26.1 Overview of the Surgical Experience
- Surgery can take place in various facilities. The most common is an inpatient hospital operating room. Others include ambulatory surgical centers, and specialty providers offices or clinics.
- Surgical procedures can be organized into three categories: elective, urgent, and emergency. Each requires the same type of diligent attention to detail, with the difference being how fast the procedure is scheduled.
- Suffixes in the name of the procedure signal the type of surgery to the health-care team members. For instance, -ostomy means artificial opening or creating an opening; -plasty means surgical repair or reshaping; -scopy means examination or visualization.
- To be a competent and safe nurse within the surgical team, one must fully understand the roles and responsibilities assigned to each team member. Team members consist of medical providers like surgeons and anesthesiologists, and specialized nursing roles like circulating nurse, scrub nurse, and RNFA. The team is also comprised of support staff who play a vital role in creating a seamless continuum of care.
- The surgical team functions as a cohesive unit, using a variety of skills and expertise to deliver comprehensive and patient-centered care throughout the perioperative process.
- Collaboration and communication among the surgical team members are pivotal, emphasizing the importance of a harmonious working relationship.
- The continuous commitment to excellence and collaboration underscores the significance of the surgical team in navigating the complexities of the operating room and ensuring a positive surgical experience for the patient.
26.2 Intraoperative Considerations
- The surgical environment is one that is strictly controlled to maintain best patient outcomes and reduce safety errors. Maintaining a secure and aseptic environment during surgical procedures is critical.
- Implementation of principles of surgical asepsis, sterile technique, and appropriate surgical attire minimizes the risk of infections.
- Surgical time-out is an evidence-based standard practice paramount for maintaining patient safety and reducing any errors during the surgical procedure.
- Meticulous planning and execution of patient positioning, tailored to the specific requirements of each surgical procedure, contribute to optimal exposure and accessibility while prioritizing patient safety.
- There are many types of anesthesia each with their own unique purpose. General anesthesia refers to a complete state of reversible unconsciousness. Moderate sedation means the patient remains conscious but has no pain or memory of the procedure.
- Airway management, a cornerstone in ensuring adequate ventilation and oxygenation, requires careful assessment and intervention by anesthesia providers to mitigate potential complications.
- The administration of anesthesia demands precision, and takes into account patient factors, type of surgery, and monitoring to achieve the delicate balance of inducing and maintaining a controlled state of unconsciousness.
26.3 Intraoperative Nursing Management
- The intraoperative nurse utilizes the clinical judgment medical model (CJMM) as a critical thinking tool to recognize and analyze cues for risks or complications related to the surgical procedure. Then, the nurse will prioritize the cues and develop a hypothesis for implementation of care. After the nurse acts through a seamless integration of aseptic techniques, vigilant patient monitoring, and collaboration with the surgical team, they will evaluate the outcomes to allow for real-time adjustments, ensuring the effectiveness of interventions.
- Patient education is a foundational aspect of nursing care. Education empowers patients with knowledge about the surgical process, monitoring devices, and postoperative care, allowing the patient to play a role as a vital team member.
- The nurse must use critical thinking and clinical judgement skills to prevent complications related to the surgical process. Examples of complications include blood loss, impaired airway, anaphylaxis, and impaired thermoregulation such as hyper- or hypothermia.