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Study Guide Questions Flashcards

1
Q

What must occur in a room prior to the first case cart entering the room or the first case taking place?

A
  • Damp dust all horizontal surfaces at beginning of day
    • Surgical lights
    • Booms
    • Equipment
    • Furniture
    • Counters
    • Computer/key boards
  • Cleaning must be done before bringing case carts or supplies in room
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2
Q

ASA 2

A

A patient with mild systemic dz

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3
Q

ASA 3

A

Patient with severe systemic dz

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4
Q

ASA 4

A

A patient with severe systemic dz that is a constant threat to life

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5
Q

ASA 5

A

A moribund pt who is not expected to survive without the operation

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6
Q

ASA 6

A

A declared brain-dead pt whose organs are being removed for donor purposes

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7
Q

Fasting with clear liquids

A

2 hrs

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8
Q

Fasting with breast milk

A
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9
Q

Fasting with infant formula

A
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10
Q

Fasting with Nonhuman milk

A

6 hrs

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11
Q

Fasting with light meals

A
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12
Q

Cricoid pressure

A
  • Located below thyroid cartilage
  • Firm pressure with thumb/index finger to occlude esophagus
  • Do not release until cuff for ET tube is inflated and position is confirmed
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13
Q

Phase 1 induction

A
  • Anesthetic agents given to put patient to sleep
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14
Q

Phase II Maintenance

A
  • anesthetics are continually through IV or inhalants to maintain anesthetized state
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15
Q

Phase III Emergence

A
  • End of procedure, anesthetic agents d/c or reversed.
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16
Q

Tx of MH

A
  1. Stop Sx if possible and d/c inhalants (anesthesia) and succinylcholine. If Sx cannot be stopped then continue with non-triggering agents
  2. Grab MH cart and Dantrolene
  3. Call for help
  4. Hyperventilate with 100% O2 at 10L/min
  5. Give 2.5mg/kg Dantrolene rapidly by IV. Repeat as needed until pt responds. If > 10mg/kg given without response, consider another Dx.
  6. Obtain blood gasses
  7. If core temp > 39C or 102F cool pt
  8. Stop cooling measures once temp reaches 38C or 100F
  9. Tx dysrhythmias and electrolytes
  10. Call MHAUS hotline to consult
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17
Q

Why must cricoid pressure be applied?

A
  • to occlude esophagus and move cricoid cartilage
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18
Q

When do you release cricoid pressure?

A

cricoid pressure should not be released until the cuff on the ET tube is inflated and the position is confirmed

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19
Q

What is the most specific sign of MH?

A
  • Increase in end-tital CO2
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20
Q

Definition of Hypothermia

A

core body temperature of < 36C (96.8F)

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21
Q

Factors that contribute to hypothermia in the OR

A
  1. OR is cold
  2. Large areas of skin exposed to air
  3. Prep is wet and applied to skin
  4. Irrigation fluids are cooler than body temp
  5. Long surgeries
  6. General and regional anesthesia can dysregulate body’s thermoregulation mechanisms
  7. Vasodilation shifts blood from the body to cooler peripheral tissues
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22
Q

Role of RN when a pt is scheduled to receive local-only anesthesia during sx.

A
  • continously monitored during procedure
    • BP
    • ECG
    • O2
    • HR
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23
Q

Role of RN in moderate sedation during Sx

A
  • No other competing responsibilities
  • competent in cardiac monitoring
  • ability to administer reversal medications and provide advanced cardiac life support measures
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24
Q

Patient’s rights

A
  • considerate/respectful care
  • relevant, current, and understandable information concerning their dx, tx, and prognosis
  • Self-determination concerning tx and refusal of tx
  • Respect wishes written in AD
  • Privacy
  • Confidentiality
  • Access to their medical records
  • Health care in a facility and a transfer to another facility when indicated or requested
  • Information regarding hospital business relationships
  • Consent to or decline involvement in research studies
  • Continuity of care when possible and to be informed when hospital care is no longer an option
  • Be informed of hospital charges and available payment methods; including hospital P&P for dispute resolutions, grievances, ethical concerns/conflicts
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25
Q

Elements of SODH

A
  • economic stability
  • education
  • social/community context
  • access to health care
  • neighborhood/built environment
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26
Q

What is the purpose of a preoperative interview?

A

Determine that we have the correct patient, correct sx. correct site, and that the patient understands what is being done, their NPO status, medical hx, sx hx , questions or concerns

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27
Q

Describe how a pt’s use or abuse of cannabis can affect them during sx?

