Intraoperative Patient Care

Pregunta	Respuesta
Intraoperative nursing definition	"behind the blue line" nursing responsibilities anaesthesia positioning documentation
What does the OR RN DO?	responsibilities pre-anesthesia holding room - PAHR operating room (OR) Post anaesthesia care unit (PACU)
In the holding room	introduce self check correct patient check charts (history, physical, orders, consent, ACR, surg checklist, sign it
Getting ready to go to the OR	warm blankets allow time for goodbyes once family gone to waiting room - go over sensitive information in waiting room
Are we ready?	preparing the perioperative environment - patient safety - staff safety - hazard management - advocacy role - maintaining dignity and modesty
Environmental preparation	checking of periop area self-check functional checks visual checks
Why do we check?	preparation, safe patient management and outcome, saves time, ensures equipment, saves hassle
What to check?	enough staff knowledge of procedures know what their role is going to be, what are they able to undertake dressed appropriately- prevent transmission of organisms from you to patient equipment, working order, sterile
When to undertake checking?	at least one day prior to surgery commencement of each day start of list between cases
Supplies from outside organisation	check availability, organise loan, arrange for it to arrive in timely matter time to check equipment before/after Time to sterile equipment
Checking other areas	Anaesthetics day surgery units operating room patient reception areas postanaesthetic recovery units
What to check?	Equipment anaesthetic machine oxygen and suction outlets Gas supply (main) (multegas alarm system) Suction (all units) operating light operating table, parts attached, brakes on equipment diathermy, ESU microscope/camera system Instruments defibrillator machine (2 people) emergency system supplies- scrub brushes, masks, gloves skin prep, trolleys, dressings, sutures, rubbish bags, linen bags IV fluids, syringes, IV cannulas, tape, ETTs, airways environmenta cleanliness, rationale, reduce airborne contaminants
What is this dictated by?	ACORN 2010 S6 'environmental management' Hospital policies and procedures cleaning protocols microbiological controls done after any renovation work, air con maintenance, yearly (infection control)
What to use? environmental cleanliness	soap and water - lint free cloth Bleach - diluted - for body fluids clean equipment used for each patient floor- when visibly soiled? sharps - dispose in yellow bins
What to check?	terminal cleaning at end of day reduce number of microorganisms, dust, lint, reduce potential sources of infection all areas within theatre room - booms, wheels, trolley casters, hallways, other rooms etc hospital policy is it a legal requirement as a duty of care to our patients
The OR before the client gets there nursing responsibilites	preparation setup open instruments aseptically preference card checklist -make sure everything is there, equipment, instruments, drugs scrub surgical scrub technician in count anaesthesia setup set up the bed specimen jars warm blankets
In the OR - RN responsibilities	-take client from PAHR to OR introduction to everyone in room anesthesia provider (formal title) surgical team members anaethetic nurse -position for anaesthesia move client to OR table warm blankets hook up to monitor provide support and reassurance stay with client make sure room is quiet
anesthesia types	general conscious sedation (MAC) spinal epidural local
General anesthesia	induction - intubation, gases, IV maintenance - keeping client unconscious reversal/wakeup - extubation, airway maintenance
Conscious sedation (MAC)	Used for scopic cases, podiatry, and ports induction - IV loading dose, no intubation, often oxygen Maintenance - small top-up doses, natural state of sleep Wakeup - natural wakeup process
spinal and epidural	spinal - pain control, local anaesthetic, intrathecal space, total block of sensation epidural - pain control, local anaeathetic, epidural space
Local anaesthesia	The 'caine' family dermatomes lidocaine bupivacaine with or without adrenaline
In surgery - RN responsibilities	positioning, foley, SCD stockings, shave, skin prep, time out
Foley	catherisation - any allergies, for procedure only, or kept in longer, temp sensing, hourly bag
SCD stockings	DVT prophylaxis, size, operative site, any contraindications
skin prep	shave,site area, clipper, site of surgery, ACORN standard recommendations, preference card, HCF protocol
Time out	WHO directions team work communication
Positioning in detail	to achieve optimum exposure during operative procecure maintenance of patient's airway access to monitoring devices and intravenous lines maintenance of physiological and anatomically safe patient
Factors to consider with positioning	surgical procedure the surgeons preference anaesthetists requirements patient's privacy physiological effects of positioning on anaesthesised and awake patient knowledge of anatomical structures
Positioning definitions	inferior or caudal - foot of the body Medial - structure nearest to the midline Abduction - movement or extremity away from midline eversion - being turned or rotated outward pronation - turning of part so that it faces downward
Skeletal anatomy - bony prominences	may cause pressure on overly tissues external pressure from positioning devices, staff, equipment can also damage blood vessels, nerves, supporting tissues prominences - ridges, crests, tubercles, trochanters, spines, condyles etc
