OR Residency 2022 Flashcards
1
Q
A
Taper Needle
- Spreads tissues as it goes between layers
- Used for soft tissue, bowel, vascular, nerves, head and neck
2
Q
A
Cutter Needles
- Cuts tissue as it is passed through → may cause damage
- Used for fascia, skin, tendons
3
Q
Suture Types
A
4
Q
Suture Sizes
A
5
Q
Suture Size and Use
A
6
Q
CT
A
- Circle Taper
7
Q
FS
A
- For Skin
- Fsx, FSlx → For skin extra large
8
Q
PS
A
- Plastic Skin
9
Q
LR
A
- Long Retention Suture
10
Q
SH
A
- Small half
11
Q
CP
A
- Circle Point
12
Q
A
- Keith (straight) needle
- The straight-body needle is used to suture easily accessible tissue that can be manipulated directly by hand
- Skin closure of abdominal wounds
13
Q
Absorbable Sutures
A
- Monocryl (Coral/Orange)
- PDS II (Grey) lasts months
- Fast Gut (Bright Yellow)
- Plain Gut (Yellow)
- Chromic Gut (Tan)
- Vicryl/Dexon (Purple)
- Maxon (Grey)
14
Q
Non-Absorbable
A
- Nylon (Green)
- Prolene (Light Blue)
- Gore-Tex (White)
- Silk (Blue)
- Cotton (Pink)
- Stainless Steel → Used for Sternum
- Ticron (Orange) → Mesh
15
Q
Braided Sutures
A
- Knots are more secure
- Germs can reside inside of braids
- Avoid vicryl (braided) if infection is present
16
Q
Monofilament
A
- has memory → Unravels (stretch to remove memory)
- must tie multiple knots to hold
- Better for infection
17
Q
Chromic Gut _____ ______ and is used in ________.
A
- absorbs quick
- head/neck
18
Q
Why might vicryl be appealing to gen surgery or ortho?
A
- long healing time
19
Q
Why is prolene/silk appealing to vascular?
A
- it keeps it’s integrity long term/over a life time
20
Q
Items to include with consent documentation
A
- Name of healthcare facility
- Specific name of the intervention to be performed
- Indications for the proposed intervention
- Name of the Health care professionals performing the intervention
- Risks and benefits associated with the proposed intervention
- Discussion of the risks and benefits with the patient or patient’s legal representative
- Signature of the patient or the patient’s legal representative
- Date and time the patient or the patient’s legal representative signed the informed consent document
- Date, time, and the signature of the person who witnessed the patient or the patient’s legal representative signing the informed consent
21
Q
Am I responsible for obtaining the informed consent?
A
- No. The surgeon, anesthesiologist, or other licensed practitioner obtains the informed consent.
22
Q
You may be asked to witness the patient or guardian’s signature on the informed consent …
A
- This is only okay if you are not directly involved in the case.
23
Q
Complications of surgical bleeding
A
- Obstruction of view of surgical field → longer operating times
- Need for blood replacement therapy → Multiple organ failure, systemic inflammatory response syndrome, transfusion-related lung injury (TRALI), increased infection risk, increased mortality
- Risk for hypothermia
- Hemodilution and Acidosis
- lactic acid forms with decreased O2 levels
- large amounts of banked blood, acidosis can occur due to lactate production in the tissues, along with excessive IVF administration of chlorides
24
Q
Surgical hypothermia
A
- Potential for coagulopathies
- When core body temp nears 34°C (93.2°F), platelets begin to lose their ability aggregate; AKA hypothermic coagulopathy
- Hypothermia alters the pharmacodynamics of anesthesia /meds, increased PACU stay, contributes to adverse myocardial outcomes.
25
Q
Methods for warming
A
- Active
- Forced air, conductive heating blankets
- Passive insulation
- Warm blankets
- Ambient room temperature
- Warmed IVF
26
Q
Thrombocytopenia may occur due to ____
A
- Massive blood loss
- After Heparin administration → HIT
27
Q
Hypovolemic shock
A
- Decreased CO → affects gas exchange →compensation mechanisms can fail if bleed doesn’t stop → Patient death
28
Q
How to monitor I&O
A
- Communicate amount of irrigation solution used → Subtract from suction canister
- Place used sponges in location where the anesthesia professional can visualize them
- Weigh sponges
29
Q
How to stop surgical bleeding
A
- Hold pressure → with sponges
- Electrosurgery
- Energy generating devices
- Suturing and ligaing
- Turnoquets
- Hemostatic agents and medications
- Ligating clips
30
Q
Risks associated with energy generating devices
A
- ignition source and the most frequent source of OR fires
31
Q
Medications for Hemostasis
A
- Epinephrine → vasoconstriction
- Vitamin K
- Protamine
- Vasopressors
32
Q
RN Circulator responsibilities rt RSI (Retained surgical items)
A
- Ensure no open, countable items are in the room from a previous procedure
- Verify that count boards and count sheets do not contain information from a previous procedure
- Initiate the Count
- View the surgical items being counted
- Record in a visable location (count board) the counts of soft goods, sharps, misc. items, and items placed in the wound
- Record instrument counts on preprinted count sheets
- Report any discrepancy
- Primary responsibility: Prevent RSI
33
Q
Scrub person responsibilities rt RSI (Retained surgical items)
A
- Maintain organized sterile field and standardize instrument set ups
- Perform counts in a manner that allows RN circulator to see the surgical items being counted
- Know the location of soft goods, sharps, and instruments on the sterile field and in the wound
- Know the character and the configuration of items used by the surgeon and first assistants
- Speak up → for discrepancy
- Inspect items for breakage or fragmentation before use and immediately after removal from the surgical site
- Primary responsibiliy: accurately accounting for items used during surgical procedure
34
Q
Why are F/C always indicated for appendectomies?
A
- To help monitor for bladder perforation
35
Q
Counts are performed when?
A
- Before procedure
- When adding new items
- Before closure of a cavity within a cavity
- When wound closure begins
- Whenever RN/Scrub is permanently relieved
36
Q
How to document discrepancies
A
- All actions taken to recover the missing item
- Description and location of the item if known
- Patient notification and consultation
- Plan for FU care
37
Q
Document to prevent RSI
A
- Who did the counts
- Discrepancy? → What resolution?
- Surgeon notification about the status of the count (if count is correct or if items are missing)
38
Q
A