A
  • Cannabis can affect the tolerance to induction agents
  • unknown tolerance of anesthesia agents
  • hyperreactive airway
  • bispectral index elevation (BIS) - Uses state-of-the-art technology to process EEG information to provide a direct measurement of the patient’s level of consciousness and insight into the effects of anesthesia on the brain.
  • Increased myocardial infarction risk within 1 hr after use
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28
Q

How can Hx of ETOH abuse affect a patient during Sx?

A
  • lowered immunity
  • prolonged bleeding times
  • increased stress response
  • cardiac complications
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29
Q

Insufflation

A

The act of blowing gas into a body cavity for visual examination

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30
Q

What is the most common gas used for insufflation?

A

CO2

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31
Q

Potential complications of CO2 insufflation

A
  • elevated BP
  • elevated CO2 in blood
    • acidosis
  • decreased C/O
    • decreased renal blood flow
    • decreased U/O
  • Cardiac arrythmias
  • Gas embolism
  • Peritoneal irritation
  • Gas embolism
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32
Q

Clinical signs of gas embolism

A
  • systemic hypotension
  • dyspnea
  • cyanosis
  • cardiac anomalies
    • tachycardia
    • bradycardia
    • arrhythmias
    • asystole
  • elevated pulmonary arterial pressure
  • elevated central venous pressure
  • hypoxemia
  • end-tidal CO2 changes
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33
Q

Borescope

A

An inspection tool that is placed through an instrument’s lumen and is used to inspect the internal element of the instrument

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34
Q

No Fly Zone

A
  • hybrid OR
  • Designating a collision-free or “no-fly” zone in which personnel, monitors, and other ceiling-mounted equipment cannot be present while the C-arm is in motion limits opportunities for damage or injury.
  • Restricted area reserved for imaging equipment
  • Other necessary equipment is positioned outside of this area or moved to allow for imaging equipment use
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35
Q

Pneumoperitoneum

A

Presence of air or gas within the peritoneal cavity

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36
Q

Practices to reduce the risk for patient injuries and complications associated with gas insufflation are ______

A
  • Placing the insufflator above the level of the surgical cavity
  • Checking that the alarms are on and audible
  • Ensuring that a hydrophobic filter is between the insufflator and the insufflation tubing
  • Flushing the insufflator tubing with the gas that will be used for the surgery before the tubing is connected to the cannula
  • Setting the flow rate according to the manufacturer’s instructions for use and surgeon’s preference
  • Maintain the pneumoperitoneum at a pressure less that 15mm Hg
  • Maintaining insufflation pressure at the lowest level necessary for the pneumoperitoneum and surgical site visualization
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37
Q
A
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38
Q

What pressure must the gas be sustained at to reduce injury rt gas insufflatio n

A

Maintain the pneumoperitoneum at a pressure less that 15mm Hg

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39
Q

Fiber Optic Cable safety

A
  • Check that all cable connections are secure before turning on the light source
  • Ensure that the sterile cable end does not contact the patient’s skin or any flammable material or liquids
  • Ensure that the cable end does not rest on sterile drape
  • Turn off the light source or place it on standby when the cable is disconnected from the endoscope
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40
Q

Gas cylinder safety

A
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41
Q

Irrigation and distension media - Low viscosity non-electrolyte fluids

A
  • Is used for procedures performed using monopolar instruments
  • Is used for gynecological and urological procedures
  • Is hypotonic
  • Can cause TUR syndrome if absorbed in large quantities
  • Examples:
    • 1.5% glycine
    • 5% mannitol
    • 3% sorbitol
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42
Q

Irrigation and distention media - NS

A

Is often selected for use with bipolar instruments

Is isotonic

Contains electrolytes

safer than nonelectrolyte fluids if large amounts are absorbed

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43
Q

Irrigation and distention media - High viscosity fluids

A
  • Is a plasma volume expander provides good visibility when bleeding occurs
  • Can draw six times its own volume into the bloodstream
  • Can cause significant complications (eg, fluid overload, heart failures, pulmonary edema)
  • Contains a high glucose content
  • Example
    • Dextran
      • Note: rinse surgical instruments with sterile water for irrigation after use
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44
Q

SSI

A

an infection that develops at or near the surgical site within 30 days of the procedure or within a year when the prosthesis is implanted.

