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CNOR > Intraoperative patient care and safety pt. 4 > Flashcards

Intraoperative patient care and safety pt. 4 Flashcards

1
Q

What is perioperative asepsis (ie, aseptic/sterile technique)

A

a combination of techniques and protocols employed to prevent microorganisms from entering an open surgical wound or contaminated a sterile field during surgery

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2
Q

What are 5 components of perioperative asepsis?

A
  1. performing surgical skin antisepsis
  2. wearing correct surgical attire
  3. performing hand hygiene and the surgical hand scrub
  4. gowning and gloving correctly
  5. maintaining the sterile field using aseptic technique, which includes preparing the sterile field, draping the surgical field, and moving within the sterile field
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3
Q

What is the goal of perioperative skin antisepsis?

A

to reduce the risk of developing a surgical site infection by removing soil and transient microorganisms at the surgical site

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4
Q

What are 2 other methods contribute to a reduction of microorganisms on the skin?

A
  1. preoperative bathing
  2. hair management
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5
Q

What can also reduce transient microbes?

A

soap or antiseptic agent, such as CHG

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6
Q

Where is hair removal most ideal?

A

Should be performed outside of the OR to limit the number of bacteria shed in the OR

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7
Q

What should be used to remove hair at the surgical site?

A

an electric or battery-operated clipper or a depilatory

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8
Q

What does using a depilatory require?

A

a pretest on a site removed from the surgical site to ensure that the patient does not have a skin reaction to the agent

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9
Q

What is a consideration for hair removal with clippers?

A

should be performed with care to avoid nicking or cutting the underlying skin

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10
Q

What can cuts or nicks in the skin cause?

A

may allow cutaneous bacteria to proliferate and contribute to a possible SSI

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11
Q

What is the potential harm from providone-iodine antiseptics in patients with a burn?

A

repeated application leads to iodine absorption and possibly iodism

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12
Q

What are 2 possible reactions from providone-iodine antiseptics in patients with a burn?

A
  1. induced hyperthyrodism
  2. metabolic acidosis
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13
Q

What is the potential harm from providone-iodine antiseptics in patients with a thyroid disorder undergoing a thyroidectomy?

A

even a single application can result in iodism in patients with thyroid cancer or a goiter

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14
Q

What are 2 possible reactions from providone-iodine antiseptics in patients with a thyroid disorder undergoing a thyroidectomy?

A
  1. intereference with radioactive iodine therapy
  2. thyroid dysfunction
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15
Q

What is the potential harm from providone-iodine antiseptics in neonates?

A

neonates and premature neonates have increased skin permeability to iodine

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16
Q

What is the potential reaction from providone-iodine antiseptics in neonates?

A

iodism that leads to either hypothyroidism or transient hypothyroidism

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17
Q

What is the potential harm from providone-iodine antiseptics in women who are pregnant?

A

iodine crosses the placenta

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18
Q

What is the potential reaction from providone-iodine antiseptics in women who are pregnant?

A

higher cord blood concentrations of iodine

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19
Q

What is the potential harm from providone-iodine antiseptics in women who are lactating?

A

iodine is retained in the skin of the breast

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20
Q

What is the potential reaction from providone-iodine antiseptics in women who are lactating?

A

transient hypothyroidism in the nursing newborn

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21
Q

What are surgical scrub recommendations?

A
  1. scrubs donned daily should be clean and freshly laundered in a helath care accredited laundry facility
  2. scrubs should be changed if soiled
  3. tops should be tucked in or fit closely
  4. jackets, if worn, should be buttoned or snapped
  5. personal clothing that cannot be contained within the scrub attire should not be worn or should be laundered by a health care-accredited laundry facility
  6. personnel should change into street clothes when leaving the building
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22
Q

What are recommendations for shoes?

A
  1. shoes should be clean and dedicated for the perioperative area
  2. shoes should be close-toed and have heels as identified by OSHA
  3. shoes should not have holes or openings
  4. Single-use shoe covers, or boots must be worn when the potential for gross contamination from fluid exists
  5. shoe covers should be removed after use
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23
Q

What are surgical recommendations for masks?

A
  1. masks should be worn in conjunction with eye protection when there is a potential for exposure to fluids
  2. masks should fit snugly and co er the mouth and nose
  3. masks are singl-use and should eb changed for each new procedure
  4. masks should be replaced and discarded when soiled
  5. masks should not be allowed to dangle around the neck
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24
Q

What are surgical recommendations for jewelry, stethoscopes, and personal identification?

