Chapter 15 EAQ
A patient scheduled for surgery is being assessed by the holding area nurse for identification and allergies. Which statement by the patient must be reported to the surgeon?
"I love seafood but I am allergic to shellfish." An allergy to shellfish indicates an allergy to iodine, so this must be reported. Povidone-iodine used for skin preparation before surgery contains some allergens found in shellfish. The nurse should perform psychosocial interventions to comfort the patient before the first surgical experience. The family is allowed to wait in the holding area with the patient. All patients scheduled for surgery must sign an informed consent form. From IGGY: The nurse asks the patient about any allergies and determines whether autologous blood was donated. A special allergy bracelet on the patient's wrist and the medical record must be verified with what has been communicated.
Which patient factors are considered when the dose of anesthetic is selected? Select all that apply.
-Age of patient -Status of procedure -Area of body undergoing surgery -Patient position needed for procedure Patient factors that are considered in the selection of dose of anesthetic include the age of the patient, status of the procedure, area of the body undergoing surgery, and patient position needed for the procedure. If the patient has an allergy to the drug, he or she will not be prescribed any dose of it. From IGGY: Patient health problems are factors in the selection and dose of anesthetic. Selection is also influenced by: 1. Type and duration of the procedure 2. Area of the body having surgery 3. SAFETY issues to prevent injury, such as airway management 4. Status of procedure (elective, emergent) 5. Pain management options after surgery 6. How long it has been since the patient ate, had any liquids, or had any drugs 7. Patient position needed for the surgical procedure 8. Requirement of the patient to be alert enough to follow instructions during surgery 9. Patient's previous responses and reactions to anesthesia
When inducing anesthesia, the anesthesiologist uses ice to reduce the surface temperature of the surgical site. What is this type of anesthesia called?
Cryothermia Cryothermia involves the use of cold to reduce the surface temperature of the surgical site. Acupuncture involves use of needles to stimulate certain points in the body. Hypnoanesthesia induces a passive, trancelike state. Local anesthesia involves using injections to anesthetize the surgical area and the tissues around it. From IGGY: Less commonly used forms include hypnosis, cryothermia (use of cold), and acupuncture.
A patient is undergoing minimally invasive splenectomy procedure. Which intervention is most important at the beginning of the surgery?
Injecting air into the abdominal cavity Air or gas should be injected into the abdominal cavity at the beginning of a minimally invasive splenectomy procedure to separate organs and improve visualization. This injection is known as insufflation and is an important factor in deciding whether to perform a traditional surgery or endoscopy. Anesthesia is administered to the patient after entering the operating room before starting the surgery. The operating bed is made up with gel pads before the patient is placed to prevent pressure ulcers during surgery. A three-dimensional view of the patient's anatomy is taken throughout the surgery to allow precise control. From IGGY: An important part of MIS for abdominal surgery, pelvic surgery, and surgery in some other body cavity areas is injecting gas or air into the cavity before the surgery to separate organs and improve visualization. This injection is known as insufflation and may contribute to complications and patient discomfort. This factor is considered when deciding whether to perform a procedure by traditional surgery or endoscopy.
Which intervention is least likely to be monitored by the anesthesia provider in an intubated patient during surgery?
Instrument count The scrub nurse is responsible for arranging the required instruments for surgery. The anesthesia provider monitors pulse oximetry, a cardiopulmonary function, in an intubated patient during surgery. The anesthesia provider monitors the level of anesthesia in an intubated patient during surgery using a peripheral nerve stimulator or electroencephalogram bispectral analysis. The anesthesia provider monitors the arterial blood gases, a cardiopulmonary function, in the intubated patient during the surgery. From IGGY: Administers anesthetic agents and continually monitors patient status Plans medications for anesthesia, analgesia, and blocks Monitors major bodily functions (such as breathing, heart rate and rhythm, body temperature, blood pressure, and blood oxygen levels) during surgery Addresses any problems that might arise during surgery
A patient is brought to the emergency department with head trauma and requires immediate surgery. The patient has a history of chronic kidney disease and hepatic dysfunction. Which type of anesthesia would be contraindicated in this patient?