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45
Q

Reservoir

A

Reservoir: the environment in which an organism grows, lives, and multiplies (source of infection). Dirty surfaces and equipment, people, water, animals/insects

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46
Q

Vehicle

A

Vehicle: infectious organism leaves reservoir via portal of exit

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47
Q

Mode of Transmission

A

Mode of Transmission: organism transmitted to a susceptible host via contact, ingestion, and inhalation.

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48
Q

Chain of infection

A

Infectious agent → Reservoir → Portal of Exit → Mode of Transmission → Portal of entry → Susceptible Host

* vehicle is the pathogen’s transport to portal of entry. Mod of transmissionion describes the orgin of vehicle?

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49
Q

Disrupting the chain of infection - Infectious agents

A

Hand hygiene antimicrobial stewardship to reduce abx resistance. Dx and Tx

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50
Q

Disrupting the chain of infection - Reservoir

A

Infection prevention policies, cleaning , disinfection, sterilization, pest control.

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51
Q

Disrupting the chain of infection - Portal of exit

A

PPE, Hand hygiene, control of aerosols, respiratory etiquette, proper waste disposal

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52
Q

Disrupting the chain of infection - mode of transmission

A

Hand hygiene, PPE, cleaning, disinfection, sterilization, isolation, food safety

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53
Q

Disrupting the chain of infection - Portal of entry

A

Hand hygiene, first aid, PPE, personal hygiene, safe removal of catheters and tubes.

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54
Q

Disrupting the chain of infection - Susceptible host

A

Hand hygiene, immunization, treatment of underlying dz, patient education

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55
Q

IFU for cleaning products includes _____

A

microorganisms killed, contact time required, ingredients, cleaning instructions, removing gross materials, cleaning the surface with clean water and allowing time to air dry.

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56
Q

How is cleaning performed in the OR?

A

Clean from top to bottom

Clean from less-soiled areas to dirty areas

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57
Q

Why are standardized method of cleaning a room employed?

A

to avoid missing areas

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58
Q

Zone cleaning method

A

room is divided into zones/areas. One person focuses on their assigned area. The team cleans their respective zones until the whole room is clean.

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59
Q

Perimeter cleaning method

A

Contaminated items moved to center of room and perimeter is cleaned and disinfected. Contaminated equipment is then cleaned and moved to the perimeter. Center of the room is cleaned after contaminated equipment is cleaned and moved to the perimeter.

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60
Q

Divide in half cleaning method

A

Contaminated equipment moved to one side of the room. Empty side is cleaned and disinfected, and then the equipment is cleaned and moved to the clean side. Repeat with the second side.

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61
Q

Adjunct cleaning technologies

A

Room decontamination can be done via UV light or hydrogen peroxide in addition to manual cleaning. Technologies are approved by multiple departments.

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62
Q

Turnover cleaning

A
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63
Q

Terminal cleaning

A

Terminal cleaning occurs at end of each day, should be cleaned x1 q 24 hrs. Through cleaning performed by special trained EVS.

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64
Q

Universal cleaning conditions

A

Equipment, trash, contaminated laundry are removed after patient leaves the OR

Methodical cleaning process is followed to limit microorganism transmission.

Equipment is cleaned and disinfected before it enters OR or returned to storage

Clean and disinfect high touch objects and surfaces

Floor is always considered contaminated

Reusable mop heads and cleaning cloths are soaked in cleaning solution and then put in laundry.

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65
Q

How can RNs reduce the amount of wasted supplies in the OR?

A

Review preference cards at least yearly

Open only what is needed

Hold items that are labeled as “hold items” on the preference card

Ask the surgeon before opening

Create spreadsheet comparing costs and show to surgeons → make surgeon aware of cost

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66
Q

Describe the process of turnover cleaning

A

Hand hygiene

Don PPE → check type of precautions

Check supplies, cleaning cloths, bed linens, mop buckets

Remove large debris from floor

Remove trash and linen

Clean and disinfect all items used in patient care → remember transfer devices

Mop floor → move bed

Spot clean walls

Place used cloths in trash or linen

Remove PPE

Hand hygiene

Don appropriate PPE

Take trash and linen out

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67
Q

Describe the process of terminal cleaning

A

Similar to turn over cleaning except

  • All exposed surfaces of items in OR are cleaned and disinfected including wheels and casters
  • Entire floor is mopped or wet vacuumed, including under bed/equipment
68
Q

What are the rooms/areas of SPD?

A

Areas of the sterile processing department (SPD) include the decontamination area, assembly area, sterilization of equipment area, and sterile storage areas.

