CNOR Flashcards
1
Q
What is the first sign of Malignant Hyperthermia?
A
↑ ETCO2 & tachycardia
2
Q
What is the treatment for Malignant Hyperthermia?
A
dantrolene (2-3mg/kg IV every 5min) w/ sterile water
3
Q
What are the nursing interventions when a patient shows signs of Malignant Hyperthermia?
A
Stop anesthetic
Start central line
Bring down body temp
4
Q
How do you bring down body temp for Malignant Hyperthermia?
A
Chilled Water
Ice Packs
Bladder instillation
5
Q
What is the most common trigger of Malignant Hyperthermia?
A
Halothane
6
Q
What is Halothane?
A
General anesthetic for induction / maintenence
7
Q
What are the symptoms of Malignant Hyperthermia?
A
skeletal muscle contractions
↑ body temp
hypoxia
desaturated blood
mottled skin
cola colored urine
8
Q
What is the main complication of Malignant Hyperthermia?
A
Rhabdomyolosis
9
Q
What is Rhabdomyolosis?
A
damaged muscle tissue releases proteins and electrolytes into the blood - can lead to death
10
Q
When can signs of Malignant Hyperthermia appear?
A
Up to 1-3 days post op
11
Q
What anesthetics are safe to use in patient with Malignant Hyperthermia?
A
Nitrous oxide and sodium panthenol
12
Q
What are the risk factors of Malignant Hyperthermia?
A
Muscular dystrophy
halothane use
first time under anesthesia
younger patient
13
Q
Where should the safety strap be placed during positioning?
A
2” above the knees over the blanket
14
Q
What position should the patient’s arms be in to prevent brachial plexus injury during surgery?
A
The patient’s arms should be at a 90° angle when supine.
15
Q
How many people should be used to move an incapacitated patient during surgery positioning
A
4+
16
Q
Who calls the count when moving a patient?
A
The person at the head
17
Q
What is the shearing force?
A
dragging the skin across the sheet
Avoid
18
Q
What is the recommended hand position for a patient in the supine position when arms are tucked?
A
Arms should be tucked with thumbs up (palms towards the body) to prevent ulnar injury
19
Q
What are the pressure areas to be monitored in supine positioning?
A
scapula, elbows, sacrum, coccyx, heels, and occiput
20
Q
What is the positioning for a patient undergoing perineal prostatectomy?
A
high lithotomy
21
Q
What precautions should be taken during positioning for a pregnant patient?
A
positioner should be placed under the right side (left lateral decubitus) to relieve pressure off the inferior vena cava (IVC) and aorta
22
Q
Where does the kidney rest?
A
12th rib
23
Q
What is Trendelenberg?
A
feet higher than head
24
Q
What should be monitored in Tredelenberg?
A
Intrathoracic and intracranial pressure
25
What are the effects of Low Trendelenburg?
cerebral edema and ischemic pressure on optic nerve
26
What are the effects of Steep Trendelenburg?
optic nerve neuropathy
27
What is reverse Trendelenberg?
Head higher than feet
28
What are the effects of low reverse Trendelenburg?
venous pooling to lower body
29
Where does the safety strap go in lithotomy?
Off the patient
30
What should be monitored in hemilithotomy positioning?
compartment syndrome
31
Where do candy canes put pressure?
plantar nerve / ankles & feet
32
How should legs be managed during positioning changes (ex: lithotomy)?
Elevate and lower them together for hemodynamic stability
33
Which nerve can become damaged in lithotomy?
Obturator nerve (hip)
34
Which nerve can become damaged in obese patients in lithotomy?
Peroneal nerve
35
How to avoid peroneal nerve damage?
pad the lateral aspect of the knee
36
What is seated position?
knees flexed at 30°
37
What effects does seated positioning have?
bradycardia and hypotension
38
What are the risks of beach chair positioning?
DVT, VTE, or air embolism
39
How do you treat an air embolus?
Remove air with CVC from right atrium, put the patient in steep trendelenburg with right side up to prevent air embolus from going into lungs
40
Which pressure points should be monitored in seated positioning?
Scapula, heels, ischial tuberosities
41
Which pressure points should be monitored in lateral positioning (>4hr)?
Ear, acromion, olecranon, iliac crest, trochanter, lateral leg, and malleolus
42
What positioning tools are needed for wide axillary positioning?
chest roll/support under ribs
No rolled towels/blankets
43
How should the upper arm be positioned in lateral positioning?
Level with the shoulder
44
Where should the safety strap be placed in lateral positioning?
at the hip
45
What pressure points should be monitored in lateral positioning?
ear, iliac crest, dependent knee, acromion process, greater trochanter of femur, malleolus
46
How should the chest rolls be positioned in the prone position?
laterally from clavicle to iliac crest
47
What should be done to ensure proper foot positioning in the prone position?
pillow or ankle roll should be placed so that the feet are off the OR table
48
Where does the safety strap go in prone position?
over the thighs
49
What should be monitored for when the patient is in the prone position?
facial edema and ocular pressure
50
Where are the pressure points in prone position?
face, breasts, iliac crest, patella, male genitalia, and dorsum of feet
51
How should cervical alignment be maintained during surgery in the prone position?
Keep cervical neck aligned with rest of spine
52
What potential issues can the jack-knife position cause?
circulatory changes and compromise respirations
53
When should hand hygiene be performed?
Before/after patient contact, touching surroundings, wearing gloves, eating/bathroom, touching bodily fluids, aseptic procedures, and handling medications
54
How long should hand hygiene be performed for C-Diff patients?
15 seconds with soap and water
55
What can hot water cause in hand hygeine?
dermatitis
56
What should be done after using hand sanitizer?
Let it dry naturally, avoid waving hands
57
How long should surgical scrub last?
2-5 minutes
58
When do bean bags cause injury?
When they are left on suction
59
What are the characteristics of iodine as a prep solution?
Intermediate acting, oxidizes bacteria, minimal residual effect
60
What are the effects of iodism?
burns, thyroid issues
61
What is iodism?
Too much iodine
62
What is contraindicated when using iodine?
pregnancy / lactation
63
What should be avoided when using iodine?
Mucous membranes
64
Where can iodine be safely used?
Perineum, eyes, ears
65
What alternatives can be used for iodine if allergic?
PCMX or undiluted 3% H2O2
66
What should be considered regarding iodine use and pregnancy?
iodine can cross placenta
67
What is the recommended eye prep solution?
Ophthalmic betadine
68
What are the characteristics of chlorhexidine gluconate?
Intermediate acting, disrupts cell membrane, long residual effect (up to 6 hours)
69
What inactivates iodine?
blood or mucus
70
What should be avoided when using chlorhexidine gluconate?
mucus membranes
71
What types of bacteria can ethyl/isopropyl alcohol effectively combat?
gram -/+
72
What is the residual effect of ethyl/isopropyl alcohol?
none
73
What types of bacteria is Chloroxylenol Parachlorometaxylenol effective against?
gram -/+, disrupts cell wall
74
Is Triclosan used as prep?
No, banned due to environmental impact and is antibiotic resistant
75
Where do you start prepping the abdomen?
at the incision line and it is not passed over
76
What does wearing a jacket during prep do?
prevents skin shedding
77
What action should be avoided during surgery regarding drapes?
Avoid repositioning
78
When can chlorhexidine gluconate be used?
in patients with VRE
79
Which areas are prepped first?
areas considered contaminated and umbilicus
80
What happens if hair is removed during surgical prep?
There are higher rates of post-op infection
81
What is the main source of transmission for microorganisms?
person to person contact
82
Where do bacteria commonly form biofilms?
warm, moist areas
83
What do Bacillus and Clostridium bacteria form?
endospores, which are hard to kill
84
What is the first line of defense against microorganisms?
skin
85
What type of bacteria is commonly found on the skin and body hair?
staphylococcus aureus
86
What does MRSA stand for, and how does it spread?
MRSA stands for Methicillin-resistant Staphylococcus aureus. It spreads through skin contact.
87
Name some diseases transmitted via droplet transmission.
common cold, chickenpox, flu, bacterial meningitis, strep throat, tuberculosis, measles, mumps, whooping cough, diphtheria, and pertussis.
88
When should a mask be worn to prevent droplet transmission?
within 3 feet of talking
89
What type of mask should be worn to prevent TB transmission?
N95
90
What are some ways to prevent airborne transmission in the operating room?
damp dusting, surgical plume (smoke), drapes, and minimal in/out traffic
91
How is prion disease characterized?
nonliving protein-based helical structure without DNA/RNA that forms a sponge-like protein in the brain
92
What is Creutzfeldt-Jakob Disease (CJD) commonly known as?
mad cow disease
93
How is Creutzfeldt-Jakob Disease diagnosed?
brain biospy
94
How can Creutzfeldt-Jakob Disease be transmitted?
blood, instruments, growth hormone, brain tissue, dual grafts, infected cattle, and can be inherited or spontaneous
95
How is prion disease inactivated?
heat, drying, freezing, most chemical radiation
96
What is Spongiform Encephalopathy (TSE)?
rare family of prions that causes fatal neuro disorders (ex: CJD)
97
What parts of the body does Creutzfeldt-Jakob Disease affect?
brain, spinal cord, CSF, cornea, present in low concentrations in other tissues
98
What are the long term effects of Creutzfeldt-Jakob Disease?
dementia and death
99
What is the recommended size for a tourniquet cuff?
Wide cuff (> 1/2 diameter of extremity)
100
What should be applied under the tourniquet cuff?
Wrinkle-free padding
101
How much higher should the tourniquet pressure be compared to SBP when placed on upper extremity, calf, and ankle?
30-70mmHg higher, typically at 200-250mmHg
102
When should antibiotics be given when using a tourniquet?
20 min before tourniquet goes up
103
What should the tourniquet pressure be when placed on thigh?
250-300mmHg or 400mmHg if patient is larger
104
How does limb occlusion pressure (LOP) affect tourniquet pressure settings?
Adjust pressure based on LOP or systolic pressure & limb circumference.
105
When is limb occlusion pressure checked?
Prior to inflation
106
How is limb occlusion pressure checked?
Use doppler to locate artery distal to cuff, slowly increase pressure until pulse stops
107
What is the recommended tourniquet pressure adjustment for LOP < 130 mmHg?
Increase the tourniquet pressure by 40 mmHg
108
What is the recommended tourniquet pressure adjustment for LOP between 130-190 mmHg?
Increase the tourniquet pressure by 60 mmHg
109
What is the recommended tourniquet pressure adjustment for LOP > 190 mmHg?
Increase the tourniquet pressure by 80 mmHg
110
How is pediatric tourniquet pressure adjusted in relation to LOP?
set 50 mmHg greater than LOP
111
How long can the tourniquet be inflated for upper extremity surgeries?
1 hr
112
What complication can arise from rapid deflation of a tourniquet?
