CNOR: Normothermia & Patient Warming

The circulating nurse is transitioning from after adjusting the patient's warming blanket (touching the patient or surroundings) to a clean/aseptic procedure when she prepares to spike a new intravenous fluid bag. This triggers WHO Moment 2. Option B is correct because hand hygiene must be performed immediately before handling clean equipment or invasive devices to prevent healthcare-associated infections. Option A is incorrect because performing hand hygiene after the task defeats the purpose of protecting the sterile fluid pathway. Options C and D are incorrect because gloves are not required for spiking an IV bag, and donning gloves never replaces the strict requirement for proper hand hygiene.

Using the correct size blanket ensures safe and effective heat transfer. D is correct. A and B are incorrect because placing the hose directly under a cotton blanket or taping it to the patient causes concentrated heat delivery, leading to severe thermal burns. C is incorrect because cutting a forced-air warming blanket alters its structural integrity, causing uneven airflow, potential debris in the surgical field, and increased burn risk.

The American Society of PeriAnesthesia Nurses (ASPAN) provides evidence-based clinical practice guidelines specifically for normothermia management during the immediate postoperative and perianesthesia phases. Preventing unplanned hypothermia requires a continuum of care, and ASPAN dictates the standards for the PACU transition. Option D is correct because it directly addresses patient thermal regulation in the perianesthesia setting. Option A is incorrect; HSPA regulates the maintenance of warming cabinets, but not direct patient thermal care protocols. Option B is incorrect; although hypothermia increases SSI risk, APIC does not write the clinical patient warming protocols. Option C is a near-miss, but it focuses only on the sterile field rather than the PACU transition.

Focus on how evidence-based practice and leadership are key pillars for advanced clinical ladder progression. Option A is correct because implementing a new protocol based on clinical data clearly demonstrates evidence-based practice, and precepting orientees is a recognized form of clinical leadership. Option B is incorrect because precepting involves mentorship and leadership rather than just continuing education for the nurse. Option C is incorrect because protocol implementation represents a systemic practice change that goes well beyond standard direct patient care. Option D is incorrect because it misses the primary focus of clinical ladders, which prioritize evidence-based practice and leadership over general risk management. By accurately categorizing these achievements, the nurse effectively highlights the professional accountability and systemic impact required for a Level III designation.

When active warming is applied to a hypothermic patient, it can cause peripheral vasodilation, leading to a sudden drop in blood pressure as core blood volume shifts to the periphery. The perioperative nurse must communicate this so the PACU nurse anticipates and manages potential hypotension. Shivering (Option A) is a consequence of hypothermia, but active warming aims to prevent it, not cause it. Thermal burns (Option C) are a risk of improper equipment use, but hypotension is the expected physiological complication of the rewarming process itself. Delayed emergence (Option D) is caused by hypothermia directly, whereas the specific risk of initiating active rewarming is the rapid hemodynamic shift.