NURS 4200 Chapter_019 Easy
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Questions and Answers

What is a type of local anesthesia that does not involve loss of consciousness?

  • Topical anesthesia (correct)
  • General anesthesia
  • Monitored anesthesia care
  • Inhalation anesthesia

    • Which technique involves injecting local anesthetic into the epidural space?

  • Spinal anesthesia
  • Epidural block (correct)
  • Topical anesthesia
  • Regional block

    • What adverse effect can occur with the use of succinylcholine during anesthesia?

  • Malignant hyperthermia (correct)
  • Bradycardia
  • Coughing
  • Hypotension

    • Which method of local anesthesia involves applying a cream or ointment prior to the procedure?

    <p>Topical anesthesia</p> Signup and view all the answers

    What distinguishes spinal anesthesia from epidural anesthesia?

    <p>Spinal anesthesia involves injection into the CSF whereas epidural does not</p> Signup and view all the answers

    Which of the following statements about regional anesthesia is true?

    <p>It can provide effective pain relief after surgery.</p> Signup and view all the answers

    Which local anesthetic method involves injecting the agent into the tissues through which an incision will pass?

    <p>Local infiltration</p> Signup and view all the answers

    What is the primary purpose of the anesthesia care provider (ACP) during the surgical procedure?

    <p>To administer anesthetic agents and manage vital functions</p> Signup and view all the answers

    What is a common complication of regional anesthesia that requires close monitoring?

    <p>Local anesthetic systemic toxicity</p> Signup and view all the answers

    Which type of anesthesia is specifically administered directly into the spinal canal?

    <p>Spinal anesthesia</p> Signup and view all the answers

    What is the main focus of the psychosocial assessment performed before surgery?

    <p>Providing physical and emotional comfort to the patient</p> Signup and view all the answers

    Which of the following best describes a nurse anesthetist (CRNA)?

    <p>Requires a master's or doctorate degree</p> Signup and view all the answers

    During which phase of surgery is a preoperative assessment conducted?

    <p>Before surgery</p> Signup and view all the answers

    Which of the following is NOT part of the chart review before surgery?

    <p>Surgical technique explanation</p> Signup and view all the answers

    What is the distinction between spinal and epidural anesthesia?

    <p>Epidural anesthesia is administered at a higher level in the spine</p> Signup and view all the answers

    Which of the following is a common adverse effect of anesthetics?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is a key reason for obtaining informed consent before administering general anesthesia?

    <p>To ensure the patient understands the risks and benefits</p> Signup and view all the answers

    Which of these responsibilities is NOT typically associated with the anesthesia care provider?

    <p>Managing surgical instruments</p> Signup and view all the answers

    Which method is primarily used for surgical scrubbing?

    <p>Wet scrubbing technique</p> Signup and view all the answers

    What is the primary purpose of standard precautions in nursing management during surgery?

    <p>To prevent the transmission of infections</p> Signup and view all the answers

    Which of the following is a key consideration when positioning a patient for surgery?

    <p>Maintaining proper musculoskeletal alignment</p> Signup and view all the answers

    What is an effect of local anesthesia on sensory functions?

    <p>Blocks sensory nerve impulses</p> Signup and view all the answers

    Identify a common adverse effect of anesthetics.

    <p>Hypothermia</p> Signup and view all the answers

    Which statement accurately describes spinal anesthesia?

    <p>It blocks sensation below the site of injection.</p> Signup and view all the answers

    What must be avoided to ensure patient safety during anesthesia?

    <p>Inadequate padding for joints</p> Signup and view all the answers

    What technique is important for effective regional anesthesia administration?

    <p>Understanding effects of anesthetic agents</p> Signup and view all the answers

    What role does the circulating nurse play in anesthesia management?

    <p>Places monitoring devices and ensures safety</p> Signup and view all the answers

    Which patient positioning principle prevents undue pressure during surgery?

    <p>Providing adequate thoracic excursion</p> Signup and view all the answers

    Which of the following is a responsibility of the circulating nurse during surgery?

    <p>Implementing the intraoperative plan of care</p> Signup and view all the answers

    What is a key preparation step for ensuring patient safety during the transfer to the operating room?

    <p>Applying safety straps on the patient</p> Signup and view all the answers

    Which of the following is NOT a focus during patient admission before surgery?

    <p>Administering anesthesia</p> Signup and view all the answers

    What is the primary purpose of complementary and alternative therapies before surgery?

    <p>To decrease anxiety and promote relaxation</p> Signup and view all the answers

    What is the role of aseptic technique practiced in the operating room?

