Operative positions, instruments, prep

Question 1

Dorsal/ supine position

Answer 1

Lying on back

Question 2

Lithotomy

Answer 2

Legs abducted by stirrups

- Vaginal or perianal surgeries

Question 3

Fowlers/ sitting

Answer 3

Inclined position of 45-60 degrees

- Abd drainage following surg

Question 4

Prone

Answer 4

Lying on stomach

Question 5

Knee/ chest

Answer 5

• Ass in the air

- Useful for sigmoidoscopy, lumbar and anorectal exam

Question 6

Jackknife

Answer 6

Butt in air

- Gluteal and anorectal procedures

Question 7

Lateral

Answer 7

• On side with top knee flexed

Access to spine, rectum

Question 8

Trendelenburg

Answer 8

• Supine, feet 15-30 degrees higher
• Increase brain circulation, abd hernia reduction
• Central line
• Increased resp perfusion

Question 9

Reverse tredelenburg

Answer 9

• Legs lower than head

- Reducing intracranial pressure

Question 10

Tissue forceps

Answer 10

Used for grasping and holding tissue

- Tweezer looking

Question 11

Clamps

Answer 11

• Ratcheting device
• Hold things in place, compression of vessels
• Application of staples

Question 12

Scissors

Answer 12

• Dissecting/ cutting through tissue

- Cut sutures

Question 13

Needle holders

Answer 13

• Used to hold needles steady during suture

Question 14

Hand held retractor

Answer 14

• Blades and rakes to hold tissue open

- Not sharp

Question 15

Self retaining retractor

Answer 15

• Place retractor and leave open and in place

Question 16

Suction

Answer 16

Removal of blood and debris

Question 17

Cautery

Answer 17

• Heat to stop vessel bleeding

Question 18

Bovie

Answer 18

• Electrode knife used for cutting or coagulation

Question 19

Diathermy

Answer 19

• Electromagnetic or US heat for muscle relaxation

Question 20

Informed consent

Answer 20

• PARQ
• ID meds
• Lifesaving measures wanted

Question 21

Presurgical bowel prep

Answer 21

• Decrease bacterial load
• Polyethylene glycol to rid stool
• Abx prophylaxis- Neomycin and erythromycin

Question 22

NPO status/ nasogastric tube

Answer 22

• Last solid food 6-8 hrs prior to anesthesia
• Reduces risk of aspiration
• Nasogastric tube to empty contents if gastric retention

Question 23

DVT prophylaxis

Answer 23

• Pneumatic compression devices
• Early ambulation
• Low dose heparin if moderate risk
• High risk = heparin and compression device
• Must stop 24 hrs prior to surg

Question 24

Abx prophylaxis

Answer 24

• Clean contaminated or contaminated cases
• Decrease rate of infection
• Choose by sensitivity studies

Question 25

Blood type, cross and screen

Answer 25

• Type and cross all pts at risk of blood loss

Question 26

Anesthesia risk

Answer 26

• Completed by anesthesiologist

- Perioperative classification scheme- Normal, well controlled chronic, poorly controlled chronic, emergency

Question 27

Anxiety reduction

Answer 27

• Provide reassurance, comfort and data regarding M&M

- Benzos 15 min prior