lOMoAR cPSD| 28505380
NCLEX RN Copy of Medsurg Review
Session
That's just not really important what is important when you look at the OR is the space itself the
physical space when we start looking at page 313 really talks about the characteristics of the
OR a lot of these areas need to be a a really minimized with infection why because all of these
people skin usually are open during surgery and so it's very important that staff really adhere to
strict principles of aseptic things what do I mean by this surgical gowns mask shoe covers and
really sterile donning and doffing and that's what so much of our staff they're much better than at
it than usually the ICU staff but really again the idea here is we try to minimize that exposure I'm
going to tell you as you transfer patients typically into the OR you're going to learn your own
hospitals policy and procedure but typically you're going to see some lines on the ground if you
were a bedside nurse or Ed or ICU nurse we typically don't cross those and unless we're
properly gowned and we make sure we have physical coverings once the time you'll see up on
the wall bonet covers these are the hats that a lot of staff will put on and then they'll also put on
face masks and typically the other unusual thing about pacu staff and or staff is most of the time
they come into the hospital usually in street clothes why is this is because most of the hospital
that's the scrubs in the OR and they'll come to have lockers and they'll change and all
And all of the scrubs essentially are from a scrub dispensing machine these uniforms need to be
clean and really laundered well to minimize as much infection as we can and so ultimately we
don't want to let family members who don't want to even let staff nurses are really into these
areas we want to be very restrictive of in the operative care because we can cross
contaminate patient very easily also we want to minimize how many staff are in there in your
book talks about that these areas of pressure within these rooms most of the rooms all have this
positive pressure where they're blowing things outside the room we want to try to minimize
particles landing inside the patient we want to try to minimize doors opening and closing even
though they're fine particles we can't see again we want to try to minimize as much moving
around and things like that as we can just to the patient safety so again please make sure we're
not letting family members we're not unnecessarily staff and if you do need to transfer patient
transported patient directly into for whatever reason please be mindful of those surgical areas
making sure that you are down properly and covered make sure that when you are dropping off
patients usually the pack you are going nurses will meet you and we'll take the patient into the
order for further evaluation what else do you want to see sometimes hospitals can have what
they call a holding area but this is really kind of maybe a prep area or packing of what we call
preoperative care essentially before they actually go in this is when physicians may come in and
talk to I talked to the patient they may also this is where anesthesia when they come in and talk
to the patient and so they they may also ask you know are you allergic to anything they just
want to double check on the patient I remember it's the physician's primary duty to talk to the
patient about what they really need to know what they need to be prepared for it is our duty
essentially as the nurse to reinforce education and also part of our job is that we can
witness informed consent that is kind of important just because you know we always want to
make sure we're new patient goes back into the board consent is we need to physically see it in
the chart or it needs to be documented documented somewhere a lot of our hospitals are all
, lOMoAR cPSD| 28505380
converting over to electric charting and we're seeing a lot of incentive paper this could also be
used like an iPad to sign the consent and so again consent needs to also be done and what
else do we need to be aware of I remember we work closely in the surgical team with not only
the surgeon but in this area we we talked to the anesthesiologist remember these are two
separate physicians separately trained specialty train in their own areas anesthesia really helps
to sedate and maintain while the surgical physician to work on whatever surgical ortho or hip or
are cardiac surgery it it doesn't matter again both of these teams of physicians really need to
see the patient and do their own evaluation so again the surgical physician is really
responsible for all the surgery stuff anesthesia is responsible for properly sedating the
patient most of the time anesthesia will come out before the seizure before the procedure and
talk to the patient and talk to them about their allergies and they will also have the patient
open their mouth and get their own physical assessment what they're doing is they're
looking at the patients airway sometimes their patients these sometimes they have structures
sometimes they have cancer and some agents are much more difficult to intubate and so that's
what anesthesia is coming out they'll look at the patient's airway they'll talk to them about
