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Med Surge 4th exam > Intra-op > Flashcards

Intra-op Flashcards

1
Q

The surgical suite (designed to control the spread of infection) is divided into three areas: unrestricted area, semirestricted area, and restricted area. What is allowed in each area

A
  • Unrestricted area: street clothes allowed in holding area, lockers, nsg station
  • Semirestricted area: only authorized staff are allowed in the corridors near OR and must wear surgical attire covering all head and facial hair
  • Restricted area: Masks are required to be worn, includes scrubsink and clean core and ORs
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2
Q

What is the holding area:

A

Waitng area outside of OR to identify and assess the pt pre/post-op

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3
Q

WHat is the OR;

A

A controlled geographically evironment from pathogens and limits the amount of staff. Utilizes filters/ventilations/and controlled airflow. No shelving and tables are admitted d/t collecting dust

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4
Q

This type of surgical team nurse is concerned w/sterile activites: remains in sterile field, scrubs, gowns, gloves self and other members of team, sterile drapes, counts sponges and instraments, assists w/the surgery

A

Scrub nurse

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5
Q

This type of surgical team nurse is non-sterile, assists preparing the room continually assess pt through out procedure, transfer pt, aseptic practice, also counts sponges and equipment

A

Circulating nurse

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6
Q

The joint commision has provided what is called the universal protocol prior to a start of a surgical procedure that prevents wrong site, wrong procedure and wrong pt. What are the three universal protocols:

A
  1. Pre-procedure verification: R. pt, R. procedure, R. site
  2. Mark the operative site
  3. Time out: averybody stops to verify pt identification, surgical procedure, and durgical site
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7
Q

What are some notes about aseptic technique with scrubbing, gloving, and what’s considered sterile:

A

Wash fingers and hands first moving on to forearms and elbows; hands should be held away from me and above elbows; once packages have been opened=edges are contaminated, gowns are sterile from above the table to chest level and sleeves two inches above elbow is considred sterile. Double gloves are worn.

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8
Q

6 Steps on Postioning an intra-op pt:

A
  1. correct musculoskeletal alignments
  2. prevent undue pressure on nerves/skin over bony prominences
  3. provide for adequate thoracic excrusion
  4. prevent occlusions of arteries/veins
  5. provide modesty in exposure
  6. recognize/respect/considerate in pt’s needs to baseline pain, deformities, aches
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9
Q

What are the supine, prone, and lithotomy positions used for:

A
  1. supine: most preferred for abs, heart, breast
  2. prone: back surgery
  3. lithotomy: pelvic surgery, hysterectomy
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10
Q

The prepping the surgical site is to reduce the number of microorganisms available to migrate to the surgical site. How is the site prepped:

A

Skin is scrubbed w/an antimicrobial agent in a circular motion, hair is removed with electric razor so as to not feel any burning sesation from antimicrobial agent; clean area is the incision part, distal area from the incision is the dirty part; skin is draped with only the surgical site to be exposed

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11
Q

What are the trhee types of anesthesia used:

A
  1. General
  2. regional/local
  3. conscious sedation/MAC monitores anesthesia care
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12
Q

This type of anethesia: loss of all sensation and consciousness; POSSIBLE IMPAIRED VENTILATORY/CARDIOVASCULAR FUNCTION; protective reflexes of gag/cough reflexes are lost; BLOCKS AWARENESS CENTER IN BRAIN FOR AMNESIA/ANALGESIA/HYPNOSIS/RELAATION occurs

A

General anesthesia

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13
Q

Which of the phases in general anesthesia includes the period starting w/pre-op medication, initiation of IV/arterial access/application of monitors:

A

preinduction phase of general anesthesia

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14
Q

Completing pre-op assessment, checking/confirming consents/permits; completing TIMEOUT; administering aspiration prophylactics are the roles of the pro-op nurse in what phase of general anesthesia:

A

preinduction phase of general anesthesia

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15
Q

Which of the phases in general anesthesia is the initiation of sequence of medications that render the pt unconscious and to secure the airway:

A

induction phase of general anesthesia

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16
Q

Assisting w/application of monitors (noninvasive/invasive); assist w/airway management are the roles periop-nurse during what phase of general anesthesia:

A

induction phase

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17
Q

Which of the phases of general anesthesia is the time period the surgical procedure is performed, pt remains in unconscious state with measures taken to ensure safety of airway:

A

Maintenance phase

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18
Q

Adjusting pt’s position as necessary and monitoring pt safety are the roles of the periop-nurse during what phase of general anesthesia:

A

maintenance phase

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19
Q

Which of the phases of general anesthesia is where the surgical procedure is completed, pt is prepared to return to conscious state and removal of airway assistive advices:

A

Emergence phase of general anesthesia

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20
Q

Assiting placement of dressing, preparing pt for movement to postanesthesic care unit (PACU) are roles of the periop-nurse during what phase of general anesthesia:

A

Emergence phase of general anesthesia

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21
Q

What are the general anesthesia routes:

A
  1. Intravenous agents: single dose last minutes for intubation to be inserted
  2. inhalation agents: includes volatile liquids or gases that enters the body via alveoli delieverd by an intubation tube (LMA)
22
Q

What is the adjunct to general anesthesia that is used to sedate/analgesia, induces/maintains anesthesia/analgesia; and is used as pain management post-op:

