Intraoperative Nursing Management

Intraoperative Nursing Management

• This chapter covers intraoperative nursing management.
• The surgical team includes the patient, anesthesiologist (or CRNA), surgeon, nurses, surgical technicians, and registered nurse first assistants (or surgical technologists).
• Surgical team roles include circulating nurse, scrub role, surgeon, registered nurse first assistant, anesthesiologist/anesthetist. Nurses act as patient advocates.
• The circulating nurse is responsible for monitoring the surgical team. This includes monitoring patient safety, checking OR conditions, assessing the patient for injury signs, and implementing appropriate interventions.
• Intraoperative complications can include anesthesia awareness, nausea/vomiting, anaphylaxis, hypoxia/respiratory complications, hypothermia, malignant hyperthermia, and infection.
• Adverse effects of surgery and anesthesia can include allergic reactions/drug toxicity, cardiac dysrhythmias, CNS changes (over/under sedation), trauma (laryngeal, oral, nerve, skin, burns), hypotension, and thrombosis.
• Older adult patients are at a higher risk for complications due to age-related cardiovascular and pulmonary changes, decreased tissue elasticity, reduced lean tissue mass, decreased liver's ability to inactivate anesthetic agents, decreased kidney function in eliminating waste products, and impaired ability to regulate metabolism/temperature.
• The most frequent early sign of malignant hyperthermia is tachycardia, not bradycardia.
• Prevention of infection includes a surgical environment with unrestricted, semi-restricted, and restricted zones; surgical asepsis; and environmental controls. Surgical wound contact items and sterile field materials must be sterile. Sterile drapes create a sterile field, and only the top of draped tables are considered sterile. Surgical team movements are from sterile to sterile and unsterile to unsterile. Sterile fields are prepared as close to procedure time as possible. Routine hyperoxia administration is not recommended to reduce surgical site infections.
• Anesthetic agents and delivery systems include general inhalation, intravenous, and regional (epidural, spinal).
• Nursing process interventions include reducing anxiety, reducing latex exposure, preventing perioperative positioning injury, protecting the patient from injury, serving as a patient advocate, and monitoring/managing potential complications.
• Positioning considerations include maintaining patient comfort, adequate exposure of the operative field, avoiding obstructing respiration, vascular supply, or nerves; extra precautions for older adults, thin/obese patients, and those with physical deformities, and light restraints if needed in case of excitement.
• Protecting patients from injuries during surgery includes identifying the patient correctly, ensuring consent, verifying medical records, reviewing diagnostic tests, documenting allergies (including latex), monitoring and adjusting the physical environment, implementing appropriate safety measures (grounding, restraints, etc), and ensuring verification of and accessibility to blood products.
• Inhaled general anesthetics are primarily eliminated through the lungs.

This quiz focuses on intraoperative nursing management, covering the roles of various surgical team members, including nurses and anesthesiologists. It also addresses the responsibilities of the circulating nurse and potential intraoperative complications. Test your knowledge on ensuring patient safety and managing adverse effects during surgery.