Role of the PA

Question 1

T/F: 25% of the PAs in clinical practice work in surgical specialities.

Answer 1

True

Question 2

T/F: PAs attend to much of the medical management and assistance in the OR.

Answer 2

True

Question 3

Surgically, what does a PA do?

Answer 3

1. Pre-operative consultation, evaluation, testing.
2. Intraoperative first assisting
3. Post-Anesthesia Care Unit (PACU) Care
4. Surgical Intensive Care Unit (SICU) Care
5. Inpatient Unit Care
6. Outpatient Care and F/u

Question 4

This is a type of surgery subject to choice made by the patient or physician. The procedure is beneficial to the patient but does not need to be done at a particular time. Ex. Joint replacement, skin biopsy, kidney transplant.

Answer 4

Elective Surgery

Question 5

This is a type of surgery for a condition that is potentially life-threatening. Surgery usually must be completed in 24-48 hours. Ex. kidney stone, partial stomach or bowel obstruction, bleeding hemmorhoids, ectopic preggo.

Answer 5

Urgent Surgery

Question 6

This is a type of surgery for a condition which is immediately life-threatening. Surgery must be performed within a few hours. Ex. Ruptured appendix, open skull fracture, some GSW or stab wounds, complete bowel obstruction.

Answer 6

Emergency Surgery

Question 7

What goes into a Pre-Operative Note:

Answer 7

Date and time of entry
Diagnosis
Plan/Procedure
Surgeon
Labs
CXR Results
EKG Results
Blood (if given, how much, what type, etc.)
Consent (needs to be signed)

Question 8

Integral parts before walking into the OR?

Answer 8

1. What procedure?
2. Regional Anatomy (blood supplies, lymphatics, organs
3. Normal physiology and pathophysiology of the region
4. Surgical and Nonsurgical Treatment options
5. Complications!?

Question 9

This is a term for an unexpected occurrence involving death or serious physical or psychological injury or risk thereof. Serious injury specifically includes loss of limb or gross motor function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

Answer 9

Sentinel Event

Question 10

T/F: Medical Error and Sentinel Event are synonymous

Answer 10

False! Not all sentinel events occur because of an error, and not all errors result in sentinel events. #Basic

Question 11

Most common Sentinel Events

Answer 11

1. Wrong patients, wrong site, wrong procedure
2. Unintended retention of a foreign body
3. Delay in treatment
4. Fall
5. Op/Post-op complication
6. Other unanticipated event
7. Suicide
8. Criminal Event
9. Medication Error
10. Perinatal Death/Injury

Question 12

In this position, the patient is on his/her back. Head rotation to put the brachial plexus under traction. Excess abduction of the upper limb. Forearm pronation putting pressure on the ulnar nerve in ulnar grove.

Answer 12

Supine Position

Question 13

In this position, the patient is placed on his or her ventral side with minimal neck flexion. Face should be in the soft head ring with no pressure on the eyes or nose. Shoulder should have a small degree of anterior flexion abducted and externally rotated to less than 90 degrees. There should be NO pressure in the axilla and the abdomen should be free.

Answer 13

Prone

Question 14

In this position, the patient is on their right side on a bed curved more than 180 degrees. Gives access to the left side.

Answer 14

Right Lateral Patient

Question 15

This is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The ______ position involves the positioning of an individual’s feet above or at the same level as the hips (often in stirrups), with the perineum positioned at the edge of an examination table.

Answer 15

Lithotomy

Question 16

This position is where a patient’s abdomen lies flat on the bed. The bed is scissored so the hip is lifted and the legs and head are low.

Answer 16

Jackknife

Question 17

This position is where you sit

Answer 17

Sitting

Question 18

First Assisting in the OR consists of?

Answer 18

1. Providing adequate exposure for the surgeon
2. Keep the field dry
3. Anticipate the steps in the procedure
4. Anticipate the cutting of sutures

Question 19

What do you NOT do when first assisting in the OR?

Answer 19

Do not inadvertently lean on the patient.

Do no attempt to retrieve or replace instruments on the Mayo stand.

Question 20

If just assisting in the OR, what should you do?

Answer 20

• Stay in the room until the patient leaves or the surgeon grants permission to leave.
• Assist with the application of dressing, transferring the patient from the OR table to the bed or stretcher, and other tasks.
• Write the Op note while still in the room, if time allows

Question 21

Operative Note includes:

Answer 21

• Date
• PreOp Dx
• PostOp Dx
• Procedure(s)
• Surgeon
• Assistant(s)
• Anesthesia (type)
• Findings
• Complications
• Estimated Blood Loss
• Fluid Replacement (volume/type: IVF, blood)
• Urine Output
• Drains
• Condition

Question 22

Post-Op Responsibilities (in and out patient)

Answer 22

1. Aim to facilitate every aspect of patient recovery
2. Post-op orders
3. Order/Review lab, XR, Dx procedures
4. Patient rounds
5. Order meds and adjust dosing
6. Patient education
7. Talk to your patients.
8. Know the status of your patient at any given time
9. Wound care
10. Bedside placement, central lines, chest tubes
11. Drain, tube, central line, catheter removal
12. Suture and Staple removal
13. Post-op education
14. Prescribing

Question 23

What post op orders can we order?

Answer 23

• Vital signs
• Activity (bedrest, OOB, ambulation)
• Diet (NPO, clears, advance as tolerated)
• IV fluids (Type, rate, additives)
• I&O (Foley, drains, suction)
• Medications (pain, antibiotics, routine, PRN)
• Nursing care (dressing/wound care, precautions, drain, catheter care)
• Lab Orders
• Radiological Orders (CXR)

Question 24

POD 1 Guidelines

Answer 24

1. Assess level of pain, lungs, cardiac status, flatulence and bowel movement
2. Examine for distention, tendernesss, bowel sounds, wound drainage, bleeding
3. Assess need for IVF; d/c when taking adequate PO. Discontinue Foley Catheter
4. Convert IV meds to PO
5. Out of bed activity as tolerated
6. Consider stool softener
7. DVT Prophylaxis

Question 25

POD 2 Guidelines

Answer 25

1. If passing gas and/or with stool, advance diet as tolerated
2. D/c tubes, drains as indicated
3. Change surgical dressing

Question 26

POD 3-7 Guidelines

Answer 26

1. Check pathology reports
2. Remove staples and place steri-strips
3. Assess patient daily
4. Be alert for complications and treat accordingly
5. Prepare for d/c

Question 27

D/c Summary

Answer 27

1. Admission Date
2. Discharge Date
3. Attending Surgeon
4. Primary Diagnosis
5. Secondary Diagnoses
6. Consults
7. Procedure(s) / Date(s)
8. Reason for Admission
9. Hospital Course
10. D/c Labs
11. D/c Meds
12. Condition at time of d/c
13. D/c Instructions: diet, bathing, activity restriction, wound and dressing care, parameters for reporting concern
14. F/u appt.