Thyroidectomy Nursing Lectures

This is a nursing lecture on Thyroidectomyfor nursing students and other health professionals. Enjoy!

Surgical Instrumentation | Nursing Lecture

Classification of Surgical Instruments
Cutting/Dissecting
Grasping
Retracting
Suturing/Stapling
etc.

Proper Way to Handle Instruments
Care of Instruments
Important Guidelines in Surgical Instrumentation

Principles of Sterile and Aseptic Technique Nursing lecture

This nursing lecture contains a detailed explanation on the Principles of Sterile and Aseptic technique. Sterile and Asepsis has been differentiated. Famous people and advocates of these principles are also discussed in this nursing lecture

1. • WHAT IS THE DIFFERENCE BETWEEN ASEPSIS AND STERILE TECHNIQUE??
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2. • Ignaz Semmelweis – handwashing
   • Louis Pasteur – germ theory
   • Robert Koch – use of bichloride of mercury as an antiseptic
   • Joseph Lister – Father of modern Surgery
   • Gustav Neuber – used mercuric cholride in cleaning his apron
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3. • Louis Pasteur
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4. • Ignaz Semmelwies
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5. • Joseph Lister
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6. • Gustav Neuber
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7. • Robert Koch
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8. • Airborne
   • Droplet
   • Contact
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9. • SKIN
   • HAIR
   • NASOPHARYNX
   • HUMAN ERROR
   • CROSS-INFECTION
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10. • FOMITES
    • Air
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11. • Community Acquired Infection
    • Communicable Infection
    • Spontaneous Infection
    • Nosocomial Infection – Exogenous and Endogenous
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12. • Air-Conditioning System
    • Laminar Air System
    • Doors
    • Traffic and Movement
    • Lint
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13. • Protective barriers and personal protective equipment
    • Prevention of puncture injuries
    • Management of puncture injuries
    • Oral Procedures
    • Care of specimens
    • Decontamination
    • Laundry
    • Waste
    • Handwashing
    • No touching of mucous membranes
    • Prophylaxis
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14. • Know what is sterile
    • Know what is unsterile
    • Keep the two apart
    • Remedy the contamination immediately
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15. • NO compromise on Sterility
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Sterilization and Disinfection Nursing lecture

This nursing lecture contains different sterilization and disinfection methods. It also compares the two and cites disadvantages and advantages.

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# Terminologies  Antiseptics  Disinfectants  Disinfection  Microorganism  Pathogenic Microorganisms  Sterilization nursinglectures.blogspot.com
# nursinglectures.blogspot.com
# Methods of Sterilization  A. Physical Sterilization 1. Moist Heat – kills all bacteria by coagulating or denaturing of the protein of the bacteria a. Boiling (non-pressure sterilizer) b. Saturated Steam under pressure (AUTOCLAVE) nursinglectures.blogspot.com

#  2. Dry Heat – recommended for use only where direct contact of material with steam is impractical of not available a. Dry Heat Autoclave (hot air oven) – used for oil, ointment, and powders. nursinglectures.blogspot.com
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#  B. Chemical Sterilization  Accomplished by use of ethylene oxide gas  Ethylene oxide is a chemical agent that kills microorganisms, including spores, by interfering with the normal metabolism of protein and reproductive processes, resulting in death of cells nursinglectures.blogspot.com
# nursinglectures.blogspot.com
# Shelf-Life  1. Condition of Storage  Free of dust, dirt and vermin  Paper-wrapped/muslin-wrapped items good for 30 days, open shelving 21 days  Protect from extreme temperature nursinglectures.blogspot.com
#  2. Material used for packaging  Muslin and paper wrapped items may be stored for 24-30 days, afterwhich re- sterilization is required, but if sealed in airtight plastic bag, following cooling or aerating, shelf life can be prolonged from 6-12 months nursinglectures.blogspot.com
#  3. Seal of the package  Tape sealed packages wrapped in non- warm fabrics or plastic film can be stored for 3-4 months  4. Integrity of the package nursinglectures.blogspot.com
# Disinfection  It differs from Sterilization by its lack of sporocidal power  Used in the OR to kill microorganisms on inanimate surfaces and objects that cannot be sterilized nursinglectures.blogspot.com
# Limitations of Chemical Disinfection  Doesn’t KILL SPORES  Real STRENGTH not known  LONG TIMING  DIFFICULT to submerge some articles  NOT SUITABLE for some materials  Can cause IRRITATION to tissue  ABILITY to disinfect is limited to max concentration nursinglectures.blogspot.com
# Uses for chemical disinfection  WOVEN  CATHETER  ENDOSCOPIC Instruments  POLYETHYLENE  EYE Surgery nursinglectures.blogspot.com
# Pointers when Using Chemical Disinfection  Free from blood, secretions  Rinse and dry under sterile conditions  Solutions may be rinsed off if practical nursinglectures.blogspot.com
# DISINFECTANTS  Formaldehyde (Formalin)  Glutaraldehyde (Cidex)  Phenol 100%  Lysol  Zephiran Chloride 17% nursinglectures.blogspot.com
# ANTISEPTICS  Hexacholorophene - neurotoxic  Betadine –watch out iodine sensitivity  Mercurochrome  Aqueous Zephiran  Chorhexidine Gluconate nursinglectures.blogspot.com

