Domain 3: Intraoperative Care

Primary General Readings:

Alexander’s Care of the Patient in Surgery: Chapters 2, 4, 6

Berry and Kohn’s Operating Room Technique: Chapters 2, 11, 25

Module Topics/Key Words Module-specific readings
1. Introduction of the patient to the operative/procedure area Behavioral response, beliefs, confidentiality, culture, deep vein thrombosis (DVT), hypothermia, intraoperative, knowledge deficit, patient coping mechanisms, patient education, patient transfer, physiologic response, sequential compression device (SCD), spirituality, stress, time-out, venous stasis

S&RP: Recommended practices:
Prevention of unplanned hypothermia
Transfer of patient care information
Prevention of deep vein thrombosis
Guidance Statement: Safe patient handling and movement
B&K: Chapters 7, 21

2. Support safe practices regarding anesthesia provider, surgeon, and nurse administered medications Action, analgesia, anesthetic, cricoid pressure, delivery, documentation, drugs, seven rights, labeling, malignant hyperthermia medication, medication reconciliation, moderate sedation, patient safety, pharmacology, physical status classification, physiologic response, solutions

S&RP: Recommended practices:
Managing the patient receiving moderate sedation/analgesia
Medication safety
Managing the patient receiving local anesthesia
Alexander’s: Chapter 5 B&K: Chapters 23, 24

3. Incorporate principles of safe positioning Braden score, Fowler, lateral, lithotomy, nerve injury, positioning, pressure points, prone, reverse Trendelenburg, semi-Fowler, supine, skin integrity, Trendelenburg S&RP: Recommended practices:
Positioning the patient
4. Prepare the surgical site Antiseptic, cleansing, prep, skin antisepsis, Surgical Care Improvement Project (SCIP), surgical site, wound healing S&RP: Recommended practices:
Preoperative patient skin antisepsis
5. Apply principles of asepsis Asepsis, gloving, gowning, hand hygiene, sterile field, sterile technique, surgical attire, surgical consciousness, traffic patterns S&RP: Recommended practices:
Surgical attire
Hand hygiene
Sterile technique
Traffic patterns
Product selection
Prevention of transmissible infections
B&K: Chapters 15, 16, 20 pp. 577.
6. Provide perioperative nursing care during operative and invasive procedures Anatomy, hemostasis, implant, invasive procedure, minimally invasive, operation, physiology, specialty, surgery, wound healing

S&RP: Recommended practices:
Minimally invasive surgery
Surgical tissue banking
Alexander’s: Chapters 7,8, 9;
Unit II, Surgical interventions
B&K: Chapters 19, 28, 29, 31,
Section 12: Surgical specialties

7. Identify and control environmental factors Air exchanges, antiseptic, environmental cleaning, humidity, infectious waste, noise, room turnover, spills, temperature, terminal cleaning, traffic patterns, turnover S&RP: Recommended practices:
Environmental cleaning
Safe environment of care
B&K: Chapters 10, 11, 12, 13
8.Monitor and intervene to reduce the risk of complications and adverse outcomes Adverse event, body mechanics, chemicals, electrosurgery, ergonomics, equipment testing, fire, laser, National Patient Safety Goals, radiation, patient safety, sharps injury, smoke evacuation S&RP: Recommended practices:
Laser safety
Pneumatic tourniquet
Reducing radiological exposure
Sharps injury prevention
Position statement: Creating a practice environment of safety
Alexander’s: Chapter 3
B&K: Chapters 13, 20, 22, 27, 31
9. Prepare and label specimens Culture, documentation, explanted medical device, handling, implanted medical device, specimen, tissue tracking S&RP: Recommended practices:
Care and handling of specimens
B&K: Chapters 22
10. Perform counts Closing, complication, count, instruments, miscellaneous items, needles, retained item, sharps, sponges S&RP: Recommended practices:
Prevention of retained surgical items
Alexander’s: Chapter 7
11. Maintain accurate patient records Confidentiality, documentation, electronic medical record, (EMR), patient record S&RP: Recommended practices:
Information management
B&K: Chapters 3, 11


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