Periop 101 Exam Questions And Answers Verified 100% Correct!!

Surgical Intervention: Incisional biopsy A small portion of tissue is incised and sent for examination. Specimens that will be microscopically studied by the pathologist and may undergo histologic or cytologic analysis will be sent for _______________________. biopsy Physical evidence retrieved from a person involved as a suspect or victim in a crime will be sent for _______________________ _______________________. frozen section Specimens obtained for studying cell biology will be sent for __________________. cytology Specimens that do not require immediate processing by the pathologist will be sent for _______________________ _____________________. routine specimen Specimens of tissue or fluid suspected of being infected will be sent for _____________________________. culture Identify 3 major guidelines for identifying and labeling specimens. 1. Specimen description to include type and site (also laterality if appropriate) 2. Patient name and unique identifier (medical record #) 3. Surgeon's name What organizations provide guidance related to surgical tissue banking? * AORN: has guidelines for autologous tissue mgmt, or auto-transplantation on or in the same patient * AATB (American Association of Tissue Banks) * FDA (US Food and Drug Administration) Information pertaining to specimens that is required in the perioperative record generally consists of: * Patient identification * Specimen ID, include location of suture tags, no abbrev. * Pathology examination record (gross, frozen, etc.) * Pathology requisition * Final disposition of tissue and explanted devices * Requests for special handling * Date/time of collection, notation of what markers/tags represent. * Physician ID and contact information * Perioperative RN identification What are some perioperative risks in regard to physical status classification by anesthesia (ASA)? * Length of surgery * Past experiences with anesthesia * Specific surgical procedure General anesthesia A reversible state of unconsciousness, consisting of amnesia, analgesia, and muscle relaxation. Regional anesthesia A reversible loss of sensation, which is achieved by injecting a local anesthetic to block the nerve fibers from transmitting impulses. Local anesthesia Functions like regional anesthesia, but usually applies to a smaller area or a single body part such as a finger or a toe. Monitored Anesthesia Care (MAC) Consists of intravenous medications and concurrent local infiltration of tissue at the surgical site. Four stages of anesthesia Stage I: Initial Administration - admin of anesth drugs. Only a few seconds b/t admin and unconsciousness. Stage II: Excitement - Now unconscious. Loss of consciousness to loss of eyelid reflex. Involuntary mvmts may occur. Stage III: Intrasurgery - Time of surgical anesth. REM and breathing may be labored until muscles completely relax. Time to start the surgery. Stage IV: Possibility of respiratory failure - Patient may need help. If too much anesth. has been given > resp failure > circulatory failure. Without breathing apparatus and heart support, patient can die. Three phases of anesthesia Induction - begins with admin of anesth and lasts until surgical incision is made. Maintenance - begins with surgical incision and lasts until near completion of the procedure. Emergence - starts as the patient begins to awaken and ends upon exiting the OR Perioperative nurses must be alert to the potential for _________________________________ (due to vasodilation) after the spinal anesthesia is given. hypotension One of the most consistent physiological indications of MH is __________________________________________. an increase in the ETCO2 Examples of commonly accepted nursing tools * the nursing process * Perioperative Nursing Data Set (PNDS) * the World Health Organization (WHO)/Joint Commision/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 culture is affected by BELIEFS about: the patient the perioperative setting The clinical setting reflects a culture that is affected by ATTITUDES illustrating the desire to: provide effective care engage in critical thinking The clinical setting reflects a culture that is affected by the VALUES of: fairness equitable care The clinical setting highlights the effect of acquired skills on nurses' ability to demonstrate critical thinking and clinical reasoning. These SKILLS include: problem-solving situational awareness Compare competent nurse with novice nurse . . . * Safety regarding endoscopic light source * Do not turn on the light source until the light cable is connected to the telescope. * When not in use, the light source should be placed in "standby" mode. * Always set your parameters according to the manufacturer's instructions. Precautions with CO2 insufflation * Always have a back-up tank of CO2 available. * The insufflator should be positioned on the cart at the level of the patient's heart or