AORN Final Exam Study Guide: Surgical Procedures and Techniques, Exams of Nursing

Download AORN Final Exam Study Guide: Surgical Procedures and Techniques and more Exams Nursing in PDF only on Docsity! AORN Final Exam Study Guide Defense Mechanisms Steps - correct answer 1) Stop the blood loss 2) Clean up pathogens and debris in the wound 3) Seal the wound against infection 4) Regenerate the natural epidermal covering 5) Repair deeper tissue damage Primary union wound healing (first intention) - correct answer Minimal tissue loss, wound margins approximated Granulation (second intention) - correct answer Significant tissue loss, wound remains open Delayed primary closure (third intention) - correct answer Wound kept open to monitor infection; gauze packing; closed on day 3 or 5. Why is collagen production so important in wound healing? - correct answer - Contributes to the tensile strength of the wound. -Main component of extracellular matrix. Guidelines for handling natural absorbable sutures - correct answer -Both types are packaged in fluids, which may be irritating to the eye tissue. (Types: Surgical gut and Collagen) -As a precaution, open packages over a small basin to prevent splashing. What are synthetic absorbable sutures made out of? - correct answer Polymers Surgical Stainless Steel - correct answer -Made from 316L-SS low carbon iron alloy wire -used for abdominal wall closure or sternum, respiratory tract, Ortho, or Neuro cases. -This may also be used in the presence of infection but NOT in the presence of another alloy such as titanium. Polypropylene - correct answer -Recommended size for plastics is 5-0 -Material choice for plastic surgery. Taper Point Needles - correct answer -A needle in this second category has a smooth point with no cutting edges. It pushes the tissue aside when passing through. -Used for aponeurosis, biliary tract, dura, fascia, GI tract, muscle, myocardium, etc. (example: vascular anastomosis) Blunt point needles - correct answer -Rounded blunt tip that will NOT cut tissue. -Used for dissection of friable tissue such as liver Disposable Stapling Instrument Sets - correct answer -Also known as single instruments; come preassembled and sterile -Self contained and light weight. Skin clips - correct answer -Tend to cause more scar tissue -Can be applied quickly and are good for CRITICAL cases (Not cosmetic) -Surgeon may use when infection or drainage is present. Skin Adhesives - correct answer -Combination of liquid monomers from polymers in the presence of water and act as a liquid topical skin adhesive (may be a replacement for sutures) -Fast setting ones are used on facial, extremity or torso wounds. -Attain the strength of healed tissue after 7 days. Three Principle Elements Required for infection - correct answer 1) Source of reservoir 2) Susceptible host 3) Method of transmission Hand Hygiene - correct answer -The perioperative nurse washing his/her hands prior to greeting the patient in the pre-op area. Droplet Precautions - correct answer May be used in addition to standard precautions, reduce the risk of pathogens that spread through close respiratory or mucous membrane contact. Sterile technique - correct answer Foundation of SSI prevention. Failure to adhere to these principles is independently related to the risk of SSI. Skin antisepsis - correct answer -Intended to reduce the risk of postoperative SSI by removing soil and transient microorganisms from the skin, reducing the resident microbial count to sub-pathogenic levels in a short period and with the least amount of tissue irritation. Class I - Clean - correct answer Not infected, not inflamed; wound result of blunt trauma. Class II - Clean Contaminated - correct answer NO evidence of infection or contamination -Spillage from GI tract Class III - Contaminated - correct answer Non purulent inflammation -Used to document the efficacy of specific sterilization cycles, not the sterility of the item. Storage of Sterile Items - correct answer -Condition of the storage area, that is, cleanliness, temperature (*between 72F-78F*), humidity (*60-70%*), and air exchange. -Controlled traffic (*at least 4 per hour*) -Supplies need adequate air circulation, ease of cleaning, and compliance with local fire codes. -Outside shipping containers should not be allowed in the sterile storage area. Electrosurgery - correct answer -Frequently used to cut, coagulate, dissect, fulgurate, ablate, and shrink body tissue. -Used during surgery in a high radio frequency electrical current to routinely cut and coagulate. Using the ESU Safely - correct answer -Do not activate until flammable anesthetic agents are dry or dissipated. -Fluids should never be poured on the generator or foot switch -Keep foot switch dry in a clean, clear, cover. -Safety features help alert RN of danger; when ESU is activated, audible alarm indicator must be at an audible level. ESU Power Settings - correct answer -Confirmed verbally every time there is a change. -IF the surgeon asks for continual increases in the power settings, the RN should check each component in the circuit for possible disruption. Monopolar - correct answer Most commonly used ESU modality because of its versatility and effectiveness. -Active electrodes are in the surgical site. -The patient return electrode is somewhere else. -Current passes through the patient as it completes the circuit from the active electrode to the patient return electrode. Avoid placing the dispersive electrode in these areas - correct answer -Bony prominence -Implanted prosthesis -Burned tissue -Hairy areas -Tattoo sites *Place as close to the operative site as feasible and over a large, perfused, muscle mass, which will permit uniform contact.