-
what is SCIP
focused on improving surgical care by reducing the number of complications from surgery
-
NPSG require
a pre procedure verification processes
-
whats included in the NPSGs pre procedure verification
- -relevant document
- -blood products, implants, devices and special equipment to be available
- -results: diagnostic studies included
- -surgeon must mark site with pt involvment
-
periop nurse
- prep or
- first to meet pt
- pt advocate
- asses
- comfort
- sterile or unsterile
-
circulating nurse
- unsterile
- drops stuff on sterile field
- document
- do not give meds
- coord w teams
- count w scrub rn
- surgical time out
- pt advocate
-
scrub nurse
- sterile and remain sterile
- counts equipment
- pass instruments
- guard sterile field
- doesn't have to be an rn
-
surgical time out
- - id pt
- - id procedure
- - id body part
-
positioning pt
- prevent occlusion of arteries and veins
- prevent injury
- secure extremitites
- padding and support
-
the first assistant role
- another surgeon
- PA
- RN first assistant
- sterile
- under direct supervision of surgeon
-
-
anesthesia care teams role
- monitor airway
- vitals
- meds
- NOT STERILE
- may put in central line
-
meds to ask about
- anticoagulants
- antihypertensive
- herbal supplements
- pain meds
- blood thinners
-
pre op pre induction
- -npo
- -hold meds
- -AB, aniseizure meds may be given
- -consent and pre op checklist
- -iv
- assesment
-
pre op checklist
- teach
- consent
- npo
- gown
- allergy and id band
- no jewlry
- voided
- pre op meds
- vitals
- no contacts
-
vitals are to be done within ___ hs of surery or __ after
-
PACU
- airway
- bleeding
- manage pain
- n/v
- restless
- laryngo/brocho spasm
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general anesthesia is administered by
- inhale
- iv
- adjuncts to anesthesia
- dissociative anesthesia
-
general anesthesia advantages
-
general anesthesia defined
- unconscious
- loss of sensation with loss of conscious
- eliminate cns(cough, gag)
-
general anesthesia disadvantage
- aspiration
- break teeth
- sore throat
- damage vocal cords
- long recovery
- elderly
- medically complicated pt
-
general anesthesia phases
- preinduction
- induction
- maintenance
- emergence
-
preinduction
- initiate iv
- admin pre op drugs
-
-
-
emergence
- reversal agents
- monitor for complication
- procedure complete
-
Monitored anesthesia care
- similar to general
- sedative, anxiolytic, analgesic
- no inhalation gases
- for someone that cant have general
- minor procedures
-
moderate sedation
- pt conscious
- decreased awareness
- able to respond to verbal and physical stimuli
- pt will forget after
-
moderate sedation used for
- cath lab
- colonoscopy
- planned procedures
- rn can give
-
moderate sedation drugs
-combo or opioids and benzos(fentanyl and versad)
-
local anesthesia
- topical:lidocaine
- fully awake
- minor procedures
-
regional anesthesisa(block)
- spinal and epidural blocks
- implantable pumps
- often used with MACs
-
regional anesthesisa(block) can cause
-
spinal blocks
- local
- injected into CSF in the subarachnoid space
-
epidural blocks
- local
- injected into epidural extradural space through the thoracic or lumbar approach
- -10 -20 to work
- -can cause headaches
-
PCA
- -immediate analgesia
- -constant, steady blood level of analgesic agent
-
PCA meds
- morphine sulfate
- dilaudid
- in ICU could be ativan
-
anaphylactic reactions
most severe form of an allergic reaction
-
anaphylactic reactions S/S
- -pulmonary and circulation
- -hypotension
- -tachycardia
- -bronchospasm
- -pulmonary edema
-
anaphylactic reactions tip
may be masked my anesthesia
-
anaphylactic reactions interventions
vigilaince and rapid
-
malignant hyperthermia signs
- tachycardia
- tachypnea
- muscle contracture
- hyperthermia
- hemodynamic and cardiac alterations
- lactic acidosis
-
malignant hyperthermia complications
- cardiac arrest
- renal failure
- DIC
- hemorrhage
- liver failure
- brain injury
-
malignant hyperthermia treatment
dantrium(dantrolene)
-
safe anesthetics for MH
- locals
- nitrous oxide
- barbs
- narcs
- propofol
- benzo
- ketamine
- etomidate
-
post op assessment for complications
- pulmonary
- cardiac
- renal/gu
- gi
- hypovolemia/shock
- hemmorrage
- hypothermia
- emergence delirium
- woundss
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