NURS 4200 Chapter_019 Medium
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Questions and Answers

What should be confirmed before the patient is transported to the operating room?

  • Patient's last intake of food/fluid (correct)
  • Patient's family contacts
  • Patient's previous surgical history
  • Patient's insurance details

    • Which actions are appropriate for the circulating nurse before surgery?

  • Administering anesthesia
  • Inserting a urinary catheter
  • Checking the proper functioning of the electrical equipment (correct)
  • Adjusting the patient’s medication

    • What is one primary goal of implementing complementary and alternative therapies in preoperative care?

  • To decrease anxiety (correct)
  • To replace conventional treatment methods
  • To speed up the surgical process
  • To eliminate the need for pain medication

    • What is essential to ensure during room preparation for surgery?

    <p>All entering personnel must wear surgical attire</p> Signup and view all the answers

    What key aspect is involved in the reassessment process of the admitting patient?

    <p>Confirming the last-minute questions have been asked</p> Signup and view all the answers

    Which of the following is NOT a responsibility of the nurse during patient transfer to the OR?

    <p>Confirming arrival of family members</p> Signup and view all the answers

    What is the role of the scrub nurse in the operating room?

    <p>To maintain sterility of instruments</p> Signup and view all the answers

    Why is it important to cover the patient’s hair before surgery?

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

    What does ongoing assessment during the intraoperative plan of care aim to achieve?

    <p>Promoting the best surgical outcomes</p> Signup and view all the answers

    In the context of room preparation, which statement is true regarding instrument management?

    <p>Scrub nurse counts all instruments and supplies</p> Signup and view all the answers

    What is one of the main responsibilities of a surgeon during surgery?

    <p>Directing preoperative testing</p> Signup and view all the answers

    Which of the following features is NOT typically found in an operating room environment?

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

    What role does the circulating nurse play in the surgical team?

    <p>Keeps documentation and facilitates procedure progress</p> Signup and view all the answers

    Which member of the surgical team is responsible for managing the sterile field?

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

    What is a primary function of a registered nurse first assistant (RNFA)?

    <p>Collaborate with the surgeon during surgery</p> Signup and view all the answers

    In which setting is the preferred location for an operating room?

    <p>Next to PACU and surgical ICU</p> Signup and view all the answers

    Which type of nurse must supervise LPN/VN or surgical technologist during surgery?

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

    What aspect of operating rooms is controlled to maintain a sterile environment?

    <p>Humidity and temperature</p> Signup and view all the answers

    What is the responsibility of the surgical assistant during a procedure?

    <p>Hold retractors and assist with suturing</p> Signup and view all the answers

    What characteristic is important for furniture in the operating room?

    <p>Easy to clean and adjust</p> Signup and view all the answers

    What is the correct order for preparing the surgical site?

    <p>Scrub from clean area to dirty area and then allow to dry</p> Signup and view all the answers

    Which of the following is NOT a safety consideration during surgery?

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

    What needs to be verified in the preprocedure verification process according to National Patient Safety Goals?

    <p>Procedure site marked by the surgeon and relevant documentation</p> Signup and view all the answers

    What is the purpose of applying prophylactic antibiotics before surgery?

    <p>To prevent infection at the surgical site</p> Signup and view all the answers

    What should the anesthesia care provider (ACP) ensure at the end of the surgical procedure?

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

    What is the primary purpose of using adjuncts in general anesthesia?

    <p>To enhance sedation and analgesia during surgery</p> Signup and view all the answers

    Which classification of anesthesia allows for patient cooperation and is typically used for minor procedures?

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

    What is the primary role of the ACP in anesthesia management?

    <p>To choose anesthetic technique and agents in collaboration with the surgical team</p> Signup and view all the answers

    Which statement correctly describes spinal anesthesia?

    <p>It involves injection into the subarachnoid space below L2.</p> Signup and view all the answers

    Which of the following complications can arise from the use of neuromuscular blocking agents?

    <p>Respiratory muscle paralysis</p> Signup and view all the answers

    Which anesthetic classification requires the presence of an ACP for administration?

    <p>Monitored Anesthesia Care (MAC)</p> Signup and view all the answers

    What is a primary trigger for malignant hyperthermia?

    <p>Administration of succinylcholine with volatile inhalation agents</p> Signup and view all the answers

    What is a documented side effect of regional anesthesia that should be monitored for?

    <p>Inadvertent vascular injection leading to LAST</p> Signup and view all the answers

    What is the correct order of steps for wet scrubbing before a surgical procedure?

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

    What must be done after performing surgical hand antisepsis?

