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Perioperative Nursing > Week 2: Patient Safety 1 > Flashcards

Week 2: Patient Safety 1 Flashcards

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1
Q

What is DVT?

A

A blood clot that forms in the veins of the legs; attached to the vessel wall

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2
Q

What is an embolism?

A

A blood clot which breaks off the vessel wall and travels freely throughout circulation; likely to become lodged in pulmonary (PE) or cerebral vessels causing obstruction of blood flow

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3
Q

What are the signs of a PE?

A 
Shortness of breath
Cyanosis
Chest pain
Low sats
High RR
Diagnosed with CT scan
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4
Q

How many VTE cases are the in Australia?

A 
15000 annually
9250 female: oral contraceptives risk factor
5466 male
3 331 677 between 2002-2009
1 in 10 die
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5
Q

Why does surgery place patients at risk of VTE?

A

Dehydration –> reduced circulating blood volume –> changed blood viscosity
Extended immobility
Ceasing anticoagulants

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6
Q

What are the risk factors for VTE?

A 
Hospitalisation
Female
Surgery
Smoking, diet
Older
Comorbidities: malignancies, medical or surgical treatments
Caucasian or African American
Winter: less active, less fluid intake
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7
Q

What are strong risk factors for VTE?

A 
Orthopaedic surgery
Tourniquet
Spinal cord injury
Major general surgery
Major trauma
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8
Q

What are moderate risk factors for VTE?

A 
Central venous access
Chemo
HRT
CHF/resp failure
Malignancy
Oral contraceptives
Pregnancy/post-partum
Previous VTE
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9
Q

What are weak risk factors for VTE?

A 
Bed rest > 3 days
Seated immobility 
Age
Lap surgery
Obesity
Varicose veins
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10
Q

What is the rate SSIs in Australia?

A

2.7% of surgical cases

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11
Q

Which surgical specialties have a higher risk of SSI?

A

Orthopaedics
Cardiac (coronary artery bypass)
Obstetrics (lower segment cesarean section)
Colorectal

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12
Q

How can SSIs be reduced?

A 
Reduce traffic around sterile field
Prophylactic antibiotics
ANTT package opening
Negative pressure air ventilation
Skin prep
Instrumentation sterilisation
Scrub technique
Curved floor corner for easier cleaning
WHO surgical safety checklist
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13
Q

What is a pressure injury?

A

Wound caused by lock of blood flow due to pressure between external surface and bone

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14
Q

What are intraop risk factors for pressure injury?

A

Surgery duration
Bony prominences/padding
Friction and shear when transferring patient

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15
Q

What are the instrinsic risk factors for pressure injury?

A 
60 + years
Low albumin
ASA 3 +
Diabetes
BMI < 19 or > 40
CVA
Hypotension: reduced circulation to peripheries
Pulmonary disease
Renal insuffiency
Warming mattress
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16
Q

What are the extrinsic risk factors for pressure injury?

A 
Preop immobilisation time
Operation time
Postop immobilisation time
Prone
Trauma
Hypotension
Extended use of vasopressors
Specialty: cardiac, ortho, vascular, transplant, bariatric
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17
Q

What is the most common nerve injury in the OR?

A

Ulna nerve

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18
Q

What are the risks of arms up in prone?

A

Brachial plexus injury

Dislocation

19
Q

What is the first stage of pressure injury?

A

Erythemia, no skin break down

20
Q

What is the second stage of pressure injury?

A

Adipose tissue exposed

21
Q

What is the third stage of pressure injury?

A

Muscle exposed

22
Q

What is the fourth stage of pressure injury?

A

Bone/cartilage exposed

23
Q

How do you assess for pressure injury?

A

Pressure injury risk assessment tool

Skin assessment/visual inspection

24
Q

What are the preventative strategies for VTE?

A 
Reduced fasting time
IV fluids: increase circulating volume
Positioning
Thrombo-embolic device: TEDs
Sequential Compression Device: calf compressors
Prophylactic anticoagulants
25
Q

What are the four classifications of a surgical wound?

A

Clean
Clean/contaminated
Contaminated
Dirty

26
Q

What is the definition of a clean wound?

A

Non-traumatic, elective surgery; GI, resp & GU tracts not entered

27
Q

What are examples of clean surgical wounds?

A

Mastectomy
Vascular
Hernia repair

28
Q

What is the definition of a clean/contaminated surgical wound?

A

Resp, GI or GU tract entered with minimal contamination

29
Q

What are examples of clean/contaminated surgical wounds?

A

Gastrectomy

Hysterectomy

30
Q

What is the definition of a contaminated surgical wound?

A

Open, fresh, traumatic wounds; uncontrolled spillage; minor break in sterile technique

31
Q

What are examples of contaminated surgical wounds?

A

Ruptured appendix

Emergency bowel resection

32
Q

What is the definition of a dirty surgical wound?

A

Open, traumatic, dirty wounds; perforation of hollow viscus; frank pus in wound

33
Q

What are examples of dirty surgical wounds?

A

Intestinal fistula resection

MVAs

34
Q

What are the different types of sterilisation process?

A 
Steam autoclave
Plasma hydrogen peroxide
Peracetic acid
Ethylene oxide
Cidex OPA
Gamma irradiation
35
Q

What is peracetic acid?

A

Sterris
Acetic acid, hydrogen peroxide, water
Reacts with proteins and enzymes to cause cell destruction
Sterilant concentrate mixes with water
30 min cycle
Full PPE: carcinogenic, toxic, chemical burns

36
Q

What is ethylene oxide?

A

Gas
Alkynation agent disrupts DNA in micro-organisms to prevent multiplication
Low temp
Replaced by plasma hydrogen peroxide

37
Q

What is Cidex OPA?

A

Hazardous chemical: good ventilation, designated area, PPE

Used in places that don’t have Sterris

38
Q

What is gamma irradiation?

A

Short wavelength with high penetrative intensity to destroy micro-organisms
Lucas Centre
Mass sterilisation
All implants

39
Q

How is SSI reduced by the OR environment?

A

Safe handling and storage of sterile items
Air ventilation
OR design: traffic patterns, flooring materials

40
Q

How can you prevent SSI in your own clinical practice?

A 
Opening sterile items
Preparing and maintaining sterile field
Movement around sterile field
Scrub, gown and glove
Prep and drape
Surgical conscience: doing what is right even though no one is watching, speak up about contamination
41
Q

What pharmacotherapy is used to prevent SSI?

A

Antimicrobial patient wash preop
Prophylactic A/Bs
Antimicrobial impregnated drapes and dressings
Antibiotic irrigation solutions

42
Q

What are the different tools for risk assessing pressure injury?

A

Braden
Munro
Scott Triggers
Waterlow

43
Q

What are strategies for preventing pressure injury?

A

Positioning
Pre and postop inspection
Open team communication: safe position, worst case scenario

Perioperative Nursing (9 decks)

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