Periop 101: Study Guide With Complete Solutions!!

Examples of commonly accepted nursing tools The nursing process PNDS the World Health Organization/Joint Commission/AORN surgical safety checklists The following statements reflect the concept of critical thinking Informed practice Holistic thinking Unbiased thinking Reasoned application of a step by step process The clinical setting reflects a culture that is affected by: Beliefs (about the pt and the periop setting) Attitudes (illustrating the desire to provide effective care and engage in critical thinking Values (of fairness and equitable care) Skills (problem solving, situational awareness, collaboration, conflict resolution, decision making, leadership) Define Mentor One who provides encouragement and acts as a guide and facilitator while modeling professional nursing behaviors. Define Preceptor One who teaches, counsels, inspires, serves as a role model, and supports the growth and development of the novice for a fixed and limited period. What is one difference between Mentors and Preceptors? Mentors guide nurses through a wide range of professional activities while preceptors guide nurses through defined clinical activities. Define the competent nurse: One who is now learning to apply and integrate theory and experience to patient situations. Examples of critical thinking and clinical reasoning for the competent nurse includes questions like: How does the conduction system work? What is NSR? Atrial Fib? Ventricular Fib? What are the differences between: cardioversion, defibrillation and pacing? Do I have access to a defibrillator? Is it turned on? Is it set to the correct settings? Questions the Novice nurse might ask regarding an upcoming CV surgical procedure What's the anatomy and physiology of the heart? What are we trying to do that will involve the patient's heart? Is there a map or a list of what I need to get/have/do in relation to this procedure? Who can I talk to for more information on this cv procedure? Michael has pulled a case following Dr. Cortez's preference card exactly. If he is thinking critically, what should he do next to be sure the scrub person has what is needed for Mr. O'Malley's procedure? A. Nothing--if he followed the card precisely, they should be set until they open. B. Use the Time Out to ask what else Dr. Cortez needs. C. Assess the patient and record for indicated additions. D. Both B and C Correct answer: C. Assess the patient and record for indicated additions. When a periop nurse is thinking about a course of action, a good questions to ask oneself is "What data did I use to reach this decision/course of action?" This is an example of the following component of critical thinking: --Using evidence --Being credible --Being introspective --Using sound judgement Correct answer: --Using evidence. Define Introspection Self-reflection; An introspective thinker uses self-assessment to identify personal learning needs, seeking to identify areas of strength and areas needing to be strengthened. Introspection requires reflection, evaluation and self-analysis of clinical performance and a commitment to improvement of that performance. Define Logic Reasoning; "trying to figure something out." Define Evidence The information, or data, on which a conclusion might be based. Define Credibility The quality or power of inspiring belief. "Essential to being credible is information or knowledge that is valid, genuine and authentic." Define Relevant Criteria Those that have a bearing on or relate to the matter, situation, or problem. Define Knowledge Knowledge is having a clear and justifiable grasp of "what is" or of "how to do something." Based on understanding and skill Define Judgment Based on reason, evidence, logic and "good sense". Judgment is making a decision about something based on understanding it and having "the good sense" to determine what is true or not true. "In periop patient care, judgment requires some interpretation of a patient's needs and a decision to take (or not take) action based on this interpretation." Define Questioning Being curious and inquisitive, gathering, and seeking information, and investigating all aspects of the situation. Define Ethics The discipline that deals with good and bad, sometimes including moral values and rules. ____________ is the information, or data, on which a conclusion might be based. --Logic --Knowledge --Evidence --Judgment Correct Answer: Evidence Define Context The set of circumstances or facts that surround a particular event or situation. Define Culture/Environment related to critical thinking --Influence thinking Mental links that are formed in our brains, having been raised in a particular country or region, that, if left unexamined, can unduly influence thinking. The PNDS is an example of how critical thinking supports positive patient outcomes. Why is the so? A. The PNDS provides a recipe for the clinician to follow B. Use of the PNDS assists comprehensive charting via an electronic record C. The PNDS has been tested in clinical settings by nurse, physicians, and technologists. D. Components of the PNDS necessitate application of the components of critical thing and reflect a process for identifying interventions. Correct Answer: D. Characteristics and Learning needs of: Novice Lacks