INTRAOPERATIVE PHASE Goals Asepsis Homeostasis Safe Administration of Anesthesia Hemostasis ae ete ae ‘Surgical Setting * Unrestricted Area - provides an entrance and exit from the surgical suite for personnel, equipment and patient. = _ street clothes are permitted in this area, and the area provides access to communication with personnel within the suite and with personnel and patient's families outside the suite Surgical Setting + Semi-restricted Area = _ provides access to the procedure rooms and peripheral support areas within the surgical suite. = personnel entering this area must be in proper ‘operating room attire and traffic control must be designed to prevent violation ofthis area by ‘unauthorized persons, = _ peripheral support areas consists of: storage areas for clean and sterile supplies, sterilization, equipment and corridors leading to procedure room ‘Surgical Setting + Restricted Area = _ includes the procedure room where surgery is performed and adjacent substerile areas where the Scrub sinks and autociaves are located = personne! working in this area must be in proper operating room attire POPE) ti 3% Up cee |‘Temperature and Humidity Control +The temperature in the procedure room should 7 7 maineaited Between 68 75 ( 30-24 degrees C) ial as ‘+ Humidity level between 50 - 55 % at all times 1 esd [me Environmental Safety Ventilation and Air Exchange System «The size ofthe procedure room + Air exchange in each procedure room should eee meen sxchanges every hour, and five of that shoulc + Temperature and humidity control + Ventilation and air exchange system + Ahighfitration particulate iter, working at 95% ee emclency ts recommended. + Each procedure room should maintained with postive presstre, which forces the old sir out of the roam and Devents the air from surrounding areas from entering Into the procedure room + Communication System | a case] ‘Size of the Procedure Room lectrical Safety = Usa cana or aqure shape S"ao'c20 10 wana minum ow Space of 360 sure eet + Faulty wiring, excessive us of extension cord, poor + each procure oom man Rave he owing elma Mainland Zuioren and nck of copa stehy . — measures are just some of the hazardous factors that Commute yan mest Usanaee eres Seer a eat + Ai lace equlpmant new or ued, shouldbe routinely “ Respratory and Card mater equpment checked by qualified personnel “Xray fim lamination boxes ry + Equipment that fails to function at 100% efficiency “Caria deter FRET oe stan aus oF sores inte “ragh-etisencypartulat ars trol ba keen a ot aecvicn Neiactaial “Adequate room ring Emergercy ihn system+ ThePatient + The Anesthesiologist or Anesthetist, The Surgeon % Scrub Nurse % Circulating Nurse + RNFA(Reg Nurse First Assistant) + Surgical Technologists Responsibilities + Primary responsible for the preoperative medical history and physical assessment. + Performance of the operative procedure according to the needs of the patients, +The primary decision maker regarding surgical technique to use during the procedure. + May assist with positioning and prepping the patient or may delegate this task to other members of the team Responsibilities += Selects the anesthesia, administers it, intubates the client if necessary, manages technical problems Felated to the acrhinistration of anestretic agents, and supervises tne client's condition throughout ‘the Surgical procedure. + A physician who specializes in the administration and monitoring of anesthesia while maintaining the Overall well-being of the patient. Responsibilities + May be ether a nurse ofa surgical technician + Reviews anatomy, physilegy and the surgical procedures Assists with the preparation ofthe room. Scrubs, gowns and gloves seif and other members ofthe Surges team. Brepares te instrument table and organizes stele equipment [Assists with the crapping procedure, Passes instruments to the surgeon and assistants by Anticipating thelr need 7 ‘Counts sponges, needles ang instruments. Monitor practices of aseptic technique in se and others. Keope track of iigatione used for caeulations of blood losResponsibilities + Must be a registered nurse who, after additional teducation and taining, specialized in perioperative nursing practic + Responsible and accountable for all activities occurin tring Surgical procedu String a surgical procedure. + Patient advocate, teacher, research consumer, le Sana'a role model, + Hoyo cxgnat o montorogg anc eer Be Ensure all equipment is working propery ‘Guarantees sterity of instruments and supplies. Assists with positioning Monitor the room and team members for breaks in the sterile technique, Handles specimens. Conegnates actives wth other departments, such as facioiogy and pathology Documents care provided Minimizes conversation and traffic within the operating room ute —— Medical vs. Surgical Asepsis MevicaL ASEPSIS | SURGICAL ASEPSIS. mons + Sterile object remains sterile only when touched by another sterile object «+ Assterile object or field out of range of vision or an bject held below a person's waist is contaminated eel ye Aaepee Cael Reha + When a sterile surface comes in contact with a wet, ‘contaminated surface, the sterile object or field becomes contaminated by capillary action + Fluid flows in the direction of gravity = The edges of a sterile field or container are considered to be contaminated (1 inch)‘Common Surgical Incision Taciion Site Buertiy Limba Halstead / Elica Subeosal Paramedian Transverse [Rectas MeBuriey Pranneasuel Lambotomy ‘Supine ( Dorsal Recumbent) Abdominal extremity.vascular.chest.neckfacialear breaet surgery Positioning Techniques + Pationt les flat on back with arms either extended on arm boards, ‘r piaced along side of boo. + Small padding placed under patient's head,neck and under knees + Vulnerable pressure points should be padded + Safety strap applied 2 in. above knees. + Eyes should be protected by using eye patch and ointment — = Surgeries involving posterior surace ofthe body ( spine, nock,buttocks