A
  1. scrubbed team members that wear jewelry risk accidental contamination of the wound if the jewelry were to fall into the surgical site or become a retained foreign object
  2. stethoscopes should be cleaned after each use
  3. identification badges and lanyards should be cleaned with a low level disinfectant when soiled
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25
Q

What are surgical recommendations for hair and facial covering?

A
  1. a clean surgical head cover should confine the hair and cover the scalp
  2. a cover should be used for those with a beard
  3. single-use coverings should be discarded at the end of the shift or when soiled
  4. reusable head covering should be laundered daily by a health care-approved laundry facility
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26
Q

What are surgical recommendations for personal items?

A
  1. backpacks, briefcases, and other items should be cleaned with a low-level disinfectant before entering the semi-restricted or restricted areas
  2. if brought in, these items should not be placed on the floor
  3. cell phoens and other devices should be cleaned according to the manufacturer’s recommendations
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27
Q

What are surgical recommendations for cover apparel?

A
  1. if worn, lab coats should be clean, and they are single use
  2. evidence does not support the use of cover apprel to protect surgical scrubs
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28
Q

What are the special (sometimes conflicting) considerations an RN should keep in mind before using a surgical antiseptic agent?

A
  1. No FDA approved antiseptic alternatives on the market for use in the vaginal vault when providine-iodine is contraindicated.
  2. chlorhexidine gluconate with low alcohol content (4%) is recommended as safe by the American Congress of Obstetricians and Gynecologists for vaginal preps
  3. Providine-iodine preparations should be used with caution or not at all in select patients, such as those who are susceptible to iodism
  4. fish or seafood allergies DO NOT necessarily mean that a patient will have an allergic reaction to topical iodine preps
  5. DO not use iodine or iodophors, CHG, or alcohol internally; they are intented for external use only
  6. preoperative antisepsis of the vagina with a providone-iodine agent is effective for prevention of endometritis and SSIs for patients undergoing a c-section.
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29
Q

is the use of nonsterile gloves acceptable for prepping? if yes, then what are the conditions?

A

yes; if the length of the applicator prevetns the antiseptic and surgical site area from coming into contact with the nonsterile gloves

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30
Q

What should the person performing the surgical skin prep be wearing?

A

a scrub jacket to cover his or her arms

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31
Q

What can pooling of prepping agents cause?

A
  1. skin maceration
  2. increase the risk of fire
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32
Q

What does the manufacturer’s recommendations include for prepping agents?

A
  1. dwell time
  2. pattern of use
  3. dry time
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33
Q

What changes the recommended dry times for preps?

A
  1. manufacturer
  2. solution
  3. presence of hair
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34
Q

What happens if alcohol fumes are trapped under the drape?

A

the potential for inadvertent fire increases

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35
Q

What sites require preventative measures to avoid overall contamination of the entire surgical site?

A
  1. traumatic wounds
  2. foreign substances
  3. sites that are contaminated (umbilicus, stomas, draining sinuses, skin ulcers, perineum)
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36
Q

What cannot be exposed to alcohol preps?

A
  1. mucous membranes
  2. wounds
  3. burns
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37
Q

What is the overall goal when establishing expectations for surgical attire?

A

to reduce the patient’s potential risk of infection by the surgical team

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38
Q

What is the primary method of decreasing health care-associated infections?

A

hand hygiene

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39
Q

What are the 3 primary methods of hand hygiene

A
  1. washing with soap and water
  2. performing a surgical hand scrub
  3. using surgical hand rubs
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40
Q

What are the 6 separate times health care personnel should perform hand hygiene?

A
  1. upon arrival at and before leaving health care facility
  2. before and after having contact with the patient
  3. before donning and after removing gloves
  4. before and after eating
  5. before and after going to the rest room
  6. anytime the hands are contaminated
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41
Q

What are 5 additional steps that decrease the liklihood for transmission of bacteria?

A
  1. fingernails should be short and well groomed
  2. chipped nail polish should be removed
  3. artiifical nails and nail enhancements should not be wonr
  4. rings and arm jewelry should not be worn in the periop area
  5. health care providers should have intact skin when providing direct patient care
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42
Q

What is the goal of surgical hand antisepsis

A

to remove soil and transient microorganisms from the hands and arms

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43
Q

What are the 4 initial steps of the brush and brushless methods of surgical hand prep?

A
  1. remove jewelry
  2. don a surgical mask
  3. wash hands and arms with soap and water if visible soil is present
  4. clean under the fingernails
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44
Q

What 2 things can be used for surgical hand prep using the brush method?

A
  1. sponge
  2. brush
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45
Q

What are the 5 steps used to complete the brush method?