    <p>To prevent infection during surgery</p> Signup and view all the answers

    What is the primary responsibility of the surgeon during the surgical procedure?

    <p>To obtain informed consent</p> Signup and view all the answers

    Which role does the scrub nurse perform during surgery?

    <p>Preparing and managing the sterile field</p> Signup and view all the answers

    What is a distinct feature of an operating room that ensures patient safety?

    <p>Positive air pressure</p> Signup and view all the answers

    Which individual is required to supervise an LPN/VN or surgical technologist in the operating room?

    <p>A registered nurse (RN)</p> Signup and view all the answers

    What type of anesthesia involves administering medication that blocks sensation in a specific area of the body?

    <p>Local anesthesia</p> Signup and view all the answers

    During which phase does the perioperative nurse act as the patient's advocate?

    <p>During all surgical phases</p> Signup and view all the answers

    What type of anesthesia is typically performed by administering medication into the epidural space?

    <p>Epidural anesthesia</p> Signup and view all the answers

    Which of the following is NOT a common adverse effect of anesthetics?

    <p>Dehydration</p> Signup and view all the answers

    What does the registered nurse first assistant (RNFA) need to complete to fulfill their role?

    <p>Formal education and certification program</p> Signup and view all the answers

    Which feature is crucial for maintaining a sterile environment in the operating room?

    <p>Positive air pressure</p> Signup and view all the answers

    Which of the following factors does NOT contribute to the choice of anesthetic technique and agents?

    <p>Surgeon's personal preferences</p> Signup and view all the answers

    What classification of anesthetic involves administration by an RN under direct supervision of a physician?

    <p>Moderate to deep sedation</p> Signup and view all the answers

    What is the main trigger for malignant hyperthermia during anesthesia?

    <p>Succinylcholine when given with volatile inhalation agents</p> Signup and view all the answers

    Which classification of anesthesia results in a loss of sensation without loss of consciousness?

    <p>Local anesthesia</p> Signup and view all the answers

    What is a key concern with the use of neuromuscular blocking agents during anesthesia?

    <p>They can result in longer-lasting effects than the procedure</p> Signup and view all the answers

    Which type of anesthesia involves the injection of local anesthetic into the subarachnoid space?

    <p>Spinal anesthesia</p> Signup and view all the answers

    Which of the following is NOT a common side effect associated with general anesthesia?

    <p>Immediate recovery</p> Signup and view all the answers

    Which statement best describes the use of adjuncts in general anesthesia?

    <p>They can include opioids and benzodiazepines among others.</p> Signup and view all the answers

    What is a primary benefit of minimally invasive surgery (MIS)?

    <p>Reduced pain</p> Signup and view all the answers

    In which zone can people in street clothes interact with those in scrub attire?

    <p>Unrestricted zone</p> Signup and view all the answers

    What is required for staff in the semirestricted zone?

    <p>Clean surgical attire</p> Signup and view all the answers

    What is the primary purpose of the surgical department's controlled environment?

    <p>To minimize the spread of pathogens</p> Signup and view all the answers

    What is the primary role of the anesthesia care provider (ACP) during surgery?

    <p>Managing vital life functions during the perioperative period</p> Signup and view all the answers

    Which area is designated for patient identification and assessment before surgery?

    <p>Preoperative holding area</p> Signup and view all the answers

    What is included in the preoperative assessment for a patient?

    <p>Baseline data provision</p> Signup and view all the answers

    Which of the following would NOT be part of the chart review before surgery?

    <p>Patient's postoperative preferences</p> Signup and view all the answers

    Which technology has contributed to the increase in minimally invasive surgeries?

    <p>Endoscopes</p> Signup and view all the answers

    What should be assessed to provide psychosocial support before surgery?

    <p>The patient's emotional comfort and concerns</p> Signup and view all the answers

    What is one characteristic of the restricted zone in the surgical environment?

    <p>Sterile core</p> Signup and view all the answers

    Which professional has a master's or doctorate degree in anesthesia?

    <p>Nurse anesthetist (CRNA)</p> Signup and view all the answers

    What is the Admission, Observation, and Discharge (AOD) area typically used for?

    <p>Early morning admissions, including outpatient surgeries</p> Signup and view all the answers

    What is a key feature of a surgical suite intended to ensure patient safety?

    <p>Minimized traffic when sterile supplies are open</p> Signup and view all the answers

    When M.C. arrives in the holding area, he appears anxious. What is essential to address in this situation?