Intravenous Surgery for head trauma is performed under general anesthesia. The intravenous medications used for general anesthesia need to be metabolized by the liver and excreted through the kidneys. The intravenous route of general anesthesia may cause kidney and liver dysfunction leading to drug accumulation and toxicity. Spinal anesthesia is an example of regional anesthesia; it is not preferred in a patient undergoing surgery for head trauma. Epidural anesthesia is a type of regional anesthesia that is not contraindicated in a patient with a medical history of kidney and liver diseases. Inhalation anesthesia is not appropriate for a patient with head trauma who requires surgery. This is because it is not strong enough to last through the lengthy surgery. From IGGY: *General: intravenous* Rapid and pleasant induction Low incidence of postoperative nausea and vomiting Must be metabolized and excreted from the body for complete reversal Contraindicated in presence of liver or kidney disease Increased cardiac and respiratory depression
Which interventions does the nurse perform to prevent the risk of infection in an operating room (OR)? Select all that apply.
Limiting the traffic in the operating room Reducing contaminants through air exchanges in the room Maintaining recommended temperature and humidity levels Limiting the traffic in the operating room, reducing contaminants through air exchanges, and maintaining recommended temperature and humidity levels help prevent infection in the operating room layout. Blankets or warming units are used to prevent hypothermia from poor thermoregulation in patients. Electrical equipment that meets safety standards should be used to ensure electrical safety. From IGGY: Construction and design of the OR suite centers on preventing infection by reducing contaminants through controlled air exchanges in the room, maintaining recommended temperature and humidity levels, and limiting the traffic and activities in the OR by means of sliding door closures and designated traffic patterns.
Which intervention can be performed by both the circulating nurse and the scrub nurse during the surgery?
Maintaining an accurate count of surgical instruments used Maintaining the accurate count of sponges, sharps, instruments, and amounts of irrigation fluid and drugs used can be performed by both the circulating nurse and the scrub nurse. Reviewing the patient's preoperative checklist is performed by both the circulating nurse and the holding area nurse. Both the circulating nurse and anesthesia provider can note the time the patient arrives in the post anesthetic care unit (PACU). From IGGY: With the circulating nurse, maintains accurate count of sponges, sharps, and instruments and monitors the amount of irrigation fluid and medication used
Which intervention does the nurse implement for an older adult patient to minimize skin breakdown related to surgical positioning?
Pad bony prominences. Padding bony prominences best minimizes skin breakdown. Elastic stockings assist in increased venous return. Monitoring for blood loss and securing joints do not protect the skin. From IGGY: ...interventions (e.g., positioning devices, gel pads, frames) are used to prevent skin breakdown and injury during the positioning process.
What statements are true about minimally invasive and robotic surgery? Select all that apply.
Pain is less after surgery Reduced blood loss with the surgery Incisions are smaller in the surgical area Reduced pain and smaller incisions are observed in the patient after a minimally invasive or robotic surgery. There is reduced blood loss with the surgery. Minimally invasive and robotic surgeries are more expensive, not less expensive, and the recovery time is faster, not slower, than traditional surgery procedures. From IGGY: Benefits of MIS include reduced surgery time for some surgeries, smaller incisions, reduced blood loss, faster recovery time, and less pain after surgery.
Which statement by a student nurse indicates a need for further teaching about operating room (OR) surgical attire?
"My scrubs are sterile." Scrub attire is provided by the hospital and is clean, not sterile. All members of the surgical team must cover their hair, including any facial hair. Team members who are not scrubbed (e.g., anesthesia provider, student nurse) are not required to be sterile; they may wear cover scrub jackets that are snapped or buttoned closed to prevent shedding of organisms from bare arms. Everyone who enters an OR in which a sterile field is present must wear a mask.
The holding area nurse receives a patient for surgery. What question does the nurse ask to ensure the right patient has been brought to the surgical unit?