A
  1. to prevent dermatitis, the surgical hand scrub should not be performed using a scrub brush
  2. Wash for 3-5 minutes to allow for adequate coverage of the hands and arms with the product selcted
  3. wash with an anatomical approach to cover all 4 sides of each finger and both hands and arms
  4. Rinse hands and arms thoroughly by holding the hands higher than the elbows to prevent contamination from water dripping from less clean areas to cleaner areas
    5, Dry hands with a sterile towel before gowning and gloving
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46
Q

What are the 4 steps for surgical hand prep using the brushless method?

A
  1. Dispense the manufacturer’s recommended amount of the product
  2. Apply the product to the hands and forearms according to the manufacturer’s written instructions
  3. Rub the hands thoroughly until completely dry
  4. Don a sterile gown and gloves
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47
Q

What technique is used when donning sterile gows and gloves?

A

sterile technique

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48
Q

Where should gowns and gloves be donned?

A

from a surface away from the instrument table

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49
Q

Who should perform closed gloving?

A

by the scrubbed eprson

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50
Q

What describes closed performing?

A

keeping hands inside the sleeve of the gown until gloves have covered the gown cuff

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51
Q

What is the preferred method when gloving team members during intial gowning and gloving

A

closed- assisted gloving

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52
Q

What is also recommended for gloving?

A

double gloving

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53
Q

What are the parameters of the surgical gown of which perioperative nurses should be aware?

A
  1. front of the gown, from the chest to the level of the sterile field
  2. sleeves of the gown, from 2 inches above the elbow to the cuff circumferentially
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54
Q

What are the 5 areas of the unsterile gown?

A
  1. back of the gown
  2. neckline
  3. shoulder
  4. axilla
  5. sleeve cuff after the hand has passed through the cuff
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55
Q

What is vital to the role of the RN when maintaining the sterile field?

A

surgical conscience

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56
Q

What are the 3 roles for the RN for maintaining the sterile field?

A
  1. monitors the sterile field for any breaks in teachnique
  2. speaks up
  3. corrects any identified compromises
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57
Q

What is key to time and location for preparing the sterile field?

A

as close to the time of the procedure as possible in the location in which the procedure will be performed

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58
Q

What is the managers role in preparing the sterile field?

A

are responsible for establishing a defined process and providing personnel with a detailed description of this process

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59
Q

What is an important consideration for surgical procedures that involve both the abdominal and perineal areas?

A

caution should be taken to maintain separate setups to reduce the chance of transferring microorganisms from the perineal area to the abdominal area

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60
Q

When performing bowel surgery, nurses should establish a standardized technique known as what?

A

isolation technique

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61
Q

What 3 steps are included in the isolation technique?

A
  1. instruments and equipment that have contacted the inside of the bowel should not be used after the lumen of the bowl has been closed
  2. Clean instruments should be used for closure
  3. Contaminated instruments should be removed or covered so that the surgical team does not touch them after closure begins but remain visible for completing instrument counts
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62
Q

What are the most common type of health-care associated infections?

A

infections of the urinary tact as a result of passing transurethral instruments and catheters during gynecologic laparoscopic procedures

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63
Q

What are sterile drapes used for?

A

used to establish a barrier and minimize the passage of microorganisms from the unsterile to the sterile area

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64
Q

Besides invasive surgical procedures, according to the CDC, where should full barrier precautions be used?

A

central venous catheters and peripherally inserted central catheters

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65
Q

What are 5 concepts related to the use of sterile drapes?

A
  1. unsterile equipment or furniture in or adjacent to the intended sterile field should be covered with a sterile drape
  2. Gloved hands should be protected by using a cuff when placing the sterile drape
  3. Drapes are placed from the surgical site out peripherally
  4. Once a sterile drape has been placed on the patient, it should not be moved or adjusted
  5. Items falling below the level of the sterile field are consider contaminated
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66
Q

What is one method to prevent contamination of the established sterile fields?

A

to control and reduce the amount of movement in and around the sterile field

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67
Q

What are 5 important considerations for scrubbed personnel as far as movement within the sterile field?

A
  1. wear appropriate protective devices to allow scrubbed personnel to remain at the sterile field
  2. Do not leave the sterile field to retrieve items from an autoclave
  3. Ensure that hands and arms remain above wast level
  4. Avoid changing position levels during the procedure
  5. Sit only when the entire surgical team is seated for a procedure
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68
Q

What are 2 important considerations for changing positions, as far as movement within the sterile field?

