AORN PERIOP 101 Exam Review|Complete Q&A

All the following professionals are qualified to provide anesthesia to a patient EXCEPT:a) anesthesiologist b) CRNA c) anesthesiology assistant d) operating surgeon -Answer- d) operating surgeon Of the following, which is not used to secure airway: a) ET tube b) LMA c) nasal cannula d) oral airway -Answer- c) nasal cannula The perioperative team should know the location of equipment stored in the OR and inthe department. Equipment that the anesthesia provider may request includes: a) video laryngoscopy devicesb) fiberoptic bronchoscopes c) suction tips and devices d) all of the above -Answer- d) all of the above General Anesthesia -Answer- a drug-induced reversible state of unconsciousness, it includes amnesia, analgesia, loss of responsiveness, decreased stress response, and loss of skeletal muscle reflexes to varying degree Regional Anesthesia -Answer- an injection of local anesthetics near nerve fibers to cause reversible loss of sensation over an area of the body, common examples includespinal, epidural, and peripheral nerve blocks Monitored Anesthesia Care (MAC) -Answer- when an anesthesia provider monitors thepatient, administers sedatives and other agents as needed, and provides medical services as needed Moderate Sedation -Answer- the administration of sedative, analgesic, and/or anxiolytic agents by a physician or under physician supervision. Depending on

state laws and hospital policies, a perioperative nurse may be able to administer this type of anesthesia Local Anesthesia -Answer- The infiltration or topical administration of agents to anesthetize a part of the body. It is typically used for minor procedures, does not involvean anesthesia provider, and does not involve sedation. A perioperative nurse monitors the patient and provides supportive care if needed.

The phases of general anesthesia, in order, are: a) induction, maintenance, emergence b) emergence, maintenance, induction c) maintenance, emergence, induction d) induction, emergence, maintenance -Answer- a) induction, maintenance, emergence Propofol -Answer- IV induction agent etomidate -Answer- IV induction agent methohexitol -Answer- IV induction agent IV induction agent -Answer- ketamine sevoflurane with or without nitric oxide -Answer- inhaled induction agent Succinylcholine -Answer- short-acting muscle relaxant cisatracurium -Answer- intermediate-acting muscle relaxant atracurium -Answer- intermediate-acting muscle relaxant rocuronium -Answer- intermediate-acting muscle relaxant vecuronium -Answer- intermediate-acting muscle relaxant pancuronium -Answer- long-acting muscle relaxant isoflurane -Answer- used for inhalation maintenance

desflurane -Answer- used for inhalation maintenance total iv anesthesia (TIVA) -Answer- a technique for maintaining anesthesia using infusions of short-acting IV agents without inhalation anesthetics. Propofol and remifentanil are often used for TIVA. Reversal agent for succinylcholine -Answer- none! neostigmine -Answer- reversal for muscle relaxant (except succinylcholine) edrophonium -Answer- reversal for muscle relaxant (except succinylcholine) sugammadex -Answer- reversal agent for rocuronium, vecuronium, and pancuronium flumazenil -Answer- reversal agent for benzos (midazolam) naloxone -Answer- reversal agent for narcotics (fentanyl) which of the following type of airway maintenance usually requires muscle relazants?a) spontaneous respiration b) mask ventilation c) laryngeal mask airway d) endotracheal intubation -Answer- d) endotracheal intubation When should cricoid pressure be released?a) if the patient coughs b) when the patient loses consciousness c) if the anesthesia provider cannot see the vocal cords d) after the cuff of the ET tube is inflated and the position is confirmed -Answerd) afterthe cuff of the ET tube is inflated and the position is confirmed lidocaine -Answer- local anesthetic bupivacaine -Answer- local anesthetic ropivacaine -Answer- local anesthetic tetracaine -Answer- for long-acting spinal anesthesia

epinephrine (anesthesia) -Answer- added to increase density and duration of a regionalblock bicarbonate (anesthesia) -Answer- sometimes added to reduce the acidity of the localanesthetic and speed the onset of the block Spinal Anesthesia -Answer- the subarachnoid space is entered and local anesthetic isinjected directly into the spinal canal, pt sitting or lateral Epidural Anesthesia -Answer- the anesthesia care provider finds the space between theligamentum flavum and dura, this space is identified by a loss of resistance as the needle is advanced, a single dose of anesthetic can be injected, or a catheter can be placed IV regional anesthesia (Bier Block) -Answer- used for procedures on hand, wrist, or forearm (double tourniquet method) Local Anesthetic System Toxicity (LAST) -Answer- can occur if unsafe amount of localanesthetic enters bloodstream, can occur slowly as med is absorbed over time, or quickly if accidentally injected into blood vessel CAN PROGRESS TO SEIZURES AND CARDIAC OR RESP ARREST Symptoms of LAST -Answer- -ringing in ears -tingling lips -metallic taste in mouth -dizziness Sedation can be used with any of the following types of anesthesia except:a) regional anesthesia b) monitored anesthesia carec) general anesthesia d) local anesthesia -Answer- d) local anesthesia Malignant Hyperthermia (MH) -Answer- a rare but potentially lifethreatening complication of anesthesia, triggered by inhaled general anesthetic agents and themuscle relaxant succinylcholine Complications of MH -Answer- it can lead to cardiac arrest, brain damage, organ failure,and death

