EVANGELISTA, Gabrielle Angela B.

NCMP112 – RLE (RR31)

Assignment #2: MODULE 2

Please answer the following:

1. Who are the members of the surgical team?
2. What are the roles and responsibilities of each of the surgical team?
3. What is an anesthesia? What are the types of an anesthesia? levels of anesthesia?
4. What are the steps when giving anesthesia?
5. What are the administration techniques when giving anesthesia?
6. What is surgical handwashing? Give the description, assessment, special considerations, materials,
procedure and rationale for each step.
7. How do you don a sterile gown and perform a closed gloving?

Preparation:
1. The surgical team consists of:

 The Patient
 The Anesthesiologist (physician) or Certified Registered Nurse Anesthetist (CRNA)
 The Surgeon
 Nurses
 Surgical Technicians
 Registered Nurse First Assistants (RFNAs) or Certified Surgical Technologists (assistants).
 Circulating Nurse
2. Roles and Responsibilities of Each of the Surgical Team
The anesthesiologist or CRNA - administers the anesthetic agent (substance used to induce anesthesia)
and monitors the patient’s physical status throughout the surgery.
The surgeon, nurses, technicians, and assistants’ - scrub and perform the surgery.
The person in the scrub role, either a nurse or a surgical technician - provides sterile instruments and
supplies to the surgeon during the procedure by anticipating the surgical needs as the surgical case
progresses.
The circulating nurse coordinates the care of the patient in the OR.
3. Anesthesia

 is a state of narcosis (severe central nervous system depression produced by pharmacologic

agents), analgesia, relaxation, and reflex loss
  a state of controlled, temporary loss of sensation or awareness that is induced for medical
purposes
Types of Anesthesia

 General Anesthesia
 General anesthesia is a combination of medications that put you in a sleep-like state
before a surgery or other medical procedure. Under general anesthesia, you don't feel
pain because you're completely unconscious. General anesthesia usually uses a
combination of intravenous drugs and inhaled gasses (anesthetics).
 Regional Anesthesia
 an anesthetic agent is injected around nerves so that the region supplied by these
nerves is anesthetized
 the effect depends on the type of nerve involved
 patient receiving regional anesthesia is awake and aware of their surroundings unless
medications are given to produce mild sedation or to relieve anxiety
 Epidural Anesthesia
 a is achieved by injecting a local anesthetic agent into the epidural space that
surrounds the dura mater of the spinal cord
 given medication diffuses across the layers of the spinal cord to provide anesthesia
and pain relief
 epidural anesthesia blocks sensory, motor, and autonomic functions
 Spinal Anesthesia
 an extensive conduction nerve block that is produced when a local anesthetic agent is
introduced into the subarachnoid space at the lumbar level, usually between L4 and
L5
 spinal anesthesia involves injection through the dura mater into the subarachnoid
space surrounding the spinal cord
 produces anesthesia of the lower extremities, perineum, and lower abdomen

 Moderate sedation
 it is previously referred to as conscious sedation, is a form of anesthesia that involves
the IV administration of sedatives or analgesic medications to reduce patient anxiety
and control pain during diagnostic or therapeutic procedures
 it is being used increasingly for specific short-term surgical procedures in hospitals
and ambulatory care centers.

Example: Monitored Anesthesia Care

 Local Anesthesia
 it is the injection of a solution containing the anesthetic agent into the tissues at the
planned incision site
 often it is combined with a local regional block by injecting around the nerves
immediately supplying the area.

Levels/Stages of Anesthesia

 Stage I: Beginning Anesthesia

  Dizziness and a feeling of detachment may be experienced during induction
 The patient may have a ringing, roaring, or buzzing in the ears and, although still
conscious, may sense an inability to move the extremities easily
 These sensations can result in agitation. During this stage, noises are exaggerated;
even low voices or minor sounds seem loud and unreal
 For these reasons, unnecessary noises and motions are avoided when anesthesia
begins.
 Stage II: Excitement
 The excitement stage, characterized variously by struggling, shouting, talking,
singing, laughing, or crying, is often avoided if IV anesthetic agents are given
smoothly and quickly
 The pupils dilate, but they constrict if exposed to light; the pulse rate is rapid, and
respirations may be irregular. Because of the possibility of uncontrolled movements
of the patient during this stage, the anesthesiologist or CRNA must always be
assisted by someone ready to help restrain the patient or to apply cricoid pressure in
the case of vomiting to prevent aspiration
 Manipulation increases circulation to the operative site and thereby increases the
potential for bleeding.
 Stage III: Surgical Anesthesia
 Surgical anesthesia is reached by administration of anesthetic vapor or gas and
supported by IV agents as necessary
 The patient is unconscious and lies quietly on the table
 The pupils are small but constrict when exposed to light
 Respirations are regular, the pulse rate and volume are normal, and the skin is pink or
slightly flushed
 With proper administration of the anesthetic agent, this stage may be maintained for
hours in one of several planes, ranging from light (1) to deep (4), depending on the
depth of anesthesia needed.
 Stage IV: Medullary Depression

