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periop101
| Question | Answer |
|---|---|
| What are the four basic categories for surgical instruments? | cutting instruments, clamps, grasper/holders, and retractors |
| What are cutting instruments used for? | incise, cut, dissect, and separate tissue |
| What instruments are included in cutting category? | knives, scissors, chisels, curettes, rongeurs, osteotomes and powered instruments |
| What are the parts of a knife? | Reusable stainless steel handle and a disposable sterile blade |
| When passing sharps what should the ST use? | A neutral zone instead of direct hand to hand passing |
| What are the two types of scissors? | Tissue and suture |
| What are examples of tissue scissors? | mayo, metzenbaum, castoviejo |
| What are examples of suture scissors? | bandage and wire |
| What needs to be done when passing scissors? | Make sure tips are visible, gently snap or flip the wrist at the moment of contact and then release instrument as soon as surgeon has firm grasp |
| What are clamps used for? | used to hold, join or compress parts together |
| What are examples of clamps? | hemostats and occluding clamps |
| What factors are considered when deciding what type of clamp to use? | Type of tissue and depth of the surgical procedure |
| What are the parts to a clamp? | finger rings, shanks, ratchets and jaws |
| What are the different types of joints that hold the jaws and arm of a clamp together? | box lock, screw joints or semi-box/aseptic joint |
| What should be considered when passing a clamp? | hold it by the joint, making sure it is closed and in the position of use |
| What are examples for hemostats? | crile, kelly/peom, and mosquito |
| What are occluding clamps used for? | To hold tissue that has a lumen |
| What are graspers used for? | To pick up and hold tissue |
| What instruments are included in grasper category? | forceps, tenacula, needle holder |
| Popular grasping instruments are? | Babcock, allis and kocher |
| What is a babcock grasper? | Have no teeth and are used for holding delicate tissue such as bowel |
| What is an allis? | Have multiple, tiny teeth and are used to holding tissue without crushing, devitalizing or injuring it |
| What is a kocher? | have transverse serrations and large teeth and are used to get a hold of heavy, tough and slippery tissue |
| What are some nonclamping graspers? | forceps and needle holders |
| What are forceps used for? | to grasp or hold tissue, or to tie suture |
| What are the different types of forceps? | smooth, forceps with teeth, and atraumatic forceps |
| What are examples of smooth forceps? | adson and cushing forceps |
| What are examples of forceps with teeth? | toothed adson |
| what are examples of atraumatic forceps? | DeBakey forceps |
| How should forceps be passed to the surgeon? | with the points downward, away from the hand |
| what are some other examples of graspers? | Sponge forceps, towel forceps and tenacula |
| What are needle holders for? | Hold suture needles |
| What are some examples of needle holders? | Mayo-hegar, collier, and brown needle holders |
| What are mayo-hegar needle holders used for? | Apply heavy suture in deep, abdominal areas |
| What are collier needle holders used for? | Hold medium-gauge needles |
| What are brown needle holders used for? | Hold small-guage needles for superficial areas |
| When should needle holders be loaded? | Before the actual surgery begins |
| How do you pass needle holders? | Pass it to the surgeon's hand as you would pass a clamp, paying attention to the direction of the needle. |
| What is the preferred way to pass a needle holder? | Using the neutral zone |
| What are retractors used for? | hold back tissue layers to expose the operative site |
| What types of retractors are there? | Handheld and self-retaining |
| What are handheld retractors? | Held by a member of the surgical team to pull tissues and structure aside for better exposure |
| What are some examples of handheld retractors? | Malleable ribbon, senn, volkmann, army-navy, richardson |
| What are self-retaining retractors? | have holding devices, locks and catches that keep the retractor in a preset spread position after it is inserted and adjusted |
| What are examples of self-retaining retractors? | jansen, weitlaner, balfour, o'connor o'sullivan |
| What are examples of powered instruments? | dermatomes, craniotomes, phacoemulsification, drilles, reamers, saws and sternal saws |
| What are the power sources fo powered instruments? | air, gas, eletric, battery and ultrasonic |
| What are benefits of powered instruments? | reduce operative time, improve patient outcomes through precise technical reults and eliminate the need for hand-powered tools |
| What is hemostasis? | Process of arresting or slowing the flow of blood |
| What can hemostasis be achieved? | By mechanical, thermal or chemical methods |
| What is included in mechanical hemostasis? | Manual pressure, ligating clips, bone wax, esmarch bandage, ligature, pledget and tourniquets |
| What is included in thermal hemostasis? | electrocautery (ESU, cryosurgery, hypothermia, laser wounds or argon beam coagulator) |
| What is included in chemical hemostasis? | absorbable gelatin, absorbable collagen, tannic acid, microfibrillar collagen, oxidized cellulose, collagen sponge, fibrin sealants, phenol, thrombin, styptic and silver nitrate |
| What are drains used for? | They expedite the healing process by removing blood, serosanguinous fluid and purulent material |
| Drains are categorized as? | Passive or active |
| Examples of passive drains | penrose, T-Tube, gastrostomy tubes |
| Examples of active drains | low-pressure suction devices (Jackson-pratt, hemovac) |
| What are some other reasons draines are needed? | abscesses, insecure closure of GI tract, an anticipated leakage, trauma or decompression of GI tract |
| What are some complications of drains? | Hemorrhage, sepsis, bowel herniation and accidental loss of drain |
| What are dressings used for? | To assist with hemostasis and maintain optimal healing environment. They also protect the wound from further injury, absorb excess fluid, apply pressure and support the wound |
| What are occlusive dressings used for? | TO prolong moisture to increase proliferation of epithelial cells |
| What do gauzes do? | Protect the wound and absorb the fluid |
| What do hydrogels do? | Hydrate and soothe tissue |
| Manual pressure can be done by? | Hand, sponge, digit or "packs" for pressure |
| How do hemostats work? | They are clamped onto the vessel to constrict and seal the vessel |
| How do ligating clips work? | small staple-like device that is placed around the lumen of a vessel and then closed to seal it off |
| How does bone wax work? | it provides mechanical tamponade effect to stop oozing from cut bone surface |
| When is bone wax use contraindicated? | when rapid bone regeneration is desired because it acts as a physical barrier that prevents bone union |
| When are tourniquets used? | When a bloodless surgical site is desired |
| What is the recommended time limit for tourniquets? | 1 hours for upper extremities and 1.5 hours for lower extremities |
| What is esmarch bandage? | It facilitates exsanguination of blood from the distal extremity |
| What is a ligature? | Is a strand of material that is tied around a blood vessel to occlude the lumen and prevent bleeding |
| What is a pledget? | small squares of teflon sutured over a hole in a vessel; they exert external pressure over any small needle holes |
| What are ABC used for? | to control bleeding from vascular structure, superficial bleeders and diffuse oozing of blood |
| What is cyrosurgery? | Produces local freezing of target tissue at-20 to -60 celsious (decreases need for oxygen which decreases bleeding) |
| What is hypothermia hemostasis? | cooling the body temp decreases cellular metabolism |
| What is an example of microfibrillar collagen? | Avitene and it is an absorbale topical agent |
| What is an example of oxidized cellulose? | NiKnit, Surgicel |
| What are examples of collagen sponge? | Collastat, superstat and helistat |
| What are examples of absorbale gelatin spong? | Gelfoam |
| What are examples of fibrin? | Tisseal, crosseal and floseal |
| What are examples of phenol solution? | Phenol |
| What are examples of thrombin? | Thrombin and thrombostat |
| What are examples of styptics? | Epinephrine, tannic acid and silver nitrate |
| What are the different types of sponges? | Laparotomy, tonsil, neuro-patties/cottonoids, dissector, raytecs |
| What are laparotomy sponges? | Extra absorbent 100% cotton, prewashed gauze. They help protect and pad delicate tissue/organs as well as absorb fluid |
| What are tonsil sponges? | Have a cotton filling and are used during tonsillectomies |
| What is the correct steps to do when sponge count is incorrect? | Document counts and results in record. Document actions taken to locate missing sponge, document that radiographs were taken and the name of the person who read the radiograph, follow hospital policy for completion fo unusuall occurrence report |