increased end-tidal CO2 -Answer- most specific sign of MH Dantrolene -Answer- drug used to treat MH Hypothermia -Answer- a core body temperature <36c (<96.8F) Which of the following is associated with increased risk for hypothermia?a) female sex b) higher than normal body weightc) hyperthyroid d) hypertension -Answer- a) female sex Identify the active warming devicesa) circulating water garments b) cotton blankets c) forced-air warming devices d) increased ambient room temperaturee) surgical drapes d) warmed IV fluids -Answer- a) circulating water garmentsc) forced-air warming devices d) increased ambient room temperaturef) warmed IV fluids Which of the following would be an appropriate action for the perioperative nurse whenassisting with anesthesia? a) administer the muscle relaxant reversal agent if needed?b) apply cricoid pressure if needed during intubation c) document anesthetic agents used, dose, route, and time d) extubate the patient -Answer- b) apply cricoid pressure if needed during intubation Which of the following is NOT included in basic monitoring of the patient for anesthesia?a) pulse oximetry b) ECG c) arterial line d) blood pressure -Answer- c) arterial line Which drug is used to reverse valium and midazolam?a) neostigmine

b) pancuronium c) flumazenil d) succinylcholine -Answer- c) flumazenil Which method is used to prevent aspiration during endotracheal intubation?a) applying cricoid pressure b) inserting a nasal/oral airway c) laryngoscopy d) invasive techniques -Answer- a) applying cricoid pressure How can the perioperative nurse assist the anesthesia provider with placement of aspinal or epidural block? a) inject local anesthetic b) thread the catheter through the needlec) calm the patient d) identify landmarks for insertion of the needle -Answer- c) calm the patient During IV regional anesthesia the tourniquet should be deflated slowly to prevent whichof the following from entering the bloodstream? a) bacteria b) lymphatic fluidsc) thrombus d) bolus of anestheitc -Answer- d) bolus of anesthetic Depending on state laws and hospital policies, which of the following can be performedwithout a professional anesthesia provider? a) general anesthesia b) regional anesthesia c) monitored anesthesia care d) moderate sedation -Answer- d) moderate sedation Which assessment factor is important to include when screening patients for MH?a) family history of problems related to anesthesia b) patients age c) patients use of herbal and vitamin supplements d) patients use of OTC meds -Answer- a) family history of problems related toanesthesia

The RN caring for the patient receiving moderate sedation/analgesia should:a) turn up the monitor alarms when prepping the patient b) be competent in the use of emergency resuscitation procedures c) call an anesthesia provider to administer reversal medications d) all of the above -Answer- b) be competent in the use of emergency resuscitation procedures laparoscopy -Answer- examination of the abdominal cavity or performance of a minorabdominal surgery using a laparoscope endoscopy -Answer- examination by means of an endoscope endoscope -Answer- a tube inserted into a natural body orifice or through a small incision to access internal organ structures, can be flexible, rigid, or semirigid flexible endoscope -Answer- includes cystoscope, laparoscope, sinuscope, arthroscope,and hysteroscope semi-rigid endoscope -Answer- includes a deflectable-tip video laparoscope that willallow movement through the tip to allow a complete view from a variety of different angles operative endoscope -Answer- channeled scopes that provide the ability to irrigate, suction, insert, and connect a variety of accessories capacitive coupling -Answer- transfer of electrical current from the active electrodethrough intact insulation to adjacent conductive items (tissue, trocars) Based on your knowledge of laparoscopic surgery, identify the potential complicationsrelated to it: a) pneumonia b) hypoxemia c) hypercarbia d) cardiac dysrhythmiae) hypocarbia f) CO2 embolism -Answer- b) hypoxemiac) hypercarbia

d) cardiac dysrhythmiaf) CO2 embolism Which are the major components of medical video imaging?a) electrosurgical unit b) fiber-optic light cablec) verres needle d) camera control unit -Answer- b) fiber-optic light cabled) camera control unit Based on your knowledge of cameras in endoscopic surgery, identify the tasks that should be completed while setting up the camera before surgery a) inspect the camera head for smudges or debrisb) clean the camera head using sterile water c) plug the camera into the CCU and turn on the unit d) complete white balancing of the camera -Answer- a) inspect the camera head forsmudges and debris c) plug the camera into the CCU and turn on the unitd) complete white balancing of the camera Metal Halide Light Source -Answer- emits continuous blue light, cheaper but less brightthan xenon light source Xenon light source -Answer- emit pulsing high intensity white light, expensive butbrigher Pneumoperitoneum -Answer- air or gas introduced into the body cavity as a distentionmedium (ex. carbon dioxide, nitrous oxide, helium) Verres needle (blunt tipped trocar) -Answer- used to deliver CO2 into the peritonealcavity, creates working space Laparoscopic instruments with small, blunt tips are used for:a) cutting tissue b) dissecting tissuec) grasping tissue d) moving tissue from one place to other -Answer- b) dissecting tissue

