Patient Safety Flashcards
The surgeon has decided to perform a closed reduction of the patient’s fractured radial and ulnar bones. Why is this preferable over an open reduction that might more accurately align the broken ends?
Closed reduction reduces the likelihood of infection
Opening the skin interrupts the first line of defense against infection. A closed reduction is a safer option for the patient.
The perioperative nurse explains how the surgical site will be prepared for surgery after induction. This is an example of what part of the nursing process
Implementation
It’s a nursing action. In this example the nurse is ‘explaining’.
Vasovasostomy
-vasectomy reversal, is a surgical procedure that partially reverses a vasectomy by reattaching the cut ends of the vas deferens
-microsurgery performed under the magnification of the operating microscope
Redness with blistering is considered what stage of pressure ulcer?
Stage 2
present as a shallow open ulcer with a red-pink wound bed or may also present as an intact or open serum-filled or serosanguineous filled blister.
The 54-year-old woman is scheduled for cataract removal. During the perioperative interview the patient lists the following as current medications: Timolol meleate (Timoptic) and pilocarpine for glaucoma and metoprolol (Lopressor) and diazoxide for hypertension. The perioperative nurse is aware that
The patient should not instill the eye medications on the morning of surgery
Pilocarpine causes the pupil to constrict. This opens the ocular drainage system to help lower
the pressure. Any medication that constricts the pupil would make cataract surgery impossible.
The surgical team goes to the burn unit for the patient’s dressing change. A plastic isolator is used for the 44-year-old fire fighter with second and third degree burns on his torso and lower extremities. The surgical team performs the dressing change under anesthesia through the clear plastic isolator. What is the purpose of this isolator?
To prevent hypothermia
Patient care is given through the clear plastic walls. The environment around the patient
inside the isolator is controlled at 90 F (32 C)
and 94% humidity to conserve heat loss by evaporation. While the wounds are wet
evaporation also increases fluid loss.
In the recovery area during the neuro assessment the patient’s pupils are found to be pinpoint. What might cause this and what should the nurse do next?
-A sign of narcotic toxicity
-the nurse should quickly assess for additional signs and symptoms: reduced consciousness and depressed respirations
-give Narcan as indicated
Mrs Garcia speaks very little English. What is most appropriate for her care during her experience in the perioperative area?
Allow a family member to escort her in the pre and post operative areas
How does the Roux-en Y gastric bypass procedure cause considerable weight loss for the patient?
Largely calorie restrictive and mildly malabsorptive procedure that removes a critical segment of the mucosal surface of the stomach leaving a small pouch.
Gastric band
Uses constriction
Gastrectomy
partial or total removal of stomach
performed for malignancy
G is brought to the OR for a vaginal hysterectomy. When positioning the patient on boot stirrups how can the perioperative nurse help protect the patient from experiencing foot drop postoperatively?
Rest the weight of the leg on the thigh and calf and not on the back of the knee. This avoids pressure on the popliteal nerve.
Injury to the popliteal nerve contributes to foot drop.
When placing a patient in a dorsal recumbent position how should the arms be positioned?
At the sides with palms toward the body
Dorsal (supine)
This protects the ulnar nerve and is a natural
position for the upper extremities.
The following is one example of a system used to assess for readiness for a patient to be discharged after surgery.
Aldrete scoring system
commonly used for establishing postoperative discharge criteria.
This method should not be used to replace
patient assessment in determining suitability for discharge.
A 56-vear-old woman has arrived in the OR for a cataract extraction surgery. The operative site is prepped under aseptic conditions after anesthesia has been administered. What solution does the circulator use to prep the patient’s eye?
5% povidone iodine
How is the patient positioned for placement of the Veress Needle during the laparoscopic tubal ligation?
Trendelenburg
safest position for insertion of the Veress
needle (for insufflation during laparoscopic
procedures) because the bowel drops down out
of the way.
Patients with one or more of Virchow’s triad are at increased risk for
Deep vein thrombosis
Virchow’s triad describes the three broad categories of factors that are thought to contribute to thrombosis.
Hypercoagulability
Hemodynamic changes (stasis, turbulence)
Endothelial injury/dysfunction.
Scott triggers
Increased risk of perioperative pressure ulcers if yes to 2 or more
-Age (62 or older)
-Serum albumin or BMI (<3.5 g/L or BMI <19 or >40)
-ASA (3 or greater)
-Surgery time (over 3 hours)
Munro assessment scale
Low score, low risk for pressure ulcer development
Mobility
Nutritional state (length of NPO)
BMI
Weight loss (in 30-180 days)
Age
Co-morbidity
Specific skin integrity tools for OR
Munro assessment
Scott triggers
Braden scale is not specific to OR
Avenues of heat loss- Evaporation
Sweating
Avenues of heat loss- Radiation
Heat transferred from body’s surface
Different temps not in contact with each other
Avenues of heat loss- Conduction
Heat transferred to other object by contact
Ex: cold bed
Avenues of heat loss- Convection
Air currents over the body
Radiation hazards components
Time
Distance
Shielding
Fire risk is made up of
Ignition source
Oxidizer
Fuel
Under what side should a wedge be placed for a pregnant patient
Right side
Vena cava on right side and want relief from pressure, baby weight on left side
Adequate staff required to move patient <53 pounds/24 kg 
Anesthesia and one person with draw sheet
Adequate staff required to move patient 53-105 pounds/24-48 kg
Anesthesia and two people with draw sheet
Adequate staff required to move patient 105–157 pounds/48–71 kg 
Anesthesia and three people with transfer device a.k.a. sliding board
Adequate staff required to move patient >157 pounds/71 kg
Four or more people with mechanical device, a.k.a. air transfer device
Use device for holding if extremity weighs how much?
