Chapt19 Notes

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Copyright 2008 Lippincott Williams & Wilkins.

Chapter 19Intraoperative Nursing Management


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Members of the Surgical Team

Patient

Anesthesiologist or anesthetist

Surgeon

Nursing

Surgical technologists


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Prevention of Infection

The surgical environment

Unrestricted zone

Semirestricted zone

Restricted zone

Surgical asepsis

Environmental controls


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Basic Guidelines for Surgical Asepsis

All materials in contact with the wound and within thesterile field must be sterile.

Gowns are sterile in the front from chest to the level ofthe sterile field, and sleeves from 2 inches above theelbow to the cuff.

Only the top of a draped table is considered sterile.

During draping, the drape is held well above the area andis placed from front to back.

Items are dispensed by methods to preserve sterility.

Movements of the surgical team are from sterile to sterile

and from unsterile to sterile only.


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Basic Guidelines for Surgical Asepsis

Movement around the sterile field must not causecontamination of the field. At least a 1-foot distance from

the sterile field must be maintained. Whenever a sterile barrier is breached, the area is

considered contaminated.

Every sterile field is constantly maintained and

monitored. Items of doubtful sterility are consideredunsterile.

Sterile fields are prepared as close as possible to time ofuse.


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Roles of the Members of the SurgicalTeam

Circulating nurse

Scrub role

Surgeon

Registered nurse first assistant

Anesthesiologist and anesthetist

Note: Role of the nurse as patient advocate


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Intraoperative Complications

Nausea and vomiting

Anaphylaxis

Hypoxia and respiratory complications

Hypothermia

Malignant hyperthermia

Disseminated intravascular coagulation (DIC)



Potential Adverse Effects of Surgery andAnesthesia

Allergic reactions and drug toxicity or reactions

Cardiac dysrhythmias

CNS changes and oversedation or undersedation

Trauma: laryngeal, oral, nerve, and skin, including burns

Hypotension

Thrombosis

Refer to Chart 19-1



Gerontologic Considerations

Elderly patients are at increased risk for complicationsdue to surgery and anesthesia because of:

Increased likelihood of coexisting conditions.

Aging heart and pulmonary systems.

Decreased homeostatic mechanisms.

Changes in responses to drugs and anesthetic agentsdue to aging changes such as decreased renalfunction, and changes in body composition of fat andwater.



Nursing Goals for the Patient in theIntraoperative Period

Reducing anxiety

Preventing positioning injuries

Maintaining patient safety

Maintaining the patient's dignity

Avoiding complications



Laparotomy Position, TrendelenburgPosition, Lithotomy Position, andSidelying Position for Kidney Surgery


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Protecting the Patient from Injury

Patient identification

Correct informed consent

Verification of records of health history and exam

Results of diagnostic tests

Allergies (include latex allergy)

Monitoring and modifying the physical environment

Safety measures such as grounding of equipment,restraints, and not leaving a sedated patient

Verification and accessibility of blood

Documents

Chapt19 Notes