1. FUNDAMENTALS OF NURSING
Lesson #19
INTRAOPERATIVE
TECHNIQUES

2. DEFINE TERMS/SUFFIX ostomy: opening for passage
pexy: fixation or suspension
otomy: opening into
orrhaphy: repair of
plasty: plastic surgery
oscopy: direct visualization of
ectomy: surgical removal of
lysis: destruction or dissolution of
anostomosis: joining of 2 ducts or blood vessels

3. INTRAOPERATIVE PHASE INTRAOPERATIVE PHASE:
Starts when pt enters the OR
Ends when pt enters post-anesthesia unit (PACU) or recovery room

4. ROLE OF CIRCULATING NURSE
Always an RN
Considered the charge nurse of the OR suite
Assists scrubbed or sterile personnel
Responsible for quality of pt care

5. ROLE OF CIRCULATING NURSE
ROLES DEFINED:
Prepares room and equipment
Gathers supplies and maintains the sterility
Counts supplies pre-op and post-op
Gets patient at the right time

6. ROLE OF CIRCULATING NURSE
ROLES DEFINED:
Assesses pt preoperatively
Identifies pt
Verifies teaching received
Ensures consent form accurate
Confirms allergies and lab results
Assures safe pt transfers
Applies EKG equipment
Assists team with maintaining sterility and provides supplies
Documents on operative record, nurses notes
Assists anesthesiologist, surgeon
Performs sponge count

7. ROLE OF SCRUB NURSE SCRUB NURSE: Can be RN, LPN, or scrub tech
Passes instruments & supplies to surgeon or assistants
Maintains strict asepsis
Sterile fields must be maintained
Takes knowledge & experience to do efficiently
ANY question about sterility = contaminated
Sterility must be maintained to prevent or decrease infection

8. ROLE OF SCRUB NURSE ROLES DEFINED: Assists circulating nurse
Is sterile
Sets up sterile fields
Performs sponge/instrument count at start/finish
Assists surgeons with gowning and gloving
Assists with sterile draping of pt
Monitors for breaks in sterile field
Handles specimens

9. USING STERILE TECHIQUE IN OR
SURGICAL HAND SCRUB:
Cannot sterile the skin
Can decrease the number of microbes by
Chemical (soap)
Physical (friction)
Mechanical (brush) means
Special soaps (Betadine, Hibiclens) can help
Fingernails must be short and polish free
No jewelry
Put on shoe covers, cap, mask before scrubbing in

10. USING STERILE TECHIQUE IN OR
SURGICAL HAND SCRUB:
5-10 minute scrub:
Scrub from hands to elbows
Keep hands above elbows
Rinse from fingertips to elbows
Do not tough anything once scrubbed
Water controls are at your feet
Remember sterile field…
From hands to 2 inches past elbow

11. USING STERILE TECHIQUE IN OR
APPLYING STERILE GOWN & CLOSED GLOVING:
Hand scrub
Put on sterile gown keeping hands inside

12. APPLYING STERILE GOWN & CLOSED GLOVING:
ROLE OF SCRUB NURSE
APPLYING STERILE GOWN & CLOSED GLOVING:

13. FUNDAMENTALS OF NURSING
Lesson #20
INTRAOPERATIVE
TECHNIQUES

14. POSTANESTHESIA CARE 2 PHASES: Immediate post anesthesia
Convalescent state
PHASE I
Post anesthesia:
Pt is leaving the OR and before admit to general nursing unit
Takes place in RR or PACU

15. POSTANESTHESIA CARE PHASE I: POST ANESTHESIA
Anesthesia provider gives verbal report
Orders from surgeon or admitting provider are received

16. POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA:
First 1-2 hours post op most critical
Constant assessment vital
Remember ABCs:
Airway
Breathing
Circulation

17. POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: REACT: Respiration
Energy
Alertness
Circulation
Temperature

18. POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: DRAINAGE:
Should know what kind of drainage to expect
Don’t be afraid to ask…
Risk of hemorrhage post op
Arterial bleeding
Venous bleeding
Capillary bleeding

19. POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: Types… Urine
DRAINAGE:
Types…
Urine
NG tube
Wound, Hemovac, Jackson Pratt
Report bloody drainage > cc/h

20. POSTANESTHESIA CARE COMPLICATIONS FROM ANESTHESIA: DRESSINGS:
Check and document when receiving pt from OR
Drainage should go from sanguineous to serous
If other way around…report to MD
Note content of drainage in tubes
NG placement
IV fluids: rate, site, fluid

21. POSTANESTHESIA CARE NURSING INTERVENTIONS: Report from OR
On immediate arrival
Airway
Breathing
Circulation
Spinal anesthesia
Drainage

22. POSTANESTHESIA CARE NURSING INTERVENTIONS: Pain Unique interventions
Temperature
Dressings
Edema

23. POSTANESTHESIA CARE 2 PHASES: Immediate post anesthesia
Convalescent state
PHASE II
Convalescent period:
From dc from PACU/RR to dc to home/nursing unit

24. POSTANESTHESIA CARE PHASE II: Assessment includes… VS Temperature LOC
NPO status
Complications
Incision site

25. POSTANESTHESIA CARE PHASE II: Assessment includes… Ventilation
Post-op shock
Pain
Urinary function
Venous stasis

26. POSTANESTHESIA CARE PHASE II: Assessment includes… Ambulation GI
Fluids & electrolytes

27. POSTANESTHESIA CARE PHASE II: Parenteral fluids/IV therapy Assessment
IV fluids
Isotonic, hypertonic, hypotonic

28. POSTANESTHESIA CARE PHASE II: Parenteral fluids/IV therapy IV fluids
Hyperalimentation
Infusion site

29. POSTANESTHESIA CARE IV fluids Site Rate Interventions PHASE II:
Parenteral fluids/IV therapy
IV fluids
Site
Rate
Interventions

30. POSTANESTHESIA CARE Assessment VS Reaction indicators Nursing actions
PHASE II:
Blood transfusion interventions:
Assessment VS
Reaction indicators
Nursing actions

31. POSTANESTHESIA CARE PHASE II: DC planning for post-op patient:
Incision care
Drainage
Dressing changes
Comfort
Side effects
Safety

32. THE END!!!!!