Skeletal anatomy	muscles relax under anaesthesia joints at risk of injury - abnormal range of movement pain and pressure receptors depressed, muscle tone lost anatomical position avoid undue stress and strain
neural anatomy	nerve damage common complication from positioning longer and more superficial the nerve, the greater the change of damage principle cause of injury is ischaemia associated with stretching and compression of nerve radial nerve - hand grip and use medial nerve - forearm muscles, hand deformity ulnar nerve - claw deformity of fingers sciatic nerve - pain, muscle, paralysis foot drop common peroneal nerve - foot drop tibial nerve - calf muscles, numb skin
Vascular system	hypotension results from changes in position anaesthesia dilates vessels - pooling, decreasing circulatory blood volume positioning therefore must be down slowly
Why do you position a pregnant women on her side and which side?	the uterus pressing on the vena cava can restrict blood flow resulting in low blood pressure and decreased cardiac output left lateral - with wedge, sandbag under her right hip
Vascular system	deep superficial vessels of lower extremities - femoral, popliteal, anterior, posterior tibial, peroneal artieries external lliac artery - lithotomy - pressure from thighs against abdomen subclavian and axillary arteries - injured by hyperabduction of arm
Lithotomy position why should legs be raised and lowered slowly and simultaneously?	raised to compensate for increased venous return lowered - 500 to 600mls, venous blood return to legs thus drop in blood pressure * lower over 2 minutes is recommended
respiratory system What occurs when the patient is put into trendelenburg position?	vital capacity is diminished due to pressure of the abdominal contents against the diaphragm, lung expansion is restricted more pronounced in obese patients potential for aspiration when returned to supine, because of accumulation of secretions in the hypopharynx risk of atelectasis
Prone position- respiratory system	restricted diaphragm movement - limits tidal volume positioned with devices to allow for unrestrained abdominal movement
Respiratory system - lateral position	vital capacity reduced due to pressure on the lower chest wall chest movement and lung expansion limited pooling of secretions in the dependent lung, potential for atelectasis
Integumentary system	skin over bony prominences is thin with little subcutaneous tissue when compressed, blood flow is restricted pathophysiology of a decubitus ulcer formation - cycle of pressure, ischaemia, necrosis
pressure ulcers	amount and duration of pressure greater than blood pressure - ischaemia and necrosis develop duration of pressure more important than intensity procedure longer than 2-3 hours, increased risk
positioning probelm - shear forces	shearing occurs when body tissue layers move on eachother - reverse trendelenburg
Risk of complications	smokers to within 1 month of surgery very thin severely obese presence of diabetic or vascular disease cardiac, respiratory, intracranial pathology, worse with head down tilt chronic disease state
patient assessment	skin preoperative, intra, post reddened areas, turgor, integrity document any reddened areas and reasses
Supine position	arm should not be abducted more than 90 degrees if arms by sides, pressure should not be put on the styloid process arthritic patient - raise bed head, pillow under knees
relevance for recovery	knowledge of the position used and effect on patients -haemodynamic state respiratory function neurologic function report any reddened areas - if patient unable to control limb movement
Positioning within recovery	positions used - supine, head at top of mattress -lateral -jacknife -surgical requirements patient requirements - bed of barouche positioning requirements - top of bottom
All staff duty of care	must ensure patient is positioned with care, dignity, normal body alignment, all pressure points are padded, patient is monitored throughout the operation for movement, documentation
role of instrument nurse	check for adequate supplies and instruments have availables knowledge of procedure and process of how it will progress communication with surgeon for possible variations
The sterile field	gowning, gloving, setup trolley, counting, maintenance of field, getting others scrubbed, prepping, draping, getting started
In surgery - RN responsibilites after incision	documentation - who is present, what did we do, did we place any devices on clients skin, did we irrigate, did we implant, safety and supports in place for positioning specimen, asepsis maintained, communication with scrub nurse, counts, dressings
Other issues	medications, sharps safety, electrical, radiation, laser safety, latex allergies precautions, transmission based precautions
Once surgery is complete	dressings have been applied extubation wakeup move client back to stretcher -safety take client to PACU with anasthesia provider
RN responsibilities in PACU	help PACU staff hook up to oxygen help PACU staff hook up to monitors airway management wound site preservation report document and agree on handover time
After leaving PACU - RN responsibilities	take care of specimens, change over room, set up for next case
Rn responsibilities of the OR	safety +++ assessment, diagnosis, planning, implementation, evaluation, documentation, supervision, client advocate

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	Creado por Elizabeth Then hace más de 6 años