Intraoperative Nursing Care | NCLEX RN Review

Intraoperative nursing involves caring for patients from the moment they are on the OR bed until they are transferred to the recovery room. This phase is part of perioperative nursing, which includes preoperative, intraoperative, and postoperative care. Key responsibilities include patient assessment, safety, privacy, infection prevention, and promoting healing.

The surgical team, including surgeons, scrub tech/nurse, circulating nurse, and anesthesiologist, works collaboratively. The circulating nurse (an RN) coordinates care, provides emotional support, assists the anesthesiologist, ensures patient safety and positioning, maintains sterile technique, documents care, verifies surgical specimens, addresses environmental hazards, confirms counts of sponges and instruments, and communicates with family members.

The OR environment is designed for safety, with minimal traffic, easy-to-clean surfaces, and maintained temperature (68-75°F) and humidity (40-60%) to prevent infection. Aseptic technique is crucial to prevent contamination, following AORN standards like maintaining sterile fields, using sterile drapes and items, and proper movement around the sterile field.

OR personnel are a major source of microbial contamination. Surgical attire (caps, masks, shoe covers, scrub suits) is mandatory to reduce infection risk for patients and protect staff. Sterile team members perform a surgical scrub, wear sterile gowns and double gloves. Patient skin prep includes antiseptic showers, hair removal, and antiseptic application at the incision site using a circular motion.

Before surgery, the circulating nurse initiates a 'time-out' with the surgical team to verify the correct patient identity, site, and procedure. Any implants or radiologic exams are also confirmed. This step is crucial for patient safety and its completion must be documented.

The intraoperative nurse assists the anesthesiologist with different types of anesthesia: local (loss of sensation in a small area), regional (loss of sensation in a larger body region, e.g., spinal, epidural, nerve block, Bier block), and general (unconsciousness). Nurses need to understand administration methods, side effects, and complications, including signs of toxicity from local anesthetics.

Sedation ranges from minimal (responsive, independent breathing) to moderate/conscious (purposeful response, spontaneous ventilation, amnesia) to deep (difficult to arouse, impaired breathing). General anesthesia induces unarousable unconsciousness with impaired respiratory and cardiovascular function. General anesthesia has three phases: induction (administering agents, intubation, nurse assistance), maintenance (anesthesiologist maintains levels), and emergence (patient awakening, extubation, nurse support for vomiting, shivering, restlessness).

Patients can experience hypothermia due to anesthetics, cool OR environment, IV fluids, and exposed surgical sites. Nurses must keep patients warm with blankets and warmed IV solutions. Intraoperative hyperthermia, though less common, can be caused by sepsis, infection, or malignant hyperthermia, a potentially fatal genetic complication of general anesthesia characterized by rapid temperature rise, muscle rigidity, and acidosis. Treatment involves ceasing agents, oxygen, cooling, restoring acid-base balance, treating hyperkalemia, and administering dantrolene.

Despite the technical aspects and the patient often being sedated, the intraoperative nurse plays a significant role in meeting the patient's psychosocial needs. Providing explanations and reassurance helps to alleviate stress and promotes effective coping during the surgical experience.