Rush of metabolic waste and medications
113
What are the signs and symptoms of rapid deflation of a tourniquet?
Ringing ears, numbness/tingling in lips/fingers, loss of consciousness, seizures, arrhythmias.
114
How can you facilitate proper tourniquet application in obese patients?
Gentle traction of adipose tissue distal to the cuff
115
What should be documented regarding tourniquet use?
Location of cuff, cuff pressure, time of inflation and deflation, distal pulses before and after, person who applied cuff, skin protection measures, limb occlusion pressure, skin integrity before and after, and ID# of tourniquet used.
116
What are the contraindications for esmark use?
Risk of DVT, thrombus, infection, dislocated fractures, malignancy.
117
How long can the tourniquet be inflated for lower extremity surgeries?
90 min
118
How long can the tourniquet be inflated for pediatric surgeries?
75 min
119
What do you do if you go over the time limit for tourniquet?
deflate and allow for reperfusion for at least 10-15 minutes then reinflate
120
What are the potential complications of using a tourniquet?
hyperthermia (inflation), hypothermia (deflation), emboli (1 min after deflation), increased ICP, overpressurization (nerve damage, pain at site), ischemic injury, underpressurization (bleeding, venous congestion)
121
What overlap should be maintained when applying a tourniquet?
3-6 inches
122
Where should the tubing of a tourniquet be positioned on the extremity?
On the lateral aspect of the extremity.
123
What is the purpose of using an esmark bandage before inflating a tourniquet?
exsanguinate the limb
124
What should be done if you can't use esmark to exsanguinate the limb?
Exsanguinate by elevation
125
What may cause rhabdomyolysis when using a tourniquet?
Compartment syndrome
126
What should be done if there is rapid delfation when using a tourniquet?
lactic acid bolus
127
What complications come from nerve damage from tourniquets?
permanent motor / sensory deficits
128
How should a timeout be performed when using a tourniquet?
mention placement of tourniquet
129
What are the 7 rights of medication administration?
Patient, drug, time, route, dose, reason, documentation
130
What precaution should be taken with medications regarding the rubber stopper?
Do not remove the rubber stopper from medications.
131
What are characteristics of Absorbable Gelatin?
Used for capillary bleeding, can soak up to 45x its weight, can be used on infected tissue
132
What are examples of Absorbable Gelatin?
Gelfoam, Surgiflo
133
What are characteristics of Oxidized Cellulose?
Cotton or rayon based, soak 10x its weight, not for long term use
134
Where can you place Oxidized Cellulose?
On sutures or wrap around oozing areas
135
What is Microfibrillar Collagen made from?
Bovine
136
How does Microfibrillar Collagen work?
swells to form a clot when dry and pressure is applied.
137
What are characteristics of Absorbable Collagen?
used for oozing / bleeding, not for infected wounds, 8-10 weeks to absorb
138
What does Thrombin do?
accelerates the clotting process
139
What is an example of Thrombin?
Tisseel
140
What is Magnesium Sulfate used for in pregnancy?
lower blood pressure and an anticonvulsant in preeclampsia
141
What should be avoided in patients with a PCN allergy?
Cefixime, Rocephin
142
Example of Oxidized Cellulose?
surgicel
143
What are the parameters to monitor during local anesthesia administration?
BP, HR/pulse, SpO2, pain, anxiety, LOC
144
What is the role of the monitoring RN during local anesthesia administration?
The monitoring RN can also serve as a circulator
145
How are esters metabolized?
pseudocholinesterase.
146
What is released during the metabolism of esters?
para-aminobenzoic acid (PABA)
147
What response can an allergy to esters cause?
histamine response
148
Name some examples of esters used in local anesthesia.
cocaine, procaine, and tetracaine
149
How are amides metabolized?
liver
150
Give examples of commonly used amides in local anesthesia.
bupivacaine, lidocaine, and mepivacaine
151
What is Local Anesthetic Systemic Toxicity (LAST)?
High serum levels of local anesthetics causing CNS and cardiovascular complications
152
When can signs of LAST appear?
Within 1 minute to 30 minutes after injection
153
How often should patients be assessed for LAST?
Frequently
154
What are the risk factors for LAST?
advanced age, liver disease, decreased albumin levels, CHF, ischemic heart disease, acidosis, meds that inhibit sodium channel, low EF, conduction abnormalities, BIER block
155
What are the initial signs of LAST?
Dizziness, numbness in the tongue, metallic taste, LOC, anxiety, agitation
156
What are the intermediate signs of LAST?
Shivering, slurred speech, confusion, seizures
157
What are the severe signs of LAST?
Coma, decreased heart rate, cardiac arrest
158
What is the first intervention step for LAST?
Call anesthesia
159
How should the airway be maintained in LAST?
100% oxygen and hyperventilation
160
What medication (and how) should be administered in LAST?
20% lipid emulsion 1.5 mL/kg bolus, repeat up to 3 times, then 0.25 mL/kg/min infusion IV
161
How can you prevent LAST when using local anesthetics?
Know and calculate the maximum dose
162
What should be done before injecting local anesthetics to prevent LAST?
Aspirate at the site
163
What should you ask the patient to help prevent LAST?
If they are experiencing symptoms
164
How should large or multiple wounds be repaired to prevent LAST?
Serial repairs
165
What is used to monitor moderate sedation?
Capnography, depth of sedation scale (ETCO2), BIS monitoring, and audible alarms.
166
What should be considered when adjusting medication doses for older adults during moderate sedation?
Dose adjustments are necessary, be aware of individual patient needs.
167
Why should airway obstruction be considered during the discharge of infants and toddlers?
Their heads may fall forward, causing airway obstruction.
168
Who provides guidelines for the scope of practice of the RN?
Nurse Practice Act (SBON, AORN)
169
Which ASA physical status classifications can an RN administer moderate sedation to?
ASA 1, 2, & 3
170
What patient characteristics should be avoided in moderate sedation?
Beards, dentures, and sleep apnea
171
What is required for the monitoring RN during moderate sedation?
No competing responsibilities and 2 RNs in the room at all times, with brief interruptible tasks allowed.
172
What areas should education and competency cover for moderate sedation?
Pharmacology, expected sequence of events, completing pain assessments, and patient teaching.
173
What are examples of regional anesthesia?
Topical (drops or ointment) and local infiltration.
174
How is local infiltration administered?
Injected into the incision site
175
How does epinephrine affect local infiltration?
delay absorption for post-op pain
176
What is the maximum dose of 1% lidocaine without epinephrine?
5 mg/kg/day
177
What is the maximum dose of 1% lidocaine with epinephrine?
7 mg/kg/day
178
Which herbal supplements are associated with liver damage?
Echinacea and kava.
179
What unusual effect can kava have when used with propofol?
Turns urine green
180
Which herbal supplements can increase the risk of bleeding?
Ginger, gingko, garlic, feverfew, saw palmetto, biloba, and omega-3
181
Which herbal supplements can cause arrhythmias or affect blood pressure?
Goldenseal, milk thistle, licorice, and ginseng with ephedra (with atropine)
182
Which herbal supplements can prolong emergence from anesthesia?
Gingko, St. John’s wort, and valerian
183
Which herbal supplement is associated with hypertension?
Ginseng
184
What is the function of mydriatics in eye medications?
Mydriatics dilate the pupil and reduce the effect of trauma by paralyzing the sphincter muscle of the iris.
185
Give two examples of mydriatics.
Neo-synephrine and atropine.
186
What is the function of miotic eye medications?
Miotics constrict the pupil and decrease intraocular pressure (IOP)
187
Which disease are myotic medications usually used in?
Glaucoma
188
Give two examples of miotic eye medications.
Miochol and miostat
189
What is the function of tropicamide in eye medications?
Tropicamide dilates the eyes and causes inability to focus due to its anticholinergic properties.
190
What type of eye medication is pilocarpine and when should it not be used?
Pilocarpine is a miotic and should not be used with cataracts.
191
How are aminoesters metabolized?
By plasma by liver enzymes
192
What can aminoesters stimulate?
Allergies
193
Give three examples of aminoesters.
Cocaine, tetracaine, and novocaine
194
How are aminoamides metabolized?
Liver
195
Give two examples of aminoamides.
Lidocaine and bupivacaine
196
What cardiac symptoms is lidocaine used for?
arrhythmias and pulseless ventricular tachycardia
197
How does bupivacaine compare to lidocaine in strength?
4x stronger
198
What areas are targeted by a femoral nerve block?
anterior thigh and knee, including the quadriceps and tendon repairs
199
What are the primary effects of benzodiazepines?
Reduce anxiety and provide sedation
200
What is Versed (Midazolam) primarily used for?
Amnesic and anti-anxiety effects
201
What is a key contraindication for Versed (Midazolam)?
Narrow-angle glaucoma
202
How is Versed (Midazolam) administered?
IV only
203
What is the duration of action for Versed (Midazolam)?
Short acting
204
How can Valium (Diazepam) be administered?
Orally or IV
205
What is a notable side effect of Valium (Diazepam) when given IV?
Can burn
206
What respiratory effect is associated with Valium (Diazepam)?
potent respiratory depressant
207
How long does it take for Valium (Diazepam) to be eliminated from the body?
Approximately 2 days
208
What is Romazicon (Flumazenil) used for?
As a reversal agent for benzodiazepines
209
What are the contraindications for Romazicon (Flumazenil)?
Seizures and tricyclic antidepressant (TCA) use.
210
How do our bodies control pain naturally?
Through natural endorphins.
211
What natural ability do humans have concerning pain?
The natural ability to ignore pain.
212
What is an endorphin?
Endogenous morphine
213
What effect can synthetic opioids have on the body?
Histamine release
214
What are high-risk factors associated with narcotic use?
Respiratory depression, head injuries, breathing problems, obesity, age over 60.
215
What are the key characteristics of Morphine/Duramorph?
Fast-acting, used for moderate to severe pain
216
What is the onset time for Morphine/Duramorph?
1-3 minutes
217
What are common side effects of Morphine/Duramorph?
Constipation and urinary retention
218
What is a notable complication of Morphine/Duramorph?
Nausea / vomiting
219
How long does Morphine/Duramorph last during conscious sedation or epidurals?
3-4 hours
220
What is the recommended dose of Morphine/Duramorph for conscious sedation or epidurals?
1-2 mg
221
How does Fentanyl/Sublimaze compare in potency to Morphine?
100x more potent
222
What is the onset time for Fentanyl/Sublimaze?
1-3 minutes
223
How long does a 25 mcg dose of Fentanyl/Sublimaze last?
30-60 min
224
What are potential side effects of Fentanyl/Sublimaze?
Delayed respiratory depression
225
What drug interaction should be considered with Fentanyl/Sublimaze?
MAOIs
226
How should IV Fentanyl/Sublimaze be administered?
Push slowly
227
What is the potency of Meperidine/Demerol compared to Morphine?
