Operating room

Operating Room

ARE YOU READY FOR

YOUR OPERATION?

Goal

Patient Safety:

Provide safe patient care

Provide a safe environmentERMTERUEL 2011

Goal: Patient Safety

PROVIDE SAFE PATIENT CARE Knowledge of procedure Ensure the correct patient, correct site, and correct level.

Knowledge of positioning

Adhere to safe medication administration guidelines

Surgical counts

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3 phases1.Sign in2.Time out

3.Sign out

WHO Safe Surgery Checklist

JCAHO

Goal: Patient Safety

PROVIDE A SAFE ENVIRONMENT

Adhere to asepsis

Promote coordinated and effective communication

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Nursing Roles in the OR

Circulating Nurse Scrub person RNFA Perioperative educator Specialty team leader

Perioperative managerERMTERUEL 2011

Scope of Nursing Practice

Advocate Protector Teacher Change agent Manager of

patient careERMTERUEL 2011

SURGICAL RISK

Probability of

morbidity or death

from surgery

A. Nature of condition

Severity: benign or malignant

Location: location of the disease and the

organ requiring surgeryDuration: length of the time the patient

has been exposed to the illness dictates the degree of risk involved.

B. Magnitude/urgency of the surgical procedure

Operative risk is proportional

with the magnitude of the operation

C. Physical and Mental conditions

Based on health status

and person’s mental attitude

toward surgery

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C. 1. Physical Condition a. Age

infants and elderly have the lowest tolerance to the stressful effects of surgery.

b. Nutritional status a well-nourished pre-op

client is better prepared for surgical stress and return to optimal health after surgery.

A. ObesityB. Malnutrition ERMTERUEL 2011

C. 1. Physical Condition

c. Fluid and electrolyte problems

fluid volume deficit leads to possible intra and post-op complications.

d. Presence of diseases increases the

operative risk

Presence of diseases

a. Pulmonary

b. Cardiovascular


c.Hematologicd.Neurological


e. Liverf. Renal


h.Gastrointestinal

i. Integumentaryj. Disabilitiesk. endocrine


e. Use of medications

1.Tranquilizers2.Insulin3.Adrenal

corticosteroids


e. Use of medications

4. Diuretics5. Phenothiazines

and antidepressants (MAO)

6. Antibiotics

C. 2. Mental Condition

FEAR1. Fear of the unknown2. Fear of anesthesia3. Fear of pain4. Fear of death5. Fear of disturbance

of body image6. Worries

Manifestations of Fear

1.Anxiousness2.Bewilderment3.Anger4.Tendency to

exaggerate5.Sad, evasive,

tearful, clingyERMTERUEL 2011

Manifestations of Fear

6.Inability to concentrate

7.Short attention span

8.Failure to carry out simple instructions

9.Dazed ERMTERUEL 2011

Three types of defense mechanism

1. Regression behaves in a childlike

manner.2. Denial appears unalarmed

3. Intellectualization would discuss operation

and illness rationally but without emotion

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D. Professional Resources

Caliber of the

professional staff and health care

facilities

E. Financial resourses

MEMBERS OF THE SURGICAL TEAM

1. Surgeon2. Assistant to the

surgeon3. Anesthesiologist4. Nurse anesthetist

(CRNA)5. Circulating nurse6. Scrub nurse

The health care team: Division of OR Team and their function

Scrub Nurse/ Surgical Technician

Assist through

instrumentation


sets up the sterile

table; prepares sutures, ligatures and other supplies


maintains sterility of

field during

procedure


Counting


labels tissue

specimen obtained during

procedure


keep track of time the patient is

under anesthesia


time wound is opened, incisions closed

Circulating Nurse also known as circulator

verifying consent, coordinating the team, ensuring

cleanliness, proper

temperature, humidity and lighting, safe functioning of

equipments and availability of

supplies


manages OR &

protects the safety and health needs of

client


assists in

positioning clients


performs surgical

skin preparatio

n


monitors aseptic

practices to avoid breaks in technique


coordinates movement of related personnel


implement fire safety precaution

s


Monitor patient and documents

specific activities


sends tissue specimen

Surgeon

HEADS THE SURGICAL TEAM

PERFORMS AND

MAKES DECISIONS CONCERNING

SURGICAL PROCEDURES

Assistant Surgeon

hold retractors to expose operative site clamp bleeding blood

vesselssuction blood

assist in suturing or

closing the wound

Anesthesiologist

reassess patient’s physical condition immediate prior to

initiating anesthesiaadminister anesthesia

and monitor patient’s vital

signs during entire procedure

Anesthetist

works under the direct

supervision of an

anesthesiologist; most are

nurses with required training

The Surgical Patient

Effects of Surgery

Effects of Surgery

Stress response

is elicited.