    <p>Offering emotional support and reassurance</p> Signup and view all the answers

    Which factor is a benefit of minimally invasive surgical techniques?

    <p>Shorter recovery time</p> Signup and view all the answers

    What is the primary action taken by the circulating nurse to prepare the surgical site?

    <p>Perform mechanical scrubbing with an antimicrobial agent</p> Signup and view all the answers

    What aspect of patient admission is crucial for ensuring safety and comfort?

    <p>Initial greeting and proper identification</p> Signup and view all the answers

    Which of the following is NOT required as part of the preprocedure verification process?

    <p>Patient's preference regarding anesthetic agents</p> Signup and view all the answers

    Which of the following is a common emotional response for a patient who is about to have surgery for the first time?

    <p>Anxiety and reluctance to communicate</p> Signup and view all the answers

    What does the ACP do at the end of the surgical procedure?

    <p>Administer anesthetic agents to minimize effects</p> Signup and view all the answers

    What is a crucial purpose of informed consent before general anesthesia?

    <p>To ensure the patient understands the surgery and anesthesia plan</p> Signup and view all the answers

    When preparing the surgical environment, which measure is NOT part of the SCIP measures?

    <p>Blood type crossmatch verification</p> Signup and view all the answers

    Which aspect of communication is emphasized in the surgical team protocols?

    <p>Situation, background, assessment, and recommendations</p> Signup and view all the answers

    What is the correct sequence for wet scrubbing before a surgical procedure?

    <p>Fingernails, fingers, palms, forearms</p> Signup and view all the answers

    What is the purpose of wearing two pairs of gloves during surgical procedures?

    <p>To enhance sterility and protect against contamination</p> Signup and view all the answers

    Which guideline is emphasized under OSHA and AORN for surgical procedures?

    <p>Standard and transmission-based precautions</p> Signup and view all the answers

    When positioning a patient, what must be considered to prevent complications?

    <p>Musculoskeletal alignment and potential pressure points</p> Signup and view all the answers

    What is the primary role of the circulating nurse during anesthesia care?

    <p>Ensure safety and communicate with the ACP</p> Signup and view all the answers

    What is one method to ensure effective surgical hand antisepsis?

    <p>Prewash with soap followed by alcohol-based products</p> Signup and view all the answers

    Why is it important to recognize and respect a patient's needs during positioning?

    <p>To ensure patient comfort and prevent complications</p> Signup and view all the answers

    What effect does anesthesia have during surgery regarding blood pooling?

    <p>Position changes affect where blood pools due to anesthesia</p> Signup and view all the answers

    What is a critical consideration when using electrosurgical equipment?

    <p>Secure the grounding pad and equipment placement</p> Signup and view all the answers

    What should be the status of items within the sterile field during a surgical procedure?

    <p>Only sterilized items are allowed</p> Signup and view all the answers

    What is the primary purpose of adjuncts to general anesthesia?

    <p>To supplement general anesthesia effects</p> Signup and view all the answers

    Which statement accurately describes monitored anesthesia care (MAC)?

    <p>Can be administered by an RN under supervision</p> Signup and view all the answers

    Which of the following is a common complication associated with general anesthesia?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is the role of the anesthesia care provider (ACP) during a surgical procedure?

    <p>To select anesthetic techniques in collaboration with others</p> Signup and view all the answers

    Which of the following best describes malignant hyperthermia?

    <p>An inherited disorder causing complications during anesthesia</p> Signup and view all the answers

    What is a significant risk associated with neuromuscular blocking agents?

    <p>Potential airway compromises and respiratory failure</p> Signup and view all the answers

    What distinguishes regional anesthesia from local anesthesia?

    <p>Regional anesthesia involves injecting anesthetic near a nerve group</p> Signup and view all the answers

    Which anesthetic classification involves injecting local anesthetic into the cerebrospinal fluid?

    <p>Spinal anesthesia</p> Signup and view all the answers

    What component of the operating room ensures cleanliness and hygiene?

    <p>Positive air pressure</p> Signup and view all the answers

    What is the main responsibility of a scrub nurse during surgery?

    <p>Prepare and manage the sterile field</p> Signup and view all the answers

    Which member of the surgical team is responsible for documenting the progress of the procedure?

    <p>Circulating nurse</p> Signup and view all the answers

    What is a key feature of the operating room environment?

    <p>Controlled airflow</p> Signup and view all the answers

    Which surgical team member directly assists the surgeon during the procedure?

    <p>Surgeon's assistant</p> Signup and view all the answers

    What must all equipment in the operating room undergo frequently?

