1 Flashcards
How far away from a sterile field should un-sterile staff stay?
at least 1 foot
Length of aeration time depends on what 4 factors?
- type of wrapper
- composition of the items
- temperature reached during aeration
- concentration of EO and flow rate
Convection heat
- air currents passing over skin
* keep PT covered
Radiation Heat
- when heat transfers from body surface to room atmosphere
* Increase room temp
What nursing action will overcome conduction heat loss?
Use warming blanket on PT
Evaporation Heat
- When skin becomes wet
* avoid excessive draping
Glove perforation usually occurs when?
40 minutes into case
SNIs occur most often when…
suturing of fascia or muscle with curved sharp needle
WAGs
- Exposure levels measured every 6 mos
- Maintained at less than 25ppm for nitrous oxide
- 2 ppm for halogenated agents
Most common cause of SSIs
Gram-Positive Cocci
* staphylococcal, enterococcal, pseudomonal and streptococcal
Where is staphylococci found?
skin, nose, urethra and vagina
Where is enterococci found?
GI flora and female genitalia tract
*can cause SSI, bacterial endocarditis, septicemia and UTIs
Pseudomonads
- most common: Pseudomonas aeruginosa
- moist environments
- skin and intestines
- preventative measure: cleaning and strict aseptic tech
Where is streptococci found?
Upper respiratory flora, genitourinary and GI tract
How is Hep B spread?
- blood or body fluids
* incubation 6 wks- 4 mos
How is Hep A spread?
- fecal-oral route
* hand hygiene important
How is Hep C spread?
- direct exposure to blood
* incubation 7 weeks
Where is spinal block med injected?
into subarachnoid space
Pre-op PT has anemia. What potential side effects does this PT face?
hypoxia and hypotentsion
When considering the thermoregulation of the infant ped PT, the peri-op nurse should remember that….
Infants under 3 mos do not shiver when cold
St. Johns Wort
- Prolongs sedation
* interferes with calcium channel blockers, warfarin and some abx
PT with bulimia nervosa. Notify anesthesia bc PT may have….
- inadequate kidney function
- unstable vitals
- electrolyte imbalances
Low-level disinfectants
kills most vegetative bacteria and some viruses and fungi
Intermediate level disinfectant
May kill tubercle bacilli, vegetative bacteria and most viruses and fungi but not bacteria spores
High level disinfectant
kills all microorganisms except high numbers of bacterial spores
Disinfection
The process that kills all microorganisms with the exception of high numbers of bacterial spores
Hydrogen Peroxide Vapor Sterilization
*Vapor is sterilant
* byproduct: water vapor and oxygen
* no aeration
BI–B. atropheus
Low Temp Hydrogen Peroxide Gas Plasma Sterilization
plasma is 4th state of matter
- Hydrogen peroxide vapor is charged with radio frequency and turns to plasma
- byproducts: water and oxygen
- replacing EO
- no aeration needed
- cold form
- STERRAD
- cycle time= 75 mins
- used for heat sensitive and moisture sensitive items
- dry sterilization
Percentage of OR needlesticks associated with carelessness
74%
Most common presenting sign of MH
unexplained ventricular dysrhythmia ( tachy or PVCs)
Which type of law encompasses malpractice and negligence?
Tort Law “personal injury law”
Concerning metal instruments, what type of sterilization is performed for 3 mins at 132C at 27lbs of pressure?
Immediate Use Steam Sterilization
You have prepared the sterile back table and the mayo stand. You receive word that surgery will be delayed due to an unanticipated emergency. You should….
Cover the table and stand with sterile drapes and leave them in their current position
Percent of all HAIs from S. aureus occuring in surgical PTs
35%
7 Rights of Med Administration
Right:
- PT
- drug
- dose
- reason
- time
- route
- documentation
How often should water in the ultrasonic cleaner be changed?
at least once per shift
An individual who disperses significantly increased numbers of viable contaminated particles
Shedder
Which mask protects from aerosolized carcinogens?
A mask which can filter particles as small as 0.1mm
What is the difference between sterilization and High-Level Disinfection?
Sterilization kills all microorganisms including endospores while High-level disinfection kill microorganisms only
How do you know chemical indicator tape has been subjected to a successful sterilization cycle?
Tape starts out tan then turns dk brown or black
2 common ABXs for surgical prophylaxis
Rocephin and Keflex
Vascular surgeon schedules “cold leg” for surgery. Which procedures is the surgeon expected to perform?
