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