    <p>Safety checks</p> Signup and view all the answers

    Who is primarily responsible for obtaining informed consent in the surgical team?

    <p>Surgeon</p> Signup and view all the answers

    What is the primary purpose of sterile gowning and gloving during surgical procedures?

    <p>To maintain a sterile environment and prevent infection</p> Signup and view all the answers

    What role does the registered nurse first assistant (RNFA) have in the surgical team?

    <p>Assisting collaboratively with the surgeon</p> Signup and view all the answers

    Which of the following features is essential for the operating room's environment?

    <p>UV lighting</p> Signup and view all the answers

    Which practice is essential to perform during surgical hand antisepsis?

    <p>Using soap and then alcohol-based products</p> Signup and view all the answers

    Which of the following describes the role of the perioperative nurse?

    <p>Oversees all phases of surgical care</p> Signup and view all the answers

    What is an important consideration when positioning a patient for surgery?

    <p>Correct musculoskeletal alignment must be maintained</p> Signup and view all the answers

    Which aspect is most critical to monitor during general anesthesia?

    <p>Patient's vital signs, including blood pressure</p> Signup and view all the answers

    What is the goal of using personal protective equipment during surgical procedures?

    <p>To prevent contamination and protect both staff and patients</p> Signup and view all the answers

    What is a benefit of minimally invasive surgery (MIS)?

    <p>Reduced recovery time</p> Signup and view all the answers

    What is the purpose of the unrestricted zone in a surgical department?

    <p>To allow interaction between those in street clothes and scrub attire</p> Signup and view all the answers

    What attire is required in the semirestricted zone of a surgical department?

    <p>Clean surgical attire and appropriate PPE</p> Signup and view all the answers

    Which area of a surgical department is considered the restricted zone?

    <p>Surgical suite</p> Signup and view all the answers

    What is the function of the admission, observation, and discharge (AOD) area in a surgical department?

    <p>To prepare patients in advance of surgery</p> Signup and view all the answers

    What is a primary goal of the controlled environment in the surgical department?

    <p>Minimizing infection risks</p> Signup and view all the answers

    How does minimally invasive surgery (MIS) differ from traditional surgery?

    <p>It usually involves advanced technology.</p> Signup and view all the answers

    What is primarily assessed in the preoperative holding area?

    <p>Patient identification and assessment</p> Signup and view all the answers

    What attire must authorized staff wear in the semirestricted zone?

    <p>Clean surgical attire with dedicated shoes</p> Signup and view all the answers

    What characterizes an outpatient surgical setting?

    <p>Minimally invasive procedures</p> Signup and view all the answers

    What is a key responsibility of the circulating nurse during the operation?

    <p>Implementing the intraoperative plan of care</p> Signup and view all the answers

    Which procedure is necessary before transferring a patient to the operating room?

    <p>Perform preoperative assessments</p> Signup and view all the answers

    What should be done to ensure the safety of a patient during their transfer to the OR?

    <p>Lock the wheels of the stretcher</p> Signup and view all the answers

    How does the use of complementary and alternative therapies help patients?

    <p>Decreases anxiety and promotes relaxation</p> Signup and view all the answers

    What is crucial for maintaining aseptic conditions in the operating room?

    <p>Surgical attire being worn by all staff</p> Signup and view all the answers

    Which of the following is important during room preparation for surgery?

    <p>Checking electrical and mechanical equipment for functionality</p> Signup and view all the answers

    What should be confirmed regarding the patient before they go into surgery?

    <p>Last intake of food/fluid</p> Signup and view all the answers

    What does the scrub nurse need to maintain while in the operating room?

    <p>A sterile environment for surgeries</p> Signup and view all the answers

    What is a consideration when preparing for an obese patient for surgery?

    <p>Ensuring extra staff and special equipment may be needed</p> Signup and view all the answers

    What should be reaffirmed about the patient's surgical preparation?

    <p>Preoperative drugs administered</p> Signup and view all the answers

    Study Notes

    Anesthesia Overview

    • Anesthetic techniques and agents are selected through collaboration between the anesthesia care provider (ACP), the surgeon, and the patient.
    • Key factors influencing anesthetic choices include the patient's physical and mental health, age, allergies, pain history, and the procedure's specifics.

    ASA Physical Status Classification

    • Utilizes a scale from ASA1 (healthy) to ASA6 (brain-dead).
    • Evaluates patients' overall health just prior to surgery.

    Types of Anesthesia

    • Moderate to Deep Sedation:

      • Done outside the operating room (OR) and does not require ACP's presence.
      • Can be administered by a registered nurse (RN) under physician supervision.

