Study Guide Flashcards
Who can provide anesthesia services?
- Anesthesiologists
- Certified RN Anesthetists (CRNAs)
- Anesthesiologist Assistants (AAs)
Factors to consider before determining what anesthetic to use for a patient
- Age
- Length and type of surgery
- Patient and surgeon preferences
- Patients co-existing diseases
- Patients mental and psychological status
- Patients previous experience with anesthesia
- Plans and protocols for post op pain management
- Position for surgery
How long before surgery can you have clear liquids?
2 hours
How long before surgery can you have breast milk?
4 hours
How long before surgery can you have infant formula
6 hours
How long before surgery can you have a light meal?
6 hours
How long before surgery can you have fried foods, fatty foods or meat?
8 hours
Phases of General Anesthesia
- Induction
- Maintenance
- Emergence
What is the reversal agent for fentanyl?
Naloxone
What is the reversal agent for Rocuronium, Vecuronium and Pancuronium?
Sugammadex
What is the reversal agent for Midazolam?
Flumazenil
What triggers HM?
inhalation anesthetic gases and succinylcholine
What is the most specific sign of MH?
Increased end-tidal carbon dioxide
Other signs of MH?
Skeletal muscle rigidity
Ventricular dysrhythmia
Skin mottling
Hyperthermia
How is hypothermia defined?
Temp less than 36
Two actions the RN should take when confronted with an MH crisis
Get the HM cart Call for help Ventilate with 100% O2 Give Dantrolene Cool the pt if >39 stop at <38
Role of an RN during a local only procedure
Monitor: BP EKG O2 HR
Role of the RN during moderate sedation surgery
Assess for an provide mod sedation and analgesia Cardiac monitoring Able to administer reversal meds Airway assessment CPR
After spinal anesthesia, what complication should the nurse watch out for?
Hypotension
Complications that can occur during administration of anesthesia
Difficult airway Laryngospasm Cardiac Problems Hemorrhage Anaphylaxis Hypothermia MH
Patients risk factors due to alcoholism
Lowered immunity
Prolonged bleeding times
Increased stress response
Cardiac complications
Physiological effects of cannabis
Anxiety, euphoria, memory dysfunction Tachycardia, atherosclerosis Airway edema, chronic bronchitis Increased appetite, hyperemesis Paranoia BS elevation unknown tolerance to analgesics Potential increase in pain
The SDOH
Economic stability Education Social and Community Context Health and Health Care Neighborhood and Build environment
Goals of Enhanced Recovery after surgery
- Reduce patients stress response
- Optimize physical function
- Facilitate recovery
What is the no-fly zone?
A zone designated for the safe use of imaging and other equiptment
Potential complications with gas insufflation
Increased BP Increase in blood CO2 levels Acidosis Decreased cardiac output Arrhythmias Gas Embolism Peritoneal Irritation Decreased renal blood flow/urine output
What is a boreoscope
An inspection tool that is placed through the instruments lumen and is used to inspect the internal element of the instrument
A rare but serious complication of insufflation
Gas embolism
When should damp dusting be done in the OR?
Before the first surgical case of the day
When does terminal cleaning occur?
At the end of the day in each OR that was used.
What are the areas of MDR?
Decontamination
Assembly
Sterilization
Storage
What area in MDR is cleaned last?
Decontamination
3 ways to measure cleanliness of the perioperative environment
Visual Inspections
Fluorescent gels/markers with black light
ATP monitoring
What IFU info in most important in the OR?
The contact time (time product remains wet on surface)
Documentation in the patients health care record includes:
Current and past health status
Nursing diagnoses and interventions
Expected patient outcomes
Evaluation of patients response
For surgical consent, what is the nurse responsible for?
Reinforce what has been discussed
Ensure the consent is correct
Ensure the consent is signed and witnessed
When taking a history, what should be noted?
Allergies Implants, piercings Discharge plans Medications Nutritional status Cultural considerations
Patient health record is a:
Tool for monitoring and evaluating
Resource to determine compliance
Method to review for reimbursement for services
Who can obtain informed consent?
Surgeon or licensed practitioner performing the surgery
Anesthesiologist or Anesthesia provider
Info from the pre-op nurse should include:
Patient identifies Planned procedure Operative site NPO status Allergies Diagnostic test results Current meds Blood products available Mobility issues Family contact
Info from the OR nurse to post-op nurse
Current condition for ABCs Type of anesthesia Procedure Surgical issues Skin condition Pressure injury risk Hypothermia status EBL Input/output Drains/Dressings/Packing
Informed consent should include:
Name of facility Name of intervention Indications for intervention Name of the HCP performing Risks/Benefits Discussion of Risks/Benefits Signature Date and time it was signed Date and time of the witness
What are the 3 methods of hemostasis?
