Chapter 19

Intraoperative Nursing Management

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Members of the Surgical Team
• Patient
• Anesthesiologist or anesthetist
• Surgeon
• Nursing
• Surgical technologists

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Prevention of Infection
• The surgical environment
– Unrestricted zone
– Semirestricted zone
– Restricted zone
• Surgical asepsis
• Environmental controls

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Basic Guidelines for Surgical Asepsis
• All materials in contact with the wound and within the
sterile field must be sterile.
• Gowns are sterile in the front from chest to the level of
the sterile field, and sleeves from 2 inches above the
elbow to the cuff.
• Only the top of a draped table is considered sterile.
During draping, the drape is held well above the area and
is placed from front to back.
• Items are dispensed by methods to preserve sterility.
• Movements of the surgical team are from sterile to sterile
and from unsterile to sterile only.

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Basic Guidelines for Surgical Asepsis
• Movement around the sterile field must not cause
contamination of the field. At least a 1-foot distance from
the sterile field must be maintained.
• Whenever a sterile barrier is breached, the area is
considered contaminated.
• Every sterile field is constantly maintained and
monitored. Items of doubtful sterility are considered
unsterile.
• Sterile fields are prepared as close as possible to time of
use.

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Question
Tell whether the following statement is true or false.
To maintain surgical asepsis, the nurse knows that the
sides and top of a draped table is considered sterile.

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False.
Rationale: Sterile drapes are used to create a sterile field.
Only the top surface of a draped table is considered
sterile. During draping of a table or patient, the sterile
drape is held well above the surface to be covered and is
positioned from front to back.

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Roles of the Members of the Surgical
Team
• Circulating nurse
• Scrub role
• Surgeon
• Registered nurse first assistant
• Anesthesiologist and anesthetist
• Note: Role of the nurse as patient advocate

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Intraoperative Complications
• Nausea and vomiting
• Anaphylaxis
• Hypoxia and respiratory complications
• Hypothermia
• Malignant hyperthermia
• Disseminated intravascular coagulation (DIC)

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Question
Malignant hyperthermia usually manifests within what time
frame after induction of anesthesia?
b. 5 minutes
c. 10–20 minutes
d. 30 minutes
e. 45 minutes

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Answer
a. 10–20 minutes
Rationale: Malignant hyperthermia usually manifests about
10 to 20 minutes after induction of anesthesia. It can
also occur during the first 24 hours after surgery.

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Potential Adverse Effects of Surgery and
Anesthesia
• Allergic reactions and drug toxicity or reactions
• Cardiac dysrhythmias
• CNS changes and oversedation or undersedation
• Trauma: laryngeal, oral, nerve, and skin, including burns
• Hypotension
• Thrombosis
• Refer to Chart 19-1

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Gerontologic Considerations
• Elderly patients are at increased risk for complications
due to surgery and anesthesia because of:
– Increased likelihood of coexisting conditions.
– Aging heart and pulmonary systems.
– Decreased homeostatic mechanisms.
– Changes in responses to drugs and anesthetic agents
due to aging changes such as decreased renal
function, and changes in body composition of fat and
water.

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Nursing Goals for the Patient in the
Intraoperative Period
• Reducing anxiety
• Preventing positioning injuries
• Maintaining patient safety
• Maintaining the patient's dignity
• Avoiding complications

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Question
Tell whether the following statement is true or false.
Spinal anesthesia is introduced into the subarachnoid space
at the level of L4 and L5.

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Answer
True.
Rationale: Spinal anesthesia is an extensive conduction
nerve block that is produced when a local anesthetic is
introduced into the subarachnoid space at the lumbar
level, usually between L4 and L5.

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Laparotomy Position, Trendelenburg
Position, Lithotomy Position, and
Sidelying Position for Kidney Surgery

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Protecting the Patient from Injury
• Patient identification
• Correct informed consent
• Verification of records of health history and exam
• Results of diagnostic tests
• Allergies (include latex allergy)
• Monitoring and modifying the physical environment
• Safety measures such as grounding of equipment,
restraints, and not leaving a sedated patient
• Verification and accessibility of blood
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