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Intraoperative
Definition
The intraoperative phase extends from the time the client is admitted to
the operating room, to the time of anesthesia administration, performance of
the surgical procedure and until the client is transported to the recovery
room or postanesthesia care unit (PACU).
Throughout the surgical experience the nurse functions as the patients chief
advocate. The nurses care and concern extend from the time the patient is
prepared for and instructed about the forthcoming surgical procedure to the
immediate preoperative period and into the operative phase and recovery
from anesthesia. The patient needs the security of knowing that someone is
providing protection during the procedure and while he is anesthetized
because surgery is usually a stressful experience.
Goals
1.
2.
3.
4.
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Nursing Functions
Circulating Nurse
The circulating nurse manages the operating room and protects the safety
and health needs of the patient by monitoring activities of members of the
surgical team and checking the conditions in the operating room.
Responsibilities of a circulation nurse are the following:
1. Assures cleanliness in the OR.
2. Guarantees the proper room temperature, humidity and lighting in
OR.
3. Make certain that equipments are safely functioning.
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4. Ensure that supplies and materials are available for use during
surgical procedures.
5. Monitors aseptic technique while coordinating the movement of
related personnel.
6. Monitors the patient throughout the operative procedure to ensure
the persons safety and well being.
Scrub Nurse
The scrub nurse assists the surgeon during the whole procedure by
anticipating the required instruments and setting up the sterile table. The
responsibilities of the scrub nurse are:
1.
2.
3.
4.
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Description
Example
Good
No organic disease; no
Uncomplicated hernias,
systemic disturbance
fracture
Mild to moderate
systemic disturbance
Severe systemic
Poorly controlled
disturbance
diabetes, pulmonary
Fair
Poor
complications,
moderate cardiac (III)
disease
Serious
Systemic disease
threatening life
Moribund
Massive pulmonary
but submitting to
embolus, ruptured
operation in desperation
abdominal aneurysm
with profound shock
Emergency
An uncomplicated
surgery is performed in
an emergency situation
strangulated and
associated with nausea
and vomiting.
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Anesthesia
Anesthesia controls pain during surgery or other medical procedures. It
includes using medicines, and sometimes close monitoring, to keep you
comfortable. It can also help control breathing, blood pressure, blood flow,
and heart rate and rhythm, when needed. Anesthetics are divided into two
classes:
1. Those that suspend sensation in the whole body General
anesthesia
2. Those that suspend sensation in certain parts of the body local,
regional, epidural or spinal anesthesia
General Anesthesia
This type of anesthesia promotes total loss of consciousness and sensation.
General anesthesia is commonly achieved when the anesthetic is inhaled or
administered intravenously. It affects the brain as well as the entire body.
Types of general anesthesia administration:
Volatile liquid anesthetics this type of anesthetic produces anesthesia when
their vapors are inhaled. Included in this group are the following:
1.
2.
3.
4.
Halothane (Fluothane)
Methoxyflurane (Penthrane)
Enflurane (Ethrane)
Isoflurane (Forane)
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2. Cyclopropane
Stages
General anesthesia consists of four stages, each of which presents a definite
group of signs and symptoms.
Stage I: Onset or Induction or Beginning anesthesia.
This stage extends from the administration of anesthesia to the time of loss
of consciousness. The patient may have a ringing, roaring or buzzing in the
ears and though still conscious, is aware of being unable to move the
extremities easily. Low voices or minor sounds appear distressingly loud and
unreal during this stage.
Stage II: Excitement or Delirium.
Stage II extends from the time of loss of consciousness to the time of loss of
lid reflex. This stage is characterized by struggling, shouting, talking, singing,
laughing or even crying. However, these things may be avoided if the
anesthetic is administered smoothly and quickly. The pupils become dilated
but contract if exposed to light. Pulse rate is rapid and respirations are
irregular.
Stage III: Surgical Anesthesia.
This stage extends from the loss of lid reflex to the loss of most reflexes. It is
reached by continued administration of the vapor or gas. The patient now is
unconscious and is lying quietly on the table. Respirations are regular and
the pulse rate is normal.
Stage IV: Overdosage or Medullary or Stage of Danger.
This stage is reached when too much anesthesia has been administered. It is
characterized by respiratory or cardiac depression or arrest. Respirations
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become shallow, the pulse is weak and thread and the pupils are widely
dilated and no longer contract when exposed to light. Cyanosis develops
afterwards and death follows rapidly unless prompt action is taken. To
prevent death, immediate discontinuation of anesthetic should be done and
respiratory and circulatory support is necessary.
Local Anesthesia
Local anesthetics can be topical, or isolated just to the surface. These are
usually in the form of gels, creams or sprays. They may be applied to the
skin before the injection of a local anesthetic that works to numb the area
more deeply, in order to avoid the pain of the needle or the drug itself
(penicillin, for example, causes pain upon injection).
Regional anesthesia
Regional anesthesia blocks pain to a larger part of the body. Anesthetic is
injected around major nerves or the spinal cord. Medications may be
administered to help the patient relax or sleep. Major types of regional
anesthesia include:
1. Peripheral nerve blocks. A nerve block is a shot of anesthetic near a
specific nerve or group of nerves. It blocks pain in the part of the
body supplied by the nerve. Nerve blocks are most often used for
procedures on the hands, arms, feet, legs, or face.
2. Epidural and spinal anesthesia. This is a shot of anesthetic near the
spinal cord and the nerves that connect to it. It blocks pain from an
entire region of the body, such as the belly, hips, or legs.
With regional anesthesia, an anesthetic agent is injected around the nerved
so that the area supplied by these nerves is anesthetized. The effect
depends on the type of nerve involved. The patient under a spinal or local
anesthesia is awake and aware of his or her surroundings.
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Spinal Anesthesia
This is a type of conduction nerve block that occurs by introducing a local
anesthetic into the subarachnoid space at the lumbar level which is usually
between L4 and L5. Sterile technique is used as the spinal puncture is made
and medication is injected through the needle. The spread of the anesthetic
agent and the level of anesthesia depend on:
1.
2.
3.
4.
Nursing Assessment
The following are nursing assessment after anesthesia:
1. Monitoring vital signs.
2. Observe patient and record the time when motion and sensation of
the legs and the toes return.
Side Effects
1. Some numbness or reduced feeling in part of your body (local
anesthesia)
2. Nausea and vomiting.
3. A mild drop in body temperature.
How do anesthesiologists determine the type of anesthesia to be
used?
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Positioning
The nurse should have an idea which patient position is required for a certain
surgical procedure to be performed. There are lots of factors to consider in
positioning the patient which includes the following:
1. Patient should be in a comfortable position as possible whether he
2.
3.
4.
5.
6.
7.
8.
Nursing Responsibilities
Here are the nursing responsibilities during intraoperative phase:
1.
2.
3.
4.
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