier between the sterile field and the surrounding environment.
- Applying the diathermy pad is done to prevent burns during diathermy, a surgical tool that uses heat to cut or coagulate tissue.
- Flowtron application involves applying a pneumatic compression device to the patient's legs to prevent deep vein thrombosis (DVT).
- Determination of fasting status is crucial to ensure the patient has fasted appropriately for the procedure, preventing aspiration during anaesthesia.
- Inflating the ETT cuff is necessary to ensure the endotracheal tube (ETT) is securely placed within the trachea, maintaining the airway.
- Intraoperative blood loss monitoring involves tracking the amount of blood lost throughout the surgical procedure to ensure patient safety, potentially requiring blood transfusions.
Spinal vs. Epidural Anaesthesia
- Spinal anaesthesia: Injected directly into the cerebrospinal fluid within the subarachnoid space, providing a rapid onset of sensory and motor block, typically used for lower limb and pelvic procedures.
- Epidural anaesthesia: Injected into the epidural space surrounding the spinal cord, causing a slower onset of sensory and motor block, offering a longer duration compared to spinal anaesthesia, used for labour analgesia, and surgical procedures.
Pressure Area and Nerve Considerations in Surgical Positions
- Lithotomy: Pressure areas include the heels, buttocks, and sacrum. Nerve considerations involve the sciatic nerve, femoral nerve, and common peroneal nerve.
- Supine: Pressure areas include the occiput, scapulae, elbows, sacrum, and heels. Nerve considerations include the brachial plexus, radial nerve, ulnar nerve, and sciatic nerve.
- Trendelenburg: Pressure areas include the shoulders, neck, and lower back. Nerve considerations include the brachial plexus and sciatic nerve.
- Reverse Trendelenburg: Pressure areas include the sacrum, heels, and posterior aspect of the thighs. Nerve considerations include the sciatic nerve, femoral nerve, and common peroneal nerve.
- Prone: Pressure areas include the chest, hips, knees, and feet. Nerve considerations include the brachial plexus, radial nerve, and ulnar nerve.
- Lateral: Pressure areas include the shoulder, hip, knee, and ankle of the dependent side. Nerve considerations involve the brachial plexus, sciatic nerve, and peroneal nerve.
- Fowler: Pressure areas include the sacrum, buttocks, and heels. Nerve considerations include the sciatic nerve, femoral nerve, and common peroneal nerve.
- Sitting/Reclining: Pressure areas include the buttocks, thighs, and feet. Nerve considerations include the sciatic nerve, femoral nerve, and common peroneal nerve.
ISBAR Communication for Patient Handover
- I (Introduction): "Hello, I am [your name], the theatre nurse. I am handing over [patient name], who underwent an open appendicetomy with one abdominal drain".
- S (Situation): "The patient has an LMA in place and normal vital signs".
- B (Background): "The patient is recovering well from the procedure and has a stable condition".
- A (Assessment): "The patient is conscious and comfortable. Their vital signs are within the normal range."
- R (Recommendation): "I suggest monitoring the patient's pain level, abdominal drain output, and recovery from anaesthesia. Ensure clear airway patency and vital signs are stable. Please advise on the further management plan".
Roles of the Recovery Room Nurse
- Monitoring vital signs: Continuously track and assess the patient's heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation.
- Assessing pain level: Assess and manage post-operative pain to promote patient comfort and recovery.
- Monitoring sedation status: Monitor the patient's level of consciousness, and administer additional analgesia or sedatives as required.
- Managing airway: Ensure the patient has a clear and patent airway and may provide supplemental oxygen.
- Assessing wound site: Inspect the surgical wound for signs of bleeding, infection, or swelling.
- Managing drainage: Monitor and document the drainage from tubes, such as drains or catheters.
- Providing patient education: Educate the patient about their postoperative recovery and any medication, exercises, or restrictions.
- Facilitating patient discharge: Coordinate the patient's transfer from PACU to a ward or home, providing instructions and necessary resources.
Theatre Hazards and Management
- Laser plume: Fine particles of vaporized tissue and smoke emitted during laser surgery. Management: Utilize laser smoke evacuators and appropriate personal protective equipment (PPE) (eye, respiratory protection).