higher to prevent intra-abdominal fluids or gases from contaminating the device. * Most insufflators have alarms and displays to show actual CO2 pressure and CO2 supply levels. Make sure the alarm is on, is audible, and working correctly. * Maintaining intra-abdominal pressure UNDER 12 mmHg IN ADULT PATIENTS reduces the risk of systemic hemodynamic changes. Laparscopic instruments should be thoroughly inspected because . . . . . . the problems they present may not be apparent upon casual observation. Special attention should be focused on the condition of the insulation. Electrical current will escape through any break in the insulation, and thermal burns can result from these breaks. Cleaning endoscopic instruments * Clean off external debris during the case with a moistened sponge. * Flush channels with sterile water to remove gross soil during surgery. Sterile water is recommended because saline water can cause erosion of metal surfaces. * Test scissors for sharpness prior to sterilization. Special considerations (observed by circulating RN) for the patient undergoing endoscopic or MIS 1. PREVIOUS INCISIONS that may alter the trocar insertion technique (e.g., with the Hasson minilaparotomy technique, additional sterile supplies may be needed). 2. HISTORY OF DVT or venous stasis. 3. CONSENT TO INCLUDE THE POSSIBILITY OF AN OPEN PROCEDURE: This decision is made at the discretion of the surgeon, based on how the surgery is proceeding. 4. VOIDING PRIOR TO SURGERY: Having the patient void prior to surgery empties the bladder and helps avoid puncturing it during trocar placement. This also decreases the need for unnecessary catheterization during surgery. Achieving correct fluid management for the patient include: * Monitoring overload of IV and irrigation fluids to avoid hyponatremia and hypervolemia. * Monitoring the amount of irrigation fluids dispensed and returned during the surgical procedure. Standard methods and procedures to CONFINE AND CONTAIN contamination and PHYSICALLY REMOVE microorganisms: * Discard sponges in plastic-lined receptacle. Count bag. * Bag all soiled linen and used disposable items in the proper bags prior to removal at end of procedure. * Clean up spills immediately with effective disinfectant. * Remove soiled shoe covers before leaving OR. * Items contaminated with body fluids should be discarded into appropriate impervious biohazard waste receptacles. * Unused sponges, nonwoven drapes, and other non-bloody disposable waste are placed in trash. * All disposable sharps such as blades, needles, stapling devices, pins, and cautery tips should be discarded in a sharps disposal container. A few guidelines to help prevent contamination in the OR: 1. Hand hygiene - hands should be washed with soap and water for at least 15 seconds. 2. Alcohol-based product. 3. Damp dusting all horizontal surfaces. Horizontal surfaces All horizontal surfaces should be damp dusted before the first scheduled procedure of the day. Operating rooms should be cleaned after each surgical or invasive procedure with a lint-free or microfiber cloth moistened with detergent/disinfectant and water. AORN's Guideline for Environmental Cleaning Recommendation II directly pertains to interim cleaning by stating: "A safe, clean environment should be reestablished after each surgical procedure." Order of damp dusting Begin with the higher surfaces and work down to the lower levels. wet vacuuming the most effective method for floor care in the surgical suite Any germicide that is labeled as a hospital disinfectant has passed the potency test for activity against ________________________________________, _________________________________________, and _________________________________________________. Pseudomonas aeruginosa Staphylococcus aureus Salmonella choleraesuis Perimeter of floor mopping Prior to 2014, the Recommended Practices said to mop the floor in a perimeter of 3-4 feet around the OR table. Based on the new Guidelines, THIS IS NO LONGER TRUE. * Today the recommendation is to extend the perimeter of the area being mopped to include all areas that are visibly soiled and move the OR bed to check for any items or soiled areas that might be under it. Air sampling Completed before construction begins, after demolition occurs, and at the end of the project. When the construction, renovation, remediation, repair, or demolition is completed, always perform terminal cleaning and disinfection before placing equipment and supplies in the area. The Occupational Health and Safety Act of 1970 (Public Law 91) Mandates employers to provide programs for the education and training of employees in the recognition, avoidance, and prevention of unsafe or unhealthful working conditions. Mechanical methods to maintain hemostasis * manual pressure using various types of sponges * using hemostatic clamps * suturing * using staples * clips * ligatures * pledgets Ligature Commonly known as a tie, is a