Mechanical
Thermal
Chemical
Examples of Mechanical Hemostasis
Pressure Clamps Sutures Staples Clips Ligatures (tie) Pledgets (non-absorbable suture) Bone wax
Examples of Chemical Hemostasis
Epi Vitamin K Protamine Vasopressors Lysine Active agents (thrombosis) Passive agents (collagen, flowable agents, sealants)
Examples of Thermal Hemostasis
Electric current Bipolar Laser Ultrasonic energy Argon gas
Goals of hemostasis
Decrease and control bleeding Minimize the need for blood replacement Optimize the surgical field view Avoid organ damage Shorten length of stay Decrease risk of infection Decrease costs
Issues associated with surgical bleeidng
Visualization Surgical time Blood transfusion Hypothermia SSI Thrombocytopenia Hemodilution Lactic acidosis
How can you determine how much blood was lost?
Suction canisters
Sponges
Drapes
Lab values
4 types of surgical drains
Simple
Closed suction (JP, hemovac)
Chest
Negative pressure wound therapy
6 steps of medication use
Procuring Prescribing Transcribing Dispensing/Preparing Administering Monitoring
Symptoms of anaphylaxis
Headache Anxiety Stridor Abd pain Tachycardia Hypotension Itchy Swelling
Precautions to avoid med errors
Using single dose vials
Prefilled syringes
Limiting the number of medication concentrations
Buying meds in a size close to typical dose
Securing stored meds
Side effects of extravasation
Edema
Abd distension
Intraabdominal compartment syndrome
Side effects of intravasation
Hyponatremia
Hypervolemia
Cardiovascular complications
Pulmonary edema
How to handle hazardous materials
Contain spills Dispose of materials in designated container Store correctly Use correct amount in the correct way Wear PPE
A culture of safety is promoted by:
A health care organizations commitment to patient safety
A commitment to safety at all levels of the organization
A focus on systems, process improvement, and individual accountability
Sufficient resources
Ability of providers to discuss near miss events without reprisal
3 steps for preventing wrong site, wrong procedure, wrong patient
Conducting a pre-procedure verification process
Marking the site
Performing a time out
The 3 types of errors that a team member can make:
Skill-based
Knowledge-based
Situational-based
What is a skill-based error
The provider has the knowledge for the action
There is little or no attention or attention is diverted
What is a knowledge-based error?
Mistakes include errors in perception, judgement or interpretation
What is a situational-based error
Lack of attention and situation factors play a role
What is the 3 goals of ERAS?
Reducing a patients stress
Optimizing physiological function
Facilitating a patients recovery
What is an accountable care organization (ACO)
a model of care that includes physicians, heath care organization representatives, and other health care providers joining togethers to:
- give high quality coordinated care
- avoid duplication of services
- decrease errors
Intraoperative factors to consider for positioning
Anesthesia
Length of surgery
Position required
What are the 3 basic surgical positions
Supine (dorsal recumbent)
Lateral
Prone
In the supine position, arms are extended less than 90 degress to avoid compression of the:
Brachial Plexus
What are the pressure points in a supine position
Occiput Scapulae Thoracic Vertebrae Olecranon process (elbow) Sacrum/coccyx
If a patient is pregnant, what side would you place a wedge under?
Under the right side
What happens if you return a patients legs down from lithotomy too fast?
A significant drop in blood pressure
What nerves can be damaged in the lithotomy position?
Femoral
Obturator
Perineal
What 3 forces can act upon the patient during positioning?
Pressure
Shearing
Friction
Name the 3 zones in the perioperative environment
Unrestricted
Semi-Restricted
Restricted
What medication is used in an HM crisis?
Dantrolene
How do you mix dantrolene?
With 60ml of sterile water
What med do you provide to a patient experiencing LAST?
20% Lipid emulsion therapy
Goals of surgical skin prep
To remove soil and transient microorganisms from the skin
To reduce the resident microbial count
To inhibit rapid rebound growth of microorganisms
Commonly used antimicrobial agents
Chlorhexidine gluconate (CHG) 4% Chlorhexidine gluconate (CHG) and alcohol Povidone - Iodine Alcohol
What to use for a patient with an allergy to oidine?
