preoperative duties include
Don OR attire and PPE
Prepare the OR
Gather the necessary instrumentation, equipment, and supplies
Scrub and don sterile attire
Prepare, organize, and maintain the sterile field
Count sponges, sharps, and instruments
Gown and glove sterile team members
Assist with draping the patient
Intraoperative duties include
Maintain and continually monitor the sterile field
Pass instrumentation, equipment, and supplies as needed
Anticipate the needs of the patient and surgeon
Prepare and handle medications
Count sponges, sharps, and instruments
Care for the specimen(s)
Apply sterile dressing
Postoperative duties include
Maintain the sterile field until the patient is transported to PACU or CCU or ICU
Remove used instrumentation, equipment, and supplies from the OR
Care for and maintain instrumentation, equipment, and supplies following use
Prepare the OR for the next patient
what is the ability to anticipate, or predict, the needs of the surgeon during case management.
Anticipation
What includes the psychological and physiological preparation of the patient?
Preop preperation
What information needs to be completed in the patients chart or record preop?
laboratory results
Radiology reports
consent for treatment. Surgical consent form. Anesthesia consent for,, special consent form
Preop checklist
Nurse notes
History and physical report (H&P)
Identification of patient allergies, handicaps, or other limitations
when does the patient usually arrive for their surgery?
evening before or morning of surgery
A common admission process
patient arrives at the hospital the evening before or morning of surgery
required paperwork is completed
the identification process is initiated, the ID bracelet is affixed
Patient changes clothes
Vital signs are taken
Per the physician's request, the patient may require preop hair removal and preop antiseptic cleanse
the surgical site is verified and may be marked
any necessary IVs are started
the patient chart is reviewed by the surgical team
Time is allowed with family and clergy.
Preoperative medication is given if required
The patient is transported to the OR
CirculaCirculator'stor Role/ Responsibilities are?
Patients Preoperative
Diet (NPO)
Enemas / no longer a routine
Preoperative Hygiene shower / antimicrobial soap
Preoperative hair removal
Makeup and dress
Nail polish
Patient possessions
preoperative education
sedation
If ordered, hair removal needs to be preformed when?
prior to surgery
why is it important to not have any breaks in the skin?
it can provide an easy opportunity for bacterial entry and wound infection
With hair removal, the CDC reccomends?
not removing hair preop unless it interferes with the operation, as microbial counts have been shown to be increase in pre shaved area of the skin
the patient transport to OR includes?
guardrails are in the upright and secure position
The safety belt is secured
wheels are in the correct position (straight or swivel)
The patient is transported slowly, feet first.
The patient should enter an elevator head first and exit feet first
Be certain that all parts of the patient's body are within the guidelines
Use good body mechanics
Never leave the patient unattended
when transporting the patient to the OR wheels should be
straight or swivel
when transporting the patient to the OR what is the correct way for the patient to enter the elevator?
Head first. feet exit first
how many members should be able to assist with the transfer of a mobile patient?
a minimum or 2 non sterile members
How many members should be able to assist with the transfer of an immobile patient?
a minimum of four non sterile members
it is important to prevent what in the Or for the environment?
Hypothermia, normothermia, and hyperthermia
the loss of heat from the patient's body to the environment is?
Radiation
loss of heat into the air currents (the "wind chill" effect). ?
Convection
loss of heat from the patient's body into a cooler surface such as the operating table
conduction
loss of heat via perspiration or respiration
Evaporation
prior to placing the patient in the operative position, who will apply the monitoring equipment in order to monitor and record the patient's vital signs?
the anesthesia provider
what are the anesthesia providers responsibilities?
temperature
Pulse
Respiration
Blood Pressure
When does positioning for the surgery happen?
after the administration of the anesthesia.
the patient should always be returned slowly from the operative position back to what position?
supine position
arm boards should not be positioned at more than a 90-degree angle to the operating table to prevent hyperextension nerve damage (Brachial plexus) - this is?
supine position
Lies supine or flat on their back, with their feet raised higher than their head. ( modification of the supine position )
Tredelenburg position
lies flat on their back on an incline of about 15 to 30 degrees so that the feet are lower than their head. (modification of the supine position)
Reverse Trendelenburg position
in which the patient is seated in a semi-sitting position and the legs may be straight or slightly bent.
Fowlers position and sitting position
legs must be raised and lowered and simultaneously to prevent muscle strain in the lower back.
Lithotomy position
patient is anesthetized; lying flat on your stomach
prone position
patient's abdomen lays flat on the bed, the bed is scissored, so the hip is lifted and the legs and head are low
Kraske (Jackknife) Position
the bottom leg is flexed, and the legs are separated with pillows
lateral position
modification of the lateral position
Kidney position
modification of the left lateral position for endoscopy performed via the anus; the patient remains on the stretcher an is awake and able to assist with positioning.
Sims position
how many mL of water is necessary to inflate a 5-mL balloon completely?
Ten mL of water
The surgical skin prep is performed on the surgical patient for the same reasons that the sterile surgical team members perform the surgical scrub prior to entry into the sterile field.
to remove transient organisms from the patient's skin
to reduce the number of resident organisms on the patients skin
what provides a rapid and significant reduction in skin microbial counts?
Alcohol
what less likely causes skin irritation and does not need to be removed.
Iodophors
what is not provided as rapid a reduction in skin microbial counts as alcohol but provides a longer residual effect ( 5-6 hours )
Chlorhexidine
what is the alcohol-based antiseptic solution that leaved an antimicrobial film?
Single use
consists of a scrub suit, and hair cover. A mask and shoe covers may also be required
OR Attire
PPE includes nonsterile gloves, protective eyewear and radiation protection
Protective attire
additional protective attire - a fluid proof apron may be worn by environmental services.
other protective attire
consists of the sterile gown and sterile gloves
sterile attire
what are on the surface of the skin and are easily removed by hand washing and scrubbing?
Transient organisms
what thrive deeper below the surface of the skin and are therefore difficult to remove?
Resident organisms
open gown wrapper on sterile mayo stand, and open and toss gloves onto gown.
Self- Drying and Gowning
The technique is used for donning gloves after the sterile gown has been donned
closed gloving
what is applied to expose the surgical site, create a sterile barrier, and maintain a sterile field.
drapes
intraoperative case management starts when?
when the incision is made.
post-operative case management starts when?
after the sterile dressing is applied
a sample routine for breakdown of the setup?
the specimen is cared for as needed
Instruments are removed from the Mayo stand
the basin containing the soiled instruments is placed in or on the case cart
all linen items are placed in the hamper
suction canisters and tubing are discarded
environmental decontamination of the OR is performed
The OR is set up for the next patient.