1/10th times the strength
228
What is the onset time for Meperidine/Demerol?
1-5 min
229
How long does a 10-20 mg dose of Meperidine/Demerol last?
1-2 hr
230
What additional condition is Meperidine/Demerol used for?
Shivering
231
What are the risks associated with Meperidine/Demerol?
Head injuries/increased ICP (increase in CSF pressure), liver or kidney damage.
232
How does Hydromorphone/Dilaudid compare in strength to Morphine?
7x stronger
233
How should IV Hydromorphone/Dilaudid be administered?
Push slowly
234
What is the function of Narcan/Naloxone?
It is a reversal agent that competes for opiate receptors.
235
What is the initial dose range for Narcan/Naloxone?
0.4-2 mg
236
How is Narcan administered?
IV, IM, subcutaneously, or nasally
237
How long does Narcan/Naloxone last?
30-45 min
238
What is the recommended redosing interval for Narcan/Naloxone?
0.1-0.2 mg at 2-3 minute intervals, redose every 2 minutes up to 10 mg.
239
What are potential side effects of Narcan/Naloxone?
Increased heart rate, stroke, hypertension, respiratory depression
240
How is Narcan/Naloxone metabolized?
Liver
241
How is Narcan/Naloxone excreted?
Kidneys
242
What is the primary use of neuromuscular blockers in surgery?
abdominal surgery and work on muscles
243
What do nondepolarizing neuromuscular blockers do?
Prevent muscle contraction by binding to cholinergic receptors
244
What are some characteristics of neuromuscular blockers?
do not cause fasciculation and are not MH triggers.
245
What are acetylcholine competitive antagonists?
Blocking agents that block acetylcholine and do not interact with the receptor (slower than succinylcholine)
246
What is Atracurium/Tracrium used for?
Intubation
247
How long does Atracurium/Tracrium last?
30-60 min
248
What are the effects of Atracurium/Tracrium?
Decreased blood pressure, vasodilation, and histamine release.
249
What is the intubation dose for Atracurium/Tracrium?
0.3-0.5 mg/kg
250
How long does Vecuronium/Norcuron last?
30 min
251
What is the intubation dose for Vecuronium/Norcuron?
0.6 mg/kg
252
What are the storage requirements for Vecuronium/Norcuron?
Must be refrigerated
253
Are there any notable effects of Vecuronium/Norcuron?
No notable effects
254
How long does Rocuronium/Zemuron last?
30-90 min
255
What is the intubation dose for Rocuronium/Zemuron?
0.6-1.2 mg/kg
256
What are the effects of Rocuronium/Zemuron?
Increased heart rate and possible reactions with antibiotics; patients recover quickly.
257
How long does Pancuronium/Pavulon last?
Over 1 hr
258
What are the effects of Pancuronium/Pavulon?
Decreased blood pressure, increased heart rate, and bronchospasm.
259
What are the contraindications for Pancuronium/Pavulon?
Neonates and children (contains benzyl alcohol)
260
What is Neostigmine/Prostigmine used for?
reversal agent that inhibits the destruction of acetylcholine
261
What are the contraindications for Neostigmine/Prostigmine?
Asthma
262
What are the side effects of Neostigmine/Prostigmine?
seizures, coronary artery disease, arrhythmias, bowel obstruction, and urine retention
263
What do anticholinesterases do?
Block acetylcholinesterase, increase acetylcholine concentration in the neuromuscular junction, and displace muscle relaxants from acetylcholine receptors.
264
What are the unwanted side effects of anticholinesterases?
Decreased heart rate, bronchospasm, and enhanced GI peristalsis.
265
Why are anticholinesterases combined with muscarinic antagonists?
counteract unwanted side effects
266
Examples of muscarinic antagonists.
glycopyrrolate / atropine
267
Examples of Anticholinersterases
Neostigmine, Edrophonium, Sugammadex
268
How is Neostigmine typically administered?
Mixed with glycopyrrolate
269
What occurs first when Neostigmine is mixed with atropine?
Atropine effects
270
How is Edrophonium prepared?
Mixed with atropine
271
What is Sugammadex used for?
reverse any level of paralysis from rocuronium or vecuronium
272
How do depolarizing neuromuscular blockers work?
They stimulate the ANS and act like acetylcholine.
273
What are the contraindications for depolarizing neuromuscular blockers?
Involuntary muscle contractions (fasciculations) that result in flaccidity and triggering malignant hyperthermia (MH)
274
What is Succinylcholine/Anectine used for?
Intubation and induction
275
What is the duration of Succinylcholine/Anectine?
4-10 min
276
How is Succinylcholine metabolized?
By pseudocholinesterase (longer than acetylcholinesterase)
277
Is there a reversal agent for Succinylcholine?
No
278
What are the adverse reactions to Succinylcholine?
Decreased heart rate, increased intracranial pressure, increased potassium, oxygen depletion.
279
What are the contraindications for Succinylcholine?
Family history of malignant hyperthermia, glaucoma, and degenerative neuromuscular disorders.
280
How is induction achieved in children?
Inhalation
281
What are barbiturates used for induction?
Brevital, which is a short-acting anesthetic
282
What sedatives/hypnotics are used for induction?
Propofol and etomidate
283
What is the nurse’s responsibility during induction?
Remain with the patient, manage stress response (increased BP & HR), limit sensory stimulation, and know the location of the emergency/difficult intubation cart/trach tray
284
How should asthmatic patients be managed during induction?
Induce deeper anesthesia and use a bronchodilator prior to induction
285
Why is malignant hyperthermia (MH) a concern during induction?
Signs and symptoms appear from anesthesia gases
286
Who are at risk for aspiration during induction?
Patients with GERD, trauma, pregnancy, obesity, and those requiring awake intubation
287
What technique is used to reduce aspiration risk during induction?
Applying cricoid pressure
288
What is the narrowest part of a child’s airway?
cricoid cartilage
289
How is inhalation anesthesia administered?
face mask, endotracheal tube (ET), or laryngeal mask airway (LMA) mixed with CO2
290
What are the risks associated with Halothane?
Triggers MH
291
What can Halothane cause if combined with epinephrine?
arrhythmias
292
What is the strongest inhalation agent?
Halothane
293
What are the characteristics of Nitrous Oxide (N2O)?
It’s nonflammable, nonhalogenated, provides rapid induction and quick recovery, and is safe in MH patients
294
What are the potential effects of Nitrous Oxide (N2O)?
poor muscle relaxation, hypoxia, and support combustion like oxygen
295
What effects does nitrous oxide have on the cardiovascular system?
None
296
What is the purpose of Desflurane/Suprane?
used for patients with increased intracranial pressure (ICP)
297
What are the potential effects of Desflurane/Suprane?
glycosuria and proteinuria
298
What are the characteristics of Desflurane/Suprane in terms of onset and offset?
Fastest onset / offset of inhalation drugs
299
What are common side effects of Desflurane/Suprane?
Coughing and a smell resembling rubber
300
How does Isoflurane/Forane affect heart rate?
Slows
301
How is Isoflurane/Forane metabolized?
Liver
302
Is Isoflurane/Forane safe in patients with renal disease?
Yes, not metabolized by kidney
303
What are the potential effects of Isoflurane/Forane?
Respiratory depression and vasodilation
304
What happens if Isoflurane/Forane is used with a pneumatic tourniquet?
Increased ICP
305
What is the significance of Sevoflurane in pedatrics?
Agent of choice due to rapid onset / offset
306
When is Ethrane contraindicated?
Seizures
307
What is the composition of Propofol/Diprivan?
Contains soybean oil and lecithin
308
What is the dosage range for Propofol/Diprivan?
1.0-2.5 mg/kg
309
What are the effects of Propofol/Diprivan?
Respiratory and cardiac depression
310
What is the onset of action for Propofol/Diprivan?
rapid
311
What type of anesthesia does Ketamine/Ketalar provide?
dissociative anesthesia (patient is awake but unaware)
312
What are the effects of low-dose Ketamine/Ketalar?
does not cause respiratory depression, hallucinations, or delirium
313
What is the onset of action for Ketamine/Ketalar?
rapid
314
What are the contraindications for Pentothal/Thiopental Sodium?
chronic renal or hepatic disease
315
What are the effects of Pentothal/Thiopental Sodium?
decreased arterial pressure and cardiac output
316
What is the mechanism by which Pentothal/Thiopental Sodium protects the brain?
sedative-hypnotic properties
317
How long does Zofran/Ondansetron last?
12-24 hr
318
How long does Reglan/Metoclopramide last?
6 hr
319
What is the purpose of Scopolamine/Hyoscine before surgery?
placed behind the ear as a sedative
320
What is the mechanism of action of Prilosec/Omeprazole?
proton pump inhibitor that prevents the release of gastric acid
321
What is the dosage of Prilosec/Omeprazole?
60mg
322
How quickly does Protonix/Pantoprazole work?
20min
323
What is the concentration of IV Protonix/Pantoprazole?
4mg/mL
324
What is the indication for Adenosine/Adenocard?
increasing heart rate and restoring normal sinus rhythm (NSR) by causing brief asystole
325
What is the dosage of Adenosine/Adenocard?
6mg bolus every 1-2 min
326
What is the action of Amiodarone/Cordarone?
class II antiarrhythmic used for life-threatening ventricular arrhythmias
327
How is Amiodarone/Cordarone administered?
intravenously (IVP) as 300mg in 20-30mL of normal saline (NS) or D5W, followed by a repeat dose of 150mg every 3-5 min.
328
What is the purpose of Atropine/Atropen?
anticholinergic agent used for bradycardia, asystole, and AV node block
329
What is the dosage of Atropine/Atropen?
1mg every 3-5 min
330
When is Epinephrine/Adrenaline administered?
adrenergic emergency, asystole, pulseless ventricular tachycardia, asthma/allergic reactions
331
What are the routes of administration for Epinephrine/Adrenaline?
endotracheal (ET) inhalation, subcutaneous (subq), intramuscular (IM), or intravenous (IV) routes
332
What is the dosage of Epinephrine/Adrenaline?
1mg every 3-5 min
333
What is the action of Vasopressin/Vasostrict?
increases blood pressure by constricting blood vessels and restricts renal excretion while increasing peristalsis (ADH)
334
What is the dosage of Vasopressin/Vasostrict?
40 units intravenously (IVP)
335
How does Nitroglycerin/Nitrostat work?
increases coronary blood flow by dilating arteries, thereby reducing blood pressure and relieving angina
336
What is the purpose of Lasix/Furosemide intraoperatively?
reduce intracranial pressure (ICP)
337
What is the indication for Mannitol/Osmitrol?
increased intracranial pressure (ICP) and intraocular pressure (IOP)
338
What is the action of Dilantin/Phenytoin?
prevent and treat seizures after head trauma
339
What is the action of Dantrolene/Revonto?
blocks the accumulation of calcium in skeletal muscles, primarily used for malignant hyperthermia (MH)
340
What is the administration method for Dantrolene/Revonto?
via central line as a 2-3mg/kg IV bolus
341
How should Ryanodex be reconstituted?
