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Chapter 18

Intraoperative Nursing
Management

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Members of the Surgical Team

Patient
Circulating nurse
Scrub role
Surgeon
Registered nurse first assistant
Anesthesiologist, anesthetist

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Question
Is the following statement true or false?
The circulating nurse is responsible for monitoring the
surgical team.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Answer
True
Rationale: The circulating nurse is responsible for
monitoring the surgical team.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Gerontologic Considerations
Older adult patients are at increased risk for
complications of surgery, anesthesia due to
Increased likelihood of coexisting conditions
Aging heart, pulmonary systems
Decreased homeostatic mechanisms
Changes in responses to drugs, anesthetic agents
due to aging changes (decreased renal function),
changes in body composition of fat, water

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Prevention of Infection
Surgical environment, refer to Figure 18-1
Unrestricted zone
Semirestricted zone
Restricted zone
Surgical asepsis
Environmental controls
Refer to Figure 18-2

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Basic Guidelines for Surgical Asepsis
All material within sterile field must be sterile
Gowns sterile in front from chest to level of sterile field,
sleeves from 2 inches above elbow to cuff
Only top of draped tables considered sterile
Items dispensed by methods to preserve sterility
Movements of surgical team are from sterile to sterile,
from unsterile to unsterile only

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Guidelines for Surgical Asepsis (contd)

Movement at least 1-foot distance from sterile field must


be maintained
When sterile barrier is breached, area is considered
contaminated
Every sterile field is constantly maintained, monitored
Items of doubtful sterility considered unsterile
Sterile fields prepared as close to time of use

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Surgical Team Roles
Circulating nurse
Scrub role
Surgeon
Registered nurse first assistant
Anesthesiologist, anesthetist
Note: Role of nurse as patient advocate
Refer to Chart 18-1

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Intraoperative Complications
Anesthesia awareness Hypothermia
Nausea, vomiting Malignant hyperthermia
Anaphylaxis Disseminated
intravascular coagulation
Hypoxia, respiratory (DIC)
complications
Infection

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Question
Is the following statement true or false?

The most frequent early sign for a patient at risk for


malignant hyperthermia subsequent to general anesthesia
is bradycardia.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Answer
False

Rationale: The most frequent early sign for a patient at risk


for malignant hyperthermia subsequent to general
anesthesia is tachycardia.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Adverse Effects of Surgery and Anesthesia
Allergic reactions, drug toxicity or reactions
Cardiac dysrhythmias
CNS changes, oversedation, undersedation
Trauma: laryngeal, oral, nerve, skin, including burns
Hypotension
Thrombosis
Refer to Chart 18-2

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Question

Through which route are general anesthetics primarily


eliminated?
A. Kidneys
B. Liver
C. Lungs
D. Skin

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Answer
C. Lungs

Rationale: The lungs are the primary route from which


general anesthetics are eliminated from the body.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Comparison of Anesthetic Agents and
Delivery Systems
General
Inhalation: Refer to Table 181; Figure 18-3 (A, B, C)
Intravenous: Refer to Table 18-2
Regional: Refer to Table 18-3
Epidural: Refer to Figure 18-4
Spinal: Refer to Figure 18-4

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Nursing Process: Interventions
Reducing anxiety
Reducing latex exposure
Preventing positioning injuries, refer to Figure 18-5
Protecting patient from injury
Serving as patient advocate
Monitoring, managing potential complications

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Laparotomy Position, Trendelenburg
Position, Lithotomy Position and Side-Lying
Position for Kidney Surgery

Fig. 18-5

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Positioning Factors to Consider
Patient should be as comfortable as possible
Operative field must be adequately exposed
Position must not obstruct/compress respirations,
vascular supply, or nerves
Extra safety precautions for older adults, patients who
are thin or obese, and anyone with a physical deformity
Light restraint before induction in case of excitement

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


Protecting the Patient From Injury

Patient identification Monitoring, modifying


physical environment
Correct informed consent
Safety measures
Verification of records of (grounding of equipment,
health history, exam restraints, not leaving a
sedated patient)
Results of diagnostic tests
Verification, accessibility
Allergies (include latex of blood
allergy)

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins