AORN PERIOP 101 Exam 3 phases of wound healing - ✔inflammation proliferation remodeling 3 Types of Silk Suture - ✔dermal virgin surgical 3 ways a wound heals - ✔1) primary union/first intention 2) granulation/second intention 3) delayed primary closure/third intention 4 Types of Surgical Instruments - ✔cut clamp grasp retract 5 Rights of Specimen Handling - ✔Right Patient Right date/time Right laboratory test Right surgeon Right specimen absorbable sutures - ✔derived from collagen of healthy animal or synthetic polymer, can be digested, hydrolyzed, and or assimilated by tissue active hemostatic agent (wound healing) - ✔contain thrombin and products mixed with thrombin, enhance clotting at bleeding site ex. thrombin Alcohol prep - ✔acts by denaturing proteins used w other prep DISPERSE FUMES BEFORE DRAPING All the following professionals are qualified to provide anesthesia to a patient EXCEPT: a) anesthesiologist b) CRNA c) anesthesiology assistant d) operating surgeon - ✔d) operating surgeon
allis clamp - ✔used to hold tissue without crushing, devitalizing, or injuring it, has multiple tiny, fine teeth that curve inward and hold tissue gently but firmly used for retracting tissue and grasping fascia, cysts, and knee cartilage Amputated digits and limbs - ✔specimens that are to be reimplanted anticoagulant (wound healing) - ✔should be stopped 2-7 days before surgery Any germicide that is labeled as a hospital disinfectant has passed the potency test for activity against ________________________________________, _________________________________________, and _________________________________________________. - ✔Pseudomonas aeruginosa staphylococcus aureus salmonella choleraesuis Argon Enhanced Coagulation (AEC) - ✔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 *** army navy retractor - ✔for shallow incision, generally used in pairs atracurium - ✔intermediate-acting muscle relaxant atraumatic forcep - ✔used to grasp fine tissue (ex vascular or cardiovascular surgery) ex. debakey Babcock Clamp - ✔curved, fenestrated tips w no teeth, used to grip or enclose delicate structures such as bowel, appendix, urethra, or fallopian tubes, will not penetrate, crush, or traumatize delicate tissue Bacteria common to OR - ✔staphylococci e coli streptococci mrsa pseudomonas serratia marcescens c diff balfour retractor - ✔used to hold abdominal wall open during abdominal surgery 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 debris b) 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 - ✔a) inspect the camera head for smudges and debris c) plug the camera into the CCU and turn on the unit d) complete white balancing of the camera Based on your knowledge of laparoscopic surgery, identify the potential complications related to it: a) pneumonia b) hypoxemia c) hypercarbia d) cardiac dysrhythmia e) hypocarbia f) CO2 embolism - ✔b) hypoxemia c) hypercarbia d) cardiac dysrhythmia f) CO2 embolism bicarbonate (anesthesia) - ✔sometimes added to reduce the acidity of the local anesthetic and speed the onset of the block Biological dressing - ✔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 Biopsy of lesions - ✔FROZEN IMMEDIATE ANALYSIS Biopsy of tumor - ✔FROZEN IMMEDIATE ANALYSIS Biopsy Specimen - ✔specimens that will be microscopically studied by the pathologist and may undergo histologic or cytologic analysis Bipolar Electrosurgery - ✔current flows between the tips of the two-poled instrument blunt point needle - ✔round blunt tip will not cut tissue, used on organs bc won't puncture vessels for dissection of friable tissues (kidney, liver, spleen, uterine cervix ligation) bone marrow biopsy - ✔requires specialized needle that can puncture bone
bone reamer/tissue shaver - ✔used in ortho for knee/hip/shoulder/foot surgery Breast Biopsy - ✔FROZEN IMMEDIATE ANALYSIS breast biopsy - ✔sent to radiology/mammography to ensure entire lesion is obtained may have needle placed prior to surgery to pinpoint lesion brown needle holder - ✔used for small-gague needles to apply sutures in superficial tissue bupivacaine - ✔local anesthetic capacitive coupling - ✔transfer of electrical current from the active electrode through intact insulation to adjacent conductive items (tissue, trocars) capillarity (suture) - ✔ability to soak up fluid along strand carbs and fat (wound healing) - ✔energy source, prevent oxidation of amino acids Cardiac Agents - ✔used to reduce