Periop101 Flashcards
1
Q
clamps used to grasp fascia, cysts and knee cartilage
A
Allis clamps
2
Q
a biting instrument used for cutting tough tissue or bone
A
rongeur
3
Q
what do hemostats do?
A
clamp the vessel
4
Q
What are the steps for administering a bier block
A
- double tourni with an IV cath in the operative arm - arm is raised - proximal tourni cuff is inflated and local injected in IV -The distal cuff is inflated and the proximal cuff is deflated (if discomfort under cuff) - Anethstetic last until trouni is deflated
5
Q
when does the proliferation phase start and how long does it last?
A
2nd day after incision and continues for 22days. Events: ephithelization, neovascularization, collagen synthesis, contraction
6
Q
this is a spoon shaped instrument for scraping or cutting
A
curette
7
Q
what is a safe alternative and works on mucous membranes when pt is allergic to iodophors?
A
cationic phenolic mixture. Also safe on open wounds and around the eyes
8
Q
What are the benefits of using Microfiber Mops?
A
- Enhances cleaning power. Effectively reaching into crevices - Contributes to reducing water and chemical usage. Helps reduce procurement costs. - Helps increase productivity- does not have to change the solution between tasks - Helps reduce cross contamination between patient rooms -Helps reduce the risk of worker injury weigh less than conventional wet mops
9
Q
Any germicide that is labeled as a hospital disinfectant has past for activity against..
A
Pseudomonas, staph, salmonella
10
Q
What is a Process Challenge Device?
A
resistance to a sterilization process. May contain a biological, chemical or combination indicators. Tests the EFFICACY of the sterilization process
11
Q
Adverse Reactions to antibiotics?
A
- N/V -Colititis -Tissue Damage (with irrigation solutions, or topical
12
Q
this is the “arms” that run from the box lock to the finger rings
A
shanks
13
Q
Wound Class III
A
Fresh open accidental wounds
14
Q
Examples of direct expenses
A
medical supplies, personnel, purchases services.
15
Q
what is the hinge point of the instrument
A
box lock (there are 3 parts, the extension side, indented side and the pin)
16
Q
what events can happen during the inflammation phase
A
hemostasis, phagocytosis, edema
17
Q
What are appropriate safety measures for tourniquets?
A
- complete preop assessment - proper fit of cuff - keep skin prep from pooling under the cuff, can cause chem burns - Monitor inflation time, pressure - only use minimal effective pressure to crease bloodless field
18
Q
What is considered the most dangerous position
A
kraske, more exaggerated prone implications
19
Q
this is a device for, holding, joining or compressing tissue together
A
clamp
20
Q
When should you perform a count? (6)
A
1- baseline before procedure 2- when new items are added to sterile field 3- before closure of the cavity 4- when wound closure begins 5- at skin closure 6- at the time of permanent relief
21
Q
when does the remodeling phase happen
A
21 days after the incision and may continue for 2 years. Events: collagen remodeling, tensile strength gain
22
Q
Who is known at the Father of Medicine and what was he/she known for?
A
Hippocrates - cleanliness avoids infection - irrigation of dirty wounds with wine/boiling water, fire.
23
Q
what are some thermal methods for hemostasis
A
- Argon Beam Coagulator (ABC) - Electrosurgery (ESU) - Hypothermia - Laser Wounds - photocoagulation, plasma scalpel or harmonic, diathermy
24
Q
the same size as the laparotomy sheet, but the fenestration is transverse and closer to the top of the sheet for neck procedures.
A
Thyroid Sheets
25
this drain is used to drain the common bile duct through the abdominal wall
t- tube
26
what is the primary method to reduce smoke plume inhalation?
Local Exhaust Ventilation (LEV) (secondary, personnel should wear respiratory mask)
27
How is a Bier Block Used?
- a double cuffed tourniquet - extremity is elevated - Proximal cuff is inflated - Local Anesthetic is injected. - 2nd cuff may be inflated (distal) and proximal deflated after the anesthetic has taken effect, to relieve pain
28
what are some intraoperative owund factors?
-length of surgery -location of the wound -complications -foreign bodies in the wound -elimination of dead space in the wound -hypothermia
29
Methods for preventing blood borne pathogen exposure
-PPE -Garments -Masks - Eye Protection -Surgical Caps & Shoe Coverings - Gloves
30
Neural effects of lithotomy positioning?
- damage to femoral, obturator and perineal nerve - dislocation of the hips ( if not raised simultaneously) - injury to the fingers if too close to the break of the table
31
What chemicals are used for high-level disinfection?
- glutaraldehyde -Peracetic acid -Stabilized hydrogen peroxide -Ortho-phthalaadehyde (OPA)
32
What are the 3 elements that support combustion
Oxidizers, Ignition, Fuel
33
What specialties & implants are used for orthopedic?
ankle, finger, hip, knee, shoulder and toe joint implants; metal plates, screws, nails, pins, bone
34
Fire Safety Guidelines
move patients horizontally, work your way down to a lower level, evacuate ambulatory patients first, disconnect equipment connected to patients, ambu bags ready, if you catch on fire- stop drop and roll, evacuation plan posted in surgical suite
35
How can alcohol and smoking interfere with medication administration?
alter lab values. Concerns about medications given or interaction
36
what does elasticity
the ability to regain original form and length after being stretched
37
is used to cover an extremity. It is available as a woven material that does not provide a microbial barrier, it must be covered with a layer of plastic or a disposable drape
stockinette
38
Steps to confirming the patient and procedure?
-Patient's name / ID band - DOB - Medical Record # - Consents -Other- implant, blood if ordered, radiological exams.
39
Geobacillus is used for
steam sterilizers, hydrogen peroxide gas, ozone sterilizers, hydrogen peroxide vapor
40
Examples of hemostatic agnets
-Gelfoam -Microfibrillar collagen (Avitene) - Oxidized cellulose(suricel, Oxycel) -Topical thrombin
41
SBAR for PACU
- Verify Correct Patient - Surgeon & Anesthesia professionals - Type of Anesthesia - Labs - Precautions - Advanced Directives - Special Equipment, implants - Surg Count Status - Communication with family - Estimated blood loss - Lines/ Drains - Meds - Specimens obtained - thermal interventions - DVT
42
Five Rights of surgical specimens
1- Right Patient 2- Right date/time of collection 3- Right Lab Test 4- Right Surgeon 5- Right Specimen
43
What should you document if an airway is present?
- The Type, Use of Oxygen - Liters/min when patient is transported - Mental status, drowsiness, or if still asleep- prior to discharge from surgical suite
44
Flammable=
skin antiseptic agent that has a flash point of less than 100 F
45
Examples of local anesthesia -
all end in aine (cocaine, lidocaine, mepivacaine)
46
What corrective measures should be implemented if MH is suspected?
- stop surgery, if possible -if not, cont. with safe agents - provide 100% oxygen - Use iced saline
47
1 month to 12 months ability to understand
demands are expressed by crying. Responds to voices especially high pitched sounds. Smile, babble, gurgle.
48
What is a volatile liquid?
a liquid that evaporates quickly. May be found in liquid solutions or aerosol sprays. Usually associated with skin antiseptic agents, anesthetic gases, specimen fixativees and lubricants
49
This drape is used for carpal tunnel surgery
extremity drape
50
these sponges are used to absorb fluid and blood during cranial procedures and around the spinal cord
neuro-patties or cottonoids
51
What type of pathogenic fungi might you see in the OR
Aspergilius
52
What could cause a fluid imbalance?
- fluid restrictions (NPO) - Disease process (ascites) - Loss of fluids and blood during surgery - Wound drainage - Urinary output - NG tubes - Inadequate fluid replacement
53
what procedures utilize the kraske position?
rectal, lumbar laminectromy
54
Storage requirements for sterile packages?
- temp should be 72-78F - 4 air exchanges per hour - Humidity at 60-70% - Traffic limited to those trained - compliance with fire codes -8-10 inches above the floor - 18" below sprinkler heads - 2" away from outside walls - No outside shipping containers
55
is a longer version of the laparotomy sheet to permit coverage of an orthopedic fracture table.
Hip Sheet
56
what does phenol do?
- cauterizes the blood vessels
57
7 Rights of Medication Administration
1- Patient 2- Med 3- Dose 4- Time 5- Route 6- Indication 7- Documentation
58
How should you document irrigation fluids?
- fluids instilled and removed by suctioning - product and volume instilled - Strict I/Os
59
this is an instrument used for retaining or holding back tissue to maximize surgical exposure
retractor
60
What type of pathogenic viruses might you see in the OR
Hep B or C HIV
61
what are finger rings?
located at the opposite end of the instrument from the jaws.
62
This is used to: Cover arm boards to permit extension of the sterile field • Cover pieces of furniture or equipment • Wrap around extremities to permit the extremity to remain a part of the sterile field
Minor Sheet
63
having small or horizontal grooves on the edges or tips
serrated
64
this is a blade with a sharp edge used for cutting
knife
65
What is a bier block commonly used for?
upper extremity
66
is used to create a sterile field with the patient in the lithotomy position. It may have leggings incorporated into it if it is a reusable sheet.
Perineal Sheet
67
Things to check when working with electrical equipment?
- hand piece in insulated holder when not in use - warming devices are at appropriate settings - check skin temp and condition -do not place elec equip on the patient -do not place hose under patient's blankets -do not use in an oxygen enriched env't (trach) - allow time for skin prep solutions to dry -footswitch location - ensure compatibility before use
68
what does pliability mean?
- the ability to bend easily
69
Factors to be considered when selecting drape products
-amount of irrigation fluid that is anticipated -anticipated blood loss -surgeon preference
70
What are examples of contaminated wounds?
-Rectal surgery -Laparotomy with significant spillage - Traumatic wounds (gunshot, stab, perforation) - Acute inflammation of any organ without frank pus present -Compound Fractures
71
Charting by exception is a time saver and...
based on the premise that the patient manifests normal response to most interventions
72
How can herbal preparations interfere with medication administration?
may accentuate the toxicity of anesthetics or interfere with drug metabolism or clearance. May also effect bleeding times
73
Examples of Anti-inflammatory agents
- Dexamethasone (Decadron, Hexadrol) - Hydrocortisone (Solu-Cortef) - Methyprednisolone Sodium (Solu-Medrol) - Methylprednisolone Acetate (Depo-Medrol) - Triamcinolone Acetonide (Aristocort, Kenalog)
74
Cardiovascular effects of reverse trendelenburg position?
