Chapt 19
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Chapter 19 Intraoperative Nursing Management
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Members of the Surgical Team • Patient • Anesthesiologist or anesthetist • Surgeon • Nursing • Surgical technologists
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prevention of Infection • The surgical environment – Unrestricted zone – Semirestricted zone – Restricted zone • Surgical asepsis • Environmental controls
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Basic Guidelines for Surgical Asepsis • All materials in contact with the wound and within the sterile field must be sterile. • Gowns are sterile in the front from chest to the level of the sterile field, and sleeves from 2 inches above the elbow to the cuff. • Only the top of a draped table is considered sterile. During draping, the drape is held well above the area and is placed from front to back. • Items are dispensed by methods to preserve sterility. • Movements of the surgical team are from sterile to sterile and from unsterile to sterile only. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Basic Guidelines for Surgical Asepsis • Movement around the sterile field must not cause contamination of the field. At least a 1-foot distance from the sterile field must be maintained. • Whenever a sterile barrier is breached, the area is considered contaminated. • Every sterile field is constantly maintained and monitored. Items of doubtful sterility are considered unsterile. • Sterile fields are prepared as close as possible to time of use. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Tell whether the following statement is true or false. To maintain surgical asepsis, the nurse knows that the sides and top of a draped table is considered sterile.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer False. Rationale: Sterile drapes are used to create a sterile field. Only the top surface of a draped table is considered sterile. During draping of a table or patient, the sterile drape is held well above the surface to be covered and is positioned from front to back.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Roles of the Members of the Surgical Team • Circulating nurse • Scrub role • Surgeon • Registered nurse first assistant • Anesthesiologist and anesthetist • Note: Role of the nurse as patient advocate
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intraoperative Complications • Nausea and vomiting • Anaphylaxis • Hypoxia and respiratory complications • Hypothermia • Malignant hyperthermia • Disseminated intravascular coagulation (DIC)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Malignant hyperthermia usually manifests within what time frame after induction of anesthesia? b. 5 minutes c. 10–20 minutes d. 30 minutes e. 45 minutes
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer a. 10–20 minutes Rationale: Malignant hyperthermia usually manifests about 10 to 20 minutes after induction of anesthesia. It can also occur during the first 24 hours after surgery.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Potential Adverse Effects of Surgery and Anesthesia • Allergic reactions and drug toxicity or reactions • Cardiac dysrhythmias • CNS changes and oversedation or undersedation • Trauma: laryngeal, oral, nerve, and skin, including burns • Hypotension • Thrombosis • Refer to Chart 19-1
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gerontologic Considerations • Elderly patients are at increased risk for complications due to surgery and anesthesia because of: – Increased likelihood of coexisting conditions. – Aging heart and pulmonary systems. – Decreased homeostatic mechanisms. – Changes in responses to drugs and anesthetic agents due to aging changes such as decreased renal function, and changes in body composition of fat and water. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Goals for the Patient in the Intraoperative Period • Reducing anxiety • Preventing positioning injuries • Maintaining patient safety • Maintaining the patient's dignity • Avoiding complications
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Tell whether the following statement is true or false. Spinal anesthesia is introduced into the subarachnoid space at the level of L4 and L5.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer True. Rationale: Spinal anesthesia is an extensive conduction nerve block that is produced when a local anesthetic is introduced into the subarachnoid space at the lumbar level, usually between L4 and L5.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Laparotomy Position, Trendelenburg Position, Lithotomy Position, and Sidelying Position for Kidney Surgery
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Protecting the Patient from Injury • Patient identification • Correct informed consent • Verification of records of health history and exam • Results of diagnostic tests • Allergies (include latex allergy) • Monitoring and modifying the physical environment • Safety measures such as grounding of equipment, restraints, and not leaving a sedated patient • Verification and accessibility of blood Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Members of the Surgical Team • Patient • Anesthesiologist or anesthetist • Surgeon • Nursing • Surgical technologists
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prevention of Infection • The surgical environment – Unrestricted zone – Semirestricted zone – Restricted zone • Surgical asepsis • Environmental controls
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Basic Guidelines for Surgical Asepsis • All materials in contact with the wound and within the sterile field must be sterile. • Gowns are sterile in the front from chest to the level of the sterile field, and sleeves from 2 inches above the elbow to the cuff. • Only the top of a draped table is considered sterile. During draping, the drape is held well above the area and is placed from front to back. • Items are dispensed by methods to preserve sterility. • Movements of the surgical team are from sterile to sterile and from unsterile to sterile only. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Basic Guidelines for Surgical Asepsis • Movement around the sterile field must not cause contamination of the field. At least a 1-foot distance from the sterile field must be maintained. • Whenever a sterile barrier is breached, the area is considered contaminated. • Every sterile field is constantly maintained and monitored. Items of doubtful sterility are considered unsterile. • Sterile fields are prepared as close as possible to time of use. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Tell whether the following statement is true or false. To maintain surgical asepsis, the nurse knows that the sides and top of a draped table is considered sterile.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer False. Rationale: Sterile drapes are used to create a sterile field. Only the top surface of a draped table is considered sterile. During draping of a table or patient, the sterile drape is held well above the surface to be covered and is positioned from front to back.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Roles of the Members of the Surgical Team • Circulating nurse • Scrub role • Surgeon • Registered nurse first assistant • Anesthesiologist and anesthetist • Note: Role of the nurse as patient advocate
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intraoperative Complications • Nausea and vomiting • Anaphylaxis • Hypoxia and respiratory complications • Hypothermia • Malignant hyperthermia • Disseminated intravascular coagulation (DIC)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Malignant hyperthermia usually manifests within what time frame after induction of anesthesia? b. 5 minutes c. 10–20 minutes d. 30 minutes e. 45 minutes
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer a. 10–20 minutes Rationale: Malignant hyperthermia usually manifests about 10 to 20 minutes after induction of anesthesia. It can also occur during the first 24 hours after surgery.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Potential Adverse Effects of Surgery and Anesthesia • Allergic reactions and drug toxicity or reactions • Cardiac dysrhythmias • CNS changes and oversedation or undersedation • Trauma: laryngeal, oral, nerve, and skin, including burns • Hypotension • Thrombosis • Refer to Chart 19-1
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gerontologic Considerations • Elderly patients are at increased risk for complications due to surgery and anesthesia because of: – Increased likelihood of coexisting conditions. – Aging heart and pulmonary systems. – Decreased homeostatic mechanisms. – Changes in responses to drugs and anesthetic agents due to aging changes such as decreased renal function, and changes in body composition of fat and water. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Goals for the Patient in the Intraoperative Period • Reducing anxiety • Preventing positioning injuries • Maintaining patient safety • Maintaining the patient's dignity • Avoiding complications
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Tell whether the following statement is true or false. Spinal anesthesia is introduced into the subarachnoid space at the level of L4 and L5.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer True. Rationale: Spinal anesthesia is an extensive conduction nerve block that is produced when a local anesthetic is introduced into the subarachnoid space at the lumbar level, usually between L4 and L5.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Laparotomy Position, Trendelenburg Position, Lithotomy Position, and Sidelying Position for Kidney Surgery
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Protecting the Patient from Injury • Patient identification • Correct informed consent • Verification of records of health history and exam • Results of diagnostic tests • Allergies (include latex allergy) • Monitoring and modifying the physical environment • Safety measures such as grounding of equipment, restraints, and not leaving a sedated patient • Verification and accessibility of blood Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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