experience with the situation in which they perform Needs context-free rules Unable to apply "rules" in actual situations Can benefit from multiple, similar patients to develop experience Must organize knowledge into separate groups Often acts before thinking, assessing or planning. Characteristics and learning needs of: Advanced Beginner Begins to see elements of situations Moves step-by-step, but begins to see wholeness of a situation Starts to note recurring, meaningful components of a situation Starts to formulate guidelines that dictate actions Needs to see connection between thinking and doing. Characteristics and learning needs of: Competent Sees actions in terms of long-range goals or plans Lacks speed, but has planning and organizational skils Growing ability to identify what is important and recognize patterns Adds new experiences and more complex patients Serves as excellent preceptors for their less experienced colleagues. Characteristics and learning needs of: Proficient Defines current situation through past experiences Sees changing relevance Revises priorities Performs tasks smoothly and rapidly Identifies "teachable" moments Seeks unusual, new procedures Develops contigency plans Characteristics and learning needs of: Expert Solid technical foundation Solid didactic foundation Extensive experience Needs to be exposed to new techniques, challenges, knowledge Broadens expertise by going outside his or her 'comfort zone' Generates more accurate hypotheses/diagnoses faster than novices. The culture of a clinical setting such as the periop settings is: A. is unimportant to the patient care that is delivered B. Affected by patient and staff beliefs, staff attitudes, and individual and collective values C. Irrelevant to patient outcomes D. totally determined by the people within an OR at any given time, including the patient Correct answer: B. Affected by patient and staff beliefs, staff attitudes, and individual and collective values. As a new periop nurse, you are assigned to work with a preceptor in general surgery. Rather than "show you and tell you" how to do things, this preceptor often asks you questions. She explains to you that she wants to help you discover the connections and relationships between perioperative patient care activities. Your preceptor is helping you build which component of critical thinking: A. Communication B. Context C. Relevant criteria D. Questioning Correct answer: C. Relevant criteria What are the goals of patient and family education? To provide information to the patient and family in order to increase knowledge and satisfaction. --This acquired knowledge may be necessary in order to make behavior changes. What is the ULTIMATE goal of patient education? To achieve long-lasting changes in patient health status by providing patients with the knowledge that will allow them to make autonomous decisions and to take ownership of their care as much as possible which will ultimately improve their outcomes? List important reasons for Patient and Family Education: 1. First, improvement in quality of care 2. Second, patient education improves patient satisfaction 3. Third, patient education results in increased adherence 4. Fourth, patient and family education is also important because of the ethical, legal, and regulatory mandates for patient education. It is the ethical duty of the physician or HCP to involve the patients in their care. In the perioperative arena, this involvement means the patient: 1. Has received information from the surgeon regarding the nature of the procedure 2. Risks/benefits of procedure 3. Alternative treatments/interventions to the procedure 4. The patient has signed the consent form Self-determination is the premise for respect. Truth telling and informed choice underlie this premise. Patients have the right to make informed choices based on truthful information. An example of self-determination is: Automatic suspension of DNR orders undermines the patient's right to self-determination. Required reconsideration of DNR decisions with patients is an integral component of the care of patients undergoing surgery. List barriers to effective pt/family education in the periop setting: -Anxiety about an uncertain outcome -Discomfort or pain -Fear of the unknown -Limited time for assessment and teaching What is the three roles of the periop nurse in pt/family education 1. Explaining to the pt what the pt will experience. 2. Providing emotional support to enhance coping 3. Teaching specific skills that the pt will need to perform postop. The goal of patient and family education is to: (Check all that apply) o Provide information to the patient o Improve knowledge o Achieve long-lasting changes in behavior o Make autonomous decisions o Take ownership of their care o Improve their own outcome Correct Answers: All of the choices are correct Per JCAHO, Pt/family education should include instruction in the specific knowledge/life skills that are needed to meet their ongoing health care needs. These include: --Safe and effective use of medications --Safe and effective use of medical equipment --Instruction on potential food-drug interactions --Counseling on modified diets, as needed --When and how to obtain further treatment. Based on your knowledge gained about the Joint