Intra-Operative Nursing

A nurse is changing the dressing of a sixth-grader with severe burns. What basic principles of surgical asepsis must the nurse consider? Select all that apply.

Paper field must be dry to be sterile, 1" border around sterile field is contaminated, sterile objects that contact clean objects are contaminated

before

Surgery patients receive beta-blocker therapy _____ surgery.

After abdominal surgery, a client is transferred to the postanesthesia care unit (PACU) with a nasogastric tube in place. What action should the nurse take initially when the client vomits 90 mL of bile-colored fluid?

Check the patency of the tube

thrombocytopenia, bleeding from multiple areas, hypotension, MODS

How does DIC manifest? (4)

tachycardia, muscle rigidity, tetany movements in jaw, increased temperature, acidosis

How does malignant hyperthermia manifest?

q15 min

How often should the patient VS be assessed in the PACU?

widespread clotting of small vessels

What is DIC, dissenminated intravascular coagulation?

determining readiness for PACU discharge

What is the Aldrete score used for?

discontinue anesthesia/ ventilate patient

What is the first thing that should be done if a patient develops malignant hyperthermia during surgery?

surgical anesthesia

What is the third stage of general anesthesia?

conscious sedation

minimal depression of the level of consciousness in which the patient retains ability to maintain a patent airway and respond to commands.

lidocaine, marcaine

nerve block anesthesia agents (2)

A nurse in the postanesthesia care unit identifies a progressive decrease in blood pressure in a client who had major abdominal surgery. What clinical finding supports the conclusion that the client is experiencing internal bleeding?

oliguria

malignant hyperthermia

rare inherited muscle disorder chemically induced by an anesthetic agent

A nurse in the postanesthesia care unit (PACU) is providing care to a client who had an abdominal cholecystectomy and observes serosanguineous drainage on the abdominal dressing. What is the next nursing action?

reinforce the dressing

A client is extubated in the postanesthesia care unit after surgery. For which common response should the nurse be alert when monitoring the client for acute respiratory distress?

restlessness

unsterile

If a sterile area is breached it is considered what?

AORN

RNs who are certified to work in an OR setting are certified through what board?

As close to the time they will be used as possible

Sterile fields are prepared when?

one

Urinary catheters should be removed ____ day after surgery.

topical anesthesia

anesthesia applied to skin and mucous membranes that are readily absorbed and act rapidly.

local anesthesia

anesthesia injected into specific area and used for minor surgery

IV block, Bier block

anesthesia used for procedures in arm, wrist, or hand

nerve block

anesthetic agent injected around nerves so that the region supplied by these nerves is anesthetized- patient is awake and aware

spinal anesthesia

anesthetic introduced into subarachnoid space/lumbar puncture at L4 & L5

After surgery, a client is extubated in the postanesthesia care unit. Which clinical manifestations should the nurse expect if the client is experiencing acute respiratory distress? Select all that apply

confusion, tachycardia

IV narcotics, antianxiety

conscious sedation agents (2)

lidocaine, tetracaine

local anesthesia agents (2)

After a nephrectomy a client arrives in the postanesthesia care unit in the supine position. Which action should be employed by the nurse to assess the client for signs of hemorrhage?

turn client to observe the dressings

lidocaine, benzocaine

topical anesthesia agents (2)

A postoperative client returned from the postanesthesia care unit (PACU) this morning with a patient care analgesia (PCA) pump running with a basal rate of hydromorphone (Dilaudid). The nurse assesses the client's vital signs as BP 90/60 mm Hg, heart rate 96 beats/min, and respiratory rate of 10 breaths/min. What next action should the nurse take?

turn off the pump and give narcan

inhaled, IV

Anesthetic agents used in general anesthesia are _____ or administered by _____.

A client just has returned from the postanesthesia care unit after having a laparotomy. Which sign or symptom indicates to the nurse that peristalsis has begun to return?

Borborygmi are auscultated

A nurse should employ which technique to maintain surgical asepsis?

Change the sterile field after sterile water is spilled on it.

homeostatic mechanisms decrease, immune system less reactive, respiratory capacity is decreased, collateral illness(es)

Gerontological patients may be more sensitive to medications because why? (4)

nausea, vomiting, nonexplosive

IV administered anesthetic agents produce a pleasant onset, brief duration of action, cause little _____ or_____, are ________, and are easy to deliver

positioning

If a patient in the PACU begins to feel nauseous, the nurse could try a med if what doesn't work?

oxygen, shivering, nausea

If general anesthesia is inhaled, it must be administered with ____. It produces post operative _______ and ______.