- decreased cardiac return - decrease in BRAINSTEM perfusion - pooling in lower extremities - orthostatic hypotension
75
capillarity means
the ability to soak up fluid along a strand
76
What do flowables do?
combo of passive and active hemostatic agents ex: floseal, and surgiflo
77
what are the guidelines for handling French eye and eye needles?
- inspect for dull or burred points/defects - avoid puncturing gloves - the diameter must match the use and type of suture - needle may unthread prematurely - double wrapping the eye or using 2 surues creates a larger hole causing additional trauma to tissue
78
What are examples of dirty wounds?
- incision drainage - total evisceration - perforated viscera - amputations
79
Safety measures for using a dispersive electrode
- inspect skin beforehand -document the integrity of the skin before applying and after removing -the electrode should cover as large an area of the patient's skin as possible to minimize ESU injuries. -should be an appropriate size
80
What does Class 1 Process indicator represent?
- package has been exposed to the sterilization process
81
this is an instrument with a sharp edge for cutting or scraping a bone
rasp
82
Respiratory effects of prone positioning?
- vulnerable due to compression o diaphragm - increased airway pressure
83
How should you handle foreign objects such as bullets, fragments, pellets, knives?
- handle as little as possible - use rubber tipped forceps or latex gloves - do not drop bullet into metal basin - avoid wrapping bullet in cotton or tissue - place bullet in sterile plastic specimen container - do not rinse with saline or water
84
a cutting instrument with 2 shearing blades used to cut tissue or material
scissors
85
What is the unrestricted area?
Patients families staff are permitted. Entrance exits, patho lab, blood bank. 68-75F
86
Post op Report should include?
- verify correct patient, dx, operative site, and procedure, position and allergies - Surgeon and anesthesia care professionals - current or pending lab date - precautions - Advanced directives, special equipment, instrumentation & implants - Surgical count status - Previous communication with family - Blood products available - Any catheters or invasive lines -Meds administered (dose & time) - IV and irrigation fluids used - specimens obtained - thermal interventions - DVT prophylaxis and patient family or significant other info
87
what does knot tensile strength mean
force measured in pounds which the suture strand can withstand before it breaks when knotted.
88
Potential complications in lap abdominal surgery
dysrhthmias hyper/hypotension hypoxemia extraperitoneal insufflation subq emphysema hypercarbia gas embolism instrumentation injuries peritonitis or wound infection delayed hemorrhage coupling of surrounding tisssues
89
What specialties & implants are used for ophthalmic
intraocular lens implants, scleral buckles, human donor corneas, and artifical eyes
90
The split sheet is of the same size as a laparotomy sheet, but instead of a fenestration, one end is cut longitudinally (split) up the middle. The upper end may be in the shape of a “U.” Adhesive strips are along each side of the strip to help secure the drape in place.
Split Sheet
91
Based on the physical status classification system, what is P4?
severe systemic disease that is a constant threat to life
92
this is the working end of the instrument, the part that makes contact with the tissue
jaws
93
What is Class II Wound Infection
Clean-Contaminated -evidence of infection, spillage from GI -Colon Resection -C-section, Tracheostomy, Appendectomy, hysterectomy, Cholesytecomy
94
How can recreational drug use interfere with medication administration?
close observation for symptoms of withdrawal especially during and after long procedures.
95
Cardiovascular effects of modified fowler s position?
- venous pooling in the lower extremities - air emboli due to negative pressure on the head and neck -need to use doppler
96
Symptoms of MH
- unanticipated increase in end tidal CO2 -tachycardia - jaw muscle rigidity -hyperkalemia -lactic acidosis -increased oxygen demand -increased body temp - give Dantrolene
97
What is Class IV Wound Infection
Dirty Infected - retained devitalized tissue like gangrene, presence of purulence.
98
what specimens are collected aerobic or anaerobic on culture swab in sterile tube
exudate
99
what does an ESU do?
current causes coagulation
100
What data may be monitored during surgery x6
- ECG - Pulse Ox - BP - Temp - Fluid Volume Status - Neuro Status
101
This drain is used for drainage traction and as a tourniquet
penrose drain.
102
Examples of Otic Agents?
- Xylocain with epinephrine - Epi - Gelfoam - Ringer;s lactate or saline - Floxin - Cortisporin, Cipro
103
what is the suffix for synthetic absorbable sutures
- poly
104
where do transient microorganisms live?
on the epidermis of the skin
105
At Birth ability to understand
cannot communicate. Demands are expressed by crying. Parents stay with baby as long as possible
106
what can alcohol NOT penetrate?
organice material
107
a surgical instrument used to clamp blood vessels to prevent or stop bleeding
hemostat
108
Local Exhaust Ventilation includes..?
- wall suction with inline filter -smoke evacuator
109
what do you need to document for forensic injury
- location of the wound - size, shape, depth - characteristics of edges, - discolorations - patterns - if more than one wound - take a photograph - evidence taken and name of person taking the evidence
110
Examples of non depolarizing muscle relaxants long acting?
d-tubocurarine, metocurine (maintenance)
111
What to do for a small flame fire?
pour saline or water slowly grab towel to smother keep face far away from the fire assess the surgical field for secondary fire activate alarms if necessary notify chain of command
112
What are the procedures prior to prepping with antimicrobial solutions
- hand hygiene before skin prep -open prep set -using cuffing technique to prep gloves -place the run off towels, one furthest from you first -dip towels into antimicrobial solution and squeeze out any excess
113
Common Oxidizer include
oxygen, nitrous oxide, Sevolfurane
114
What to document for skin integrity
- free from injury - skin condition under ekg pads - presence of drains or packing drainage - type of drain - foley catheter - NG tube - IV meds
115
Who is the pioneer of antiseptic practices?
Florence Nightingale
116
Effects on the cardiovascular system with trendelenburg position?
- Elevated BP - Orthostatic hypotension - cyanosis and increase vascular load to heart
117
Typical route of administration for pit hormonal agents?
regional injection
118
What does Class 3 Process indicator represent
reacts to a SINGLE parameter of the sterilization process
119
What are the 3 major guidelines to prevent contamination in the OR
hand hygiene for 15 seconds, a waterless, alcohol based produce for minimizing microbe transfer, horizontal surfaces should be damp dusted before the first procedure of the day
120
Exogenous sources for pathogens
areobes that live in the air
121
What to do for a large flame fire?
Stop the flow of breathing gas Remove the drape to the ground Water mist extinguisher or carbon dioxide Pull, Aime, Squeeze, Sweem
122
iodophors with detergents are called?
scrubs
123
What specialties & implants are used for Ear Nose Throat (ENT)
- cochlear implants, myringotomy tubes, stapedectomy prostheses, ossicular prostheses
124
This drape is used for a tympanoplasty
aperture drape
125
What is Class III Wound infection
Contaminated -non purulent inflammation - open fresh, accidental
126
Role of the scrub Nurse
Prep room for surgery Maintaining the sterile field Passing Instruments to surgical Team Prepping meds and other items on the sterile field assisting in safe transfer of patient to PACU
127
What are the 3 elements of infection
1- source or reservoir 2- Susceptible host 3- Method of transmission
128
When a pneumatic tourniquet is used documentation includes:
1- skin protection padding 2- Name of person who applied the tourniquet 3- Locations of the cuff placement 4- Cuff Pressure 5- Inflation & Deflation Times.
129
Steps to identifying the patient?
- Ask patient to state their full name - Date of Birth - State their planned procedure, document in patient's own words
130
Based on the physical status classification system, what is P1?
Normal healthy patient
131
What do active hemostatic agents do?
contain thrombin and products mixed with thrombin. They enhance clotting at the bleeding site
132
This might be used after fracture fixation. Cast, Splint. Cast - Plaster of Paris (gypsona), fiberglass. Soft padding stockinette, cotton bandage, cotton roll, (depending on location), and cast material.
rigid support
133
Where is an epidural anesthetic injected?
the space between the ligamentum flavum and the dura
134
Role of the RNFA
Under direct supervision of the surgeon
135
Which type of clamp does not have teeth?
babcock
136
Wound Class IV
Traumatic wounds over 4 hours duration
137
Common Fuel sources include
patient staff linens, prep solutions, skin degreasers, body tissues, patient hair, intestinal gases
138
Whos is the founder of bacteriology?
Robert Koch, developed flow steam sterilizer
139
Why should electrodes be inspected for insulation damage?
can cause patient burns
140
Basic safety standards for handling powered instruments
- always hand the pwred instrument to the surgeon with the SAFETY ON -Blade or drill guard in place -irrigation ready to use with the drill
141
What specialties & implants are used for Genitourinary?
- articial urinary sphincter and penile prostheses
142
When should surgical gloves be changed?
- after touching helmet system hoods and visors (ortho) - adjusting optic eyepieces on the operative microscope - after direct contact with methyl methacrylate (cements) - when gloves swell - every 90-150 minutes
143
Cardiovascular effects of lithotomy positioning?
-circulatory pooling in the lumbar region - drop in BP if legs are lowered too quickly -compromised due to compression on the abdomen.
144
These drapes may be used in eye or ear procedures. Placement of this drape onto the patient should be done carefully to prevent placing the adhesive directly onto the eyelid, or if the patient is awake, a feeling of not being able to breathe.
Aperture Drape
145
Based on the physical status classification system, what is P3?
severe systemic disease
146
What does Class 6 Process indicator represent?
Reacts to ALL parameters of a specific cycle. (emulating indicator)
147
this is a 2-bladed tweezer type instrument for handling tissues and dressings
forceps
148
these sponges are used for walling off viscera and absorbing fluid in large areas
laparotomy sponges
149
these clamps have curved fenestrated tips with no teeth. They are used to grip or enclose delicate structures
babcock
150
what is a linear stapler used for?
throughout the alimentary tract and thoracic procedures
151
Time out includes these 5 things?
- name of patient - procedure to be performed - site of procedure -implants/radiological exams needed
152
What does sterile mean?
absence of living microbes
153
What should you factor in with geriatric patients and pain
decreased sensation to pain and body temp variations. Problems with depth and color perception as well as dry eyes.
154
IV induction examples i.e Total Intravenous Anesthesia (TIVA)
thiopental or propofol midazolam and ketamine can also be given with muscle relaxant/analgesic
155
what does memory mean?
tendency of a suture to recoil to its original shape during packaging. High memory= less knot security
156
Based on the physical status classification system, what is P6?
declared brain dead, organs being removed for donor purposes.
157
The plastic sheeting has a band of adhesive along one edge of the drape. It may be used to “wall of” a contaminated area such as a stoma, from the clean skin area to prevent spillage of contents and subsequent contamination from microbes.