    • Monitored Anesthesia Care (MAC):

      • For diagnostic or therapeutic procedures, ensuring adequate sedation and pain relief by an ACP while managing physiologic complications.

    • General Anesthesia:

      • Involves total intravenous anesthesia (TIVA) or newer inhalation agents.
      • Ideal for lengthy procedures, requiring muscle relaxation or ventilation control.

    Administration Methods

    • IV Induction Agents:

      • Used to induce rapid sleep for respiratory support placement.

    • Inhalation Agents:

      • Volatile liquids/gases that enter the body through alveoli; can irritate the respiratory tract.

    • Adjuncts:

      • Include opioids for sedation and analgesia, benzodiazepines for amnesia, and neuromuscular blocking agents for muscle relaxation and intubation.

    Neuromuscular Blocking Agents

    • Classified as depolarizing or nondepolarizing muscle relaxants with potentially prolonged effects post-procedure.
    • Close monitoring of respiratory function is crucial as lack of movement may necessitate ventilatory support.

    Local and Regional Anesthesia

    • Local Anesthesia:

      • Loss of sensation without loss of consciousness; administered topically or through injections.

    • Regional Anesthesia:

      • Delivered via injection to nerves; provides pain relief during and post-surgery. Can involve risks like local anesthetic systemic toxicity (LAST).

    Spinal and Epidural Anesthesia

    • Spinal Anesthesia:

      • Injection into cerebrospinal fluid provides comprehensive sensory and motor blockade.

    • Epidural Block:

      • Injection into the epidural space, blocking sensory pathways while motor fibers remain intact; requires careful observation for complications.

    Gerontologic Considerations

    • Anesthetic drugs need careful dosing in older patients due to heightened risks of postoperative delirium and hypothermia.

    Perioperative Crisis Events

    • Anaphylactic Reactions:

      • Rapid intervention essential for reactions to various agents. Symptoms include hypotension and bronchospasm.

    • Malignant Hyperthermia (MH):

      • Rare and serious condition triggered by certain anesthetic agents leading to muscle rigidity and hyperthermia. Immediate treatment includes Dantrolene and supportive measures.

    Nursing Management Pre-Surgery

    • Conduct thorough preoperative assessments to establish baseline data.
    • Ensure proper identification and provide emotional support to reduce patient anxiety.

    Scrubbing and Aseptic Techniques

    • Emphasizes proper hand hygiene and sterile techniques to minimize infection risk during surgery.

    Assisting the Anesthesia Provider

    • Focus on patient safety by staying vigilant during anesthesia administration and monitoring vital signs, especially airway adequacy.

    Patient Positioning

    • Ensure optimal accessibility for surgery and anesthetic administration while considering patient comfort and safety to prevent pressure injuries.

    Case Management

    • Addressing specific patient needs by recognizing pain or mobility challenges and making necessary accommodations for safe surgical experiences.### Patient Diagnosis
    • Patient diagnosed with osteoarthritis in the left knee.
    • History of hypertension noted.

    Operating Room Environment

    • Operating rooms are restricted zones that are geographically, environmentally, and aseptically controlled.
    • Preferred location is adjacent to the Post Anesthesia Care Unit (PACU) and surgical Intensive Care Unit (ICU) for quick patient transport.
    • Operating rooms feature controlled airflow, positive air pressure, and temperature and humidity regulation.
    • Equipped with filters and UV lighting; strict cleaning protocols are enforced.

    Operating Room Furniture and Equipment

    • Furniture should be adjustable, easy to clean, and easily movable.
    • Equipment undergoes frequent checks for functionality and electrical safety.
    • Lighting is designed to provide a precise view of the surgical site.
    • A communication system is utilized for effective team coordination.

    Surgical Team Composition

    • Perioperative Nurse: Registered Nurse (RN) who plays three roles (preoperative, in the OR as patient advocate, and postanesthesia care).
    • Scrub Nurse: Follows surgical hand antisepsis; manages the sterile field and instruments while maintaining sterility.
    • Circulating Nurse: Maintains the unsterile area, facilitates the procedure, and keeps accurate documentation.
    • LPN/VN or Surgical Technologist: May assist as a scrub or circulating nurse under RN supervision.

    Surgeon’s Role

    • Surgeon is responsible for the entire surgical process including patient history, physical assessment, preoperative testing, postoperative management, and obtaining informed consent.
    • Lead surgeon coordinates the surgical team.

