unit V exam 2 Flashcards
This flashcard deck was created using Flashcardlet's card creator
Intraoperative period
Time enter OR until go to PACU
What is the main concern for periopertive nurses?
Pt safety & advocacy
What are the 4 fundamental purpose of physical environment of OR?
Geographic isolation
Bacteriological isolation
Centralize equipment
Centralized trained personnel
Located in separate area to restrict flow of people traffic and decrease contamination
Geographic isolation
What area can you wear street clothes, point of entry for pt’s.
Unrestricted
What area is for authorized personnel must wear scrubs
Semi restricted
What area is the OR, scrub sink, clean core?
Restricted
Who are the biggest risk for contamination
People
Who are the biggest risk for contamination
People
What contains all equipment to facilitate safe & effective surgery
Centralized of equipment
Teamwork in an isolated, restricted environment
Centralized of trained personnel
Why is fresh filtered air circulated in the OR
Infection control
Prevent accumulation of anesthetic gases
Why is the OR kept at low humidity and low temperature
Decreases bacterial growth
How many air exchanges must occur every hour in the OR
25
A group of people who recognize common goals & coordinate efforts to achieve them
OR team concept
Who is on the scrub team? Are they sterile or unsterile?
Surgeon
Assisting surgeon
Scrub nurse & technician
Sterile
Who is on the unscrubbed team? Are they sterile or unsterile?
Anesthesiologist
Circulating nurse
X-ray
Patho
Unsterile
Do not enter sterile field
Who administers agents during surgery, monitors cardiac/respiratory function
Anesthesiologist
Who sets up sterile field, assists with preparation of room count sponges, needles & instruments. Are they sterile or unsterile?
Scrub nurse
Sterile
Who coordinates, oversees & participates in care, counts sponges, needles, instruments. Pt advocacy & safety. Are they sterile or non sterile?
Circulating nurse
Non sterile
When is TIME OUT done
Done before anesthesia, skin incision, pt leaves the OR
When is TIME OUT done
Done before anesthesia, skin incision, pt leaves the OR
Is time out required on all surgeries?
Yes
Who is involved in a time out?
Involves the entire OR team
What does the time out do?
Finial verification of pt, procedure, site
What is the primary concern in positioning pt
Safety
What is the criteria for positioning?
exposure of surgical site, avoids body injury
Name the 3 basic positions used in the OR
supine, prone, lateral
What are some devices that may be used to maintain corrct position and prevent injury
arm boards, belts, sand bags etc.
What is the main reason for safety in the OR
create, maintain & control an optimally therapeutc enviorment in the OR
Who does all the documentation in the OR
Circulating Nurse
All specimens and cultures must have?
name, date, time, initial of RN
What is the biggest risk in the OR
infection
What is the name of the grounding pad to prevent electrial shock and burns
Electrocautery
Endogenous
contamination from within the PT (skin, hair, blood, respiratory, GI, GU)
Exogenous
contamination from outside the pt
ppl, enviorment
essence of aseptic technique consists of eliminating all modes and sources of contamination to the extent that is possible
aseptic technique
name some sources of contamination
scrub team skin, pt skin, pts circulating blood, linens
name some modes of contamination
direct contact, indirect contact, circulating air, brak in sterile field
what is the center of the sterile field
the incision on the pt
how far does sterile equipment and non sterile equipment have to be from each other
at least one foot
if a sterile item touches non sterile it becomes?