Identify the instruments that can be used in laparoscopic surgery a) babcocks forceps b) mosquitoes forceps c) needle holder forceps d) dissector forceps -Answer- a) babcocks forcepsc) needle holder forceps d) dissector forceps Identify the additional assessments that should be made by the perioperative nurse before an endoscopic surgery: a) history of thermal burnsb) history of DVT c) consent for open surgery d) history of anaphylactic reactione) history of previous incisions f) types of instruments used in surgery -Answer- b) history of DVTc) consent for open surgery e) history of previous incision What are complications associated with laparoscopic surgery?a) umbilical hernia b) post surgical pneumoniac) wound infection d) CO2 embolism -Answer- c) wound infectiond) CO2 embolism Identify some methods to maintain a sterile camera head a) put the camera head in a sterile pouch b) gas-sterilize the camera head c) cold soak the camera head for 20 min in glutamate d) wipe the camera head and cord with alcohol and arrange on sterile field Answer- a)put the camera head in a sterile pouch b) gas-sterilize the camera head Which pieces of equipment are used during laparoscopic surgery?a) CO2 insufflator b) ESU c) smoke evacuator d) fiberoptic

headlight e) traction apparatus -Answer- a) CO2 insufflatorb) ESU c) smoke evacuator What actions can the scrub person take to help prevent incidental thermal burns a) inspect laparoscopic instrumentation for excessive wear or obvious breaks andreplace when necessary b) clean all instruments with sterile waterc) watch the surgery carefullt d) replace instruments that have damaged insulation -Answer- a) inspect laparoscopicinstrumentation for excessive wear or obvious breaks and replace when necessary d) replace instruments that have damaged insulation Identify one characteristic difference between laparoscopic instruments and those usedin open procedures: a) all laparoscopic scissors are "take apart" b) laparoscopic instruments have long, thin shafts to accommodate trocar cannulasc) one cannot dissect tissue with laparoscopic instruments d) all laparoscopic instruments are disposable -Answer- b) laparoscopic instrumentshave long, thin shafts to accommodate trocar cannulas What region of the patients abdomen is traditionally used to establish pneumoperitoneum for MIS? a) periumbilical b) supraumbilic alc) subumbilical d) umbilical -Answer- a) periumbilical What is an important safety consideration when using a light source?a) leave the light cord on the sterile field at all times b) place the light cord in standby mode whenever it is not in usec) coil the light cord tightly to keep its fibers in shape d) replace light cords only when more than 50% of the fibers are broken Answer- b)place the light source in standby mode whenever it is not in use CO2 is the gas used for abdominal insufflation because it:a) is not readily absorbed by the body b) is inexpensive c) suppresses combustion

d) is rapidly eliminated from the body -Answer- b) is

inexpensivec) suppressed combustion d) is rapidly eliminated from the body Bacteria common to OR -Answerstaphylococcie coli streptococci mrsa pseudomonas serratia marcescensc diff viruses common to OR -Answer- hep B and CHIV fungi common to OR -Answer- aspergillus Endogenous source of infection -Answer- surgical personnel, OR environment, tools,instruments, supplies, pt's own skin Exogenous source of infection -Answer- aerobes in OR Identify activities that may be handled by EVSa) preliminary room prep b) damp dusting/moppingc) endof-procedure clean d) terminal clean Answer- CD Any germicide that is labeled as a hospital disinfectant has passed the potency test for activity against

,

, and . -Answer- Pseudomonas aeruginosa staphylococcus aureus salmonella choleraesuis

Tuberculocidals are a special class of disinfectants. In order to be labeled 'tuberculocidal', products need to have demonstrated potency against: a) Pseudomonas b) Staphylococcusc) Mycobacteria d) Salmonella -Answer- C Post Procedure Clean -Answer- purpose is to break cycle of contamination from pt toenvironment to staff to subsequent patient Terminal Clean -Answer- a more thorough cleaning and disinfection of periop environment decreases the number of pathogens and amount of dust and debris created during the day, done at end of day Identify the best practices to follow when performing environmental sanitation a) when cleaning spills of blood or any other potentially infectious material, use glovesand any other PPE appropriate to the task b) visibly soiled OR equipment, furniture, and floors should be cleaned with a hospital-grade germicide c) infectious waste should be segregated from noninfectious waste in the general wastestream d) color coded or labeled bags should be used to facilitate separation of the variouswastes -Answer- a b c d HIV -Answer- only survives in blood and body fluids that contain white blood cells,fragile and easily destroyed outside the body Creutzfeldt-Jakob disease -Answer- a rare but progressive fatal disease caused byprions MRSA -Answer- one of the hardiest bacteria and most difficult to treat

VRE (vancomycin-resistant enterococcus) -Answer- usually spread by the hands ofcaregivers or patients and contaminated equipment or environmental surfaces Select the correct statements about spray bottles a) spray bottles can aerosolize potentially infectious materials b) spray bottles are occasionally used to apply disinfectantc) spray bottles are not used to apply disinfectant d) spray bottles are an easy way to clean the environment Answer- ac Hemostasis -Answer- 1) the stoppage of bleeding or hemorrhage 2) the stoppage of blood flow through a blood vessel or body part3) the stagnation of blood Mechanical Hemostasis -Answer- achieved by occluding severed vessels until plateletformation occurs Thermal Hemostasis -Answer- application of extreme cold or heat to body tissues Chemical Hemostasis -Answer- includes pharmacological agents and topical hemostaticagents Microfibrillar collagen (avitene) -Answer- absorbable topical agent applied directly tobleeding source with dry, smooth forceps do NOT USE WITH: sensitivity to bovine collagen, skin closure, methyl methacrylate, contaminated wound,cell saver Oxidized Cellulose (nuknit, surgicell) -Answer- absorbs 7-8x its weight producing clot,applied directly to bleeding site, do NOT leave near spinal cord, optic nerve, or area with nerve damage, do NOT use with thrombin Collagen Sponge (collastat, superstat, helistat) -Answer- dehydrated hemostatic spongeor foam, dissolves as hemostasis occurs, do not use in infection or pooled blood Fibrin Sealant (tisseal, crosseal, floseal) -Answer- type of tissue adhesive derived from human and animal blood product, forms stable clot, used to control bleeding