5mL of non-bacteriostatic water, used within 6 hours
342
Why should you add epinephrine to local anesthesia?
delay absorption for post op pain
343
What is the effect of Dopamine/Intropin on blood pressure?
Decreases
344
What is the effect of Dopamine/Intropin on cardiac output?
increases
345
What is the therapeutic indication of Dopamine/Intropin?
renal failure
346
What is the purpose of including Mannitol with Dantrolene?
increase renal function
347
What are the four kinds of brachial plexus blocks?
Interscalene
Supraclavicular
Infraclavicular
Axillary
348
What is the complication of an interscalene block?
Horner's syndrome
349
What is Horner's syndrome?
Disrupted nerve pathway on one side from the brain to the face / eye
350
What are symptoms of Horner's syndrome?
Drooping eyelid, little / no sweating on affected side, smaller pupil
351
What is the complication of a supraclavicular block?
pneumothorax
352
What is the complication of an infraclavicular block?
short duration
353
What is the complication of an axillary block?
hematoma
accidental vascular injection
354
What is a Bier Block or Intravenous Regional Anesthesia (IVRA)?
regional anesthesia technique used for hand procedures
355
What is the typical duration of cases for which Bier Block is used?
Cases lasting 20-60 min
356
What is the primary advantage of Bier Block?
provides a bloodless surgical field
357
How quickly does Bier Block typically onset?
less than 5 min
358
What is the sequence of steps for performing a Bier Block?
1. Exsanguinate the extremity.
2. Apply a tourniquet.
3. Inflate the proximal cuff.
4. Inject local anesthesia and remove the IV.
5. Perform the procedure.
6. Deflate the cuff.
359
What surgical areas are well suited for a Femoral Block?
anterior thigh or knee, such as quadriceps tendon repair
360
In addition to surgery, what other purpose can the Femoral Block serve?
postoperative pain management after femur or knee surgery
361
Why is aspiration before injection important in neuraxial anesthesia?
prevents accidental intravascular injection
362
Which medication commonly causes LAST?
bupivacaine used in epidural procedures
363
What should be monitored during neuraxial anesthesia?
Sensory block and autonomic function of nerve roots and spinal cord.
364
What precautions should be taken while positioning or transferring patients during neuraxial anesthesia?
Careful positioning for proper body alignment and avoiding rapid changes to prevent hypotension.
365
When does motor function typically return compared to sensory functions during neuraxial anesthesia?
Motor function returns before sensory function
366
What factors should be considered before administering neuraxial anesthesia?
History of spinal malformation, previous spinal surgery, psychological status, and high skill level required in pediatric patients
367
What are the contraindications for neuraxial anesthesia?
Anticoagulation, increased intracranial pressure (ICP), septicemia, skin infection at insertion site, pre-existing neurological disorders (such as MS), cancer of brain or spinal cord, and patient refusal
368
What complications are associated with neuraxial anesthesia?
Respiratory depression, bladder distention, hypotension, and post-dural puncture headache
369
What can cause respiratory depression in epidurals?
sedation used with regional anesthesia or high placement affecting phrenic nerve
370
How do you treat bladder distension during an epidural?
offer void or catheter
371
What kind of needles are used in spinal anesthesia and why?
pencil point (not beveled)
prevent accidental dural puncture
372
What are some noninvasive treatments for post-dural puncture headache?
HOB flat, fluids, analgesics, caffeine, sumatriptan
373
Where is medication injected in peridural/epidural/caudal anesthesia?
epidural space
374
For what purpose can peridural/epidural/caudal anesthesia be used?
postoperative pain relief
375
What is a characteristic of peridural/epidural/caudal anesthesia in terms of duration?
Longer duration is achievable
376
In which regions of the body is peridural/epidural/caudal anesthesia commonly administered?
Thoracic / lumbar
377
Why is peridural/epidural/caudal anesthesia preferred for obstetrics?
Pain relief during labor
378
What is the typical onset time for peridural/epidural/caudal anesthesia?
15-30 min
379
Where is subdural/spinal/saddle anesthesia injected?
below L2
380
What is the duration of subdural/spinal/saddle anesthesia?
2 hr
381
or what purpose is subdural/spinal/saddle anesthesia NOT typically used?
post operative pain relief
382
What is the typical onset time for subdural/spinal/saddle anesthesia?
5 min
383
What is the goal of general anesthesia?
Achieving a level of sedation adequate to prevent the patient from being awake
384
What factor determines the amount of sedation required during general anesthesia?
Intensity of stimulation
385
How can the effectiveness of general anesthesia be enhanced?
By combining various drugs, which often has a synergistic effect
386
What is the potency comparison between a sedative and narcotic combination versus a larger dose of either alone during general anesthesia?
The sedative and narcotic combination is more potent
387
What is compromised during general anesthesia regarding compensatory vasoconstriction?
Compensatory vasoconstriction
388
What does ASA 1 denote in anesthesia classification?
relatively healthy patient with a localized pathologic process
389
What does ASA 2 denote in anesthesia classification?
Mild systemic disease
390
What does ASA 3 denote in anesthesia classification?
severe systemic disease that limits activity but are not totally incapacitated
391
What does ASA 4 denote in anesthesia classification?
incapacitating disease that poses a constant threat to life
392
What does ASA 5 denote in anesthesia classification?
moribund patient who is not expected to survive 24 hours with or without surgery
393
What does ASA 6 denote in anesthesia classification?
brain dead and are considered for organ donation
394
How is an emergency indicated in terms of ASA?
The number followed by "E"
395
Give an example of ASA 2.
Diabetes mellitus
396
Give an example of ASA 3.
HTN, COPD
397
Give an example of ASA 4.
cardiovascular disease, renal disease
398
What should be monitored during spinal anesthesia?
Hypotension, decreased temperature, hematoma formation, and postural headache
399
What is a postural headache in spinal anesthesia?
headache caused by migration above 1-2 subarachnoid space
400
What complications should be watched for during epidural anesthesia?
slow absorption when used with epinephrine
401
Where is epidural anesthesia administered?
above and surrounding dura matter
402
What characterizes Stage 1 of anesthesia?
Induction, oxygenation, vital signs monitoring, airway establishment, analgesia, amnesia, consciousness, and ability to follow commands
403
What occurs during Stage 2 of anesthesia?
Excitement, stable vital signs, slight unconsciousness with retained reflexes, potential for delirium, risk of laryngospasm and cardiac arrest, and REM sleep
404
What defines Stage 3 of anesthesia?
Maintenance, safe for positioning, and surgical intervention.
405
What are the four planes of Stage 3 anesthesia and their respiratory patterns?
Plane 1: Regular respirations.
Plane 2: Regular respirations with cessation of movement.
Plane 3: Diaphragmatic respirations (ideal).
Plane 4: Irregular respirations.
406
What characterizes Stage 4 of anesthesia?
Overdose, danger, reaction to medication, failure of cardiovascular and respiratory systems, medullary depression, and respiratory paralysis
407
What constitutes as an emergency state during anesthesia?
Laryngeal reflexes remain intact
408
What happens during the emergence phase of anesthesia?
Recovery from anesthesia
409
How do you treat laryngospasm?
100% O2, sedation, and paralysis if needed
410
What are potential concerns in emergence of anesthesia?
hypoventilation, incomplete reversal of muscle relaxation, CNS depression, and laryngospasm
411
What are the guidelines for documentation requirements?
PNDS (perioperative nursing data sets)
412
What is the status of DNR/AND (Do Not Resuscitate/Allow Natural Death) orders during perioperative care?
not automatically suspended
413
How are DNR/AND orders addressed with the patient?
Conversation between MD and patient
414
Who is not authorized to alter DNR/AND orders?
RN
415
What is the process if a DNR/AND order needs to be suspended?
Written order by physician
416
What are intentional torts in healthcare?
Violations of patient rights without requiring actual harm
417
Define assault as an intentional tort.
Instilling fear of being touched without consent.
418
Define battery as an intentional tort.
Touching a person without their permission
419
Define false imprisonment as an intentional tort.
Unjustified detention of an individual
420
What's important regarding documentation when using restraints?
Thorough documentation is crucial
421
What characterizes quasi-intentional torts in healthcare?
Actions without intent to harm or distress
422
What are examples of quasi-intentional torts in healthcare?
Patient abandonment
invasion of privacy
defamation of character
breach of confidentiality
423
What are the ethical principles that guide nursing practice?
autonomy
beneficence
nonmaleficence
justice
veracity
fidelity
424
Define autonomy in nursing ethics.
individuals making decisions for themselves
425
Define beneficence in nursing ethics.
act of doing good
426
Define nonmaleficence in nursing ethics.
principle of doing no harm
427
Define justice in nursing ethics.
ensuring fairness in treatment
428
Define veracity in nursing ethics.
truthfulness in communication
429
Define fidelity in nursing ethics.
faithfulness to commitment
430
What must be completed before a procedure as part of the Preprocedural Verification?
H&P & anesthesia assessment
431
What needs to be available before a procedure?
Blood, implants, special equipment
432
How must the consent form be prepared?
Accurate, signed, and witnessed
433
What should be done if a patient changes their mind after signing consent?
Notify the surgeon
434
When is consent not required?
During an emergency
435
Where is the site marking done?
Outside the OR
436
How should the site mark be used across hospitals?
Consistent mark used throughout hospitals.
437
What condition must the patient be in during site marking?
not sedated and participating
438
Who marks the surgical site?
medical person participating in the procedure.
439
How is site verification for a child performed?
With the parent
440
When is the time out performed?
Prior to the procedure, ideally before anesthesia
441
When is the time out performed?
Prior to the procedure, ideally before anesthesia
442
Who performs the time out and how?
designated person in a standardized manner defined by the organization.
443
How is the information exchanged during a time out?
Two way conversation
444
What is the response during a time out?
Info given and acknowledged if correct or not
445
How many times is a time out performed per procedure?
Once or whenever surgeon leaves room
446
When should a second time out be performed?
For a different surgeon or if re-draping.
447
What needs to be assessed preoperatively?
Age
Height, weight, BMI
Baseline VS, cardiac, and respiratory status
PMH
Allergies
NPO status
Medications
Skin
Neurological status
Educational needs
Diagnostic results (labs)
Communication barriers
Mobility / sensory impairments
Detrimental behavior
Cultural considerations
Ability to tolerated surgical position
Anxiety level
Pain level
Need for IV access
Preceptions of surgery
Physical acuity
448
What is the purpose of the assessment in the nursing process?
To formulate a nursing diagnosis.
449
What does one do in the assessment phase?
