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tville01
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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.
Conscious/Moderate sedation
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Which sedation can a credentialed nurse perform under physician supervision
Conscious sedation
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What is used to monitor the levels of sedation
Ramsay's scale
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Which nurse sets up the sterile field, hands tools to surgeon, and helps in counting sponges,instruments, and needles
Scrub nurse(usually surgical tech)
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Which nurse does the preop work and transfers the pt
holding area nurse
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which 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
-Updates family
-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
Circulating Nurse
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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.
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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
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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
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How can pressure ulcers develop during surgery
reduced bloodflow and effects of general anesthesia on peripheral circulation
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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
- anesthesiologist
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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
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Care that:
-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
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