Surgical test and procedures

Question 1

Minor Office Surgical Procedures

Answer 1

Argon Laser
Botulinum Toxin Type A
Excision of chalazion
Cryotherapy
Eyelid Lesion Removal
Refractive Surgery
Tear duct probing and irrigation
Yag Laser

Question 2

Argon laser

Answer 2

Pan Retinal Photocoagulation for diabetic retinopathy (PRP)
Focal treatment for cystoid macular edema (CME) and diabetic macular edema (DME)
Laser treatment of retinal tears
LAser Trabeculoplasty; laser to shrink trabecular meshwork (SLT and ALT)

Question 3

Botulinum Toxin Type A

Answer 3

Injection for management of blepharospasm

Question 4

Excision of chalazion

Answer 4

Removal of obstructed meibomian gland in the eyelid

Question 5

Cryotherapy

Answer 5

Freezes ciliary body to treat intractable glaucoma

Question 6

Eyelid Lesion Removal

Answer 6

Removal of small growths (papillomas, verrucae, xanthelasma) for histopathology

Question 7

Refractive Surgery

Answer 7

To reduce the need for glasses and or contact lenses with LASIK (aka. aser assisted in situ keratomileusis-eye surgery to correct vision in which a laser reshapes the inner cornea), PRK (aka. Photorefractive keratectomy), LASEK (Laser Assisted Sub-Epithelial Keratectomy), RK (aka. Radial keratotomy-correct myopia (nearsightedness)), AK (Astigmatic Keratotomy), or CLE (aka. Clear Lens Extraction Ophthalmology)

Question 8

Tear duct probing and irrigation

Answer 8

To evaluate for presence of obstruction of the nasolacrimal passage

Question 9

Yag Laser

Answer 9

Capsulotomy-to treat capsular opacity after cataract surgery.
Iridotomy-a small hole is made in the iris with a YAG laser

Question 10

Operating room procedures

Answer 10

Cataract extraction
Corneal transplant
Dacryocystorhinostomy (DCR)
Iridectomy
Enucleation
Evisceration
Exenteration
Glaucoma
Plastics 
Pterygium
Scleral buckle procedure
Strabismus surgery
Vitreous surgery (pars Plana Vitrectomy)

Question 11

Cataract extraction

Answer 11

Removal of cloudy lens and replacement with intraocular lens

Question 12

Corneal transplant

Answer 12

Replacement of cloudy or scarred cornea with donor cornea
Lamellar-partial penetrating
DMEK-descement’s Membrane Endothelial Keratoplasty
DSEK-descement’s stripping endothelial keratoplasty
Full thickness penetrating keratoplasty

Question 13

Dacryocystorhinostomy (DCR)

Answer 13

Opening between the wall of the nose and the lacrimal sac to relieve obstruction due to infection or scarring

Question 14

Iridectomy

Answer 14

Excision of a section of the peripheral iris

Question 15

Enucleation

Answer 15

Removal of the entire globe

Question 16

Evisceration

Answer 16

Removal of the contents of the globe

Question 17

Exenteration

Answer 17

Removal of the orbital contents and sometimes the adnexa

Question 18

Glaucoma

Answer 18

Iridectomy-excision of a section of the peripheral iris
Iridotomy-surgical opening in the iris (often performed with laser in the office for angle closure glaucoma prophylaxis)
Trabeculectomy-removal of a section of trabecular meshwork
Laser Trabeculoplasty-laser to shrink trabecular meshwork
Shunts-permanent implant to drain aqueous

Question 19

Plastics

Answer 19

Ectropion repair-repair of eyelid that turns outward
Entropion repair-repair of eyelid that turns inward
Blepharoplasty-removal of excess eyelid skin of upper and/or lower eyelid(s)
Ptosis repair-repair of drooping eyelid
Brow lift-repair of drooping eyebrow

