Chapter 3/4

Question 1

What is the primary role of the CST in rendering care to the surgical pt?

Answer 1

Assisting the surgeon during the surgical procedure.
-establishment and protection of a sterile field
-care/handling of surgical instrumentation
-assistance with technical tasks throughout procedure.

Question 2

What is Maslow’s hierarchy of needs?

Answer 2

Model of human development. (lower levels must be met before the higher ones)

Physiological needs: Basic biological needs such as water, oxygen, food, and temperature regulation.

Safety needs: individual’s perception that his or her environment is safe.

Love and belonging needs: These are basic social needs: to be known and cared for as an individual and to care for others.

Esteem needs: positive evaluation of one’s self and others; a need to be respected and to respect others.

Self-actualization: individual’s need to fulfill what he or she believes is purposeful.

Question 3

What are some religious values to be aware of?

Answer 3

Add later from table

Question 4

What are the needs of the surgical patient?

Answer 4

Physical- Anything relating to genetics or anatomy/physiology (nutrition, sleep, regulation, fluid balance, o2/co2 exchange, elimination of waste)

Physiological- Anything related to identification and understanding of one’s self (shortened life, the unknown, anesthesia, death, pain, disfigurement, loss of self-control, financial, employment, individualism, self-image, left roles)

Social- Anything w identification of one’s self and interactions with others (relationships w peers and support system)

Spiritual- Anything with one’s identification and place within the universe (religion and right to refuse)

Question 5

What are the common factors that lead to surgical intervention

Answer 5

-Trauma
-Genetic Malformation
-Benign Neoplasm
-Condition
-Physiological State

Question 6

What are the two broad factors that apply to the majority of pt’s in reaction to hospitalization/health?

Answer 6

Adaption and Stress

Question 7

What is adaption?

Answer 7

both physiological and psychological changes that indicate the person’s attempt to adapt to and counter the stressors of illness or trauma. can be either rapid or slow, based on the nature and type of illness or trauma, family support, patient’s culture, level of the patient’s social development, level of the patient’s intelligence, patient’s personality, and learned responses.

Question 8

What are the two different types of stress?

Answer 8

Nonspecific response of the body to a demand. Emotional, physical, and chemical.
Distress- bad
Eustress- good

Question 9

What are the factors that contribute to stress?

Answer 9

-Type, nature, and severity of trauma/disease/condition
-previous experience
-age; peds pts feel vulnerable when taken away from parents, adolescents are conscious about privacy, and adults are concerned about death, family, finances, etc.
-family role
-economic factors
-religious beliefs

Question 10

What are the different coping mechanisms?

Answer 10

Denial- does not accept what is happening
Rationalization
Regression- pt regresses to an earlier stage of life (ex: fetal position, crying, pouting)
Repression: Avoids thoughts and feelings on the matter

Question 11

What are the three accepted stages of death?

Answer 11

Cardiac- Irreversible loss of cardiac and respiratory function

Higher-brain Death: Irreversible loss of higher brain function (breathing, BP, heartbeat)

Whole Brain Death: Loss of all functions of the brain (defined as death in courts). Examples are flat EEG, unresponsiveness etc.

Question 12

What are the five stages of grief?

Answer 12

-denial
-anger
-bargaining
-depression
-acceptance

stages may not occur in order and not everyone will go through all stages

Question 13

What are the general categories of death?

Answer 13

-accidental: natural disaster, gunshot, car accident, etc.
-terminal: cancer
-prolonged/chronic: high bp, asthma
-sudden: deaths without warning (SIDS)

Question 14

What are palliative procedures?

Answer 14

Procedures meant to provide pt w symptom relief and avoidance of pain. Does not alter the ultimate progression of original disease. Improves quality of life.

Question 15

What are therapeutic procedures?

Answer 15

Used to treat or manage a disease. For example, a pacemaker or live organ donation transplant.

Question 16

What is life support?

Answer 16

A set of therapies that preserve a patient’s life when body systems are not functioning sufficiently to sustain it.
(feeding tubes, IV drips, mechanical respiration, heart bypass, etc.)

Question 17

What are ordinary means of care?

Answer 17

Used to prolong life which physician is morally obligated to provide without imposing additional burden on the pt.

Question 18

What are extraordinary means of care?

Answer 18

Therapies that may impose an additional burden and may be costly

Question 19

What is the difference between active and passive euthanasia?

