final Flashcards
what is the purpose of surgical hand scrub
reduce transient and resident flora & reduce hospital acquired infection rates
recommended practices for sponge count procedures
1- initial count
2- closing and final
only use radiopaque materials, two people count (one is RN)
ways RNs can assist with general anesthesia induction
1- cricoid pressure
2- remain at pt’s side to offer reassurance and safety
3 steps to be followed to remove of the gown and gloves at end of procedure
1- turn sleeves inside out
2- pull away from body
3- glove to glove, skin to skin
5 actions that should be included in the care of a patient with suspected latex allergy
1- assess cross sensitivity and previous reactions
2- door signs on every room the pt uses
3- use latex free from IV, dressings and other materials
4- verify tx team is aware of allergy
5- schedule for first case of day if possible
4 steps that should be followed in correctly draping sterile field
1- handle drapes as little as possible
2- time between tape and cut should be small
3- allow prep to dry before drape
4- keep drapes from touching non-sterile areas
4 reasons why patient and family education is important
1- discuss risk and benefit of treatment
2- family can help retain and understand information
3- legal/ethical regulatory mandates
4- increased healthcare safety
5- decrease communication errors and inconsistencies in care
2 characteristics included in the elements of a culture of safety within a healthcare organization
1- safety, communication, accountability
2- learning
4 ways to prevent of minimize electrosurgical unit injuries to the patient
1- allow alcohol prep to dry for at least 3 minutes
2- ESU in safety holster when not used
3- right size grounding pad for patient
4- no metal near grounding site
3 unique identifiers to ensure proper handling of surgical specimen verified by the RN before the patient enters the OR
1- name
2- DOB
3- MRN
psychosocial assessments should include what 4 aspects
1- assess their level of understanding for the procedure consented for
2- coping mechanisms
3- barriers to communication
4- evaluate response to instruction
documentation of skin prep should include the following 5 elements
1- verify allergies 2- surgical wound falsification 3- skin assessment prior to prep 4- prep/shaving 5- antiseptic used, area prepped, name of person who prepped
5 factors regarding the proper attire of the surgical team member
1- gown 2- gloves 3- mask 4- head covers 5- no jewelry/dictated OR shoes
4 phases of nursing process that the RN practices during the pre-op phase
1- assess
2- implement
3- planning
4- evaluation
4 practices you should follow during the surgical scrub procedure
1- scrub duration/counted strokes
2- arms up in front of body with hands above elbows
3- avoid plashing onto scrub attire
4- rinsing thoroughly
3 safety precautions when handling and caring for powered instruments
***
1- inspection (intact)
2- assembly
3- testing
if a patient is unable to move themselves independently, what 4 steps should be taken to prevent shearing?
1- sliding board
2- adequate staff for moving
3- procedure bed slightly lower than gurney
4- consider mechanical lift
name 3 practices recommended during decontamination of used instruments
1- begin immediately after use
2- separate clean from dirty instruments
3- cleaning person wears PPE
what are 5 things to consider when preparing and administering medications?
1- a “no interruption” zone
2- checking for allergies and contraindications
3- preparing for only one pt at a time
4- labeling name, concentration on syringe
5- performing “read backs”
name 3 responsibilities of the OR management team in regards to safety in the OR
1- establishing policies and protocols
2- ensure staff complete competencies
3- reporting safety violations
EPA registered germicides labeled as hospital disinfectants must demonstrate effectiveness against these 3 microorganisms
1- pseudomonas (MRSA)
2- streptococcus (VRE)
3- staph-areaus (c-diff)
what is the surgical wound classification for a total abdominal hysterectomy?
class 2- clean contaminated
name an enciromental sanitation device that is required to limit the transmission of microorganisms to personnel when handling body fluid spills
PPE
according to AORN RP for positioning the patient, the nurse should
use additional precautions based on unique patient considerations
what is aseptic technique
practice restricts microorganisms in environment, equipment and supplies
what source in the fire triangle are trading materials categorized as?
fuel
what is the safest way to pass a cutting instrument to a surgeon
the neutral zone
3 risks to patients and staff members associated with laser use
1- eye injury
2- fire
3- smoke
which nursing intervention can reduce a pre- op patients anxiety
provide a climate of privacy, comfort and confidentiality when providing care
a patient with L breast cancer is scheduled for a L mastectomy. the patient has informed the surgeon and RN that she is a Jehovah’s witness and does not want any blood transfusions. in preparation for intra-op care of this patient, what measures does the nurse take?