- Surgical plume: Smoke and aerosolized blood generated during surgical procedures. Management: Utilize smoke evacuation units, provide eye and respiratory protection to staff, and ensure adequate ventilation.
- Volatile anaesthetic gases: Residual anaesthetic agents in the operating room atmosphere. Management: Provide proper ventilation, minimizing exposure to both staff and patients.
- Latex allergy: Allergic reactions to latex proteins present in gloves, medical equipment, and other supplies. Management: Utilize latex-free gloves, and follow the hospital's protocol for latex allergy management, ensuring availability of emergency medications.
Anaesthesia Reversal Agents
- Sedatives/Tranquilisers: Reversal agents include Flumazenil (for Benzodiazepines) and Naloxone (for opioids).
- Narcotics: Reversal agents include Naloxone and Naltrexone.
- Anticholinergics: Reversal agents include Physostigmine.
- Antiemetics: Reversal agents depend on the specific antiemetic used.
- Muscle relaxants: Reversal agents include Sugammadex (for rocuronium, vecuronium, and pancuronium) and Neostigmine (for succinylcholine).
- Inotropes: Reversal agents will depend on the specific inotrope used.
- Blood products: No specific reversal agent, relies on close monitoring and potentially blood transfusion.
- Reversal agents: These are drugs that counteract the effects of specific medications, and are often used to reverse sedation, muscle paralysis, or opioid effects, ensuring a safe and timely recovery.
Phases of General Anaesthesia
- Induction: The period from the start of anaesthetic administration until unconsciousness is attained, typically involves IV medications, potentially inhaled agents, and muscle relaxants.
- Maintenance: The period of sustained anaesthesia, where the patient is kept unconscious and free of pain, often involves intravenous and/or inhaled anaesthetics, and continuous monitoring of vital signs.
- Emergence: The period where the effects of the anaesthesia begin to wear off, the patient starts to regain consciousness, and muscle function returns.
- Recovery: The phase after surgery where the patient fully regains consciousness, and vital signs stabilize, requiring ongoing monitoring for complications, pain management, and discharge planning.
Administration of a General Anaesthetic
- Pre-induction: Pre-oxygenation with 100% oxygen for 3-5 minutes, vital sign assessment, establishing an intravenous line for medication administration, and a pre-anaesthetic medication induction if required.
- Induction: Rapid sequence induction (RSI) if needed, IV anaesthetic agent administration, intubation with an endotracheal tube (ETT).
- Maintenance: Maintaining the patient's airway and ventilation, administering anaesthetic agents, and closely monitoring vital signs.
- Emergence: Reversing the effects of muscle relaxants and other drugs, ensuring safe ventilation for the patient as they regain consciousness.
- Recovery: Monitoring and management of the patient's post-operative recovery until stable enough for discharge to a ward or home.
Airway Equipment Function
- Endotracheal tube (ETT): A plastic tube inserted into the trachea to maintain a clear airway and allow for mechanical ventilation during surgery.
- Laryngeal Mask Airway (LMA): A supraglottic airway device that sits in the pharynx, providing a seal above the vocal cords, facilitating airway maintenance and ventilation.
- Oropharyngeal airway (OPA): A plastic device inserted into the mouth to prevent the tongue from obstructing the airway, particularly used for unconscious patients.
- Nasopharyngeal airway (NPA): A plastic tube inserted into the nostril to maintain a patent airway, used when an OPA cannot be inserted due to jaw mobility limitations.
- Face mask: A device placed over the nose and mouth to deliver oxygen or inhaled anaesthetics to the patient.
- Self inflating bag/anaesthetic bag: A device used to manually ventilate the patient with oxygen or anaesthetic gases, used in emergencies or when mechanical ventilation is unavailable.
- Laryngoscope: A handheld device that provides light to visualise the larynx and vocal cords, facilitating endotracheal intubation.
- Cuff manometer: A device attached to the ETT cuff to measure the pressure within the cuff, ensuring proper placement and preventing airway obstruction.