"When were you born?" The question "When were you born?" is an appropriate question asked by the nurse to identify the patient. This practice prevents errors by drowsy or confused patients. The nurse should ask open-ended questions to obtain the patient's name and type of surgery scheduled. When the procedure involves a specific site every health care professional is responsible for validating the site before and at the time of surgery. Asking the patient about the operating surgeon does not help to identify the patient.
What is the range of desired humidity in the operating room (OR)?
30-60% The temperature and humidity of the OR must be maintained to prevent infection or contamination. Optimal humidity is typically set between 30% and 60%. From IGGY: Managing room temperature (between 68° and 73° F [20° to 23° C]) and *humidity (30% to 60%)* at recommended levels is optimal for fire SAFETY
In which patient would an anesthesia regimen that includes thiopental, morphine, and pancuronium be contraindicated?
A 60-year-old patient undergoing a cervical discectomy who has a history of renal dysfunction An anesthesia regimen including thiopental, morphine, and pancuronium is an example of balanced anesthesia. Balanced anesthesia is a combination of inhaled and intravenous general anesthesia. The risk of toxicity is higher in older adult patients with liver and kidney impairment. A cervical discectomy is performed under general anesthesia; the older patient may develop toxicity if general anesthesia is administered to a patient with renal dysfunction. An appendectomy is performed by inducing general anesthesia; the patient is middle-aged with a history of asthma, which is not contraindicated. A hysterectomy is performed by using general anesthesia; the patient is middle-aged with a history of hypertension, which is not contraindicated. A knee arthroplasty is performed by inducing regional anesthesia, which does not involve the risk of toxicity.
The nurse is preparing to enter the operating room (OR) for surgery after performing a surgical scrub. What should be the position of the nurse's hands while entering the OR?
Above elbow level A surgical scrub is performed by surgeons and nurses before beginning surgery. This involves thoroughly washing the hands with broad spectrum surgical antimicrobial solution. After scrubbing, the hands should be kept above elbow level while entering the OR. This ensures that the hands are not contaminated and they do not touch anything. In any other position, the hands will become contaminated and the purpose of scrubbing would be lost.
Which operating room team member may wear a cover scrub jacket during a surgery?
Anethesiologist Surgical scrubbing makes the skin sterile and should be performed by operating team members who are scrubbed and at the bedside during the surgery. An anesthesiologist may wear a cover scrub jacket that is snapped or buttoned closed as he/she is not scrubbed at the bedside during the surgery. Surgeon, surgery assistant, and operating room technician perform a surgical scrub after putting on a mask and before putting on a sterile gown and gloves because they are in direct contact with the patient undergoing surgery. From IGGY: Everyone who enters an OR where a sterile field is present must wear a mask. Surgical team members who are scrubbed and at the surgical field during the surgery must also wear a sterile fluid-resistant gown, sterile non-powdered gloves, and eye protectors or face shields. Team members who are not scrubbed (e.g., anesthesia provider, circulating nurse) may wear cover scrub jackets that are snapped or buttoned closed and eyewear, as warranted.
The nurse is caring for a patient in the presurgical holding area. What interventions does the nurse perform before the patient is moved to the operating room (OR)? Select all that apply.
Assess the patient's physical and emotional status. Verify that operative consent forms are signed. Review the medical record and preoperative checklist. The holding area nurse assesses the patient's physical and emotional status, provides emotional support, and answers questions before the patient is moved to the OR. The nurse also verifies that the operative consent forms are signed and reviews the patient's medical record and preoperative checklist. The circulating nurse who is involved in the patient's care in the OR ensures that blood supply and diagnostic support are available. The circulating nurse also prepares the operating table with gel pads to protect the patient against pressure ulcers.
Which intervention, normally performed in the preoperative holding area, should be performed by the circulating nurse if there is no holding area nurse available?