Commission and pt education needs: Jake Brown is scheduled for a complex surgical procedures. He and his immediate family are asking for more information. Which of the following form part of Jake's ongoing educational needs as a pt? (Select all that apply) A. The medications to be given and the time intervals at which they are to be taken B. Details about how the surgery was carried out. C. Details about the life support machines that may be required in case there are complications D. A list of foods that might be harmful if taken during the time the patient is on medications. E. Counseling on modified diets. Correct answers: A, C, D, and E. Truth telling and the process of reaching informed consent underlie the principle of: o Respect o Empathy o Self-determination o Communication Correct Answer: Self-determination What four categories of information does the nurse need to provide the patient and his or her family? Procedural: What does the pt already know about the planned procedure? What additional information does the patient need? Sensory/Temporal: What will the pt experience in the preop holding, in the OR, or in the PACU? Coping Mechanisms: What coping mechanisms has the pt already established for themself? What additional coping mechanisms are available in the periop setting? Reassurance: The nurse is in a unique position to offer reassurance to pt via words, looks, touch. Surgical pt assessment should be based on critical activities that the pt will be expected to accomplish before,during and immediately after surgery. List those critical activities. o Managing Pain o Wound care/Infection prevention o Mobility o Coughing, deep breathing Ability to understand is influenced and determined by: Age, maturation, past learning, physical and mental health, environment, and primary language. Based on the knowledge gained about the steps to conclude a successful preop interview, identify the CORRECT ORDER to tasks to complete in an assessment: A. Ask questions to determine the patient's knowledge of the procedure B. Determine, from the patient's responses, the patient's knowledge. C. Collate information from the pt;s previous medical record. Correct Answer: C, A, B Pain management is affected by: Check all that apply 1. The site of the surgery 2. The nature and intended purpose of the surgery 3. The patient's age, sex, and weight 4. Level of anxiety or fear that the pt has about the procedure. Correct Answers: A, B, and D Based on the knowledge gained about the communication skills required while preparing the pt for surgery, identify the correct ways to inform and reassure the pt and family about the procedure: A. explain all details about the procedure so that the pt has full knowledge B. Explain the procedure in general terms C. Explain the procedure in specific terms D. Keep the family updated about the progress of the procedure. Correct Answers: B and D The knowledge gained in the informal process of a teaching and learning interaction between a pt and periop nurse can be a simple narrative in the nursing notes, but should include: (SATA--select all that apply): A. Pt's medical history B. Content of the interview C. Assessment data and outcomes of the assessment D. Referrals to other disciplines Correct Answers: B, C and D Effective forms of periop documentation R/T pt. education combine: A. Pt data, outcomes, and nursing interventions B. Nursing diagnosis, pt outcomes, and evaluation C. A narrative note with referrals D. Teaching protocols, objectives, and outcomes. Correct Answer: D Factors affecting the patient's ability to learn include: (SATA) A. Age B. Disability C. Fear of dying D. Pain E. Self-esteem Correct Answers: B, C, D and E Patient and family education is a combined process involving: SATA a. Influencing behavior b. Determining pt competency c. Producing changes in knowledge d. Producing change in attitudes and skills Correct Answers: a, c, and d. Factors affecting patient's ability to learn include: SATA A. Age B. Attitude C. Emotional state D. Intellectual ability E. Physical ability F. Socio-economic status Correct Answers: B, C, D and E. The perioperative nurse should use the directive interview technique over a nondirective interview technique when the information they need: SATA A. Consists of predetermined questions B. Consists of questions in a predetermined order C. Is to assess the patient's emotional reactions and concerns D. Is to document the pt's health history E. Requires observation of the pt's non-verbal behavior F. Requires the pt to respond in an open, formal manner. Correct Answers: A, B and D Obtaining informed consent is a two-step process of: A. Weighing the benefits and burdens of treatment options. B. Communicating information and documenting the decision. C. Determining patient competency and authenticity of the signature D. Communicating the plan of care and reaching a decision Correct Answer: B: Communicating information and documenting the decision. How does the periop nurse test the patient's level of understanding? A. By checking to see if the patient feels knowledgeable enough to sign the consent B. By asking questions about the procedure and evaluating the answer C. By offering reassurance D. By returning at another time to test recall. Correct Answer: B. By asking questions