| Defintion of perioperative nursing | a combination of individualized and standardized care and is practiced in a variety of settings |
| When is perioperative nursing practiced? | the preoperative, intraoperative, and postoperative phases of the surgical experience |
| What are the three roles of the intraoperative nurse? | scrub person, circulator and RN first assistant |
| Respiratory effects of Trendelenburg | respiratory embarrassment due to decreased lung volume, increased potential for pulmonary congestion and edema, decreased diaphragmatic movement, impaired gas exchange |
| Use of Reverse TB | upper abdomen, head and neck, and facial surgery |
| Safety of reverse TB | pillow/donut under knee and knees, padded footboard to prevent slippage |
| CV effects of reverse TB | decreased cardiac return and brainstem perfusion, pooling of blood in lower extremities (venous stasis), potential for circulatory overload if brought back to supine too quickly |
| Respiratory effects of reverse TB | unimpaired respiratory movement, potential reduction in diffusing capacity of lung, potential for respiratory insufficiency |
| Modified Fowler use | posterior cervical spine, cranial procedure |
| Safety of MF | hands on pillow, pressure areas padded, protect eyes |
| CV effects of MF | venous pooling, potential for air emboli d/t negative pressure on head/neck, hypotension r/t position and affect of anesthesia |
| Respiratory effects of MF | unimpaired respiratory movement, potential reduction in diffusing capacity of lung, potential for respiratory insufficiency |
| What does the nursing process help guide? | Helps guide the actions and interventions in preparing and planning a patient's care |
| What are the phases of the nursing process? | Assessment, diagnosis, outcome identification, planning, implementation and evaluation |
| What is an important aspect of the assessment phase? | data collection |
| Definition of nursing diagnosis phase? | is the process of identifying and classifying data collected during the assessment |
| Definition of outcome identification? | Are defined after the nursing diagnoses are determined and documented |
| Definition of planning? | incorporationg the interventions identified into actions |
| Definition of implementation? | the actual performance of the activities identified |
| Definition of evaluation? | determines if the care rendered to the patient, based on assessment and diagnosis, was effective or of any impact ( + or -). |
| What core concepts are fundamental to periop nursing process? | Perioperative mission and philosophy, competencies and standards and quality indicators |
| A perioperative nursing mission statement defines? | A department's purpose for existing within a facility or organization |
| Expected competencies set what? | Skills and abilities that serve as a means to guide a practitioner in the periop setting |
| Standards serve as? | A guide for ensuring that periop practitioners provide quality patient care |
| Quality indicators are used for? | To devise appropriate intervention strategies to improve or change the way patient care is delivered. |
| What is perianesthesia nursing? | It encompasses the care of the patient before and after anesthesia administration |
| Units that are staffed by perianesthesia nurses? | |
| Who are perianesthesia nurses? | RN's with advanced knowledge concerning general, regional and local anesthesia (usually with critical care experience) |
| Role of PAT nurses? | Call patients pre-operatively to conduct an interview or have the patient come to have a face-to-face interview and testing. |
| When is the PAT interview done? | |
| What is the PACU? | |
| PACU level Phase 1 | All patients who have had general anesthesia must be admitted to this phase |
| PACU level Phase 2 | |
| What is the extended care unit? | |
| Equipment needed for perianesthesia care? | All that are concerned with measuring and monitoring patient systems and physical assessment |
| Post-operative phone call | Any outpatient should get a phone call usually 24-48 hours after discharge |
| Care of patients is done through what? | |
| What does the surgical environment include? | Operating rooms, endoscopy suites, cardiac cath labs, ambulatory surgery centers |
| Surgical environment is designed to obtain what? | |
| Unrestricted zone | Provides an entrance and exit site for staff, patients, vendors and equipment (street clothes are allowed) |
