1. Interventions for Intraoperative Clients Care

2. Members of the Surgical Team Surgeon Surgeon Surgical assistant Surgical assistant Anesthesiologist Anesthesiologist Certified registered nurse anesthetist Certified registered nurse anesthetist Holding area nurse Holding area nurse Circulating nurse Circulating nurse Scrub nurse Scrub nurse Surgical technologist Surgical technologist Operating room technician Operating room technician

3. Environment of the Operating Room Preparation of the surgical suite and team safety Preparation of the surgical suite and team safety Layout Layout Health and hygiene of the surgical team Health and hygiene of the surgical team Surgical attire Surgical attire Surgical scrub Surgical scrub

4. Anesthesia Induced state of partial or total loss of sensation, occurring with or without loss of consciousness Induced state of partial or total loss of sensation, occurring with or without loss of consciousness Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and, in some instances, achieve a controlled level of unconsciousness Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and, in some instances, achieve a controlled level of unconsciousness

5. General Anesthesia Reversible loss of consciousness is induced by inhibiting neuronal impulses in several areas of the central nervous system. Reversible loss of consciousness is induced by inhibiting neuronal impulses in several areas of the central nervous system. State can be achieved by a single agent or a combination of agents. State can be achieved by a single agent or a combination of agents. Central nervous system is depressed, resulting in analgesia, amnesia, and unconsciousness, with loss of muscle tone and reflexes. Central nervous system is depressed, resulting in analgesia, amnesia, and unconsciousness, with loss of muscle tone and reflexes.

6. Stages of General Anesthesia Stage 1: analgesia Stage 1: analgesia Stage 2: excitement Stage 2: excitement Stage 3: operative Stage 3: operative Stage 4: danger Stage 4: danger

7. Administration of General Anesthesia Inhalation: intake and excretion of anesthetic gas or vapor to the lungs through a mask Inhalation: intake and excretion of anesthetic gas or vapor to the lungs through a mask Intravenous injection: barbiturates, ketamine, and propofol through the blood Intravenous injection: barbiturates, ketamine, and propofol through the blood Adjuncts to general anesthetic agents: hypnotics, opioid analgesics, neuromuscular blocking agents Adjuncts to general anesthetic agents: hypnotics, opioid analgesics, neuromuscular blocking agents

8. Balanced Anesthesia Combination of intravenous drugs and inhalation agents used to obtain specific effects Combination of intravenous drugs and inhalation agents used to obtain specific effects Combination used to provide hypnosis, amnesia, analgesia, muscle relaxation, and reduced reflexes with minimal disturbance of physiologic function Combination used to provide hypnosis, amnesia, analgesia, muscle relaxation, and reduced reflexes with minimal disturbance of physiologic function(Continued)

9. Balanced Anesthesia (Continued) Example: thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, and pancuronium for muscle relaxation Example: thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, and pancuronium for muscle relaxation

10. Complications from General Anesthesia Malignant hyperthermia: possible treatment with dantrolene Malignant hyperthermia: possible treatment with dantrolene Overdose Overdose Unrecognized hypoventilation Unrecognized hypoventilation Complications of specific anesthetic agents Complications of specific anesthetic agents Complications of intubation Complications of intubation

11. Local or Regional Anesthesia Sensory nerve impulse transmission from a specific body area or region is briefly disrupted. Sensory nerve impulse transmission from a specific body area or region is briefly disrupted. Motor function may be affected. Motor function may be affected. Client remains conscious and able to follow instructions. Client remains conscious and able to follow instructions. Gag and cough reflexes remain intact. Gag and cough reflexes remain intact. Sedatives, opioid analgesics, or hypnotics are often used as supplements to reduce anxiety. Sedatives, opioid analgesics, or hypnotics are often used as supplements to reduce anxiety.

12. Local Anesthesia Topical anesthesia Topical anesthesia Local infiltration Local infiltration Regional anesthesia Regional anesthesia –Field block –Nerve block –Spinal anesthesia –Epidural anesthesia

13. SPINAL ANASTHESIA

14. OPERATION POSITIONS

15. ENDOTRACHEAL INTUBATION

16. Complications of Local or Regional Anesthesia Anaphylaxis Anaphylaxis Incorrect delivery technique Incorrect delivery technique Systemic absorption Systemic absorption Overdosage Overdosage(Continued)

17. Complications of Local or Regional Anesthesia (Continued) Assess for central nervous system stimulation, central nervous system and cardiac depression, restlessness, excitement, incoherent speech, headache, blurred vision, metallic taste, nausea and vomiting, tremors, seizures, increased pulse, respirations, and blood pressure. Assess for central nervous system stimulation, central nervous system and cardiac depression, restlessness, excitement, incoherent speech, headache, blurred vision, metallic taste, nausea and vomiting, tremors, seizures, increased pulse, respirations, and blood pressure.

18. Treatment of Complications Establish an open airway. Establish an open airway. Give oxygen. Give oxygen. Notify the surgeon. Notify the surgeon. Fast-acting barbiturate is usual treatment. Fast-acting barbiturate is usual treatment. If toxic reaction is untreated, unconsciousness, hypotension, apnea, cardiac arrest, and death may result. If toxic reaction is untreated, unconsciousness, hypotension, apnea, cardiac arrest, and death may result.

19. Conscious Sedation IV delivery of sedative, hypnotic, and opioid drugs reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands. IV delivery of sedative, hypnotic, and opioid drugs reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands. Diazepam, midazolam, meperidine, fentanyl, alfentanil, and morphine sulphate are the most commonly used drugs. Diazepam, midazolam, meperidine, fentanyl, alfentanil, and morphine sulphate are the most commonly used drugs.(Continued)

20. Conscious Sedation (Continued) Nursing assessment of airway, level of consciousness, oxygen saturation, electrocardiographic status, and vital signs are monitored every 15 to 30 minutes. Nursing assessment of airway, level of consciousness, oxygen saturation, electrocardiographic status, and vital signs are monitored every 15 to 30 minutes.

21. Collaborative Management Assessment Assessment Medical record review Medical record review Allergies and previous reactions to anesthesia or transfusions Allergies and previous reactions to anesthesia or transfusions Autologous blood transfusion Autologous blood transfusion Laboratory and diagnostic test results Laboratory and diagnostic test results Medical history and physical examination findings Medical history and physical examination findings

22. Risk for Perioperative Positioning Injury Interventions include: Proper body position Proper body position Risk for pressure ulcer formation Risk for pressure ulcer formation Prevention of obstruction of circulation, respiration, and nerve conduction Prevention of obstruction of circulation, respiration, and nerve conduction

23. Impaired Skin Integrity and Impaired Tissue Integrity Interventions include: Plastic adhesive drape Plastic adhesive drape Skin closures, sutures and staples, nonabsorbable sutures Skin closures, sutures and staples, nonabsorbable sutures Insertion of drains Insertion of drains Application of dressing Application of dressing Transfer of client from the operating room table to a stretcher Transfer of client from the operating room table to a stretcher

24. Potential for Hypoventilation Continuous monitoring of: Continuous monitoring of: –Breathing –Circulation –Cardiac rhythms –Blood pressure and heart rate Continuous presence of an anesthesia provider Continuous presence of an anesthesia provider