Question 20

Pterygium

Answer 20

Removal of fibrovascular growth on conjunctiva impinging on cornea

Question 21

Scleral buckle procedure

Answer 21

Repair of retina detachment with silicone encircling band

Question 22

Strabismus surgery

Answer 22

Recession/Resection-weaking or strengthening of the rectus muscles to improve the alignment of the eyes
Myotomy-lengthening a muscle
Tenotomy-complete severing of the muscle or tendon
Advancement-shortening a muscle

Question 23

Vitreous surgery (pars Plana Vitrectomy)

Answer 23

Removed the vitreous and scar tissue on the retina
Treats vitreous hemorrhage in diabetics
Removes vitreous floaters
repairs retinal detachment (with or without sterol buckle)
Repairs macular hole
repairs epiretinal membrane
Repairs trauma (ruptured globe, intraocular foreign body)

Question 24

Autoclave

Answer 24

A high-quality, regulated pressure cooker that uses steam under pressure and high temperature to bring about sterilization; sometimes referred to as clave or sterilizer; sterilization is any process that destroys all types and forms of microorganisms including spores.

Question 25

Disinfection

Answer 25

The use of a chemical procedure that eliminates most recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial endospores) on inanimate objects; there are three levels of disinfection recognize:high, intermediate, and low

Question 26

High level disinfection
Intermediate level disinfection
low level disinfection

Answer 26

Kills all organisms except high levels of bacterial spores, and is effected with a chemical germicide cleared for marketing as a sterilant by the Food and Drug Administration (FDA)
     Kills Bactria (including mycobacteria) and most viruses with a chemical
     Kills some viruses and bacteria with a chemical germicide registered as a hospital disinfectant by the EPA.

Question 27

Germicide
Infection
Microorganism

Answer 27

A chemical that kills germs
Condition created when pathogenic microorganisms overcome the body’s natural defenses and protective barriers and invade and multiply in body tissues or fluids
Any organism that, due to its small size, can only be viewed with the aid of a microscope; typically single-celled and encompasses viruses, bacteria, protozoa, and fungi.

Question 28

Sterile Operating field

Sterilization

Answer 28

The space and the materials contained within the area that has undergone sterilization
Any process that destroys all types and forms of microorganisms, including spore; the more common types of sterilizers include the dry heat over, the force air dry heat over (convection type), the autoclave (steam under high pressure and high temperature), and the chemiclave; a chemical vapor type of sterilizer which relies on heat, pressure, and alcohol/formaldehyde-based propriety solutions to chive sterilization at a standards operating temperature.

Question 29

Aseptic technique

Answer 29

The man goal is to keep patients as free from microorganisms as possible, in particular those areas especially susceptible to infection (wounds, etc.). Most effectively reached by ensuring that only sterile equipment and fluids are used during invasive ophthalmic procedures. In the ophthalmologist’s office, the assistant needs to assure that all equipment is sterile and that the surrounding area is clean and as free of microorganisms as possible (wiping area with 70% alcohol or prep solution with a lint free cloth). In the hospital ophthalmic operating room, all members of the surgical team are aware that good aseptic technique must be followed and typically there is a person (ophthalmic surgical assistant, ophthalmic technician, scrub nurse, or surgical technologist) whose responsibilities include the set-up and maintenance of the sterile field. Most importantly, aseptic technique encompasses any efforts to prevent the spread of microorganisms to or from petits, physicians, and medical staff.