Collect data
450
What is the purpose of the diagnosis in the nursing process?
identify and classify data collected
451
What does the diagnosis phase focus on?
Human response
452
What types of diagnoses & outcomes are considered in the diagnosis phase?
Actual vs. potential
453
What is the capability of nursing treatment during the diagnosis phase?
Correcting the issue
454
What classification system is used in the diagnosis phase?
NANDA
455
What is the purpose of identifying outcomes in the nursing process?
describe the desired or expected condition achievable.
456
How are nursing interventions measured?
Based on outcome
457
How do we evaluate the outcome?
Goals
458
What characteristics must goals have?
Specific and measurable
459
What is the purpose of planning in the nursing process?
select interventions to meet desired outcomes
460
What must be identified during the planning phase?
Measurable outcomes
461
What type of goals and interventions should be created during the planning phase?
Individualized
462
Who should be communicated with during the planning phase?
patient, family, interdisciplinary team, and during change of shift
463
What should be prepared in advance during the planning phase?
what will/may happen and prioritize care
464
What is the purpose of the implementation phase in the nursing process?
Carry out plan of care
465
What are the nursing actions during the implementation phase?
Promote wellness, restore health, prevent disease, cope with altered functions
466
How should nurses respond during the implementation phase?
Critical thinking
467
What is the purpose of the evaluation phase in the nursing process?
Identify if goal was met
468
What questions are addressed during the evaluation phase?
Was the goal met? Which factors were (not) met?
469
What should be done if the goal was not met in the evaluation phase?
Modify plan accordingly
470
What is the active electrode in electrosurgery?
Bovie pencil
471
What is the function of the bovie pencil?
sends current to surgical tissue
472
What is the dispersive electrode in electrosurgery?
The bovie pad
473
Where should the bovie pad be kept away from?
Keep away from implants and tattoos
474
What surfaces should be avoided when placing the bovie pad?
Avoid bony, scarred, or hairy surfaces
475
Where should the bovie pad be placed for optimal effectiveness?
On a large muscle close to the surgical site.
476
What should be done to an ICD or pacemaker before electrosurgery?
Turn it off
477
What type of electrosurgery should be used if possible with an ICD or pacemaker?
Bipolar
478
What type of electrosurgery should be used with nerve stimulators?
Bipolar
479
What type of electrosurgery should be avoided with cochlear implants?
No monopolar
480
What is needed for return current in monopolar electrosurgery?
Grounding pad
481
What are the different modalities of monopolar electrosurgery?
Cut, coagulate, blend, fulgurate, and desiccate.
482
How does current return to the generator in bipolar electrosurgery?
One side of the forceps returns current to the generator.
483
What is a characteristic of bipolar electrosurgery?
uses lower voltage for smaller areas
484
What does a lower score on the Braden Scale indicate?
Higher risk of pressure ulcers
485
What score on the Braden Scale indicates severe risk?
Less than 10
486
What score range on the Braden Scale indicates high risk?
10-12
487
What score range on the Braden Scale indicates moderate risk?
12-14
488
What score range on the Braden Scale indicates mild risk?
15-18
489
What are the stages of healing?
Inflammation, proliferation, maturation
490
What is the timeframe for the inflammatory phase of wound healing?
Day 0-3
491
What are the key characteristics of the inflammatory phase of wound healing?
Redness, edema, phagocytosis
492
What is the timeframe for the proliferation phase of wound healing?
Day 4-24
493
What occurs during the proliferation phase of wound healing?
Granulation and epithelial tissue formation
494
What is the timeframe for the maturation phase of wound healing?
Day 24 - 1 year
495
What occurs during the maturation phase of wound healing?
Scar formation and contraction
496
What is primary intention in wound healing?
Minimal tissue loss, no dead space, all layers approximated
497
Which type of wounds typically heal by primary intention?
most surgical wounds
498
What is secondary intention in wound healing?
Significant tissue loss, granulation, closes from bottom up
499
Which type of wounds typically heal by secondary intention?
pressure ulcers
500
What is tertiary intention in wound healing?
Delayed primary intention, left open and packed, closed day 3-5
501
When is tertiary intention used?
High suspicion of contamination
502
What effect do steroids and anti-inflammatory drugs have on wound healing?
delay wound healing
503
What is wound separation?
wound edges come apart
504
What is dehiscence?
Separation of the fascial layer with a new development of drainage
505
What is evisceration?
Abdominal contents spilling out, surgical emergency
506
What is the expected infection rate for Class I (Clean) wounds?
< 5%
507
What are the characteristics of Class I (Clean) wounds?
primary closure, no break in technique
508
What is the expected infection rate for Class II (Clean-Contaminated) wounds?
8-11%
509
What constitutes a class II wound?
GI, GU, respiratory tract entered under controlled conditions without spillage
510
What is the infection rate for Class III (Contaminated) wounds?
15-20%
511
What constitutes a class III wound?
fresh traumatic injuries, break in technique, spillage
512
What are examples of class II procedures?
bowel resection, hysterectomy, T&A
513
What are examples of class III procedures?
appendectomy for appendicitis, cholecystectomy for cholecystitis
514
What is the infection rate for Class IV (Infected) wounds?
27-40%
515
What constitutes a class IV wound?
clinical infection, perforated viscera, necrotic tissue
516
What are examples of class IV procedures?
I&D of abscess, ruptured appendix, GSW to abdomen
517
What is the trauma triage order?
1. Cervical Spine
2. Airway obstruction
3. Hemorrhage
4. Cardiac tamponade
5. Pneumothorax
6. Increased ICP
7. Massive burns
8. Spinal Cord Injury
9.Extremity Injury
518
What is the first step in rapid sequence intubation?
pre-oxygenation
519
What maneuver is used to prevent aspiration of stomach contents during rapid sequence intubation
Sellick's maneuver
applying cricoid pressure
520
What does applying cricoid pressure do?
Closes the esophagus
521
What is the third step in rapid sequence intubation?
paralysis with induction
522
What is the final step in rapid sequence intubation?
placement with proof
523
What is another name for pneumatic antishock garments?
MAST trousers
524
What do pneumatic antishock garments do?
Prevent hypovolemia in patients with hemorrhage
525
What must be done prior to deflating the pneumatic antishock garment?
Fluid resuscitation
526
How should the pneumatic antishock garment be deflated?
slowly
527
What are the key signs of cardiac tamponade?
Jugular vein distention and narrowing pulse pressures
528
What type of injury typically causes a tension pneumothorax?
Closed chest injury to lung
529
What changes in vitals indicate increased ICP?
increased BP and decreased HR
530
What does a higher score on Glasgow Coma Scale Indicate?
better neurological status
531
What are signs of fluid overload?
Edema, dyspnea, rales, weight gain, neck vein distension, increased central venous pressure and BP
532
What are the signs of hypovolemia?
Postural hypotension / decreased BP, increased HR, dry mucous membranes, decreased urine output, dizziness, fainting
533
What is the function of the sodium potassium pump?
Moves sodium out of cell and potassium into cells
534
What is the normal range of serum sodium?
135-145 mEq/L
535
What occurs in hyponatremia?
Fluid shifts into tissues
536
What are the signs/symptoms of hyponatremia?
N/V, irritability, decreased respirations, headache, blurred vision, edema, muscle twitching
537
What is the treatment for hyponatremia?
Fluid restriction, diuretics, hypertonic saline (3% or 5%)
538
What occurs in hypernatremia?
Fluid shifts out of tissues into vascular space
539
What are the signs/symptoms of hypernatremia?
Hypovolemia, thirst, concentrated urine, muscle weakness, diaphoresis, increased temp, restlessness
540
What is the treatment for hypernatremia?
fluid administration
541
What is the normal range of serum potassium?
3.5-5.0 mEq/L
542
What causes hypokalemia?
diuretics, bowel prep, V/D, laxative abuse, alkalosis
543
What are the signs and symptoms of hypokalemia?
Abdominal distention, loss of bowel sounds, decreased BP, weakness, paralysis, loss of T wave
544
What is the first sign of hypokalemia?
Hypotension
545
What is the treatment for hypokalemia?
Potassium replacement
546
What causes hyperkalemia?
Medical conditions, crushing trauma, DKA, burns, Addison's disease
547
What are the signs and symptoms of hyperkalemia?
Intestinal cramping, elevated T wave, increased BP, sporadic paralysis, cardiac standstill
548
What is the treatment for hyperkalemia?
D50 with insulin, correction of acidosis, takes hours
549
What is the normal range of serum calcium / ionized calcium?
8.5-10.5 mg/dL
4.5-5.6 mg/dL
550
What causes hypocalcemia?
multiple blood transfusions, parathyroid disease, diuretics
551
What are the signs and symptoms of hypocalcemia?
Twitching, laryngospasm, cramping, arrhythmias, Chvostek's sign, Trousseau's sign
552
What is the treatment for hypocalcemia?
Calcium replacement
553
What causes hypercalcemia?
medical conditions, bone cancer, multiple myeloma, sarcoidosis
554
What are the signs and symptoms of hypercalcemia?
Neuromuscular depression, arrhythmias
555
What is the treatment for hypercalcemia?
Mithramycin, phosphate replacement
556
What is the relationship between calcium and phosphorus?
Inverse
557
What is the normal range of serum phosphorus?
1-2 mEq/L
558
What causes hypophosphatemia?
hyperparathyroidism, hypercalcemia, V/D, diuresis, burns
559
What are the signs and symptoms of hypophosphatemia?
Decreased HR / BP, weakness, decreased DTR, decreased bowel sounds, decreased LOC
560
What is the treatment for hypophosphatemia?
phosphate replacement
561
What causes hyperphosphatemia?
Hypoparathyroidism, hypocalcemia
562
What are the signs and symptoms of hyperphosphatemia?
Twitching, laryngospasm, cramping, prolonged ST/QT intervals, diarrhea, Chvostek's sign, Trousseau's sign
563
What is the treatment for hyperphosphatemia?
Calcium replacement, dialysis
564
What is the normal range of serum magnesium?
1.5-2.5 mEq/L
565
What causes hypomagnesemia?
poor nutrition, alcoholism, pancreatitis, diuretics, muscle spasms
566
What is a key effect of hypermagnesemia?
sedative effect of CNS
567
What are the medical uses of magnesium?
premature labor, preeclampsia, v-fib, torsades de pointes
568
What electrolyte imbalances appear in hypoparathyroidism?
decreased calcium, increased phosphorus
569
What is the normal hemoglobin range for men?
13.2-17.5 g/dL
570
What is the normal hemoglobin range for women?
11.5-16 g/dL
571
When should hemoglobin levels be reported to anesthesia?
< 8
572
Why is hematocrit monitored?
Watch for anemia
573
What is the normal hematocrit range for men?
42-52%
574
What is the normal hematocrit range for women?
37-47%
575
What condition is indicated by low platelet count?
thrombocytopenia
576
What is a normal range for platelets?
