Intra-Operative Nursing Care PDF

Nursing care of patients undergoing surgery (Intraoperative Care) Dr/ Manal Omer Associate prof. In Critical care & Emergency Nursing ❑ Intended Learning Outcomes S.E.E.1: Distinguish various areas of perioperative department and appropriate attire. S.E.E.2.1: Ou...

Nursing care of patients undergoing surgery (Intraoperative Care) Dr/ Manal Omer Associate prof. In Critical care & Emergency Nursing ❑ Intended Learning Outcomes S.E.E.1: Distinguish various areas of perioperative department and appropriate attire. S.E.E.2.1: Outline the roles and responsibilities of interprofessional surgical team members. S.E.E.2.2: Analyze role of a perioperative nurse in the management of patients undergoing surgery. H.P.M.2: Prioritize needs of patients undergoing surgery S.E.E.1: Identify intraoperative positions. ❑ Intended Learning Outcomes S.E.E.2.1: Apply basic principles of infection prevention and aseptic technique in the operating room. S.E.E.2.2: Recognize operating room safety measures related to patients, equipment, and anesthesia. PH.I.2: Distinguish various anesthesia techniques and common anesthesia drugs P.H.I.1: Identify adverse effect of surgery and anesthesia G.H.E.2: Introduce to the updated operating room safety measures related to patients, equipment, and anesthesia G.H.E.2: Discuss the latest measures for infection prevention and aseptic techniques used in the OR. ❑ Intraoperative period Period of time from when pt is transferred to operating room table to when pt is admitted to post anesthesia care unit (recovery room) ❑ Surgical Team Patient Circulating Nurse Scrub nurse Surgeon Assistant Surgeon Anesthesiologist and anesthetist ❑ Surgical Team Circulating Nurse (Runner nurse) Main responsibilities include: Assist with patient positioning Preparing patient skin for surgery Managing surgical specimens Documenting intraoperative events Verifying consent Coordinating team Ensure proper lighting, cleanliness, temperature &humidity , safe function of equipment, and availability of supplies and materials. Monitor scrubbed team for breaks in sterile fields Not scrubbed, gowned, or gloved Remains in unsterile field ❑ Surgical Team Scrub Nurse activities Wear sterile gown and gloves. sterile attire “uniform” Remain in sterile field Perform surgical hand scrub Set up sterile tables Prepare supplies and equipment on sterile table Assist surgeon during procedure Count all needles, sponges, and instruments +circulating nurse Label specimens & sent it to lab by circulating nurse ❑ Surgical Team Surgeon Performs surgical procedure Responsible for: Preoperative medical history obtaining informed consent Physical assessment Patient safety Postoperative management ❑ Anesthesia care provider Prescribes preoperative medicines Administers anesthesia Maintenance of physiologic homeostasis throughout intraoperative period Monitors cardiac and respiratory status and vital signs throughout procedure ❑ Surgical environment Operating room Controlled area Access limited to authorized personnel Designed to minimize spread of infections Surgical area Holding (waiting) area Operating room (OR) Postanesthsia care unit (recovery room) ❑ Surgical environment Methods used to prevent transmission of infection Filters Controlled airflow Positive air pressure [When intake fans’ combined airflow is greater than exhaust (Dust reduction) Traffic control Adhering to principles of surgical asepsis Sterility of equipment and surfaces Processes of scrubbing, gowning, and gloving OR attire Cleanliness of rooms ❑ Surgical environment Surgical area divided into : Unrestricted areas/zone Semi restricted areas/zone Restricted areas Unrestricted areas/zone street clothes allowed Includes Holding area (point of entry of patient : Waiting area ) Staff locker rooms Nursing station ❑ Surgical environment Holding area Final identification and assessment before pt is transferred to OR Minor procedures performed (e.g. insert IV catheter, remove cast, drug administration) Friends/family allowed ❑ Surgical environment Semirestricted area/zone Peripheral support areas and corridors with only authorized people Must wear surgical attire and cover all head and facial hair. ❑ Surgical environment Restricted areas Operating rooms and Scrub sink areas Attire consists of Scrub cloths Gloves Head covers (caps) Masks Shoes covers\caps In trauma and some types of surgery Double gloves Waterproof apron Eye protector ❑ Principles of surgical asepsis Aim to : Prevent contamination of wound All staff should adhere to these principles All equipment that comes in direct contact with pt must be sterile Basic guideline for maintaining surgical asepsis p507 ❑ Basic Guidelines for Surgical Asepsis All materials in contact with wound, within sterile field must be sterile Gowns sterile in front from chest to level of sterile field Movements of surgical team: from sterile to sterile, from unsterile to unsterile Movement around sterile field must not cause contamination of field Items of doubtful sterility considered unsterile Health Hazards Health Hazards associated with surgical environment Exposure to blood and body fluids, radiation, and toxic agents Laser risks Latex allergy (latex-free products) Unintentional leaving of an object in a person Policies and procedures to minimize exposure to these hazards  ❑ Nursing Management Before surgery Room preparation (done before transfer pt to OR ) Surgical attire worn by all persons entering OR suite Electrical and mechanical equipment checked for proper function Psychosocial assessment Physical assessment Chart review : ensure that all required blood and other studies are available.  ❑ Nursing Management Diagnostic tests (i.e., Chest x-ray, CT scan) Pregnancy testing Surgical and blood transfusion consent Allergies Blood type and crossmatch Admitting patient Proper identification (ask pt to state his or her name, name of surgeon procedure), ID BAND, ❑ Nursing Management Admitting patient Reassessment Last-minute questions Questioning about valuables, prostheses, contacts, last intake of food/fluid  ❑ Nursing Management Assist with anesthesia care provider NURSE SHOULD Understand mechanism of anesthetic administration and pharmacologic effects of the agents Know location of emergency equipment and drugs in the OR May place monitoring devices on patient Remain at patient’s side to ensure safety ❑ Types of Anesthesia and sedation General anesthesia Local anesthesia Regional anesthesia  ❑ General anesthesia Anesthesia: state of narcosis (severe CNS depression produced by pharmacologic agents) , analgesia, relaxation, and reflex loss Loss of sensation loss of consciousness Skeletal muscle relaxation Possible impaired ventilatory and Cardiovascular ❑ Methods of GA agents administration 1. Intravenous agents Used during initial period of anesthesia Rapid action Induce pleasant sleep Insert endotracheal tube (ET) and start inhalation agent Table 19-2 barbiturates, benzodiazepines, non-barbiturate hypnotics, and opioid agents Morphine sulfate ❑ Methods of GA agents administration 2. Inhalation agents Volatile liquids (liquid at room temp) mixed with O2 as carrier gas. E.G Halothane Gases agents (gas at room temp) (nitrous oxide(N2O) with O2) Given by: ✓Endotracheal tube ✓Mask ✓Tracheostomy  Muscle relaxants (neuromuscular blockers IV) : ✓relax muscles in abdominal and thoracic surgery ✓relax eye muscles in certain types of eye surgery ✓facilitate ET intubation ✓treat laryngospasm ✓assist in mechanical ventilation ❑ Local Anesthesia Local anesthesia Loss of sensation without loss of consciousness Methods of administration Topical application (EMLA cream) 30-60 min before procedure [Lidocaine 2% and Prilocaine 2% ) SC Regional injection ❑ Local Anesthesia Advantages of local anesthesia Simple and economical. Minimal Equipment needed Brief Postoperative recovery Avoid Undesirable effects of general anesthesia Ideal for short and superficial surgical procedures.  ❑ Regional anesthesia local anesthetic Injection of anesthetic agent into or around specific nerve or group of nerves Loss of sensation in body region without loss of consciousness Epidural anesthesia Spinal anesthesia ❑ Regional anesthesia Spinal anesthesia Injection of local anesthetic agent into CSF of subarachnoid space at lumbar level Usually below L2 (between L4-L5) Used for surgical procedures in lower abdomen, groin, perineum, lower extremity Patient can remain fully conscious ❑ Regional anesthesia Epidural anesthesia Injection of local anesthetic agent into epidural space that surrounds dura matter of spinal cord Does not enter CSF Patient can remain fully conscious Commonly used for obstetrics, lower extremities surgeries  A=epidural catheter B=single injection epidural C=spinal ❑ Potential Intraoperative Complications Nausea, vomiting Anaphylaxis Hypoxia and respiratory complications Hypothermia Malignant hyperthermia ❑ Nausea and Vomiting side effect of anesthesia Nursing actions Turn Patient to side Lower head of table Provide basin to collect vomitus Suctioning ❑ Anaphylaxis/Allergic reactions Reaction to medication, latex, or other substances Nurse should alert to possibility and observe for changes in vital signs and symptoms of anaphylaxis Hypotension Bronchial constriction ❑ Hypoxia and other Resp. complications Due to inadequate ventilation, anesthetic agent..etc Nursing actions: Monitoring oxygenation Monitoring peripheral perfusion Pulse oximetry ❑ Hypothermia core body temp lower than 36.6C or less Metabolic acidosis Causes : low OR temperature, cold fluids gases, open wound…etc Nursing actions Reset OR temperature 25-26.6 C Warm IV and irrigating fluids to 37 C Replace wet gowns by dry materials Re-warm patient gradually ❑ Malignant Hyperthermia ▪Uncontrolled increase in oxidative metabolism in skeletal muscle, which reduces the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if not immediately treated. ▪Uncommon ▪Rare inherited muscle disorder ▪induced by anesthesia agents ▪Hyperthermia with rigidity of skeletal muscles. ▪Can result in death. causes Anesthetic agents Stress ❑ Malignant Hyperthermia S&S Tachycardia (early sign) Ventricular dysrhythmia Hypotension Oliguria and decrease cardiac output Cardiac arrest Rise in temperature (late sign developed rapidly) ❑ Malignant Hyperthermia Management Identification of patients at risk If occur Stop surgery Hyperventilation 100% O2 Muscle relaxant agents Monitoring ❑ Intraoperative Positions positions depend on surgical procedure to be performed physical conditions of patient Factors to be considered includes:- Comfortable position Operative area must be exposed No interference with respiration and vascular supplies Nerves must be protected ❑ Intraoperative Positions Positions Supine (suited for abdomen, heart, breast surgeries. Dorsal Recumbent Position Trendelenburg Position Lithotomy Position Lateral Position Prone (back surgeries) Intraoperative Positions Trendelenburg position  Thank you Any Questions ?