CNOR EXAM Questions and answers, 100% Accurate, Graded A

CNOR EXAM Questions and answers, 100% Accurate, Graded A What are the three elements of the fire triangle? What are the most common surgical sites of pt fires? What is the most common source that contributes to 90% of OR fires? - -oxidizer, ignition source, fuel -chest, neck, face, head -Electrosurgical units FIRE TRIANGLE: Name IGNITION sources in the OR Name FUEL sources in the OR Name OXIDIZERS in the OR what is the most common fuel source in the OR? - -Electrosurgical units, drills, heated probes, lasers, electrocautery devices, fiberoptic cords -alcohol-based prep, Collodion, drapes, ET tubes, gowns -Oxygen, Nitrous Oxide -drapes AIRWAY FIRE: what should you remove from the patient? (2) stop the flow of? what do you pour down the airway? What is the 1st line of defense to put out an OR fire? - -ET tube, drapes/flammable supplies -all medical gases -saline -noncombustible/nonflammable solutions from back table or smothering technique MINIMIZING SURGICAL FIRES: What should you place in the pt's throat for procedures involving the mouth/face/airway and why? What should you inflate the ET tube cuff with and why? - -saline moistened lap, to assist with decreasing/preventing O2 leaks from tube -tinted saline solution, the liquid helps increase the temp required to rupture the cuff, the color helps visualize a rupture SURGERY IN THE AIRWAY/CHEST AREA: To prevent fire, what should you coat the pt's head/facial hair with? What should you use between the surgical site and O2 source? What should anes suction be used to evacuate? - -water soluble gel -Ioban incise drape -accumulated anes gas SURGICAL FIRES: What type of fire extinguishers are recommended for OR use?(2) Should you use fire blankets in the OR?-why?(4) When using open source O2, how should the drapes be placed over the head? - -Water mist and Carbon dioxide -no, they can trap the fire next to/under the pt, they can dislodge instruments, they can cause wound contamination, they can spread the fire -in a way that allows for O2 to flow freely/prevent accumulation under the drape SURGICAL FIRES: What gases are present in the bowel? How should you create an incision in the bowel or trachea? What prevention technique should you use for surgeries near the rectum? What should you use to administer supplemental O2 in pt's that need O2 greater than 30%? When is an environment considered oxygen rich? - -methane, hydrogen -with a scalpel rather than monopolar cautery -cover or pack the rectum with a wet lap -laryngeal mask airway or ET tube -if the O2 concentration is greater than 21% by volume MEDICAL GASES: where/how should you store med gases in a facility? store separately from? what identifiers are present on med gas cylinders to determine their contents?(3) - -indoors in a secured access-controlled area with chain like devices to lock and in a holder/on a rack -industrial gases -the color of the cylinder, written labels on the cylinders, the pin index safety system specific to each type of med gas MEDICAL GASES: The emergency supply of O2 for a facility should be enough to support for how long? what kind of drugs are medical gases considered to be/they should be given by ? only The room medical gas is stored in should be fire resistant for how long at a minimum? - -uninterrupted use for 1 day -prescription -1 hour how would you describe a medical gas cylinder that is considered for immediate use? vs storage use? What components make batteries considered hazardous waste if contained in them? (3) if a product contain what chemical element?, it must be disposed of as hazardous waste. - -immediate: attached to a transport vehicle that has a pt on it or directly associated with a current present pt storage use: on a transport vehicle that is not directly associated w/ a pt and has been unoccupied for 30 mins or more -cadmium, lead, silver -mercury Flammable liquids such as?(6) are ? wastes and must be contained/placed for disposal where? A flammable solution has a flash point of less than? A combustible solution will ? but requires ? for ignition. What is the temp point? - -alcohol benzoin collodion formalin MMA monomer and silver nitrate, characteristic, in hazardous waste receptacle -37.8 c or 100f -burn, higher temperatures, greater than 37.8c/100f Give examples of critical points in a case where noise/distractions should be decreased/removed. (7) What do ALERT ALARMS alert the team to?-examples of these what do CLINICAL ALARMS alert the team to?