Question 30

Scrubbing

Answer 30

Follow correct procedure before entering a surgical suite or operating area
Wear proper attire
Long sleeve gowns
Face mask (covers both nose and mouth)
Surgical cap
Shoes (or shoe covers)
Eye protection (shield or goggles)
Proper attire required even if not directly participating in surgery
Use of clean gives for handling non-sterile materials, or sterile surgical gloves for handling sterile materials
Wear a mask prior to hand washing
Keep fingernails short and clean
Remove rings, watches, other jewelry
Use restroom before scrubbing
Handwashing
Correct water temperature
Correct water flow to avoid splashing
Antiseptic solution, e.g., Providone-Iodine 2%, Chlorhexidine Gluconate 1.5%, and others
Hands kept above elbow level to azure that water flows down from the fingertips to the elbow
Use sterile brush for nails and sterile pick for under the nails (discard pick)
Scrub hands and forearms to just above the elbow
Rinse from fingertips to just above the elbow
Keep hands higher than elbows, allows arms to drip dry for a few moments
Use towels from gown pack to dry hand and forearm, discard towel when hands are dry
Holding gown from inside, place hands through gown sleeves, stopping at the cuff. Using gown cuff and closed gloving technique, pick up one glove, put on glove (repeat for other hand); (note: use of gloves does nor replace surgical scrub process)
Some facilities now use alcohol-based foams or lotions in place of surgical scrub.
Request assistance for a colleague for fasting your gown at the back
Keeps hands up at all times; do not touch anything that is not sterile
Sterile areas are usually marked by a blue-or grim colored drape, typically the operative field, instrument table, front and sleeves of gown
Back of your gown and anything below the waist are considered non-sterile
Your mask, eye protection, and cap are also considered non-sterile
Wash your hands after removing gloves (change gloves between clean and dirty procedures)
Disposable attire must be placed into the designated garbage container when finished
Non-disposable gowns should be placed in the appropriate laundry basket

Question 31

Pre-operative care

Answer 31

Refers to the preparations and management of a patient before surgery. This time period might be short, in the case of an emergency surgery, or it may encompass several days as follows:
     Record
     Check
     Verify
     When ordered
     Before transfer to operating room

Question 32

Record

Answer 32

Vital signs
Patient's nothing-by-mouth (NPO) status
Medical and Surgical history
Allergies and current medications
Any physical handicaps
Any signs of infection

Question 33

Check

Answer 33

Patient’s understanding of the operative, pore-operative, and postoperative procedures
Patient’s questions or potential anxieties
Family’s knowledge of the planned surgery

Question 34

Verify

Answer 34

Accuracy of patient’s signed informed consent form
All required paperwork is complete and accurate
The physician’s pre-operative orders are fulfilled correctly
The patient’s identification bands and blood type are accurate
Surgeon and/or anesthesiologist has reviewed ordered pre-operative testing which may include electrocardiogram, chest x-ray, or laboratory test
Surgical side/site and ensure site is properly marked by surgeon

Question 35

When ordered

Answer 35

Confirm operative site
Administer pre-operative medications
Pre-operative sedation administered by anesthesiologist

Question 36

Before transfer to operating room

Answer 36

Patient voids
Side rails of the bed are raised
Completed chart available
Patient’s personal items removed for safekeeping (e.g., dentures, contact lenses, jewelry, other valuables)

Question 37

Preoperative care part 2

Answer 37

Be sure to provide support to patient and their family throughout pre-operative preparation (full instructions, explanation of procedure, emotional support, honestly answer patients questions, responding to any anxiety, reassuring the patient)
An uneventful recovery can be anticipated for those patients who are well prepared physically and psychologically for their operation

Question 38

Post operative care

Answer 38

Refers to all patient care from immediately after completion of their surgery through the patient’s recovery period. Immediate care includes assuring airways are clear, pain is under control, wound healing is occurring, and the patient’s mental status is good.
Be sure patient’s and their families understand post-operative instructions regarding systemic and ocular medications, activities, follow-up appointments and actions they should take if ether is a change in their status.

Question 39

Time out

Answer 39

All activity in room must stop
Proceduralist or Staff calls the Time Out
Involve the patient whenever possible
All surgical team will state (I agree or I need clarity)
Procedure may begin after the verification process is complete

Question 40

Anethesia/RN

Answer 40

Verify consent is accurate/complete

Question 41

Anesthesia/RN Proceduralist

Answer 41

Verify patient identity procedure and laterality

Correct site mark visualized

Question 42

RN

Answer 42

Verify implant and diopter (if applicable)
Verify antibiotics/irrigation fluids (if applicable)
Verify safety/allergy precautions (if applicable)