members of ot team and their role.ahnpptx

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1. Members of the OT team and their roles University institute of nursing

2. Perioperative Nursing Definition of Surgery Surgery is any procedure performed on the human body that uses instruments to alter tissue or organ integrity .

3. Perioperative Nursing Perioperative Nursing - connotes the delivery of patient care in the preoperative , intraoperative , and postoperative periods of the patients surgical experience through the framework of the nursing process. The nurse assesses the patient- collecting,organizing, and prioritizing patient data; establishing nursing diagnosis;identifies desired patient outcomes;develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient.

4. Perioperative Nursing Phases Preoperative phase – begins when the decision to have surgery is made and ends when the client is transferred to the OR table. Intraoperative phase – begins when the client is transferred to the OR table and ends when the client is admitted to the PACU. Postoperative phase - begins with the admission of the client to the PACU and ends when the healing is complete.

5. Perioperative Nursing Surgical settings Surgical suites Ambulatory care setting Clinics Physician offices Community setting Homes

6. Perioperative Nursing Surgical settings Disadvantages Less time for rapport Less time to assess, evaluation, teach Risk of potential complication post D/C. Advantages of outpatient : Low cost Low risk of infection Less interruption of routine Less than from work Less stress

7. Intraoperative Phase Surgical Team Surgeon Anesthesiologist Scrub Nurse Circulating Nurse OR techs

8. Intraoperative Nursing Care Roles of team members Surgeon -responsible for determining the preoperative diagnosis, the choice and execution of the surgical procedure, the explanation of the risks and benefits, obtaining inform consent and the postoperative management of the patient’s care. Scrub nurse- (RN or Scrub tech)- preparation of supplies and equipment on the sterile field; maintenance of pt.s safety and integrity: observation of the scrubbed team for breaks in the sterile fields; provision of appropriate sterile instrumentation, sutures, and supplies; sharps count .

9. Perioperative Nursing Care Surgical team Circulating Nurse - Responsible for creating a safe environment, managing the activities outside the sterile field, providing nursing care to the patient. Documenting intraoperative nursing care and ensuring surgical specimens are identified and place in the right media. In charge of the instrument and sharps count and communicating relevant information to individual outside of the OR, such as family members .

10. Perioperative Nursing Care Surgical team Anesthesiologist and anesthetist- anesthetizing the pt. providing appropriate levels of pain relief, monitoring the pt’s physiologic status and providing the best operative conditions for the surgeons. Other personnel- pathologist, radiologist, perfusionist, EVS personnel.

11. Perioperative Nursing Care Surgical team Nursing Roles: Staff education Client/family teaching Support and reassurance Advocacy Control of the environment Provision of resources Maintenance of asepsis Monitoring of physiologic and psychological status

12. Intraoperative Nursing Care Surgical asepsis Ensure sterility Alert for breaks

13. Int r ao p e r a ti v e P h as e Anesthesia Greek word- anesthesis, meaning “negative sensation.” Artificially induced state of partial or total loss of sensation, occurring with or without consciousness. • • • • Blocks transmission of nerve impulses Suppress reflexes Promotes muscle relaxation Controlled level of unconsciousness

14. Intraoperative Phase Anesthesia Factors influencing dosage and type : 1. Type and duration of the procedure 2. Area of the body being operated on 3. Whether the procedure is an emergency 4. Options of management of post. Op. pain 5. How long it has been since the client ate, had any liquids, or any medications 6. Client position for the surgical procedures

15. Intraoperative Phase Types of Anesthesia General- method use when the surgery requires that the patient be unconscious and/or paralyzed. A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur.

16. Intraoperative Phase Stages of General Anesthesia Stage 1- Analgesia state and sedation, relaxation - patient is conscious, decresed perception of pain Stage 2- delirium state- patient is unconscious, irregular breathing pattern Stage 3- Operative anesthesia, surgical anesthesia - increased degree of musle relaxation Stage 4- Medullary depression- depression of CV and Respiratory center

17. Intraoperative Phase Complications of General Anesthesia Overdose Hypoventilation Related to anesthetic agents Malignant hyperthermia ( rigid muscles, increased HR) Related to intubation

18. Intraoperative Phase Local or Regional Anesthesia Temporarily interrupts the transmission of sensory nerve impulses from a specific area or region. Motor function may or may not be affected Client does not lose consciousness Gag reflex remains intact Supplemented with sedatives, opioids, or hypnotics

19. Types of Regional Anesthesia Topical (surface) Local Nerve Block Intravenous (Bier Block) Spinal Epidural (peridural )

20. Intraoperative Phase Complications of Local/Regional Anesthesia Anaphylaxis Administration technique Systemic absorption Overdosage

21. Spinal Anesthesia I ndications - surgical procedures below the diaphragm -patients with cardiac or respiratory disease Advantages - mental status monitoring -shorter recovery Disadvantages - necessary extra expertise -possible patient pain Contraindications - coagulopathy -uncorrected hypovolemia

22. Spinal Anesthesia Involved medications - lidocaine -bupivacaine -tetracaine Patient assessment - continuous heart rate, rhythm, and pulse oximetry monitoring -level of anesthesia -motor function and sensation return monitoring

23. Spinal Anesthesia Complications - hypotension -bradycardia -urine retention -postural puncture headache -back pain

24. Spinal analgesia Indications - postoperative pain from major surgery Involved medications - lipid-soluble drugs -preservative-free morphine Monitoring recovery - respiratory depression -urine depression -pruritus -nausea and vomiting

25. Examples of location for Spinal and Epidural Anesthesia.

26. Nerve Block Sites

27. Intraoperative Phase Conscious Sedation Administration of IV sedative, hypnotic, and opioid medications . Produces a depressed level of consciousness Retains ability to maintain a patent airway Able to respond to verbal commands or physical stimulation Used for relatively short procedures

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