150,000-450,000
577
What is the normal range of WBC?
4,000-10,000
578
What is the normal prothrombin time?
11-12.5 seconds
579
What coagulation factors does prothrombin time evaluate?
I, II, V, VII, X
580
Wat conditions can prothrombin time help diagnose?
bleeding / clotting disorders
581
What conditions and treatments can affect prothrombin time?
Liver disease, warfarin therapy
582
What is the normal partial thromboplastin time?
30-40 seconds
583
What coagulation factors does partial thromboplastin time evaluate?
II, V, VIII, IX, X, XI, XII
584
Wat conditions can partial thromboplastin time help diagnose?
bleeding / clotting disorders
585
What conditions and treatments can affect partial thromboplastin time?
heparin therapy, hemophilia, DIC
586
What happens to partial thromboplastin time in DIC?
it shortens
587
What is the universal blood donor?
O-
588
What is a normal pH level?
7.35-7.45
589
What does low pH indicate?
acidosis
590
What does high pH indicate?
alkalosis
591
What is a normal PaO2 level?
80-100
592
What is a normal O2 saturation?
> 98%
593
What is a normal PaCO2 level?
35-45
594
What does low PaCO2 indicate?
alkalosis
595
What does high PaCO2 indicate?
acidosis
596
What is a normal level of HCO3?
22-26
597
What does low HCO3 indicate?
acidosis
598
What does high HCO3 indicate?
alkalosis
599
What levels indicate respiratory acidosis?
low pH
high PaCO2
600
What levels indicate respiratory alkalosis?
high pH
low PaCO2
601
What levels indicate metabolic acidosis?
Low pH & HCO3
602
What is the treatment for metabolic acidosis?
bicarb to counteract the production of acid
603
What levels indicate metabolic alkalosis?
High pH & HCO3
604
What is the treatment for metabolic alkalosis?
treat the cause
605
What can cause metabolic acidosis?
acid loss, diuretics, upper GI loss
606
How does hypoventilation affect blood gas levels?
increase in CO2 levels and decrease in pH
607
What are the potential complications of alkalosis?
Seizures
608
What can cause metabolic acidosis?
Hemorrhage
609
What are the symptoms of metabolic acidosis?
Vasodilation, myocardial depression, hyperkalemia, shift of oxyhemoglobin dissociation curve to the right, confusion, and stupor
610
What is the treatment for metabolic acidosis?
Warm patient to reverse coagulopathy, administer blood, fresh frozen plasma (FFP), and platelets
611
What should you avoid using in the treatment of metabolic acidosis?
Bicarbonate
612
How does an air embolism occur?
pressure in the right atrium is lower than atmospheric pressure
613
What are the venous causes of air embolism?
neuro procedures with the patient in a sitting position, hysteroscopy, TUR procedures
614
What are the arterial causes of air embolism?
bypass surgery and dialysis
615
What are the signs and symptoms of air embolism?
decreased end-tidal carbon dioxide (ETCO2), decreased blood pressure, arrhythmia, decreased oxygen saturation (SPO2), pulmonary edema, and neurologic damage
616
What is the first sign of an air embolism?
Decreased ETCO2
617
How do you treat venous air embolism?
identifying and occluding entry sites, use sloppy wet sponges, using an irrigation syringe, and stopping nitrous oxide (N2O), aspirate right atrium catheter
618
What position should the patient be during a venous air embolism?
Durant's maneuver - left lateral
619
How do you treat arterial air embolism?
Aspirate air from the circuit
620
What position should the patient be during a arterial air embolism?
deep trendelenburg
621
What is DIC?
disseminated intravascular coagulation
622
What causes DIC?
trauma, sepsis, amniotic fluid in obstetrics, or release of procoagulants into the bloodstream (cancer)
623
What complications are associated with DIC?
severe bleeding, stroke, decreased blood flow to organs, and kidney or liver overload
624
How do you treat DIC?
addressing the underlying cause, administering fresh frozen plasma (FFP) and cryoprecipitates, initiating heparin initially, and replacing volume and blood as necessary
625
What should be kept nearby in case of swelling during head and neck procedures?
tracheostomy (trach) tray
626
Why should wire cutters be available during head and neck procedures?
in case the jaw is wired closed
627
What should be sent with tracheostomy patients postoperatively?
obturator
628
What postoperative symptoms should be anticipated after head and neck surgery?
dizziness and nausea/vomiting.
629
What is the risk after long bone procedures?
fat emboli
630
How can DVTs be prevented after orthopedic procedures?
sequential compression devices (SCDs), coumadin/heparin, and early ambulation
631
What should be monitored for after orthopedic procedures?
pulmonary embolism using Virchow's Triad
632
What are the signs and symptoms of pulmonary embolism?
sudden onset of pain and shortness of breath
633
How should casts be handled postoperatively?
Wet casts should be handled with palms only
634
How should casts be positioned and cared for?
Elevate casts and keep them open to air
635
What is the biggest concern regarding circulation in flap procedures?
Vasoconstriction in graft areas
636
How should circulation be monitored post-flap procedure?
doppler
637
From what should the site be protected after a flap procedure?
shearing / pressure
638
What measures should be taken to regulate body temp after a flap procedure?
Keep patient warm
639
What precautions should be taken for patients on renal dialysis?
Avoid using a blood pressure cuff or IV in the AV fistula arm
640
What are common issues seen in renal dialysis patients?
Fluid & electrolyte imbalances
641
How should medications be managed for renal dialysis patients?
avoid medications metabolized by kidneys
642
What complication are burn patients prone to?
Hypothermia
643
What are common issues seen in burn patients?
Fluid & electrolyte imbalances
644
What complications are diabetic patients prone to?
HTN, GERD, delayed wound healing
645
What equipment should be available for diabetic patients?
glucometer
646
What types of surgeries should one be mindful of in diabetes insipidus?
pituitary/hypothalamus/head trauma-related surgeries
647
How is diabetes insipidus treated?
fluids to match urinary output, vasopressin / DDAVP
648
How long does it take for ciliary function to return in smokers?
7-8 weeks
649
What is the recommendation for smokers preoperatively?
Stop smoking ASAP
650
What is the goal for blood pressure management in patients with cardiac complications?
Maintain steady blood pressure on the low side of baseline
651
What factor is deficient in hemophilia?
Factor VIII
652
How is hemophilia managed during surgery?
synthetic factor VIII replacement
653
What precautions should be taken for pregnant patients preoperatively?
Check for pregnancy and position off the vena cava to maintain fetal perfusion
654
What monitoring is required for pregnant patients during surgery?
fetal heart monitor
655
What is a characteristic of vasomotor tone in CHF patients?
poor vasomotor tone
656
What is a risk for CHF patients regarding fluid?
fluid overload
657
What preoperative precautions should be taken for CHF patients?
NPO status and avoiding diuretics preoperatively
658
How do CHF patients respond under anesthesia?
They may dilate, requiring fluid management
659
How is wound healing affected in morbidly obese patients?
compromised
660
What should be considered during intubation for morbidly obese patients?
may be difficult, need glidescope
661
What considerations should be made when positioning morbidly obese patients?
Positioning can make ventilation difficult
662
What should asthmatic patients bring with them for surgery?
Own inhaler
663
What special consideration should be taken during intubation for asthmatic patients?
Deeper sedation may be required
664
How do COPD patients respond to oxygen levels?
Low oxygen levels stimulate breathing, not high oxygen
665
What postoperative ventilation parameters are indicative of complications in COPD patients?
tidal volume lower than 500mL and PaCO2 > 45mmHg
666
What special consideration should be taken regarding joint immobility in rheumatoid arthritis patients?
Creative positioning
667
What is a common complication seen in rheumatoid arthritis patients?
Anemia
668
What risk does steroid coverage pose for rheumatoid arthritis patients?
risk for impaired stress response, potentially leading to hypoadrenal crisis
669
What specific considerations are necessary for anesthesia management in sickle cell anemia?
avoid triggers and use tools like bair huggers and fluid warmers
670
What complications may arise during surgery for sickle cell anemia patients?
decreased temperature, decreased blood pressure, hypovolemia, decreased blood glucose, and decreased oxygen levels
671
How should SPD be set up?
physical separation between decontamination and processing areas
672
What is the workflow progression of SPD?
decontamination
preparation / packaging
sterilization processing
clean distribution . storage
673
What is the most important step of decontaminating instruments?
cleaning - prevents infection
674
What areas are targeted during cleaning to prevent infection?
Brush lumens, channels, crevices, and joints
675
What is recommended before the decontamination of instruments?
pre-treatment
676
What method can be used for automated cleaning during instrument decontamination?
Ultrasonic or washer
677
What is sterilization?
Complete elimination/destruction of all forms of microbial life
678
What does a Pre-Vacuum Autoclave do during sterilization?
Sucks air out of chamber
679
What temperature is used in a Pre-Vacuum Autoclave?
270°F
680
How long does it take to sterilize porous/lumenn (vs. non-porous) items in a Pre-Vacuum Autoclave?
4 min (vs. 3 min)
681
What testing is recommended for Pre-Vacuum Autoclaves?
Geobacillus stearothermophilus spore testing at least weekly, preferably daily.
682
What is the purpose of the Bowie Dick test?
to test air removal function in the autoclave's empty chamber, done daily.
683
What preconditioning techniques can be used in a Pre-Vacuum Autoclave?
vacuum pump, above atmospheric pressure process, steam-flush-pressure-pulse
684
What is the purpose of a Gravity Displacement Autoclave?
focuses steam into the chamber
685
What temperature is used in a Gravity Displacement Autoclave?
275°F
686
When should consecutive air removal tests be done for new, renovated, or moved equipment in a Pre-Vacuum Autoclave?
Before the biological tests
687
How does a Gravity Displacement Autoclave remove air from the chamber?
Steam displacing air
688
How long does it take to sterilize porous/lumen items in a Gravity Displacement Autoclave?
10 min
689
How long does it take to sterilize nonporous items in a Gravity Displacement Autoclave?
3 min
690
What is the function of the thermometer in a Gravity Displacement Autoclave?
closes the drain
691
What kind of items can be sterilized in a Gravity Displacement Autoclave?
Heat and moisture stable.
692
What testing is recommended for a Gravity Displacement Autoclave?
Geobacillus stearothermophilus spore testing - At least weekly, preferably daily
693
What is necessary for steam sterilization to be effective?
Steam must contact all surfaces of the item.
694
What is the purpose of evacuating air from the chamber during steam sterilization?
To ensure steam reaches all surfaces by pushing air down.
695
What should be avoided during steam sterilization?
condensation
696
Why is it important to allow airflow between trays during steam sterilization?
To facilitate steam penetration.