-examples of these - -surgical time out, briefings about case, implant sizing, anes induction/emergence, surgical counts, specimen management, crucial portions of procedure such as aneurysm clipping or anastomosis -system failures that would effect multiple pts, code blue alarms medical gas systems blood fridges fire alarms ethylene oxide level alarms warmer alarms -pt specific alarms that alert to poss emergency situations, cardiac monitors ventilators anes machine What are Glutaraldehyde based agents used for? how should these agents be disposed of? What kind of waste do red hazard bags indicate? yellow bags? - -high level disinfection of medical items sensitive to heat that can't be steam sterilized -using a pump system transfer device to transfer used solution -red: regulated medical waste, yellow: hazardous waste such as waste contaminated by chemo agents METHYL METHACRYLATE BONE CEMENT: How many pairs of gloves should you wear when handling? What should you do after handling the cement? what kind of mixing systems are recommended for mixing/dispensing the cement? What absorbent should be used to cover the MMA polymer(liquid portion) if spilled? what can happen if you allow the formed cement to come in contact with skin? - -2 -change your top gloves -vacuum systems or closed systems -activated charcoal -pt burns can occur LATEX RESPONSE CATEGORIES(3): what kind of reaction is IRRITANT CONTACT DERMATITIS? it is not an? what are the signs of it? how long does it take for signs to appear? what kind of activities in healthcare cause irritant contact dermatitis? what can it be a warning sign of? - -common reaction to latex exposure, allergy -red itchy rash that breaks out where latex contacted skin, 12-24hr after contact -washing hands frequently and incompletely drying hands, using hand sanitizers, wearing powdered latex gloves -development of a latex allergy LATEX RESPONSE CATEGORIES(3): is CELL MEDIATED CONTACT DERMATITIS life threatening? what causes this category of latex response? when does dermatitis typically appear for this type of response? where can it spread to? symptoms often resolve ? - -no -sensitivity to chemicals added to latex in the production process -24 to 48 hours after contact -any area touched by the affected area -spontaneously LATEX RESPONSE CATEGORIES(3): What is an IGE MEDIATED LATEX ALLERGY? This response is ? and ? How is it triggered? (3) What are risk factors for latex sensitivity?(5) - -allergic reaction to natural rubber latex proteins -severe, life threatening -contact with latex to skin, contact with latex to mucous membranes, inhalation of latex proteins into lungs -history of multiple surgeries, history of spina bifida, food allergies to kiwi banana raw potato avocado chestnuts, history of long term bladder care, symptoms of dermatitis urticaria hay fever UNIQUE DEVICE IDENTIFICATION(UDI): Who created the system? What is the purpose of the system?(3) What are the two versions that a UDI must be presented in? - -FDA -improve patient safety, modernize device post market surveillance, facilitate medical device innovation -written and automatic identification & date capture aka a bar code so that the UDI can be uploaded to pt's chart UDI REGULATIONS: Part 801 covers? Part 803 covers? Part 807 covers? - -labeling requirements for labels on the device and literature that accompanies the device -medical device reporting programs that provide a method for the FDA/manufactures to identify/monitor significant adverse events involving the devices -requires that medical device manufactures/importers both USA and foreign register med devices w/ the FDA FINANCIAL IMPACT ANALYSIS OF PRODUCTS FACTORS: Direct cost examples? Indirect cost examples? the potential for ? from agencies such as? what kind of pricing is considered? - -cost of product, replacement cost, associated equipment costs -utilities, waste disposal, processing, staff training on item, storage, energy use, retrofitting of existing equipment, depreciation, renovation/construction related to it's use -reimbursement, medicaid medicare -group purchasing organization contract pricing examples of QUANTITATIVE methods to measure cleaning practices examples of QUALITATIVE methods to measure cleaning practices If CJD tissue falls on the floor, what should the RN apply to the floor first/for how long? then what should the RN apply to the area? - -cultures, adenosine triphosphate monitoring -fluorescent marking, visual inspection of cleanliness/cleaning practices -detergent for 30 mins, sodium hypochlorite or hydroxide TOURNIQUET USE: Name potential systemic contraindications to T use(7) Name potential surgical site issues that would contraindicate T use(5) - -AV grafts/fistulas, diabetic neuropathy, VTE/history of, sickle cell anemia, severe infection, previous revascularization, peripheral vascular disease -malignancy, open fractures, severe crush