| Semirestricted zone | includes peripheral support areas and access corridors and provides entrance into restricted zone (caps and body covers are to be worn) |
| Restricted zone | includes the actual OR (surgical attire, temperature and humidity are maintained) |
| Proper surgical attire | Body cover, head cover, shoe covers, surgical maske and PPE items |
| PPE is worn why? | to protect against hazardous conditions in the semi-restricted and restricted areas |
| Who comprises the surgical team? | |
| Responsibility of doctor? | Performing the surgery and actions r/t the surgical procedure |
| Responsibility of Anesthesia care providers? | |
| Responsibility of scrub techs? | responsible for setting up and maintaining the sterile field and keeping an accurate count of the sponges, sharps and instruments used in the procedure |
| Responsibility of circulating nurse? | for maintaining a physically and mentally safe and secure surgical environment |
| Basic furniture needed inside surgical suite? | |
| Most commonly used equipment during procedure? | |
| Special equipment needed for suites? | |
| What does the PNDS provide? | |
| What is aseptic technique? | practices that result in the restriction of microorganisms on the patient, environment and equipment and supplies |
| Goal of aseptic technique? | |
| Surgical asepsis is designed to do what? | |
| Medical asepsis is designed to do what? | |
| What is surgical conscience? | |
| When did aseptic technique begin? | Can be traced back 4000 years to the time of Hippocrates |
| Important names with aseptic technique? | |
| Principle 1 of aseptic technique | All items used within a sterile field must be sterile |
| Principle 2 of aseptic technique | A sterile barrier that has been permeated must be considered contaminated |
| Principle 3 of aseptic technique | The edges of a sterile wrapper or container are considered unsterile after the package is opened |
| Principle 4 of aseptic technique | gowns are considered sterile in front, from chest to level of sterile field, and the sleeves are sterile from two inches above the elbow to the cuff |
| Principle 5 of aseptic technique | tables are sterile at table level only |
| Principle 6 of aseptic technique | Sterile persons and items touch only sterile areas. unsterile persons and items touch only unsterile areas. |
| Principle 7 of aseptic technique | movement within or around a sterile field must not contaminate the field |
| Principle 8 of aseptic technique | all items and areas of doubtful sterility are considered contaminated |
| Recommended Practice 1 for maintaining a sterile field | scrubbed persons should function within a sterile field |
| Recommended Practice 2 for maintaining a sterile field | sterile drapes should be used to establish a sterile field |
| Recommended Practice 3 for maintaining a sterile field | |
| Recommended Practice 4 for maintaining a sterile field | all items introduced to a sterile field should be opened, dispensed and transferred by methods that maintain sterility and integrity |
| Recommended Practice 5 for maintaining a sterile field | a sterile field should be maintained and monitored constantly |
| Recommended Practice 6 for maintaining a sterile field | |
| Recommended Practice 7 for maintaining a sterile field | policies for maintaining a sterile field should be written, reviewed annually, and readily available within the practice setting |
| What is the assessment? | |
| Subjective data? | information about the patient's own feelings or perceptions regarding surgery |
| Objective data? | includes lab data |
| Two components of periop assessment? | |
| Physiological assessment includes? | |
| What does rapport help with? | |
| Maslow's Hierarchy | |
| psychosocial assessment includes? | perception of surgery, expectations of care, coping styles, knowledge levels, ability to understand, philosophical/religious beliefs and cultural practices |
| What is latex? | |
| What are the three types of reactions to latex? | |
| What are the routes of exposure to latex? | Direct external contact, mucosal contact, airborne contact and IV exposure |
| What are the 3 methods used to clean the OR? | |
| How to do cloth cleaning? | soft, absorbent, and low-lint cloths are used to wipe all surfaces within the suite and then placed in laundry or discarded to avoid cross-contamination |
| How to use vacuum cleaning? | |
| How to use mop cleaning? | |
| When is end of procedure cleaning done? | |
| How to handle contaminated disposable and reusable items | |