    <p>Don a sterile gown and two pairs of gloves</p> Signup and view all the answers

    Which of these is NOT part of basic aseptic technique?

    <p>Ensure the area remains dry at all times</p> Signup and view all the answers

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

    <p>Place monitoring devices on the patient</p> Signup and view all the answers

    When positioning a patient for surgery, which factor is NOT important?

    <p>Comfortable positioning</p> Signup and view all the answers

    What should be secured when positioning a patient for surgery?

    <p>The patient's extremities</p> Signup and view all the answers

    How can anesthesia affect fluid pooling in a patient?

    <p>It may lead to uneven pooling based on position changes.</p> Signup and view all the answers

    Why is it important to recognize needs such as previous pain or deformities when positioning a patient?

    <p>To prevent undue stress and injury</p> Signup and view all the answers

    What does the grounding pad and electrosurgical equipment placement prevent?

    <p>Injury from burns or fire</p> Signup and view all the answers

    Which practice is part of standard and transmission-based precautions as per OSHA guidelines?

    <p>Using personal protective equipment (PPE)</p> Signup and view all the answers

    Which of the following is a characteristic of general anesthesia?

    <p>Total IV anesthesia is a common method</p> Signup and view all the answers

    What is a potential complication of using neuromuscular blocking agents?

    <p>Longer duration of effects than the procedure</p> Signup and view all the answers

    Which type of anesthesia is characterized by the need for an anesthetist during administration?

    <p>Monitored Anesthesia Care (MAC)</p> Signup and view all the answers

    What does the ASA classification system assess?

    <p>Physical status of the patient before surgery</p> Signup and view all the answers

    Which medication is primarily used to treat malignant hyperthermia?

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

    What is a drawback of regional anesthesia?

    <p>Discomfort at the injection site and possible technical issues</p> Signup and view all the answers

    How can adjuncts to general anesthesia affect patient management?

    <p>Provide additional sedation and pain management</p> Signup and view all the answers

    What are the complications associated with inhalation agents in general anesthesia?

    <p>Increased secretions and bronchospasm</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 do people in street clothes interact with those in scrub attire?

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

    What attire is required in the semirestricted zone?

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

    What is a defining characteristic of the restricted zone in a surgical environment?

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

    What is the purpose of the preoperative holding area?

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

    Which of the following is considered a technological advancement in minimally invasive surgery?

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

    What term describes the area designated for early morning admissions for outpatient surgery?

    <p>Admission, observation, and discharge (AOD) area</p> Signup and view all the answers

    What impact does minimally invasive surgery (MIS) have on blood loss during procedures?

    <p>Decreases blood loss</p> Signup and view all the answers

    Which statement is true about the physical environment of a surgical department?

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

    Which zone requires authorized personnel to wear surgical attire?

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

    What is the primary goal of implementing complementary and alternative therapies during the admitting process?

    <p>Enhance the patient's emotional state</p> Signup and view all the answers

    Which of the following actions should be taken when preparing the operating room?

    <p>Ensure all equipment is in working order</p> Signup and view all the answers

    What is a crucial consideration when transferring a patient to the operating room?

    <p>Ensuring all electronic monitoring devices are properly attached</p> Signup and view all the answers

    Which practice is essential when the scrub nurse is handling instruments in the operating room?

    <p>Practicing aseptic technique rigorously</p> Signup and view all the answers

    What is an important aspect of the continual assessment performed by the circulating nurse?

    <p>Reassessing the patient's care plan to enhance outcomes</p> Signup and view all the answers

    How can the use of antiembolic stockings and IPC be beneficial before surgery?

    <p>They enhance blood circulation to reduce the risk of clots</p> Signup and view all the answers

    What is a necessary measure when preparing for the transfer of an obese patient to the OR?

    <p>Provide extra staff and equipment for transfer</p> Signup and view all the answers

    Which is a key step in ensuring patient safety during transport to the OR?

    <p>Locking the wheels of the transport bed</p> Signup and view all the answers

    What is the first step in preparing the surgical site?

    <p>Scrub from clean area to dirty area with antimicrobial agent</p> Signup and view all the answers

    What is the primary function of the reassessment during the admitting process?

    <p>To gather updated medical history information</p> Signup and view all the answers

    Which of the following is a measure included in the Surgical Care Improvement Project (SCIP)?

    <p>Prophylactic antibiotic administration 30 to 60 minutes before incision</p> Signup and view all the answers

    Which statement best describes the role of the circulating nurse regarding the patient's care plan?