and speedhealing, seal hollow organ, cover hole, slow release of med, do NOT use w allergy to bovine protein Thrombin -Answer- extracted from dried beef blood, topical agent, accelerates coagulation and controls capillary bleeding, often used w/ gelatin sponge, should beused immediately Styptic (epi, tannic acid, silver nitrate) -Answer- chemicals that cause vasoconstriction Penrose Drain -Answer- Usually placed in a "stab" wound that is made adjacent to themain incision or may be placed near an intestinal anastomosis abdominal surgery, peritoneal cavity or skin wound T Tube -Answer- inserted into biliary tract to allow for drainage of bile, left for 10 days ormore to develop tract through which bile can drain after removing tube Suction Drain -Answer- to drain accumulated blood and fluid from operative site JP drain -Answer- Used to drain fluid or blood after abdominal, urologic, thoracic, andhead and neck procedures abdominal or breast surgery Hemovac -Answer- orthopedic Chest Tube -Answer- conduit for drainage of air, blood, and other fluid from intrapleuralor mediastinal space, and reestablishment of negative pressure in intrapleural space Occlusive dressing -Answer- prevent drying of wound, increase proliferation of epithelialcells bioclusive, dermicell, duoderm hydrocolloids, opsite, dermagel, tagaderm, vasoline gauze, xeroform Gauze dressing -Answer- protect wound, absorb fluid (impregnated: vaseline, xeroform)(nonimpregnated: adaptic, telfa, nu-gauze, 4x4, ABD) Hydrogel dressing -Answer- hydrate and soothe tissue (tegagel, nu-gel, vigilon,

karaya,collonplast) Pressure dressing -Answer- minimize intracellular fluid, eliminate dead space, distributepressure evenly fluffed gauze, non-radiopaque and gauze covered pads Biological dressing -Answer- control infection in denuded area, prevent loss of serum,decrease pain allograft of human skin, xenograft of porcine skin, added antimicrobial or chemotherapeutic ointments (silver) silvadene, scarlet red Rigid support dressing -Answerimmobilizecast, splint Sponge counts are done for all the following reasons EXCEPTa) account for used sponges b) prevent injury by retained foreign object c) bc state law requires specific count procedure -Answer- C Reasons to avoid using radiopaque sponges in dressing -Answer- 1) possibleinvalidation of subsequent count if returns to OR with dressing 2) may appear as foreign body on post op x ray Cardiac Agents -Answer- used to reduce mammary artery spasm, test patency and integrity of graft, and sustain radial artery dilatation Otic Agents -Answer- anesthetize, stop or slow bleeding, irrigate, anti-infective Hormonal Agent -Answer- stimulate smooth muscle Side effects of diagnostic imaging agents -Answer- cell sicklingrenal failure Characteristics of Antimicrobial Agents -Answer- Broad SpectrumHigh log reduction capability

persistent nonirritatin gnontoxic fast acting Chlorhexidine Gluconate (CHG) -Answer- TOPICAL skin prep, commonly used for pt w/iodine allergy do NOT USE ABOVE NECK can cause corneal and ototoxicity can cause nerve tissue damage not for vaginal or mucus membrane Povidone Iodine -Answer- Scrub (with detergent)Paint (without detergent) Iodophors are safe for mucus membrane use Alcohol prep -Answer- acts by denaturing proteinsused w other prep DISPERSE FUMES BEFORE DRAPING PCMX -Answer- chloroxylenol, cocamidopropyl PG dimonium chloride phosphate cationic phenolic mixture safe for mucus membranes Vaginal Preps -Answer- povidone-iodine scrub and paintor chloroxylenol 3% Monopolar Electrosurgery -Answer- uses dispersive electrode to remove current frompatient in fluid filled cavity must be used with isotonic fluid ex. dextran 10, dextran 70, glycine1.5%, sorbitol, mannitol near head/neck fire risk

Bipolar Electrosurgery -Answer- current flows between the tips of the two-poledinstrument Argon Enhanced Coagulation (AEC) -Answer- combo of electrosurgical energy and argon gas creates more direct pathway for electrosurgical energy to travel to target tissue argon gas helps clear site of blood and fluid *** CAN CAUSE GAS EMBOLI *** Ultrasonic Electrosurgery -Answer- Converts electrical energy into mechanical energy Components of the electrosurgical circuit include a) active electrode, dispersive electrode, generatorb) dispersive electrode, fiber, generator c) active electrode, dispersive electrode, generator, scratch padd) dispersive electrode, fiber, generator, key -Answer- a Needle Aspiration -Answer- a fine gauge needle and syringe are used to aspirate anarea of abnormal appearing tissue or body fluid Incisional Biopsy -Answer- A small portion of tissue is incised and sent for examination excisional biopsy -Answer- an entire section of tissue is sent for examination 5 Rights of Specimen Handling -Answer- Right PatientRight date/time Right laboratory testRight surgeon Right specimen Routine Specimen -Answer- specimen that does not require immediate processing bythe pathologist Frozen Section Specimen -Answer- specimen that require immediate examination bythe pathologist