| What is terminal cleaning? | a more thorough cleaning that takes place at the end of the day's schedule, which decrease the number of pathogens, dust and debris |
| What is the PNDS? | a standardized nomenclature in documentation that provides a means of gathering and aggregating data in a form that can be used for statistical analysis. |
| Who describes the importance of setting performance standards and expectations for patient safety? | |
| What are the four elements required to create a culture of safety? | |
| Skill-based errors | Occur when our attention is diverted and we fail to monitor the actions we are performing |
| Knowledge-based errors | Arise when a nurse misinterprets a situation or incorrectly applies a rule |
| Situational-based errors | |
| Purpose of National Patient Safety Goals | promote specific improvements in patient safety. They highlight problematic areas in health care and describe evidence based soluations to these problems. |
| What is the goal of the universal protocol? | |
| What processes are used to promote correct site surgery? | |
| When to identify the patient? | Before entering the OR, before being operated on, before being transferred to another unit |
| How many patient identifiers should be used? | |
| How should marking of the patient occur? | |
| When should the time out occur? | |
| What factors contribute to intraoperative injuries? | |
| The NFPA reports how many hospital fires each year? | 8000 |
| What are the three elements for a fire | Ignition source, fuel source, an oxidizer |
| What should the nurse follow when there is a fire? | |
| Who is responisble for devising an emergency electrical outage plan? | |
| What are staff members responsible to know about outage plans? | Responsible for knowing, understanding and complying with the outage plan. |
| What to do when line isolation monitor alarms | unplug last piece of equipment in the room that was plugged in. If alarm continues, unplug all unnecessary equipment. |
| What is the most important measure to prevent postop infection? | |
| When are aseptic practices implemented to minimize wound contamination? | |
| Where does prevention of infection begin? | |
| What is the process or steps for getting instruments ready for use? | Decontamination - cleaning - assembly - packaging - sterilization - storage |
| What is decontamination? | process in which bioburden is reduced and contaminants are removed, either by hand cleaning or mechanical methods |
| Types of automated cleaning machines? | |
| What is shelf life? | |
| What is sterilization? | |
| Types of sterilization? | |
| What is disinfection? | |
| What is the Spaulding Classification system | |
| What methods are used to measure sterilization parameters? | |
| What is biological monitoring? | used to document the efficacy of specific sterilization cycles, not the sterility of the item |
| What does surgical tissue banking encompass? | |
| Transient Organisms | |
| Resident Organisms | |
| What is included in the surgical attire? | hair covering, mask, protective eyewear, scrubs |
| What are the scrubbing procedure steps | |
| Closed glove technique | |
| Open glove technique | |
| What are the layers of the skin? | |
| Goal of surgical skin prep? | |
| What characteristics should a antimicrobial agent possess? | |
| What are different types of prep? | |
| Where should prep start at on the patient? | |
| What are the seven steps of a prep? | |
| What is drape selection based on? | |
| Laparotomy sheets | referred as lap sheets. Fenestration is longitudinal and covers the surgical site on the abdomen, back or a comparable area |
| Thyroid sheet | same size as the lap sheet but the fenestration is transverse and closer to the top of the sheet for neck procedures |
| Breast sheet | similar to lap sheet except the fenestration is larger to permit larger exposure and is used for breast and chest procedures |
| Kidney sheet | the fenestration is transverse |
| Hip sheet | is a longer version of a lap sheet to permit coverage of an orthopedic fracture table |
| Perineal sheet | used to create a sterile field with patient in lithotomy. May have leggings incorporated into it |
| Combined sheet | combo of a lap sheet and perineal sheet. Used for combined abdominal-perineal resection of the rectum |
| Split sheet | same size as a lap sheet but instead of a fenestration, one end is split up the middle. Upper end may be in the shape of a U |
| Minor sheet | has many uses (cover armboards to permit extension of field, cover pieces of equipment, wrap around extremities to permit extension of field) |