Operating Room Team Members Nursing Lecture

This nursing lecture contains an introduction to the different Operating Room Team members. The .sterile team members work aseptically and the non-sterile team members avoid contaminating the sterile field

1. • Anesthesia Provider
   • Administers anesthetics
   • CNRA
   • Oversees the PACU
   • CPR
   • Pain therapy
   • consultants
2. • Monitors and coordinates activity within the room
   • Controls physical and emotional atmosphere
   • Application of nursing process
   • Creation and maintenance of safe and comfortable environment
   • Provision of assistance
   • Identification of any potential danger/stress
3. • Surgeon
4. • First Assistant
   • Visibility of SS
   • Close wounds
   • Apply dressing
   • Handles tissue
   • Uses instruments
5. • Scrub Person
   • Maintains integrity of
   • Sterile field
   • May be an RN, LPN/
   • LVN or an ST

Surgical Positioning Nursing Lecture

This nursing lecture includes an introduction to studying Surgical Instrumentation. It contains topics on classification of surgical instruments, proper handling and use. Contains images and explanations.

1. http://nursinglectures.blogspot.com
2.  1. Optimize Exposure for the SURGEON  2. Minimize the for adverse physiologic effects  3. Facilitate by the ANESTHESIA provider  4. Promote for the patient nursinglectures.blogspot.com 2
3.  The Anesthesiologist has the on of the patient  The patient is until the anesthesia provider indicates it is safe to do so. nursinglectures.blogspot.com 3
4.  Patient is  Patient is Assessed for Mobility status  OR bed is securely locked  The anesthesia provider guards the  Body exposure should be minimal  Don’t Cross Ankles(causes DVT) nursinglectures.blogspot.com 4
5.  Respiratory Considerations  Circulatory Considerations  Peripheral Nerve Considerations  Musculoskeletal Considerations  Soft Tissue Considerations nursinglectures.blogspot.com 5
6. nursinglectures.blogspot.com 6
7.  OPERATING BED nursinglectures.blogspot.com 7
8.  Safety Belt (Thigh Strap)  Lift Sheet (Draw Sheet)  Upper Extremity Table  Shoulder Bridge ( Thyroid Elevator)  Shoulder Braces / Support  Body Rests and Braces  Body (Hip) Restraint Strap  Headrests nursinglectures.blogspot.com 8
9.  Anesthesia Screen nursinglectures.blogspot.com 9
10.  Armboard nursinglectures.blogspot.com 10
11.  Positioning for Anal Procedures with Adhesive Tape nursinglectures.blogspot.com 11
12.  Stirrups nursinglectures.blogspot.com 12
13.  Surgical Vacuum Positioning System nursinglectures.blogspot.com 13
14.  Supine (Dorsal) Position nursinglectures.blogspot.com 14
15.  Trendelenburg’s nursinglectures.blogspot.com 15
16.  Reverse Trendelendurg’s nursinglectures.blogspot.com 16
17.  Fowler’s Position nursinglectures.blogspot.com 17
18.  Lithotomy Position nursinglectures.blogspot.com 18
19.  Prone Position nursinglectures.blogspot.com 19
20.  Kraske (Jackknife) Position nursinglectures.blogspot.com 20
21.  PILONIDAL SINUS nursinglectures.blogspot.com 21
22.  Knee-Chest Positions nursinglectures.blogspot.com 22
23.  Lateral Positions nursinglectures.blogspot.com 23
24.  Kidney Position nursinglectures.blogspot.com 24
25.  Beach-Chair Position nursinglectures.blogspot.com 25
26.  Dorsal Position  Dorsal Recumbent  Fowler’s Position  Sitting Position  Lithotomy  Trendelenburg  Reverse Trendelenburg  Prone  Kraske  Knee-Chest Position  Sim’s  Kidney  Chest Position nursinglectures.blogspot.com 26
27. Visit: http://nursinglectures.blogspot.com For more Free Nursing lectures on MS, OB, Psych, OR, And more…. nursinglectures.blogspot.com 27

Perioperative Nursing Introduction to Operating Room Nursing lecture

Introduction to Operating Room Nursing lecture. Contains detailed lecture on the perioperative period, classification and types of surgery, etc.