    Surgeon’s Assistant

    • Can be a physician, RN first assistant, surgical resident, physician assistant, or certified surgical first assistant.
    • Assists in holding retractors, hemostasis, suturing, and may perform parts of the procedure under supervision.

    Registered Nurse First Assistant (RNFA)

    • Requires formal education; collaborates with the surgical team.
    • Can be certified through programs available to CNOR nurses or nurse practitioners.

    Nursing Management in the OR

    • Admitting patients involves reassessment, addressing last-minute questions, and confirming preoperative drug administration.
    • Complementary therapies may decrease anxiety and promote relaxation.
    • The circulating nurse implements the intraoperative care plan, focusing on ongoing assessment and adjustments to improve surgical outcomes.
    • Room preparation is crucial for privacy, infection prevention, and safety; requires checking equipment functionality and maintaining aseptic technique.

    Patient Transfer Protocol

    • Patients are securely transported into the OR after completing preoperative assessment; wheels of transport beds must be locked.
    • Sufficient staff is necessary for safe patient handling, including utilization of safety straps.
    • Monitoring equipment (e.g., BP cuff, pulse oximeter) is applied during transfer.

    Case Study Details

    • Patient M.C. to be transported to OR for surgery.
    • Left knee marked by the surgeon; preoperative measures include antiembolic stocking on the right leg and an IV infusion.
    • Orders for administering cefazolin (1 gram IV) and urinary catheter insertion are confirmed.

    Anesthesia Overview

    • Anesthesia techniques and agents are determined by the anesthesia care provider (ACP) in collaboration with the surgeon and patient.
    • Factors influencing anesthetic choice include patient's physical and mental status, age, allergies, pain history, ACP expertise, and procedure specifics.

    ASA Classification System

    • American Society of Anesthesiologists (ASA) physical status classification ranges from ASA I (healthy) to ASA VI (brain-dead), evaluating patients pre-surgery.

    Types of Anesthesia

    • Moderate to Deep Sedation: Does not require ACP presence; can be administered by an RN with physician supervision.
    • Monitored Anesthesia Care (MAC): Involves varying levels of sedation, analgesia, and must be managed by an ACP with focus on physiologic problem assessment.
    • General Anesthesia: Includes total IV anesthesia and inhalation agents for lengthy, muscle-relaxing, or ventilator-controlled procedures.
    • Inhalation Agents: Delivered via alveoli; easy to administer but may irritate respiratory tract. Risks include coughing and laryngospasm.

    General Anesthesia Agents

    • IV Induction Agents: Rapidly induce sleep, lasting just a few minutes for airway management.
    • Adjuncts: May include opioids, benzodiazepines, and neuromuscular blocking agents for sedation, amnesia, and paralysis.

    Neuromuscular Blocking Agents

    • Facilitate endotracheal intubation and muscle relaxation but effects can outlast the procedure, requiring care with monitoring and potential ventilator support.

    Local and Regional Anesthesia

    • Local Anesthesia: Loss of sensation without loss of consciousness; includes topical, ophthalmic, nebulized, and injectable forms.
    • Regional Anesthesia: Involves injections to central nerves for analgesia; potential for adverse CNS effects like local anesthetic systemic toxicity (LAST).

    Anesthesia Administration Methods

    • Topical: Applied before procedure for surface anesthesia.
    • Spinal Anesthesia: Involves injection into the subarachnoid space for autonomic and sensory blockade.
    • Epidural Block: Injected into the epidural space, preserving motor function while blocking sensory pathways.

    Gerontologic Considerations

    • Anesthetic titration is essential to avoid postoperative delirium and ensure communication; care for injury risks due to age-related conditions.

    Perioperative Crisis Events

    • Anaphylactic Reactions: May occur due to anesthetic agents or materials; require rapid response.
    • Malignant Hyperthermia (MH): Rare, inherited condition triggered by certain anesthetics, causing severe metabolic dysregulation; treat promptly with Dantrolene and supportive measures.

    Intraoperative Care

    • Transitioning to minimally invasive surgeries (MIS) has reduced blood loss, incision size, pain, recovery time, and length of hospital stays.

    Physical Environment of the OR

    • Controlled surgical environments minimize infection risk and ensure efficient workflow, divided into unrestricted, semi-restricted, and restricted zones, each with specific dress and access rules.

    Nursing Management in Surgery

    • Comprehensive preoperative assessment establishes baseline data and comfort measures, including thorough history review and patient identification protocols.
    • Scrubbing, gowning, and gloving procedures are critical for maintaining asepsis in the surgical field, adhering to OSHA and AORN guidelines.