sterile
only sterile can touch
sterile
what is work to maintain aseptic technique in the OR
surgical attire
sterile gown, mask, hat, gloves shoe covers
what determines the effectivenessin the surgical hand scrub
the length of time (at least 5 minutes)
fingers, hands, arms to elbows
what kind of bacteria is limited to exposed skin and easily removed by mechanical cleansing
transient bacteria
what kind of bacteria inhabits deep structures of dermis, sweat glands and hair follicles
resident bacterial
when should a pt be shaved for the OR
immediatley prior to surgery
time between pre op shave and surgery has direct effect on would infection rates
done by circulating nurse
what is the sterile area of the scrub team
gown front from chest to table level and sheeves to 2 inches above the elbow
if a sterile field is left unattended is it sterile
NO
what antimicrobial agents disinfect skin
cholor-prep (blue)
what kind of drapes are applied directly to the skin, used in orthopedic procedures to decrease splattering and trasmissions of organisms
plastic incisional drapes
how can the surgical specimens be sent to pathology
fresh, in saline or in a preservation solution, can also be frozen
what does hemostatsis do
control bleeding to prevent hemorrhage, allow visulization of surgical field, and promote wound healing
hemostasis
stop bleeding
how much blood do you have in your body
5 liter
what are the two ways we stop blood loss
natural (thrombin, fibrin, platelets)
artificial (head, pressure, bonewax, tourniquets)
wounds involvinga break in skin or mucous membranes
open wound (external)
wound involving no break in skin integrity
closed wound (internal)
what is the cause for a wound resulting from therapy
intentional wound
what is the cause for a wound that occurs unexpectedly
unintential wound
what kind of wound involves only epidermal layer of skin
superficial wound
what kind of wound involving break in epidermal skin layer as well as dermis and deeper tissues or organs
penetrating wound
what kind of penetrating wound in which foreign object enters and exits an internal organ
perforating wound
what is the degree of contamination of a closed surgical wound that did not enter the gastrointestinal, respiratory, or GU tract
clean wounds
what is the degree of contamination of a wound entering gastrointestinal, respiratory, or GU tract
clean/contaminated wounds
what is the degree of contamination of a open, traumatic wound; surgical wound with break in asepsis
contaminated wounds
what is the degree of contamination of a wound site with pathogens present. signs of infection
infected wounds
name the types of incision closures
sutures, staples, retension sutures, steri strips, incision glue
what type of staples must be removed before healing is complete
non absorbable
what type of incision closure are large rubber encased wire sutures
retention sutures (secondary sutures)
how long do absorbable sutures take to disappear
7-10 days
what protects from microorganisms, aides hemotasis and promotes healing
surgical dressing
Who ID’s the pt (name & DOB)
Circulating nurse
The surgical dressing is made up of how many layers
3
Name the three layers of the surgical dressing
Contact or primary dressing
Absorbent layer
Outer layer
What do drains do
Provide exit for serum, blood & bloody secretions, unexpected bile, intestinal or vascular leaks
Low pressure, used when large amount drainage (ortho)
Self suction drain
Hemovac
Gentle pressure, small collapsible bulb
JP or Blake drain
No suction, open drainage
Penrose
Placed in common bile duct for bile drainage
T-tube
Allows healing from base of wound
Gauze wick (iodoform)
Negative pressure allow lung expansion
Chest tube
General anesthesia
Total loss of all sensation & consciousness and protective reflexes
Disadvantages of general anesthesia
Vital function depression
Fears & anxiety
Long term effects
Risk of death
Advantages of general anesthesia
Vital functions regulated
Adjustable to surgery
Age
Physical status
What stage is operative anesthesia done at
3
Regional anesthesia
Not unconscious
Interruption of nerve impulses to a specific area of body
Minimal depression of consciousness, airway maintained, quick emergence
Conscious sedation
Name the three phased of anesthesia
Induction
Maintenance
Emergence
Complications of general anesthesia
OD, hypoventilation, aspiration,hypotension
Complications with regional anesthesia
Nerve damage, hematoma at injection site, spinal HA
Complications of local anesthesia
Safe with rare complications
Genetic reaction to general anesthesia. Increase temperature, heart rate, muscle rigidity
Genetic
Malignant hyperthermia
What affects can surgery have on the elderly
Blood loss Fluid loss Hypothermia Pain Issues with anesthesia
What kind of teaching can be done
About anesthesia
Treatment of symptoms
Explore pts fears & feelings
Advantages & disadvantages
Goal of PACU
Promote I eventful recovery from anesthesia & the immediate effects of surgery
Special clothing & footware
Separate water supply, Airflow system, Laundry & disposal systems
Bacterial isolation