Towel Drape
158
Respiratory effects of modified fowler's position?
- unimpaired respiratory movement - reduction in lung capacity - respiratory insufficiency
159
What is the medication use process?
1- Procuring 2- Prescribing 3- Transcribing 4- Dispensing 5- Administering 6- Monitoring
160
Bacillus atropheus is used for
ethylene oxide sterilizers, dry heat
161
What are prions
- not bacteria or viruses, but malformed proteins - Breutzfeldt- Jakob Disease is a degenerative neuro disease caused by prions - Resistant to most forms of sterilization - Do NOT have vulnerability to moist heat
162
Respiratory effects of reverse trendelenburg position?
- impaired respiratory movement - decreased lung capacity - respiratory insufficiency
163
What should the surgical team do if there is a count discrepancy?
- Circulator notifies the team - Surgeon suspends wound closure and conducts search of wound - Periop searches the surgical field, instrument table, count bags, trash and linen receptacles - If items is not recovered intraop imaging should be performed -Imaging should be read by radiologist, communicate to surgeon - Follow policy/procedures for documentation
164
Surgical conscience demands the recognition of improper practices observed during surgery by
any member of the health care team
165
What is the order of operations at the end of a procedures for removing drapes?
1) Last suture placed 2) Incision site dressed 3) Removal of instruments 4) Removal of drapes 5)Dispose of disposables
166
What position is used for chest and kidney procedures?
lateral recumbent
167
What type of pathogenic bacteria might you find in the OR
- staph - e. coli - strep -MRSA - Pseudomonas - Serratia marcesens - C.diff
168
What complications may occur with spinal anesthesia?
- periop nurses must be alert to HYPOTENSION - paralysis, respiratory mgmt, bp support - postop spinal headache (younger patients)
169
what are suture/straight scissors used for?
prepping strands of suture, cutting sutures. Cutting fabric or paper,
170
Common Ignition sources include
electrosurgical units, argon beam coagulators, lasers, fiber optic light sources/cables, power tools, defib, electrical equip
171
Skin Condition of Pediatric patients
no thermoregulatory system. Body temp varies with environmental changes. Inspect for color, temp, sensation, turgor, thickness, amt of subq tissue
172
this is an instrument with a single beveled cutting edge for cutting or chipping bone
chisel
173
What does Class 5 Process indicator represent?
reacts to ALL parameters over a specified range. (integrating indicator)
174
What are the 4 basic style of drapes
1- towels 2-fenestration sheets 3- non-fenestrated 4-plastic
175
What are the goals of sterile technique and aseptic practices?
prevent surgical site infection optimize primary wound healing minimize length of recovery from surgery
176
How often should terminal cleaning be performed?
Once every 24 hours
177
Patients that should be treated as latex sensitive?
- hx of anaphylaxis to latex - allergic or non-systemic reactions to latex - Multiple surgical procedures - Child with Spina Bifida and GU abnormalities - High risk group
178
this drape would be used for a vaginal hystrectomy
perineal drape
179
What are some cardiovascular effects related to supine positioning
- decreased HR - increase in cardiac output - Decrease in systolic pressure - venous pooling in lower extremities
180
What are the properties of CHG?
-disrupts cell membranes -gram positive and gram negative -kills yeasts and molds - rapid acting in resistant and transient microbes. -inhibited after 24 hours of application -the alcohol lasts up to 48 hours
181
what do fibrin sealants do?
- promote blood clotting by increasing the amt of fibrinogen and thrombin at a bleeding site ex: tisseel, Tachosil, Vitgel, Coseal, Duraseal, Progel, Bioglue, Omnex
182
This drape would be used for an umbilical hernia repair
lapartomy
183
What specialties & implants are used for General Surgery
- synthetic mesh
184
Examples of inhalation induction anesthetics
nitrous oxide, halothane, sevoflurane (used mostly with children to avoid IV)
185
What are the 2 kinds of data?
subjective & objective
186
Why are occlusive (semipermeable) dressings used?
to prevent drying of the surgical wound and to increase the proliferation of epithelial cells.
187
What are biological dressing used for?
to help control infection by covering denuded area, preventing loss of serum, decreasing pain, stimulating the formation of epithelium in the dermis directly underneath it, and promoting formation of granulation tissue.
188
Wound Class II
respiratory tract is entered under controlled conditions
189
Who introduced hand-washing with chlorine solution to reduce mortality rates?
Ignaz Semmelweis (1865)
190
where do resident microorganisms live
on the deeper layers of the skin
191
Steps in sterilization
1) cleaning 2) decontamination 3) Assembly 4) packaging 5) sterilization 6) storage 7) transportation
192
13-19 years ability to understand
May not feel comfortable asking questions, explain procedures ahead of time with realistic explanations
193
What are examples of a clean wound?
- eye surgery - hernia repairs - breast surgery - non traumatic neurosurgery - non-traumatic orthopedic, cardiac, or peripheral vascular surgeries
194
What are some preoperative risk factors for surgery?
-nutrition -physiology -medications -age -pre-op skin prep -pre-op stress -existing bacterial infection
195
Safety hazards with lasers?
