1. The nursing responsibilities in the pre-operative phase of surgery
are to do a patient screening, this includes any blood and lab work, history of surgery, any allergies to medications, history of chronic illness, nutrition level including any dietary regimens the patient should be on before and after surgery, as well as assessing all medications the patient is on and if there are any contraindications to surgery. To prepare the patient mentally physically and spiritually and also to conduct a patient teaching to ensure the patient has all the information that they have the right to know. The nurse also acts as a witness to the signing of the informed consent. 2. The nurse must assess the needs of the patient pre-operatively this can include the need for information, education, the need for comfort, the need for spiritual guidance. The patient may need to use the bathroom; the patient may feel ill or need some calming techniques shown to them. 3. The nurse has the responsibility of ensuring the patient is ready for surgery. The nurses duties usually include placing the patient on N! status, starting an "# line, prepping the intestinal tract and skin and administering the preoperative medicines. The nurse is usually following orders from the surgeon or guidelines of the facility they work in. The nurse also had the responsibility of ensuring that the patient feels as though they have all the information that they have rights to and that they have been well educated on the surgery. The nurse also can mentally and spiritually as well as emotionally prepare the patient for undergoing surgery. 4. The nurse administers patient teaching in regards to many things, patients usually have fears when it comes to the effects of surgery and anesthesia they may at times have questions about how the surgery will affect their home lives negatively. The nurse can teach the patient about the surgery to diminish some worry about the after effects. The nurse can e$plain what anesthesia does to provide some knowledge for the patient. %ome post op teaching like deep breathing and coughing e$ercises are done pre op to ensure the patient understands and can start them as soon as he or she is able. The nurse is there to answer any questions and place the patient into a state of ease. Intra-Operative 1. The average si&e of todays surgical suites is '(( square feet. They are usually located near the intensive care units that speciali&e in the surgery that was performed. )or e$ample, a heart surgery suite would be located on the same floor as the cardiovascular intensive care unit. *s to safety factors within surgical suites there are many; sterile techniques are always used, the suites have great ventilation and temperature control via +#*, units to prevent airborne infections and they are very well lit. 2. *ssessment of the patient is happening at all times. -onitoring the patients vitals continuously is especially important so the surgeons know what condition the patient is in that they are receiving. The patient is constantly with someone who is caring for them in different ways. The patient is identified at many times and then when they are in the !. they staff performs a /time-out0 this is used to identify the patient as well as the surgery that is going to be performed and the site to which they will be performing it. 3. The roles of the individual members of the surgical team are as follows1 A. Surgeon: To perform the designated surgery in a surgically aseptic and safe manner ensuring patient safety and well being at all times. B. Anesthesiologist or Nurse anesthetist 1 To monitor the patient during surgery and identify the medications to be used with that specific patient prior to surgery. To stay with the patient after surgery until the airway is established. C. Scrub Nurse 1 To don sterile 2 and ensure sterility at all times to provide surgeon with instruments and all equipment for the surgery. To prepare the sterile working field before surgery and to anticipate the needs of the other members of staff to provide them with their equipment and needs throughout the surgery. D. Circulating Nurse 1 To manage patient care in the !. and protect patient safety and health needs. They control the environment for cleanliness, temperature, lighting and humidity. The circulating nurse ensures that the patients rights are being protected. To monitor care and coordinate activities are also the circulating nurses responsibilities. The circulating nurse and the scrub nurse are responsible for accounting for all sponges and instruments at the close of surgery. E. OR Technician 1 ,reate an optimal environment for surgical patients. There are scrub technicians who are overseen by the scrub nurse and there are circulating technicians who are overseen by the circulating nurse. Their 3ob is to assist to ensure a sterile and safe surgical environment for patients and staff. 4. 4efore surgery the surgical team uses a surgical scrub technique of washing their hands as well as how they don their 2. 5uring surgery the team keeps all items within their sterile field, they inspect packaging before opening to ensure sterility. The team is ensuring that their gowns and gloves also remain sterile and are donned correctly. .emember where their sterile field ends and how to ensure not to contaminate your sterile field. %crubbed personnel pass one another with backs away from each other and hands up to maintain sterility. The team ensures that they do not stray from their working sterile field and that they do not allow any unscrubbed personnel to enter their sterile field. 5. 5epending on the surgery there are different types of anesthesia. 6eneral anesthesia is used for larger more serious surgery. .egional anesthesia is used for a specific area of the body or if the patient cannot receive general anesthesia. 7ocal anesthesia can also be used for surgical procedures but is mostly a topical anesthetic and not used for large or invasive surgery unless there are many implications that the patient cannot receive general. 6. ,ommon surgical positions are1 %upine 8dorsal recumbent9 or where the patient is laying on their back. Trendelenberg is where the patient is on their back and their feet are in a higher position then their head, .everse Trendelenberg is the opposite where the head is in a higher position then the feet. 7ithotomy is where both feet are placed in stirrups and the lower back is placed toward the end of the surgical table. %itting and prone 8lying on your stomach9 are also used and side lying positions as well. 7. %ome safety factors that were used are the instrument count before and after the circulating nurse ensuring everyone within the surgical space is practicing sterile technique. The /time-out0 is a very important safety technique that is used to ensure the right patient and the correct surgery. Post-Operative 1. The purpose of the *,: unit is to provide an area where patients are monitored closely directly after surgery. The goal of the *,: is to get all vitals within one hour back to normal. 2. The role of the *,: nurse is to provide immediate care for the patient, monitoring them at all times. The *,: nurse is to do an immediate assessment of all of the patients vitals as well as a full assessment of the patients systems, starting with the respiratory system. The nurse is there also to provide mental emotional and spiritual support, many patients will be scared and disoriented coming out of surgery. 3. The immediate post-operative care of the patient is a full assessment of all body systems as well as closely monitored vitals.