Assessing the patient's physical and emotional status before surgery The holding area nurse assesses the patient's physical and emotional status before surgery, gives emotional support to the patient and caregiver, answers questions, and provides additional education as needed. In the absence of the holding area nurse, the circulating nurse should perform the assessment of the patient's physical and emotional status before the surgery. The circulating nurse is responsible for ensuring the availability of supplies needed in the operating room. The circulating nurse is responsible for greeting the patient and reviewing the medical record of the patient. Both the circulating nurse and the certified registered nurse anesthetist (CRNA) are responsible for documenting the drugs, blood, and blood components used during surgery.
A patient undergoing a cervical discectomy is induced with general anesthesia. What are the appropriate nursing interventions for the patient during the stage of surgical anesthesia? Select all that apply.
Assisting the CRNA with intubation Placing the patient in the operative position Scrubbing the patient's skin over the operative site as directed Surgical anesthesia is the third stage of general anesthesia, also known as operative anesthesia. During this stage, the patient should be intubated for ventilatory support. The patient is placed in the operative position, and the operative area is scrubbed to prevent infection. Assisting in treatment of pulmonary and cardiac arrest is the nursing intervention made in the fourth stage of general anesthesia. Assisting the anesthesiologist with suctioning is the nursing intervention in the second stage of general anesthesia. From IGGY: *Stage 3 (Operative Anesthesia, Surgical Anesthesia)* Begins with generalized muscle relaxation and ends with loss of reflexes and depression of vital functions. The jaw is relaxed, and breathing is quiet and regular. The patient cannot hear. Sensations (i.e., to pain) are lost. Assist the anesthesiologist or CRNA with intubation. Place patient into operative position. Prepare (scrub) the patient's skin over the operative site as directed. Providing assistance helps promote smooth intubation and prevent injury. Performing procedures as soon as possible promotes time management to minimize total anesthesia time for the patient.
Which type of anesthesia causes minimal disturbance to physiologic functions and is used in older and high-risk patients?
Balanced A balanced type of anesthesia is used in older and high-risk patients as it causes minimal disturbance to the physiologic function. Regional anesthesia is not used for extensive procedures. Inhalation anesthesia is used along with other agents; it may cause postoperative nausea and shivering. Intravenous anesthesia is contraindicated in high-risk groups.
Which type of anesthesia is associated with complications related to drug-drug interactions?
Balanced Drug-drug interactions are noticed when two or more types of drugs are administered together. A balanced type of anesthesia is a combination of many types of drugs including inhaled and intravenous drugs which may cause complications associated with drug-drug interactions. Regional anesthesia involves the injection of one anesthetic agent at the site closest to the surgical site causing minimal chance of drug-drug interactions. Inhaled anesthetic agents' administration alone does not cause drug-drug interactions. Intravenous administration of anesthetic agents does not cause complications associated with drug-drug interactions. From IGGY: Minimal disturbance to physiologic function Can be used with older and high-risk patients Drug interactions can occur
A patient undergoing hip replacement surgery suddenly develops unexplained bradycardia. The anesthetist administers epinephrine to the patient. Which complication is the anesthetist trying to prevent?
Cardiac arrest Hip replacement surgery is usually done under spinal anesthesia. Cardiac arrest is a common complication of spinal anesthesia, which is manifested as unexplained bradycardia and can be managed by administering epinephrine. Apnea, hypotension, and unconsciousness are the risk factors associated with overdose and systemic absorption of local or regional anesthesia. These risk factors are well managed by administering barbiturates. From IGGY: Cardiac arrest may occur as a rare complication of spinal anesthesia. Epinephrine is given to prevent cardiac arrest in patients who develop sudden, unexplained bradycardia.
A preoperative patient wears a hearing aid and is extremely hard of hearing without it. What does the nurse do to help reduce this patient's anxiety?
Check to see whether the operating room (OR) staff minds if the patient wears the hearing aid until anesthesia is given. In some facilities, patients may wear eyeglasses and hearing aids until after anesthesia induction. The OR staff may have a different policy, or the hearing aid may get lost. Listening isn't always enough; more intervention is needed. Telling the patient that a policy precludes the patient's needs is not therapeutic.