 This stage is reached if too much anesthesia has been given

 Respirations become shallow, the pulse is weak and thread, and the pupils become
widely dilated and no longer constrict when exposed to light
 Cyanosis develops and, without prompt intervention, death rapidly follows
 If this stage develops, the anesthetic agent is discontinued immediately, and
respiratory and circulatory support is initiated to prevent death
 Stimulants, although rarely used, may be given; narcotic antagonists can be used if
the overdose is due to opioids
 It is not a planned stage of surgical anesthesia.

4. Steps in Giving Anesthesia

 Before the procedure

Before you undergo general anesthesia, your anesthesiologist will talk with you and may ask questions
about:

 Your health history

  Your prescription medications, over-the-counter medications and herbal supplements

 Allergies

 Your past experiences with anesthesia

 This will help your anesthesiologist choose the medications that will be the safest for you.

 During the procedure

 Your anesthesiologist usually delivers the anesthesia medications through an intravenous line in
your arm. Sometimes you may be given a gas that you breathe from a mask. Children may prefer
to go to sleep with a mask.

 Once you're asleep, the anesthesiologist may insert a tube into your mouth and down your
windpipe. The tube ensures that you get enough oxygen and protects your lungs from blood or
other fluids, such as stomach fluids. You'll be given muscle relaxants before doctors insert the
tube to relax the muscles in your windpipe.

 Your doctor may use other options, such as a laryngeal airway mask, to help manage your
breathing during surgery.
Someone from the anesthesia care team monitors you continuously while you sleep. He or she will adjust
your medications, breathing, temperature, fluids and blood pressure as needed. Any issues that occur
during the surgery are corrected with additional medications, fluids and, sometimes, blood transfusions.

 After the procedure

When the surgery is complete, the anesthesiologist reverses the medications to wake you up. You will
slowly wake either in the operating room or the recovery room. You'll probably feel groggy and a little
confused when you first wake. You may experience common side effects such as:

 Nausea

 Vomiting

 Dry mouth

 Sore throat

 Muscle aches

 Itching

 Shivering
  Sleepiness

 Mild hoarseness
You may also experience other side effects after you awaken from anesthesia, such as pain. Your
anesthesia care team will ask you about your pain and other side effects. Side effects depend on your
individual condition and the type of surgery. Your doctor may give you medications after your procedure
to reduce pain and nausea
5. Administration Techniques when Giving Anesthesia

 Through Intravenous
 Local Infiltration
 Anesthetic may also be administered through a laryngeal mask
 Anesthetic may also be administered through an endotracheal technique
 Anesthetic may also be administered through an intranasal intubation
 Anesthetic may also be administered through an oral intubation
 Conduction Blocks and Spinal Anesthesia
 Local Infiltration Anesthesia

6. Surgical Handwashing. Description, assessment, special considerations, materials, procedure and

rationale for each step.

