Download Intra operative Nursing Management

Intra operative Nursing
Management
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• The patient may experience variety of
complications once entered the OR that
include:
• Allergic reaction
• Myocardial depression and cardiac arrhythmia
• Central nervous system(CNS) agitation
• Hypoxemia and hypercarpia
• Hypotension, hypothermia, hyperthermia
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• There is 2 types of nurses in the OR the
circulating nurses and the scrub nurse.
The circulating nurse
• Must be RN
• Main role is to manage the OR and protect
patient safety
• Monitor environment inside the OR: lighting,
humidity, temperature, cleanliness
• Verify consent
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The scrub nurse
• Perform surgical handscrub
• Set up the sterile table
• Prepare suture
• Assist the surgeon during surgery
At the end of the surgery both the circulating nurse
and the scrub nurse count all eqipments and
ensure that nothing retained inside patient body
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Principles of surgical asepsis
• All material in contact with the surgical wound
must be sterile
• Gowns of the surgical team are considered from
the chest to the level of setrile filed
• The top of surgical drapes is considered sterile
• Movement of sterile to sterile and from unsterile
to unsterile
• Items is dispensed to the sterile filed by method
that preserve sterility
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The Surgical Experience
Anesthesia : a state of narcosis ( svere central
nervous system depression) , relaxation, and
reflex loss that is induced by pharamcologic
agent.
Pharmacologic agents include inhaled gases such as
nitrous oxide and IV agents such as fentanyl, and
morphine
Types of anesthesia
General anesthesia : consists of 4 stages with
clinical manifestations for each
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Stages of general anesthesia
• Stage 1: beginning anesthesia: once patient breath in the
anesthetic mixture warmth, dizziness, and feeling of
detachment may be experienced , noise is exaggerated
• Stage 11: the excitement : patient may sing, shout, talk,
laugh, cry, patient may have uncontrolled movement and
needs strap.
• Stage 111: surgical anesthesia: the patient in this stage is
quite and unconscious
• Stage 1V: medullary depression:in case of anesthesia
overdose the patient respiration become shallow, pulse
thready and weak, pupils dilated and cyanosis may develop
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Regional anesthesia
Regional anesthesia : Anesthetic agents is injected
around a nerve so that the area supplied by the
nerve is anesthized. Includes 3 types epidural
anesthesia, spinal and local conduction block
• Epidural anesthesia: injecting local anethetic
agent inside the epidural space that surround the
dura matter
• Spinal anesthesia: inject the anesthetic agent
inside the subarachnoid space
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• Local anesthesia: injection of the anesthetic
agent in the tissue at the planned site.
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Potential Intraoperative Complications
• Nausea and vomiting
• Anaphylaxis: sever allergic reaction cause
mostly by medications
• Hypoxia and hypercarpia
• hypothermia.
• Malignant hyperthermia
• Dissiminated Intravascular coagulopathy (DIC)
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NURSING PROCESS
Assessment : VS, physichological status, nutrition…..
Diagnosis
• Anxiety,risk for injury
• Disturbed sensory perception
Planning : to reduce anxiety, and prevent injury and
complications
Intervintion
• Reduce anxiety, prevent injury,
Evaluation : expected outcomes include low level of
anxiety, remain free of injury, free of complications
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Post operative nursing management
• Post anesthesia care unite ( Recovery room) is located near
the OR. Patient who still under anesthesia are placed in this
unite
• The nursing role in the recovery room is to provide care until
the patient recover from anesthesia
Main nursing activities include
• Assess the patient
• Maintain patent airway( head tilt chin left or jaw thrust)
• Maintain cardiovasular stability : prevent and manage
hypovolemic shock , hemorrhage, hypertension and
arrhytmia.
• Relieving anxiety and fear
• Control nausea and vomiting
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The classic signs of hypovolemic shock
Pallor
Cool moist skin
Rapid breathing
Cyanosis
Narrowing pulse pressure
Low blod pressure
Concentrated urine
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NURSING PROCESS FOR HOSPITALZIED
PATIENT RECOVERING FROM SURGERY
Assessment : VS, respiratory and cardiac status, complications
Diagnosis : risk for ineffective airway clearence, decrease
cardiac output, impaired skin integrity, risk for imbalanced
nutrition.
Planning : main goals is to obtian clear airway, no pain,
unimpaired wound healing, increased activite tolerance…
Intervention : relieve pain,encourage activity, monitor and
manage bleeding and hypotension , promote wound
healing, maintain normal body temperature, promote
bowel function and manage voiding
Evaluation: expected outcomes include optimal respiratory
function, no pain, wound heal with no complications,
normal body temperature, normal voiding pattern
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