A
  1. Scrubbed personnel should move back-to-back or front-to-front.
  2. Non-scrubbed personnel should always face the sterile field and maintain a minimum distance of 12 inches from the sterile field
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69
Q

What are 4 important general considerations, as far as movement within the sterile field?

A
  1. limit talking at the surgical field
  2. keep the number of personnel to a minimum
  3. Use methods of communication to reduce entering and departing the room when a procedure is under way.
  4. Limit the number of door openings for breaks and retrieving supplies
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70
Q

What are the 3 things should perioperative personnel inspect each sterile item for?

A
  1. the item has been sterilized
  2. the packaging remains intact and has not been compromised
  3. if there is an expiration date, the item is not expired
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71
Q

Sterility is related to what instead of what?

A

event related, not time related

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72
Q

An item is considered sterile if…

A
  1. the item has been exposed to the parameters of sterilization
  2. the integrity of the package remain intact
  3. the item’s packaging has not been compromised by excessive handling or unreliable conditions
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73
Q

define event-related sterility

A

used to describe a sterile item that will remain sterile regardless of time

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74
Q

When is sterility compromised?

A

if the item is exposed to events such as excessive handling, humidity, or alterations in there required temperature range

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75
Q

How are items most often sterilized at the health care facility?

A
  1. using steam under pressure
  2. form of plasma using hydrogen peroxide
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76
Q

What are the 2 forms of sterilization used by companies?

A
  1. ethylene oxide
  2. irradiation
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77
Q

What does the FDA require that manufacturers do for packaging?

A

label their packaging with the method of sterilization as well as with the phrase “sterile unless damaged or opened”

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78
Q

true or false; before presenting sterile items to the field, perioperative personnel need to confirm that the package is labeled with the method of sterilization as well as with the phrase “sterile unless damaged or opened”

A

true

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79
Q

What are the 3 packaging methods?

A
  1. wraps
  2. peel packs
  3. rigid containers
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80
Q

Before presenting a sterile item to the surgical field, the nurse must check what?

A

the integrity of the package

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81
Q

to verify sterile integrity of sterile items what should the RN do?

A
  1. inspect all packaging for any compromise caused by moisture, tearing, or rough handling
  2. Ensure that the sterile contents of a wrapped package do not come in contact with the edges of the wrapper or peel pack before placing them on the sterile field
  3. Verify the presence of external locks, filters, or valves when opening items in rigid containers and ensure that all are intact and free of moisture before opening and placing them on the sterile field
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82
Q

true or false; specimen management is an unessential component of the RN’s scope of practice

A

false; it is essential

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83
Q

what happens to errors in specimen management?

A

can lead to incorrect diagnoses and medical management

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84
Q

What are the four ways a specimen can be sent to pathology?

A
  1. frozen
  2. fresh
  3. permanent
  4. culture
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85
Q

Please read the specimen managment policies”

A
  1. assessing for needed supplies and processes during the briefing
  2. notifying applicable personnel
  3. specifiying the requirements for specimen collection and handling
  4. identifying the correct method of transfer and transport needs
  5. delineating the requirements for containment
  6. verifying the method of preservation
  7. clarifying the correct disposition of the specimen
  8. including the correct specimen and disposition in the debriefing
  9. documenting all of these specifics in the intraoperative record
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86
Q

What is really important with specimen management?

A

they must be collected and handled in a manner that protects and preserves the integrity of the specimen

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87
Q

What are 3 considerations for forensic specimens?

A
  1. placing them in dry plastic containers
  2. not allowing them to come in contact with metallic basins if they contain metal
  3. handling them as little as possible
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88
Q

What does an RN need to do if a specimen has markers - sutures and paint?

A

RN must annotate those markers on the label and requisition form for orientation for pathology so appropriate diagnoses may be made

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89
Q

Each specimen needs to be labeled with what?

A
  1. the patient’s name, ID number, and DOB
  2. the origin of the specimen and laterality
  3. the date and time the specimen was obtained and placed in preservative
  4. the surgeon’s name
  5. preservative and biohazard info
  6. any other info the facility requires
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90
Q

What 2 things are under implantable materials?

A
  1. biologic
  2. synthetic
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91
Q

What is the RN’s responsibility for implants and explants?

A

responsible for complying with tracking regulations for implantable materials and devices and must use meticulous aseptic technique with minimal handling

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92
Q

do patients have the right to refuse tracking on their medical devices?

A

yes

93
Q

What is the minimum documentation for implantable devices?

A
  1. device identification
  2. date of manufacture
  3. patient info
  4. implant location
  5. surgeon contact info
94
Q

What is a sterilization process for unwrapped items that are intended to used immediately, not stored and used later?

