Fichas
Intraoperative Patient Care
Fichas del conjunto (57)
- 1Intraoperative nursing definition"behind the blue line"
nursing responsibilities
anaesthesia
positioning
documentation - 2What does the OR RN DO?responsibilities
pre-anesthesia holding room - PAHR
operating room (OR)
Post anaesthesia care unit (PACU) - 3In the holding roomintroduce self
check correct patient
check charts (history, physical, orders, consent, ACR, surg checklist, sign it - 4Getting ready to go to the ORwarm blankets
allow time for goodbyes
once family gone to waiting room - go over sensitive information in waiting room - 5Are we ready?preparing the perioperative environment
- patient safety
- staff safety
- hazard management
- advocacy role
- maintaining dignity and modesty - 6Environmental preparationchecking of periop area
self-check
functional checks
visual checks - 7Why do we check?preparation, safe patient management and outcome, saves time, ensures equipment, saves hassle
- 8What 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 - 9When to undertake checking?at least one day prior to surgery
commencement of each day
start of list
between cases - 10Supplies from outside organisationcheck availability, organise loan, arrange for it to arrive in timely matter
time to check equipment before/after
Time to sterile equipment - 11Checking other areasAnaesthetics
day surgery units
operating room
patient reception areas
postanaesthetic recovery units - 12What 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 - 13What 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) - 14What to use? environmental cleanlinesssoap 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 - 15What 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 - 16The OR before the client gets there nursing responsibilitespreparation
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 - 17In 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 - 18anesthesia typesgeneral
conscious sedation (MAC)
spinal
epidural
local - 19General anesthesiainduction - intubation, gases, IV
maintenance - keeping client unconscious
reversal/wakeup - extubation, airway maintenance - 20Conscious 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 - 21spinal and epiduralspinal - pain control, local anaesthetic, intrathecal space, total block of sensation
epidural - pain control, local anaeathetic, epidural space - 22Local anaesthesiaThe 'caine' family
dermatomes
lidocaine
bupivacaine
with or without adrenaline - 23In surgery - RN responsibilitiespositioning, foley, SCD stockings, shave, skin prep, time out
- 24Foleycatherisation - any allergies, for procedure only, or kept in longer, temp sensing, hourly bag
- 25SCD stockingsDVT prophylaxis, size, operative site, any contraindications
- 26skin prepshave,site area, clipper, site of surgery, ACORN standard recommendations, preference card, HCF protocol
- 27Time outWHO directions
team work
communication - 28Positioning in detailto 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 - 29Factors to consider with positioningsurgical procedure
the surgeons preference
anaesthetists requirements
patient's privacy
physiological effects of positioning on anaesthesised and awake patient
knowledge of anatomical structures - 30Positioning definitionsinferior 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 - 31Skeletal anatomy - bony prominencesmay 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 - 32Skeletal anatomymuscles 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 - 33neural anatomynerve 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 - 34Vascular systemhypotension results from changes in position
anaesthesia dilates vessels - pooling, decreasing circulatory blood volume
positioning therefore must be down slowly - 35Why 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 - 36Vascular systemdeep 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 - 37Lithotomy 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 - 38respiratory 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 - 39Prone position- respiratory systemrestricted diaphragm movement - limits tidal volume
positioned with devices to allow for unrestrained abdominal movement - 40Respiratory system - lateral positionvital 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 - 41Integumentary systemskin 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 - 42pressure ulcersamount 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 - 43positioning probelm - shear forcesshearing occurs when body tissue layers move on eachother - reverse trendelenburg
- 44Risk of complicationssmokers 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 - 45patient assessmentskin
preoperative, intra, post
reddened areas, turgor, integrity
document any reddened areas and reasses - 46Supine positionarm 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 - 47relevance for recoveryknowledge 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 - 48Positioning within recoverypositions used
- supine, head at top of mattress
-lateral
-jacknife
-surgical requirements
patient requirements - bed of barouche
positioning requirements - top of bottom - 49All staff duty of caremust ensure patient is positioned with care, dignity, normal body alignment, all pressure points are padded, patient is monitored throughout the operation for movement, documentation
- 50role of instrument nursecheck for adequate supplies and instruments
have availables
knowledge of procedure and process of how it will progress
communication with surgeon for possible variations - 51The sterile fieldgowning, gloving, setup trolley, counting, maintenance of field, getting others scrubbed, prepping, draping, getting started
- 52In surgery - RN responsibilites after incisiondocumentation - 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 - 53Other issuesmedications, sharps safety, electrical, radiation, laser safety, latex allergies precautions, transmission based precautions
- 54Once surgery is completedressings have been applied
extubation
wakeup
move client back to stretcher -safety
take client to PACU with anasthesia provider - 55RN responsibilities in PACUhelp 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 - 56After leaving PACU - RN responsibilitiestake care of specimens, change over room, set up for next case
- 57Rn responsibilities of the ORsafety +++
assessment, diagnosis, planning, implementation, evaluation, documentation, supervision, client advocate
Información
- Descripción
- El usuario ha eliminado su información de asignaturas Fichas sobre Intraoperative Patient Care, creado por Usuario eliminado el 12/06/2018.
- Creado por
- Usuario eliminado · jun 2018
- Actualizado
- 12 jun 2018
- Visitas
- 19
- Historial
-
- Creado por Elizabeth Then · 12 jun 2018
- Copiado por Elizabeth Then · 12 jun 2018
- Valoración