- Eye injury - Tissue Burns - Plume Inhalation - Fire Hazards - Beam Exposure - Electrical Hazards
196
Combustible=
requires a higher temperature to cause ignition and has a flash point \> 100 F
197
Role of the Circulating Nurse
Prep room for surgery assisting in positioning of the patient assisting the anesthesia care provider completing the nursing documentation ADOPIE
198
What are some respiratory effects related to supine positioning
- decrease vital capacity - decrease in diaphragmatic expansion - even distribution of lung ventilation
199
be used as added protection above or below the surgical area,or for draping areas in which a fenestrated sheet cannot be used.
Medium Sheet
200
Technique for Wet Vacuuming?
flood the floor with detergent disinfectant. May be dispersed through a spraying device. Water is left to sit for at least 5 minutes.
201
The fenestration is longitudinal and covers the surgical site on the abdomen, back, or a comparable area.
Lap Sheets
202
Technique for damp dusting
begin with higher surfaces and work down to the lower leveles
203
What are 14 elements to include in documentation during intraoperative phase
patient positioning, electrical equip, temp regulatory devices, lasers, tourniquets, medications, skin preps, implants, tubes, instruments (sponges, sharps), blood administered, F & Es, specimens, dressings applied
204
What are interoperative responsibilities of the periop nurse undering general anesthesia
- Starting IVs - Setting up monitoring equipment & art lines - Double checking blood - warm blankets and ER equip - Applying cricoid pressure
205
Based on the physical status classification system, what is P5?
moribund patient not expected to survive without operation
206
Endogenous sources for pathogens
surgical personnel, the OR env't, tools, instruments, supplies brought to the sterile field,
207
How is the patient position in reverse trendelenburg?
head are higher than the feet
208
what are the 3 parts of an ESU
generator, active electrode, and dispersive electrode
209
What biopsies require specialized equipment?
- nerve - muscle - testicular - bone marrow
210
this is used to scrape away soft tissue
currettes
211
Examples of depolarizing muscle relaxants used?
succinylcholine- short acting
212
3-6 years ability to understand
Able to interpret terms LITERALLY. Give child a toy if possible
213
what do gelatin sponges do?
swells, forming a clot
214
What specialties & implants are used for cardiac or vascular surgery?
- valve prostheses, artificial human hearts, arterial tube grafts, Teflon & Dacron patches, vena cava filters, pacemakers, implantable cardioverter defibrillator
215
What does certification do for nurses?
- enhances feeling of personal accomplishment - professional growth - validates specialized knowledge - evidence of professional commitment
216
Adverse reactions with hemostatic agents?
- thrombis if introduced to vascular space - Gelfoam can increase wound infection due to blood residue - Oxidized cellulose may cause pressure in confined spaces
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What precaution measures should you take when using an electrode?
-coupled pad should be an appropriate size -positioning devices should not be placed btwn the electrode and the patient -check for tears or breaks in the pad
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5 Domains of PNDS?
Safety, Physiologic, Behavioral (knowledge), Behavioral (Rights/Ethics), Health Systems.
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Based on the physical status classification system, what is P2?
has a mild systemic disease
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Standard Precautions include
- For every patient -Hand Hygiene -PPE -Patient resuscitation - Environmental Control
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4 Basic Concept of periop care that don't change
1- patient's safety is first 2- patient needs to openly communicate with nurse 3- Nurse must be able to educate the family 4- Rapport can make a different in patient/family's perception of the perioperative experience.
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What are examples of a clean contaminated wound?
-Dilatation and Curettage (D& C) - Total abdominal hysterectomy (TAH) - Gastrectomy - Cholecystectomy without spillage - Elective appendectomy - Cytoscopy - Transurethral Resection (Bladder procedures on a patient with neg urine cultures)
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what is the term for the dispersive electrode?
"grounding pad"
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Power Outtage precautions
- which outlets are connected to ER power - Battery operated lights - handhelf flashlights in each OR and other anesthsia and patient care areas - routinely check back up equipment - document back up equipment checks
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What specialties & implants are used for plastic reconstructive
arch bars, breast implants, chin implants, stainless steel wire and mini plating devices
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What is the restricted area?
Where sterile field is established and must be monitored Specialized equipment Scrubs must be worn, hair covered, masks Operating Rooms or Invasive Procedures 68-75F, 20-60% humidity
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these are used to cut skull bones in cranial surgery
trephines
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What is a Class I wound infection
Clean - not infected, not inflamed. result of blunt trauma -Thyroidectomy, Mastectomy, Ganglion, Herniorrhaphy, Laminectomy
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What do occlusive hydrogel dressing do?
Absorb fluid and blood and protect wound from drying out. Also has cooling effect.
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Medication & Solutions relabeling x6
- name - concentration - initials of RN - Expiration (if used within 24 hours) - Expiration time if less than 24 hrs - Date prepped
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when does the inflammation phase start and how long does it last
immediately after incision, lasts for 6 days
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this is the portion of the instrument located slightly above the finger rings on the shanks.
ratchet
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What are the key business metrics for the OR that OR nurse can affect:
- On time starts - Turnover Time - Volume of cases- ( can be increased by on time starts and lowering turnover time) -Length of cases- have all equipment ready to go
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what specimens are prepared in a dry sterile container?
calculi
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Objective Data includes
independent facts, history and physical, lab and radiology reports, patients POC, nursing notes
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what is the term for the active electrode
"pencil"
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What does Class 4 Process indicator represent?
reacts to TWO or MORE critical parametrs of sterilization
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Who is the founder of microbiology?