A

Immediate-use steam sterilization

95
Q

Is IUSS recommended for implantable devices?

A

NO

96
Q

When should IUSS be used?

A

should only be used in a defined emergency with no other option

97
Q

What should happen if IUSS is required for an implant?

A

a biological indicator must be used, and the cycle determined by the IFU must be selected

98
Q

explants are sent where?

A

to pathology laboratory for evaluation and gross examination

99
Q

What determines final disposition of an explant?

A

facility policy

100
Q

What are RNs responsible for complying with implants and explants? and must use what?

A

complying with tracking regulations from the US food and drug admin for implantable materials and devices and must use meticulous aseptic technique with minimal handling

101
Q

What is autologous tissue?

A

tissue that is harvested and preserved for later replantation into the donor’s own body

102
Q

What are examples of autologous tissue?

A
  1. cranial bone flaps
  2. parathyroid gland
  3. skin
  4. vessels
  5. femoral heads
103
Q

What does the autologous tissue process provide for?

A

the process - keeping tissue in-house and replanting it into the same patient - provides an exemption from the US food and drug admin requirement to register the facility as a tissue establishment

104
Q

What are the AORN guidelines for cranial bone flaps?

A

may be frozen, cryopreserved, or placed in a tissue pocket

105
Q

What are the AORN guidelines for parathyroid gland tissue?

A

may be cryopreserved

106
Q

What are the AORN guidelines for skin?

A

may be refrigerated and stored in a storage medium or normal saline, or it may be cryopreserved

107
Q

What are the AORN guidelines for vessels?

A

may be refrigerated and stored in normal saline, lactacted ringer solution, or a storage medium

108
Q

What are the AORN guidelines for femoral head?

A

may be placed in a tissue pocket

109
Q

How long can vessels be stored?

A

14 days

110
Q

Who should determine the appropriate methods for storing and preserving and time until expiration of all autologous tissue?

A

an interdisciplinary team of physicians, infection preventionists, and nurses

111
Q

What is a safety risk to patients undergoing surgical or other invasive procedures?

A

RSI’s

112
Q

What must be conducted consistently for every operative or invasive procedure according to the facility’s policies and procedures?

A

surgical counts

113
Q

What 3 things should the RN and scrub do when counting?

A

count them audibly, visually, and concurrently

114
Q

Who is responsible for documenting counts?

A

RNs

115
Q

Are RSIs events that are reportable to TJC?

A

they are never events that are reportable to TJC

116
Q

Counted items include what?

A

surgical soft goods, sharps, and instruments

117
Q

What is the flow of counting?

A

from the sterile field to the mayo stand to the back table and then off the field

118
Q

When are the 7 times a count should be performed?

A
  1. at the time of instrument assembly for sterilizaion
  2. before the procedure begins to establish the baseline
  3. when new items are added to the field
  4. at the time of permanent relief of either the scrub person or the RN
  5. before the closure of a cavity within a cavity (uterus, bladder)
  6. when a cavity closure begins
  7. when final closure begins
119
Q

What are the 8 steps to take if the count is not correct at any point?

A
  1. the rn circulator or scrub person informs the surgeon immediately
    2, the RN circulator or scrub person repeats the entire count procedure
  2. The RN circulator searches for missing items in the trash, under furniture, on the floor, in the laundry, and in any other receptacle in room
  3. the scrub person searches the sterile field
  4. the surgeon searches the wound
  5. the RN circulator notifies the supervisor
  6. the surgical team follows the facility’s policy for x-rays to be taken before the patient leaves the OR if all search options have been exhausted and the discrepancy has not been resolved
  7. The RN circulator documents the incorrect counts and all actions taken in the record.
120
Q

What should the nurse complete and submit once turning care over to PACU nurse when there has been a count discrepancy?

A

should complete and submit an incident report ASAP

121
Q

Should the RN mention the incident report in the chart?

A

no

122
Q

What should be put in the chart following a count discrepancy?

A

any interventions performed - intraoperative x-ray and its findings

123
Q

What are the responsibilities of the manager when it comes to counts?

A
  1. responsible for developing and periodically reviewing and revising the policies and procedures for performing counts and preventing the need for RSIs.
  2. managers should conduct a review of policies concerning the processes in place to deal with unretrieved device fragments and the use of adjunct technologies that supplement the manual cont procedures
  3. ensure that all surgical personnel are educated and trained on these policies and procedures intially and for ensuring ongoing competency evaluation
  4. promoting ongoing quality improvement of the count process anywhere that operative or other invasive procecures are performed to prevent the occurrence of RSIs and improve outcomes for surgical patients
124
Q

How are wound classifications determined?