* Capacative Coupling - correct answer Transfer of electrical current from the active electrode through intact insulation to adjacent conductive items, such as tissues or trocars. Implanted Electronic Devices - correct answer -if ESU is necessary, utilize bipolar ESU. -Active electrode and dispersive electrode should be located as close together and as far away from IED generator as possible. -Monitor patient closely for signs of complications Closed Glove Technique - correct answer -Scrub person's hand remain inside the gown sleeves and should NOT touch the cuff edges -Used for the INITIAL donning of sterile gown and gloves Open Gloved Technique - correct answer -Scrub person's hand slides all the way through the sleeves and out beyond the cuffs -Used for subsequent gloving and when performing procedures in which a gown is not worn. Fomite - correct answer An inanimate object or substance, such as clothing, furniture, or soap that is capable of transmitting infectious organisms from one individual to another. Surgical Hand Scrub Steps - correct answer 1) Wash hands and forearms with soap and running water before beginning. *Dry with sterile cloth towel* 2) Dispense approved antimicrobial scrub agent. 3) Clean the subungual areas of both hands under running water using nail cleaner 4) Visualize each finger, hand, and arm as having four sides. Wash all sides effectively. Strike through - correct answer The hands and arms must be thoroughly dried, before donning the gown, to prevent this. *Organisms on the wet skin from soaking through and contaminating the sterile object* Surgical Consciouse - correct answer -The honesty and moral integrity necessary to strictly adhere to the principles of asepsis *Consider items of doubtful sterility contaminated* Aseptic Technique Practice Goals - correct answer -Minimize the length of recovery -Optimize primary wound healing -Prevent SSI When transferring and handling medications what should be used? - correct answer A sterile transfer device such as vial spike Sterile Fields - correct answer -Should be constantly monitored and *not left unattended* -Direct observation INCREASES the likelihood of detecting breaches in sterility. -Covering may help preserve the sterility of the field and minimize exposure to environmental contaminants. Transient bacteria - correct answer -*Easily removed by mechanical cleansing* -Usually limited to exposed areas of skin -Resident Microorganisms - correct answer -Inhibit the deep structures of the dermis, the glands, and the hair follicles. -*Require chemical agents to eliminate and prevent their regrowth for period of time* CHG - correct answer Topical use only. -NOT for above the neck due to the potential corneal damage and toxicity when introduced to the auditory canal. Abdominal Prep Scrubbing - correct answer -Beginning at the site of the incision, use friction and scrub in a circular motion, moving away from the site in all directions. (This directs contaminates away from critical area) -If paint solution is applied; use an outward circular motion starting at the incision site. Skin Antisepsis Documentation Activities - correct answer -Appropriate restrictions on and alternatives to hair removal -Assessment of the skin at the operative site -Type of antiseptic used -Person performing the prep -Area prepped. Exposing the Area to be Prepped - correct answer -The prep area should extend at least *6-8 inches* in all directions beyond the planned incision site. Routine Specimens - correct answer Do not require immediate processing by the pathologist Frozen Section Specimen - correct answer Specimens that require immediate examination by pathologist Biopsy Specimen - correct answer Specimens that will be microscopically studied by the pathologist and may undergo histologic or cytologic analysis Culture Specimens - correct answer Specimens of tissue or fluid suspected of being infected Cytology Specimens - correct answer Specimens obtained for studying biology Forensic Specimens - correct answer Physical evidence retrieved from a person involved as a suspect or victim in a crime Labeling Routine Specimens - correct answer -The specimen is identified by the surgeon before being passed off the surgical field to the RN. might invalidate a sponge count if the patient is returned to surgery with the dressing intact. How is the drainage of body fluids