Which member of the surgical team is responsible for keeping track of the number of sponges used during surgery?
Circulating Nurse The circulating nurse is the team member concerned with keeping a count of sponges used during the procedure. The circulating nurse also keeps an account of the needles and instruments used in the procedure. The nursing assistant can help with specific tasks, including patient positioning. The anesthesiologist delivers anesthesia to the patient during surgery. The holding area nurse handles the patient before the patient enters the operating room and when the patient is in the holding area. From IGGY: Uses clinical decision-making skills to develop a plan of care and coordinates care delivery to patients and their family members; coordinates, oversees, and implements nursing care interventions to support the patient during the surgical procedure Sets up the operating room, gathers supplies, anticipates equipment needed, and inspects all equipment for safety and functionality; prepares positioning devices and ensures that the physical environment is clean and at the proper temperature for the patient's arrival Throughout the surgery the circulating nurse: • Protects the patient's privacy • Ensures the patient's safety • Monitors traffic in the room • Assess urinary output and blood loss • Communicates finding to surgeon and anesthesiologist • Monitors sterile field and provides sterile supplies and medications to the sterile field • Anticipates the patient's and surgical team's needs • Communicates patient's status to family member(s) per protocol • Documents care, events, interventions, and findings
What is the drug of choice for treating malignant hyperthermia?
Dantrolene Sodium (Dantrium) Malignant hyperthermia is a complication which can occur after general anesthesia. The drug of choice for treating this condition is dantrolene sodium, which is a skeletal muscle relaxant. Morphine is an analgesic. Pancuronium is also a muscle relaxant, but has slower onset of action. Nitrous oxide is an anesthetic agent. From IGGY: Emergency Care of the Patient With Malignant Hyperthermia • Stop all volatile inhalation anesthetic agents and succinylcholine. • If an endotracheal tube (ET) is not already in place, intubate immediately. • Ventilate the patient with 100% oxygen at the highest possible flow rate to flush anesthetics and lower end-tidal carbon dioxide. • Administer dantrolene sodium (Dantrium) IV at a dose of 2 to 3 mg/kg. Repeat as needed. • If possible, terminate surgery. If termination is not possible, maintain general anesthesia with IV anesthetic agents that do not trigger malignant hyperthermia (MH) (IV sedatives, narcotics, amnestics and nondepolarizing neuromuscular blockers). • Assess arterial blood gases (ABGs) and serum chemistries for metabolic acidosis and hyperkalemia. • If metabolic acidosis is evident by ABG analysis, administer sodium bicarbonate IV. • If hyperkalemia is present, administer 10 units of regular insulin in 50 mL of 50% dextrose IV. • Use active cooling techniques: • Administer iced saline (0.9% NaCl) IV at a rate of 15 mL/kg every 15 minutes as needed. • Apply a cooling blanket over the torso. • Pack bags of ice around the patient's axillae, groin, neck, and head. • Lavage the stomach, bladder, rectum, and open body cavities with sterile iced normal saline. • Insert a nasogastric tube and a rectal tube. • Monitor core body temperature to assess effectiveness of interventions and avoid hypothermia. • Monitor cardiac rhythm by electrocardiography (ECG) to assess for dysrhythmias. • Insert a Foley catheter to monitor urine output. • Treat any dysrhythmias that do not resolve on correction of hyperthermia and hyperkalemia with antidysrhythmic agents. Avoid calcium channel blockers. • Administer intravenous fluids at a rate and volume sufficient to maintain urine output above 2 mL/kg/hr. • Monitor urine for presence of blood or myoglobin. • If urine output falls below 2 mL/kg/hr, consider using osmotic or loop diuretics, depending on the patient's cardiac and kidney status. • Contact the Malignant Hyperthermia Association of the United States (MHAUS) hotline for more information regarding treatment: (800) 644-9737. • Transfer the patient to the intensive care unit (ICU) when stable. • Continue to monitor the patient's temperature, ECG, ABGs, electrolytes, creatine kinase, coagulation studies, and serum and urine myoglobin levels until they have remained normal for 24 hours. • Instruct the patient and family about testing for MH risk. • Refer the patient and family to the Malignant Hyperthermia Association of the United States at (800) 986-4287 or www.mhaus.org. • Report the incident to the North American Malignant Hyperthermia Registry at the Malignant Hyperthermia Association of the United States: (800) 644-9737.