Description Assessment Special Materials Needed Procedure Rationale

Considerations
Surgical Presence of All personnel Soap Remove all Jewelry harbors
Handwashing — factors increasing entering the Warm running jewelry microorganisms
the removal and susceptibility of operating room water
killing of transient infection and (OR) or a specific Disposable or  No artificial Artificial nails,
micro-organisms possibility of sterile procedure sanitized towels nails, extenders, extenders, and
and substantial undiagnosed must perform a or chipped nail chipped nail
reduction and infection (e.g., surgical hand polish should be polish can harbor
suppuration of the HIV). scrub. worn in the OR microorganisms
resident flora of Use of Hands must be
the surgical team immunosuppressiv free from rings,
for the duration of e medications. watches, and Inspect hands
the operation Recent diagnostic bracelets. Nails for sores or Open sores can
procedures or should be free abrasions; cover harbor
treatment that from any nail or report to microorganisms.
penetrated the skin enhancements, supervisor as
of body cavity. artificial required
Current extenders,
nutritional status. acrylics, wraps,  Ensure sleeves
Signs and and tips. Nail are at least two to This step prevents
symptoms polish must be three inches sleeves from
indicating the free from chips or above the elbows becoming moist
presence of an cracks. Research
infection. shows that the Clean hands
Localized signs number of with ABHR or Hand hygiene is
recommended by
such as swelling, bacteria is nine soap and water to the Association of
redness, pain or times higher on remove visible periOperative
tenderness with rings and on the debris Registered Nurses
palpation or skin beneath the (AORN)
movement, fingernails.
palpable heat at All skin on the Turn on water Regulate the
site, loss of forearm and temperature of the
function of affected hands (including water. Warm
body part, presence cuticles) should water is
of exudates. be free from open recommended to
Systemic lesions and prevent drying out
indications, such as breaks in skin of hands
fever, increased integrity. Any
pulse and allergies to the A good amount of
 Apply the
respiratory rates, cleansing soap is required to
required amount
lack of energy, products should create lather for a
of microbial soap
anorexia, enlarged be reported to the three- to five-
to hands
lymph nodes. manager. minute scrub
If hands touch
anything during Keeping hands
cleaning, the Nail files work
above elbows,
entire procedure more effectively
start timing; scrub
must be started than a nail brush.
each side of each
from the Clean the
finger, between
beginning. subungual area
fingers, under
(under the
each nail with a
fingernails) with a
nail file, and the
nail file. Nail
back and front of
brushes are not
hands for the
recommended as
recommended
they may damage
time, according to
the skin around
agency policy
the nail

 Scrub the arms,

Keeping hands
using an up-and-
down motion, above the wrist
keeping hands allows for the
above the elbows microorganisms
at all times. Wash to slide off the
each side of the hands into the
arm from wrist to sink
elbow for one
minute

 Repeat the Use an equal

entire process amount of time to
with the other wash each hand
hand and forearm
  With hands This step allows
raised, rinse for all the soap to
hands and arms be rinsed off from
by passing them cleanest to dirtiest
through running area
water, letting the
water drip down
from the
fingertips to the
elbow

 Proceed into the This step prevents

operating room contamination of
(keep hands the hands and
above the waist), adheres to the
and dry arms principles of
using a sterile sterile technique
towel, starting at
the fingertips, and
working down
toward the
forearms using a
dabbing motion
Data source: ATI, 2015a; Bartlett, Pollard, Bowker, & Bannister, 2002; Kennedy, 2013; WHO, 2009a

7. Donning of a sterile gown and performing a closed gloving.

 Gowning: To don the gown, the scrub person:

 Lifts the folded gown directly upward from the sterile package.
 Steps back from the table into an unobstructed area.
 Carefully locates the neckband and holds the inside front of the gown just below the
neckband with both hands.
 Let’s the gown unfold while keeping the inside of the gown toward the body without
touching the sterile exterior of the gown with bare hands. (NOTE: If the gown does not
unfold completely, then the circulating nurse may assist by pulling down the unfolded
bottom inside the gown).
 Holds the hands at shoulder level and slips both arms into the armhole simultaneously.

 Closed Glove Technique - In the closed-glove technique, the scrub person's hands remain inside
the sleeves and should not touch the cuffs. In the open-glove technique, the scrub person's hands
slide all the way through the sleeves out beyond the cuffs.

 Keeps both hands within the cuff so that the hands do not touch the cuff edges.
 Grasps the folded cuff of the left glove with the right hand.
 Holds the top edge of the cuff in the left hand above the palm.
  Places the palm of the glove against the palm of the left hand - the glove fingers point up
the forearm.
 Grasps the back of the cuff in the right hand and turn it over the open end of the left
sleeve and hand while holding the top of the left glove and underlying gown sleeve with
the covered right hand.
 Pulls the glove over the extended left finger onto the wrist by pushing the hand through
the glove until it completely covers the cuff of the glove.
 Gloves the right hand in the same manner by reversing the above steps.
 Inspects the gloves for integrity after denning.
 Hands the tie end to the circulator and secures the wraparound glove (when used).

References:
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of medical-surgical
nursing (14th ed.). Wolters Kluwer.
Mayo Foundation for Medical Education and Research. (2018, December 4). General anesthesia. Mayo
Clinic. https://www.mayoclinic.org/tests-procedures/anesthesia/about/pac-20384568.
Handwashing. Nurses Guild- Nursing Procedures.
http://nursingproceduresng.blogspot.com/2012/05/handwashing.html?q=surgical+handwashing.
Doyle, G. R., & McCutcheon, J. A. (2015, November 23). 1.7 Sterile Procedures and Sterile Attire.
Clinical Procedures for Safer Patient Care. https://opentextbc.ca/clinicalskills/chapter/sterile-gloving/.