Answer 19

Passive: Physician does nothing to preserve life

Active: Actions that speed up the process of dying

Question 20

What does the AHA Patient Care Partnership do?

Answer 20

Allows patients the right to refuse care

Question 21

What does the Patient Self Determination Act do?

Answer 21

requires medical facilities to inform patients of their right to choose the type and extent of their medical care and to provide patients with information concerning advance directives

Question 22

What is an advanced directive?

Answer 22

general term that refers to one of two legal documents used to speak for patients in the event that they become incapacitated

Question 23

What is a living will?

Answer 23

allows patients to state in writing exactly what medical interventions they are willing to endure to sustain life

Question 24

What does a power of attorney do?

Answer 24

legal way to appoint a health care proxy who will make medical decisions for the patient in the event that he or she cannot

Question 25

What does a DNR/DNI do?

Answer 25

states that resuscitation should not be attempted if a patient suffers a cardiac or respiratory arrest.

Question 26

What is the common policy and procedure that must be followed by the surgical team when a death occurs in the OR?

Answer 26

-notify supervisor and implement postmortem care
-friends and family at hospital must be notified
-religious leader may be notified
-in certain cases evidence may be needed to be preserved
-postmortem care/preparation of viewing

Question 27

What must happen for someone to be considered a candidate for donation after cardiac arrest (DCD)?

Answer 27

it is predicted that the heart will cease functioning within 90 minutes of removal from mechanical support.

Question 28

What are the steps to organ donation after DCD

Answer 28

-family of pt is consulted
-assessments
-schedule procedure

Question 29

What are the special terms for the pediatric patient?

Answer 29

neonate: <28 days
infant: 2-18 mo
toddler: 19-30 mo
preschooler: 31mo-5yr
school age: 6-12 yr
adolescent: 13-18 yr

Question 30

What are some anatomical and physiological considerations for pediatric patients?

Answer 30

Temperature: kids under 6 mo can’t shiver and are at risk for brachycardia, hypothermia, and acidosis

HR/resps: decline w age; adolescents are normal

BP: Child of 1 year and older: systolic pressure in mm Hg = 80 + (2 × age) and diastolic = systolic

Head: Suture ridges palpable until 6mo; posterior fontanelle closes at 3, anterior at 19

Vision: 2/200 at birth and no tears until 2-3 mo

Ears: more at risk for infection cuz of shape of auditory tube

sinuses: no sphenoid until puberty

breasts: develop at 9-13 and mature at 13-19

abd: liver proportionately larger

neurological: not fully developed

genatalia: testes descend at 1yr.

Question 31

What are normal HR ranges for peds?

Answer 31

Infants: 80-130 (110)
2-6 years: 70-120 (100)
6-10 years: 70-110 (90)
10-16 years: 60-100 (85)

Question 32

What are normal resp rates for peds?

Answer 32

1 yr: 10-40
3 yr: 20-30
6 yr: 16-22
10 yr: 16-20
17 yr: 12-20

Question 33

What should be considered when it comes to language and peds patients?

Answer 33

Neonates and infants are startled easy so quiet environment is important. The preschool/school-aged child may use words to inform, persuade, distract, or manipulate but they will not use language the same way. Descriptions of pain, for instance, are likely to be imprecise in terms of both symptoms and location. Learning to understand the child takes considerable experience.

Question 34

What is the main fear a child may have when it comes to surgery and how can the surgical team help?

Answer 34

Separation from parents/abandonment.
To help:
-Let child bring toy/stuffed animal
-Introduce all members of surgical team
-Show child department
-Let parents walk child to OR
-let parents come into PICU after first set of vitals

Question 35

What is another primary fear of children?

Answer 35

Anesthesia. Preop visit is helpful where equipment should be shown and questions should be answered truthfully.

Question 36

What are the critical parameters to monitor after surgery in pediatric patients?

Answer 36

temperature, urine output, cardiac function, and oxygenation.

Question 37

How is temperature regulation in peds patients?

Answer 37

Neonates lack the ability to shiver, little subcutaneous fat, and lean body mass. They lose heat through radiation, conduction, convection, and evaporation. Incubators help.

Temperature is monitored through rectal, esophageal, skin, and axillary.

In OR, temp is often increased and overhead radiant heating is used for pt’s under 2. Keep extremities wrapped. Warm water/air filled blankets may be used.

Question 38

How is urine output different in peds patients?