| Medium sheet | used as added protection above above or below the surgical area, or for draping areas when fenestrated sheet cannot be used |
| Leggings | cover patients legs when in lithotomy |
| Stockinette | used to cover an extremity |
| Incise – drapes | Plastic, impermeable, incise drapes used in conjunction with conventional drapes. Iodophor provides an antimicrobial barrier between skin and wound. |
| Towel drape | plastic sheeting has a band of adhesive along one edge of drape to wall of a contaminated area |
| Aperture drape | adhesive surrounds fenestration in plastic sheeting. |
| Advantages of aperture draping | prevention of lateral microbial migration, organisms can’t penetrate through plastic, permit visualization of skin tones/landmarks, eliminates need for towel clips, conform to body |
| Guidelines for draping | preparation, draping procedure, precautions |
| Preparation step for draping | carry folded drape to bed, allow enough time to permit careful application, ensure prep has dried, and allow enough space to use aseptic technique |
| Draping procedure | cuff drape over gloved hand, drape from incision site to periphery, drape from sterile to unsterile by draping nearest first, incorrect drapes should be removed by unscrubbed |
| Precautions step of draping | don’t allow drapes to fall below waist, don’t contaminate gown when draping, never reach across an unsterile area, once drape or towel clip is placed don’t move it |
| What is electrosurgery? | cutting and coagulation of body tissue with high radio frequency current that is delivered by use of a generator, which directs electrical current to an active electrode |
| How does monopolar mode work? | current is returned to the generator by means of a dispersive electrode |
| How does bipolar mode work? | current is passed between the tips of the forceps and then is returned to the generator |
| When is bipolar mode used? | when coagulating around nerves or brain tissue because the current doesn’t spray or spread. Also with pacemakers. |
| What is capacitive coupling? | occurs when the electrical current from active electrode passes though intact insulation to adjacent conductive items. Instrucments with insulation must be inspected before and after use |
| What is Argon-enhanced coagulation? | uses argon gas with electrical current. Has the risk for gas emboli |
| Care that must be taken with ESU and pacemaker | dispersive electrode must be placed as closely to active electrode as is feasible, and the current should not be allowed to pass in the vicinity of the heart of through the heart |
| What are the goals of positioning? | maintaining physiologically and anatomically safe environment, provide optimal exposure during surgery, maintaining airway and allowing access to monitoring devices/IV lines |
| What can improper positioning lead to? | neural damage |
| Supine position | most natural position of body at rest |
| How to reduce injury from shearing | lift patient slightly with draw sheet and allow skin to realign with skeletal structure and to reduce the time that shearing may occur |
| How to reduce injury from friction | ensure that adequate personnel available and use lifting devices |
| Maceration | occurs when moisture on the skin saturates and weakens the epidermis |
| Uses of supine | most abdominal, head, neck, vascular and breast procedures |
| Safety measures of supine | arm extension less than 90 degrees to avoid compression of brachial plexus, pad under head, pressure points padded, strap 2 inches above knee, place pillow under knees to relieve pressure off back, a wedge should be inserted under right hip if pregnant |
| Cardiovascular effects of supine position | |
| Respiratory effects of supine position | compromised respiratory function, decrease in vital capacity and diaphragmatic expansion, even distribution of lung ventilation |
| Use of trendelenburg’s | |
| Trendelenburg safety measures | |
| Cardiovascular effects of Trendelenburg | |
| Units that are staffed by perianesthesia nurses? | |
| Pre-admission testing unit, pre-operative care unit, pre-operative holding, post-anesthesia care unit, extended care unit | |
| When is the PAT interview done? | |
| Well in advance to allow for appropriate evaluation and to perform necessary testing and obtain results | |
| What is the PACU? | |
| Highly specialized unit that came into existence because of use of anesthetic gases, advancement of surgical procedures, use of specialized equipment and intro of PACU standards by ASA | |