A patient has undergone an 8-hour surgical procedure under general anesthesia. In assessing the patient for complications related to positioning, the nurse is most concerned with which finding?
Diminished peripheral pulses in the lower extremities Diminished peripheral pulses in the lower extremities indicate diminished blood flow. Decreased sensation; pale, cool extremities; and reddened areas over bony prominences can be normal occurrences in patients who have undergone a long surgical procedure. From IGGY: Preventing Injury Planning: Expected Outcomes. The patient is expected to be free of injury as indicated by: • Adequate capillary refill and peripheral pulses in all extremities • Sensory perception and motor function after surgery at the same level as before surgery • Absence of injury to the skin (redness, open skin areas, bruising, burns) • Absence of retained surgical items
A patient who was administered general anesthesia is experiencing malignant hyperthermia (MH). How does the nurse assist the surgical team? Select all that apply.
Ventilate the patient with 100% oxygen. Insert a Foley catheter to monitor urine output. Monitor core body temperature to assess the effectiveness of interventions. The nurse should ventilate the patient experiencing MH with 100% oxygen, using the highest possible flow rate to overcome the decrease in oxygen saturation. A Foley catheter should be inserted to monitor urine output and checked for the presence of blood or myoglobin. The patient should be administered iced saline (0.9% NaCl) IV at a rate of 15 mL/kg every 15 minutes as needed, and the core body temperature should be monitored to assess the effectiveness of the intervention. The patient does not need electric blankets during the onset of MH; there needs to be a reduction in body temperature. IV pain medication is not warranted in the setting of MH, as the scenario typically does not lead to pain. From IGGY: Emergency Care of the Patient With Malignant Hyperthermia • Stop all volatile inhalation anesthetic agents and succinylcholine. • If an endotracheal tube (ET) is not already in place, intubate immediately. • Ventilate the patient with 100% oxygen at the highest possible flow rate to flush anesthetics and lower end-tidal carbon dioxide. • Administer dantrolene sodium (Dantrium) IV at a dose of 2 to 3 mg/kg. Repeat as needed. • If possible, terminate surgery. If termination is not possible, maintain general anesthesia with IV anesthetic agents that do not trigger malignant hyperthermia (MH) (IV sedatives, narcotics, amnestics and nondepolarizing neuromuscular blockers). • Assess arterial blood gases (ABGs) and serum chemistries for metabolic acidosis and hyperkalemia. • If metabolic acidosis is evident by ABG analysis, administer sodium bicarbonate IV. • If hyperkalemia is present, administer 10 units of regular insulin in 50 mL of 50% dextrose IV. • Use active cooling techniques: • Administer iced saline (0.9% NaCl) IV at a rate of 15 mL/kg every 15 minutes as needed. • Apply a cooling blanket over the torso. • Pack bags of ice around the patient's axillae, groin, neck, and head. • Lavage the stomach, bladder, rectum, and open body cavities with sterile iced normal saline. • Insert a nasogastric tube and a rectal tube. • Monitor core body temperature to assess effectiveness of interventions and avoid hypothermia. • Monitor cardiac rhythm by electrocardiography (ECG) to assess for dysrhythmias. • Insert a Foley catheter to monitor urine output. • Treat any dysrhythmias that do not resolve on correction of hyperthermia and hyperkalemia with antidysrhythmic agents. Avoid calcium channel blockers. • Administer intravenous fluids at a rate and volume sufficient to maintain urine output above 2 mL/kg/hr. • Monitor urine for presence of blood or myoglobin. • If urine output falls below 2 mL/kg/hr, consider using osmotic or loop diuretics, depending on the patient's cardiac and kidney status. • Contact the Malignant Hyperthermia Association of the United States (MHAUS) hotline for more information regarding treatment: (800) 644-9737. • Transfer the patient to the intensive care unit (ICU) when stable. • Continue to monitor the patient's temperature, ECG, ABGs, electrolytes, creatine kinase, coagulation studies, and serum and urine myoglobin levels until they have remained normal for 24 hours. • Instruct the patient and family about testing for MH risk. • Refer the patient and family to the Malignant Hyperthermia Association of the United States at (800) 986-4287 or www.mhaus.org. • Report the incident to the North American Malignant Hyperthermia Registry at the Malignant Hyperthermia Association of the United States: (800) 644-9737.