A

determined by the probability that hte patient will sustain a postoperative infection based on predetermined criteria

125
Q

what is class I?

A

clean

126
Q

What are class I wound classifications examples?

A

knee arthroscopy, breast biopsy

127
Q

What is class II?

A

clean contaminated

128
Q

What are class II wound classifications examples?

A

laryngoscopy, appendectomy

129
Q

What is class III?

A

contaminated

130
Q

What are class III wound classifications examples?

A

appendectomy for rupture, traumatic wound with bowel involvement

131
Q

What is class IV?

A

dirty-infected

132
Q

What are class IV wound classifications examples?

A

amputation of gangrenous extremity, delayed primary closure

133
Q

Why is it important to verify the wound classification at the end of the procedure?

A

in the event that during the procedure there was a break in technique or process that changed the planned wound classification

134
Q

When a penrose drain is initially placed what is the class?

A

there is a fresh, open wound so class III/contaminated

135
Q

What happens if the drainage from a wound is purulent after a penrose drain is placed? what is the class?

A

class IV/dirty-infected wound

136
Q

What is the arrest or stoppage of blood flow?

A

hemostasis

137
Q

What are 3 ways surgical hemostasis can be achieved?

A
  1. external means - application of a tourniquet to an extremity
  2. manual pressure - holding pressure with packing laparotomy sponges
  3. chemical or internal mechanical agents that assist in the arrest of active bleeding
138
Q

What are the 2 types of bleeding that we encounter in surgery?

A
  1. active bleeding from arteries and/or veins
  2. venous oozing from cut surfaces
139
Q

What are 2 crucial factors in successful closure of a wound?

A
  1. hemostasis, without wound formation
  2. eliminated of dead space
140
Q

What is the most common type of internal mechanical hemostasis?

A

the use of hemostats or other clamping instruments, ties, or electrosurgery employed by the surgical team

141
Q

What is another means of mechanical hemostasis

A

thermal agents

142
Q

other mechanical means of achieving hemostasis involve the use of what kind of pressure?

A

external pressure

142
Q

What are examples of thermal agents

A

cryosurgeryy, diathermy, handheld electrocautery, argon beam coagulator, hemostatic scalpel, ultrasonic-harmonic scalpel, laser photocoagulator

143
Q

What does external pressure do for hemostasis?

A

occludes or creates a barrier to the flow of blood

144
Q

What are examples of external pressure devices?

A
  1. pneumatic or simple tourniquets
  2. medical antishock trousers (MAST)
145
Q

What is a MAST device?

A

an extreme compression device has been used for trauma victims to prevent shock

146
Q

When is a MAST device deflated?

A

only after a victim is in the OR, anesthesia is induced, and the means to control hemorrhage are immediately available

147
Q

Use of porcine- or bovine-sourced agents may be what as chemical agents for hemostasis?

A

contraindicated by the patient’s faith or by allergy to porcine or bovine derivatives

148
Q

Hemostatic materials should not be what?

A

should not be packed into closed spaces where they could cause undue pressure on nerves or other tissues, such as the spinal canal

149
Q

When are chemical agents absorbed?

A

either during the wound healing process, others are long lasting

150
Q

What is absorbable gelatin material?

A

powder or compressed pad from porcine gelatin

151
Q

What is the action of absorbable gelatin?

A

provides a framework for fribrin deposition and clot formation in areas of capillary bleeding

152
Q

What are 4 nursing considerations for absorbable gelatin?

A
  1. not soluble and swells to up to 40 times its own weight
  2. the sponge or pad form may be used dry or with warm saline solution, epi, or thrombin
  3. the powder form is mixed with saline to create a paste, which is then applied to the bleeding source
  4. should not be used in presence of infection or in small closed spaces such as the spinal canal
153
Q

What is absorbable collagen material?

A

sponges made from bovine collagen

154
Q

What are 2 actions of absorbable collagen?

A
  1. applied dry to oozing or bleeding sites
  2. activates the coagulation cascade, especially platelet aggregation
155
Q

What are 3 nursing considerations for absorbable collagen?

A
  1. must be kept dry
  2. scrubbed team members should handle it with dry gloves and dry instruments because it has an affinity for wet surfaces
  3. keep away from the skin incision, as it will form a barrier to wound healing
156
Q

What is the material of microfibrillar collagen?

A

loose or nonwoven pad

157
Q

What is microfibrillar collagen made from?

A

bovine corium collagen

158
Q

What are the 2 actions for microfibrillar collagen?

