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What anethesia is:
-Given IV,PO, or IM to decrease level of consciousness (LOC) but maintain airway and respond to commands.
-May use opioids, sedatives, anxiolytics, and hypnotics. Midazolam (Versed) and Fentanyl are a common combination used in IV sedation.
Which sedation can a credentialed nurse perform under physician supervision
What is used to monitor the levels of sedation
Which nurse sets up the sterile field, hands tools to surgeon, and helps in counting sponges,instruments, and needles
Scrub nurse(usually surgical tech)
Which nurse does the preop work and transfers the pt
holding area nurse
-Ensures “time out” is before surgery
-helps with induction of anesthesia and intubation
-helps place invasive monitoring lines if needed
-Monitors OR traffic
-Gathers and sets up supplies
-Ensures sterile field/ technique integrity
-Ensures all counts are done and correct
-Completes documentation and charging for all used supplies
-Calls report to unit receiving patient following surgery
-May be pre-op area, PACU or inpatient unit
During the Intraoperative stage of surgery what assessments should the RN make
- Review history and physical exam
- verify pt.
- note allergies, medications, any
- problems with anesthesia or transfusions.
- Check labs and diagnostic test results.
- Verify that appropriate consents are signed
- emotional support.
- Explain procedures, what to expect.
During the Intraoperative stage of surgery what interventions and plans need to be made
- Skin prep –in OR using aseptic technique
- Start IV if not already done.
- Position patient and pad appropriately.
- Coordinate pt transfers
- Administer prophylactic antibiotics.
- Apply grounding pads (cautery).
- Protect against cross contamination – limit OR traffic, maintain sterile field integrity.
- Monitor/document VS, and O2 saturation if pt is under conscious sedation
What are some risk factors for intraoperative patient injury
- -Positioning(correct joint alignment, aware of patient history of joint issues)
- -Preventing pressure areas
- -Impingement on peripheral nerves and blood vessels and even the patient’s airway, depending on body positioning
- -Skin and tissue integrity impairment must be monitored involving choice of surgical
- body draping, types of tissue closures, dressings, how drains are inserted, and
- even how gently the patient is transferred from one “bed” to the next
- -Intraoperative hypoventilation
How can pressure ulcers develop during surgery
reduced bloodflow and effects of general anesthesia on peripheral circulation
Who is responsible to ensure the patient
has continuous monitoring of breathing, central and peripheral blood circulation and close monitoring of heart rhythm and rate, and blood pressure*It is mandatory that
someone is in continuous assessment of these factors during a surgical event*
- Surgical nurse
What happens if hypoventilation occurs
- -prolonged intubation, possibly ventilation postoperatively
- -Intensive care nursing may be required
- -pt could experience a cardiac/respiratory arrest for up to 2 weeks postoperatively
-Starts in the PACU
-focus on immediate postop patient stabilization
-nurses are highly skilled in both Med/Surg and Intensive Care Nursing
Postop nursing care