1. The branch of medicine that deals with the diagnosis and treatment of surgery, deformity or disease by manual or instrumental means.  3 phases : (Perioperative phase) Pre-Operative Intra-Operative Post-operative nursinglectures.blogspot.com
2. nursinglectures.blogspot.com
3. Identification of physiological, psychological, sociological needs of patient and implementation of nursing care Based on the knowledge of the natural and behavioral science In order to restore, or maintain the health and welfare of the patient during and after the surgical intervention nursinglectures.blogspot.com
4.  Correct deformities or defects nursinglectures.blogspot.com
5.  Repair Injuries nursinglectures.blogspot.com
6.  Alter form or structure nursinglectures.blogspot.com
7.  Diagnose and Cure Disease Process nursinglectures.blogspot.com
8.  Relieve Suffering nursinglectures.blogspot.com
9.  Prolong Life nursinglectures.blogspot.com
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11.  Preserve Life  Maintain Dynamic Body Equilibrium  Undergo Diagnostic Procedures  Prevent Infection and Healing  Obtain Comfort  Ensure ability to earn a living  Restore or reconstruct organ that is malformed  To alter cosmetic appearance nursinglectures.blogspot.com
12. Congenital Acquired Trauma Anomalies nursinglectures.blogspot.com
13.  According to Purpose 1. Diagnostic – to establish presence of disease 2. Exploratory – to determine extent of disease 3. Curative – to treat disease condition 4. Ablative – involves removal of an organ 5. Constructive – involves repair of congenitally defective organs 6. Reconstructive – involves repair of damaged organ 7. Palliative – to relieve distressing signs and symptoms, not necessarily to cure nursinglectures.blogspot.com
14.  MAJOR SURGERY – HIGH RISK 1. Extensive 2. Prolonged 3. Large amount of blood loss 4. Vital organ may be handled or removed 5. Great risk of complication  MINOR SURGERY 1. Generally not prolonged 2. Leads to few serious complications 3. Involves less risk nursinglectures.blogspot.com
15.  Emergency – to be done immediately to save life or limb  Imperative – to be done within 24 – 48 hours  Planned / Required – necessary for well-being  Elective – not absolutely necessary for survival, delay or omission will not cause adverse effect  Optional – Requested by the client usually for aesthetic purposes  Day (Ambulatory) - done on an outpatient basis nursinglectures.blogspot.com
16.  Obstructions – impairment to the flow of vital fluids nursinglectures.blogspot.com
17.  Perforations – rupture of an organ nursinglectures.blogspot.com
18.  Erosions – wearing off of a surface or membrane nursinglectures.blogspot.com
19.  Tumors – abnormal cell growth of tissue that serves no physiologic function in the body nursinglectures.blogspot.com
20. 1. Malnutrition 2. Obesity 3. Presence of disease such as : Cardiac problem, URTI, Renal diseases, DM, Liver Diseases 4. Age 5. Concurrent or prior pharmacotherapy 6. Nature of the condition 7. Location of the condition 8. Magnitude and extent of surgical procedure 9. Mental attitude of the person toward surgery 10. Caliber of the professional staff and health care facilities nursinglectures.blogspot.com
21.  Stress response is elicited  Defense against infection is lowered  Vascular system is disrupted  Organ functions may be disturbed  Lifestyles may change nursinglectures.blogspot.com
22.  Prefixes – A, Ecto-, Intra-, Inter-, Pan-, Peri-, Poly-, Pseudo-, Retro-  Suffixes – Algia, -centesis, -copy, -ectomy, - itis, -lith, -logy, -lysis, -oma, -ostomy, -pexy, - plasty, -rrhapy  Rootwords – Adeno, Arthro, Auto, Blephar, Cardio, Cephalo, Cerebro, Cheil, Chole, Cholecyst, Choledocho, Chondro, Colpo, Costo, Cranio, Gastro, Hepar, Hyster, Lapar, Nephro, Oculo, Oophoro, Orchi, Osteo, Oto, Phlebo, Pyel, Salphingo nursinglectures.blogspot.com