A
  1. activates the coagulation cascade, especially platelet aggregation
  2. applied dry to the bleeding surface with firm pressure, then any excess material is removed
159
Q

What are 2 nursing considerations for microfibrillar collagen?

A
  1. may swell up to 20% its volume within 10 min.
  2. considerations are the same as for absorbable collagen
160
Q

What is oxidized cellulose made from?

A

oxidized cotton cellulose or oxidized regenerated cellulose (rayon)

161
Q

What is oxidized cellulose material?

A

pad or knitted fabric that is either low- or high-density

162
Q

What are the 2 actions of oxidized cellulose?

A
  1. applied dry and may be sutured in place
  2. creates a gel when in contact with blood, forming a clot rapidly
163
Q

What are the 5 nursing considerations for oxidized cellulose?

A
  1. absorbs 10 times its own weight
  2. has some bactericidal properties
  3. use only the minimum amount needed
  4. inactivated in the presence of thrombin
  5. not recommended for use on bone
164
Q

What is thrombin?

A

enzyme extracted from human or bovine blood

165
Q

What does thrombin promote?

A

coagulation of blood and controls capillary bleeding by activating the coagulation cascade

166
Q

What is the action of thrombin?

A

topical thrombin may be sprayed on areas that are hard to access with other methods

167
Q

What are 4 nursing considerations for thromin?

A
  1. contraindicated fo ruse in sites with active bleeding
  2. contraindicated for patients with bovine allergies
  3. human recombinant product may contain viral or prion contamination
  4. used as topical hemostatic agent along with other agents or alone
168
Q

How is synthetic oxytocin prepared?

A

as an injection

169
Q

How can synthetic oxytocin be delivered?

A

either intravenously or injected directly into the uterine muscle

170
Q

How does oxytocin related to child birth?

A

pituitary hormone used to initiate or augment uterine contractions after the baby is born

171
Q

What are 4 nursing considerations for oxytocin?

A
  1. commonly used in c-sections
  2. controls uterine hemorrhage but can also be used to induce labor for vaginal birth
  3. ergonovine has demonstrated cases of sustained contractions lasting more than 3 hours
  4. ergonovine is contraindicated if the patient has preeclampsia or eclampsia causing seizures
172
Q

What is ergonovine used to treat?

A

can be used to treat uterine bleeding after childbirth or abortion after the placenta is delivered

173
Q

What are the 2 actions of phenol and alcohol?

A
  1. cauterizes tissue by coagulating proteins
  2. used on a cottons wab to cauterize tissue
174
Q

What are 3 nursing considerations for phenol and alcohol?

A
  1. used in some podiatric surgeries
  2. neuralized by 70% alcohol
  3. can cause severe burns
175
Q

What is epi?

A

adrenal hormone that caues vasoconstriction

176
Q

What is epi used with and to do what?

A

used with local anesthestics to prolong the anesthetic effect by increasing the time for the anesthetic to be cleared from the surgical area

177
Q

What is a nursing consideration for epi?

A

excess can be absorbed systematically, causing a rapid heart rate

178
Q

How are silver nitrate sticks packaged?

A

packaged as applicator sticks with modled silver nitrate in 20% to 50% silver chloride solution

179
Q

What are silver nitrate sticks used to treat?

A
  1. burns or other moist wounds
  2. to seal areas of previous surgical incision that are left open to heal by secondary intention
180
Q

What are 2 nursing considerations for silver nitrate sticks?

A
  1. should not be used on the face because it may cause discoloration of the skin
  2. staining darkens to black int he presence of light
181
Q

What do drains promote?

A

the wicking of fluid away from the surgical site by capillary action and gravity

182
Q

Tubes placed in the chest tubes, common bile duct, or bladder allow what?

A

fluids to be captured in a closed container for accurate measurement

183
Q

Open drains desposit what?

A

collected fluid directly onto dressings

184
Q

Closed drains collect what?

A

collect fluid in reservoir

185
Q

true or false; drains can be fenestrated or have one long tube

A

true

186
Q

Primary dressings are placed where?

A

placed directly on the surgical wound

187
Q

What should primary dressings be made of?

A

an absorbent material that will wick drainage from the wound and move it toward the periphery

188
Q

What can primary dressings be made of?

A

cotton or synthetic materials

189
Q

What are 2 other things that primary dressings can contain/be made of?

A

they can contain antimicrobial properties and can be made of non-adherent material if no debridement is desired

190
Q

secondary dressings are placed where?

A

directly over primary dressings to absorb additional drainage

191
Q

What are often used as secondary dressings?