69
Q

What area of SPD is cleaned last?

A

When cleaning SPD the Deon room is cleaned last → most contaminated area of SPD

70
Q

How often are the floors of SPD cleaned?

A

Clean the floors in all SPD areas every day the areas have been used.

71
Q

Define scheduled cleaning and give examples of what items should have scheduled cleaning.

A

Scheduled cleaning is cleaning of equipment (eg, appliances, air-handling systems, closets, cupboards) that occurs on a periodic, routine basis (eg, daily, weekly, monthly).

Includes ice machines, fridge, sinks, vents (ducts/grilles), air filters

72
Q

When is enhanced cleaning employed and why?

A

Enhanced cleaning when pts with MDROS or Spores occupy OR → these pathogens are hard to kill and need special measures.

ex.

C.diff → bleach

Aspergillus found in air systems thus systems need to be cleaned and filters replaced as well as air handling testing

73
Q

If the patient has TB, measles, chicken pox, or COVID which measures should be employed and what PPE is used?

A

N95, PAPR,CPAR with aerosolizing procedures (Airborne transmission; TB, measles, chicken pox, COVID.

74
Q

How does an N95 mask work?

A

N95 creates negative pressure inside mask dt inhalation → must be fitted or else negative pressure will draw pathogens into mask.

75
Q

How does a PAPR/CAPR work?

A

PAPR/CAPR provide positive pressure, HEPA filter in blower filters germs and provides clean air.

76
Q

Once a patient with airborne precautions leaves the OR what must occur?

A

After Pt leaves room it must remain unoccupied for designated amount of time → depends on how many air exchanges in OR

77
Q

What are some sources of environmental contamination in the OR, and how must they be dealt with?

A

Construction

Flooding

Condensation on surfaces

Mold

Pests

Terminal cleaning must occur following correction of source of contamination

78
Q

How must potential contamination from construction be dealt with?

A

Temporary barriers and access paths created to decrease contamination

All areas under construction are cleaned before barriers are removed and terminally cleaned before returning to service.

79
Q

How can cleanliness of rooms be measured?

A

Rooms can be tested for cleanliness via visual inspection, fluorescent gel, markers, microbio tests, ATP testing

80
Q

What is the difference between cleaning and disinfecting?

A

Cleaning: the removal of dust, debris, blood, and other infectious materials

Disinfecting: the removal of pathogenic and other microorganisms from surfaces by using chemical or physical means

81
Q

What information should you communicate to the cleaning personnel when a patient is suspected or diagnosed with tuberculosis and the OR needs to be cleaned? When should this information be communicated?

A

Prior to EVS entering OR contaminated with TB the RN should alert EVS and communicate that the OR must be unoccupied for the recommended amount of time based on the number of air exchanges in the facility. RN may encourage use of airborne PPE (N95 etc.) when entering room after waiting for recommended amount of time.

82
Q

Visual inspection

A

Room is checked for clean appearance. Used to assess cleaning routine and provide immediate feed back.

83
Q

Fluorescent gel markers

A

A gel is applied before cleaning. Blacklight illumination applied following cleaning. Presence of fluorescent gel shows that cleaning was not done per protocol or cleaning was performed with dirty cloth

84
Q

Microbiology tests

A

ATP found in saliva, blood, etc. ATP monitoring shows residual organic material following cleaning. Surface is swabbed and swab is inserted into luminometer. Test results available within seconds.

85
Q

ATP testing

A

ATP measured in RLUs (relative light units) as numeric value. Numeric value correlates with amount of ATP swabbed from service.

86
Q

What are the goals of documentation?

A

Support RN workflow

Data capture

Eliminate redundancy in data entry

Reflecting patient focused care

Contain infor for transitional care

87
Q

Perioperative Nursing Data Set (PNDS)

A

Standardized nursing language focused on perioperative nursing and supports EBP practice → helps to standardize nursing care

PNDS is inclusive of nursing process workflow and represents each phase (preadmission, preop, intraop, postop)

Recognized by ANA and registered in National Library of Medicine

88
Q

Benefits of Structured Vocabulary

A

Helps develop computer databases

Helps to shape policy

Quality indicators for research

Compare cost and performance

89
Q

Downtime procedures

A

Process in place for alternate data entry during system downtime

Be prepared → paper forms for documentation, how will new orders be documented?, potential loss of data, how will downtime data be reincorporated into EHR?

90
Q

When should verbal orders be used?