Surgical Experience Anesthesia

Surgical Experience - Nursing lecture
OUTLINE OF NURSING LECTURES

1. • IV line inserted
   • Receiving a sedating agent prior to induction
   • Losing consciousness
   • Being intubated; if indicated
   • Receiving a combination of anesthetic agents
   • Has no recall of events
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2. • Concurrent medications
   • Optimization of medical treatment for:
   • Diabetes Mellitus (DM) – glycemic control
   • Nutritional status – malnourishment
   • Smoking – cessation
   • Obesity – weight loss
   • COPD – respiratory status, postop exercises
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3. • • class 1 - able to visualize soft palate, fauces, uvula, ant and post tonsillar pillars
   • • class 2 - able to visualize all of the above, except anterior andposterior tonsillar
   • pillars are hidden by the tongue
   • • class 3 - only the soft palate and base of the uvula are visible
   • • class 4 - only the soft palate can be seen (uvula not visualized)
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4. • Common classification of physical status
   • at the time of surgery
   • ASA 1 : healthy fit patient
   • ASA 2 : with mild systemic disease
   • ASA 3 : with severe systemic disease that limits activity
   • ASA 4 : with incapacitating disease that is a constant threat to life
   • ASA 5 : a moribund patient not expected to survive 24 hours with/without surgery
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5. nursinglectures.blogspot.com Levels Findings Minimal Sedation Patient responds normally to VERBAL commands, Cognitive & Coordination Fxn may be impaired, but Ventilatory & Cardiovascular Fxns Unaffected Moderate Sedation Midazolam(Versed)/Diazepam(Valium) used often. Depressed LOC that does not impair patient’s ability to maintain a patent airway Deep Sedation Patient cannot be easily aroused but can respond purposefully after repeated stimulation. IV or Inhalation. NO2 most commonly used GAS Anesthetic ANESTHESIA State of Narcosis (severe central nervous system depression produced by pharmacologic agents), analgesia, relaxation, and reflex loss. Not arousable.
6. nursinglectures.blogspot.com Stages of ANESTHESIA Findings Beginnning Anesthesia / Induction Patient feels DIZZY,WARMTH and DETACHED . May have ringing, roaring, or buzzing in the ears. AVOID NOISE Excitement PR is rapid. Respirations maybe IRREGULAR. SAFETY of the patient is the PRIMARY CONCERN. Surgical Anesthesia Unconscious patient. RR is regular . PR and BP is normal . SKIN is PINK and slightly Flushed. Continuous administration of Anesthetic agent. Medullary Depression Too much Anesthesia. Pulse is weak and thready. Pupil become WIDELY DILATED .Respiratory and Cardio Support. DEATH rapidly follows.
7. • Inhalation – administered with mixing the vapors with OXYGEN. Via ET TUBE or MASK
   • Injection – no buzzing, roaring, or dizziness. THIOPENTAL, agent of choice. Useful in EYE surgery(low Nausea and Vomiting)
   • Rectal – obsolete but sometimes used in Pediatric patients.
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9. • Tranquilizers and Sedative – Hypnotics
   • a. Benzodiazepines
   • 1. Midazolam ( Versed ) – Monitor Respiratory Status
   • 2. Diazepam ( Valium ) –
   • - may produced Thrombophlebitis
   • - Central vein is preferred
   • 3. Chlordiazepoxide ( Librium ) – hypnosis(induction)
   • 4. Droperidol ( Inapsine ) – Extramidal rigidity
   • 5. Lorazepam ( Ativan ) – Hepatoxic/Nephrotoxic
   • Flumazenil (ANEXATE) – benzodiazepine antagonist
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10. • b. Opiods
    • 1. Morphine ( High Doses ) –
    • - not a myocardial depressant
    • - orthostatic hypotension(decreasing systemic vascular resistance)
    • 2. Meperidine HCl ( Demerol ) –
    • - “ Spasmolytic effect ”
    • - DOC for bile duct , distal colon , and rectum surgery . - Ready diphenhydramine (benadryl) for Allergic reaction.
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11. • - refers to combination of short-acting synthetic opiod agent ( fentanyl ) and a butyrophenone ( droperidol )
    • 1. Fentanyl (Sublimaze )
    • 75%-100% more potent than morphine
    • little Cardio effect
    • Respiratory depression
    • 2. Sufentani l (Sufenta)
    • Onset extremely rapid
    • 1/3 duration of fentanyl
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12. • The patient appears to be asleep or anesthesized, but rather dissociated from surroundings.
    • Ketamine (Ketalar;Ketaject)
    • useful when Hypotension can be hazardous
    • may experience hallucinations
    • AVOID Verbal, Visual, or TACTILE stimulation .(triggers psychic aberration )
    • Droperidol or Diazepam may eliminate such psychic phenomena.
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13. • Thiopenthal sodium ( Pentothal )
    • not for children
    • Rapid induction
    • Powerful depressant for breathing
    • Methohexital sodium ( Brevital )
    • rapid onset
    • seizures
    • necrosis if IV infiltrates
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14. • Etomidate (Amidate)
    • Useful for FRAIL patients
    • Transient ADRENAL suppression
    • Involuntary muscle movements
    • Propofol (Diprivan)
    • Rapid induction
    • May have antiemetic effect
    • Pain on injection
    • Myocardial depression
    • Contraindicated in patients with allergy to EGGS and Soybean Oil
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16. • Anesthetic agent is injected around nerves .
    • Motor fibers have the thickest myelin sheath
    • Sympathetic fibers are the smallest and have minimal covering
    • Sensory fibers are intermediate
    • An anesthetic is worn off until all three are no longer affected.
    • A QUIET environment is THERAPEUTIC
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18. • Epidural Anesthesia – injection of local anesthetic into the spinal canal in the space surrounding the dura mater.
    • Absence of spinal headache
    • Difficult to introduce anesthetic agent into the epidural rather than the subarachnoid space.
    • HIGH spinal can result(subarachnoid injection) – causes severe hypotension, respiratory depression and arrest (TREATMENT: Airway, IV, Vasopressor)
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19. • Spinal Anesthesia – local anesthetic is introduced into the subarachnoid space at the lumbar level, usually between L4 and L5.
    • Anesthesia of the lower extremities, perineum and lower abdomen
    • Lumbar puncture procedure – KNEE-CHEST(side)
    • Procaine,tetracaine (Pontocaine), lidocaine (Xylocaine), and bupivacane (Marcaine).
    • Respiratory Paralysis (Temporary/Complete) – High concentrations of med reached the upper thoracic and cervical spinal cord
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20. • Risk Factors
    • Size of spinal needle used
    • Leakage of CSF from the subarachnoid space
    • Patient’s hydration status
    • Decreasing Cerebrospinal pressure
    • TREATMENT
    • 1. Keep patient LYING FLAT