injuries, severe scar tissue at cuff site, thigh circumference >100cm TOURNIQUET USE: What should you assess preoperatively in a pt that requires a T cuff? What pts should you use caution when using a T cuff? - -circulation of extremity(cap refill pulses temps), skin condition at potential cuff site/distal to cuff site, sensory/motor responses of the operative extremity vs the contralateral extremity -older pts, pts with low prep hemoglobin, pts with high BMI, pts at increased risk for VTEs TOURNIQUET USE: What should you place around the limb under the T cuff? Why should you use an adhesive drape around a T cuff? Where should you position T cuff tubing? Where should you apply the T cuff to prevent neurovascular damage to an extremity? What should the size be based on? - -low linting soft padding -to prevent fluid accumulation under the cuff/contamination of cuff -lateral aspect of the extremity to prevent pressure and away from the surgical site -the point of maximum circumference proximal to the surgical site -size to maintain pressure/fit/field of visibility according to manufacture IFU TOURNIQUET USE: What should you do to the extremity before inflating the T cuff? Methods to do this? (2) What technique should NOT be used and why? If you need to change the position of the cuff what do you do? What kind of cuff should you use if it will be positioned close the surgical site? - -exsanguinate it -Elevation or Elevation plus elastic band use (ESMARK) -Hand over Hand, its associated with more skin tension blisters and increased post op pain -remove the T cuff completely and reposition, DO NOT MOVE AGAINST PTS SKIN -sterile cuff TOURNIQUET USE: how should you select the pressure of the cuff? When does EARLY RELEASE of the cuff occur? When does LATE RELEASE of the cuff occur? - -keep to a minimum based on the pts needs PT SPECIFIC NOT A STANDARD PRESSURE -anytime before dressings are placed -after dressings are placed TOURNIQUET USE: What are preconditioning techniques used for? name two methods to do this. What is the Reperfusion time? The Safety Margin with t cuff use refers to? - -to reduce oxidative stress & increase skeletal muscle ischemia tolerance related to t cuff inflation, short intervals of temporary ischemia with t cuff or anesthetic regimens -time the T cuff is deflated and then reinflated during surgery -additional pressure added to the cuff pressure to account of physiological variations during the procedure TOURNIQUET USE: What is the LIMB(ARTERIAL) OCCLUSION PRESSURE? What should it's measurement be used to determine? What is the Gold Standard choice for measuring it? other options to do so?(2) - -minimum pressure required to stop flow of arterial blood into limb distal to the T cuff -the initial T cuff pressure -ultrasound doppler, FDA cleared automatic system or arterial occlusion pressure estimation formula TOURNIQUET USE: you should monitor pediatric pts for what during T cuff use? Describe the staggered T cuff deflation method, What is the goal for this method? the goal of prophylactic antibiotic admin & T cuff use? T cuffs should overlap a minimum of how many inches and no more than how many inches? - -respiratory acidosis -releasing & reinflating the T cuff a few times before completely deflating it at the end of the procedure, to mitigate a physiological response to sudden loss of blood volume -achieve optimal tissue concentration of antibiotic -3in, 6in CONTOURED T CUFFS: On what kind of extremity should you use a Contoured cuff? What end of this cuff is shorter? How do Cylindrical cuffs look in comparison and what type of extremity would you use them on? - -extremity that tapers in size btwn the upper and lower edge of the cuff -distal -they are equal on both size of cuff and used for non tapered extremities What is Baroreflex Autoregulation? What kind of compression develops in Compartment Syndrome? What does this compression cause? What are the clinical manifestations of Compartment Syndrome? - -physiological response to control BP fluctuations -Arterial compression -reduction in blood supply to the limb or body area -severe pain/loss of sensation at site, swelling, restriction of movement, vascular compromise Why must health care organizations establish a process for selecting/evaluating sharp safety devices? What does a DECISION SUPPORT FRAMEWORK provide when evaluating products? What is kill/contact/dwell time? - -it is the regulatory requirement for the written blood-borne pathogens exposure control plan -a standardized tool to compare products equally -a specific length of time a disinfectant must remain on surfaces to achieve disinfection If you remove a cleaning chemical from its original container, what must you do