mammary artery spasm, test patency and integrity of graft, and sustain radial artery dilatation Cellulose agent (mechanical hemostasis) - ✔surgicel, nu-knit Characteristics of Antimicrobial Agents - ✔Broad Spectrum High log reduction capability persistent nonirritating nontoxic fast acting Chemical Hemostasis - ✔includes pharmacological agents and topical hemostatic agents chemo (wound healing) - ✔inhibit protein synthesis thus delaying wound repair Chest Tube - ✔conduit for drainage of air, blood, and other fluid from intrapleural or mediastinal space, and reestablishment of negative pressure in intrapleural space chisel - ✔used to sculpt bone, has beveled edge Chlorhexidine Gluconate (CHG) - ✔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 Chromic Gut (Type C) - ✔infected tissues and slow-healing tissue and ligation of larger vessels, biliary, urinary tracts and muscle and fascia closure cisatracurium - ✔intermediate-acting muscle relaxant clamp - ✔used to hold, join, or compress parts together clips - ✔used to approximate skin edges, cause more scar than other methods may be used when infected, or to secure towel to skin 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 - ✔b) is inexpensive c) suppressed combustion d) is rapidly eliminated from the body coated multifilament nylon (surgilon) - ✔coated multifilament treated w/ silicone, enhances passage thru tissue, similar to silk and uncoated nylon coated polyester fiber suture - ✔cardio anastamosis, protheses placement, retains strength ex: silicon (ticron), polybutilate (ethibond), polytetrafluoroethylene (teflon, polydek, tevdek) coefficient of friction (suture) - ✔ability to glide thru tissue and retain knot, high to low Collagen agent (mechanical hemostasis) - ✔avitene, ultrafoam, helistat, helitene, instat collagen remodeling (remodeling phase) - ✔fibers weave into more organized pattern determined by stress demand of wound Collagen Sponge (collastat, superstat, helistat) - ✔dehydrated hemostatic sponge or foam, dissolves as hemostasis occurs, do not use in infection or pooled blood Collagen Suture (absorbable suture) - ✔made from tendons of cattle, chemically treated, purified and processed into strands, mostly in ophthalmic surgery
collagen synthesis (proliferation phase) - ✔2-22 days, fibroblasts synthesis collagen molecules, the basic protein substance of connective tissue collier needle holder - ✔holds medium-gague needle Complications of MH - ✔it can lead to cardiac arrest, brain damage, organ failure, and death Components of the electrosurgical circuit include a) active electrode, dispersive electrode, generator b) dispersive electrode, fiber, generator c) active electrode, dispersive electrode, generator, scratch pad d) dispersive electrode, fiber, generator, key - ✔a contraction (proliferation phase) - ✔2-20 days, contraction caused by fibroblasts transforming into myofibroblasts--> help strengthen wound and close any remaining deficit control release needle - ✔will release when intentionally pulled (pop off needles) Conventional Cutting Point Needle - ✔triangular shape, cutting edge inside curve, for ligaments, nasal/oral cavity, pharynx, skin, tendon small path that heals quickly Correct order of events wound healing - ✔*Inflammation* 1) hemostasis 2) phagocytosis 3) edema *Proliferation* 4) epithelialization 5) neovascularization 6) collagen synthesis 7) contraction *Remodeling* 8) collagen remodeling 8) tensile strength craniotome - ✔special type of power tool used to enter skull for craniotomy Creutzfeldt-Jakob disease - ✔a rare but progressive fatal disease caused by prions crile clamp - ✔used to control bleeding in subcutaneous tissue, can be straight or curved Culture Specimens - ✔specimens of tissue or fluid suspected of being infected