and purulent material achieved? - correct answer Passive (gravity) or active (suction) means through a drain to drain pus, purulent, or necrotic material from a wound. What about drains should be passed onto the PACU nurse? - correct answer -Type, location, and patency of all drains. Major indications of suction drains - correct answer -Abdominal or breast surgery (Jackson Pratt) Penrose drains - correct answer -Abdominal surgery, peritoneal cavity or skin wound. Nasogastric - correct answer Decompression of the stomach. T Tube - correct answer Inserted into the biliary tract to allow for drainage of bile Rules for the endoscopic light source - correct answer -Do not turn on the light source until the cable is connected to the telescope. -When not in use, the light source should be placed in standby mode. -Always set parameters to manufacturers setting. Precautions to prevent a pneumoperitoneum - correct answer -Always have a back up CO2 tank -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 contaminated the device. -Make sure alarm is working properly -Maintaining intra-abdominal pressure under 12 mm/Hg in adult patients reduces the risk of systemic hemodynamic changes. Cleaning endoscopic instruments - correct answer -Clean off external debris during the case with a moistened sponge -Flush the channels with sterile water to remove gross soil during surgery. *Saline may cause erosion* -Test scissors for sharpness prior to sterilization RN should focus on what for endoscopic or MIS - correct answer -Previous incision sites -History of DVT -Consent to include the possibility of an open procedure -Voiding prior to surgery Achieving correct fluid management for the patient include - correct answer - Monitoring overload of IV and irrigation fluids to avoid hyponatremia and hypervolemia -Monitoring the amount of irrigation fluids dispensed and returned during the procedure. True or false, do you use alcohol to disinfect large environment surfaces? - correct answer FALSE When do we damp dust? - correct answer -Before the first procedure of the day. When we damp dust, we must begin with higher surfaces then lower. -OR Rooms should be cleaned after each surgical or invasive procedure with a lint free or microfiber cloth moistened with a detergent/disinfectant and water. Exogenous sources - correct answer Pathogens are mainly aerobes (live in the air) Endogenous sources - correct answer Sources from the patient's own skin. What do you use to terminally clean floors - correct answer A wet vacuum or single use mop and an EPA registered disinfectant -Leave water to sit for at least *5 minutes* then vacuum. What bacteria should are hospital disinfectants pass the potency test for? - correct answer -Pseudomonas aeruginosa -Staphylococcus aureus -Salmonella Choleraesuis Air sampling - correct answer -Done before construction begins, after demolition occurs, and at the end of a project. What are the four stages of Anesthesia? - correct answer 1) Initial administration 2) Excitement (time from loss of consciousness to loss of eyelid reflex) 3) Intrasurgery (time of surgical anesthesia) 4) Possible Resp. Failure. Three phases of anesthesia - correct answer 1) Induction (administration of anesthetic until surgical incision is made) 2) Maintenance (surgical incision to near completion) 3) Emergence (pt begins to awaken and exits room) Examples of Regional Anesthesia - correct answer -Upper/Lower extremity blocks -Spinal blocks -Epidural blocks -Eye blocks What should perioperative RN's be alert for after spinal anesthesia is given? - correct answer Hypotension due to severe vasodilation Where is the epidural anesthetic injected? - correct answer The space between the ligamentum flavum and the dura. RN's roles during Moderate sedation - correct answer -Constant vigilance and monitoring -Reversal agents readily available -Able to perform airway assessments -Able to use emergency equipment and drugs -ACLS certified. Symptoms of Malignant Hyperthermia - correct answer -Unexplained increase in ETCO2 -Jaw muscle rigidity -Hyperkalemia -Lactic Acidosis -Increased O2 Demand Corrective measures for MH - correct answer -If possible, stop surgery -Avoid all triggering agents -Provide 100% O2 -Used iced saline to cool patient the "Sign in" - correct answer When the patient enters the OR 2 - correct answer -Inside a traditional OR setting, patients should be transferred with a minimum of _________ staff members 4 - correct answer If patients are unable to move themselves or are combative how many staff members are required to assist? Two main contributing factors to skin injuries - correct answer 1) Diabetes 2) Inadequate tissue perfusion Who should be treated as latex allergic/sensitive? - correct answer -Has a history of anaphylaxis to latex -Multiple surgical procedures -A child with spinal bifida and genitourinary abnormalities requiring surgical procedures What suggests allergic sensitization? - correct answer When workers or HCPs give a history of severe or worsening latex or glove-induced