697
What should be done with sterilized loads immediately after the steam sterilization process?
remove immediately
698
What can lead to condensation in steam sterilization?
leaving the door ajar to cool after sterilization is complete
699
Where should hot items not be placed after steam sterilization?
cold surfaces / racks
700
What happens if condensation is observed on items after steam sterilization?
They are unsterile
701
What testing is recommended for a Steam Sterilizer?
Geobacillus stearothermophilus spore testing - At least weekly, preferably daily
702
What is Immediate Use Steam Sterilization (IUSS) commonly known as?
Flash sterilization
703
What is the purpose of Immediate Use Steam Sterilization (IUSS)?
Sterilization for immediate use.
704
What should never be used in IUSS?
packaging, wrapped items, and textiles
705
What is essential for lumens in the decontamination process for IUSS?
Brushing and flushing
706
What type of chemical indicator must be used for IUSS?
Class 5
707
What are the characteristics of Class 1 chemical indicators?
only react to heat and are represented by tape
708
What type of containers are used for IUSS?
Rigid sterilization containers with a lid.
709
What records must be maintained for IUSS?
Sterilization log
710
What temperature and time are used for sterilizing implants in IUSS?
270°F for 10 minutes.
711
What is the dry time requirement after IUSS?
Minimal or no dry time.
712
When should items sterilized with IUSS be used?
ASAP
713
What are the characteristics of Class 2 chemical indicators?
only reacts to pressure
714
What are the characteristics of Class 3-4 chemical indicators?
reacts to time and temperature
715
What are the characteristics of Class 5-6 chemical indicators?
reacts to time, temp, pressure, and steam
716
What is the method of sterilization involving glutaraldehyde?
Cold sterilization
717
Where is glutaraldehyde typically used?
point of care use only
718
How long does it take for glutaraldehyde to sterilize items through immersion?
10 hr
719
What types of materials are suitable for sterilization with glutaraldehyde?
plastic & rubber
720
Why is glutaraldehyde considered suboptimal for sterilization?
poses environmental problems and is difficult to use
721
What type of items is ethylene oxide used to sterilize?
Heat and moisture-sensitive items (cold and dry), specifically instruments
722
How long is the typical exposure time for ethylene oxide sterilization?
2-5 hr
723
How long does aeration typically take after ethylene oxide sterilization?
8-12 hr
724
What risk is associated with ethylene oxide exposure?
human carcinogen
725
What is required for lumens before ethylene oxide sterilization?
be completely dry and clean
726
What are the parameters considered in ethylene oxide sterilization?
Pressure in the chamber (concentration), exposure time, humidity (moisture), and temperature
727
What testing is recommended for ethylene oxide sterilization?
Bacillus atrophaeus spore testing with every load
728
What is the exposure limit for ethylene oxide?
1 ppm over an 8-hour day, not exceeding 40 hours per work week
729
Name some examples of items suitable for ethylene oxide sterilization.
GI scopes, lensed instruments, delicate instruments, and electrical devices
730
What happens when ethylene oxide is mixed with water?
forms antifreeze
731
What is another name for Low Temp Hydrogen Peroxide Plasma Sterilization?
Sterrad System
732
For what type of items is Low Temp Hydrogen Peroxide Plasma Sterilization typically used?
Heat and moisture-sensitive items when indicated by the manufacturer's instructions for use (IFU)
733
How does the Sterrad System sterilize items?
A vacuum is created, and liquid peroxide is injected, which becomes vapor and kills pathogens
734
Is aeration needed after Low Temp Hydrogen Peroxide Plasma Sterilization?
No, it is dry
735
How long does Low Temp Hydrogen Peroxide Plasma Sterilization typically take?
75 min
736
How does Low Temp Hydrogen Peroxide Plasma Sterilization impact the environment?
environmentally sound
737
What testing is recommended for Low Temp Hydrogen Peroxide Plasma Sterilization?
Geobacillus stearothermophilus spore testing at the same interval as other sterilizers in facility (daily)
738
What is another name for Peracetic Acid sterilization?
Steris System
739
For what types of items is Peracetic Acid sterilization typically used?
Items that can be immersed, such as scopes.
740
How does Peracetic Acid impact instruments and people?
It is corrosive
741
What temperature range is typically used for Peracetic Acid sterilization?
120-130°F
742
How long does Peracetic Acid sterilization typically take?
20-30 min
743
What type of water rinse is typically used after Peracetic Acid sterilization?
Micron filtered tap water rinse
744
Where is Peracetic Acid sterilization typically performed?
Point of care
745
What testing is recommended for Peracetic Acid?
Geobacillus stearothermophilus spore testing daily
746
What temperature should ozone sterilization be?
Low
747
For what types of materials is ozone sterilization commonly used?
plastic and metal
748
How many manufacturers of ozone sterilization systems are there in the USA?
one
749
What regulatory clearance does ozone sterilization have from the FDA?
FDA cleared
750
What process does the exhaust of ozone sterilization pass through?
Catalytic converter
751
How does ozone impact the environment?
environmentally sound
752
What is the aeration time for ozone?
none
753
What are the restrictions on the types of devices that can be sterilized with ozone?
No sealed glass ampules
754
What testing is recommended for ozone?
Geobacillus stearothermophilus spore testing daily
755
Where is dry heat sterilization commonly found?
In doctor/dentist offices and tattoo parlors.
756
What is a characteristic of the dry heat sterilization process in terms of duration?
Longer compared to others
757
What temperature range is typically associated with dry heat sterilization?
high
758
For what types of items is dry heat sterilization best suited?
Heat-stable powders and oils.
759
Name some examples of items commonly sterilized using dry heat.
Dental instruments, burrs, reusable needles, glass, oil, and foil packages.
760
What type of indicators are required upon installation and after any repair for dry heat sterilization?
Bacillus atrophaeus indicators
761
Is tape used in dry heat sterilization?
No
762
What is the purpose of disinfection?
kill all microorganisms except high numbers of bacterial spores on inanimate objects
762
What testing is recommended for dry heat?
Bacillus atrophaeus weekly
763
When is disinfection typically used?
non-critical items
764
Name some examples of disinfectants.
Glutaraldehyde solutions, phthalaldehyde (ortho), peracetic acid, alcohols, chlorine compounds, hydrogen peroxide, iodine/iodophors, phenolics
765
What is the purpose of pasteurization?
kill bacteria but not endospores
766
When is pasteurization typically used?
reusable respiratory devices and anesthesia breathing circuits, but not metal instruments
767
What is the objective of decontamination?
To remove, inactivate, or destroy bloodborne or other pathogens
768
What is high-level disinfection?
process that destroys all microorganisms except spores
769
What items is high-level disinfection used on?
Semi-critical
770
What is low-level disinfection effective against?
It kills most vegetative bacteria, fungi, and viruses, targeting the least resistant organisms.
771
Define sterility.
The absence of all living organisms
772
What is cavitation?
process that uses sound waves traveling through water to create gas bubbles, producing a vacuum to rid instruments of debris.
773
What type of medical equipment is considered the highest piece associated with Healthcare-Associated Infections (HAIs)?
Endoscopes
774
What procedure is typically performed on endoscopes before cleaning?
Leak testing
775
How is an endoscope cleaned?
water in the lumen, wiped on the outside
776
What is the timeframe for cleaning an endoscope after use?
Within 1 hour or following delayed processing instructions.
777
How should an endoscope be maintained during delay or transport to decontamination?
Kept damp/wet but not submerged - do not let dry out
778
What are the storage options for endoscopes after cleaning?
In a drying cabinet or positive pressure cabinet with HEPA filter
779
What is the purpose of a Biological Indicator (BI)?
To monitor the efficacy of the sterilizer, not the sterility of the item.
780
What should be done with BI loads until results are known?
Quarantine
781
What should all implant loads have?
Biological indicators
782
What is the purpose of a Chemical Indicator?
To immediately verify if a package has been exposed to the sterilization process.
783
What are the two classes of Chemical Indicators and how are they used?
Class 1 (tape) is placed externally, while Class 2 (Bowie Dick) is a specialty test.
784
What documentation should be included to trace items from the method of sterilization?
Lot control number, load/cycle number, date, and time.
785
What is sterile technique founded in?
An individual's surgical conscience.
786
What is the frequency of Biological Challenge (spore testing) for autoclaves?
Daily biological for gravity displacement, daily Bowie Dick for pre-vacuum, and with every implant.
787
What is the purpose of the Bowie Dick test for pre-vacuum autoclaves?
To check function, not sterility
788
What is the purpose of the Spaulding Classification?
To determine the correct processing method for preparing instruments and other items for use
789
What are critical items?
Items introduced into the human body
790
Give an example of a critical item.
acupuncture needles
791
What are semi-critical items?
Items that come into contact but do not penetrate
792
Give an example of a semi-critical item.
bronchoscope, laryngoscope blade
793
What are non-critical items?
items that only come into contact with the outside of the skin
794
Give an example of a non-critical item.
blood pressure cuff, tourniquet, stethoscope
795
What is a requirement for packaging regarding compatibility with the type of sterilization?
It must work with the type of sterilization being used
796
What kind of packaging must be used for items?
Packaging must allow for identification of contents
797
Where should count sheets be placed in wrapped sets or rigid containers?
outside
798
What should the packaging be free of?
Lint, holes, textiles, peel pouches, or rubber mats inside trays.
799
What are the requirements for the storage area where sterile items are kept?
It must not exceed 78 degrees and 60% humidity.
800
What should be the condition of instruments inside packaging?
Disassembled, open, and unlocked
801
Where should the integrator be placed in the tray?
In the corner of the tray, both inside and outside
802
Where should the count sheet be located in relation to the tray?
outside
803
How should peel pouches be positioned inside the sterilization chamber?
do not stack
804
Which part of the peel pouch should be written on?
plastic, not paper
805
What type of items are peel pouches not suitable for?
heavy items (drills)
806
What is the requirement for double pouching with peel pouches?
inner pouch cannot fold, face the same direction.
807
What characteristics should sharp disposal containers have?
Puncture and leak resistant
808
Where should sharp disposal containers be placed?
In a recognizable and visible location, in proximity to use
809
When should sharps be removed from the area?
Before decontamination
810
What role should perioperative RNs play in sharp disposal?
Serve as role models for other team members
811
What practices should perioperative RNs follow regarding sharps precautions?
Follow regulations, use PPE, report and treat injuries timely, and adhere to universal precautions for Hepatitis C immunization
812
When can patients with airborne precautions enter the OR?
Only in emergency cases
813
What type of mask is worn for airborne precaution?
Fit tested N95
814
Who should wear the N95?
Both the healthcare provider and the patient if possible
815
Where should intubation take place for patients under airborne precautions?
In an isolation room
816
What should be used on the endotracheal tube for patients with airborne precautions during intubation?
Bacterial filter
817
What equipment should be used in the OR on a patient with airborne precautions who is not intubated?