| PACU level Phase 2 | |
| Once patients meet discharge criteria from phase 1 they go to phase 2 | |
| What is the extended care unit? | |
| patients come here for additional observation after time in the PACU | |
| Care of patients is done through what? | |
| collaboration and teamwork (between OR nurse and perianesthesia nurses) | |
| Surgical environment is designed to obtain what? | |
| Geographic isolation within the facility, protected from unauthorized personnel, obtain bacteriologic isolation through specific practices | |
| Responsibility of Anesthesia care providers? | |
| For administering the correct dose of anesthesia and monitoring the patient | |
| Basic furniture needed inside surgical suite? | |
| Bed, mayo stand, back table, ring stand, kick bucket | |
| Most commonly used equipment during procedure? | |
| ESU, suction | |
| Special equipment needed for suites? | |
| Defibrillators, crash cart, MH cart, sterilizers and latex allergy cart | |
| Goal of aseptic technique? | |
| to optimize primary wound healing, prevent surgical infection and minimize the length of recovery from surgery | |
| Surgical asepsis is designed to do what? | |
| Exclude all microbes | |
| Medical asepsis is designed to do what? | |
| reduce microbes | |
| Important names with aseptic technique? | |
| Ignaz Semmelweis, Louis Pasteur, Joseph Lister, Robert Koch, Florence Nightingale | |
| Recommended Practice 3 for maintaining a sterile field | |
| items used within the sterile field should be sterile | |
| Recommended Practice 6 for maintaining a sterile field | |
| all personnel moving within or around a sterile field should do so in a manner that maintains the sterile field | |
| What is the assessment? | |
| Ongoing systematic collection of data to identify actual or potential problems that may occur during the periop event | |
| Two components of periop assessment? | |
| Physiological and psychosocial assessment | |
| Physiological assessment includes? | |
| age, skin condition, mobility, diagnostic studies, vital signs, sensory impairment, cardiovascular status, respiratory status, renal status, allergies, medications, implants, prosthetics, external fixators and special assessment needs | |
| What does rapport help with? | |
| it can make a difference in the patients/family's perception of the periop experience | |
| Maslow's Hierarchy | |
| biological needs, safety/security, social aspects, ego/self-esteem, self-actualization needs | |
| What is latex? | |
| cytosol portion of the sap of the rubber tree called Hevea brasiliensis | |
| What are the three types of reactions to latex? | |
| Irritant contact dermatitis, allergic contact dermatitis (delayed type IV hypersensitivity reaction), immediate type 1 hypersensitivity reaction | |
| What are the testing means for latex? | |
| skin-prick test, wearer or use test, and radioallergosorbent text (RAST) | |
| Guidelines when taking care of latex allergic patient | |
| notify physician of allergy, check to see if patient is scheduled as first case, admit patient in a latex-safe area, place an allergy armband on the patient, post latex allergy warning signs on OR doors. | |
| What are the 3 methods used to clean the OR? | |
| Cloth, Vacuum, Mop | |
| How to use vacuum cleaning? | |
| wet vacuuming is the most effective method for floor cleaning. May be used dry first in order to pick up large amounts of suture remnants and debris. | |
| How to use mop cleaning? | |
| reusable string and microfiber mops and cleaning cloths should be changed after each use. | |
| When is end of procedure cleaning done? | |
| at the end of each case | |
| How to handle contaminated disposable and reusable items | |
| Classified as either potentially infectious or noninfectious. Use principle of confine and contain contamination. | |
| What is the PNDS? | |
| A method approved in 1999 by ANA to document and reliably track and evaluate info to provide EBP and establish patient outcomes in the health care system | |
| Who describes the importance of setting performance standards and expectations for patient safety? | |
| Institute of Medicine (IOM) | |
| What are the four elements required to create a culture of safety? | |
| trust between team members, dissemination and verification of receipt of inro to all levels of staff and management, development and support of a proactive approach rather than a reactive, blaming approach and a commitment to affirming safety as priority | |