about the procedure and evaluating the answer. A directive interview is: A. Open-ended and unstructured B. Structured with predetermined questions C. Used to determine personality traits D. An observation of the pt's non-verbal behavior` Correct Answer: B. Structured with predetermined questions Many factors impact the amount of postop pain the pt will experience. Factors that may affect the amound of pain are: SATA A. The surgical site B. The nature and intended purpose of the surgery C. The patient's fears regarding anesthesia or surgery D. The level of anxiety of the pt's family members Correct Answer: A, B and C. The standards of nursing practice require that documentation is based on which of the following: SATA a. the pt's condition or need b. current and past health status c. evaluation of the pt's response d. the relationship of the condition or need to the proposed intervention. Correct Answers: A and D Properly executed informed consent for surgery must include: o Name of the health care facility providing the surgery or invasive procedure. o Specific name of the intervention o Indications for the proposed intervention o Name of the responsible HCP performing the intervention o Statement identifying the R/B associated with the proposed intervention and indication that a discussion took place with pt or pt's rep. o Signature of the patient or pt's rep o Date/time the pt or pt's rep signed the document o Date and time and signature of the individual that witnessed the signing of the informed consent document o Signature of the responsible health care provider who discussed the informed consent document with the pt or pt's rep. Preop documentation must include: o *Antibiotic prophylaxis and admin of other ordered preop medications o Preop visits by the surgeon and anes provideer o Preop skin prep and hair removal, if appropriate o Skin assessment prior to and post hair removal or skin prep if applicable o Performance of the Universal protocol for preventing Wrong Site, Wrong Procedure, Wrong Person Surgery* What are the 6 steps of the Nursing Care Plan 1. Assessment 2. Nursing diagnosis 3. Outcome Identification 4. Planning 5. Implementation 6. Evaluation Documenting the intraop pt position should include: (4 answers) *1. Pt position and all devices used (bolsters, pillows, braces, sandbags. 2. Identity of persons assisting in positioning of the pt. 3. The position and use of any specific positioning devices like immobilizing devices, safety belt. 4. Placement of arms* Documenting of all medications and solutions used on and off the sterile field should include: (5 answers) Drug name Drug concentration Route of administration Dose administered Time the dose was given. Documentation of the placement of tubes, catheters, drains and packing should include: (4 answers) Type of tubes inserted (ie Foley, penrose) Type of packing that is inserted The size and length The placement location on the pt. Which of the following statements are accurate regarding the documentation required for equipment used during operative procedures: 1. location of the dispersive electrode pad 2. the use of any warming/cooling blankets 3. Identification number on the laser 4. Identification of the person that applied the tourniquet. Correct answers: All are correct Describe Class I--Clean Wounds. No inflammation encountered No breaks in sterile technique Resp/Alimentary/genital/uninfected urinary tracts not entered Primarily closed wounds Closed drainage used if necessary Describe Class II--Clean-Contaminated Wounds Nontraumatic wounds No inflammation encountered No breaks in sterile technique Hollow viscus entered Resp/GI/GU tracts entered under controlled conditions. Class III--Contaminated Wounds Traumatic wounds or spillage of infected materials Open or fresh traumatic wound of less than 4 hours Major break in technique Entrance into GU or biliary tracts with infection Gross spillage from gastrointestinal tract Class IV--Dirty Wounds Trauma from a contaminated source or gross spillage of infected materials Traumatic wounds of over 4 hours Existing clinical infection Describe ASA's classification system for patients based on their preop physical status. (6 categories) P1: A normal healthy pt P2: A pt with mild systemic disease P3: A pt with severe systemic disease P4: A pt with severe systemic disease that is a constant threat to life P5: A moribund pt who is not expected to survive without the operation P6: A declared brain-dead pt whose organs are being removed for donor purposes. A successful lawsuit: a. does not require patient injury b. only requires a nurse-patient relationship c. must show duty, breach, causation, and damages d. considers whether the patient has filed previous lawsuits Correct answer: C Charting by exception is a time saver and _______________. a. is easy even if you don't understand what is expected of a nurse b. does not require assessment skills c. is based on the premise that the pt manifests normal response to most interventions d. does not require documentation during the shift or notes on changes in patient's progress` Correct Answer: C--Is based on the premise that the patient manifests normal response to most interventions. Accurate preop documentation of the patient admission is an integral part of the