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 anesthesiaRegional 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 perceptionPlanning : 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 SURGERYAssessment : VS, respiratory and cardiac status, complicationsDiagnosis : 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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