Embolectomy and possible Revascularization Grafting
Assault
Threat to do harm
Kasai Procedure
The construction of a bile drainage system by use of an intestinal conduit
The 5 Rights of Delegation
The Right:
- task
- circumstance
- person
- communication and direction
- supervision and evaluation
Peracetic Acid
- STERIS I
- for items that can be immersed
- corrosive to instruments and people
- temp 120-130
- micron filtered tap water rinse
- for point of care use only - will be wet
Battery
Ex: Operating without consent
Tort
wrong committed against someone
Negligence
Failure to use reasonable care
ABX given pre-op that can potentiate neuromuscular blocking agents
Clindamycin
ABX usage and/or admin for C-Sections
Administer intraop after umbilical cord clamped
Primary ICF anion
Phosphate
Osmosis
Movement of fluid through a selective semipermeable membrane from a soln that has a lower solute conc to one that has a higher conc
isotonic
A soln that has same osmolality as blood plasma
- NS, LR
- prevent shift from IC compartments
Neonate heart murmurs
- Patent Foramen Ovale: closes in 3-12 mos
- Patent Ductus Arteriosis: up to 2 mos to close
- Undetected anomaly
- innocent flow murmur
Why are infants prone to dehydration?
- Renal function is immature
- ability of kidneys to concentrate urine is limited
- complete renal maturation at @ 2 yrs
Myelomeningocele
- form of spina bifida
- always associated with Chiari type II malformations
- Meninges, spinal cord and nerve roots protrude
Omphalocele
- intestines out through umbilical cord
- error in digestive tract development
- may be associated with other major congenital defects
Dry heat spore testing
Bacillus atropheus
Cloaca
single opening for the urethra, rectum and vagina
talipes
Deformities of the foot
Talipes Varsus
Clubfoot
most common
Talipes Equinovarus
idiopathic true club foot deformity
Milwaukee Brace
brace for scoliosis
What gives the patient the right to chose not to be treated for an emergent event precipitated in response to normal anesthesia during surgery?
Self Determination Act
Most common childhood chronic condition
Secretory Otitis Media
Most common source of pathogens in the OR
Surgical staff ( S. aureus 25%)
When using bipolar delivery of electrical current remember….
One side of the bipolar forceps returns the current back to generator
Do not scrub longer than how many minutes?
5 mins
Who are qualified to perform and document H&Ps
- Physician
- NP
- PA
- RNFA
4 domains of the Perioperative Patient Focused Model
- Behavioral Responses
- Patient Safety
- Physiological Responses
- Health Systems
Nursing Process
Assessment Nursing dx Outcomes identified Planning Implementation Evaluation
Spaulding Class “Critical”
- Will enter sterile tissue or the vascular system
- should be sterile
- Ex: caths, instruments, needles, etc
Spaulding Class “Non-critical”
- will come in contact with skin
- intermediate or low level cleaning
- linens, tourniquets
“Rule of Ten” and cleft palates
Pt is:
10 weeks old
10 lbs
hemoglobin = 10
LMA
- provides an airway
- forms a seal with trachea
- used in place of ET tube
- does not protect against regurg and aspiration
Where should gloved hand be placed when “buzzing the forceps”?
Covering as much of the forcep as possible.
current is delivered below hand
Precordial thump can be used as a rapid measure to correct
V fib
Durant position/maneuver
- Left lateral with steep Trendelenberg
- air embolus enters right atrium during surgery
- anesthesia aspirates air bubble
Why do infants have an increased sensitivity to sedatives, opioids and hypnotics?
- immature blood-brain barrier
* decreased protein-binding
What is LR good for intraoperatively?
Fluid replacement to help correct intraoperative third-space losses
inherent resistence
The bacteria can avoid absorption of the ABX by coating itself with asn impervious biofilm
Bacteria demonstrate their resistance to ABX through…
- inherent resistance
2. Acquired resistance
Vertical Evolution
Bacteria can mutate spontaneously, transmitting a chromosome to one of its own population
Horizontal Evolution
A bacteria which already has an ABX resistant gene shares that gene with a member of a different bacgterial population
Instruments used on PT with Creutzfeld-Jakob disease should be…
- Steam sterilized for 60 mins at 132C or 272F
2. after being soaked in bleach for 1 hour at room temp
Superficial Incisional SSI
- within 30 days
- only involves skin or subq
- must have one of the following:
1. purulent drainage
2. pain
3. tenderness
4. localized swelling
5. redness/heat
6. surgeon deliberately opens
7. surgeon dx
Complementing Action
using nonverbal communication to support or augment verbal communication
85% of the microbial contaminants located in an open surgical site originate from…
Room Air
Treatment of DIC
blood plasma dextran blood thinners replacement clotting factors
Ozone sterilization used for all types of devices except…
sealed glass ampules
implants
flexible scopes
3 Factors necessary to achieve steam sterilization
- time
- temp
- saturated steam
Primary Hyperthyroidism is associated with…
Hypercalcemia
You are caring for a PT with breast CA who is scheduled for a lumpectomy followed by radiation therapy. When do you administer ABX?
Preop, intraop and post op
Central Venous catheters are threaded into…
Right Atrium
Ginseng may cause…
- hypertension
2. bleeding
What is ectropion?
The eyelid is everted to expose conjunctival surface
Geriatric PTs need extra care with what aspects of the environment?
- hypothermia
- potential for emboli
- monitoring fluid loss/blood loss
- positioning to avoid injury
entropion
When eyelid margin is inverted causing eye lashes to abrade the cornea
Stye
infection of eyelash follicle