strand of material that is ties around a blood vessel to occlude the lumen and prevent bleeding. Large, pulsating vessels may require a transfixion suture, which is a crisscross stitch placed to control bleeding from a tissue surface or small vessel when it is tied. Pledget A non-absorbable suture support used when there is possibility of sutures tearing through tissue. They can be used on a variety of surgical procedures, but are most commonly used for vascular closure, septal repair, myocardial closure, heart valve suturing, and hepatic repair. Bone wax Is composed of a mixture of beeswax, isopropyl palmitate, and a softening agent. Provides a mechanical tamponade effect to stop oozing from cut bone surfaces. Bone wax is used in some orthopedic and neurosurgical procedures and on the sternum during heart procedures. Chemical methods of achieving hemostasis 1. Pharmacological (epinephrine, vit-K, protamine, desmopressin, lysine analogues such as aminocaproic acid and tranexamic acid). 2. Topical products: active agents (thrombins), passive agents (collagen-based gelatins, spheres, flowable agents, and sealants). Thermal methods of hemostasis * Laser - intense and concentrated beam of light that coagulates and cuts at the same time while minimizing tissue destruction. * Argon beam - uses ionized gas and electrical current to coagulate vessels. * Electrosurgery - ESU is used to apply electrical current through the patient's tissue to cut and/or coagulate the tissue. Counting sponges * Counts are performed before, during, and after surgical procedures. * Sponges are to be separated as they are counted. * Two people, one of whom is the RN circulator, should count the sponges simultaneously and audibly as each sponge is separated. Participation guidelines for sponge counts * All perioperative personnel involved in a surgical case are responsible for the accuracy of the sponge count. * Each has a duty to remain aware of the location of the sponges on the sterile field and in the wound. * Two people, one of whom is the RN circulator, must perform the sponge count. * The scrub person should maintain awareness of the location of all soft goods (e.g, ray-tecs, towels, textiles). * The scrub person and the CRN should count sponges simultaneously and audibly as each sponge is separated from others in the pack before the beginning of the operation, before any closure begins, and when skin closure is begun. * All sponges must remain in the same OR room until the count is complete. Uses for penrose drain abdominal surgery, peritoneal cavity, or skin wound Uses for nasogastric drain decompression of the stomach (Levin tube) Indications for a Miller-Abbott is to treat obstructive lesions of the small intestine. NG suction (salem sump tube). uses for T-tube inserted into the biliary tract to allow for drainage of bile. Generally left in place for 10 days or more in order to develop a tract through which bile can drain after the tube is removed. uses for suction drains abdominal or breast surgery (JP) orthopedic surgery (hemovac) uses for Chest tubes thoracic surgery and cardiac surgery Relevant patient history information * Current medications and dosages. * Medication allergies and idiosyncratic responses. * Potential interaction with other medications. * Herbal or dietary supplements. * Patient's weight, age, and existing disease or condition. Proactive decision-making to reduce errors in the medication procurement phase related to: * unit-of-use (NO MULTI-USE CONTAINERS!) * shelf life * general supply chain which includes medication availability, delivery, and protection during transit When available, prescribers should use __________ systems. Those systems with rule-based decision support aids have reduced the opportunity for errors. CPOE Advantages of a CPOE include: Allowing electronic recording of medication administration. Decreasing the risk for misinterpretation of medication orders due to illegible handwriting or misunderstood verbal orders. Medications that are removed from the original package and found in a secondary container without a label should be _______________________. discarded Labeling medications should include * Medication name * Concentration * RN initials that prepared * Exp date when not used in 24 hrs * Exp time if less than 24 hrs * Date prepared Do not remove __________________ from the vials. stoppers Use commercially available ______________ _______________ _____________ whenever possible. sterile transfer devices Avoid use of ______________________________ _________________________ with autologous blood salvage units. microfibrillar collagen Symptoms of systemic toxicity include, but are not limited to: * Metallic taste * Tinnitus * Lightheadedness * Visual disturbances * Numbness of tongue and lips * Confusion * Tremors * Shivering * Generalized seizures * Tachycardia/HTN (initially) * Bradycardia/HoTN (with increased toxicity) * Ventricular arrhythmia; cardiac arrest * Respiratory arrest Examples of moderate sedation agents are: * Opioids (morphine sulfate, meperidine hydrochloride, fentanyl) * Benzodiazepines (diazepam, midazolam) * Propofol goals of patient and family education To provide information to the patient and family in order to increase knowledge and satisfaction. 