allergies and they'll talk to them about other things and the other thing that you know I didn't see
it in here but maybe you guys are talking about it have you no I don't really see it I didn't notice it
either when I read this chapter but one of the things that we have to be very mindful of during
this time especially for as many diabetic patients as we see a lot of her patients and surgery it
contrast to help visualize the you know the vasculature or something like that and which
is a good thing we wanna see wanna help the physician visualize whatever structures are
going to see one of the medications you'll definitely learn about in pharmacology hopefully or
maybe you've already is a medication called metformin have you guys heard of this medication
maybe maybe not yes what tell me what you know Kaylee about metformin tell me what's its
use I didn't get that far I I just two metal forming with diabetics a lot yeah ideally you're gonna
die a little bit deeper into metformin probably inform the net metformin is given to diabetic
patients to help control their blood sugars and helps to excrete glucose out of the
bloodstream essentially metabolized this essentially these patients urinated great
medication very helpful ton of her diabetic patients are on this here's the problem with this
medication when we give especially operative patients metformin with medications like contrast
where are these medications ultimately processed they're ultimately processed and you know
the body is getting rid of them through the renal system this is how these medications are
leaving the body when metformin is given with Ivy contrast what happens is that the kidneys
have an extreme you'll learn about ABG metabolic acidosis in the kidneys of both medications
create really this super super super acidotic environment and it actually will kill the
nephrons what's the what's the big deal there OK I got thousands of nephrons there could be
significant injury so if a diabetic patient takes metformin before surgery at least 40 they have to
hold it at least 48 hours before but if they were to take it before surgery they can significantly
have a higher risk for developing an acute kidney injury and going into renal failure so
again that is one of the OR or even the packing jobs to make sure that they have not taken a
medication like this especially if we suspect the physicians can use contrast and sometimes
even hospitals use waivers essentially to and make sure these patients do not take take that so
again that is something that we're doing another couple of things I want to highlight in chapter
18 especially on page 315 I notice this chart table 18.1 it talks about intraoperative nursing and
NCLEX RN Copy of Medsurg Review
Session
That's just not really important what is important when you look at the OR is the space itself the
physical space when we start looking at page 313 really talks about the characteristics of the
OR a lot of these areas need to be a a really minimized with infection why because all of these
people skin usually are open during surgery and so it's very important that staff really adhere to
strict principles of aseptic things what do I mean by this surgical gowns mask shoe covers and
really sterile donning and doffing and that's what so much of our staff they're much better than at
it than usually the ICU staff but really again the idea here is we try to minimize that exposure I'm
going to tell you as you transfer patients typically into the OR you're going to learn your own
hospitals policy and procedure but typically you're going to see some lines on the ground if you
were a bedside nurse or Ed or ICU nurse we typically don't cross those and unless we're
properly gowned and we make sure we have physical coverings once the time you'll see up on
the wall bonet covers these are the hats that a lot of staff will put on and then they'll also put on
face masks and typically the other unusual thing about pacu staff and or staff is most of the time
they come into the hospital usually in street clothes why is this is because most of the hospital
that's the scrubs in the OR and they'll come to have lockers and they'll change and all
And all of the scrubs essentially are from a scrub dispensing machine these uniforms need to be
clean and really laundered well to minimize as much infection as we can and so ultimately we
don't want to let family members who don't want to even let staff nurses are really into these
areas we want to be very restrictive of in the operative care because we can cross
contaminate patient very easily also we want to minimize how many staff are in there in your
book talks about that these areas of pressure within these rooms most of the rooms all have this
positive pressure where they're blowing things outside the room we want to try to minimize
particles landing inside the patient we want to try to minimize doors opening and closing even
though they're fine particles we can't see again we want to try to minimize as much moving
around and things like that as we can just to the patient safety so again please make sure we're
not letting family members we're not unnecessarily staff and if you do need to transfer patient
transported patient directly into for whatever reason please be mindful of those surgical areas