Effects of Surgery

Defense against

infection is

lowered

Effects of Surgery

Vascular system

is disrupted

Effects of Surgery

Organ functions

are disturbed

Effects of Surgery

Body image may be

disturbed

Effects of Surgery

Lifestyles may change

Nursing Responsibility: Preoperativ

e Phase

1. Assessment

physiological and

psychological response

Preoperative health teaching

2. Pre-operative teaching

Leg exercises

To stimulate blood circulation in the extremities to prevent thrombophlebitis

Deep breathing and Coughing Exercises

To facilitate lung aeration and secretion mobilization to prevent atelectasis and hypostatic pneumoniaDone every two to four hours

Positioning and Ambulation

For circulation, stimulate respiration, decrease stasis of gas

Diaphragmatic Breathing and Splinting When Coughing

Leg Exercises and Foot Exercises

3. Physical preparations

Correct any

dietary deficiencies

Physical preparations

Reduce an

obese person’s weight


Correct fluid and

electrolyte imbalances


Restore adequate

blood volume

with blood transfusio

n.


HALT OR TREAT

INFECTIOUS PROCESS.


TREAT CHRONIC

DISEASES.

Physical preparationsTreat an alcoholic person with

vitamin supplementation

IVF or oral fluids if

dehydrated.

On the Night of Surgery

PREPARING THE SKIN

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PREPARING THE

GI TRACT


PREPARING

FOR ANESTHESIA


PROMOTING REST AND SLEEP

On the Day of Surgery

AWAKEN AN

HOUR BEFORE PRE-OP

MEDICATIONS


Morning bath

mouth wash


PROVIDE CLEAN GOWN


REMOVE HAIRPINS

BRAID LONG HAIRS

COVER HAIR WITH CAP


Remove dentures foreign materials colored nail polish

hearing aidcontact lens

(wedding ring secured to waist)


Take baseline

VS before pre-op meds


Check ID band


Skin prep


Check for special orders

EnemaIV line


Check NPO


Have client void

before pre-op meds


Continue to

support emotionally


Accomplish “pre-op

checklist.”

4. PRE-OP CHECKLIST

Client has ID band and allergy bracelet

Informed consent is signed and witnessed

Diagnostic and laboratory test results

Client voidedDocument height and weightVital signs before exiting the

wardPre-op meds givenDocument allergy

5. Pre Anesthesia or Pre Medication

Purpose: allay anxiety

produce amnesia reduce n&v

dec resp secretionsdec vagal nerve stimulations

inc pain thresholdinc effects of anesthetic

agents

5. Pre Anesthesia or Pre Medication

Peak effect is desired at the

time of induction Usually given 45

min before induction

Pre-operative medications Pre-op Drugs Example Purpose

Anti-anxiety Diazepam To decrease nervousnessPromote relaxation

Anti-cholinergic Atropine Decreases secretionsPrevent bradycardia

Muscle relaxant Succinylcholine To promote muscle relaxation

Anti-emetic Promethazine To prevent nausea and vomiting

Antibiotic Cephalosporin To prevent infection

Pre-operative medications Pre-op Drugs Example Purpose

Analgesics Meperidine To decrease pain and decrease anesthetic dose

Anti-histamine Diphenhydramine To decrease occurrence of allergy

H-2 antagonist Cimetidine To decrease gastric fluid and acidity

Make sure pre-op meds are givenensure all documentation and pre-operative procedures and orders are complete

Send entire medical record or chart to the Operating room with patient

6. Transporting the client to the OR30-60’ in the holding area

7. Patient’s familyDirect proper waiting room.

Doctor informs family immediately after surgery.

Explain reason for long interval of waiting.

Explain what to expect.

8. LEGAL Considerations

Informed ConsentOperative PermitSurgical ConsentLEGAL

document required for certain

diagnostic procedures or

therapeutic measures including surgery

Legal aspect of the informed consent

PURPOSE:

Protection

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3 Major Elements of Informed Consent

1. Given voluntarily2. Given to individual

who have the capacity to understand.

3. Given information to be the ultimate decision maker.

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Requisites for Validity of Informed Consent

Written consent made by the client. No signs of pressure No Sedation 24 hours before elective surgery emancipated minor Legal age and mentally capable 2 surgeon signed the consent in

emergency. Authorized representative-minor,

unconscious, psychologically incapacitated. ERMTERUEL 2011

Legal aspect of the informed consent

Exemptions:

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Nursing Consideration

No sedationThe surgeon explains the consent

The nurse: ADVOCATOR

Activities during the Intra-op

Assisting the surgeon as scrub nurse and circulating nurse

Principles of sterility

Sterile Field

AREA around the site of incision

and equipments

including all furniture covered w/ sterile drapes

and personnel who are properly attired.

Sterile Technique

METHODby which

contamination w/ microorganism

is prevented

to maintain sterility

throughout the operative procedure.

SCRUB OUT !!!

PRINCIPLES OF STERILE TECHNIQUE

Only sterile items are

used within the sterile

field


Gowns are considered sterile only

from the waist to shoulder

level in front and sleeves


Tables are sterile only

at table level.


Persons who are sterile touch only

sterile items or areas.


Unsterile persons avoid reaching over a sterile field; sterile

persons avoid leaning over an unsterile area.


Edges of anything that

encloses sterile contents are considered unsterile


Sterile field is created as

close as possible to time of use.


Sterile areas are

continuously kept in

view


Sterile persons keep well within the sterile

area


Sterile persons keep contact with sterile areas

to a minimum


Unsterile persons

avoid sterile areas


Destruction of integrity of microbial barriers

results in contamination


Microorganisms must be kept to an irreducible minimum

Operating room

Health & Medicine

Transcript of Operating room