with the secondary container? Name situations in the OR when you would TERMINALLY CLEAN the room Name situations in the OR when you would use ENHANCED CLEANING PRECAUTIONS Why shouldn't you use alcohol to disinfect large surfaces in the OR? - -label it w/ chemical name, concentration, and exp date -after construction/renovations are complete, after c diff case, after pest infestations are resolved, and EVERYDAY for used ORs -MRSA pts, VRE pts any drug resistant bacteria -its not a EPA registered disinfectant, its increases risk for fire due to oxygenated environment/ignition sources What is the primary and secondary line of defense to protect pts from pathogens in OR procedures? In the health care setting, you should keep your nails no longer than? What temperature should hand washing water be kept between and why? - -surgical hand antisepsis, wearing sterile surgical gloves -2mm or 0.08in -70 & 80F to prevent dermatitis List instances when you should wash your hands in the healthcare setting (7) after hand washing, what should you do before donning gloves &why? in the absence of visible soil, how should you disinfect your hands and why? - -before/after pt care, before performing sterile/clean tasks, after body fluid/blood exposure, after contact with pt surroundings, visibly soiled hands, before/after eating, after using bathroom -dry hands completely to prevent skin irritation from wet hands in gloves -use alcohol sanitizer, well tolerated and association with less contact dermatitis than soap/h2o What should you consider when determining how to deal with a contamination of your sterile gloves? (4) Describe how a contaminated glove should be changed - -degree of contamination, part of the glove that was contaminated, risk of exposing pt or others to blood/body fluids/infectious material, length of time left in procedure -circulator removes contaminated glove w/o altering position of cuff, scrub holds open new glove and person inserts hand into glove while only touching cuff to inside of glove GLOVE CHANGES: after each pt ? every ?-? mins if you suspect the glove was? immediately after contact with what? after touching unsterile equipment such as? after touching what on your head? - -procedure -90 to 150 -perforated/is visibly perforated or contaminated -methyl methacrylate (bone cement) -eye pieces on microscope or c-arm -surgical helmet hood or visor GOWNING/GLOVING: Where do you keep your cuffs for initial g/g? What is Closed Assisted gloving? What is Open Assisted gloving? - -at or beyond the fingertips -your cuffs are at or beyond finger tips, cuff only touches inside of glove -your cuffs are pulled down to wrist level and you insert your hand w/o touching outside of glove What parts of the your gown are sterile and what parts aren't? What is the Critical Zone on the sterile field? - -chest down to level of sterile field and your sleeves cuff to 2in above the elbow circumferentially, neckline shoulders axillary region back & sleeve cuffs after hands pass through them -area of protective apparel or surgical drape where direct contact w/ blood/body fluids/infectious materials is more likely to occur SCRUBBED IN: keep hands&arms above? if arms are folded, don't put your hands where? avoid changing levels and only sit when? don't turn your ? on the sterile field how should you turn during position changes? remain outside a ? unidirectional air system curtain and don't walk between a ? one. - -waist level -axillary region -the whole procedure will be performed seated -back -turn face to face or back to back with others while keeping distance from others/sterile field/unsterile field -vertical, horizontal Where should you start placing drapes on the sterile field? what parts of the drape are considered sterile and what parts aren't? if in the lateral position and in general, what part of the c-arm is considered unsterile? what is the two cuffed drape method? - -start at incision and work to periphery -top surface of drape is sterile, any items below sterile field aren't -upper portion/top of c-arm drape -place 1st drape horizontally over area to be covered with the cuff at or just beyond the halfway point then place the 2nd drape from opposite side of table with cuff positioned so it completely covers cuff of 1st drape what should assess before prepping the pt? (3) Where do you start prepping and move out to? When should you throw away your prep stick and get a new one? - -skin integrity/sensitivities, allergies, procedure site -incision site moving away towards periphery of the site -after contact periphery or contamination area When the incision site is more contamination than the surrounding skin such as ?