Which activities are the circulating nurses responsibilities in the operating room?
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 Caiaimage/Sam Edwards/OJO+/GettyImages Circulating and scrub nurses are two of the most important healthcare workers in an operating room. Together, they are responsible for anticipating and meeting the needs of the surgeon and patient. During a surgery, each performs her own duties, but they work together to make the procedure as successful as possible. Scrub NurseA scrub nurse works in the sanitized area of the surgery. He is "scrubbed in," putting on sterile masks and clothing before approaching the surgical station. The scrub nurse hands the surgical tools and other supplies to the doctor performing the operation. A scrub nurse maintains the sanitation of the operating area, making sure everything stays sterile to reduce the likelihood of contamination. Scrub nurses are also responsible for the care of the surgeon. If her glasses are foggy, or if she is sweating, the scrub nurse is in charge of taking care of those problems, allowing the surgeon to continue her work unhindered. During the surgery, the scrub nurse is also responsible for monitoring the health of the patient. This involves keeping track of the patient's vital signs. If there are potential problems, it is the scrub nurse's job to alert the doctor. Circulating NurseA circulating nurse operates as a go-between for the operating room and the rest of the hospital. She is not scrubbed in. A circulating nurse does the initial assessment of the patient as he is wheeled into the operating room and makes sure that the patient is comfortable. The circulating nurse also assists the surgeon and scrub nurse as they clean up and prepare for the surgery. During the surgery, circulating nurses hand packages of supplies to the scrub nurse as necessary. If something is required from outside of the room, or if the surgeon needs a message passed on to another staff or family member, it falls to a circulating nurse. After the surgery, the circulating nurse counts opened packages and used supplies, to make sure the numbers add up correctly. This is to ensure that there were no supplies accidentally left inside the patient during the surgery. Shared DutiesBoth scrub nurses and circulating nurses are responsible for keeping the operating room running smoothly. Each is responsible for patient care; the circulating nurse takes care of the patient before the operation and the scrub nurse monitors the health of the patient during the operation. They also share the task of preparing the room for surgery; the scrub nurse prepares the sterile area while the circulating nurse makes sure back-up supplies are available in case they are needed. Photo Credits Caiaimage/Sam Edwards/OJO+/GettyImages
DefinitionThe intraoperative phase extends from the time the client is admitted to the operating room, to the time of anesthesia administration, performance of the surgical procedure and until the client is transported to the recovery room or postanesthesia care unit (PACU). Throughout the surgical experience the nurse functions as the patient’s chief advocate. The nurse’s care and concern extend from the time the patient is prepared for and instructed about the forthcoming surgical procedure to the immediate preoperative period and into the operative phase and recovery from anesthesia. The patient needs the security of knowing that someone is providing protection during the procedure and while he is anesthetized because surgery is usually a stressful experience. Goals
The Surgical TeamThe intraoperative phase begins when the patient is received in the surgical area and lasts until the patient is transferred to the recovery area. Although the surgeon has the most important role in this phase, there are key members of the surgical team.
Nursing FunctionsCirculating NurseThe circulating nurse manages the operating room and protects the safety and health needs of the patient by monitoring activities of members of the surgical team and checking the conditions in the operating room. Responsibilities of a circulation nurse are the following:
Scrub NurseThe scrub nurse assists the surgeon during the whole procedure by anticipating the required instruments and setting up the sterile table. The responsibilities of the scrub nurse are:
Classification of Physical Status for Anesthesia Before Surgery The anesthesiologist should visit the patient before the surgery to provide information, answer questions and allay fears that may exist in the patient’s mind. The choice of anesthetic agent will be discussed and the patient has an opportunity to disclose and the patient has opportunity to disclose previous reactions and information about any medication currently being taken that may affect the choice of an agent. Aside from that, the patient’s general condition must also be assessed because it may affect the management of anesthesia. Thus, the anesthesiologist assesses the patient’s cardiovascular system and lungs. Inquiry about preexisting pulmonary infection sand the extent to which the patient smokes must also be determined. The classification of a client’s physical status for anesthesia before surgery is summarized below.