    • 2. QUIET
    • 3. Well hydrated
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21. • Brachial plexus block – anesthesia of the arm
    • Paravertebral anesthesia – anesthesia of nerves supplying the Chest, Abdominal wall & Extremities .
    • Transsacral (caudal) block – anesthesia of the perineum, and occasionally, the lower abdomen.
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22. • The injection of a solution containing the local anesthetic into the tissues at the planned incision site
    • Advantages
    • Simple, Economical, non-explosive
    • Equipment needed is minimal
    • Post-operative recovery is brief
    • Undesirable effects of GA are avoided
    • Ideal for SHORT and SUPERFICIAL operations
    • Usually given with EPINEPHRINE
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23. • maximum dose usually expressed as (mg of LA) per (kg of lean body weight) and as a total maximal dose (adjusted for young/elderly/ill)
    • lidocaine maximum dose: 5 mg/kg (with epinephrine: 7mg/kg)
    • chlorprocaine maximum dose: 11 mg/kg (with epinephrine: 14 mg/kg)
    • bupivicaine maximum dose: 2.5 mg/kg (with epinephrine: 3 mg/kg)
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24. • Occurs by accidental IV injection, Overdose or unexpectedly rapid absorption
    • CNS effects
    • N umbness of tongue, P erioral tingling
    • D isorientation, d rowsiness
    • T innitus
    • V isual D istrubances
    • M uscle twitching, tremors
    • C onvulsions, seizures
    • G eneralized CNS d epression, c oma, r espiratory arrest
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25. • CVS effects
    • V asodilation, hypotension
    • D ecreased myo cardial contractility
    • D ose-dependent delay in cardiac impulse transmission
    • P rolonged PR, QRS intervals
    • S inus bradycardia
    • C VS collapse
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26. • Early recognition of signs
    • 100% O2, manage ABCs
    • Diazepam may be used to increase seizure threshold
    • If seizures are not controlled by diazepam, consider using :
    • Thiopental (increases seizure threshold)
    • SCh (stops muscular manifestations of seizures, facilitates intubation)
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27. • Nausea & Vomiting
    • Turn to side, head lowered, provide basin
    • Pre-op Antiemetic drugs
    • Suction for Saliva and vomited gastric contents
    • Aspiration of Vomitus can lead to Pneumonitis and Pulmonary Edema leading to HYPOXIA.
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28. • Anaphylaxis
    • Reaction of the body to foreign substances
    • Meds common cause of anaphylaxis
    • Latex reaction can also occur
    • Life-threatening – vasodilation, hypotension, and bronchial constriction
    • Fibrin sealants and cyanoacrylate adhesives – can also cause anaphylactic reaction
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29. • Hypoxia and Respiratory Complications
    • Patient’s oxygenation status is the PRIMARY FUNCTION of the ANESTHESIA PROVIDER and the CIRCULATING NURSE .
    • Pulse Oximetry Values are monitored continuously.
    • Anatomic variation, ET tube may be inserted
    • Surgical POSITIONING (Trendelenburg)
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30. • Hypothermia
    • Glucose metabolism is reduced, TEMP decreases results in METABOLIC ACIDOSIS
    • Below 36.6°C[98.0°F] – below Normal core temp
    • Low temp in OR (Set at 25 to 26.6 Celsius)
    • Infusion of cold fluids (Warm to 37.6 Celsius)
    • Warming should be gradual
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31. • Malignant Hyperthermia – inherited MUSCLE DISORDER chemically induced by anesthetic agents.
    • Susceptible People
    • Those with strong and bulky muscles
    • History of muscle cramps or muscle weakness
    • Unexplained temperature elevation
    • Unexplained death of a family member after surgery
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33. • Tachycardia – (150 beats/min), early sign
    • Ventricular dysrhytmia
    • Hypotension
    • Decreased Cardiac Output
    • Oliguria
    • Cardiac Arrest
    • Rigidity , tetanus-like movements
    • Rise in temp , usually a late sign, develops fast
    • 1° to 2° C every 5 mins, can exceed 40°C
    • Trismus (masseter spasm) – common not specific for MH, occurs 1% in children given SCh w/ Halo
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34. • Death / Coma
    • Disseminated intravascular coagulation (DIC)
    • Muscle Necrosis / weakness
    • Myoglobinuric renal failure
    • Electrolyte abnormalities (i.e. iatrogenic hypokalemia)
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35. • Suspect possible MH with family history of problems/death with anesthetic
    • Dantrolene prophylaxis no longer routine
    • Avoid all triggers
    • Central Body temp and ET CO2 monitoring
    • Use regional anesthesia if possible
    • Use equipment “clean” of trigger agents
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36. • Discontinue inhaled anesthetic agent and SCh, terminate procedure
    • Hyperventilate with 100% O2
    • Dantrolene 1mg/kg, repeating until stable or 10mg/kg maximum reached
    • Treat metabolic/physiologic derangements accordingly
    • Control body temperature
    • Diligent monitoring (especially CVS, lytes, ABGs, urine output)
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37. • Life-threatening, characterized by thrombus formation and depletion of select coagulation proteins, Idiopathic
    • Predisposing factors:
    • Emergency surgery
    • Massive trauma
    • Head Injury
    • Massive transfusion
    • Liver/kidney involvement
    • Embolic events or shock
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38. • AVOID Derogatory comments
    • Patient is treated as a person
    • Respecting cultural and spiritua l values
    • Providing physical privacy
    • Maintaining Confidentiality
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39. • 1. A patient in the holding area awaiting surgery indicates that he had not received instructions not to take his usual medications ( antihypertensive agent, diuretic, digoxin, potassium chloride, and insulin injection ); as a result, he took them a few hours ago . What implications does this have for the patient’s care and well-being while awaiting surgery, during surgery, and in the immediate postoperative period?
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40. • 2. What are the differences in responsibility of the operating room nurse for care of patients who receive general anesthesia, conscious sedation, spinal anesthesia, and regional anesthesia ?
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41. • 3. While she is being transferred from the stretcher to the operating table, a female patient says she is very anxious about her surgery because of previous negative experiences . What assessment and interventions are indicated at this time?
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Introduction to Operating Room Nursing