Biopsy Specimen -Answer- specimens that will be microscopically studied by the pathologist and may undergo histologic or cytologic analysis Culture Specimens -Answer- specimens of tissue or fluid suspected of being infected Slide Specimens -Answer- specimens of tissue or fluid that is smeared on a slide for microscopic examination Cytology Specimens -Answer- specimens obtained for studying cell biology Forensic Specimens -Answer- physical evidence retrieved from a person involved as asuspect or victim in a crime Gross Examination Specimens -Answer- specimens that will only receive a macroscopicvisual inspection with the naked eye Explanted Medical Devices -Answer- specimens may be sent to pathology for grossexamination Organ Donation -Answer- "organ" specimens obtained from a living donor or a cadaver Amputated digits and limbs -Answer- specimens that are to be reimplanted Breast Biopsy -Answer- FROZEN IMMEDIATE ANALYSIS Biopsy of tumor -Answer- FROZEN IMMEDIATE ANALYSIS Biopsy of lesions -Answer- FROZEN IMMEDIATE ANALYSIS Rectal biopsy for ganglion cells -Answer- FROZEN IMMEDIATE ANALYSIS Lymph nodes -Answer- may be frozen for diagnostic purposes Require special handling to preserve cells -Answernervemuscle bone marrow testicular

biopsies bone marrow biopsy -Answer- requires specialized needle that can puncture bone muscle biopsy -Answer- requires special forcep that are applied to muscle beforeremoval to keep it stretched during processing breast biopsy -Answer- sent to radiology/mammography to ensure entire lesion is obtained may have needle placed prior to surgery to pinpoint lesion cytology -Answer- tissue and body fluid obtained during procedure can be sent for cytology to identify the function and origin of cells within fluid/tissue done with suspected malignancy can be obtained through "washings" inject saline and aspirate fluid through "luken trap"ex: bronchial, bladder, pelvic Forensic Specimen (fluid) -Answer- collect in tube or specimen container, swab aroundwounds, absorb on clean cotton, air dry, paper envelope Forensic Specimen (hair and fiber) -Answer- collect and place in separate paperenvelope Forensic Specimen (fingernail) -Answer- place in paper envelope Forensic Specimen (debris) -Answer- (ex. glass, paint chip, splinter, animal teeth)collect and place in paper envelope Forensic Specimen (foreign object) -Answer- (ex. bullet, fragment, pellet, knife) rubbertipped clamps, latex gloves, do not mark, no metal basin Forensic Specimen (fabric/clothing) -Answer- keep as intact as possible, air dry if possible, place on paper, paper between layers, separate bags 4 Types of Surgical Instruments -Answercutclamp grasp retrac t

knife / scalpel -Answer- used to make incision and for tissue dissection Iris scissor/castroviejo scissor -Answer- scissor used in ophthalmic or reconstructive procedure metzenbaum scissor -Answer- used for intra-abdominal tissue dissection (delicate) curved mayo scissor -Answer- used to cut heavy or tough tissue such as fascia straight scissors -Answer- used for cutting suture osteotome -Answer- used to shape or mark bone, may remove periosteum from bone chisel -Answer- used to sculpt bone, has beveled edge saw -Answer- any notched blade used for cutting bone trephine -Answer- used to cut bone from skull, has circular, sharpened edge currette -Answer- used to remove soft tissue or bone by scraping with the sharp edge ofthe cup, loop, ring, or scoop rasp -Answer- are used to smooth rough bone surfaces or to evacuate medullary canalsin prep for insertion of orthopedic prostheses rongeur -Answer- biting instrument used for cutting tough bone or tissue, often used onbones or heavy ligaments clamp -Answer- used to hold, join, or compress parts together hemostat -Answer- used to grasp bleeding vessels occluding clamp -Answer- used to clamp bowel, ducts, vessels, and other tissue thathas a lumen, usually have vertical serrations or special jaws ex: kocher, oshsner, curved hemostat crile clamp -Answer- used to control bleeding in subcutaneous tissue, can be

straight orcurved mosquito clamp -Answer- used for superficial bleeding, delicate plastic or hand tissue,can be straight or curved kelly / peon clamp -Answer- used to control bleed in muscle tissue, hold kitner sponges,and pass drains, straight or curved Babcock Clamp -Answer- curved, fenestrated tips w no teeth, used to grip or enclosedelicate structures such as bowel, appendix, urethra, or fallopian tubes, will not penetrate, crush, or traumatize delicate tissue Kocher clamp (ochsner) -Answer- transverse serration and 1'' by 2'' teeth, to grasp heavy, tough, slippery tissue such as fascia, bone, cartilage, uterine broad ligaments allis clamp -Answer- used to hold tissue without crushing, devitalizing, or injuring it, hasmultiple tiny, fine teeth that curve inward and hold tissue gently but firmly used for retracting tissue and grasping fascia, cysts, and knee cartilage Tissue forcep -Answer- with teeth and long jaws, used when firm grip is needed, ex.tough skin, fascia, cartilage ex. adson, russian atraumatic forcep -Answer- used to grasp fine tissue (ex vascular or cardiovascular surgery) ex. debakey