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. Importance of patient and family education 1. Improvement in quality of care. 2. Patient education improves patient satisfaction. 3. Patient education results in increased adherence. 4. Patient and family education is also important Ethical duties of surgeon, means the patient has received information from the surgeon regarding: 1. the nature of the impending procedure, 2. the risks and benefits of the procedure, 3. if there are any alternative treatments or interventions to the procedure, and 4. the patient has signed the consent form. example of self-determination in the perioperative setting Automatic suspension of DNR orders during the perioperative experience 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. Barriers to effective patient and family education in perioperative settings include * anxiety about an uncertain outcome * discomfort or pain * fear of the unknown * limited time for assessment and teaching The perioperative nurse's role in patient and family education includes: * Explaining to the patient what the patient will experience. * Providing emotional support to enhance coping. * Teaching specific skills that the patient will need to perform postoperatively. What should the perioperative nurse know about a patient that is admitted to Phase 1 Postanesthesia Care? * Airway - Always FIRST * Monitor for BP, SaO2, HR * LOC * Pain and PONV Properly executed informed consent for surgery (red items only) * Specific name of the intervention * Indications for the proposed intervention * Signature of the patient or the patient's representative * Date and time and signature of the individual that witnessed the signing of the informed consent document Preoperative documentation * Orders for abx prophylaxis and admin of other ordered preop medications * Preoperative visits by the surgeon and anesthesia care provider * Preoperative skin preparation and hair removal if appropriate * Skin assessment prior to and post hair removal or skin prep if applicable * Performance of the Universal Protocol for preventing wrong site, wrong procedure, wrong person surgery Documentation of the Intraoperative Patient Position * Document patient position and all positioning devices such as bolsters, pillows, braces, or sand bags * Identify the persons who assisted the positioning * Document position and use of any specific positioning devices like immobilizing devices, including safety belt * Document placement of arms Documenting medications * Drug name * Drug concentration * Route of administration * Dose administered * Time dose was given Documentation of the placement of tubes, catheters, drains, and packing * Type of tubes inserted * Type of packing inserted * Size and length * Placement location on the patient __________________ orders should be documented in the perioperative record, authenticated with the physician's signature and include the date and time ordered. Verbal Potential sources of fuel for surgical fires include: * Patient and staff linens and drapes * Prep solutions * Skin degreasers/tinctures/aerosols * Body tissues and patient hair * Intestinal gases Basic steps in fire safety in the correct order R - Rescue A - Alarm C - Confine E - Evacuate Methods to prevent an unsafe situation, mishap, or fire when using electrosurgical equipment include: * Do not use in an oxygen-enriched environment, such as the trachea or when oxygen is being "blown over" a patient. * Allow enough time for skin preparation solutions that are flammable or contain alcohol to thoroughly dry. * Visually check the integrity and insulation of all cords and coagulation instruments before use. ______________________________________ is responsible for devising an emergency electrical outage plan, BUT _______________________ ______________________, including the ____________ ______________, are responsible for knowing, understanding, and complying with that plan. OR management staff members OR nurse Allow prep solution to completely dry and for the vapors to dissipate _________________ draping. BEFORE Pneumatic tourniquet documentation * TQ system identification and serial number * limb occlusion pressure (LOP) * cuff pressure * skin protection measures * location of TQ cuff * skin integrity under the cuff before and after use of the TQ * (name of person placing cuff) * time of inflation and deflation * assessment and evaluation of entire extremity * (systemic reaction to ischemia and reperfusion) Time Out documentation * Patient's identity using 2 identifiers * Site/side of surgical procedure * Verification of