Answer 38

Higher risk of infection so no cauterization. Appropriate urine output is 1 to 2 mL/kg/hr.

Question 39

How is cardiac function monitored in pediatric patients?

Answer 39

Intra arterial measurement (catheter inserted in artery)-ill children who require constant ECG monitoring.

Cutdown to radial artery- Infants and children

Umbilical Artery- Neonates

Central Venous Catheter- Subclavian/internal jugular of older children w no cardiac abnormalities

Cutdown to External Jugular- Neonates and infants w no cardiac abnormalities

Question 40

How is oxygenation measured for pediatric patients?

Answer 40

ABG is measured with pulse ox (same w all age groups)

Question 41

How does shock present in pediatric patients?

Answer 41

Septic Shock- Most common in children. Caused by gram-negative bacteria usually be peritonsis from intestinal perforation. Other common causes are UTI, URI, and contaminated IV. Causes reduced circulating blood volume (tx is infusion of colloid solutions)

Hypovolemic Shock- Brachycardia, Decreased venous return that leads to low cardiac output and tissue perfusion and then lactic acidosis. In infants dehydration is most common symptom (fixed w infusion of fluids and blood). Emergency tx is infusion of hypotonic sodium chloride.

Question 42

How is the management of fluids and electrolytes different in pediatric patients?

Answer 42

Normal changes in body fluid are interrupted when neonate has to undergo surgery. To help, cover extremities with towels and humidify gases. An increased extracellular fluid (ECF) volume in a premature neonate stimulates the release of prostaglandin E2, which maintains ductus arteriosus patency.

Question 43

Why are newborns at greater risk of infection?

Answer 43

Microbial barriers of skin and GI are underdeveloped and are the host defense mechanisms. (by day 10 they have the same flora as adults)

Question 44

What are the most common sites of postoperative infection in neonates?

Answer 44

Lungs, surgical wound, urinary tract, and vascular sites. Tx includes incision, debridement, and packing of antibiotic impregnated packing or removal of catheter and administration of antibiotics.

Question 45

What are the three differences in side effects from antibiotics in children?

Answer 45

Sulfonamides (such as Bactrim or Septra) are associated with an increased incidence of kernicterus in neonates, which is an excess of bilirubin in the blood. Therefore, sulfonamides should not be administered to newborns.

Chloramphenicol (Chloromycetin) is the synthetic form of an antibiotic originally isolated from Streptomyces venezuelae and is associated with the cause of “gray syndrome” in which the infant’s skin turns gray from drug toxicity. Chloramphenicol should not be administered to newborns.

Tetracycline causes staining and hypoplasia of the enamel of the developing teeth; therefore, it should not be administered to children.

Question 46

What does the administration of practically every antibiotic associated with?

Answer 46

pseudomembranous enterocolitis, from overgrowth of Clostridium difficile due to antibiotic suppression of the growth of normal bacteria in the colon. treatment consists of discontinuing the antibiotic that contributed to the cause of the enterocolitis (infection of the small and large bowel) and oral administration of vancomycin.

Question 47

How are the metabolic/nutritional needs different in children?

Answer 47

Much higher than adults and surgery increases caloric needs (20-30%). Gastrotomy tubes are often used postop for procedures with the GI tract.

Question 48

How is trauma unique in children?

Answer 48

Blunt trauma is the most common with MVAs being most common. Other causes are falls, bike accidents, drowning, burns, poisoning, and child abuse.

Question 49

What is a professional?

Answer 49

An individual who has specialized education and training in a given field and who meets certain competency-based and ethical criteria.

Question 50

Why is it important to understand the cultural and religious influences?

Answer 50

Pt population in the United States is diverse and values can easily conflict w modern medicine. This can create both ethical and legal issues.

Question 51

What is the Roy Adaption Model

Answer 51

Views the pt as a biopsychosocial individual that is interacting w environment w ability to adapt by using coping skills in dealing w internal and external stressors. Based on nature of illness/trauma, family support, culture, social development, intelligence, personality and learned responses.

Question 52

What are some of the spiritual/religious rituals that play an important role in death and dying?

Answer 52

Roman Catholic: anointing the sick
Catholic/Protestant: offer last rights
Muslim: Turn east to face Mecca after death
Jewish: dying pt is not left alone. don’t touch body until rabbi offers last right. relative closes eyes and washes and dresses body
Buddhist: reincarnation, last thoughts determine rebirth condition.
Hindus: Cremation- soul begins its journey