Operating Room Roles and Responsibilities Quiz

Nursing Care of Patients Undergoing Surgery (Intraoperative Care)

• The presentation covers intraoperative care, focusing on the perioperative department, roles of the surgical team, surgical environment, and potential intraoperative complications.

Intended Learning Outcomes

• Identify various areas of the perioperative department and appropriate attire.
• Outline the roles and responsibilities of interprofessional surgical team members.
• Analyze the role of a perioperative nurse in managing patients undergoing surgery.
• Prioritize the needs of patients undergoing surgery.
• Identify intraoperative positions.
• Apply basic principles of infection prevention and aseptic technique in the operating room.
• Recognize operating room safety measures related to patients, equipment, and anesthesia.
• Distinguish various anesthesia techniques and common anesthesia drugs.
• Identify adverse effects of surgery and anesthesia.
• Introduce the updated operating room safety measures related to patients, equipment, and anesthesia.
• Discuss the latest measures for infection prevention and aseptic techniques used in the OR.

Intraoperative Period

• The intraoperative period is the time from when the patient is transferred to the operating room table until admission to the post-anesthesia care unit (recovery room).

Surgical Team

• Patient: The patient undergoing the surgery.
• Circulating Nurse: Assists with positioning, prepares the patient's skin, manages surgical specimens, documents events, verifies consent, coordinates the team, ensuring proper lighting, cleanliness, temperature, humidity, equipment function, and availability of supplies. They remain in the unsterile field.
• Scrub Nurse: Wears sterile gown and gloves; remains in the sterile field; performs surgical hand scrub; sets up sterile tables; prepares supplies and equipment; assists the surgeon during the procedure; counts all needles, sponges, and instruments; labels specimens to be sent to the lab.
• Surgeon: Performs the surgical procedure; responsible for the patient's preoperative medical history; obtaining informed consent; physical assessment; patient safety; and postoperative management.
• Anesthesiologist and Anesthetist: Prescribes preoperative medicines; administers anesthesia; maintains physiologic homeostasis throughout the intraoperative period; monitors cardiac and respiratory status and vital signs throughout the procedure.

Surgical Environment

• Operating room: A controlled area with limited access to authorized personnel, designed to minimize the spread of infections.
• Unrestricted Area/Zone: Entrance area, holding area, and waiting area; street clothes are allowed.
• Semi-Restricted Area/Zone: Peripheral support areas and corridors; surgical attire and head and facial hair coverings are required.
• Restricted Area: Operating rooms and scrub sink areas; attire consists of scrub cloths, gloves, head covers, masks, shoes covers, and in some surgical procedures, double gloves and waterproof aprons, eye protectors are required.
• Methods to Prevent Transmission of Infection: Use of filters, controlled airflow (positive air pressure), adherence to principles of surgical asepsis, sterile equipment and surfaces, proper scrubbing, gowning, and gloving, and OR attire. Maintaining cleanliness of the rooms.

Holding Area

• Final patient identification and assessment before transfer to the operating room.
• Minor procedures may be performed, such as IV catheter insertion, cast removal, or drug administration.
• Friends/family may be allowed.

Principles of Surgical Asepsis

• The aim is to prevent contamination of the wound.
• All staff and equipment in direct contact with the patient must be sterile.
• Basic guidelines for maintaining surgical asepsis are provided.

Nursing Management (Before Surgery)

• Room preparation before the patient is transferred to the OR.
• Surgical attire for all individuals entering the OR suite.
• Function checks of electrical and mechanical equipment.
• Psychosocial and physical assessments.
• Chart review to ensure all required blood and other studies are available.

Nursing Management (Diagnostic and Preoperative)

• Diagnostic tests (e.g., chest x-ray, CT scan).
• Pregnancy testing.
• Surgical and blood transfusion consent.
• Allergy checks.
• Blood type and crossmatch.
• Admitting the patient.
• Proper patient identification.
• Last-minute questions about patient valuables, prosthetics, contacts, and last food/fluid intake.
• Patient Reassessment.

Nursing Management (Intraoperative)

• Assisting anesthesiologists and anesthetists.
• Understanding mechanism of anesthetic administration and pharmacologic effects of agents.
• Knowing the location of critical care equipment and drugs.
• Placing monitoring devices on the patient.
• Remaining at the patient's side to ensure safety.

Types of Anesthesia and Sedation

• General anesthesia
• Local anesthesia
• Regional anesthesia

General Anesthesia

• A state of narcosis (severe CNS depression) produced by pharmacologic agents.
• Includes analgesia, relaxation, and reflex loss.
• Loss of sensation, consciousness, and skeletal muscle relaxation is involved.

Method of GA agents administration

• Intravenous agents (used during the initial period of anesthesia for fast action to induce pleasant sleep).
• Inhalation agents (volatile liquids and gases, used with O2, and are given via endotracheal tubes, masks, or tracheostomies.)
• Muscle relaxants (neuromuscular blockers) ( used for procedural relaxation in surgical settings).

Local Anesthesia

• Loss of sensation without loss of consciousness.
• Methods: Topical application (e.g., EMLA cream), injections (subcutaneous, regional).
• Advantages: Simple, economical, minimal equipment, brief postoperative recovery, and avoidance of general anesthesia side effects, suitable for short procedures

Regional Anesthesia

• Injection of anesthetic agent into or around a specific nerve(s).
• Loss of sensation in a body region without loss of consciousness.
• Subtypes: Epidural and spinal anesthesia.

Spinal Anesthesia

• Involves injection of local anesthetic agent into cerebrospinal fluid (CSF) within the subarachnoid space.
• Commonly below L2 (between L4-L5), used for surgical procedures in lower abdomen, groin, perineum, and lower extremities.
• Patient can remain fully conscious.

Epidural Anesthesia

• Injection is administered into the epidural space surrounding the dura, but does not enter the CSF.
• Used frequently in obstetrics and some lower extremity surgeries.
• Patient can remain fully conscious.

Potential Intraoperative Complications

• Nausea/vomiting
• Anaphylaxis
• Hypoxia/respiratory complications
• Hypothermia
• Malignant hyperthermia

Nausea and Vomiting, Nursing Management

• Patient positioning (side lying)
• Head of table lowering
• Vomit collection basin provision
• Suctioning techniques

Anaphylaxis, Nursing Management

• Awareness of potential reactions to medications, latex, etc.
• Vital sign monitoring for changes, symptoms of anaphylaxis observation

Hypoxia/ Respiratory and Complications, Nursing Management

• Oxygenation monitoring, peripheral perfusion monitoring, and blood oxygen saturation (pulse oximetry).

Hypothermia, Nursing Management

• Adjusting OR temperature to appropriate levels.
• Warming IV solutions and irrigating fluids.
• Dry coverings for patients.
• Gradual rewarming of the patient.

Malignant Hyperthermia, Management

• Identification of at-risk patients.
• Stopping surgical procedures if signs occur.
• Hyperventilation using 100% O2.
• Muscle relaxant administration.
• Constant monitoring during treatment.

Intraoperative Positions

• Positions depend on the surgical procedure and the patient's physical condition.
• Operative area exposure without interfering with respiration and vascular supplies.
• Nerve protection and comfortable positioning are key.
• Common positions: Supine, Dorsal Recumbent, Trendelenburg, Lithotomy, Lateral, Prone.