Operating Room Nursing is the application of the nursing process during the Operation or Surgery.

1. • Many surgical procedures that were once performed in an inpatient setting now take place in an Ambulatory or Outpatient setting.
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2. • Approximately 60% of elective surgeries are now performed in an ambulatory or outpatient setting.
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3. • Pre -operative Phase – begins when decision to proceed with surgical intervention is made and ends with the transfer into the operating table
   • Intra -operative Phase – starts from the transfer of patient to the operating table and ends with the admission of the patient to the PACU (post-anesthesia care unit)
   • Post -operative Phase – begins with admission to the PACU and ends with follow-up evaluation in the clinical setting or home
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4. • Diagnostic – Eg. Biopsy or explorative laparotomy
   • Curative – Eg. Excision of a tumor or inflamed appendix
   • Reparative – Eg. Multiple Wound Repair
   • Reconstructive / Cosmetic – Eg. Mammoplasty or facelift
   • Palliative – Eg. To relieve pain, a PEG tube is inserted to compensate for dysphagia
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5. • Voluntary and written INFORMED consent from the patient is necessary before nonemergent surgery can be performed.
   • Consent must be signed before administration of ANY PSYCHOactive medications .
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6. • Voluntary Consent – given FREELY
   • Incompetent Patient – (those who are mentally ill, and comatose CANNOT give consent)
   • Informed Subject – should be in WRITING. Includes explanation of risks, procedure. Description of benefits & alternatives
   • An EMANCIPATED Minor may sign his consent form
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7. nursinglectures.blogspot.com Brunner & Suddarth’s Textbook
8. • The signed consent form is placed in a prominent place on the patient’s chart and accompanies the patient to the operating room.
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9. • The overall goal in the pre-operative period is for the patient to have as many positive health factors as possible…
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10. • o besity, u ndernutrition, w eight loss,
    • m alnutrition, d eficiencies in specific nutrients, m etabolic a bnormalities,
    • the e ffects of medications on nutrition, and s pecial p roblems of the hospitalized patient (Quinn, 1999)
    • m easurement of b ody m ass i ndex and
    • w aist c ircumference (National Institutes of Health, 2000)
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11. • Protein
    • Calories
    • Water
    • Vitamin C
    • Thiamin, Niacin, Riboflavin, Folic Acid, Vit. B12
    • Vitamin A
    • Vitamin K
    • Iron
    • Zinc
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12. • People who abuse drugs attempt to HIDE and DENY it
    • Acutely intoxicated persons are susceptible to injury
    • Alcohol withdrawal delirium ( delirium tremens ) may be anticipated up to 72 hours after alcohol withdrawal.
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13. • Goal : Optimal Respiratory Function
    • B reathing E xercises
    • Use of I ncentive S pirometry
    • Surgery is USUALLY postponed if patient have a R espiratory I NFECTION
    • SMOKING urged to STOP 2 Months before surgery (Counseling has a positive effect 24 hours before operation)
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14. • i ncreased a irway r eactivity
    • d ecreased m ucociliary c learance,
    • p hysiologic c hanges in the c ardiovascular and i mmune systems
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15. • GOAL : to ensure a well functioning cardiovascular system to meet the oxygen, fluid, and nutritional needs of the perioperative period.
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16. • GOAL : optimal function of the liver and urinary systems so that medications, anesthetic agents, body wastes, and toxins are adequately processed and removed from the body.
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17. • Hypoglycemia and Hyperglycemia
    • Acidosis
    • Glucosuria
    • GOAL : Maintain the blood glucose level at less than 200 mg/dl
    • Adrenal insufficiency – for those who have received corticosteroids
    • Thyrotoxicosis (hyperthyroid disorders)
    • Respiratory failure (hypothyroid disorders)
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18. • Existence of Allergies
    • Latex Allergy
    • Immunosuppression
    • The mildest symptoms or slightest temperature elevation must be investigated.
