Intra-operative nursing

Nursing members of the surgical team Circulating nurse Highly experienced nurse who co-ordinates lots of activities before, during and after a surgical procedure. Also known as a scout nurse.  The circulating nurse oversees the physical aspects of the operating room - including equipment. Assists with transferring and positioning the patient. Prepares the patient's skin.  Records the surgical count of all accountable items. Responsible for documenting all intraoperative nursing activities.   Instrument nurse primarily involves technical skills, manual dexterity and in-depth knowledge of the anatomical and mechanical aspects of the surgery. Handles sutures, instruments and other equipment immediately adjacent to the sterile field.    PACU nurses are part of the surgical team and are responsible for assessing, monitoring and implementing care of people during recovery from anaesthesia.

Primary assessment

Modified Aldrete Scale

How is it decided if a patient is ready to be discharged from the PARU? Patient must have a score of more than 9 on the mod. Aldrete score to return to the ward. Mod. Aldrete score SpO2 At least 92% on room air [RA] (2) Above 90% on oxygen (1) Less than 90 on O2 (0) Consciousness Fully awake (2) Responds when woken (1) Unconscious (0) Respiration Breathing deeply and coughs freely (2) Dyspnoeic, shallow or limited breathing (1) Apnoea (0) Blood Pressure BP +/- 20 mmhg normal (2) BP +/- 50 mmhg normal (1) BP > +/- 50 mmHg normal (0 Activity Moves all extremities (2) Moves two extremities (1) Can't move extremities (0)

Time-out

Prior to surgery this WHO procedure helps to reduce surgical errors  Briefing - ensure everyone is aware of roles and goal assoc. with surgery Sign in- Identify patient, allergies, written consent, blood transfusion requirements, equip needed Time out- double checking everything, patient, surgery etc.  Checking staff presence and roles - IMPORTANT - ensure that antibiotics have been given 30 mins prior MINIMUM Sign out - confirmation of return of instruments, supply and equip, finalise meds req'd post-operatively