    Patient Safety and Positioning

    • Proper patient positioning enhances accessibility to the surgical site while preventing nerve and skin compression, ensuring adequate ventilation and circulation, and requires careful consideration of existing conditions.

    Case Study Context

    • The case study involves a 56-year-old male preparing for knee replacement surgery, highlighting the need for informed consent and addressing patient anxiety prior to the procedure.### Surgical Preparation and Management
    • The circulating nurse prepares the patient by cleansing the surgical site using antimicrobial agents, starting from clean to dirty areas.
    • It is vital to allow the surgical site to dry completely before draping.

    Safety Considerations

    • Major safety considerations include preventing infection, avoiding physical trauma, addressing physiological effects of surgery, and maintaining clear communication among the team.

    Effective Communication in the Surgical Team

    • Communication within the surgical team encompasses Situation, Background, Assessment, and Recommendations (SBAR) for clear and efficient exchanges.

    Holding Area Protocols

    • Surgical Care Improvement Project (SCIP) measures include administering prophylactic antibiotics 30 to 60 minutes prior to incision, using warming blankets, and applying intermittent pneumatic compression devices (IPCs) to enhance patient safety.

    National Patient Safety Goals (NPSGs)

    • NPSGs necessitate a pre-procedure verification process that involves checking relevant documents, diagnostic study results, availability of blood products and special equipment, and ensuring the procedure site is marked by the surgeon.

    Post-Operative Management

    • The Anesthesia Care Provider (ACP) prepares for the end of the procedure by administering appropriate anesthetic agents to minimize lingering effects.
    • The ACP accompanies the patient to the Post-Anesthesia Care Unit (PACU), ensuring proper hand-off that includes the patient's status and details of the procedure performed.

    Post-Surgery Condition

    • After completing the surgery, the patient is transported to the PACU, where he has a drain in his left knee, and his left leg is wrapped from ankle to thigh with an elastic bandage.

    Anesthesia Techniques and Considerations

    • Anesthetic techniques are selected by the anesthesia care provider (ACP) in partnership with the surgeon and patient.
    • Factors influencing anesthetic choices include the patient’s physical and mental health, age, allergies, pain history, ACP expertise, and surgery specifics.

    ASA Physical Status Classification

    • American Society of Anesthesiologists (ASA) categorizes patients preoperatively from ASA1 (healthy) to ASA6 (brain-dead).

    Classification of Anesthesia

    • Moderate to deep sedation can occur outside the OR; does not need ACP on site; RNs may administer under physician supervision.
    • Monitored Anesthesia Care (MAC) involves various sedation levels, requiring ACP administration, with readiness to switch to general anesthesia if necessary.
    • General anesthesia includes Total IV Anesthesia (TIVA) and newer inhalation agents, suitable for lengthy procedures, muscle relaxation, and controlled ventilation.

    Induction and Agents

    • General anesthesia starts with an IV induction agent to rapidly induce sleep, allowing placement of airway devices (LMA or ET tube).
    • Inhalation agents are volatile agents administered via alveoli, facilitating easy delivery but can irritate the respiratory tract.

    Neuromuscular Blocking Agents

    • Used to facilitate intubation and muscle relaxation; classified as depolarizing or nondepolarizing. Effects may outlast the procedure.
    • Monitoring for respiratory muscle movement is crucial to ensure airway security.

    Adjuncts to General Anesthesia

    • Opioids provide sedation, analgesia during procedures, and postoperative pain management.
    • Benzodiazepines are employed for amnesia and anesthesia induction.
    • Antiemetics are utilized to prevent nausea associated with anesthesia.

    Local and Regional Anesthesia

    • Local anesthesia provides sensation loss without unconsciousness, with methods including topical, ophthalmic, nebulized, and injectable forms.
    • Regional anesthesia involves injecting anesthetics into a nerve or group to provide analgesia pre-, during, and post-surgery.

    Risks and Complications

    • Local and regional anesthesia has low systemic absorption, ensuring quick recovery with minimal cognitive effects.
    • Risks with regional blocks include discomfort, vascular injection leading to serious systemic toxicity, requiring immediate intervention.

    Gerontologic Considerations

    • Anesthetic dosing must be cautious for older patients due to postoperative delirium and communication barriers.
    • Older patients face increased risks from external sources such as tape and heating devices and are susceptible to hypothermia.