    <p>They implement and modify the intraoperative care plan as needed</p> Signup and view all the answers

    What does the preprocedure verification process include according to National Patient Safety Goals?

    <p>Verification of the patient's identity and procedure site</p> Signup and view all the answers

    What is critical for ensuring patient safety during surgery?

    <p>Clear communication regarding situation, background, assessment, and recommendations</p> Signup and view all the answers

    What should the anesthesia care provider (ACP) focus on at the end of a surgical procedure?

    <p>Giving proper types and doses of anesthetic agents for minimal effects</p> Signup and view all the answers

    Which technique is emphasized during the wet scrubbing process?

    <p>Cleaning fingernails last</p> Signup and view all the answers

    What is the correct procedure after performing surgical hand antisepsis?

    <p>Don a sterile gown and two pairs of gloves</p> Signup and view all the answers

    Which principle is NOT part of maintaining a sterile field during a surgical procedure?

    <p>Inclusion of non-sterilized items</p> Signup and view all the answers

    What factors should be considered when positioning a patient for surgery?

    <p>Maintaining the patient's airway and musculoskeletal alignment</p> Signup and view all the answers

    Which statement accurately reflects the role of anesthesia during positioning of the patient?

    <p>Anesthesia blocks sensory nerve impulses, affecting blood pooling</p> Signup and view all the answers

    What is the purpose of securing extremities when positioning a patient?

    <p>To prevent unnecessary movement during the procedure</p> Signup and view all the answers

    Which of the following factors may compromise a patient's status during anesthesia?

    <p>Presence of cardiovascular disease and hypovolemia</p> Signup and view all the answers

    Which practice is essential for preventing burns or fires when using electrosurgical equipment?

    <p>Positioning the grounding pad correctly</p> Signup and view all the answers

    What aspect of personal protective equipment is covered under OSHA and AORN guidelines?

    <p>Utilization of engineering and work practice controls</p> Signup and view all the answers

    Which of the following statements regarding waterless, alcohol-based hand agents is true?

    <p>They effectively reduce bacteria after prewashing with soap</p> Signup and view all the answers

    What is the primary purpose of adjuncts in general anesthesia?

    <p>To enhance sedation and analgesia</p> Signup and view all the answers

    Which factor is NOT considered in selecting anesthetic techniques and agents?

    <p>Patient insurance coverage</p> Signup and view all the answers

    What is the main characteristic of monitored anesthesia care (MAC)?

    <p>Can include varying levels of sedation, analgesia, and anxiolysis</p> Signup and view all the answers

    What are the signs of local anesthetic systemic toxicity (LAST)?

    <p>Confusion, metallic taste, and seizures</p> Signup and view all the answers

    Which classification of anesthesia allows for loss of sensation without loss of consciousness?

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

    What is the first step in preparing the surgical site?

    <p>Cleansing around the surgical site</p> Signup and view all the answers

    Which of the following is a requirement of the preprocedure verification process as per National Patient Safety Goals?

    <p>Results of any diagnostic studies</p> Signup and view all the answers

    What is a common complication associated with neuromuscular blocking agents?

    <p>Respiratory muscle paralysis</p> Signup and view all the answers

    What is the most critical intervention for malignant hyperthermia once diagnosed?

    <p>Administration of Dantrolene</p> Signup and view all the answers

    What action should be taken regarding the surgical site before an incision is made?

    <p>Ensure the site is draped for sterility</p> Signup and view all the answers

    What is one of the safety considerations during surgery related to infection prevention?

    <p>Ensuring clear communication within the team</p> Signup and view all the answers

    What is one of the major concerns when using regional anesthesia?

    <p>Inadvertent vascular injection</p> Signup and view all the answers

    What should occur after surgery regarding the anesthesia care provider's (ACP's) responsibilities?

    <p>The ACP should stay with the patient in recovery</p> Signup and view all the answers

    What is a characteristic feature of the operating room environment?

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

    Which member of the surgical team is responsible for overseeing the sterile field?

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

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

    <p>Leading the surgical team</p> Signup and view all the answers

    What aspect of the operating room’s physical environment aids in maintaining cleanliness?

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

    Which role may an LPN/VN or surgical technologist take in the operating room?

    <p>Scrub nurse with direct supervision from RN</p> Signup and view all the answers

    What is a crucial step in the reassessment of a patient before surgery?

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

    What system is employed in the operating room to facilitate communication among the surgical team?

    <p>Internal intercom system</p> Signup and view all the answers

    What is a significant function of the circulating nurse during surgery?