A nurse is preparing to change a client's dressing. What is the reason for using surgical asepsis during this procedure?

Keeps the area free of microorganisms

inhalation anesthetic agents and muscle relaxants

Malignant hyperthermia can be triggered by what two drugs?

A client is admitted to the postanesthesia care unit after a segmental resection of the right lower lobe of the lung. A chest tube drainage system is in place. When caring for this tube, what should the nurse do?

Mark the time and fluid level on the side of the drainage chamber

A client has emergency surgery for a ruptured appendix. While in the postanesthesia care unit, the client manifests signs and symptoms of shock. The nurse should:

Notify surgeon immediately

one

Prophylactic antibiotics are to be received ___ hour(s) before surgical incision.

24

Prophylactic antibiotics should be discontinued within ___ hour(s) after the end of surgery.

patient, circulating nurse, scrub nurse, surgeon, RN first assistant, anesthetist, and anesthesiologist

The surgical team is made up of who? (7)

ASA1-6

What abbreviation can be used interchangeably with P1-6

Risk for injury, risk for impaired skin integrity, risk for infection, risk of hypothermia

What are 4 nursing diagnoses for every surgery patient?

Assessment, maintaining airway, maintaining CV stability, relieving pain and anxiety, controlling N/V

What are 5 general nursing responsibilities in PACU?

postoperative confusion and delirium

What are elderly patients at risk for after surgery?

Faulty equipment, exposure to toxins/radiation, surgical plume, infectious waste, cuts, needlestick injuries, latex allergy

What are some health hazards associated with the surgical environment? (Name 3 of 7)

severe hypotension, respiratory depression and arrest, temporary leg paralysis

What are some potential complications of epidural anesthesia if the dural sac is punctured? (3)

Anesthesia awareness, N/V, anaphylaxis, hypoxia, hypothermia, DIC, intubation complications

What are some potential intraoperative complications? (7)

eye and skin exposure to beam, plume inhalation, fire hazard

What are the 3 risks of using lasers in surgery?

opioids, barbituate, nonbarbituate hypnotic, benzodiazepine, dissociative agent

What are the 5 IV anesthetic agents usually used?

Identify patient, improve staff communication, use meds safely, prevent infection, safety risks, prevent surgery mistakes

What are the Summary of the 2012 National Patient Safety Goals? (6 goals) (p.416)

P1- not dangerous, P2 through P4-systemic disease, P6-brain dead

What are the classifications showing how dangerous anesthesia is to each individual surgery patient?

Assess airway, check VS, physical assessment, monitor urine output

What are the initial nursing responsibilities upon arrival to the PACU?

beginning, initiation, induction

What is the first stage of general anesthesia?

circulating nurse

What member of the surgical team communicates information to the PACU nurse and the family (if surgeon is unavailable)?

front part above waist and below neck

What part of the gown is considered sterile

to control sterile area and prevent infection

Why are sterile drapes used

sepsis, tissue damage, shock

Why might DIC happen?

moderate or conscious

_______ or _______ sedation may be used alone or in conjunction with regional anesthesia for some tests and procedures.

epidural anesthesia

local anesthetic agent injected into epidural space

general anesthesia

loss of all sensation and consciousness, protective reflexes are lost.

In the postanesthesia care unit it is reported that the client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour postoperative care?

monitor RR hourly

regional anesthesia

temporary iterruption of transmission of nerve impulses to and from a specific area or region of the body. Patient remains conscious.

Surgical Care Improvement Project

What does SCIP stand for?

romazicon

What is the antidote to benzodiazepines?

medullary depression

What is the fourth stage of general anesthesia?

excitement

What is the second stage of general anesthesia?

double gloved, sleeve protectors, rubber boots, waterproof apron, face shield, bubble mask and hood

What is the whole getup used in case of exposure to blood and body fluids?

scrub nurse

What member of the surgical team assists with suturing and labels tissue during surgery?

While in the postanesthesia care unit, a client reports shortness of breath and chest pain. Which is the most appropriate initial response by the nurse?

Initiate oxygen via a nasal cannula

24, 24

Surgery patients may receive venous thromboembolism prophylaxis within ___ hour(s) before surgery to ___ hour(s) after surgery.

sterile to sterile and unsterile to unsterile

Surgical team movements go from what to what?