INTRAOPERATIVE NURSING MANAGEMENT
The
perioperative nurse performs an assessment and prepares the patient for the
operating room and recovery experience. Any changes in the patient’s status and
the need for changes in therapy are identified. Procedures are explained before
they are performed, such as the application of electrodes and use of continuous
mon-itoring, indwelling catheters, and an SpO2
probe. Intravenous lines are inserted to administer fluids, medications, and
blood products. The patient will receive general anesthesia, be intubated, and
placed on mechanical ventilation. In addition to assisting with the surgical
procedures, perioperative nurses are responsible for the comfort and safety of
the patient. Some of the areas of interven-tion include positioning, skin care,
wound care, and emotional support of the patient and family.
Before
the chest incision is closed, chest tubes are positioned to evacuate air and
drainage from the mediastinum and the tho-rax. Epicardial pacemaker electrodes
are implanted on the surface of the right atrium and the right ventricle. These
epicardial elec-trodes can be used to pace the heart and to monitor it for
dys-rhythmias through the atrial leads.
Possible
intraoperative complications include dysrhythmias, hemorrhage, MI, CVA (stroke,
brain attack), embolization, and organ failure from shock, embolus, or adverse
drug reactions. As-tute intraoperative patient assessment is critical in
preventing these complications and for detecting symptoms and initiating prompt
therapy.
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