    • Great care is taken to ensure strict asepsis
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19. • OTC Meds – Aspirin, HPN meds, Insulin
    • Herbal Meds –
    • echinacea,
    • ephedra,
    • garlic ( Allium sativum),
    • ginkgo, ginseng
    • kava kava ( Piper methysticum),
    • St. John’s wort ( Hypericum perforatum)
    • licorice (Glycyhiza glabra)
    • valerian ( Valeriana officinalis)
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20. • Emotional Reaction
    • Psychological Distress
    • Anxiety – Anticipatory response
    • Different responses of persons to FEAR:
    • 1. Repeatedly asking questions
    • 2. Withdrawal, avoiding communication
    • 3. Some talk about it
    • *** NURSE Must be an EMPHATETIC listener
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21. • Cortico steroids – Prednisone(Delta sone )
    • Diuretics – Hydrochlorothiazide(Hydro DIURIL )
    • Pheno Thiazines – Chlorpromazine (Thor azine )
    • Tranquil izers – Diazepam (Val ium )
    • Insulin
    • Anti biotics – Erythro mycin (Ery-tab)
    • Anti coagulants – Warfa rin (Coumadin)
    • Anti seizure – Pheny toin (Dilantin)
    • MAO Inhibitors – Phenelzine sulfate (Nardil)
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22. • Less physiologic Reserve
    • Sensory limitations – vision, hearing and reduced tactile sensitivity
    • Arthritis – may affect mobility
    • Dental assessment – impt to Anesthesiologist
    • Ability to perspire – fragile skin (dry)
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23. • Fatty Tissues – susceptible to infection
    • Technical & Mechanical Problems
    • Wound dehiscence(separation) and wound infections are more common.
    • For Every 30 lbs excess weight, additional 25 miles of blood vessels needed, thus increasing workload of the heart.
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24. • IDEAL timing – Pre-admission visit not ON the DAY of SURGERY
    • GOAL – Promote OPTIMAL Lung Expansion after ANESTHESIA
    • USE of Incentive SPIROMETER
    • Splinting of Incision line if possible
    • GOAL – Coughing, mobilizes secretions
    • Deep Breathing
    • Promote Mobility POST-OP
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29. • Identification of ACUTE and CHRONIC Pain
    • PAIN Scale
    • Patient Controlled Analgesia ( PCA )
    • Epidural Catheter (Bolus/Infusion)
    • P.Controlled Epidural Analgesia ( PCEA )
    • Oral Meds for Home Meds
    • Cognitive Coping Strategies – Imagery , Distraction , Optimistic Self-recitation
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30. • Watch out! UNNECESSARY LONG FASTINGS
    • Warn Patients they might feel thirsty and teach strategies(as permitted): b rushing teeth, r insing the mouth, and c hewing gum
    • 8 hours fasting after eating fatty foods
    • 4 hours after ingesting milk products
    • 2 hours for clear liquids in an elective procedure
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31. • G own left U ntied, O PEN in the B ACK
    • M outh Inspected, D entures removed
    • Jewelries not WORN , If patient refuse , some allow ring to be taped in finger
    • All Patients should VOID immediately(except those with UROLOGIC D/O) to promote continence and make abdominal organs more accessible
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33. • Anxiety related to the surgical experience (anesthesia, pain) and the outcome of surgery
    • Fear related to perceived threat of the surgical procedure and separation from support system
    • Knowledge deficit of preoperative procedures and protocols and postoperative expectations
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34. • 1. During the preoperative assessment of a man scheduled for hand surgery in an ambulatory setting, you think that the patient’s responses indicate that he does not understand the procedure and that he has not made plans for postoperative care. What further assessment and teaching is indicated? What nursing interventions are warranted?
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35. • 2.A patient with a long history of the use of several herbal supplements is scheduled for major surgery. What effect would this information have on your preoperative care of this patient?
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36. • 3. Two patients are admitted to the same-day surgery unit for bilateral knee replacements. One patient is a 30-year-old who ambulates with crutches and the other is a 75-year-old who lives alone. How would your assessments, preoperative teaching , and preparation differ for these two patients?
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Post Operative Nursing