A patient who is preparing to undergo a vaginal hysterectomy is concerned about being exposed. How does the nurse ensure that this patient's privacy will be maintained?
Ensure that drapes will minimize perianal exposure. Using drapes is the best action to take. Telling the patient that she will be asleep or explaining the procedure will not alleviate the patient's anxiety. The number of people involved in the procedure is not something the nurse can necessarily control.
A patient is scheduled to undergo minor plastic surgery. Which type of regional anesthesia does the nurse anticipate being used?
Field Block Field block anesthesia is most suitable for patients undergoing plastic surgery. In this type of anesthesia, a series of injections are given around the operative field. In spinal anesthesia, the anesthetic agent is injected in to the cerebrospinal fluid in the subarachnoid space in the patient. This is more suitable for abdominal, pelvic, hip, and knee surgeries. In epidural anesthesia, the anesthetic agent is injected in to the epidural space. It is most commonly used for anorectal, vaginal, perineal, hip, and lower extremity surgeries. In nerve block anesthesia, the anesthetic agent is injected into or around the nerve or group of nerves in the involved area; it is more suitable for limb surgery. From IGGY: Field block Series of injections around the operative field -Most commonly used for chest procedures, hernia repair, dental surgery, and some plastic surgeries Nerve block Injection of the local anesthetic agent into or around one nerve or group of nerves in the involved area -Most commonly used for limb surgery or to relieve chronic pain Spinal anesthesia Injection of an anesthetic agent into the cerebrospinal fluid in the subarachnoid space -Most commonly used for lower abdominal, pelvic, hip, and knee surgery Epidural anesthesia Injection of an agent into the epidural space (see Fig. 15-7) -Most commonly used for anorectal, vaginal, perineal, hip, and lower-extremity surgeries
The nurse is assisting an older patient scheduled for cataract surgery in the operating room. What patient item does the nurse retain until the patient receives anesthesia?
Hearing aid The nurse should retain the hearing aid until the patient receives anesthesia to allow for effective communication. Items such as rings, bracelets, and wristwatches may be removed and handed over to the family before the patient is taken to the holding area.
A patient diagnosed with malignant hyperthermia has a body temperature of 110° F. Which nursing interventions should be done to decrease the high body temperature? Select all that apply.
Place a cooling blanket over the torso of the patient Place ice packs around the patient's axilla, groin, neck, and head Administer iced normal saline intravenously at 15 mL/kg every 15 minutes The abnormally high temperatures caused by malignant hyperthermia can be minimized with the use of active cooling techniques. Placing a cooling blanket over the torso of the patient helps decrease the body temperature. Placing ice packs around the patient's axilla, groin, neck, and head is also an active cooling technique which helps decrease body temperature. Administering iced normal saline intravenously at 15 mL/kg every 15 minutes helps decrease the core body temperature. Administering antipyretics such as paracetamol parenterally may not be effective in decreasing body temperature. Administering loop diuretics to maintain the urine output also may not help decrease the body temperature.
What measure implemented in the operating room helps to prevent joint complications in the patient related to positioning during surgery?