HEPA filter and PAS-HEPA (antechamber)
818
What should the air exchange be in the OR if a patient is on airborne precautions?
Proceed as usual
819
How long should the OR remain empty after a patient with airborne precautions? 
28 min
820
What kind of pressure should be in the room for airborne precautions?
Positive pressure
821
How are droplets released?
Coughing, sneezing, talking
822
What are the PPE guidelines for droplet precautions?
Wear PPE within 3 feet of talking
823
What kind of PPE is used for contact precautions?
Gown, gloves
824
How are contact precautions maintained during transport?
Reverse isolation (patient wears gown)
825
How do you prevent spread of infection with contact precautions?
Adequate disinfection and cleaning
826
What are prions?
Proteins that self-replicate and are usually fatal
827
What disease is associated with prions?
Creutzfeldt-Jakob Disease (CJD)
828
What type of instruments should be used for prion-contaminated procedures?
Disposable
829
How should areas contaminated with prions be cleaned?
With bleach or lye (sodium hypochlorite, sodium hydroxide)
830
What is the contact time for cleaning prion-contaminated areas with bleach or lye?
15 minutes contact time, soak for 1 hour
831
What are the conditions for steam sterilization of prion-contaminated instruments using a pre-vacuum method?
18 minutes at 272°F
832
What are the conditions for steam sterilization of prion-contaminated instruments using gravity displacement?
60 minutes at 272°F
833
What areas are included in terminal cleaning?
restricted and semi-restricted areas in OR, preop, postop, SPD
834
What is the temperature range for unrestricted areas?
70-75°F
835
What is the temperature range for semi-restricted areas?
72-78°F
836
What is the temperature range for restricted areas?
68-75°F
837
What is the temperature range for decontamination areas?
60-73°F
838
What is the acceptable humidity range?
20-60%
839
Why is controlling humidity important?
controls growth of microorganisms and prevents electrostatic discharges
840
What should be done with contaminated instruments and garbage?
remove from area
841
What should be used to clean transport vehicles, equipment, and OR furniture?
hospital-grade germicidal agent
842
What should be used for mopping the floors?
new / freshly laundered mop head
843
What kind of water should be used for mopping the floors?
New water that has never been double dipped
844
How should the floors be mopped?
OR table and equipment should be moved out of the way
clean to dirty
845
Is there a specific time after which sterility is no longer maintained?
No, sterility is event related, not time related
846
What should the air pressure in the OR be relative to the hallway?
Greater than in the hallway
847
How should a dirty case be handled in terms of turnover?
regular turnover
848
How much space should be between supplies and the ceiling?
18 inches
849
Who are the members of the multidisciplinary team?
Perioperative RNs, SPD, EVS, infection prevention
850
What are the main responsibilities of the multidisciplinary team?
Education and competence, developing / adhering to policies and procedures, quality improvement
851
What should be done if an item touches the floor?
Disinfect it before patient use
852
What should be done with items that are difficult to clean?
use a barrier / cover
853
Why are insects / vermin a concern in clinical environments?
carry pathogens and antibiotic resistance
854
What cleaning should be done prior to the first case of the day?
Damp dust horizontal surfaces
855
What happens the longer MDROs stay in the environment?
Become more difficult to control, increased morbidity / mortality
856
What are some common MDROs?
MRSA, VRE, VRSA, C-Diff, Klebsiella, ESBL, CRE
857
Where is central venous pressure measured?
Right atrium
858
What is the normal range of central venous pressure?
4-8 mmHg
859
What conditions can cause low central venous pressure?
hemorrhage, venous pooling, dehydration
860
What conditions can cause high central venous pressure?
pulmonary HTN, pulmonary edema, right ventricular failure
861
What is the normal range for cardiac output measured by a Swan-Ganz catheter?
4-8 L/min
862
What is the normal range for right atrial pressure measured by a Swan-Ganz catheter?
4-8mmHg
863
What are normal pulmonary artery pressures?
1/3 of systemic pressures
864
What is the normal range for pulmonary artery wedge pressure?
4-12 mmHg
865
What additional measurement can a Swan-Ganz catheter provide?
Core temp
866
What does a high pulmonary artery wedge pressure indicate?
left heart failure
867
What are potential risks associated with using a Swan-Ganz catheter?
Microshock and arrhythmias
868
What is the purpose of an arterial line?
continuous monitoring of BP
869
What drugs is an arterial line needed for and why?
Hemodynamic drugs because they require tight control (nitroprusside)
870
Which artery is most commonly used for arterial line insertion?
Radial
871
What test should be performed before a-line insertion, and what does it assess?
Allen test ensures adequate hand perfusion
872
Who is at an increased risk for a latex allergy?
Healthcare workers
873
What are risks associated with latex allergies?
Prolonged exposure throughout career and cross-reactivity with allergies to banana & kiwi
874
What are signs/symptoms of a latex allergy?
Nausea, abdominal pain, tachycardia, hives, shortness of breath, hypotension, fainting
875
What is the Self-Determination Act?
Gives patient right to choose not to be treated for emergent event secondary to normal anesthesia during surgery
876
What other rights are included in the Self-Determination Act?
informed consent, living will, POA, DNR, organ procurement
877
What is a surgical conscience?
Willingness to be held liable for one's own actions in providing care to a patient
878
When should sensory items (eyeglasses, hearing aids) be taken from the patient?
Start of anesthesia
879
What are signs of shock?
cool / clammy skin, anaphylaxis, pale / cyanotic skin, hypotension, tachycardia, tachypnea, N/V, hypovolemia
880
What is an Andrew's table used for?
modified knee/chest position in prone
Resembles letter "Z"
881
What is counted in sets of 5?
laps, tonsil sponges, peanuts
882
When are counts performed during a c-section?
Initial: beginning
Second: prior to uterine closure
883
How much blood loss is considered minor?
500-700mL
884
How much blood loss is considered moderate?
750-1500mL
885
How much blood loss is considered major?
1500-2250mL
886
How much blood loss is considered catastrophic?
> 2250mL
887
What are the components of the fire triangle?
fuel, oxidizer, ignition source
888
What should be done if the ETT catches fire?
ensure airway safety
extubate patient
turn off gas
889
What are examples of laser precautions?
Safety glasses for staff and patient, laser safe ETT, smoke evacuator
890
What is a sentinel event?
Unexpected event causing harm / risk of harm to patient
891
What is an important characteristic of a surgical gown?
impervious to fluids
892
How can patients be protected from radiation?
place lead shielding under patient
893
Who regulates radiation exposure limits?
OSHA
894
Give examples of ionizing radiation sources.
portable x-ray, portable c-arm
895
Give an example of non-ionizing radiation sources.
laser
896
What is the purpose of a vasovasostomy?
vasectomy reversal
897
What equipment is needed for a vasovasostomy?
microscope
898
What risk should be watched for during a long bone fracture/surgery?
fat embolism
899
Why is continuous bladder irrigation used during a transurethral resection of the prostate?
prevent clots in bladder
900
What is the treatment for narrow angle glaucoma?
peripheral iridotomy (laser) to decrease IOP
901
What caution should be taken with a spica cast?
diminish pressure on the fibular head
902
What is a complication of a spica cast?
peroneal nerve palsy
903
What arteries are involved in a carotid endartectomy?
external carotid artery, internal carotid artery, and common carotid artery
904
When do superficial infections typically occur post surgery?
within 30 days
905
What causes conduction heat loss?
physical contact
906
How can conduction heat loss be prevented or countered?
using a warming blanket on the patient
907
What causes convection heat loss?
air currents
908
How can convection heat loss be prevented or countered?
Minimizing drafts and maintaining a warm environment
909
What causes radiation heat loss?
ambient temperature, no physical contact
910
How can radiation heat loss be prevented or countered?
Turning up the room temperature to keep the environment warmer
911
What is Root Cause Analysis (RCA)?
tool used to understand areas for improvement
912
How does Root Cause Analysis (RCA) differentiate between issues?
distinguishes between patient safety issues and system-level concerns
913
What nursing actions are included in a handoff?
patient information, diagnosis, treatment plan, patient condition, medications, ongoing needs
914
What is excluded from a nursing handoff?
anesthesia related report
915
What is Ventricular Bigeminy?
PVCs occurring every other beat
916
What does PVC stand for?
Premature Ventricular Contractions
917
What is the treatment for Ventricular Fibrillation (v-fib)?
Defibrillation
918
What is Asystole characterized by?
Sudden cessation of cardiac activity
919
What are the immediate interventions for asystole?
CPR, epinephrine, and vasopressin administration
920
What is the management approach for 3rd Degree Heart Block?
Stabilization with temporary pacing
921
What is the recommended first-line treatment for cardiac emergencies?
Amiodarone or lidocaine
922
What is Virchow's Triad?
set of factors contributing to the formation of deep vein thrombosis
923
What are the components of Virchow's triad?
hypercoagulation, blood stasis, and endothelial injury
924
How far in advance should an inservice be provided before the introduction of new instrumentation?
2 weeks
925
What is stress urinary incontinence characterized by?
Leakage of urine due to pressure on the bladder, such as during coughing, sneezing, or exercise
926
What is urge urinary incontinence defined as?
Sudden and intense need to urinate, often resulting in involuntary urine loss
927
What is overflow urinary incontinence characterized by?
Incomplete emptying of the bladder, leading to continual leakage or dribbling of urine
928
Describe functional urinary incontinence
Incontinence resulting from physical or mental impairment, where the individual may have difficulty reaching the bathroom in time
929
What is mixed urinary incontinence?
simultaneous occurrence of stress and urge urinary incontinence
930
Where is the sterile field of a sterile gown?
chest to the level of the field, with sleeves from 2 inches above the elbows to the cuffs
931
What does the Aldrete Score evaluate?
Recovery after anesthesia and readiness for discharge from the Post-Anesthesia Care Unit (PACU)
932
Define malpractice
Negligence by a professional in the performance of a professional act that results in patient injury
933
What are the elements of malpractice?
Duty, breach of duty, causation, and damages
934
Which suture has the highest tensile strength?
2-0 vicryl
935
What is the role of The Joint Commission?
regulatory agency responsible for surveying facilities' compliance with the universal protocol
936
What are the signs and symptoms of hypothermia?
Shivering, impaired speech, cyanosis, muscle rigidity, dizziness, and hypotension
937
What methods test for Geobacillus Stearothermophilus?
steam (gravity displacement/dynamic air), plasma (hydrogen peroxide), ozone, and peracetic acid
938
How is Bacillus Atrophaeus tested?
ethylene oxide and dry heat
939
What action should be taken if BUN/Creatinine levels are elevated?
Avoid using aminoglycosides/glycopeptides due to their nephrotoxic effects
940
What items are included in the WHO Checklist?
Patient identity, procedure, laterality/procedure, relevant images, implants, equipment concerns, anticipated critical events, antibiotics, and confirmed sterilization indicators
941