currette - ✔used to remove soft tissue or bone by scraping with the sharp edge of the cup, loop, ring, or scoop curved mayo scissor - ✔used to cut heavy or tough tissue such as fascia cytology - ✔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 Cytology Specimens - ✔specimens obtained for studying cell biology Dantrolene - ✔drug used to treat MH Depending on state laws and hospital policies, which of the following can be performed without a professional anesthesia provider? a) general anesthesia b) regional anesthesia c) monitored anesthesia care d) moderate sedation - ✔d) moderate sedation Dermal Silk Suture - ✔strands encased in gelatin/protein for skin suture, prevents in-growth dermatome - ✔cuts layers of skin for grafts, blade cuts predetermined thickness of skin adjusted by calibration of handpiece desflurane - ✔used for inhalation maintenance diameter (suture) - ✔distance across given in millimeters dissector - ✔used in general surgery (can be powered, ligating, irrigating) double armed swaged needle - ✔two needles swaged to one strand dressing - ✔transparent, plastic film with adhesive backing that generally covers length of incision, vented for exudate to escape drills - ✔used in orthopedic and podiatry to cut through bones, drill screw holes, and clean out bone marrow
During IV regional anesthesia the tourniquet should be deflated slowly to prevent which of the following from entering the bloodstream? a) bacteria b) lymphatic fluids c) thrombus d) bolus of anestheitc - ✔d) bolus of anesthetic Edema (inflammation phase) - ✔0-6 days, starts within minutes of injury, capillary walls become permeable to plasma, plasma leaks into wound --> edema edrophonium - ✔reversal for muscle relaxant (except succinylcholine) elasticity (suture) - ✔ability to regain form and length after being stretched Endogenous source of infection - ✔surgical personnel, OR environment, tools, instruments, supplies, pt's own skin endoscope - ✔a tube inserted into a natural body orifice or through a small incision to access internal organ structures, can be flexible, rigid, or semirigid endoscopy - ✔examination by means of an endoscope Epidural Anesthesia - ✔the anesthesia care provider finds the space between the ligamentum 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 epinephrine (anesthesia) - ✔added to increase density and duration of a regional block Epithelialization (proliferation phase) - ✔1-4 days, fibroblasts migrate toward wound site in first 12-72 hours, keratinocytes begin formation of scab etomidate - ✔IV induction agent excisional biopsy - ✔an entire section of tissue is sent for examination Exogenous source of infection - ✔aerobes in OR Explanted Medical Devices - ✔specimens may be sent to pathology for gross examination Factors that affect wound healing - ✔1) preoperative factors/general systemic factors 2) intraoperative wound factors
Fibrin Sealant (tisseal, crosseal, floseal) - ✔type of tissue adhesive derived from human and animal blood product, forms stable clot, used to control bleeding and speed healing, seal hollow organ, cover hole, slow release of med, do NOT use w allergy to bovine protein fibrin sealants (wound healing) - ✔promote clotting by increasing amount of fibrinogen and thrombin at bleeding site ex. tisseel, tachosil, vitgel, coseal, duraseal, progel, bioglue, omnex flexible endoscope - ✔includes cystoscope, laparoscope, sinuscope, arthroscope, and hysteroscope flowable hemostatic agent (wound healing) - ✔combo of passive and active agent, mechanically obstruct blood flow and convert fibrinogen into fibrin at bleeding site ex. floseal, surgiflo flumazenil - ✔reversal agent for benzos (midazolam) Forensic Specimen (debris) - ✔(ex. glass, paint chip, splinter, animal teeth) collect and place in paper envelope Forensic Specimen (fabric/clothing) - ✔keep as intact as possible, air dry if possible, place on paper, paper between layers, separate bags Forensic Specimen (fingernail) - ✔place in paper envelope Forensic Specimen (fluid) - ✔collect in tube or specimen container, swab around wounds, absorb on clean cotton, air dry, paper envelope Forensic Specimen (foreign object) - ✔(ex. bullet, fragment, pellet, knife) rubber tipped clamps, latex gloves, do not mark, no metal basin Forensic Specimen (hair and fiber) - ✔collect and place in separate paper envelope Forensic Specimens - ✔physical evidence retrieved from a person involved as a suspect or victim in a crime Frozen Section Specimen - ✔specimen that require immediate examination by the pathologist fungi common to OR - ✔aspergillus Gauze dressing - ✔protect wound, absorb fluid (impregnated: vaseline, xeroform) (nonimpregnated: adaptic, telfa, nu-gauze, 4x4, ABD)