Placing a pillow under bony prominences. In order to prevent any joint complications, the nurse can place a soft pillow below bony prominences. The extremities are placed in proper anatomical alignment. Covering the patient with blankets is necessary to make the patient comfortable, but does not affect the joints. Repositioning the patient frequently is necessary to avoid development of pressure ulcers. Similarly, if the patient must be moved, he or she should be lifted and not dragged; dragging can contribute to the development of pressure ulcers. From IGGY: *Prevention of Joint Complications (Stiffness, Pain, Inflammation, Limited Motion)* • Place a pillow or foam padding under bony prominences. • Maintain the patient's extremities in good anatomic alignment. • Slightly flex joints and support with pillows, trochanter rolls, or pads.
A patient with diabetes is undergoing abdominal surgery. In addition to regular sutures, which type of suture does the nurse expect the surgeon will likely use for this patient?
Retention sutures Because this patient is diabetic, he or she is at high risk for impaired wound healing. Retention (stay) sutures may be used in addition to standard sutures for patients who are diabetic, obese, taking steroids, or having major abdominal surgery. Interrupted sutures, staples, and tapes are common wound closures used for a variety of surgeries on patients who are not at high risk for impaired wound healing. From IGGY: Retention (stay) sutures may be used in addition to standard sutures for patients at high risk for impaired wound healing (obese patients, patients with diabetes, and those taking steroids).
What is the role of the scrub nurse in the operating room?
Set up a sterile table and drape the patient. For a smoothly functioning intraoperative setup, every person is given clearly defined roles and responsibilities. The scrub nurse sets up a sterile table and drapes the patient, taking care of all aseptic precautions. The scrub nurse is also responsible for handing out sterile equipment to the surgeon while performing surgery. The circulating nurse monitors the traffic in the room and records the blood and blood components given to the patient. The anesthesiologist is responsible for administering anesthesia. From IGGY: Provides patient care at the surgical field, assisting the surgeon and assistants; maintains the integrity, safety, and efficiency of the sterile field during the procedure Sets up the sterile field, hands up sterile instrumentation/equipment With the circulating nurse, maintains accurate count of sponges, sharps, and instruments and monitors the amount of irrigation fluid and medication used
Which is a complication that occurs only with local or regional anesthesia?
Systemic Absorption Systemic absorption of the anesthetic agent administered by local or regional routes causes complications related to central nervous system (CNS) stimulation followed by CNS and cardiac depression. Overdose is a common complication associated with both general and regional or local anesthesia. Patient sensitivity is a risk associated with both general and regional or local anesthesia. Intubation complications are related to general anesthesia. From IGGY: Complications of local or regional anesthesia are related to patient sensitivity to the anesthetic agent (anaphylaxis), incorrect delivery technique, systemic absorption, and overdose. Complications seen early after administration of a local anesthetic agent include edema and inflammation. Abscess formation, tissue necrosis, and/or gangrene may occur later. Abscesses result from contamination during injection of the agent. Necrosis and gangrene may occur as a result of prolonged blood vessel constriction in the injected area. Systemic toxicity of a local agent may result in adverse reactions in the central nervous and cardiovascular systems (Gmyrek & Elston, 2015). The nurse continually assesses for restlessness; excitement; incoherent speech; headache; blurred vision; metallic taste; nausea; tremors; seizures; and increased pulse, respiration, and blood pressure. Interventions include establishing an open airway, giving oxygen, and notifying the surgeon. Usually a fast-acting barbiturate is needed for treatment. If the toxic reaction is untreated, unconsciousness, hypotension, apnea, cardiac arrest, and death may result. Cardiac arrest may occur as a rare complication of spinal anesthesia. Epinephrine is given to prevent cardiac arrest in patients who develop sudden, unexplained bradycardia.
A student nurse is demonstrating the actions to be performed during the surgical scrub. Which action by the student nurse indicates the need for further teaching?
Washing hands with an antimicrobial soap after using the surgical scrub Hands should be washed with an antimicrobial soap immediately before, not after, using the surgical scrub to decrease the risk for infection. The members should enter the operating room only after scrubbing. Sterilized gowns, gloves, and materials should be used at the operative field to prevent infections. Hands should be folded in front of the body when not in use after donning scrubbed personnel attire in order to prevent contamination.