    Perioperative Crisis Events

    • Monitor for anaphylactic reactions to substances like anesthetic agents, antibiotics, and latex, which can lead to hypotension and bronchospasm.
    • Malignant hyperthermia is a severe reaction involving muscle rigidity and hyperthermia, primarily triggered by succinylcholine alongside inhalation agents.

    Management of Malignant Hyperthermia

    • Immediate Dantrolene administration is critical to decrease metabolism and muscle contraction.
    • Monitoring for signs of ANS blockade such as bradycardia and hypotension is essential in spinal and epidural anesthesia.

    Intraoperative Environment Changes

    • A shift towards outpatient settings for many surgeries minimizes invasiveness, leading to reduced recovery times and hospital stays.
    • The surgical department is structured to control infection spread and ensure the safety of surgical procedures.

    Zones in the Surgical Department

    • Unrestricted zones allow interaction between street clothes and scrub attire, balancing patient flow and communication.
    • Semirestricted zones require scrub attire and limit access to authorized personnel only, while restricted zones (surgical suite) necessitate strict sterile protocols.

    Case Study Introduction

    • M.C. is a 56-year-old scheduled for left knee replacement surgery, highlighting typical patient profiles in surgical settings.### Patient and Health Background
    • Diagnosis: Osteoarthritis of left knee, history of hypertension.

    Physical Environment of Operating Room

    • Operating rooms are restricted zones, controlled geographically, environmentally, and aseptically.
    • Preferably located next to the Post Anesthesia Care Unit (PACU) and surgical ICU for quick post-surgery transport.
    • Features include filtered air, controlled airflow, positive air pressure, and regulated temperature and humidity.
    • Utilizes UV lighting and follows strict cleaning protocols.
    • Furniture is adjustable, easy to clean, and mobile; equipment is checked for functioning and safety.
    • Specialized lighting enhances visibility of the surgical site; a communication system is utilized for coordination.

    Surgical Team Composition

    • Perioperative Nurse: Registered Nurse (RN) involved in preoperative, intraoperative, and postanesthesia care.
    • Scrub Nurse: Maintains sterile field, follows surgical hand antisepsis, and prepares instrumentation in sterile attire.
    • Circulating Nurse: Remains in non-sterile area, facilitates procedure progress, and maintains documentation.
    • LPN/VN or Surgical Technologist: May assist as circulating or scrub nurse under supervision of an RN.
    • Surgeon: Responsible for surgical procedure, medical history, assessments, preoperative testing, postoperative care, and consent processes.
    • Surgeon’s Assistant: Can be various professionals, assisting in retracting, hemostasis, suturing, and possibly performing parts of the surgery under supervision.
    • Registered Nurse First Assistant (RNFA): Requires formal training, collaborates with the surgeon and team, can become certified.

    Nursing Management: Preoperative Care

    • Patient Admission: Includes reassessment, inquiries about valuables/medical history, confirmation of drug administration, and patient hair covering.
    • Complementary therapies may be used to reduce anxiety and improve relaxation.
    • Circulating nurse implements surgical care plan through ongoing assessments and necessary adjustments.

    Room Preparation Measures

    • Ensure privacy and safety measures; special equipment may be needed for obese patients.
    • All personnel must wear appropriate surgical attire; all equipment checked for functionality.
    • Aseptic techniques are crucial when opening and placing instruments, with careful counting of items.

    Patient Transfer Protocols

    • Patients transferred post-assessment with secure locking mechanisms and adequate staffing; monitoring devices applied before transfer.
    • Positioning must consider operative site accessibility, anesthesia monitoring, and airway maintenance, ensuring musculoskeletal alignment and pressure prevention.

    Aseptic Technique and Safety

    • Proper scrubbing technique requires cleaning fingernails and hands, using alcohol-based products.
    • Maintain a sterile field for surgical procedures, only allowing sterilized items.
    • Compliance with OSHA and AORN guidelines requires standard precautions and personal protective equipment.

    Assisting Anesthesia Team

    • Knowledge of anesthetic effects and familiarity with emergency procedures is essential for circulating nurses.
    • Positioning should allow for patient safety and comfort while preventing complications related to anesthesia.

    Posture and Support

    • Ensure correct body alignment and adequate padding to minimize pressure injuries and accommodate previous injuries or deformities.
    • Awareness of how anesthesia affects sensory impulses and circulation is vital for patient care.

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    Description

    This quiz covers the fundamentals of anesthetic techniques and agents as chosen by the anesthesiology care provider (ACP) in collaboration with the surgical team and the patient. It focuses on the various factors that influence these choices, including the patient's health status, age, allergies, and the nuances of the surgical procedure.

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