gelatin agent (mechanical hemostasis) - ✔gelfoam, surgifoam General Anesthesia - ✔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 Granulation/second intention healing - ✔more complicated and longer, failed primary union, infection, excessive trauma, tissue loss, imprecise approximation, may require graft, wound left open to heal from inside out, granulation tissue forms and closes it by contraction ex. infected wound, drain, trauma, tissue loss Gross Examination Specimens - ✔specimens that will only receive a macroscopic visual inspection with the naked eye Handling Natural Absorbable Suture - ✔-open over basin -watch splashing into eye -will dry and lose pliability -can quickly immerse in saline NOT SOAK Hemostasis - ✔1) the stoppage of bleeding or hemorrhage 2) the stoppage of blood flow through a blood vessel or body part 3) the stagnation of blood hemostasis (inflammation phase) - ✔begins 0-2 hrs, vasoconstriction, platelets aggregate to form clot, erythrocytes and leukocytes appear to start infiltration hemostat - ✔used to grasp bleeding vessels Hemovac - ✔orthopedic HIV - ✔only survives in blood and body fluids that contain white blood cells, fragile and easily destroyed outside the body Hormonal Agent - ✔stimulate smooth muscle How can the perioperative nurse assist the anesthesia provider with placement of a spinal or epidural block? a) inject local anesthetic b) thread the catheter through the needle c) calm the patient d) identify landmarks for insertion of the needle - ✔c) calm the patient
Hydrogel dressing - ✔hydrate and soothe tissue (tegagel, nu-gel, vigilon, karaya, collonplast) Hypothermia - ✔a core body temperature <36c (<96.8F) Identify 3 basic guidelines for handling powered instruments a) always have safety on when passing to surgeon b) always use with drill guard in place c) always soak before cleaning d) always have irrigation ready e) clean cords with moistened sponge - ✔a b d Identify activities that may be handled by EVS a) preliminary room prep b) damp dusting/mopping c) end-of-procedure clean d) terminal clean - ✔C D Identify one characteristic difference between laparoscopic instruments and those used in open procedures: a) all laparoscopic scissors are "take apart" b) laparoscopic instruments have long, thin shafts to accommodate trocar cannulas c) one cannot dissect tissue with laparoscopic instruments d) all laparoscopic instruments are disposable - ✔b) laparoscopic instruments have long, thin shafts to accommodate trocar cannulas 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 - ✔a) put the camera head in a sterile pouch b) gas-sterilize the camera head Identify the active warming devices a) circulating water garments b) cotton blankets c) forced-air warming devices d) increased ambient room temperature e) surgical drapes d) warmed IV fluids - ✔a) circulating water garments c) forced-air warming devices
d) increased ambient room temperature f) warmed IV fluids Identify the additional assessments that should be made by the perioperative nurse before an endoscopic surgery: a) history of thermal burns b) history of DVT c) consent for open surgery d) history of anaphylactic reaction e) history of previous incisions f) types of instruments used in surgery - ✔b) history of DVT c) consent for open surgery e) history of previous incision Identify the best practices to follow when performing environmental sanitation a) when cleaning spills of blood or any other potentially infectious material, use gloves and any other PPE appropriate to the task b) visibly soiled OR equipment, furniture, and floors should be cleaned with a hospitalgrade germicide c) infectious waste should be segregated from noninfectious waste in the general waste stream d) color coded or labeled bags should be used to facilitate separation of the various wastes - ✔a b c d Identify the features of DISPOSABLE instrument sets: a) come pressembled and sterile b) many moving detachable parts c) self-contained and light weight d) supplied w. presterilized staples and disposable cartridges - ✔a c Identify the instruments that can be used in laparoscopic surgery a) babcocks forceps b) mosquitoes forceps c) needle holder forceps d) dissector forceps - ✔a) babcocks forceps c) needle holder forceps d) dissector forceps Identify the nutritional component that supports collagen formation and increases capillary formation a) vitamin a b) vitamin b