| Situational-based errors | |
| lack of attention | |
| What is the goal of the universal protocol? | |
| to eliminate wrong site, wrong procedure and wrong person surgery | |
| What processes are used to promote correct site surgery? | |
| Preoperative verification, operative skin marking, and time out | |
| How many patient identifiers should be used? | |
| minimum of two | |
| How should marking of the patient occur? | |
| Physician should involve the patient and use their initials using a marker that is visible after prep/draping. | |
| When should the time out occur? | |
| Take place in the room where the procedure is to occur and should involve the entire surgical team | |
| What factors contribute to intraoperative injuries? | |
| Preoperative skin integrity, nutritional status, preexisting metabolic dysfunction, tissue perfusion | |
| What should the nurse follow when there is a fire? | |
| RACE | |
| Who is responisble for devising an emergency electrical outage plan? | |
| OR management | |
| What is the most important measure to prevent postop infection? | |
| Flawless application of aseptic technique principles | |
| When are aseptic practices implemented to minimize wound contamination? | |
| Preop, intraop and postop | |
| Where does prevention of infection begin? | |
| Central supply with decontamination, assembly, preparation, and sterilization of instruments | |
| Types of automated cleaning machines? | |
| Ultrasonic units, washer, sterilizer | |
| What is shelf life? | |
| period of time that sterility is maintained and is r/t capability of packaging material and storage conditions to protect sterility | |
| What is sterilization? | |
| process by which all forms of microbial life (bacteria, viruses, spore and fungi) are destroyed to an acceptable sterility assurance level | |
| Types of sterilization? | |
| Saturated steam, immediate-use, chemical, ethylene oxide, low-temp gas plasma | |
| What is disinfection? | |
| any process, chemical or physical that kills or destroys pathogenic microorganisms on inanimate surfaces and objects | |
| What is the Spaulding Classification system | |
| Items to be disinfected are either critical, semicritical or noncritical | |
| What methods are used to measure sterilization parameters? | |
| Charts/graphs, chemical indications, temperature specific indicators, integrators, and daily function tests | |
| What does surgical tissue banking encompass? | |
| Retrieval, processing, preserving, and storing of human tissue | |
| Transient Organisms | |
| acquired by direct contact that attaches loosely to skin surface and are removed from mechanical friction of scrub | |
| Resident Organisms | |
| flora below the skin in hair follicles and sebaceous/sweat glands. The chemical action of scrub reduces and neutralizes these | |
| What are the scrubbing procedure steps | |
| Inspect hands/arms, Open gown & place on table, open sterile scrub brush, wet & lather hands and forearms, clean under nails, scrub fingertips, nails, palm and wrist two inches above elbow, repeat for other hand, rinse while keeping finger pointed upward | |
| Closed glove technique | |
| scrub person’s hands remain inside gown sleeves and should not touch cuff edges. It is used for the initial donning of sterile gown/gloves | |
| Open glove technique | |
| scrub person’s hands slide all the way through the sleeves and out beyond cuffs. Used for subsequent gloving | |
| What are the layers of the skin? | |
| Dermis and epidermis | |
| Goal of surgical skin prep? | |
| to remove the soil and transient organisms from the skin. To reduce the resident count to below pathogenic levels and to inhibit rapid rebound growth of organisms | |
| What characteristics should a antimicrobial agent possess? | |
| broad spectrum, high log reduction capability, persistency, nonirritating, nontoxic, and fast acting | |
| What are different types of prep? | |
| chlorhexidine gluconate, povidone-iodine, alcohol, parachlorometaxylenol, and a cationic phenolic mixture | |
| Where should prep start at on the patient? | |
| at the site of incision and move outward. Clean areas should be first and then dirty/contaminated areas last | |
| What are the seven steps of a prep? | |
| assessment, preoperative cleansing, preoperative hair removal, exposing area to be prepped, preparing to apply agent, sponging, subsequent sponges | |
| What is drape selection based on? | |
| type of procedure, amount of area around incision to be included, furniture and equipment to be draped |
Created by:
burnss2