A

Verbal orders should be used only when required by clinical necessity

91
Q

Orders should be _____

A

Enter/document as close to the time they were given as possible

Verify by reading back orders

Record the names and roles of all individuals involved in perioperative care

Avoid abbreviations → write out name or unit of measurement

Avoid trailing zeros → 2.0g should be 2g

Use standardized names

Preprinted and standing orders should be reviewed by physician according to facility policies/procedures

92
Q

How can a nurse make corrections to a paper chart?

A

Single line through inaccurate info

Write “error,” “mistaken entry,” “omit” next to incorrect text

Provide rationale for correction above statement or in margin

Sign and date entry

Enter correct info next to inaccurate info

93
Q

How can a nurse make a correction in an EHR?

A

Versioning or “track corrections” function; electronic strike through with time stamp

Automatic date, time, and author stamp feature

EHR should feature a symbol or notation to identify when an alteration has been made and a new version of document was created

Retain and link original to new version

Reflect corrections in EHR in paper chart

94
Q

What acronym is used when documenting?

A

FACT

Factual

Accurate

Complete

Timely

95
Q

U/O

A

An occurrence can be an actual event or near miss; RSI (retained surgical item), patient injury or med error

96
Q

How to reduce risk of a lawsuit.

A

Maintain open, honest, respectful communication with others

Maintain patient confidentiality

Maintain competence in your practice

Attend nursing continuing professional development programs

Know your job description and scope

Know your strengths and weaknesses

Discuss assignments with preceptor or manager

Only accept duties that you can perform competently

97
Q

Nurse practice act

A

provides legally binding rules and regulations that collectively describe the scope of nursing practice in that state or territory.

98
Q

Causes of lawsuits

A

Failure to:

  • Communicate
  • Document
  • Assess and monitor
  • Follow standards of care
  • Act as patient advocate use equipment in a reasonable manner
  • Top 10 Safety Issues of Concern
    • wrong site/procedure/patient
    • RSI
  • Med errors
  • Instrument reprocessing failures
  • Pressure Injuries
  • Specimen management errors
  • Surgical Fires
  • Perioperative hypothermia
  • Burns from energy devices
99
Q

These rights are protected via informed consent for medical procedures

A

For procedure itself

Any research interventions

Patient’s wishes listed in advanced directive

100
Q

If a nurse wanted to know when informed consent is required where would they look?

A

P&P

101
Q

In addition to informed decision making a patient or a patient representative is entitled to ____

A

Requesting or refusing treatment

102
Q

Items to Include in Informed Consent

A
  • Facility name
  • Name of intervention
  • Indication for intervention
  • Name of health care professional performing intervention
  • Risks and benefits of intervention
  • Discussion of risks vs. benefits with pt or pt representative
  • Patient or Pt rep. Signature along with date and time
  • Signature of witness along with date and time
103
Q

Am I Responsible for Obtaining Informed Consent?

A

No. The surgeon or anesthesiologist is

You may be asked to witness the patient’s or patient rep’s signature on informed consent

Review informed consent forms during preoperative interview

104
Q

What should be taken into account with visitors in the OR?

A

HIPAA

ORs should have policies to limit product reps or other visitors in the OR → policies must have revisions for pt consent

105
Q

How can an RN protect an anesthetized patient’s privacy?

A

Protect patient from unnecessary exposure

Comments about pt appearance, lifestyle, or social status are never appropriate unless necessary to provide safe care.

106
Q

What are the phases of care and what do they entail?

A
  • Preoperative → decision for Sx is made
    • Informed consent obtained
    • See documentation elements for specific documentation guidelines
  • Handover → ends when patient is transferred to OR bed
    • See documentation elements for specific documentation guidelines
  • Intraoperative → Starts when pt on OR bed and end at PACU
    • See documentation elements for specific documentation guidelines
  • Handover
  • Postoperative → return home or be admitted to hospital
107
Q

What patient information shared between the preoperative and intraoperative nurses during the hand off?

A

Patient identifiers

Planned procedure

Operative side/site

NPO status

Allergies

Diagnostic test results

Current medications

Blood products available

Patient mobility issues

Family contact information

108
Q

What patient information shared between the intraoperative and postoperative nurses during the hand off?