35 lbs or greater
Shearing
Folding and compression of tissue in between two surfaces moving in opposite directions
Warm ischemic time
The time the breast specimen is removed from the patient
Cold ischemic time
The time the breast specimen is placed in fixative
When providing patient education for a child, it is important to understand which learning characteristic of children?
Children respond to a trial and error approach
-They are task oriented, use extrinsic thought process, and value self-esteem 
How many different levels of Perioperative teaching are there?
3
Perioperative teaching: information
Includes explanations of procedure on what to expect throughout the phases of Perioperative care
Perioperative teaching: psychosocial support
Includes encouraging the patient to share their anxiety and supporting coping mechanisms
Perioperative teaching: skill training
-Allows the patient to learn the skills required to function after the procedure
-provides confidence and understanding
Wound healing phase: inflammatory
0 to 3 days
Redness, edema, phagocytosis
Think of: firefighters coming to burning building
Wound healing phase: proliferation
4 to 24 days
Granulation and epithelial tissue forms
-Think of: rebuilding building foundation
-Nutrition important - high albumin levels and proteins necessary
Wound healing phase: remodeling
24 days to one year
Scar formation and contracture
-Think of: adding bricks and cement to building
Wound closure: primary intention
All layers of wound are approximated, closing skin
-Most surgical wounds
Wound closure: secondary intention
Skin left open following surgery
-deep tissue layers may be closed or open
-For patients with chronic wounds
-Granulation
-Pressure ulcer
Wound closure: tertiary intention
Delayed primary intention
-High suspicion of contamination
-Left open and packed
-Wound vacs
-Example: compartment syndrome
Wound healing patient risk factors
-nutrition
-Age (very young and old)
-Immuno suppression from steroids, NSAIDs, -chemo, radiation
-circulation/oxygenation
-Comorbidities such as diabetes 
Wound healing environmental risk factors
-Length of surgery
-Trauma
-Prolonged stress (increase in cortisol levels)
-Coagulopathies (hematomas created dead space)
Deep infection or implant defined by CMS as SSI if occurs within
90 days
Superficial infection, defined by CMS as SSI if occurs within
30 days
Dehiscence
Separation to the fascial layer
Class 1 (clean)
-Infection rate less than 5%
-Primary closure
-No break in technique
-Closed drain
Class 2 (clean/contaminated)
-Expected infection rate 8 to 11%
-Includes cases in which GI, GU, respiratory tract are entered under controlled conditions, and without spillage
-Bowel resection, hysterectomy, T&A, cholecystectomy
Class 3 (contaminated)
-expected infection rate 15 to 20%
-Fresh traumatic injury (<4 hours, delay)
-Breaking technique/spillage
-Appendectomy for acute appendicitis, cholecystectomy for acute cholecystitis
Class 4 (infected)
-expected infection rate 27 to 40%
-Clinical infection, perforated viscera, necrotic tissue
-I&D of abscess, ruptured appendix, GSW to abdomen, dead bowel
Skin antisepsis – hexachlorophene
Recommended as scrub for gram-positive MRSA
Not broad-spectrum
Not for use in premature babies
Skin antisepsis recommended for VRE
Chlorhexidine
Skin antisepsis that cannot penetrate organic material
Alcohol
Cloroxylenol
Para–chloro–meta-xylenol (PCMX)
Skin antisepsis for perineum, eye or ear
Povidone iodine
If iodine allergy use PCMX or 3% H2O2 for vaginal prep
Normal saline, PCMX or BSS for eyes
Normal saline, or PCMX for ears
Abdominal incision: right subcostal “kocher”
For open gallbladder, or pancreas
Abdominal incision: left subcostal
Splenectomy
Abdominal incision: paramedian and transverse
For too much skin adhesions
Abdominal incision: Chevron
For autopsy, or a liver transplant
Abdominal incision: pfannenstiel
C-section
Abdominal incision: McBurney’s
Appendix
Abdominal incision: midline
Exploratory laparotomy
Abdominal incision: inguinal
Hernia repair
Hernia inside hesselbach triangle
Direct inguinal hernia
Hernia outside hesselbach triangle
Indirect inguinal hernia
Usually scrotum
How long are multidose vials good for?
28 days
Virchow’s triad categories
-Hypercoagulability: clotting cascade triggered
-Hemodynamic changes (Venous stasis): immobility during surgery
-Endothelial injury/dysfunction: surgery interrupts vascular endothelium
What category of Virchow’s triad do we have control of?
Venous stasis: immobility during surgery
Can apply SCDs
