INTRA OPERATIVE CARE
OF A PATIENT
PRESENTED
BY
OLUKOYA MARY BUSOLA
AND
AWONUSI MONSURAT
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Intraoperative Care
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Physical Environment
• Surgical suite
• Controlled environment
• Designed to minimize spread of
infections
• Allows smooth flow of patients,
personnel, and instruments/equipment
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Physical Environment
• Unrestricted areas
• Personnel in street clothes interact
with those in scrubs
• Holding and information areas
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Physical Environment
• Semi-restricted areas
• Peripheral support areas and corridors
with only authorized people
• Must wear surgical attire and cover all
head and facial hair
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Physical Environment
• Restricted areas
• Operating rooms
• Scrub sink areas and clean core
• Masks required
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Physical Environment
• Holding area
• Waiting area inside or adjacent to
surgical area
• Final identification and assessment
• Minor procedures performed
• Friends/family allowed
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Physical Environment
• Operating room
• Geographically, environmentally,
bacteriologically controlled
• Restricted in inflow and outflow of
personnel
• Preferred location is next to postanesthesia care unit
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Surgical Team
• Perioperative nurse
• Prepares room with team
• Patient advocate throughout surgical
experience
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Surgical Team
• Circulating nurse
• Not scrubbed, gowned, or gloved
• Remains in unsterile field
• Documents
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Surgical Team
• Scrub nurse
• Follows designated scrub procedure
• Gowned and gloved in sterile attire
• Remains in sterile field
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Surgical Team
• Surgeon
• Physician who performs the procedure
• Responsible for:
• Preoperative medical history
• Physical assessment
• Patient safety
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Surgical Team
• Surgeon’s assistant can be physician or
RN who functions in assisting role
• Holds retractors
• Assists with hemostasis and suturing
• May perform portions of procedure
under direct supervision
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Surgical Team
• Anesthesia care provider
• Administers anesthesia
• Anesthesiologist or nurse anesthetist
• Maintenance of physiologic
homeostasis throughout intraoperative
period
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Nursing Management
• Before surgery
• Psychosocial assessment
• Physical assessment
• Chart Review
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Nursing Management
• Chart review
• History and PE
• Urinalysis
• CBC
• Serum electrolytes
• Chest x-ray
• ECG
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Nursing Management
• Chart review
• Diagnostic tests (i.e., CT scan)
• Pregnancy testing
• Surgical and blood transfusion
consent
• Allergies
• Blood type and crossmatch
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Nursing Management
• Room preparation
• Surgical attire worn by all persons
entering OR suite
• Electrical and mechanical equipment
checked for proper functioning
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Nursing Management
• Aseptic technique practiced with
placing instruments
• Counts
• Delineation of team members
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Nursing Management
• Basic aseptic technique
• Center of sterile field in surgical
incision
• Only sterilized items in sterile field
• Face shields
• Caps, gloves, aprons, eyewear
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Nursing Management
• Positioning of patient
• Accessibility of operative site
• Administration and monitoring of
anesthetic agents
• Maintenance of airway
• Correct skeletal alignment
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Commonly Used Intra Op
Positions
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Nursing Management
• Prevent pressure on nerves, skin over
bony prominences, eyes
• Provide for adequate thoracic
excursion
• Prevent occlusion of arteries and veins
• Provide modesty in exposure
• Recognize and respect needs such as
pain or deformities
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Nursing Management
• Prevent injury
• Patient will not feel pain impulses
due to anesthesia
• Secure extremities
• Provide adequate padding and
support
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Classification of Anesthesia
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General anesthesia
Local anesthesia
Regional anesthesia
Conscious sedation
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Classification of Anesthesia
• General Anesthesia
• Loss of sensation with loss of
consciousness
• Skeletal muscle relaxation
• Analgesia
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Classification of Anesthesia
• General anesthesia
• IV induction agents
• Induce pleasant sleep
• Rapid onset
• Inhalation agents
• Enter body through alveoli
• Rapid excretion by ventilation
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Classification of Anesthesia
• Adjuncts to general anesthesia
• Opioids
• Pre-op: Sedation and analgesia
• Intra-op: Induction & maintenance
• Post-op: Pain management
• Respiratory depression
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Classification of Anesthesia
• Adjuncts to general anesthesia
• Benzodiazapines
• Premedication for amnesia
• Induction of anesthesia
• Conscious sedation
• Supplemental IV sedation during local and
regional anesthesia
• Anxiety and agitation
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Classification of Anesthesia
• Adjuncts to general anesthesia
• Neuromuscular blocking agents
• Facilitate endotracheal intubation
• Relaxation/paralysis of skeletal
muscles
• Interrupt transmission of nerve
impulses at neuromuscular junction
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Classification of Anesthesia
• Adjuncts to general anesthesia
• Antiemetics
• Prevent nausea and vomiting
associated with anesthesia
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Classification of Anesthesia
• Local anesthesia
• Loss of sensation without loss of
consciousness
• Topically
• Intracutaneously
• Subcutaneously
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Classification of Anesthesia
• Spinal anesthesia
• Injection of agent into CSF in
subarachnoid space
• Usually below L2
• Autonomic, sensory, and motor
blockade
• May become hypotensive from
vasodilation
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Classification of Anesthesia
• Epidural block
• Injection of agent into epidural space
• Does not enter CSF
• Binds to nerve roots as they enter
and exit the spinal cord
• Patient can remain fully conscious
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Classification of Anesthesia
• Observe closely for signs of
autonomic nervous system (ANS)
blockade
• Bradycardia
• Hypotension
• Nausea/vomiting
• Decreased incidence of headache
associated with spinal anesthesia
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Classification of Anesthesia
•
Regional anesthesia
• Loss of sensation in body region
without loss of consciousness when
specific nerve or group of nerves is
blocked with administration of local
anesthetic
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Classification of Anesthesia
• Conscious sedation
• Minimally depressed level of
consciousness with maintenance of
patient’s protective airway reflexes
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Additional Anesthetic
Considerations
• Controlled hypotension
• Decrease amount of expected blood
loss by lowering blood pressure during
administration of anesthesia
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Additional Anesthetic
Considerations
• Hypothermia
• Deliberate lowering of body
temperature to decrease metabolism
• Reduces demand for O2 and anesthesia
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Catastrophic Events in the OR
• Anaphylactic reactions
• Manifestations may be masked by
anesthesia
• Vigilance and rapid intervention
essential
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Catastrophic Events in the OR
• Malignant hyperthermia
• Inherited hypermetabolism of skeletal
muscle resulting in altered control of
intracellular calcium
• Rare metabolic disease
• Hypermetabolism of skeletal muscles →
muscle contracture, hyperthermia,
hypoxemia, lactic acidosis,cardiac collapse
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Catastrophic Events in the OR
• Malignant hyperthermia
• Tachycardia
• Tachypnea
• Hypercarbia
• Ventricular arrhythmias
• Rise in body temperature NOT an early
sign
• Can result in cardiac arrest and death
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