A

opioid: fentanyl

23
Q

what is the reversal agent used for fentanyl:

A

narcan

24
Q

What is the adjunct to general anesthesia that has an amnesic effect; induces.maintains anesthesia; and is used for anxiety/agitation post-op:

A

Benzodiazepines: Versed

25
Q

What is the reversal agent for Versed:

A

Benzodiazepine reversal agent is flumazenil

26
Q

What is the adjunct to general anesthesia that facilitates endotracheal intubation; paralysis/relaxes skeletal muscles:

A

Nerve blosk: succinylcholine (watch BP if it falls to 40/20=RR distress

27
Q

What is the reversal agent for succinylcholine:

A

Reversal agent for nerve block: Neostigmine

28
Q

What is the common adjunct antiemetic that counteracts emetic effects of inhalation/opioid anesthesia agents; considered a prophylactic prevention of N/V:

A

Inaspine

29
Q

This type of anesthesia causes the loss of sensation to a region of the body w/o loos of consciusnesswhen a group of nerves are blocked:

A

Regional anesthesia is always injected (nerve block)

30
Q

This type of anesthesia causes the loss of sensation w/o loss of consciousness and w/o blocking the nerves in an immediate area:

A

Local anesthesia (lidocaine)

31
Q

Notes on spinal anesthesia:

A
  • type of regional anesthesia into the CSF
  • Lower extremities
  • increase risk of losing CSF causing pts to have HA
32
Q

Notes on epidural blocks:

A
  • Regional anesthesia into epidural space via thoracic or lumbar space
  • does not enter CSF
  • Lower extremities
33
Q

Some notes on Nerve blocks:

A
  • Type of regional anesthetic
  • for upper extremities
34
Q

This is a type of sedation that causes minimal depression level of consciousness in which the pt retains his airways and responds to commands; achieves a level of emotional/pysical acceptance of a painful procedure is called:

A

conscious sedation

35
Q

What is the combination of anxiolytic and opioid for conscious sedation:

A

Versed and fentanyl

36
Q

What are some gerontologic considerations concerning anesthesia:

A
  • careful titration
  • sensory deficits d/t old age
  • increased pressure sore risk
  • log-term injury can occur if not careful in postioning elderly pts during sedation
37
Q

Because anesthesia can mask anaphylactics what are the common S/S and what are the two things most likely to cause it:

A
  • hypotension
  • tachycardia
  • bronchospasm
  • pulmonary edema

caused by abx or latex allergy

38
Q

A rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles is called what and what is the most common cause of it:

A

Malignant hyperthermia (MH) most likely caused by succicholine

39
Q

What is prescribed for reversal of MH:

A

Dantrium

40
Q

WHy is hypothermia induced in the OR:

A

to decrease metabolism and demand for O2 (used in neurosurgery)

41
Q

What is used to visualize/assess ventricular function and competency of heart valves or to reconize air embolism:

A

TEE or transesophagel echocardiography

42
Q

In order to palce a nerve block more accurately by visualization of the nerves/plexus to prevent less side effects, what technique is used:

A

Ultrasonic-guided regional anesthesia (UZ in pickline)

43
Q

What is robotic-assisted surgery used for:

A

laparoscopic, cholecystectomy, bild duct repair…

44
Q

What is telesurgery:

A

A MD performs a surgery distant from the pt by controlling a robotic system located at the pt’s bed side.

45
Q

Proper attire for a semi-restricted area includes: A)street clothing, B) surgical atttire and head cover, C) surgical attire, head cover, mask,

A

B:surgical attire with head cover

46
Q

Acitivites that a scrub nurse may preform are, select all that apply: A) checking electrical equipment, B) preparing the instrument table, C) passing instruments to MD, D) coordination activites accurring in the OR room, E) assissting the ACP w/monitoring of pt during surgery

A

B, C, E

47
Q

The nurse is caring for a pt undergoing surgery for a knee replacement. Which of the following is critical to the safety of the pt’s surgery (select all that apply): A) Universal protocol is followed, B)The ACP is an anesthesiologists, C) The pt has adequate insurance, D) the circulating nurse is a registered nurse, E) the pt’s allergies are communicated to the surgical team

A

A, E

48
Q

The nurse’s primary responsibility for the care of the pt undergoin surgery is: A) developing an individualized plan of nsg care for pt, B) carrying out specific tasks r/t surgical policies and procedures, C) ensuring that the pt has been assessed for safe administration of anesthesia, D) performing a preop H&P assessment to identify pt’s needs

A

A

49
Q

When scrubbing at a scrub sink, the nurse should: A) scrub from elbows to hands, B) scrub without mechanical friction, C) scrub for a minimum of 10 min, D) hold hands higher than elbows

A

D: hold hands higher than elbows

50
Q

When postioning a pt in preparation for surgery, the nurse understands that injury to the pt is most likely to occur as a result of: A) incorrect musculskeletal alignment, B) loss of perception of pain/pressure, C) pooling of blood in peripheral vessels, D) disregarding the pt’s need for modesty

A

A: improper alignment

51
Q

Intravenous induction for general anesthesia is the method of choice for most pts bc A) the pt is not intubated, B) the agents are nonexplosive, C) induction is rapid and pleasant, D) emergence is longer but w/fewer complications

A

C: induction is rapid and pleasant

Med Surge 4th exam (8 decks)

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