A

Current condition on airway, breathing, and circulation

Type of anesthesia administered

Procedure performed

Any surgical issues/complications and corrective actions taken

Skin condition

Pressure injury risk

Hypothermia status

Estimated blood loss

Input and output

Presence and location of drains, wound packing

109
Q

Complications of surgical bleeding

A

Surgeon’s view is obstructed → longer Sx times

Blood replacement therapy and associated risks →multiple organ failure, SIRS, TRALI, increased risk for infection and mortality

Hypothermia and associated coagulopathies → as temp nears 34C (93.2F) platelets do not stick to each other as well

Altering pharmacodynamics of anesthesia

Hypothermia and acidosis reduces thrombin generation due to altered function of enzymes. Low O2 levels and Cl- in fluids contribute to acidosis

Aggressive fluid resuscitation can cause hemodilution decreasing O2 carrying capacity and diluted coagulation factors/ platelets

Progressive coagulopathy leads to further hemorrhage and shock

Thrombocytopenia can occur to massive blood loss

Hypovolemic shock may occur → reduces cardiac output and affects pulmonary gas exchange

110
Q

What are the 7 goals of hemostasis?

A
  1. Decrease and control bleeding
  2. Minimize the need for blood replacement
  3. Optimize the surgical field view
  4. Avoid major organ damage
  5. Shorten the length of surgery and length of facility stay
  6. Decrease the risk of infection
  7. Decrease health care costs for patients and facilities
111
Q

How can EBL be determined?

A

Inspect surgical drapes, suction canisters, sponges

Weigh surgical sponges

Monitor lab values

Circulator and scrub can help by:

Communicating amount of irrigation solution used during Sx for accurate I&O

Place used sponges in visible location

112
Q

Traditional Methods to Achieve Surgical Hemostasis

A

Hold pressure

Electrosurgery or energy generating devices

Suturing and ligating

Trad methods are usually mechanical, chemical (pharmaceutical), or Thermal (energy)

113
Q

Mechanical methods of achieving hemostasis

A

Direct pressure → applied with surgical sponges

Sutures, staples, clips → Pressure or ligation will stop bleeding

Dressings → Placed once Sx is complete

114
Q

Ligating Clips

A

Small V-shaped devices placed around lumen of vessel

Countable item

115
Q

Thermal based energy sources

A
  • used to promote hemostasis
  • ignition source
  • include:
    • Lasers
    • Monopolar Electrosurgery device
    • Ultrasonic Devices
    • Bipolar electrosurgery devices
    • Vessel sealing devices
116
Q

Chemical methods of achieving hemostasis

A

Epinephrine → A hormone that causes direct vasoconstriction and increases HR

Vitamin K → administered preop to reverse warfarin

Protamine → Heparin reversal agent

Vasopressors → (Desmopressin) Administered preop to patients with hemophilia A

117
Q

Topical hemostatic agents and surgical sealants

A

Used when Trad methods fail or are impractical

Requires physician’s order

Not medications and not intended for IV use

118
Q

Adjunct methods to obtain hemostasis

A

Topicals can be divided into 4 categories:

  • Mechanicals (Passive hemostatic agents) → collagen, cellulose, gelatin, polysaccharides
  • Actives → Thrombin products
  • Flowables → Thrombin + Gelatin
  • Fibrin Sealants → Thrombin + Fibrinogen
119
Q

Tissue sealants

A

Aka Adhesives (glues tissue together):

  • Cyanoacrylates
  • Synthetic Skin sealants
  • Tissue sealants
  • Glutaraldehydes
  • PEG polymers
120
Q

What are some considerations that must be taken with tissue sealants?

A

Some patients may have allergies to sealants

Cultural beliefs may limit use of some products

Some products may be limited in use of some pt populations

Topical products may have requirements for transport, storage, handling, and disposal

Product may only be good for specific amount of time

121
Q

What questions should a nurse ask a patient in preop regarding hemostasis?

A

Allergies to hemostatic agents, bovine, porcine products

Active prescriptions

Is patient taking anticoagulants, antiplatelets, aspirin, NSAIDS?

Taking vitamin E, bilberry, ginkgo biloba, garlic, ginseng, fish oil, grape seed extract, dandelion root, saw palmetto, and quinine → increased bleeding time

Results of coag profile

Hx bleeding gums, easy bruising, excessive superficial bleeding, severe nosebleeds

Anemia?

Hx of renal/hepatic dz

Proposed Sx procedure

Blood products ordered?

Has pt expressed cultural, ethical, or religious beliefs against blood or blood product use?

122
Q

What is the principal enzyme for hemostasis?