procedure to be performed Strategies to prevent RSIs include: * Using the same standardized approach for every count procedure. * Unnecessary activity and distractions should be eliminated during the counting process. * Types of items to be counted include: radiopaque soft goods, sharps, miscellaneous items and instruments. * Any of the surgical team members can initiate a count or an additional count. * Performing a methodical wound exploration when counts are initiated. * Planning anesthetic milestones. Patient transfer from the OR bed to the gurney * Lock the wheels of the gurney and the bed * Make sure the patient is covered with a sheet or light blanket * Stand next to the gurney on the side opposite from the bed * Ask another team member to stand on the opposite side of the bed to assist * Use a draw sheet and patient transfer device to transfer the patient * Cross the patient's arms across the chest * Roll the patient up to one side to place the transfer device under the patient * Gather and secure IV lines, catheters, and other apparatus so they will not be disturbed during the transfer * Gently roll the patient to the awaiting gurney * Roll the patient up to retrieve the transfer device * Center the patient on the bed * Apply a safety strap just above the patient's knees * Pull the guard rails up and unlock the gurney * Push the patient feet first to the OR area In the OR, the patient has a heightened risk for skin injury due to: * Preexisting metabolic conditions (diabetes) * Unusual positions or positioning devices * Use of electrical equipment * Prolonged length of surgery * Reduced tissue perfusion * The use of chemical agents DO NOT place the hose of the warmer ________________ the patient's blanket. under Documentation provides a means for _______________________ perioperative care as well as _____________________ of the care rendered. planning evaluation When making an assessment, the nurse must take into consideration the patient's: * Mobility * Preexisting health conditions * Planned duration of the procedure * Type of anesthesia * Physiological status * Body size * Environment Patients need to be assessed for their ability to move between the gurney and the OR bed. Utilize the patient's chart and the __________________________________________________________________________________________________________________________________________________________________________ to assess baseline functional status. results of the preoperative interview Geriatric concerns * Decrease and slowing of blood flow from coronary arteries > decreased rate of medication absorption > need for DVT prophylactic devices. * May need warming devices to maintain normothermia. * Position may have to be adapted for effective air exchange. * Decreased sensation to pain and body temperature variations. * May have problems with depth and color perception, as well as dry eyes. The following three main factors should be taken into account while assessing the patient for allergies. * PRIOR REACTION - Ascertain if the patient has had a prior reaction to any medications or prep solutions. Notify the surgeon if the patient has ever had any reaction to surgical prep solutions. * HEREDITY - It is also important to note if the patient or anyone in the family has had problems with anesthesia in the past. Reactions vary from itching or rash to full anaphylaxis and cardiovascular collapse. * TYPE - If the patient has an allergy, ask the type of rx. (determine if rx is true allergy) When assessing the patient for medication use, it is important to ask questions about the following: * Herbal preparations - interfere with drug metabolism or clearance. Herbal preparations might also affect bleeding times. * Recreational drugs: changes premedication options and to maintain closer monitoring for symptoms of w/d. * Drugs, alcohol, and smoking - may alter lab values A psychosocial assessment should include the patient's: 1. Expectations of perioperative care including patient levels of anxiety or stress. 2. Understanding of the surgical procedure. 3. Philosophical and religious beliefs. 4. Cultural beliefs and practices. The _____________ is responsible for discussing the risks, benefits, and alternatives of the planned procedure with the patient before surgery. surgeon The responsibility of the _________________________________ ____________ is to reinforce what has been discussed with the patient. perioperative nurse For the age group between 3 and 6 years of age - this age group interprets terms ____________________, so be _______________________ and __________________________. literally specific and honest Four steps of the "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery" 1. Patient participation 2. Identifying the patient 3. Marking the site 4. Time Out HIPAA Health Insurance Portability and Accountability Act What provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information? HIPAA