and lowor extremities ) Positioning Techniques + Chest rolls or bolster are placed on operating table prior to postioning + Foam head rest, head tumed to side or facing downward + Patient's arms are rotated tothe padded armoards that face head, bringing them through their normal range of motion, “+ Padding for knees and pilow for lower extremities to prevent toes from touching mattress, + Safety strap applied 2 in. above the knees ~ Surgeries involving lower abdomen, pelvic organ when there is a need to tit abdominal viscera away from the Pelvic area. Positioning Techniques + Patient is supine with heed lower than feet + Shoulder braces should not be used as they may cause damage brachial plexus. + When patients returned to supine position, care must be taken ‘move leg section slowly, then the entire table to level position. ‘Modification ofthis position can be used for hypovolemic shock, + Extremity postion and safety strap are the same as for supine. Reverse Trendelenburg Position Upper abdominal, head, neck and facial surgory Positioning Technique + Patent is supine with head higher than feet. + Small pilow under neck and knees. + Well - padded footboard should be used to prevent slippage to {oot ofthe table + Anti embolic hose should be used if position isto be maintained {for an extended period of time. + Pationt should be rotumned slowly to supine position. Lithotemy Perinesl, vaginal, rectal surgeries; combined abdominal vaginal procedure Positioning Techniques = Patients placed in supine positon with buttocks near lower break in the table ( sacrum are should be well padded ) + Feet are placed in stir ‘excessively high or low, + Knee brace must not compress vascular structures or nerves in the popliteal space. + Pressure from metal stirrups against upper inner aspect of thigh ‘and calf should be avoided. + Legs should be raised and lowered slowly and simultaneously (may require two people }‘Jack Knife Position State of "Narcose fal cares, imoioscopy and eonoscapy * spt ces ce lek nemisen + Tecan also temporary decrease memory retrieval and real, “The effects of anesthesia are monitored by considering the Positioning Techniques ‘oliowing parameters: + Table is flexed at center break + All precautions taken with prone postion are taken with or ‘Jack knife position (02 saturation + Table strap applied over thighs CO? levels i and BP + Urine output Modified Fowler ( Siting Position ) Otorhinology (ear and nose ), neurosurgery ‘Types of Anesthesia Positioning Techniques 1. General Anesthesia + Patents supine, postioned over the upper break inthe table + Backrest s elevated, knees flexed + Arms rest on pillow, placed in lap; safety strap 2 in. above the + reversible state consisting of complete loss of consciousness and sensation. Knees. : + Slow movementin an out of positon must be used to prevent 4 protective reflexes such as cough and gag are drastic changes in blood volume movement. lost + An enboichoee shou be ised to eel venous return, 4 provides analgesia, muscle relaxation and {Won using special neurologic headrest, yee must bo Sedation. protected produces amnesia and hypnosis. 7 Techniques used in General Anesthesia ANESTHESIA A. Intravenous Anesthesia 4 This is being administered intavenously and extremely rapid 4 Itseffet will immediately take place after thirty ‘minutes of intoduct 4 Te prepares the clint for smooth transition tothe surgical anesthesia lation Anesthesia 4 This comprises of volatile liquids o ga and oxygen 2% Administered through a mask or endotracheal ube.‘Stages of General Anesthesia |) Stage 1: Onset / Induction. ') Stage 2: Excitement / Deli ') Stage 3: Surgical )) Stage 4: Medullary / Stage of Danger ium, 2.Regional Anesthesia + temporary interruption ofthe transmission of nerve spulses to and from specific area or region of the body. + achieved by injecting local anesthetics in close Proximity to appropriate nerves. + reduce all puingl sensation in one region ofthe body ‘without inducing unconsciousness, + agents used are lidocaine and bupivaceine Techniques used in Regional Anesthesia: A. Topical Anesthesia + applied directly tothe skin and macous membrane, ‘open skin surfaces, wounds and bums, realy absorbed and act rapidly 4 used topical agents are lidocaine and benzocaine. B. Spinal Anesthesia ( Subarachnoid block) local anesthetic is injected through lambarpuncture, ‘between L2 and St 4 anesthetic agent is injected into subarachoid space surrounding the spinal cor + Low spinal, for perineab etal reas + Mid spinal T10 (below level of umbilicus) {or hernia repair and appendectomy, High spinal T4 (nipple ine ), for CS . Epidural Anesthesia ‘achieved by injecting local anesthetic into epidural space by way of lumbar panstre. ‘esl similar t spinal analgesia # agents use are chloroprocaine, idoaine and bupivacaine D. Peripheral Nerve Block ‘achieved by injecting a local anesthetic to anesthetize the sue ste # agents use are chloroprocane, lidocaine and bupivacaine.E- Intravenous Block (Bett block) ‘often used for arm rist and hand procedure accosted he exe treet 4 Hypothermia «due to exposure toa col ambient OR infiltration and absorption of the injected IV agents beyond the ‘environment and loss of thermoregulation capacity from invert. ct Peripheral Nerve Damage due improper Cauda Aneta toning of pate ore ofa "pty aston ti asi esa peyton of patito 4 Headache G.Fled Beck Asetnote # Th ae prota a ped acon ca ened intel wih cal nett get Nursing Management ‘Assessment Diagnosis Planning Intervention Evaluation Complications and Discomforts of Anesthesi + Hypoventilation - inadequate ventilatory support after paralysis of respiratory muscles. + Oral Trauma + Malignant Hyperthermia - uncontrolled skeletal ‘muscle contraction + Hypotension - due to preoperative hypovolemia or ‘untoward reactions to anesthetic agents. + Cardiae Dysrhythmia - due to preexisting cardiovascular compromise, electrolyte imbalance or ‘untoward reaction to anesthesia.