    <p>Keeping documentation of the procedure</p> Signup and view all the answers

    What is the primary goal of implementing complementary and alternative therapies in the preoperative setting?

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

    Why is controlled airflow important in the operating room?

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

    What is an important consideration during the transfer of a patient to the operating room?

    <p>Ensuring wheels are locked during transfer</p> Signup and view all the answers

    What important preparation is done before a surgery in relation to the patient?

    <p>Confirming the surgical procedure and site</p> Signup and view all the answers

    Which of the following responsibilities does the circulating nurse NOT have during surgery?

    <p>Maintaining a sterile field</p> Signup and view all the answers

    What is the primary role of the registered nurse first assistant (RNFA)?

    <p>Collaborating with the surgeon and team</p> Signup and view all the answers

    What is essential for ensuring privacy and preventing infection in the operating room during preparation?

    <p>Restricting access and ensuring proper attire is worn</p> Signup and view all the answers

    What must be done regarding surgical instruments when preparing the operating room?

    <p>Items must be counted before and after opening them</p> Signup and view all the answers

    What is a requirement for all personnel entering the operating room?

    <p>They must wear surgical attire</p> Signup and view all the answers

    Which action should be taken regarding the patient's belongings before surgery?

    <p>Valuables should be secured away from the surgical area</p> Signup and view all the answers

    What type of monitoring equipment is typically applied to the patient prior to surgery?

    <p>Blood pressure cuff, pulse oximeter, and monitor leads</p> Signup and view all the answers

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

    <p>Clean fingernails, scrub palms, forearms</p> Signup and view all the answers

    What should be done after performing surgical hand antisepsis?

    <p>Wear a sterile gown</p> Signup and view all the answers

    When positioning a patient for surgery, which of the following factors is crucial for maintaining patient safety?

    <p>Providing adequate padding and support</p> Signup and view all the answers

    What is a critical consideration when using electrosurgical equipment during surgery?

    <p>Grounding pads must be placed correctly to prevent burns</p> Signup and view all the answers

    What is the recommended method for hand hygiene when using alcohol-based agents?

    <p>Wash hands for at least 30 seconds with soap before application</p> Signup and view all the answers

    Which of the following actions is important for the circulating nurse during patient anesthesia care?

    <p>Placing monitoring devices on the patient</p> Signup and view all the answers

    What is the primary purpose of basic aseptic technique in the surgical setting?

    <p>Ensure only sterilized items are in the sterile field</p> Signup and view all the answers

    What effect does positioning have on fluid pooling during anesthesia?

    <p>Positioning can influence where fluid pools in the body</p> Signup and view all the answers

    Why is it important to respect a patient's previously assessed pain or deformities during positioning?

    <p>It prevents potential complications during the surgery</p> Signup and view all the answers

    Which guidelines outline precautions and controls for maintaining a sterile environment in the OR?

    <p>Both OSHA and AORN guidelines</p> Signup and view all the answers

    Study Notes

    Anesthesia Overview

    • Anesthetic techniques and agents are collaboratively chosen by the Anesthesia Care Provider (ACP), surgeon, and patient.
    • Factors influencing this choice include the patient's physical and mental status, age, allergies, pain history, and specifics of the procedure.

    ASA Physical Status Classification

    • The American Society of Anesthesiologists (ASA) classifies patients from ASA1 (healthy) to ASA6 (brain-dead).
    • This classification represents the patient's status immediately before surgery.

    Anesthesia Types

    • Moderate to Deep Sedation

      • Used for procedures outside the operating room (OR).
      • ACP presence not mandatory; can be administered by an RN under physician supervision.

    • Monitored Anesthesia Care (MAC)

      • For diagnostic or therapeutic procedures in or outside the OR.
      • Administered by an ACP, includes various sedation and analgesia levels, with critical assessment of physiological problems.

    • General Anesthesia

      • Involves total intravenous anesthesia (TIVA) and newer inhalation agents.
      • Indications include long procedures, need for muscle relaxation, uncomfortable positions, and controlled ventilation.

    Induction and Agents

    • Induction Agent

      • Initial agents for routine general anesthesia induce sleep rapidly, lasting a few minutes, enough for airway management.

    • Inhalation Agents

      • Volatile liquids/gases administered through alveoli, allowing easy administration and rapid excretion, with side effects like coughing and laryngospasm.

    Adjuncts to General Anesthesia

    • Opioids

      • Used for sedation, analgesia, and pain management, but may cause respiratory depression.

    • Benzodiazepines

      • Provide premedication for amnesia, anesthesia induction, and monitored anesthesia care.