eczema, urticaria, or work related conjunctivitis, rhinitis, or asthma. Time out documentation should include - correct answer -The patients identity with 2 identifiers -The site and side -Verification of the procedure to be performed. Barriers to effective patient and family education in the perioperative setting - correct answer 1) anxiety about an uncertain outcome 2) discomfort or pain 3) fear of the unknown 4) Limited time for assessment and teaching. Assessment - correct answer -Key activity for the perioperative nurse -It also is the foundation of the patient education process The perioperative nurse's role in patient and family education includes - correct answer -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 after surgery. Preoperative patient assessment factors - correct answer -Nutritional status -Preexisting conditions -Physical/mobility limits -BMI Stage 1 Pressure Ulcer - correct answer -Does not blanch to fingertip pressure Stage II Pressure Ulcer - correct answer -Skin is abraded, blistered, or has shallow craters. Stage III Pressure Ulcer - correct answer -Full thickness skin loss possibly down to the fascial layer. Stage IV Pressure Ulcer - correct answer -Full thickness skin loss with extensive destruction and tissue necrosis. What type of factors can contribute to the development of pressure injuries? - correct answer Extrinisic and Intrinsic factors Trendelenburg position - correct answer -Modification of the supine position -Knees are placed over the break in the table -AVOID shoulder braces Lithotomy Position - correct answer -Buttocks even with the lower break in the OR bed to prevent *lumbosacral strain* -Padded arm boards -Circulatory and respiratory systems may be compromised due to compression of abdominal contents on the inferior vena cava and abdominal aorta. -Watch for nerve damage Prone position - correct answer -Rolled on his/her stomach -Arms should be rotated slowly -Improper positioning can result in pressure on the inferior vena cava and femoral veins -Pressure on the carotid artery can produce hypotension and arrhythmias -Most vulnerable to respiratory problems due to compression of the diaphragm which impairs air exchange -Increased airway pressure can occur. Three forces can act on as the patient as they lay on the surgical table - correct answer 1) Pressure 2) Shearing 3) Friction *surfaces rubbing over a rough, stationary surface* Pressure - correct answer -Duration is more important than intensity -Great amount of ________ for a short period of time is tolerated better than low __________ during a long period due to diminished tissue perfusion. Common fuel sources - correct answer -Linens/Drapes -Prep solutions -Skin degreasers/aerosols -Body tissues and patient hair -Intestinal gases Handling ESU Equipment - correct answer -Do not use in an oxygen enriched envirornment, such as the trachea or when O2 is being "blown over" a patient -Allow enough time for skin prep solutions that are flammable or contain alcohol to dry -Visually check integrity and insulation of all cords. Reducing personnel exposure to a risk of fire for specimens fixatives such as formalin - correct answer -Avoid splashing -Wear gloves -If skin contact occurs, wash thoroughly with water. -Wear a mask to avoid inhalation -Wear goggles -If eye contact occurs, immediately flush with water -Use absorbent material and then tripe rinse with water any area or surface where accidental formalin spillage occurs -Store in a dedicated area away from medications -So securely so they are inaccessible to persons unfamiliar with use. What to document with a pneumatic tourniquet - correct answer -Serial number -Limp occlusion pressure (LOP) -Cuff pressure -Skin protection measures -Location of the cuff -Skin integrity underneath the cuff before and after use -Time of inflation and deflation -Assessment and evaluation of entire extremity. Complications of Pnematic Tourniquets - correct answer -Nerve injury/paralysis -Skin blisters -Abrasions -Necrosis -Selling -Chemical Burns Biological Indicators - correct answer -Document the efficacy of specific sterilized cycles Immediate Type 1 Hypersensitivity Symptoms - correct answer -Eczema -Allergic Rhinitis -Orbital edema -Urticaria What consists of a psycho-social assessment? - correct answer -Culture -Expectations -Religion Phase 2 PACU - correct answer -Patient/caregiver education for home. Biopsies that require special prep to preserve cells - correct answer -Bone marrow -Muscle & nerve -Testicular Only way to diagnose malignant hyperthermia - correct answer Muscle biopsies Wound healing phase where contraction occurs - correct answer Proliferation Phase 1 PACU - correct answer -Assessment of BP, LOC, O2, and Pain. Space where level of direct, reflected or scattered lazer - correct answer -Nominal Hazard Zone JC 2 Safety Goals - correct answer 1) Promote specific improvements 2) Highlight problematic areas Proper handling of an explant removed due to failure - correct answer -Document the serial number -Fill out a risk assessment