A

pads with cotton filling

192
Q

What is the purpose of a secondary dressing?

A

to add a layer of protect of the wound to decrease liklihood of further trauma

193
Q

Who is typically responsible for securing the dressing at the end of the procedure?

A

RN

194
Q

A wound that cannot be closed by primary intention may be dressed with what?

A

a negative pressure dressing that serves to promote granulation of tissue and remove excess secretions simultaneously

195
Q

What are contraindications for negative pressure wound therapy?

A
  1. exposure of vital organs within the wound
  2. inadequate wound debridement
  3. untreated osteomyeletis or sepsis within the vicinity of the wound
  4. untreated coagulopathy
  5. necrotic tissue with eschar
  6. malignancy in the wound
  7. an allergy to any component of the dressing
196
Q

What is wound healing?

A

is the body’s response to repair tissue disruption that has occurred through surgical intent, traumatic events, or a chronic condition that occurs over time

197
Q

What are the 3 phases of wound healing?

A
  1. infalmmatory
  2. proliferative
  3. remodeling
198
Q

What are the 3 types of wound closures?

A
  1. primary intentions
  2. secondary intention
  3. delayed primary closure, third intention
199
Q

What is primary intention wound closure?

A

which occurs when wounds are created with aseptic technique and then closed as soon as possibel with sutures, staples, tape, or surgical adhesives

200
Q

What is secondary intention or granulation and contraction?

A

occurs in wounds with tissue loss and the inability to proximate edges

201
Q

What typically happens with secondary intention wounds?

A

typically left open so that they can heal from the inside out

202
Q

Are dressing changes normally required for secondary intention?

A

yes

203
Q

What do delayed primary closure or third intention involve?

A

involves wounds that require debridement first and then later require primary or secondary closure

204
Q

What is suture a generic term for?

A

all materials used to repair and re-approximate incised or torn tissue

205
Q

Suture materials have what 3 characteristics?

A
  1. physical -tensile strength, memory
  2. handling - pliability
  3. tissue-reaction - absorption
206
Q

Sutures fall into what 2 categories?

A
  1. absorbable
  2. nonabsorbable
207
Q

What are some examples of absorbable sutures?

A
  1. surgical gut sutures
  2. collagen sutures used in eye surgeries
  3. synthetic absorbable sutures used in laparotomies
208
Q

What are 3 class of non-absorbable sutures?

A
  1. class I: silk and synthetic fibers
  2. class II: cotton or linen fibers
  3. Class III: sutures with a composition of monofilament or multifilament metal wire
209
Q

What are examples of nonabsorbable sutures?

A
  1. silk
  2. cotton
  3. nylon
  4. polyester fiber - used for general closure of fascia
  5. polypropylene - often used in the presence of infection
  6. barbed suture - used extensively in plastic surgeries; resists know-related issues
  7. stainless steel
210
Q

What are the 3 basic components of surgical needles?

A
  1. the eye
  2. the body
  3. the point or tip
211
Q

Selection of closure material is determined by what?

A
  1. lesion location
  2. anticipated wound tension
  3. defect size
  4. type of repair
  5. patient attributes
212
Q

What are taper point needles used for?

A

for most soft tissues below the skin’s surface

213
Q

What are penetrating points used for?

A

for ligaments and tendons

214
Q

What are blunt points used for?

A

for friable tissues

215
Q

What are protect points used for?

A

primarily for fascia

216
Q

What are reverse cutting needles used for?

A

for skin closures

217
Q

What are cutting tapers used for?

A

microsurgery

218
Q

What are spatula side cutting needles used for?

A

eye surgery

219
Q

What are regular cutting needles used for?

A

for general skin closures

220
Q

What is the primary goal of the perioperative team?

A

safe patient care

221
Q

What is essential to a culture of safety that supports a supportive environment?

A

communication

222
Q

What is the primary role of the RN in patient advocacy?

A

to provide a safe patient care through advocacy, which is supported by the ANA and AORN

223
Q

Part of being a patient advocate is to protect the patient’s what?

A

privacy

224
Q

who is a common part of the perioperative team when it comes to privacy?

A

health care industry representative (HCIR)D

225
Q

Do HCIR’s need to be present while the patient is awake and being transferred and positioned?

A

no; unnecessary exposure of the paitnet

226
Q

How can we promote privacy in the OR?what 3 things?

A
  1. ensure exposure of only necessary anatomy
  2. limited traffic in the room
  3. limited talking
227
Q

the RN collaborates with the patient how?

A

in a manner that preserves and protects the patient’s autonomy, dignity, and human rights

228
Q
A

CNOR (13 decks)

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