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Okay let's take a closer look at specific intraoperative nursing priorities. We want to decrease the risk of anxiety related to surgery. So to do this as perioperative nurses, we explain the sequence of events to our patients, we also create a calm OR environment with little noise, and we're also going to remain with the patient during induction and emergence of anesthesia. All of these things help to decrease the risk of anxiety related to surgery in a surgical patient.
Surgical errors are another risk of surgery. So to decrease the risk of wrong-site or wrong-procedure surgery we verify that the surgical site has been marked by the provider, we make sure that the patient specifies the site that is going to be operated on, and we also perform a surgical “time out” right before incision is made. So guys a surgical “time out” is basically a communication tool or checklist that is used to prevent any injury to the patient. The “time out” is spoken out loud in the operating room with all of the involved perioperative team members present and introduced and includes things like, patient’s name, the procedure, the site, antibiotics ordered and given, and availability and display of implants and x-rays. All involved give a verbal confirmation that they agree!
So with surgery another risk is a retained surgical item. So to decrease this risk as perioperative nurses we perform surgical counts. Depending on the procedure there are different amounts of counts required but a count is always performed before incision is made, typically during the procedure, and also immediately before closure. At any time any of the perioperative team members can request an additional count be performed. Performing surgical counts is critical to decreasing the risk of any retained surgical items which obviously can cause harm to the surgical patient.
So an additional intraoperative nursing priority is decreasing the risk of postoperative infections. So obviously an infection is not going to be apparent until after the procedure but as perioperative nurses we do certain things to prevent or decrease the risk of these occurring. One of the ways we do this is verifying that aseptic or sterile technique is being performed which would include team members scrubbing appropriately before gowning and gloving. Also we decrease this risk by verifying the sterility of our supplies and instrumentation and we verify that the proper antibiotic is being given for the specific procedure as well as the timing of the antibiotic is appropriate. And of course we make sure the patient is prepped with an appropriate and approved prepping agent.
So guys perioperative hypothermia is a significant risk of our surgical patients and a definite intraoperative nursing priority. So what can we do to decrease the risk of perioperative hypothermia in a surgical patient? We are going to use warm blankets on the areas that are not being operated on and warming units that blow warm air over the patient during the procedure. We also use fluid warmers for irrigation solutions to decrease the risk of hypothermia and also we can warm our IV solutions which help to decrease this risk.
Okay guys injuries related to how our patients are positioned in surgery is a definite risk that we would like to decrease through intraoperative nursing priorities. So how do we do this? We decrease these injuries by padding bony areas on the patient, we make sure they are positioned in a way that maintains proper alignment, we also use positioning devices to prevent shearing, and we identify pressure points so that we can protect them adequately. Be sure to check out the lesson on intraoperative positioning!
Okay what about tissue breakdown which is a definite risk to our patients? So an intraoperative nursing priority that we use to decrease this risk is to verify that patient is not laying in or being surrounded by certain things like prepping agents, irrigation solutions, even the patient’s blood or urine. Make sure that this is a priority because this will decrease the risk of tissue breakdown in our patients. How awful would it be that the patient has a successful surgery but now they have some type of breakdown because we did not pay close attention to this risk. Guys, I just want to mention that this isn't always the easiest of tasks but you are the patient advocate so making sure that everyone is on the same page with this is super important.
OK guys another intraoperative nursing priority would be decreasing the risk of deep vein thrombosis or DVTs as these can occur because of positioning and anesthesia due to the fact that the patient is in a motionless state. So what do we do to decrease this risk? We apply TED hose or sequential compression devices or SCDs.
Ok so what about the risk of anesthesia complications? We make sure as intraoperative nurses that a thorough preoperative nursing priority is performed to decrease the risk of anesthesia complications like malignant hyperthermia and aspiration. Guys be sure to check out the lessons we have on preoperative nursing priorities, malignant hyperthermia, and general anesthesia for more information!
And finally guys our surgical patients are at risk for fluid volume issues for many reasons! So the intraoperative nursing priority that helps to prevent these risks are to monitor closely the blood loss in surgical patients and also the urine output if they have a catheter of course and guys we like to monitor the amount of irrigation going in and coming out. Sometimes patients require replacement of blood products during surgery so we need to pay special attention to blood loss! Be sure to check out the lesson we have on intraoperative complications!
Ok so which nursing concepts can we apply to intraoperative nursing priorities? So there are many risks that we have to worry about with our surgical patients like impaired tissue and skin integrity and issues with thermoregulation so paying special attention to these risks helps to keep the surgical patient safe!
Alright guys let’s look at some key points! The goal of intraoperative nursing priorities is to keep the patient safe and prevent injury due to surgical errors, positioning, and temperature. We remain with the patient, explain to them the sequence of events with surgery, and provide a calm OR environment all to decrease the risk of anxiety. We decrease the risk of surgical errors and retained surgical items by verifying site is marked by provider which the patient confirms, a surgical “time out” is performed as well as surgical counts. We decrease the risk of postoperative infections by confirming and performed aseptic technique, we confirm that only sterile supplies and instruments are utilized and the patient is prepped appropriately. We decrease the risk of injuries related to position by maintaining proper body alignment, padding, and using correct positioning devices. Finally we pay special attention to fluid volume issues by monitoring blood loss, urine output, and the use of irrigation solutions.
Okay guys I hope you enjoyed this lesson on intraoperative intraoperative nursing priorities! Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!
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