(name sites), where should you start your prep? If a pt doesn't bathe or use CHG wipes pre op, what can you do? What areas of greater contamination should you clean before starting prep? Isolate areas of high contamination such as? with what? - -axilla stoma open wounds anus perineum catheter site, start at the low bacterial count site first and work to the higher contamination incision site -wash them with soap/water -umbilicus, foreskin, under nails, intestinal/urinary stoma -anus & colostomy, sterile barrier drape What pts are susceptible to Iodism(iodine poisoning)? What type of preps should you be conscious of for these pts? When is clipping hair at the surgical site recommended? - -burn pts, pts w/ thyroid disorders, neonates, pregnant women, lactating moms -iodine or iodophor based preps -if you're using alcohol based prep/cautery ISOLATION TECHNIQUES: What types of surgeries should use this technique? why? What point in surgery should you initiate & conclude this technique? At conclusion, don't use instruments/supplies that have been used where? - -bowel surgery/resection of metastatic tumors, to prevent the spread of bacteria/cancer cells to other areas thus causing SSIs/cancer cell reseeding -right before resections, when resection or anastomosis is complete -in the bowel lumen or for resection of the tumor ISOLATION TECHNIQUES: What should you remove or isolate from the sterile field at conclusion of this technique? You should change ? at the conclusion of this technique. What should you do to the drapes? What should you use to close the site after conclusion of the technique? - -contaminated instruments/items -gown/gloves -cover them with new drapes -clean instruments Name what you should assess an item for before opening to a sterile field (5) Who's guidelines should be followed for selecting prep products? What is the primary strategy to reduce contamination of the sterile field/items? secondary strategy? - -sterility of contents based on what package states, exp date if applicable, package integrity, product integrity, verification of sterility via chem indicators -FDA -#1 open instruments/supplies as close to time of use as possible, #2 cover sterile field w/ sterile towel or drape Name instances where you would consider the instruments contaminated if found that way (3) What wound classes does the WHO recommend use a wound protector? - -assembled/clamped closed, organic material such as blood/hair/tissue/bone on them, debris such as bone cement/grease/mineral deposits -all but clean ELECTROSURGICAL SAFETY: What is Active Electrode Monitoring? What is a Dispersive Electrode aka a grounding pad? - -process of searching for insulation failures and capacitive coupling during monopolar surgery, if the monitor detects an unsafe level of stray energy, it signals the generator to deactivate -The accessory that directs electrical current flow from the patient back to the electrosurgical generator ELECTROSURGICAL SAFETY: What is ElectroCAUTERY? What is ElectroSURGERY? - -A surgical device, often battery powered, that is used to cauterize blood vessels. No electrodes are used. The current flows through the wire at the end of the application device and not through the patient. Cauterization is produced by heat -The cutting and coagulation of body tissue with a high-frequency (ie, radio-frequency) current. The current is passed through the body or the tissue and between two poles. Heat is generated in the tissue through which the current passes ELECTROSURGICAL SAFETY: How does the electrical current pass with Monopolar cautery? How does the electrical current pass with Bipolar cautery? What type of voltage does Bipolar use? It has limited ability to cut/coag what? It gives better control over? Risk for burns with Bipolar is? - -from the active electrode to the tissue through the patient to the dispersive electrode & back to the ESU -From one tip of the bipolar instrument through the tissue touched ONLY to the other tip of the instrument -low, large bleeding areas, the target area/damage to other tissues, significantly reduced when using a cautery tip, clean the tip when ? is present, using what? why should you keep the cautery tip clean? what kind of trocar do you use if you use cautery & why? - -eschar, a moistened lap or instrument wipe for coated tips, scratch pad for non coated tips -to decrease resistance between the tip and the tissue therefore decreasing the power required from the ESU -conductive, it helps the energy current flow safely between cannula and the body what medical devices warrant greater attention when using cautery in surgery? where should the ekg leads and pulse ox be placed in relation to the surgical site? what type of cautery is recommended when