A

⭐ Thrombin is the principal enzyme for hemostasis ⭐

123
Q

Surgical Sponges

A

Only sponges with radiopaque indicator should be used during Sx

Different sponges have different uses during Sx, (ex. Packing, removing blood from field)

All sponges must be accounted for before procedure, during procedure, and before closing wound

124
Q

What are the types of surgical sponges?

A

Laps

X-ray detectable 4x4

Surgical peanuts

Cottonoids

Tonsil sponges

125
Q

What are the circulator’s responsibilities in preventing RSIs?

A

Room survey → check for open countable items from previous Sx before next case

“Reset” count boards and sheets prior to new case

Initiate count

View items while counted

Record count items in a visible area

Record instrument counts on preprinted count sheets

If item is passed or dropped from sterile field put on gloves, show it to scrub, isolate it from field, and include it in final count.

Ask team members if any items will be needed before closing count

Separate and point out items off of sterile field while audibly counting

Participate in count reconciliation

Report discrepancies

Document counts

126
Q

What is the scrub’s responsibilities in preventing RSIs?

A

Maintain sterile field according to P&P

Maintain awareness of the location of each countable item on sterile field and in the Pt.

Know function configuration of all medic devices used during procedure

Verify integrity and completeness of items returned from surgical site

Consult with surgeon whether supplies will be needed before closing count

Count audibly and point out items on sterile field (SF) so circulator can see

Speak up when discrepancy occurs

Participate in count reconciliation

127
Q

What are anesthesia’s responsibilities concerning RSIs?

A

Plan anesthetic milestones (induction and emergence) to allow for proper counting

Tell team when bite blocks, throat packs, and other devices inserted in oropharynx, nose, or nasopharynx

Verify removal of above listed items and communicate to team when removed

128
Q

When should the first count be performed?

A

before the patient enters the room

129
Q

Standardized sequence of counting countable items

A
  1. Sponges on or in the patient
  2. Mayo stand
  3. Back table
  4. Kick bucket
  5. Pocketed sponge bag
130
Q

What happens if the count is interrupted?

A

If count is interrupted, restart count for item type that was being counted

131
Q

In what way should items be counted?

A

During the initial count and when adding items to the SF, count packaged items according to the number in which the item is packaged

Verify the package contains # of items on label

132
Q

What should be done if packages contain an incorrect # of items or the items are defective?

A

Exclude them from the count

Remove them from the field

Isolate them from the rest of the countable items in OR

133
Q

How should a count be recorded?

A

Immediately after each type of item is counted

On a standardized template

In a location that is visible to the surgical team

In agreement with the scrub person

134
Q

How should items be added to the field after the initial count?

A

Count items immediately

Record item and number added on the count board in a standardized format as defined by the health care organization

Verify # with scrub

135
Q

Break/relief counts

A

account for items in use and perform structured handover communication of accounting procedures

136
Q

Permanent relief counts

A

Perform complete count when there is permanent relief of the RN circulator or scrub person

Account for all items → even those not seen

137
Q

When should counts not be performed?

A

Do not perform counts or actions requiring counts (breaks) during critical moments (time outs, critical dissections, confirming and opening implants, induction and emergence, care and handling of specimens)

138
Q

When can counted items be removed from room?

A

Do not remove counted items from room until counts complete and reconciled

Do not remove linen and waste containers from the room until all counts are completed and reconciled and pt has been transported from room

139
Q

When is final count considered complete?

A

Do not consider final count complete before all items removed from patient and returned to scrub

140
Q

What types of sponges should be used for vaginal antisepsis?

A

use radiopaque and count them

Inspect vagina for radiopaques following vaginal procedures

141
Q

Can radiopaques be used as dressings?

A

Do not use Radiopaques for dressings unless it is left in wound intentionally

142
Q

Can towels be used in surgical wounds?

A

Do not use regular towels in surgical wound

143
Q

When should non-radiopaque sponges be added to field?

A

Hold non-radiopaque sponges from field until surgical incision is closed and final count complete

144
Q

When a radiopaque sponge is left as packing in a wound how should it be placed in wound?

A

Leave portion of radiopaque outside of wound to visualize if possible

145
Q

What happens if surgical sponges fall on the ground?

A

Place sponges in kick bucket or pocketed holder, show scrub sponges that fall before placing in holder

146
Q

What should be done if radiopaques are used as packing?

A

Document # and type if possible

Compare items removed to items that were charted as packing in prior case

Isolate removed sponges and do not include in counts for procedure

Surgeon should thoroughly explore wound and order X-ray

Remove packing before final closure

147
Q

When should sutures be counted?