    • Neuromuscular Blocking Agents

      • Facilitate intubation and muscle relaxation by interrupting nerve signal transmission; effects may persist beyond the procedure.

    Anesthesia Administration Methods

    • Local Anesthesia

      • Loss of sensation without consciousness; can be topical, ophthalmic, nebulized, or injectable.

    • Regional Anesthesia

      • Involves injecting anesthetic into central nerves, providing analgesia during preoperative and postoperative phases.

    • Spinal and Epidural Anesthesia

      • Spinal: Injection into cerebrospinal fluid (CSF) for complete blockade.
      • Epidural: Injection into epidural space preserving motor function.

    Gerontologic Considerations

    • Anesthetic drugs must be carefully titrated in older adults, who may experience postoperative delirium and communication difficulties.
    • Increased risk of injury from medical devices and hypothermia.

    Perioperative Crisis Events

    • Anaphylaxis

      • Allergic reactions to anesthetic agents, antibiotics, or latex, requiring vigilance and rapid intervention, with symptoms such as hypotension and tachycardia.

    • Malignant Hyperthermia (MH)

      • A rare genetic disorder leading to severe complications during anesthesia, characterized by muscle rigidity and hyperthermia triggered primarily by succinylcholine or volatile agents.
      • Symptoms include tachycardia, hypercarbia, and potential cardiac arrest; treatment involves Dantrolene and supportive care.

    Monitoring and Response

    • Continuous monitoring for signs of anesthetic complications is crucial, especially in distinguishing between normal reactions and severe crises during surgeries.### Patient Diagnosis
    • Patient diagnosed with osteoarthritis in the left knee and has a history of hypertension.

    Physical Environment of the Operating Room

    • Operating room characterized as a restricted zone, geographically and aseptically controlled.
    • Ideal location adjacent to Post Anesthesia Care Unit (PACU) and surgical ICU for quick patient transport post-surgery.
    • Equipped with advanced features:
      • Filters and controlled airflow
      • Positive air pressure management
      • Temperature and humidity controls
      • UV lighting
      • Strict cleaning protocols and maintenance checks.

    Operating Room Furniture and Equipment

    • Furniture should be adjustable, easy to clean, and portable.
    • Equipment undergoes regular checks for operational efficiency and electrical safety.
    • Specialized lighting enhances visibility of the surgical site.
    • Effective communication systems in place among the surgical team.

    Surgical Team Roles

    • Perioperative Nurse:
      • Registered Nurse involved in preoperative, intraoperative, and postoperative care phases.
      • Advocates for the patient during surgery.
    • Scrub Nurse:
      • Maintains sterile environment, follows antiseptic protocols, and prepares surgical instruments.
    • Circulating Nurse:
      • Operates within unsterile field, facilitating procedural progress and managing documentation.
    • LPN/VN/Surgical Technologist:
      • Can assume circulating or scrub role under RN supervision.
    • Surgeon:
      • Responsible for all surgical actions including patient consent, pre-op assessment, and postoperative management.
    • Surgeon's Assistant:
      • May be physician or other trained professionals assisting with various surgical tasks.

    Nursing Management Before Surgery

    • Admittance Process:
      • Involves patient reassessment, confirming last food/fluid intake, and verifying preoperative medications.
      • Covers patient’s physical preparation, including hair covering.
    • Nursing Care:
      • Addresses both complementary and alternative therapies to alleviate anxiety and pain.
      • Circulating nurse ensures implementation of the intraoperative care plan, including ongoing assessments.

    Preparation of Operating Room

    • Ensure privacy and infection control, especially for obese patients needing special equipment.
    • Confirm compliance with surgical attire and functionality of electrical/mechanical equipment.
    • Employ aseptic techniques in handling instruments and maintain correct item counts.

    Patient Transfer and Positioning

    • Safely transfer the patient post-assessment with locked wheels and adequate staff support.
    • Monitor vital signs and apply necessary medical devices before surgery begins.
    • Position the patient carefully to maintain access, proper alignment, and avoid any physical trauma during surgery.

    Assistance During Anesthesia

    • Circulating nurse assists anesthesia provider by applying monitors and ensuring patient safety.
    • Clear communication is crucial for effective anesthesia management.

    Postoperative Care

    • After surgery, anesthesiologist is responsible for maintaining patient stability and medication management during recovery.
    • During hand-off to PACU, thorough communication regarding patient status and procedural details is essential.

    Safety and Infection Control

    • Key safety considerations include preventing infection, physical trauma, and managing physiological effects of surgery.
    • Clear communication protocols outline expectations in surgical team interactions (SBAR: Situation, Background, Assessment, Recommendations).