1- make physician aware of patients request
2- inform the patient of potential risks
to reduce the incidence of patients with a known history or risk of MH, what best practices are put into place? (5)
- list of medications available for emergency treatment of MH
- dedicated MH cart with treatment medications
- treatment before, during and after if the patient has known history or risk
- additional nursing support on call if MH develops
- available MH hotline number
which 3 factors may lead to an anesthetic overdose in a patient
- older patient
- slowed metabolism and drug elimination
- liver or kidney disease
what 4 techniques are essential to performing a proper surgical scrub of the scrubbed persons
- broad spectrum, surgical antimicrobial solution
- alcohol based antimicrobial solution
- hold the hands higher than the elbows during the scrub and rinse
- scrub for 3-5 minutes, followed by water
to avoid electrical safety issues during surgery, what does the RN do?
ensures proper placement of the grounding pad
which medication condition increases a patients risk for surgical wound infection
diabetes mellitus
a packaging system for items undergoing sterilization should process this characteristic
permit aseptic delivery of contents onto the sterile field
silicone catheters should be placed in what particular cart on the unit
latex free
this type of healing the wound remains open
granulation
this item should be placed as close to the surgical site as possible
grounding pad
this desires patient outcome most closely relates to the use of local anesthesia for a procedure
patient reports adequate pain control throughout the perioperative process
what 2 actions should the RN take if a patient states they are allergic to shellfish and breaks out into hives when they ingest it
- notify the OR team
- avoid iodine and iodine based products
principles of care for forceps during a surgical procedure should include
frequently inspecting tips and wipe clean of tissues and blood as needed
most reliable early indication of malignant hyperthermia
hypercarbia (increase end title CO2)
what is recommended for damn dusting in the OR (2)
- clean from top to bottom or clean to dirty
- ALL HORIZONTAL SURFACES
name one step that should be used to follow the join commissions universal protocol for preventing wrong site/person/procedure surgeries
time out
after this is procured by the surgeon, the scrub person should keep it moist with saline in a sterile basin until it can be passed to the RN
surgical specimen
AORN states this should be matched to the type of laser, optical density and wavelength
safety goggles and window coverings
what is recommended for transferring medication from a multimodes vial to the sterile field
- use multidose spike/sterile transfer device
- note and communicate with scrub
- ensure containers are labeled
what are assessment favorites when screening patients for potential risk of MH (2)
- family hx
- previous experience
what is the normal hazard zone for laser use
space in which the level of direct, reflected or scattered radiation used during normal use exceeds explicable
what is decontamination
- contaminants removed
- bioburden reduced
- by hand or cleaning methods
what is the culture of a clinical setting
- safety
- communication
- accountability
- learning
what are sensory assessment findings common among elderly patients
- decreased vision, auditory, taste, smell and touch senses
- increased pain threshold
what is critical thinking (3)
- requires purposeful outcomes
- directed thoughts
- driven by pt needs
what is the proliferation phase of healing
begins within hours of injury where epithelial cells cover the wound
what are guidelines for safe use of an endoscopic light source (4)
- do not look into the light when on
- ensure ends of cables do not touch patients skin or other flammable materials
- turn off when not in use–> stand by mode
- moist towel
exposure to what sterilization method is potentially carcinogenic and mutagenic
ethylene oxide
placing this item in a sterile plastic container is the proper handling of this item when removed for forensic evidence
bullet
who can sign an informed consent (4)
pt/POA
physician + witness
what are the phases of perioperative nursing
pre-op, intra-op, post-op
what are the 3 zones in the perioperative department
unrestricted, semi-restricted, restricted
what is the acceptable process when the surgeon marks the surgical site
confirm with patient and confirm consent matches. X not acceptable
what are the 3 components of the fire triangle
oxidizer (oxygen)
ignition source (fire)
fuel (sheets)
what wound classification is needed when there is bile leaking from the gallbladder into the peritoneal cavity
class 3- contaminated
SSI, diabetes and smoking are all causes of
prolonged/ delayed wound healing
definition of sterilization
complete elimination or destruction of all forms of microbial life
what type of sterilization should only be used when there is not enough time to process an instrument by the preferred method
flash/ immediate use steam sterilization
RACE stands for
rescue
alarm
contain
extinguish/evacuate
patients who have allergies to foods such as bananas, avocado, chestnut, apricot, kiwi, tomato may also have allergies to
latex
when IUSSing an instrument, the temp should be
270F
during a rapid sequence induction, the RN must
apply cricoid pressure until the anesthesiologist tells you to release
what should be minimized during transfer of patient care
distractions and interruptions
this drug should be available to reverse MH
dantrolene (36 vials)
this person has the ultimate responsibility for obtaining informed consent
surgeon
what is a sentinel event
an unexpected occurrence involving death or risk of serial physical or psychological injury