A

Count all sutures regardless of size or procedure

148
Q

In item is returned to scrub broken what should they do?

A

Account for sharps and misc. Items used in the surgical wound in their entirety immediately after removal

Notify perioperative team if broken or separated item is returned from surgical site

Immediately attempt to locate and retrieve item

Remove free clips from abd cavity when possible

149
Q

Precaution regarding prep sticks used in vagina

A

Account for preparation sticks used in vaginal antisepsis

150
Q

Keeping track of instruments and device fragments

A

Count all instruments for open cases (eg, thorax, abd)

Count instruments when sets are assembled for sterilization

Do not consider the final count complete until instruments used to close wound are removed and returned to scrub

Account for individual pieces of instruments

Inspect instruments for all removable parts, breakage, fragmentation immediately on instrument’s removal

Keep all counted instruments in room until all counts complete

Standardize instrument sets

151
Q

When there is a count discrepancy what is the role of the RN?

A

Inform team → team should acknowledge type and # missing

Call for assistance

Search room

Recount with scrub

152
Q

When there is a count discrepancy what is the role of the scrub?

A

Organize SF

Search SF including drapes and tables

Recount with circ.

153
Q

When there is a count discrepancy what is the role of the surgeon and first assist?

A

Suspend closure of wound if possible

Perform a methodical wound exam

Participate in attaining intraop x-rays

Remain in room until item is found or determined not to be in pt

154
Q

What happens if count discrepancy is not resolved?

A

No breaks or relief until count is resolved

Do not use empty packages to resolve count discrepancies

When missing item is found recount item type

If missing item is not recovered request x-ray, if unstable then obtain imaging ASAP once stable

Document unresolved counts

Description and location of item if known

All measures taken to recover

Patient notification and consultation

Plan for f/u care

*Inform EVS and next team in room of discrepancy *

155
Q

Documenting counts

A

Types of counts items counted

Number of counts

Names and titles of personnel performing counts

Results of counts (eg correct, incorrect)

Verification of removal and integrity of items

Surgeon notification of count results

Explanation for waived counts

Number and location of any instruments/items intentionally remaining with patient as packing

Actions taken for discrepancies

Rationale if counts were not performed or completed as prescribed by P&P

Outcomes of actions taken

156
Q

RSI are considered _____

A

Never events

157
Q

How are chest tube wounds dressed in a patient?

A

Sutured in place and dressed with gauze 4x4 split dressing and 4x4s

Connections secured with plastic zip ties at end of procedure

158
Q

What should be documented concerning drains?

A

Type

Size

Serial #

Location

Description and amount of drainage

Functionality → was it working when pt left OR?

159
Q

Primary dressing

A

applied directly over wound; usually nonadherent

160
Q

Secondary dressing

A

cover primary dressing (eg 4x4 gauze sponges, abd pads, perineal pads)

161
Q

How are dressings secured?

A

Dressings may be secured with soft gauze rolls, elastic bandages, and tape

162
Q

Iodoform packing

A
  • Sterile single-use wound dressing consisting of a single cotton gauze strip impregnated with formulated Iodoform solution that are packaged in HDPE amber-colored jars. They are primarily used for sterile drainage of open and/or infected wounds.
  • Iodoform is the organoiodine compound with the chemical formula CHI₃. A pale yellow, crystalline, volatile substance, it has a penetrating and distinctive odor and, analogous to chloroform, sweetish taste. It is occasionally used as a disinfectant.
163
Q

Why might splints be chosen over a cast?

A

Flexible and allows for swelling post op → cast may be applied after swelling subsides

164
Q

How should dressings be documented?

A

Type of dressing material and device used to secure it (eg tape, elastic bandage, wrap)

Ointments/meds

Location of dressing or packing

Immobilization devices

Elevation of limb, if applicable and equipment used (eg pillows)

CMS (circulation, motion, and sensation) checks of affected extremity

Functionality of a devices part of dressing

165
Q

How should specimens be documented?

A

Specimen name, body location, tissue type, and side of body

Correct spelling of anatomical parts

Requested pathology exam

Date and time specimen collection

Electronic health records may include several of the necessary components that the RN circulator fills out with the specific details

166
Q

How should specimens be treated on the SF?

A
  • Handle the specimen as little as possible
  • Keep the specimen moist
  • Cover the specimen or place it into a container
  • Label the covered or contained specimen
  • Protect the specimen in a secure location on the back table or other sterile field location
167
Q

Transferring specimens off of SF

A

OR (9 decks)

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