    Holding Area Protocols

    • Implementation of Surgical Care Improvement Project measures, ensuring preoperative safety checks.
    • Verification processes mandated by National Patient Safety Goals, including documentation checks and marking the surgical site.

    Case Study Overview

    • Example of patient M.C. includes surgical preparations: IV infusion, antiembolic stocking application, and medication orders before knee surgery.
    • Post-surgery notes indicate a drain present in the left knee and an elastic bandage from ankle to thigh.

    Anesthesia Overview

    • Anesthetic techniques and agents are collaboratively chosen by the Anesthesia Care Provider (ACP), surgeon, and patient.
    • Factors influencing this choice include the patient's physical and mental status, age, allergies, pain history, and specifics of the procedure.

    ASA Physical Status Classification

    • The American Society of Anesthesiologists (ASA) classifies patients from ASA1 (healthy) to ASA6 (brain-dead).
    • This classification represents the patient's status immediately before surgery.

    Anesthesia Types

    • Moderate to Deep Sedation

      • Used for procedures outside the operating room (OR).
      • ACP presence not mandatory; can be administered by an RN under physician supervision.

    • Monitored Anesthesia Care (MAC)

      • For diagnostic or therapeutic procedures in or outside the OR.
      • Administered by an ACP, includes various sedation and analgesia levels, with critical assessment of physiological problems.

    • General Anesthesia

      • Involves total intravenous anesthesia (TIVA) and newer inhalation agents.
      • Indications include long procedures, need for muscle relaxation, uncomfortable positions, and controlled ventilation.

    Induction and Agents

    • Induction Agent

      • Initial agents for routine general anesthesia induce sleep rapidly, lasting a few minutes, enough for airway management.

    • Inhalation Agents

      • Volatile liquids/gases administered through alveoli, allowing easy administration and rapid excretion, with side effects like coughing and laryngospasm.

    Adjuncts to General Anesthesia

    • Opioids

      • Used for sedation, analgesia, and pain management, but may cause respiratory depression.

    • Benzodiazepines

      • Provide premedication for amnesia, anesthesia induction, and monitored anesthesia care.

    • Neuromuscular Blocking Agents

      • Facilitate intubation and muscle relaxation by interrupting nerve signal transmission; effects may persist beyond the procedure.

    Anesthesia Administration Methods

    • Local Anesthesia

      • Loss of sensation without consciousness; can be topical, ophthalmic, nebulized, or injectable.

    • Regional Anesthesia

      • Involves injecting anesthetic into central nerves, providing analgesia during preoperative and postoperative phases.

    • Spinal and Epidural Anesthesia

      • Spinal: Injection into cerebrospinal fluid (CSF) for complete blockade.
      • Epidural: Injection into epidural space preserving motor function.

    Gerontologic Considerations

    • Anesthetic drugs must be carefully titrated in older adults, who may experience postoperative delirium and communication difficulties.
    • Increased risk of injury from medical devices and hypothermia.

    Perioperative Crisis Events

    • Anaphylaxis

      • Allergic reactions to anesthetic agents, antibiotics, or latex, requiring vigilance and rapid intervention, with symptoms such as hypotension and tachycardia.

    • Malignant Hyperthermia (MH)

      • A rare genetic disorder leading to severe complications during anesthesia, characterized by muscle rigidity and hyperthermia triggered primarily by succinylcholine or volatile agents.
      • Symptoms include tachycardia, hypercarbia, and potential cardiac arrest; treatment involves Dantrolene and supportive care.

    Monitoring and Response

    • Continuous monitoring for signs of anesthetic complications is crucial, especially in distinguishing between normal reactions and severe crises during surgeries.### Intraoperative Care
    • Historically performed in operating rooms; now often in outpatient settings.
    • Growth in minimally invasive surgery (MIS) utilizing endoscopes, robotics, and advanced technologies.
    • MIS results in reduced blood loss, smaller incisions, less pain, shorter recovery times, and decreased hospital stays.

    Physical Environment

    • Surgical departments designed to minimize pathogen spread and ensure smooth patient, staff, and equipment flow.
    • Unrestricted Zone: Allows interaction between street clothes and scrub attire; includes patient intake areas and staff facilities.
    • Semirestricted Zone: Access restricted to authorized personnel in clean surgical attire, including scrubs and appropriate PPE.
    • Restricted Zone: Encompasses the surgical suite where adherence to sterile protocols is critical; masks worn and traffic minimized.