nursing process. This includes: SATA a. Patient identification b. Preop orders c. Discharge referral d. Patient assessment Correct Answers: A, B and D The primary purpose of documentation is to: a. Be prepared in case a court case is filed. b. Make sure everything is written down c. Record the chronological order of events during the nursing care of a patient d. Relate any conversations and discussion with the patient and family in detail. Correct Answer: C When documenting the placement of a surgical drain, which of the following components should be included? a. Date for expiration noted on the packaging b. Manufacturer's name c. Serial number d. Where the drain was placed on the patient Correct Answer: D When documenting, the perioperative nurse should: SATA a. Document in a timely manner b. Use medical diagnoses c. Use nursing diagnoses based on sound judgment d. Use patient statements to verify your findings e. Use patient statements written as fact. Correct answers: a, c, and d. When documenting the use of a pneumatic tourniquet, which items must be included? SATA A. Cuff pressure B. Location where the cuff was placed C. Name of person who applied the tourniquet cuff D. Name of person who inflated the tourniquet E. Serial number of the unit Correct Answers: A, B, C and E Which of the following statements is true about informed consents? SATA A. is not covered in hospital policy B. is a physician's duty and RN's are witnesses to patient's signature C. does not expose you to liability if you don't follow hospital policy D. does not have approved substitutes to give consent for patient E. Must contain the name of the health care facility F. Needs to state the indications for the proposed intervention Correct Answers: B, E and F Provide an example of Microfibrillar Collagen Avitene Provide an example of Oxidized Cellulose Surgicel, Nuknit Provide an example of a collagen sponge Collastat, Superstat, Helistat Provide an example of a Gelatin sponge Gelfoam Provide an example of a Fibrin sealant Tisseal, Crosseal, FloSeal What method does Phenol use to provide hemostasis> Cauterization What is the mechanism of action of Thrombin as a hemostatic agent? It accelerates coagulation of blood and controls capillary bleeding Provide an example of a Styptic epinephrine, tannic acid, silver nitrate List four different kinds of sponges Laparotomy sponges Tonsil sponges Neuro patties (AKA Cottonoids) Dissector Sponges (include cherry dissectors, peanut dissectors and K-dissectors) Differentiate between: Laser Argon Beam Electrosurgery Laser: An intense and concentrated beam of light that coagulates and cuts at the same time while minimizing tissue destruction Argon Beam: A device that uses ionized gas and electrical (radio frequency) current to coagulate vessels Electrosurgery: The ESU is used to apply electrical current through the patient's tissue to cut/coagulate the tissue. Name an example of a Pharmacological agent to achieve hemostasis. Epinephrine, Vitamin K, Protamine, Desmopressin, Lysine analogues Name an example of a topical hemostatic product. Active agents include thrombins. Passive agents include collagen-based gelatins, spheres, flowable agents and sealants. Guidelines for counting sponges come from: A. The American College of Surgeons B. Guidelines Advisory Board C. The Joint Commission D. None of the above Correct Answer: B. AORN Guidelines Advisory Board What precaution should be taken when microfibrillar collagen is used as a hemostatic agent intraoperatively? A. Antibiotics must be administered concurrently because of the increased risk of wound infection B. Avoid using it in a confined space in the operative site C. Avoid using it with an autologous blood salvage unit D. Protamine sulfate should be available as a reversal agent. Correct Answer: C Avoid using it with an autologous blood salvage unit. Which of the following drains allows for passive drainage of fluid from the body? A. Jackson-Pratt B. Penrose C. T-tube D. Hemovac Correct answers: B and C Which type of dressing is used to prevent drying of the wound and increase the proliferation of epithelial cells? A. Gauze B. Pressure C. Rigid support D. Occlusive Correct Answer: D. Occlusive Which of the following is true in handling hemostatic agents such as collagen or gelatin sponges? A. Should be moistened prior to use B. Should not be left in the wound, since they are not absorbable C. Are highly perishable and should be refrigerated prior to use. D. Must not be injected or allowed to enter large vessels, as extensive intravascular clotting may occur Correct Answer: D Order the following events into the correct sequence regarding wound healing: 1. Regenerate the natural epidermal covering 2. Stop the bleeding 3. Repair deeper tissue damage 4. Seal the wound against infection 5. Clean the wound of debris Correct sequence: 2, 5, 4, 1, 3 Name 5 factors affecting healing that are controlled by the surgical team: 1. Maintenance of sterile and aseptic techniques to prevent infection 2. Hemostasis 3. Removal of necrotic tissue and foreign material 4. Choice of closure material 5. Closing with sufficient tension 6. Elimination of dead space 7. Length and direction of incision 8. Dissection technique 9. Tissue handling 10. Maintaining moisture in tissues 11. Hypothermia