Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Members of the Surgical Team
Patient Circulating nurse Scrub role Surgeon Registered nurse first assistant Anesthesiologist, anesthetist
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Is the following statement true or false? The circulating nurse is responsible for monitoring the surgical team.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer True Rationale: The circulating nurse is responsible for monitoring the surgical team.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gerontologic Considerations Older adult patients are at increased risk for complications of surgery, anesthesia due to Increased likelihood of coexisting conditions Aging heart, pulmonary systems Decreased homeostatic mechanisms Changes in responses to drugs, anesthetic agents due to aging changes (decreased renal function), changes in body composition of fat, water
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prevention of Infection Surgical environment, refer to Figure 18-1 Unrestricted zone Semirestricted zone Restricted zone Surgical asepsis Environmental controls Refer to Figure 18-2
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Basic Guidelines for Surgical Asepsis All material within sterile field must be sterile Gowns sterile in front from chest to level of sterile field, sleeves from 2 inches above elbow to cuff Only top of draped tables considered sterile Items dispensed by methods to preserve sterility Movements of surgical team are from sterile to sterile, from unsterile to unsterile only
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Guidelines for Surgical Asepsis (contd)
Movement at least 1-foot distance from sterile field must
be maintained When sterile barrier is breached, area is considered contaminated Every sterile field is constantly maintained, monitored Items of doubtful sterility considered unsterile Sterile fields prepared as close to time of use
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Surgical Team Roles Circulating nurse Scrub role Surgeon Registered nurse first assistant Anesthesiologist, anesthetist Note: Role of nurse as patient advocate Refer to Chart 18-1
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Is the following statement true or false?
The most frequent early sign for a patient at risk for
malignant hyperthermia subsequent to general anesthesia is bradycardia.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer False
Rationale: The most frequent early sign for a patient at risk
for malignant hyperthermia subsequent to general anesthesia is tachycardia.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Adverse Effects of Surgery and Anesthesia Allergic reactions, drug toxicity or reactions Cardiac dysrhythmias CNS changes, oversedation, undersedation Trauma: laryngeal, oral, nerve, skin, including burns Hypotension Thrombosis Refer to Chart 18-2
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Question
Through which route are general anesthetics primarily
eliminated? A. Kidneys B. Liver C. Lungs D. Skin
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Answer C. Lungs
Rationale: The lungs are the primary route from which
general anesthetics are eliminated from the body.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Comparison of Anesthetic Agents and Delivery Systems General Inhalation: Refer to Table 181; Figure 18-3 (A, B, C) Intravenous: Refer to Table 18-2 Regional: Refer to Table 18-3 Epidural: Refer to Figure 18-4 Spinal: Refer to Figure 18-4
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Interventions Reducing anxiety Reducing latex exposure Preventing positioning injuries, refer to Figure 18-5 Protecting patient from injury Serving as patient advocate Monitoring, managing potential complications
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Laparotomy Position, Trendelenburg Position, Lithotomy Position and Side-Lying Position for Kidney Surgery
Fig. 18-5
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Positioning Factors to Consider Patient should be as comfortable as possible Operative field must be adequately exposed Position must not obstruct/compress respirations, vascular supply, or nerves Extra safety precautions for older adults, patients who are thin or obese, and anyone with a physical deformity Light restraint before induction in case of excitement
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Protecting the Patient From Injury
Patient identification Monitoring, modifying
physical environment Correct informed consent Safety measures Verification of records of (grounding of equipment, health history, exam restraints, not leaving a sedated patient) Results of diagnostic tests Verification, accessibility Allergies (include latex of blood allergy)
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins