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Perioperative Nursing

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Change into scrubs when your patient moves to the holding area. Holding Area ... over the scrub sinks in each ... Earrings must be covered by the scrub cap. ... – PowerPoint PPT presentation

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Title: Perioperative Nursing


1
Perioperative Nursing
2
  • Surgery has been performed since ancient times.
    The earliest recorded surgical operations were
    circumcision and trepanation.
  • (Circumcision removal of the foreskin of the
    penis.
  • Trepanation making a hole in the skull to
    relieve pressure and/or release spirits.)
  • The earliest instruments used in these procedures
    were flint or obsidian (shiny stone) knives and
    saws.

3
  • Nursing did not exist as an occupation in the
    United States before the Civil War.

4
  • A typical "operating room" was in the open air
    where the surgeon had plenty of light.
  • Otherwise, it was the room of a farmhouse, the
    center of a barn, or under a tree.
  • Assistants held lamps over the surgeon to provide
    light.
  • Patients were placed on a door removed from its
    hinges and set on sawhorses.
  • With little more than a rag to wipe his hands,
    the surgeon then began the examination of the
    wounded soldier and then decided on what course
    to take.

5
  • Although the women who tended the sick and
    wounded during the Revolutionary War were not
    nurses as known in the modern sense, they helped
    blaze the trail for another generation nearly one
    hundred years later, when, in 1873, civilian
    hospitals in America began operating recognized
    schools of nursing.

6
  • Anesthesia was discovered by two American
    dentists, Horace Wells (1815-1848) and William
    Morton
  • Before the advent of anesthesia surgery was a
    traumatically painful procedure and surgeons were
    encouraged to be as swift as possible to minimize
    patient suffering.
  • Also meant that operations were largely
    restricted to amputations and external growth
    removals.
  • Beginning in the 1840s surgery began to change
    dramatically in character with the discovery of
    effective and practical anaesthetic chemicals
    such as ether and chloroform. In Britain, John
    Snow pioneered the use of these two anaesthetics.
  • In addition to relieving patient suffering,
    anaesthesia allowed more intricate operations in
    the internal regions of the human body. The
    further discovery of muscle relaxants also
    facilitated safer applications.

7
  • At that time, the OR was a true theater

8
O.R. 1908
9
(No Transcript)
10
This was a typical OR during WWII
11
OR today
12
Perioperative Phase
  • Period of time that constitutes the surgical
    experience includes the preoperative,
    intraoperative, and postoperative phases of
    nursing care.

13
Preoperative phase
  • Period of time from when the decision for
    surgical intervention is made to when the patient
    is transferred to the operating room table.

14
Intraoperative phase
  • Period of time from when the patient is
    transferred to the operating room table to when
    he or she is admitted to the postanesthesia care
    unit (PACU).

15
Postoperative phase
  • Period of time that begins with the admission of
    the patient to the PACU and ends after a
    follow-up evaluation in the clinical setting or
    home.

16
  • Operating Room (OR) nurses
  • referred to as perioperative nurses to more
    accurately reflect their specialized duties

17
  • As surgical care evolves, so does the role of the
    registered nurse who assists with patient care in
    the operating room.

18
Perioperative nurses
  • RNs
  • work in
  • hospital
  • surgical departments
  • day-surgery units (ambulatory surgery)
  • physicians offices
  • Work closely with the surgical patient, family
    members and other health-care professionals to
    help
  • Plan
  • implement
  • evaluate treatment

19
Being a nurse in the OR
  • Offers you the opportunity to acquire and use
    professional, technical, and practical skills,
    and problem-solving skills.

20
  • As with everything else in nursing and medicine
    and nursing, the OR is a fluid environment .

21
The effect of technology on OR nurses
  • The nurse has to have knowledge of the working of
    and be able to trouble shoot problems with any
    and all equipment used in the OR's
  • Microscope
  • Fluid pumps
  • Video equipment
  • Lasers

22
  • If there is a problem with any of the equipment
    the nurse hasto be able to initiate corrective
    action for the malfunctioning equipment.

23
  • The exponential growth of OR technology during
    the past 10 years has placed increased demands on
    perioperative nurses.

24
Other equipment that is used in the OR
  • Surgical lights
  • OR tables, accessories and furniture
  • Oxygen and nitrous oxide lines
  • Computerized monitors and video equipment
  • Lasers
  • Robotic equipment
  • Nitrogen tanks
  • Drills saws
  • Cement system
  • Emergency cardiac equipment
  • Warming blanket/Bair hugger

25
  • Proficiency is required not only in patient care
    but also in the understanding, operating, and
    troubleshooting of video systems, computers, and
    cutting edge medical devices

26
OR Terminology
  • excision - cutting out an organ, tumor, or other
    body part.
  • resection - partial removal of an organ or other
    bodily structure.
  • reconnection of organs, tissues, etc.,
    particularly if severed. Resection of organs such
    as intestines involves reconnection. Internal
    suturing or stapling may be used. Surgical
    connection between blood vessels or other tubular
    or hollow structures such as loops of intestine
    is called anastomosis.
  • ligation - tying off blood vessels, ducts, or
    "tubes".
  • grafts - may be severed pieces of tissue cut from
    the same (or different) body or flaps of tissue
    still partly connected to the body but resewn for
    rearranging or restructuring of the area of the
    body in question. Grafts may be taken from one
    area of the patient's body and inserted to
    another area of the body or may be from other
    persons, cadavers, or animals.

27
The Nursing Process in Perioperative practice
28
Like all nurses, OR nurses use
  • Knowledge
  • Skills
  • Judgment

29
  • Implements nursingactions to ensure and maintain
    a safe environment for thepatient

30
  • Manages the overall nursing care in the operating
    room and helping to maintain a safe, comfortable
    environment.

31
  • Performs sharps, sponge, and instrumentcounts
    per policy with the scrub tech or scrub nurse

32
  • Implements the safe transfer of the patient to
    and from theOR bed and ensures that the side
    rails and safety straps are used appropriately.
  • Responsible for positioning of the patient using
    proper body alignment and body mechanics
    anddemonstrates proper positioning of the
    patient on the ORequipment that is appropriate
    to the operative procedure

33
  • Maintains the patient's skin integrity and
    ensuresthat clothing and bedding are clean and
    dry, uses proper techniques when prepping the
    surgical site and adjusts bedding and clothing by
    lifting rather than using shearing force

34
  • Checks sterility of items to be used during the
    operative procedure by verifying the expiration
    date, package integrity and by the sterile
    indicator color change

35
  • Opening instruments and sterile suppliesusing
    sterile technique to the back table
  • Pouringsterile solutions into sterile containers
  • Adjusting the ORlights

36
  • Preparing labels and taking care of specimens per
    policy
  • Remaining with the patient during induction of
    anesthesiaand assisting anesthesia with the
    induction
  • Assisting with gowning of surgical team members

37
  • Anticipating needs of thesurgical team members
  • Supplying items as needed
  • Sending forthe next patient in a timely manner
  • Perparing forsubsequent procedures.

38
Roles in the OR
39
Circulating Nurse
  • The circulators duties are performed outside the
    sterile field.
  • The circulator is responsible for managing the
    nursing care of the patient within the OR and
    coordinating the needs of the surgical team with
    other care providers necessary for completion of
    surgery.
  • Using critical thinking skills, the circulator
    nurse observes the surgery and the surgical team
    from a broad perspective and assists the team to
    create and maintain a safe and comfortable
    environment for the patient.
  • The circulator nurse assesses the patients
    condition before, during, and after the operation
    to ensure an optimal outcome for the patient.
  • Circulating during surgery is a perioperative
    nursing function. The role of the circulator may
    not be delegated to a UAP, Licensed Practice
    Nurse or Licensed Vocational Nurse.

40
  • In the operating room, most patients are
    anesthetized or sedated and are powerless to make
    decisions on their own behalf during the
    intraoperative phase. The circulating nurse
    serves as the patient advocate while the patient
    is least able to care for him or herself

41
Scrub Nurse
  • The scrub nurse works directly with the surgeon
    within the sterile field, passing instruments,
    sponges, and other items needed during the
    procedure.
  • The sterile field is the area closely surrounding
    the OR table and instrument tray.
  • Surgical team members who work within the sterile
    field have scrubbed their hands and arms with
    special disinfecting soap and generally wear
    surgical gowns, caps, eyewear, and gloves.
  • This is a nursing role that may be delegated to a
    LPN.

42
Surgeon
  • MD or DO
  • Credentialed by the hospital
  • Must be a graduate of an accredited medical
    school and complete a surgical residency.

43
Anesthesia Care Provider
  • Anesthesiologist
  • MD or DO
  • Supervising physician for CRNAs
  • CRNA
  • RN with additional education
  • Current entry level for practice is Masters
    degree

44
Sterile processing
  • Responsible for providing sterile instrumentation
    to OR for use in cases

45
  • Perioperative nurses also may work as an OR
    director, managing budgets, staffing, and other
    business aspects of the operating room.

46
  • Some perioperative nurses may later consider a
    career in business as a management consultant,
    clinical educator, researcher, or medical sales
    professional.

47
  • AORN is the professional organization of
    perioperative nurses representing over 40,000
    nurses

48
Important information for your clinical
experience in the OR
49
  • Your experience starts where the patient enters
    the system.
  • 2nd Floor Same Day Admission
  • OPS prep area (basement)
  • Change into scrubs when your patient moves to the
    holding area

50
Holding Area
  • Last chart review by RN to make sure all required
    paperwork is on the chart.
  • IV started
  • Interview with anesthesiologist

51
In the OR
  • Lockers are available for your use during the
    hours between 0700-1800 while you are in the
    operating room.
  • You must bring your own lock.

52
DRESS CODE - SURGICAL ATTIRE
  • All persons who enter the semi restricted and
    restricted areas of the surgical suite should be
    in hospital laundered surgical attire intended
    for use only within the surgical suite at
    Presbyterian Hospital. Surgical attire includes
    hospital issued scrubs, scrub jacket and head
    cover. Shoe covers are not necessary.
  • All possible head and facial hair, including
    sideburns and neckline, should be covered when in
    the surgical suite.

53
  • All persons entering an operating room or should
    wear a mask.
  • Masks are located over the scrub sinks in each
    suite.
  • All personnel entering the suite should have all
    jewelry confined or removed.
  • Watches and plain wedding bands are acceptable.
  • Earrings must be covered by the scrub cap.

54
  • Protective barriers (gloves, masks, protective
    eyewear, and face shields) are provided by the
    hospital and should be utilized to reduce the
    risk of exposure to potentially infective agents.
  • Shoe covers are not required. If shoe covers are
    necessary, the wearer should remove them before
    leaving the operating room to avoid tracking
    blood and debris through the department.

55
Points to Remember about Aseptic Technique
  • The patient is the center of the sterile field.
  • Only sterile items are used within the sterile
    field.
  • Sterile persons are gowned and gloved.
  • Tables are sterile only at table level.
  • Sterile persons touch only sterile items or
    areas unsterile persons touch only unsterile
    items or areas.

56
  • Unsterile persons avoid reaching over sterile
    field sterile persons avoid leaning over
    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.
  • Non-sterile persons should stay at least 12
    inches from the sterile field

57
  • Sterile persons keep well within sterile area.
  • Unsterile persons avoid sterile areas.
  • Destruction of integrity of microbial barriers
    results in contamination.
  • Microorganisms must be kept to irreducible
    minimum.

58
  • Enjoy your
  • experience
  • in
  • Perioperative Services

59
Remember
  • Act interested
  • Ask questions
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