Surgeon assistant- holds retractors to expose areas, assists w/ homeostasis and suturing
Registered Nurse First Assistant (RNFA)
collaborates with surgeon to produce optimal outcome- handles tissues, using instruments, providing exposure to the surgical site, assists with homeostasis, and suturing
formal education required
Anesthesia Care Provider (ACP)
administers anesthesia - (anethesiologist or nurse anesthetist
assigns anesthesia classification
protects life functions and vital organs
manages pain, CPR, problems with pulmonary care, critically ill pts in special care units
after surgery-maintain pt in comfortable state during recovery and provision of care in PACU
Specific questions regarding to the details of the surgical procedure and anethesia may be referred to:
the surgeon or ACP
Preoperative nursing assessments that decrease surgical risk factors:
Allergies- prevent catastrophic reactions
skeletal/muscle impairments- prevent injury during positioning
presence of piercings- remove to prevent site burns with electrosurgery
sensory deficits- adapting communication techniques
altered LOC- increased safety/protection measures
NPO status- aspiration
sources of pain- prevent unnecessary discomfort
medications, herbs, supplements- alterations with anesthesia
Surgical attire
pants and shirt
mask
protective eyewear
caps/hoods
worn by all entering the OR
Universal Protocol
preventing wrong site, wrong procedure, and wrong surgery
safety checklists
surgical time-out-surgicall team stops what they are doing just before surgery starts to verify identification of pt, surgical procedure, and surgical site
Most common position used
supine
Antimicrobial agents need to:
reduce microorganisms on intact skin
nonirritating antimicrobial agent
broad spectrum
fast acting
persistant
nonallergenic
circular motion
Monitored anesthesia care (Conscious Sedation)
mode of delivery that facilitates the transition from inpatient recovery to early discharge
used with local or regional anesthesia for procedures outsite OR
Registered nurses with training can administer this type under direct supervision of a physician
relieves anxiety, provides analgesia and amnesia
pts remain responsive and breathe w/o assistance
Choice of anesthetic
responsibility of ACP
factors considered:
pts current physical, mental, and emotional status
allergy and pain hx
expertise of the ACP
length, site, discharge plans
contraindications: pt refusal
General Anesthesia
induced via IV(mainly)or inhalation & maintained by either 1 or a combo of the 2
a balanced technique-using adjunctive drugs to complement the induction
loss of sensation to a region of the body w/o loss of cosciousness
local anesthesia injected into a central nerve or group of nerves that innervate a site remote to the point of injection
Local anesthesia
loss of sensation without loss of consciousness
alters the flow of sodium into nerve cells thru cell membranes
Ketamine(Ketalar)
commonly administered dissociative anesthetic
potent analgesic and amnesic
used in asthmatic pts bc promotes bronchodilation
increases heart rate to help with cardiac function in trauma pts
PCP derivative-causes hallucinations and nightmares
concurrent use of midazolam(Versed) reduces or eliminates hallucinations
Spinal Anesthesia
injection of a local anesthetic into the cerebrospinal fluid found in the subarachnoid space, usually below the level of L2
produces autonomic, sensory, and motor blockade
epidural block
injection of a local anesthetic into the epidural space via a thoracic or lumbar approach
sensory pathways are blocked but motor fibers remain intact
observe for hypotension, bradycardia, nausea, vomiting
eldery patient considerations
onset, peak, and duration of medications are greatly altered- should be titrated
blood and fluid loss and replacement
hypothermia
pain
tolerance to surgical procedure and positioning
Malignant Hyperthermia
rare disorder characterized with rigidity of skeletal muscles that can result in death
increase in body temp is not an early sign
succinylcholine(Anectine)- primary trigger
other factors- stress, trauma, heat
caused by calcium not leaving the cell
TX- prompt administration of dantrolene (Dantrium)
Holding area
admission, observation, and discharge (AOD) area
waiting area inside surgical suite
identify and assess pt here b4 transfer to OR
minor procedures performed here-i.e. IV insertion, arterial lines, cast removal
Admitting the pt
reassess pt and answer ?'s
review chart for any changes
? last intake status
ensure correct pre-op med was given
cover pts hair to prevent shedding
prophylactic antibiotic given 30-60min before incision
remove hair around incision site
Postioning the pt
ACP indicates when to position
musculoskeletal alignment
no undue pressure on nerves, skin over bony prominences, earlobes, eyes
adequate thoracic excursion
no occlusion of arteries, veins
modesty
respect individual needs, i.e. aches pain
(True/False)
The American Society of Anesthesiologists (ASA) physical status classification is based on the physiologic status of the patient with no regard to the surgical procedure to be performed.
True
Type of anesthesia used for procedures outside the OR
local or regional with MAC
Adjuncts
drugs added to an anesthetic
to achieve unconsciousness, analgesia, amnesia, muscle relaxation, or ANS control
Nursing role during the Preinduction Phase of general anesthesia
complete pre-op assess.
confirm operative permits
complete "time-out"
Nursing role during the Induction Phase of general anesthesia
Assist with applying monitoring devices
assist with airway mgmt
Nursing role during the Maintenance Phase of general anesthesia
Adust pt position PRN
monitor pt safety
Nursing role during the Emergence Phase of general anesthesia
Assist in placement of dressing
protect pt during full return of reflexes
prep pt for move to PACU
Disadvantages to local and regional anesthetics
inadvertent vascular injection leading to refractory hypotension
dysrhythmias
inability to precisely match duration of action to duration of procedure
Insulin
controls hyperglycemia
stimulates glucose uptake
inhibits glucose production
use cautiously in:renal/hepatic impairment. stress, infection
can cause: hypoglycemia
beta-blockers-may mask signs of hypoglycemia
corticosteroids-increase insulin requirements
Narcan
an antidote for opioids
reverses CNS depression and respiratory depression
onset 1-5minutes, duration 45min
use cautiously in: cardiovacular disease
may cause: ventricular arrhythmias, hyper/hypotension
assess respirations, PR, BP, and LOC after admin
used to treat resp. depression but also reverses analgesia
(midazolam) Versed
benzodiazepine
*induces amnesia effect
reduces anxiety pre/post-op
induce and maintain anesthesia
treat emergence delirium
supplement sedation in local & regional anesthesia
adverse effects: synergistic effect with opioids, increased risk for resp. depression, hypotension, tachycardia, prolonged sedation/confusion
interventions: monitor LOC, assess for mentioned adverse effects
(enoxaparin) Lovenox
anticoagulant
prevents DVT and pulmonary embolism
use cautiously in: malignancy, ulcer disease, kidney/liver disease, bleeding disorders
causes: bleeding, anemia, dizzyness
interventions: assess for signs of bleeding to include fall in BP or Hct
morphine sulfate
Opioid
induce and maintain anethesia, reduce stimuli from sensory nerves, analgesia during/after surgery
adverse effects: resp. depression, stimulation of vomiting, bradycardia, peripheral vasodilation, hypotension, constipation
interventions: assess respirations, SpO2, protect airway, may need to give antiemetic