    Preoperative Holding Area

    • Functions as an unrestricted zone for patient identification and assessment prior to surgery.
    • Admission, observation, and discharge (AOD) area facilitates early morning admissions for outpatient and same-day surgeries.

    Nursing Management

    • Critical components include patient admitting phase: reassessment, addressing questions, and confirming preoperative medication.
    • Use of complementary therapies can alleviate anxiety and enhance relaxation.
    • Circulating nurse manages the intraoperative care plan, performing ongoing assessments and adjusting as necessary.

    Room Preparation

    • Ensures safety, privacy, and infection prevention with adequate staff and equipment, especially for obese patients.
    • All personnel entering the OR must wear surgical attire, and equipment is checked for functionality.
    • Aseptic technique practiced when opening instruments; items counted to ensure accuracy.

    Patient Transfer and Preparation

    • Patients transported with safety precautions, including locked wheels and adequate monitoring devices.
    • Scrubbing, gowning, and gloving follow strict protocols to maintain sterility, including wet scrubbing and using alcohol-based agents.

    Positioning and Surgical Site Preparation

    • Proper positioning facilitates surgical access and monitoring of anesthetic agents while ensuring musculoskeletal alignment and preventing pressure injuries.
    • Surgical site is cleansed with antimicrobial agents, scrubbed from clean to dirty areas, and draped appropriately.

    Safety Considerations

    • Key focus areas include infection control, physio-trauma risks, and effective communication among the surgical team.
    • Protocols for patient care during the procedure emphasize clarity in communication, including situation, background, assessment, and recommendations.

    Holding Area Protocols

    • Compliance with Surgical Care Improvement Project (SCIP) measures includes timely antibiotic administration, warming blankets, and IPC devices.
    • Pre-procedure verification process mandates checking documentation, diagnostic study results, and marking procedure sites.

    Postoperative Care

    • Anesthesia care provider ensures minimal effects at the end of surgery, overseeing patient transfer to the Post Anesthesia Care Unit (PACU).
    • Important hand-off includes sharing the patient's status and details of the procedure performed.

    Anesthesia Overview

    • Anesthetic techniques and agents are collaboratively chosen by the Anesthesia Care Provider (ACP), surgeon, and patient.
    • Factors influencing this choice include the patient's physical and mental status, age, allergies, pain history, and specifics of the procedure.

    ASA Physical Status Classification

    • The American Society of Anesthesiologists (ASA) classifies patients from ASA1 (healthy) to ASA6 (brain-dead).
    • This classification represents the patient's status immediately before surgery.

    Anesthesia Types

    • Moderate to Deep Sedation

      • Used for procedures outside the operating room (OR).
      • ACP presence not mandatory; can be administered by an RN under physician supervision.

    • Monitored Anesthesia Care (MAC)

      • For diagnostic or therapeutic procedures in or outside the OR.
      • Administered by an ACP, includes various sedation and analgesia levels, with critical assessment of physiological problems.

    • General Anesthesia

      • Involves total intravenous anesthesia (TIVA) and newer inhalation agents.
      • Indications include long procedures, need for muscle relaxation, uncomfortable positions, and controlled ventilation.

    Induction and Agents

    • Induction Agent

      • Initial agents for routine general anesthesia induce sleep rapidly, lasting a few minutes, enough for airway management.

    • Inhalation Agents

      • Volatile liquids/gases administered through alveoli, allowing easy administration and rapid excretion, with side effects like coughing and laryngospasm.

    Adjuncts to General Anesthesia

    • Opioids

      • Used for sedation, analgesia, and pain management, but may cause respiratory depression.

    • Benzodiazepines

      • Provide premedication for amnesia, anesthesia induction, and monitored anesthesia care.

    • Neuromuscular Blocking Agents

      • Facilitate intubation and muscle relaxation by interrupting nerve signal transmission; effects may persist beyond the procedure.

    Anesthesia Administration Methods

    • Local Anesthesia

      • Loss of sensation without consciousness; can be topical, ophthalmic, nebulized, or injectable.

    • Regional Anesthesia

      • Involves injecting anesthetic into central nerves, providing analgesia during preoperative and postoperative phases.

    • Spinal and Epidural Anesthesia

      • Spinal: Injection into cerebrospinal fluid (CSF) for complete blockade.
      • Epidural: Injection into epidural space preserving motor function.

    Gerontologic Considerations

    • Anesthetic drugs must be carefully titrated in older adults, who may experience postoperative delirium and communication difficulties.
    • Increased risk of injury from medical devices and hypothermia.

    Perioperative Crisis Events

    • Anaphylaxis

      • Allergic reactions to anesthetic agents, antibiotics, or latex, requiring vigilance and rapid intervention, with symptoms such as hypotension and tachycardia.

    • Malignant Hyperthermia (MH)

      • A rare genetic disorder leading to severe complications during anesthesia, characterized by muscle rigidity and hyperthermia triggered primarily by succinylcholine or volatile agents.
      • Symptoms include tachycardia, hypercarbia, and potential cardiac arrest; treatment involves Dantrolene and supportive care.

    Monitoring and Response

    • Continuous monitoring for signs of anesthetic complications is crucial, especially in distinguishing between normal reactions and severe crises during surgeries.### Patient Diagnosis
    • Patient diagnosed with osteoarthritis in the left knee and has a history of hypertension.

    Physical Environment of the Operating Room

    • Operating room characterized as a restricted zone, geographically and aseptically controlled.
    • Ideal location adjacent to Post Anesthesia Care Unit (PACU) and surgical ICU for quick patient transport post-surgery.
    • Equipped with advanced features:
      • Filters and controlled airflow
      • Positive air pressure management
      • Temperature and humidity controls
      • UV lighting
      • Strict cleaning protocols and maintenance checks.

    Operating Room Furniture and Equipment

    • Furniture should be adjustable, easy to clean, and portable.
    • Equipment undergoes regular checks for operational efficiency and electrical safety.
    • Specialized lighting enhances visibility of the surgical site.
    • Effective communication systems in place among the surgical team.

    Surgical Team Roles

    • Perioperative Nurse:
      • Registered Nurse involved in preoperative, intraoperative, and postoperative care phases.
      • Advocates for the patient during surgery.
    • Scrub Nurse:
      • Maintains sterile environment, follows antiseptic protocols, and prepares surgical instruments.
    • Circulating Nurse:
      • Operates within unsterile field, facilitating procedural progress and managing documentation.
    • LPN/VN/Surgical Technologist:
      • Can assume circulating or scrub role under RN supervision.
    • Surgeon:
      • Responsible for all surgical actions including patient consent, pre-op assessment, and postoperative management.
    • Surgeon's Assistant:
      • May be physician or other trained professionals assisting with various surgical tasks.

    Nursing Management Before Surgery

    • Admittance Process:
      • Involves patient reassessment, confirming last food/fluid intake, and verifying preoperative medications.
      • Covers patient’s physical preparation, including hair covering.
    • Nursing Care:
      • Addresses both complementary and alternative therapies to alleviate anxiety and pain.
      • Circulating nurse ensures implementation of the intraoperative care plan, including ongoing assessments.

    Preparation of Operating Room

    • Ensure privacy and infection control, especially for obese patients needing special equipment.
    • Confirm compliance with surgical attire and functionality of electrical/mechanical equipment.
    • Employ aseptic techniques in handling instruments and maintain correct item counts.

    Patient Transfer and Positioning

    • Safely transfer the patient post-assessment with locked wheels and adequate staff support.
    • Monitor vital signs and apply necessary medical devices before surgery begins.
    • Position the patient carefully to maintain access, proper alignment, and avoid any physical trauma during surgery.

    Assistance During Anesthesia

    • Circulating nurse assists anesthesia provider by applying monitors and ensuring patient safety.
    • Clear communication is crucial for effective anesthesia management.

    Postoperative Care

    • After surgery, anesthesiologist is responsible for maintaining patient stability and medication management during recovery.
    • During hand-off to PACU, thorough communication regarding patient status and procedural details is essential.

    Safety and Infection Control

    • Key safety considerations include preventing infection, physical trauma, and managing physiological effects of surgery.
    • Clear communication protocols outline expectations in surgical team interactions (SBAR: Situation, Background, Assessment, Recommendations).

    Holding Area Protocols

    • Implementation of Surgical Care Improvement Project measures, ensuring preoperative safety checks.
    • Verification processes mandated by National Patient Safety Goals, including documentation checks and marking the surgical site.

    Case Study Overview

    • Example of patient M.C. includes surgical preparations: IV infusion, antiembolic stocking application, and medication orders before knee surgery.
    • Post-surgery notes indicate a drain present in the left knee and an elastic bandage from ankle to thigh.

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    Description

    This quiz explores the anesthetic techniques and agents selected by the Anesthesia Care Provider (ACP) in collaboration with both the surgeon and patient. Key factors such as the patient's physical and mental status, age, allergies, and pain history are discussed in relation to the choice of anesthesia. Test your knowledge on this critical aspect of surgical care.

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