- Style: A thin, flexible wire inserted into the endotracheal tube to assist with its insertion into the trachea, providing structure and direction.
- Bougie: A long, thin, flexible tube used to pass through the airway to help guide the endotracheal tube into the trachea, especially during difficult airway situations.
- Video laryngoscope: Modern device used to view the larynx and vocal cords, enabling the intubation procedure with enhanced visualisation, particularly valuable in difficult intubation cases.
Gold Standard for ETT Position Confirmation
- Bilaterally symmetrical breath sounds indicating the ETT is placed in the trachea, confirmed through auscultation of the chest.
Rapid Sequence Induction (RSI)
- A technique that involves rapidly administering medications to induce anaesthesia and paralyse the muscles, to facilitate intubation and prevent aspiration, used in situations where the patient has a high risk of aspiration like full stomach.
Cricoid Pressure
- Purpose: Used in RSI to reduce the risk of aspiration by occluding the oesophagus, preventing gastric contents from entering the airway during induction.
- Process: A specific pressure is applied to the cricoid cartilage, gently compressing the oesophagus.
Instrument Trolley Preparation
- Sterility: Ensuring all instruments are sterile and ready for use following appropriate sterilisation procedures.
- Functionality: Checking that all instruments are in good working order and able to perform their intended function during the procedure.
- Quantity: Confirming the correct number and type of instruments is available for the planned procedure.
- Sharps and Blades: Ensuring sharp instruments are properly labelled, stored, and protected, minimizing the risk of sharps injuries.
- Specialty Instruments: Verifying the availability of any specialty instruments required for the specific surgical procedure.
Team Timeout
- Purpose: A structured process to ensure the correct patient, procedure, and surgical site, enhancing patient safety and reducing the risk of errors.
- Participants: All members of the surgical team, including the surgeon, anesthesiologist, scrub nurse, and circulating nurse.
Surgical Safety Checklist
- Purpose: A standardized checklist used to improve communication and coordination, minimizing the risk of errors and potential complications during surgical procedures.
- The nurse's role: The nurse participates in the pre-procedural checklist, during the timeout process, and during the post-procedural checklist, ensuring that each item is reviewed and confirmed by the entire surgical team.
Surgical Count
- Purpose: To ensure that all instruments, sponges, and sharps used during surgery are accounted for before the patient leaves the operating room, preventing retained foreign objects.
- When: A count occurs before the procedure starts, after any part of the surgery that involves the use of potentially retained items, and before the closure of the surgical site.
- Who: The scrub nurse performs the counts in conjunction with the circulating nurse, ensuring all items are accurately counted and documented.
- What: All items such as instruments, sponges, sharps, including needles, are counted and documented.
Surgical Haemostasis
- Definition: The stopping of bleeding or blood flow. It can occur naturally through the process of vasoconstriction, blood clotting, and platelet aggregation.
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Artificial Methods:
- Ligature (tying): Using sutures to tie off blood vessels to prevent bleeding.
- Cauterization: Using heat from diathermy to seal blood vessels.
- Compression: Applying physical pressure to the bleeding site, often with a sponge or gauze.
Diathermy (Electro Surgical Unit)
- Description: A surgical device that uses high-frequency electrical currents to cut, coagulate, and ablate biological tissues.
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Nurse's role:
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Ensuring safe deployment:
- Proper grounding: Connect the patient to a grounding pad to prevent electrical burns.
- Appropriate settings: Ensure the settings are accurate for the desired surgical procedure and tissue type.
- Monitor and record: Observe for signs of burns or tissue damage, and document the settings used during the procedure.
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Ensuring safe deployment:
Monopolar vs. Bipolar Diathermy
- Monopolar: Uses one active electrode to deliver electrical current to the tissue and a separate grounding pad to complete the circuit.
- Bipolar: Uses two electrodes that are in close proximity, creating a localized electrical circuit, minimizing the risk of collateral damage to surrounding tissues.
Reasons for Using Sutures
- 1. Wound closure: To hold the edges of a wound together to promote healing.
- 2. Ligature: Tying off blood vessels to stop bleeding.
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