Baby shampoo and a balanced salt solution
Examples of EARS protocols
Strengthening exercises
Smoking cessation
Improved nutrition
Additional pre-op education
Factors that determine the level of the patient care in post-anesthesia
Type of surgery Length of surgery Type of anesthetic Comorbid conditions Anticipated postanesthetic requirements and interventions
What is Capnography
Capnography is the monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases
Elements of the nursing process
Assessment Nursing diagnosis Outcome identification Planning Implementation Evaluation
What is research
Systematic inquiry or investigation
What is quality improvement
A method of creating a change to a current process and then measuring the effectiveness of the change
Policies and procedures are created to protect:
Patients
Personnel
Organization
What is an Indemnity Payment
Payment made on behalf of the policy holder
What is Liability
Legal responsibility
What is malpractice
A nurses negligence or any intentional act that causes physical, financial, emotional, psychosocial and/or cognitive harm
What is standard of care
Actions of a reasonable and prudent professional
What is tort
A breach of duty to another person as outlined by law
What are the 4 elements of malpractice
Duty
Breach of duty
Breach caused an injury
The injury was harmful to the patient
3 tenets of radiation safety
Time
Distance
Shielding
NIOSH (National Institute for Occupation Safety and Health’s Hierarchy of controls:
Eliminate
Substitute
Engineering controls (smoke evac, needles IV)
Administrative controls (policies, education, testing)
PPE
Factors that affect event-related sterility
Packaging material quality Storage conditions How an instruemnt is transported How the instrument in handled Environment conditions
Asepsis is:
The absence of pathogenic microorganisms
Sterility is:
The absence of virtually all microorganisms
What is used to monitor a sterilizers efficiency and effectiveness ?
A biological indicator
What does a negative biological indicator mean?
Sterilization conditions were met
If a sterilization load has an implant, what must the load have?
A biological indicator
What are the 3 testing methods that can be done during instrument sterilization?
Swab/strip
Solution vial
ATP
How does the swab/strip testing method work?
A swab/strip that tests for specific contaminants (protein, blood, carbs)
A wet swab is wiped on a surface, if it changes color, the instrument is not clean
How does the Solution Vial testing method work?
Individual vials test for specific contaminants
A water moistened swab is wiped on the surface, swab and placed into the vial, if the vial turns a color, that contaminant is present.
How does the ATP testing work?
Tests for ATP which is in all organic material
A pre-treated swab is wiped on a surface then placed in a test device. If ATP is present, a bioluminescence is created and can be read by the testing device
What are the two types of steam sterilizers?
Dynamic Air Removal: Pre-Vacuum
Gravity Displacement
How does the Dynamic Air Removal Pre Vacuum sterilizer work?
A vacuum pulls out the air which is replaced by steam
How does the Gravity Displacement Sterilizer work?
Air is removed by gravity in which incoming steam replaces.
The air is pushed down and pushed though a port or drain at the bottom of the sterilization chamber
What is the bowie-dick test?
A quality assurance test that detects if any air is trapped in the sterilizer
How long should you wash your hands for?
20 seconds
What are instruments typically made out of?
Stainless steel
Titanium
can be plated, but prone to chipping, peeling, rupture and corrosion
What are 3 categories for stainless steel instruments
Anodized plating -satin finish -glare proof -prone or corrosion Ebony -black finish -prevention glare and reflection Mirror plating -shiny -impedes visibility
What are some qualities of titanium instruments
Inert: doesn't react with other substances Nonmagnetic Lighter/Stronger Used in microsurgery Blue anodized finished reduces glare
4 types of instruemnts
Cutters
Clamps
Retractors
Other
3 classifications of endoscopes
Rigid
Semi-Rigid
Flexible
What is the chain of infection
Causative organism Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host
Define Pathogenicity
Proportion of infect people who develop clinically apparent disease
Virulence
Proportion of clinically apparent cases that are severe or fatal
Suture classification system elements
Natural or Synthetic
Absorbable or Nonabsorbable
Monofilament or multifilament
Suture material characteristics
Physical configuration
Handling
Potential tissue retraction
Suturing methods
Interrupted Continuous or Running Retention Subcuticular (suture line under the epidermis) Purse string
SSI catergories
Superficial -epidermis/dermis/subcutaneous (30 days) Deep Incisional -fascial/muscle (30-90 days) Organ/Space -organ, space (30-90 days)
