Trauma Nursing Interventions for Certified Perioperative Nurse (CNOR)
Trauma Nursing Interventions Guidelines: Know expectations and population Trauma center Heart center Facility policy and training Carts Standby OR/staff Call-lists for providers Life, limb, function Triad of death Coagulopathy Metabolic acidosis Hypothermia Warm OR! Considerations: HOT, lead, warm room, gowns ice vests, sweatbands under cap, etc PPE is a must Find help, don’t […]
Hemorrhage Nursing Interventions for Certified Perioperative Nurse (CNOR)
Hemorrhage Nursing Interventions Guidelines: Identification (insert story) Little looks like a lot Irrigation count subtle/out of view Laparoscopic Always sweep on entry! Visibility of instruments Robots Antifibrinolytic Transexamic acid TXA most common Risk for hypercoagulopathy, evidence supports use Reduces blood transfusion Cellsaver Pressure,time, clamp, consider downstream Kidneys Considerations: Robot emergent undocking gown for […]
Local Anesthetic Systemic Toxicity (LAST) Nursing Interventions for Certified Perioperative Nurse (CNOR)
Local Anesthetic Systemic Toxicity (LAST) Nursing Interventions Guidelines: Wide variety of symptoms (difficult to differentiate from normal pacu patient) Mouth numbness/metallic taste confusion Seizures Hallucinations Dysrhythmia Low BP Old and young vulnerable Kidney disease LIPOSOMAL BUPIV (Exparel) Bier block Lipid emulsion 20% IV solution Moves anesthetic away from organs into muscles/liver Considerations: Epi […]
Interdisciplinary Team Member Functions for Certified Perioperative Nurse (CNOR)
Interdisciplinary Team Member Functions Guidelines: TOTS Anesthesia king before turnover Usually unspoken, facility specific Anesthesia techs Consulting surgeons Boardrunner/floorwalker Primary RN stay in room as much as possible Secondary arrivals make better runners “Neck up” = anes Communicating is key Closed loop Considerations: Know attending Capabilities of residents Supervising staff anes Speak up! […]
Patient and Healthcare Team Safety (Disasters, Environmental Hazards) for Certified Perioperative Nurse (CNOR)
Patient and Healthcare Team Safety (Disasters, Environmental Hazards) Guidelines: Earthquakes Secure equipment Dust Know zone and capabilities Flood Typically slow enough to cancel cases SPD likely affected Fire RACE Evacuate Close if possible Blue towels staples Medsled Portable vent/bag/etc Communicate TRAIN Considerations: Train for specifics Have gear available and visible Designated routes Horizontal […]
Function Within Scope of Practice for Certified Perioperative Nurse (CNOR)
Function Within Scope of Practice Guidelines: State specific Osha ANA AORN EBP Facility Certifications (equipment) Service specific Provider credentials Competent(not drunk) On file Visiting surgeons beware Supervising staff Proximity policy Considerations: Credentials poorly specific fellow? New procedure? “Hip to hip” is not the same Up to date EBP CEU’s Recognize limits Nurse’s […]
Accountability and Assistance for Personal Limitations for Certified Perioperative Nurse (CNOR)
Accountability and Assistance for Personal Limitations Guidelines: Physical Use tools, use help Auditory Pause music Ask to repeat Several times if needed Repeat in different words Quiet the room if needed Scope of practice Ethical Facility dependent State dependent Staff availability dependent Considerations: Know resources Plan ahead Size of room Identify need early […]
Visitor Supervision for Certified Perioperative Nurse (CNOR)
Visitor Supervision Guidelines: The perioperative RN is the gatekeeper of the OR Perioperative nursing practice is an art and a science that includes scientific principles, best practices, and patient advocacy Visitors including students, family, and other non-OR personnel should have approval to be in the OR and be supervised while in the OR Visitors […]
HCIR Management (Healthcare Industry Representative) for Certified Perioperative Nurse (CNOR)
HCIR Management (Healthcare Industry Representative) Guidelines: The perioperative RN must manage the presence of HCIRs in the OR A HCIR may be present during an operative procedure under conditions prescribed by the healthcare organization and in compliance with accreditation requirements and local, state, and federal regulations. Considerations: The same key takeaways from the […]
Environmental Stewardship (Waste Minimization) for Certified Perioperative Nurse (CNOR)
Environmental Stewardship (Waste Minimization) Guidelines: Principles of product evaluation and cost containment Environmental Stewardship Go Green Go Clear Considerations: Interdisciplinary team effort Key stakeholders Expertise of organization’s structure and patient population Standardize evaluation process Equal comparison Transparency Accountability Sustainability Assess environmental impact Support environmentally preferable purchasing Comprehensive plan to introduce new products/devices into […]