Louis Pasteur. fermentation caused by particles of living matter.
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What is the specimen preps are prepared fresh in a sterile container?
muscle, ova, donor tissue, biopsy, permanent section (gallbladder), hormonal assay
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What is peracetic acid sterilization?
- liquid chemical method - uses LOW temps - Equal in efficacy to steam and ethylene oxide - Requires a special unit - CANNOT be used for ALL surgical items
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chemical methods for hemostasis
pharmacological, topical (thrombins, gelatins, flowable agents, etc)
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this is a blade that is offset from the axis of the handle
bayonet
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Contraindications for CHG
- should not be used above the neck - not brain or meninges -no vaginal or mucous membranes
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Items included in the documentation accompanying specimens are
Date and Time of collection Site Surgeon's name & Contact Information
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When is trendelenburg position used?
lower abdomen and pelvic organs when there is a need to tilt the viscera away from the pelvic area
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Effects on the respiratory system with trendelenburg position?
-decreased lung volume -pulmonary congestion/edema -decrease diaphragmatic movement -impaired gas exchange
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What procedures utilize modified fowler's position?
- posterior cervical spine procedures
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Respiratory effects of lithotomy positioning?
- lung tissue can be engorged with blood, decreased lung capacity
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Examples of Cardiac Agents?
-Papaverine hydrochloride (dilator) - Plasma Lyte (patency of graft) - Radial Artery solution (verapamil, nitro)
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Adverser Rx to Pituitary agents?
- uterine tetany - tremor - diaphoresis - vertigo - ab cramps - nausea
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What measures should you take when contamination is found?
- remove everything that has come in contact - change gloves and gown of team member in contact - break down back table to re-establish sterile field
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Adverse Reactions to Anticoagulants?
- Chills - Rash - Urticaria - Pruritus - Fever - Anaphylaxis
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Administration for hemostatic agents?
- topically - spray form
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How are antibiotics administered?
- Irrigation solutions - IV - Ointments/topicl
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Name 1 example of Anticoagulants?
Liquaemin (heparin)
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What are the 4 elements of culture of safety?
1- A sense of trust among team members 2- Proactive approach rather than reactive, blaming 3- Dissemination & verification of receipt of information to all levels of staff & mgmt 4- A Sincere commitment to affirming safety as the first priority
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what are the procedures when utilizing the hand to hand method (from scrub to surgeon)
- hold knife between thumb and fingers with the cutting edge down - present the handle of the knife with the cutting edge of the blade pointing down and away from both of you - must be able to see the tip
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What does Class 2 (Bowie-Dick) indicator represent?
- used to detect air leaks, ineffective air removal. Presence of non condensable gases.
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What specialties & implants are used for Neurosurgery?
- aneurysm clips and ventricoculoatrial shunts
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what does a coefficient of friction?
- the ability to glide through tissue and retain a knot
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Scrubbing procedure steps (8)
1- inspect hands and arms 2- open gown and place on the table 3- open scrub brush package 4- wet and lather hands and forearms 5- clean under fingernails of both hands with nail cleaner 6- scrub fingertips nails palm and wrist to 2 inches above elbow 7- repeat the procedure to other hand 8- rinse hands and arms keeping fingers pointed upward
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What information is needed for an explanted device, as far as specimen data?
- date of explantation - name, mailing address and phone of physician - date of the pt's death or date of device was returned to manufacturer,
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these sponges are used in all surgical procedures to absorb blood and other fluids. Contains x-ray detectable filaments?
- raytec
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this is an instrument capable of being placed into a fixed position
self retaining
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what do stryptics do?
vasoconstrictive effect
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to grasp fascia, bones and uterine ligaments
kocher clamps
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When is reverse trendelenburg position utilized?
- upper abdomen, head/neck, facial surgery
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What are relative contraindications endoscopic MIS procedure
• Prior abdominal or pelvic surgery • Previous generalized peritonitis • Obesity (except bariatric surgeries) • Advanced cardiac disease • Pregnancy • AAA • Umbilical abnormalities • Surgeon’s lack of experience
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this is a double beveled cutting edge for cutting or marking bone
osteotome
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What is PNDS used for with regard to positioning.
- nursing dx - accurate assessment - to plan nursing interventions - pt status and responses to positioning.
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What type of specimens are usually fresh in sterile container?
- CSF (virology) - Amniotic fluid (genetic) - Semen (cell count) - Infertility Study (cell Count)
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psychosocial assessment includes...
perception of surgery, expectations of care, coping styles, knowledge levels, ability to understand, religious beliefs, and cultural practices
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What is the semi-restricted area?
Scrubs must be worn and hair covered. Restricted to specific personnel and patients. Storage areas, processing, instruments, utility areas, scrub sinks, preop holding. 72-78F
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what are some mechanical methods for hemostasis?
- manual pressure - ligating clips - bone wax - tourniquets - esmarch bandage - ligature - pledget
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1 - 3 years ability to understand
will be able to understand and respond to simple commands. Let child have a familiar toy
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what are some chemical methods for hemostasis
- fibrin sealants - phenol solution - Gelatin Sponge - Oxidized cellulose - microfibrillar collagen
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Transfering a patient steps? (7)
1- gurney close to the patient's bed 2- cover pt with a sheet/blanket 3- stand next to gurney on side opposite from the bed to prevent the patient from moving too far 4- 4 personnel if can't move- cross pt's arms, use draw sheet, roll 5- roll pt up to retrieve the transfer device 6-pull up guard rails and unlock gurney 7- wheel feet first into OR area
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Wound Class I
clean and nontraumatic
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What are absolute contraindications endoscopic MIS procedure
-advanced generalized peritonitis -abdominal distention -irreducible hernia -coagulopathy -Patient’s inability to tolerate formal laparotomy
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Which patients are at risk if there is a fire?