smooth forcep -Answer- simple serration and smooth tapered point for holding delicatetissue and vessels ex. smooth adson, cushing, bayonet tenacula -Answer- usually penetrates tissue and is used to retract or pull tissue into position for dissecting sponge forcep -Answer- w. ring shaped jaw, used to hold gauze sponges, can be usedfor skin prep, retracting tissue, absorbing blood, soft tissue dissection ex. fletcher sponge forcep, forester sponge forcep, sponge stick towel forcep -Answer- used to attach and secure drape material can be perforating or nonperforating collier needle holder -Answer- holds medium-gague needle mayo (mayo-hegar) needle holder -Answer- used to hold medium to heavy-gague needle to apply heavy sutures in deep abdominal area (ex. cardio-thoracic surgery) brown needle holder -Answer- used for small-gague needles to apply sutures in superficial tissue retractor -Answer- used to pull aside tissue in order to provide the best exposure possible while inflicting a minimum amount of trauma to the surrounding tissue Richardson retractor -Answer- for abdominal surgeries, used to retract broad tissuesuch as subcutaneous tissue senn retractor -Answer- to maintain exposure in small areas such as carpal tunnel surgery malleable retractor -Answer- flat metal ribbons that may be bent/shaped by surgeon atthe field, used to protect soft tissue and aid in blunt retraction of bowel and malleable retraction of soft tissue around bone volkmann retractor -Answer- handheld rake retractor generally used in pairs to retractsuperficial tissue

army navy retractor -Answer- for shallow incision, generally used in pairs balfour retractor -Answer- used to hold abdominal wall open during abdominal surgery o'connor retractor (o'sullivan) -Answer- used to hold abdominal wall open duringabdominal surgery, consists of spreader and various sized blades

weitlaner retractor -Answer- to maintain wound exposure during repair of inguinal hernia jansen retractor -Answer- may be used for biopsy or removal of a small tissue mass dermatome -Answer- cuts layers of skin for grafts, blade cuts predetermined thicknessof skin adjusted by calibration of handpiece craniotome -Answer- special type of power tool used to enter skull for craniotomy phaco -Answer- ultrasonic tool that breaks up and aspirates lens in cataract surgery drills -Answer- used in orthopedic and podiatry to cut through bones, drill screw holes,and clean out bone marrow sternal -Answer- designed to cut through sternum for cardiac or thoracic surgery bone reamer/tissue shaver -Answer- used in ortho for knee/hip/shoulder/foot surgery dissector -Answer- used in general surgery (can be powered, ligating, irrigating) Identify 3 basic guidelines for handling powered instrumentsa) always have safety on when passing to surgeon b) always use with drill guard in placec) always soak before cleaning d) always have irrigation ready e) clean cords with moistened sponge Answer- ab d 3 phases of wound healing -Answerinflammationproliferation remodeling Inflammation phase -Answerhemostasisphagocytosis edema

proliferation phase -Answerepithelializationneovascularization collagen synthesis contraction remodeling phase -Answer- collagen remodeling tensile strength hemostasis (inflammation phase) -Answer- begins 0-2 hrs,

vasoconstriction, platelets aggregate to form clot, erythrocytes and leukocytes appear tostart infiltration Phagocytosis (inflammation phase) -Answer- 0-4 days, neutrophils and macrophages appear to digest and dispose of pathogens and debris, wound appears red and swollen Edema (inflammation phase) -Answer- 0-6 days, starts within minutes of injury, capillarywalls become permeable to plasma, plasma leaks into wound --> edema Epithelialization (proliferation phase) -Answer- 1-4 days, fibroblasts migrate towardwound site in first 12-72 hours, keratinocytes begin formation of scab neovascularization (proliferation phase) -Answer- 2-7 days, when granulation tissue isformed, new vessels form and endothelial cells are replenished, red beefy granular appearance, most wound disruptions happen here! collagen synthesis (proliferation phase) -Answer- 2-22 days, fibroblasts synthesiscollagen molecules, the basic protein substance of connective tissue contraction (proliferation phase) -Answer- 2-20 days, contraction caused by fibroblaststransforming into myofibroblasts--> help strengthen wound and close any remaining deficit collagen remodeling (remodeling phase) -Answer- fibers weave into more organizedpattern determined by stress demand of wound tensile strength gain (remodeling phase) -Answer- over years, scar tissue remodels asfibroblasts disappear from wound only 80% of original strength can be regained Correct order of events wound healing -Answer*Inflammation*1) hemostasis 2) phagocytosis 3) edema *Proliferation* 4) epithelialization 5) neovascularization 6) collagen synthesis 7) contraction *Remodeling*

8) collagen remodeling

8) tensile strength 3 ways a wound heals -Answer- 1) primary union/first intention2) granulation/second intention 3) delayed primary closure/third intention

Primary intention healing -Answer- ideal condition, clean incision sutured or stapled, minimal tissue damage heals fastest, minimal scar, minimal dead space, no post opcomplications example: surgical incision, simple laceration Granulation/second intention healing -Answer- more complicated and longer, failed primary union, infection, excessive trauma, tissue loss, imprecise approximation, mayrequire graft, wound left open to heal from inside out, granulation tissue forms and closes it by contraction ex. infected wound, drain, trauma, tissue loss third intention healing -Answer- safest method for contaminated, dirty, infected traumaticwound w. extensive tissue loss and high infection risk, debridement allows check for infection and removal of nonviable tissue, delayed suturing, open to monitor infection, gauze packed ex. compartment syndrome, burns, debridement, wound disruption, excessive trauma Tensile Strength (wound) -Answer- ability of healed wound to withstand the stresses ofnormal activity, will reach only 80% of original intact tissue wound class I -Answer- clean ex. thyroidectomy, mastectomy, ganglion excision, hemiorrhaphy, laminectomy wound class II -Answer- clean contaminated ex. cholecystectomy, hysterectomy, c section, colon resection, tracheostomy, appy, cystoscopy wound class III -Answer- contaminated ex. inflamed but unruptured appendix/gallbladder, open fracture, penetrating wound, unsterile instrument wound class IV -Answer- dirty or infected ex. perforated viscera, infected wound, abscess Factors that affect wound healing -Answer- 1) preoperative factors/general systemicfactors 2) intraoperative wound factors Preoperative wound factors -Answer- inadequate

