Intraoperative Nursing Care | Chapter 19 – Lewis’s Medical-Surgical Nursing (12th)

Описание: Chapter 19 of Lewis’s Medical-Surgical Nursing (12th Edition) explains the principles, environment, roles, and safety measures of intraoperative care, with a strong emphasis on the nurse’s role as patient advocate during surgery. The operating room (OR) is described as a highly controlled environment divided into unrestricted, semirestricted, and restricted zones, designed to minimize infection and ensure sterile workflow. ORs are equipped with positive-pressure airflow, controlled temperature and humidity, ultraviolet lighting, and strict cleaning protocols to reduce cross-contamination.

The chapter reviews the surgical team and their responsibilities:
👩‍⚕️ Perioperative Nurse (Circulating Nurse & Scrub Nurse) – provides advocacy, safety, asepsis, communication, documentation, and sterile field management.
🧑‍⚕️ Surgeon and Surgical Assistant – perform the procedure, ensure informed consent, and direct intraoperative care.
🤝 Registered Nurse First Assistant (RNFA) – assists with hemostasis, suturing, and exposure of the surgical field.
💉 Anesthesia Care Provider (ACP) – includes anesthesiologists, CRNAs, and anesthesiologist assistants, responsible for anesthesia, airway, hemodynamic stability, and pain control.
🔧 Surgical Technologists & LPN/VNs – may assist under RN supervision.

Nursing management during intraoperative care includes:
✨ Room Preparation – ensuring sterility, counting instruments, and preparing equipment.
🛏️ Patient Transfer & Positioning – protecting skin, nerves, airway, and circulation while preventing injury (supine, prone, lithotomy, lateral, sitting).
🧼 Scrubbing, Gowning, and Gloving – maintaining asepsis to prevent contamination.
🧴 Surgical Site Prep – using antiseptics, sterile draping, and infection-prevention techniques.
⚡ Safety Protocols – using grounding pads for electrosurgery, preventing surgical fires, applying SCIP measures (antibiotics, warming, VTE prophylaxis), and following the WHO Surgical Safety Checklist with a “time out” to verify patient, site, and procedure.
📢 Communication – using SBAR and standardized handoffs to minimize error.

Anesthesia techniques are explained:
💉 General Anesthesia – loss of sensation and consciousness, airway control, muscle relaxation, and amnesia. Uses IV induction agents, inhalation gases, and adjuncts (opioids, benzodiazepines, neuromuscular blockers, antiemetics).
💤 Moderate Sedation – anxiolysis and analgesia outside the OR (e.g., ED procedures).
👀 Monitored Anesthesia Care (MAC) – sedation with ACP monitoring, may transition to general anesthesia.
📍 Local and Regional Anesthesia – blocks nerve conduction without loss of consciousness (spinal, epidural, peripheral nerve blocks).
🌌 Dissociative Anesthesia – ketamine producing analgesia, amnesia, and catatonia.

Intraoperative complications and crises are emphasized:
🚨 Anaphylactic reactions – severe allergic responses to anesthetics, antibiotics, or latex, leading to hypotension, bronchospasm, and pulmonary edema.
🔥 Malignant Hyperthermia (MH) – life-threatening genetic reaction to succinylcholine or volatile anesthetics, causing hypermetabolism, rigidity, acidosis, hyperthermia, and cardiac arrest. Treated with IV dantrolene, cooling, and 100% oxygen.
🧊 Hypothermia – common in older adults, requiring warming devices.
💢 Positioning injuries – nerve damage, pressure ulcers, and musculoskeletal strain.

Gerontologic considerations highlight increased vulnerability in older adults due to reduced physiologic reserve, slower metabolism of anesthetics, risk of postoperative delirium, fragile skin, arthritis, osteoporosis, and impaired thermoregulation. Nurses are taught to adapt positioning, monitor responses, and provide vigilant communication and support.


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