Post-operative nursing starts when the patient is transferred to the recovery room or the PACU(Post Anesthesia Care Unit) until the time the patient is discharged from the hospital or transferred to the surgical ward.

1. • AKA post anesthesia recovery room
   • Located adjacent to Operating Rooms
   • Has soft pleasing colors, soundproof ceiling, equipments that control noise(rubber)
   • Well ventilated (decrease anxiety and promote comfort)
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2. • Phase I PACU – immediate recovery phase, Intensive nursing care is provided
   • Phase II PACU – patients who require less frequent observation and nursing care ,also referred as STEP-down , Sit-up , or progressive Care units
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3. • TO provide Nursing care until the patient has recovered from the effects of ANESTHESIA .
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5. • Signs
   • Choking
   • Noisy and Irregular respirations
   • O2 Saturation Scores
   • Cyanosis
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8. • Pallor
   • Cool, moist skin
   • Rapid breathing
   • Cyanosis of the lips, gums, and tongue
   • Rapid, weak, thready pulse
   • pulse pressure
   • blood pressure and concentrated urine
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9. • Primary – VOLUME REPLACEMENT
   • Infusion of lactated Ringer’s Solution
   • Position Patient flat on bed with legs elevated at 20° and knees straight
   • Special considerations for JEHOVAH’s witness or those who decline blood transfusions
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10. • Turn patient to the one side to promote mouth drainage & prevent aspiration of vomitus ( can cause asphyxiation and death )
    • Anti-emetics:
    • Ondansetron ( Zofran )
    • Droperidol ( Inapsine )
    • Metoclopromide ( Reglan )
    • Promethazine ( Phenergan )
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15. • PR , BP and RR –every 15 mins( 1 st hour )
    • PR , BP and RR –every 30 mins( next 2 hours )
    • Less frequently = more stable VS
    • Temperature – every 4 hours ( 1 st 24 hours )
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17. • Atelectasis (alveolar collapse)
    • Pneumonia
    • Hypostatic pulmonary congestion
    • Subacute hypoxemia
    • Episodic hypoxemia
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18. • Turn frequently and deep breathing every 2 hours
    • Encourage coughing (contraindicated in head and eye injuries)
    • Encourage YAWNING (lung expansion) or take sustained maximal inspirations
    • Use of Incentive spirometer (10 deep breaths every hour while awake)
    • Encourage early ambulation (increases metabolism and pulmonary aeration) the day of surgery or no later than the 1 st post-op day – prevents pulmonary complications in elderly
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19. • PREVENTIVE approach favored over “PRN” approach
    • Hypothalamic stress response = platelet aggregation and blood viscosity (can cause phlebothrombosis and pulmonary embolism
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20. • Patient Controlled Anesthesia (PCA) – 2 reqmts: understanding of the need to self-dose and the physical ability to self-dose.
    • Epidural infusions – local opiod + anesthetic
    • Intrapleural anesthesia – administration of anesthetic between parietal & visceral pleura
    • Subcutaneous pain management – a silicone catheter is attached to a pump that delivers the local anesthetic
    • Nonpharmacologic relief measures
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21. • Establish BASELINE Vital Signs
    • Report Sys BP 90mmhg and below
    • Report if BP drops 5mmhg every 15mins
    • Intake and Output (<240ml>
    • Promote Early ambulation (prevents DVT and peristalsis)
    • Patient may sit at the edge of bed first.
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22. • Wound drains – allow escape of blood and serous fluids that could serve as culture medium for bacteria
    • Record output of wound drains
    • Mark drainage on dressings with pen. Record date and time to note if it is increasing.
    • Portable wound suction provides continues suction and this prevents formation of “dead spaces”
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24. • Inflammatory
    • Proliferative
    • Maturation
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26. Wound is usually packed with SALINE moistened sterile dressings and covered with DRY sterile dressing nursinglectures.blogspot.com
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28. • Keep wound dry and clean
    • Apply hypoallergenic tape
    • Report signs of infection : (R,W,P,C)
    • Swelling is common (Rest, Elevate)
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29. WOUND DEHISCENCE – disruption of surgical incision or wound EVISCERATION - protrusion of wound contents nursinglectures.blogspot.com
30. • N & V – common in obese, women, pts. Prone to motion sickness and those with prolonged surgery
    • Insert NGT (for persistent Vomiting)
    • Hiccups – caused by intermittent spasms of the diaphragm 2 nd to phrenic nerve irritation
    • Phenothiazine medication for persistent Hiccups
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31. • Oral intake – stimulates digestive juices, promotes gastric function & peristalsis
    • Liquids 1 st
    • Water, fruit juices, tea in increasing amounts
    • Soft foods (gelatin, custard, milk and creamed soups)
    • Solid foods
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32. • Return of peristaltic activity
    • Auscultate bowel sounds
    • Passage of Flatus
    • Paralytic ileus and intestinal obstruction – potential post-operative complications
    • Voiding – expected within 8 hours post-op
    • Letting water run
    • Apply heat to the perineum
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33. • Risk Factors
    • Dehydration
    • Venous pooling
    • Low Cardiac output
    • Bed rest
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34. • Dorsiflexion of the foot causes pain in the calf muscle
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35. • Low-dose heparin (SQ) until ambulatory
    • Low-molecular weight heparin and low-dose warfarin
    • External pneumatic compression
    • Thigh-high elastic compression stockings
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37. • 1. Your patient has a history of esophageal cancer and is HIV positive. After undergoing ambulatory surgery to insert a gastric feeding tube, he is to be discharged to home. Indicate which assessment findings would indicate his readiness for discharge. Describe a teaching plan for the patient and his family. How would you modify the plan if the patient lives alone?
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38. • 2. A patient who has undergone abdominal surgery reports severe pain and as a result is unable to cough and deep breathe. When you listen to the patient’s lungs you hear crackles in the bases. Analyze this findings and indicate the interventions you would implement in this situation. How would your care differ if the patient has a musculoskeletal disorder that makes turning and ambulation difficult?
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39. • You are visiting a 72 yr old woman who had emergency surgery for a broken hip 3 weeks ago and has returned to her home, where she is living alone. How would you direct your assessment to identify the factors that might affect her recovery? How would you modify your assessment and nursing care plan because of her age?
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