PA's Role Flashcards
What are the 8 surgical positions?
Fowler Prone Lateral Recumbent Lithotomy Reverse Trendenberg Supine Sitting Kraske
Who is in a surgical team?
Physician/Surgeon
Physician Assistant
Scrub nurses
Circulating nurses
Define the term “Sentinel Events”, discuss different types, and outline ways to prevent them.
as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a person or persons, not related to the natural course of the patient’s illness. Sentinel events specifically include loss of a limb or gross motor function, and any event for which a recurrence would carry a risk of a serious adverse outcome.
Know specifically what constitutes informed consent, and be able to present the elements to a hypothetical patient and surgical procedure.
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What are the Pre-Op responsibilities?
Pre-op evaluation Careful H&P Order and review lab, xray and diagnostic testing Arrange outside consults as needed Pre-op teaching/consenting
What is an elective surgery?
A surgery that is subject to choice, made by the patient or physician. It is beneficial to the patient but does not need to be done
What are examples of elective surgeries?
Joint replacement
Skin biopsy
Kidney transplant
What is an urgent surgery?
A surgery for a condition that is potentially life threatening
What is the time table to complete an urgent surgery?
24-48hrs
What are examples of urgent surgeries?
Kidney stone
Partial stomach or bowel obstruction
Bleeding hemorrhoids
What is an emergency surgery?
Immediately life threatening
What is the time table to complete an emergency surgery?
a few hours
What are example of emergency surgeries?
GSW, Ruptured appendix, Stab wound, complete bowel obstruction
What are the essentials of a Pre-Op Note?
Date and time of entry Diagnosis Plan: (procedure) Surgeon Labs CXR results EKG results Blood: (none, type & screen, type & cross units) Consent (operative permit): signed
What is a sentinel event?
An unexpected occurrence involving death or serious physical or psychological injury, or the risk therefore of. The risk therefore of includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.
What is an example of a sentinel event?
Medication error, Delayed treatment, Fall, Restraint issues, Wrong surgical site/surgery, Suicide, Wrong case, Wrong patient
Is a sentinel event the same as a medical error?
No, not all sentinel events occur because of an error and not all errors result in sentinel events
What have been the most frequently reviewed sentinel events in the last 3 years?
Wrong case, wrong site, wrong patient
Unintended retention of a foreign body
What is your role in the OR during Pre-OP?
Assist OR staff w/ preparing the patient for surgery; positioning, prepping, drapping, airway, IV access
What is first assisting in the OR?
A learned behavior that requires experience and knowledge of the procedure
What is our role in first assisting?
Provide adequate exposure for the surgeon
Keep the field dry
Anticipate steps in the procedure
Anticipate the cutting of sutures
When do you write your Post Op note?
While still in the OR if time allows
What are the essentials of the Post Op note?
Date Pre-Op diagnosis Post-Op diagnosis Procedures Complications U/O Drains Surgeon Assistants Anesthesia (type) Findings EBL Fluid Replacement (volume/type:IVF, blood) Condition Dispatch
Post Op Care Day 1 Guidelines
Assess the level of pain, lungs, CV, flatulence and BMs
examine for distention, tenderness, BS, wound drainage or bleeding
assess need for IVF and foley
convert IV meds to PO
out of bed activity as tolerated
consider stool softener
DVT prophylaxis
What are our Post-Op responsibilities?
Aim to facilitate every aspect of patient recovery
Post-Op orders
Order/review labs, xray, diagnostic procedures
Patient rounds
Order Meds and adjust dosing
Patient education
Talk to patients
What are the essentials of Post-Op Orders?
VS Activity(bedrest, OOB, ambulation) Diet (NPO, clears, advance as tolerated) IV Fluids (type, rate, additives) I&O (foley, drains, suction) Meds (pain, abx, routine, PRN) Nursing care (dressing/wound care, precautions, drain/catheter care) Lab orders Radiological orders
What are our Post Op Responsibilities?
Know the status of your patient at all times
wound care
bedside placement: central lines, test tubes
Drains, tubes, central line, catheter removal
Suture and staple removal
Post-Op education
Prescribing
Circulating nurses:
‘circulate’ around the operating room and between the operating room and the outside, seeing to any equipment and other needs of the operating team. The circulating nurse assists the scrub nurse with the instrument count. No one leaves until all instruments, needles, lap pads and anything used during the procedure is accounted for.
Scrub Nurses:
usually at the elbow of the surgeon, overlooking the operative site and handing equipment to the surgeon as needed. To maintain the sterility of the operative field, a scrub nurse does not leave the side of the operating table until the procedure is completed or another nurse has scrubbed in. The scrub nurse is responsible for the instrument count.
PA
Often first assists in surgery (sometimes there is another physician, sometimes there is no first assist.) Stands directly across from the surgeon.
Surgeon/physician
Stands directly beside the patient and is the team leader.
In what surgery do you place a pt in the supine position?
most surgeries (abdomen, chest, orthopedic - spine etc.)
In what surgery do you place a pt in the prone position?
Orthopedic – Spine
In what surgery do you place a pt in the R/L Lateral position?
Orthopedic
In what surgery do you place a pt in the jack-knife position?
Colorectal, Anorectal
In what surgery do you place a pt in the lithotomy position?
Gynecologic, Urologic, Anorectal
In what surgery do you place a pt in the sitting position?
Orthopedic (neck, shoulder), neurosurgery
What goes into a daily progression note?
Date and time of entry
HD# and POD#
Abx and # day of total planned
SOAP
Post Op Care Day 2
if passing gas and/or with stool, advanced diet as tolerated
discontinue tubes, drains as indicated
change surgical dressing
Post Op Care Day 3-7
Check pathology reports remove staples and place steri-strips assess pt. daily be alert for complications and treat accordingly prepare for discharge
Hospital responsibilities for discharge planning
write discharge orders provide patient education write prescriptions arrange for home health care equip schedule follow up apts write discharge note dictate or write the discharge summary: referral MD should ALWAYS be sent a copy
Discharge Note
admission date discharge date attending surgeon primary diagnosis secondary diagnosis consults procedures/dates reason for admission hospital course discharge labs discharge mes condition @ time of discharge discharge instructions follow up apts
Ex: 19yo male c/o periumbilical pain that has moved to the RLQ x 2 days, fever, diminished appetite. + guarding, + rebound, + psoas, obturator signs, +cutaneous hyperesthesia
PMH: none
Labs: WBC 22,000
Is this an elective, urgent or emergency surgery?
emergency?