- Increased anesthetic complication - Post op Infection - Increased surgical/post op risk
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What factors can reduce risk of gas emboli?
-simultaneous coagulation before gas enters the venous system -purge air out of the argon gas line - use lowest gas flow setting -intraabdominal cavity should be flushed w/ CO2 between periods of deactivation. -insufflator alarms should be activated.
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Examples of nondepolarizing muscle relaxants used? (intermediate acting)
atracurium, mivacurium (end is curium) - intermediate duration, for intubation and maintenance anesthesia
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Cardiovascular for the elderly & pediatric patients
decrease and slowing of the blood flow. Decreased rate of medication absorption and need for DVT prophylactic devices. Warming devices for normothermia
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What should you document with a tourniquet
- serial # - Limb Occlusion Pressure (LOP) - Cuff Pressure - Location of tourni - skin before and after - name of person placing the cuff - time of inflation/deflation - assess extremity
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this has small notches or projections used to grasps tissue and prevent the instrument from slipping
toothed
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Reversal muscle relaxants
edrophonium, neostigmine, flumazenil.
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this drain is used to accumulate blood and fluid from the operative site.
suction drains
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are supplied in pairs to cover patients in the lithotomy position. One edge is cuffed to protect the sterile hand during draping.
Leggings
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What are examples of diagnostic imaging?
renographin, cystograin, hypaque
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similar to the laparotomy sheet except that the fenestration is larger to permit larger exposure. Used for breast and chest procedures.
Breast Sheet
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where should patient's heels be placed for lithotomy position
in the lowest possible position
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Safety measures for tourniquets
- Complete preop assessment -Ensure proper fit of the cuff - keep fluids from pooling - monitor inflation time -- monitor pressure display to determine accuracy - use minimal effective pressure to create bloodless field
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What microorganisms are used in biological indicators?
Geo-bacillus, Bacillus atropheus
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What are some examples of mechanical hemostatic agents?
- collagens, cellulose, gelatins, polysaccharide
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what should you document regarding positioning?
1- preop assessment 2- type & location of paddling devices 3- name/title of positioner 4- post op outcome eval
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6 - 12 years ability to understand
explain procedures ahead of time. Afraid to ask questions. Let parent make choices if possible
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Route of administration of diagnostic imaging?
contrast in instilled directly into an organ or duct with a catheter or tube. The surgeon administers the contrast. (May promoste cell sickling)
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Examples of indirect expenses
heating and cooling, electricity, administrated or support personnel (housekeeping)
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What are some uses for an occlusive (semipermeable) dressing?
pressure ulcers, dermal ulcers, donor sites, burns, and abrasions.
300
How are anti-inflammatory agents administered?
- IV - Locally
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Preventive Measures for Skin Injury
- physical alterations - determine those at risk - Verify presence of prosthetics or corrective devices - Evaluate for S/Sx of injury as a result of positioning.
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Cardiovascular effects of prone positioning?
- pressure on the inferior vena cava and femoral veins - reduced venous return and hypotension - pressure on the carotid artery, dysrhythmia
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Aseptic means
the absence of pathogenic microbes
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How are Cardiac Agents administered?
- Topical (Papaverine) - Irrigation (Plasma) - Immersion (Radial Artery solution)
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Name five things that are considered the "sterile field"
- patient - operating room - instrument table - mayo stand - equipment
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What are examples of posterior pituitary hormonal agents?
vasopressin
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what procedures utilize the prone position?
- spine, neck, buttocks, lower extremities
308
iodophors WITHOUT detergents are called?
paints
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Safety issues with the endoscopic surgery and the light source
- do no turn on the light source until until the cable connected to the telescope -when not in use should be placed in standby mode -check the status of the lightbulb -cables should not be placed on the surgical drapes
310
Routes of administration for otic agents?
topical or by instillation. Should be at body temperature
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Steps for positioning a patient?
- Ensure correct size for devices - Pad bony prominences - Protect eyes, ears, breasts & genitalia - Massage heels and back of head, ROM - Ensure skin does not touch any metal - Ensure properly secured to the OR bed with safety belts and straps.
312
Skin Condition of the Elderly
decreases in subQ fat, decrease in skin elasticity, thinning, atrophy of sweat glands
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what does atraumatic mean for surgical instrumentation
- not having a crushing or biting effect on tissue
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these sponges are used to absorb blood/fluid in very small areas or to dissect through delicate tissue
dissector sponges
315
What properties should a drape have?
- Blood and fluid resistant, to prevent microorganisms -Resistant to tearing, puncture and abrasion -Anti-static to prevent fires -dull non glaring
316
clips. The patient’s skin and anatomic landmarks are visible through the drape and the incision is made through the plastic drape. These drapes are versatile; they may be used for draping irregular body areas, to seal off a contaminated area such as stoma, or to cover equipment such as a tourniquet or a microscope.
Vi Drapes