Source: Brunner and Suddarth’s Medical-Surgical Nursing by Smeltzer and Bare AnesthesiaAnesthesia controls pain during surgery or other medical procedures. It includes using medicines, and sometimes close monitoring, to keep you comfortable. It can also help control breathing, blood pressure, blood flow, and heart rate and rhythm, when needed. Anesthetics are divided into two classes:
General AnesthesiaThis type of anesthesia promotes total loss of consciousness and sensation. General anesthesia is commonly achieved when the anesthetic is inhaled or administered intravenously. It affects the brain as well as the entire body. Types of general anesthesia administration: Volatile liquid anesthetics – this type of anesthetic produces anesthesia when their vapors are inhaled. Included in this group are the following:
Gas Anesthetics – anesthetics administered by inhalation and are ALWAYS combined with oxygen. Included in this group are the following:
Stages General anesthesia consists of four stages, each of which presents a definite group of signs and symptoms. Stage I: Onset or Induction or Beginning anesthesia. This stage extends from the administration of anesthesia to the time of loss of consciousness. The patient may have a ringing, roaring or buzzing in the ears and though still conscious, is aware of being unable to move the extremities easily. Low voices or minor sounds appear distressingly loud and unreal during this stage. Stage II: Excitement or Delirium. Stage II extends from the time of loss of consciousness to the time of loss of lid reflex. This stage is characterized by struggling, shouting, talking, singing, laughing or even crying. However, these things may be avoided if the anesthetic is administered smoothly and quickly. The pupils become dilated but contract if exposed to light. Pulse rate is rapid and respirations are irregular. Stage III: Surgical Anesthesia. This stage extends from the loss of lid reflex to the loss of most reflexes. It is reached by continued administration of the vapor or gas. The patient now is unconscious and is lying quietly on the table. Respirations are regular and the pulse rate is normal. Stage IV: Overdosage or Medullary or Stage of Danger. This stage is reached when too much anesthesia has been administered. It is characterized by respiratory or cardiac depression or arrest. Respirations become shallow, the pulse is weak and thread and the pupils are widely dilated and no longer contract when exposed to light. Cyanosis develops afterwards and death follows rapidly unless prompt action is taken. To prevent death, immediate discontinuation of anesthetic should be done and respiratory and circulatory support is necessary. Local AnesthesiaLocal anesthetics can be topical, or isolated just to the surface. These are usually in the form of gels, creams or sprays. They may be applied to the skin before the injection of a local anesthetic that works to numb the area more deeply, in order to avoid the pain of the needle or the drug itself (penicillin, for example, causes pain upon injection). Regional anesthesiaRegional anesthesia blocks pain to a larger part of the body. Anesthetic is injected around major nerves or the spinal cord. Medications may be administered to help the patient relax or sleep. Major types of regional anesthesia include:
With regional anesthesia, an anesthetic agent is injected around the nerved so that the area supplied by these nerves is anesthetized. The effect depends on the type of nerve involved. The patient under a spinal or local anesthesia is awake and aware of his or her surroundings. Regional anesthesia carries more risks than local anesthesia, such as seizures and heart attacks, because of the increased involvement of the central nervous system. Sometimes regional anesthesia fails to provide enough pain relief or paralysis, and switching to general anesthesia is necessary. Spinal AnesthesiaThis is a type of conduction nerve block that occurs by introducing a local anesthetic into the subarachnoid space at the lumbar level which is usually between L4 and L5. Sterile technique is used as the spinal puncture is made and medication is injected through the needle. The spread of the anesthetic agent and the level of anesthesia depend on:
Nursing AssessmentThe following are nursing assessment after anesthesia:
Side Effects
How do anesthesiologists determine the type of anesthesia to be used? The type of anesthesia the anesthesiologist chooses depends on many factors. These include the procedure the client is having and his or her current health. PositioningThe nurse should have an idea which patient position is required for a certain surgical procedure to be performed. There are lots of factors to consider in positioning the patient which includes the following:
Nursing ResponsibilitiesHere are the nursing responsibilities during intraoperative phase:
See Also
What are the 3 essential roles of a circulating nurse?What does a circulator nurse do?. Supervising charge nurses and informs them of their duties.. Acting as an advocate for the patient before, during and after surgery.. Monitoring and recording the patient's vitals pre-operation.. Preparing the surgical tools and materials that the surgical team will need during the operation.. What are the responsibilities of a circulating nurse quizlet?The circulating nurse is responsible for greeting the patient and reviewing the medical record of the patient. Both the circulating nurse and the certified registered nurse anesthetist (CRNA) are responsible for documenting the drugs, blood, and blood components used during surgery.
What is the primary goal of the circulating nurse during preparation of the operating room?The role of the circulating nurse is to be alert to the needs of the surgical team and ensure that all surgical supplies are correctly and promptly provided to the operating theatre. They are also responsible for the management and documentation of all supplies used in the surgical area.
What is the nursing responsibility during operation?Scope of practice
Working with patients prior to surgery to complete paperwork, and help answer questions or calm fears about surgery. Monitoring a patient's condition during and after surgery. Selecting and passing instruments and supplies to the surgeon during operation (sometimes referred to as a scrub nurse)
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