nutritionphysical condition meds age preop skin prep preop stress existing infection

intraop wound factors -Answer- length of surgerylocation of wound complications foreign body in wound elimination of dead spaceunplanned hypothermia Nutritional deficiencies that affect wound healing -Answerproteincarbs fat vitamin a vitamin b vitamin czinc Meds that impair wound healing -Answersteroidsanticoagulants chemo radiatio n Protein (wound healing) -Answer- improves tissue integrity and collagen synthesis,deficiency increases risk of evisceration carbs and fat (wound healing) -Answer- energy source, prevent oxidation of amino acids vitamin a (wound healing) -Answer- accelerates healing of skin incision, collagen production, and resistance to infection, deficiency decreases tensile strength vitamin b (wound healing) -Answer- necessary for carb metabolism vitamin c (wound healing) -Answer- supports collagen formation, increases capillaryformation zinc -Answer- necessary for collagen synthesis and tissue repair

steroids (wound healing) -Answer- suppress inflamm response, delay contraction andcollagen synthesis, chronic use decreases tensile strength, pt will have debilitated immune response anticoagulant (wound healing) -Answer- should be stopped 2-7 days before surgery chemo (wound healing) -Answer- inhibit protein synthesis thus delaying wound repair radiation (wound healing) -Answer- large dose decreases blood supply to area, mayaffect healing and produce excess scarring

Identify the nutritional component that supports collagen formation and increasescapillary formation a) vitamin a b) vitamin b c) vitamin cd) zinc e) protein -Answer- c Passive/mechanical hemostatic agent (wound healing) -Answer- applied at bleeding siteand provide barrier to stop blood flow (incl. collagens, cellulose, gelatins, polysaccharide spheres) active hemostatic agent (wound healing) -Answer- contain thrombin and products mixedwith thrombin, enhance clotting at bleeding site ex. thrombin flowable hemostatic agent (wound healing) -Answer- combo of passive and active agent, mechanically obstruct blood flow and convert fibrinogen into fibrin at bleeding siteex. floseal, surgiflo fibrin sealants (wound healing) -Answer- promote clotting by increasing amount of fibrinogen and thrombin at bleeding site ex. tisseel, tachosil, vitgel, coseal, duraseal, progel, bioglue, omnex Collagen agent (mechanical hemostasis) -Answer- avitene, ultrafoam, helistat, helitene,instat Cellulose agent (mechanical hemostasis) -Answer- surgicel, nu-knit gelatin agent (mechanical hemostasis) -Answer- gelfoam, surgifoam polysaccharide sphere (mechanical hemostasis) -Answer- aristak, hemotase, vitsure Identify the proper sequence of events in the body's defense mechanism Answer-hemostasis --> cleaning up the pathogens --> wound sealing --> regeneration of epidermal covering --> repairing deeper tissue damage Select the intraoperative factors that negatively affect wound

healing:a) surgical complication b) failure to eliminate dead space c) implantation of orthopedic hardwared) incision in area of high mobility e) incision in highly vascular areaf) use of x-ray -Answer- a b

c d Match the topical hemostatic with method of actionAgent: 1) passive 2) flowable 3) fibrin sealant 4) activ e Method : a) enhanced clotting b) mechanical obstructionc) provides barrier d) increase fibrinogen at site -Answer1-c2-b 3-d 4-a Methods of producing hemostasis include which of the following?a) administering blood b) applying pressurec) electrocautery d) irrigating w saline e) antiseptic w alcohol f) topical hemostatic Answer- ab c f Physical configuration (suture) -Answer- monofilament = single strandmultifilament = many strands capillarity (suture) -Answer- ability to soak up fluid along strand diameter (suture) -Answer- distance across given in millimeters knot tensile strength (suture) -Answer- force measured in pounds that strand can

withstand before breaking elasticity (suture) -Answer- ability to regain form and length after being stretched memory (suture) -Answer- tendency of suture to recoil to original shape during packaging, higher memory = less knot security pliability (suture) -Answer- bends easily

coefficient of friction (suture) -Answer- ability to glide thru tissue and retain knot, high tolow Two main types of suture -Answer- 1) absorbablea-surgical gut b-collagen 2) nonabsorbable absorbable sutures -Answer- derived from collagen of healthy animal or synthetic polymer, can be digested, hydrolyzed, and or assimilated by tissue nonabsorbable suture -Answer- derived from natural or synthetic material, no change tosuture during healing, become encapsulated or are removed Two types of absorbable suture -Answer- surgical gutcollagen suture Surgical Gut Suture (absorbable suture) -Answer- obtained from collagen (submucosalayer of small intestine of sheep or serosa of cattle) absorbed <21 days types a and c (plain catgut and chromic gut) Collagen Suture (absorbable suture) -Answer- made from tendons of cattle, chemicallytreated, purified and processed into strands, mostly in ophthalmic surgery Plain Catgut (Type A) -Answer- Ligation of small vessels and to suture subcutaneous fatand tissue under tension while healing Chromic Gut (Type C) -Answer- infected tissues and slow-healing tissue and ligation oflarger vessels, biliary, urinary tracts and muscle and fascia closure Handling Natural Absorbable Suture -Answer- -open over basin -watch splashing into eye -will dry and lose pliability -can quickly immerse in saline NOT SOAK Synthetic Absorbable Suture characteristics -Answer- -dyed or undyed -monofilament or multifilament -inert, nonantigenic and nonpyrogenic