making sure that you are down properly and covered make sure that when you are dropping off
patients usually the pack you are going nurses will meet you and we'll take the patient into the
order for further evaluation what else do you want to see sometimes hospitals can have what
they call a holding area but this is really kind of maybe a prep area or packing of what we call
preoperative care essentially before they actually go in this is when physicians may come in and
talk to I talked to the patient they may also this is where anesthesia when they come in and talk
to the patient and so they they may also ask you know are you allergic to anything they just
want to double check on the patient I remember it's the physician's primary duty to talk to the
patient about what they really need to know what they need to be prepared for it is our duty
essentially as the nurse to reinforce education and also part of our job is that we can
witness informed consent that is kind of important just because you know we always want to
make sure we're new patient goes back into the board consent is we need to physically see it in
the chart or it needs to be documented documented somewhere a lot of our hospitals are all
, lOMoAR cPSD| 28505380
converting over to electric charting and we're seeing a lot of incentive paper this could also be
used like an iPad to sign the consent and so again consent needs to also be done and what
else do we need to be aware of I remember we work closely in the surgical team with not only
the surgeon but in this area we we talked to the anesthesiologist remember these are two
separate physicians separately trained specialty train in their own areas anesthesia really helps
to sedate and maintain while the surgical physician to work on whatever surgical ortho or hip or
are cardiac surgery it it doesn't matter again both of these teams of physicians really need to
see the patient and do their own evaluation so again the surgical physician is really
responsible for all the surgery stuff anesthesia is responsible for properly sedating the
patient most of the time anesthesia will come out before the seizure before the procedure and
talk to the patient and talk to them about their allergies and they will also have the patient
open their mouth and get their own physical assessment what they're doing is they're
looking at the patients airway sometimes their patients these sometimes they have structures
sometimes they have cancer and some agents are much more difficult to intubate and so that's
what anesthesia is coming out they'll look at the patient's airway they'll talk to them about
allergies and they'll talk to them about other things and the other thing that you know I didn't see
it in here but maybe you guys are talking about it have you no I don't really see it I didn't notice it
either when I read this chapter but one of the things that we have to be very mindful of during
this time especially for as many diabetic patients as we see a lot of her patients and surgery it
contrast to help visualize the you know the vasculature or something like that and which
is a good thing we wanna see wanna help the physician visualize whatever structures are
going to see one of the medications you'll definitely learn about in pharmacology hopefully or
maybe you've already is a medication called metformin have you guys heard of this medication
maybe maybe not yes what tell me what you know Kaylee about metformin tell me what's its
use I didn't get that far I I just two metal forming with diabetics a lot yeah ideally you're gonna
die a little bit deeper into metformin probably inform the net metformin is given to diabetic
patients to help control their blood sugars and helps to excrete glucose out of the
bloodstream essentially metabolized this essentially these patients urinated great
medication very helpful ton of her diabetic patients are on this here's the problem with this
medication when we give especially operative patients metformin with medications like contrast
where are these medications ultimately processed they're ultimately processed and you know
the body is getting rid of them through the renal system this is how these medications are
leaving the body when metformin is given with Ivy contrast what happens is that the kidneys
have an extreme you'll learn about ABG metabolic acidosis in the kidneys of both medications
create really this super super super acidotic environment and it actually will kill the
nephrons what's the what's the big deal there OK I got thousands of nephrons there could be
significant injury so if a diabetic patient takes metformin before surgery at least 40 they have to
hold it at least 48 hours before but if they were to take it before surgery they can significantly
have a higher risk for developing an acute kidney injury and going into renal failure so
again that is one of the OR or even the packing jobs to make sure that they have not taken a
medication like this especially if we suspect the physicians can use contrast and sometimes
even hospitals use waivers essentially to and make sure these patients do not take take that so
again that is something that we're doing another couple of things I want to highlight in chapter
18 especially on page 315 I notice this chart table 18.1 it talks about intraoperative nursing and