-mild tissue reaction -for ligating and suturing (not approximation) -broken down by hydrolyzation -long lasting 3 wk to 6 month polydioxanone sutures (ex. PDS) -Answer- abdominal and thoracic closure, subcutaneous tissue, and colorectal surgery

polyglyconate sutures (ex maxon) -Answer- soft tissue except cardiovascular, neural,and ophthalmic polyglactin 910 sutures (ex vicryl) -Answer- ophthalmic procedures and when absorption is desired polyglycolic acid sutures (ex dexon) -Answer- peritoneal, fascial, and subcutaneousclosure polyglecaprone sutures (ex. monocryl) -Answer- wound closure, bowel surgery(mucosa), cosmetic closure used in general and plastics synthetic absorbable suture TYPES -Answerpolyglyconatepoliglecaprone polyglactin polyglycolic polydioxanon e NONABSORBABLE sutures -Answer- silk (3 types)surgical cotton linen stainless steel 3 Types of Silk Suture -Answerdermalvirgin surgical Dermal Silk Suture -Answer- strands encased in gelatin/proteinfor skin suture, prevents in-growth Virgin Silk Suture -Answer- natural fibers, for ophthalmic surgery Surgical Silk Suture -Answer- made from silkworm, noncapillary, good for early ambulation and rapid healing GI tract and to close non-infected fascia Surgical Cotton Suture -Answer- weakest nonabsorbable, stronger when wet, for

ligating and suturing (no advantage over silk) Linen Suture -Answer- inferior tensile strength, for GI surgery Stainless Steel Suture -Answer- high tensile strength, closing abdominal wall orsternum, retention sutures, secondary repairs, respiratory tract, ortho, neuro *hard to handle, can cut gloves, DO NOT use when another alloy is present such as titanium

Synthetic Nonabsorbable -Answermonofilamentcoated uncoated Monofilament nylon (ethilon, dermalon) -Answermonofilament nylonmicrosurgery ophthalmic plastic/cosmetic skin closure coated multifilament nylon (surgilon) -Answer- coated multifilament treated w/ silicone, enhances passage thru tissue, similar to silk and uncoated nylon uncoated multifilament nylon (neurolon) -Answer- tightly braided, for all tissue thatmultifilament nonabsorbables are acceptable coated polyester fiber suture -Answer- cardio anastamosis, protheses placement,retains strength ex: silicon (ticron), polybutilate (ethibond), polytetrafluoroethylene (teflon, polydek,tevdek) uncoated polyester fiber suture -Answer- cardio and respiratoryex mersilene and dacron polypropylene (synthetic nonabsorbable suture) -Answer- when infection is present,long healing time ex. prolene, surgilene polybutester (synthetic nonabsorbable) -Answer- flexible and elastic,ex. novafil polyethylene (nonabsorbable synthetic) -Answer- ex. dermalene Conventional Cutting Point Needle -Answer- triangular shape, cutting edge inside curve,for ligaments, nasal/oral cavity, pharynx, skin, tendon small path that heals quickly Reverse Cutting Point Needle -Answer- triangular, cutting edge along body/outercurvature for fascia, ligaments, nasal oral mucosa, skin, tendon sheath

Side cutting point needle -Answer- flat top and bottom, angulated edges, do notpenetrate but rather split layers for ophthalmic trocar cutting point needle -Answer- three cutting edges at tip

used to penetrate tough tissue Taper point needle -Answer- no cutting edge, push tissue aside, for aponeurosis, biliarytract, dura, fascia, GI, muscle, myocardium, nerve, peritoneum, pleura, subcutaneous fat, vessels Taper cut needle -Answer- cutting edge at point only, used for bronchus, calcified tissue, fascia, ligament, nasal cavity, oral cavity, ovary, perichondrium, periosteum,pharynx, tendon, trachea, uterus, vessels blunt point needle -Answer- round blunt tip will not cut tissue, used on organs bc won'tpuncture vessels for dissection of friable tissues (kidney, liver, spleen, uterine cervix ligation) Single armed swaged needle -Answer- one needle swaged to one end of strand double armed swaged needle -Answer- two needles swaged to one strand permanent swaged needle -Answer- must be cut off control release needle -Answer- will release when intentionally pulled (pop off needles) Identify the features of DISPOSABLE instrument sets:a) come pressembled and sterile b) many moving detachable partsc) self-contained and light weight d) supplied w. presterilized staples and disposable cartridges Answer- ac skin stapler -Answer- used to approximate skin edges, single fire mechanism linear stapler -Answer- two straight, double staggered or side by side rows of staples,must be placed simultaneously in the tissue, primarily for alimentary tract and thoracic intraluminal circular stapler -Answer- end to end stapler, double row of staggeredstaples placed in circle, for intraluminal anastamosis of tubular hollow organ

ligating/dividing stapler -Answer- delivers double row of staples and ligates tissue dressing -Answer- transparent, plastic film with adhesive backing that generally coverslength of incision, vented for exudate to escape clips -Answer- used to approximate skin edges, cause more scar than other methodsmay be used when infected, or to secure towel to skin

skin closure strips -Answer- approximate edges of superficial laceration or primaryclosure in conjunction w suture skin adhesive -Answer- combo of liquid monomers form polymers in presence of waterand act as liquid topical adhesive as replacement for suture