c) vitamin c d) zinc e) protein - ✔c Identify the proper sequence of events in the body's defense mechanism - ✔hemostasis --> cleaning up the pathogens --> wound sealing --> regeneration of epidermal covering --> repairing deeper tissue damage Incisional Biopsy - ✔A small portion of tissue is incised and sent for examination increased end-tidal CO2 - ✔most specific sign of MH Inflammation phase - ✔hemostasis phagocytosis edema intraluminal circular stapler - ✔end to end stapler, double row of staggered staples placed in circle, for intraluminal anastamosis of tubular hollow organ intraop wound factors - ✔length of surgery location of wound complications foreign body in wound elimination of dead space unplanned hypothermia Iris scissor/castroviejo scissor - ✔scissor used in ophthalmic or reconstructive procedure isoflurane - ✔used for inhalation maintenance IV induction agent - ✔ketamine IV regional anesthesia (Bier Block) - ✔used for procedures on hand, wrist, or forearm (double tourniquet method) jansen retractor - ✔may be used for biopsy or removal of a small tissue mass JP drain - ✔Used to drain fluid or blood after abdominal, urologic, thoracic, and head and neck procedures abdominal or breast surgery
kelly / peon clamp - ✔used to control bleed in muscle tissue, hold kitner sponges, and pass drains, straight or curved knife / scalpel - ✔used to make incision and for tissue dissection knot tensile strength (suture) - ✔force measured in pounds that strand can withstand before breaking Kocher clamp (ochsner) - ✔transverse serration and 1'' by 2'' teeth, to grasp heavy, tough, slippery tissue such as fascia, bone, cartilage, uterine broad ligaments Laparoscopic instruments with small, blunt tips are used for: a) cutting tissue b) dissecting tissue c) grasping tissue d) moving tissue from one place to other - ✔b) dissecting tissue laparoscopy - ✔examination of the abdominal cavity or performance of a minor abdominal surgery using a laparoscope lidocaine - ✔local anesthetic ligating/dividing stapler - ✔delivers double row of staples and ligates tissue linear stapler - ✔two straight, double staggered or side by side rows of staples, must be placed simultaneously in the tissue, primarily for alimentary tract and thoracic Linen Suture - ✔inferior tensile strength, for GI surgery Local Anesthesia - ✔The infiltration or topical administration of agents to anesthetize a part of the body. It is typically used for minor procedures, does not involve an anesthesia provider, and does not involve sedation. A perioperative nurse monitors the patient and provides supportive care if needed. Local Anesthetic System Toxicity (LAST) - ✔can occur if unsafe amount of local anesthetic 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 Lymph nodes - ✔may be frozen for diagnostic purposes Malignant Hyperthermia (MH) - ✔a rare but potentially life-threatening complication of anesthesia, triggered by inhaled general anesthetic agents and the muscle relaxant succinylcholine
malleable retractor - ✔flat metal ribbons that may be bent/shaped by surgeon at the field, used to protect soft tissue and aid in blunt retraction of bowel and malleable retraction of soft tissue around bone Match the topical hemostatic with method of action Agent: 1) passive 2) flowable 3) fibrin sealant 4) active Method: a) enhanced clotting b) mechanical obstruction c) provides barrier d) increase fibrinogen at site - ✔1-c 2-b 3-d 4-a mayo (mayo-hegar) needle holder - ✔used to hold medium to heavy-gague needle to apply heavy sutures in deep abdominal area (ex. cardio-thoracic surgery) Mechanical Hemostasis - ✔achieved by occluding severed vessels until platelet formation occurs Meds that impair wound healing - ✔steroids anticoagulants chemo radiation memory (suture) - ✔tendency of suture to recoil to original shape during packaging, higher memory = less knot security Metal Halide Light Source - ✔emits continuous blue light, cheaper but less bright than xenon light source Methods of producing hemostasis include which of the following? a) administering blood b) applying pressure c) electrocautery d) irrigating w saline e) antiseptic w alcohol f) topical hemostatic - ✔a b
c f methohexitol - ✔IV induction agent metzenbaum scissor - ✔used for intra-abdominal tissue dissection (delicate) Microfibrillar collagen (avitene) - ✔absorbable topical agent applied directly to bleeding source with dry, smooth forceps do NOT USE WITH: sensitivity to bovine collagen, skin closure, methyl methacrylate, contaminated wound, cell saver Moderate Sedation - ✔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 Monitored Anesthesia Care (MAC) - ✔when an anesthesia provider monitors the patient, administers sedatives and other agents as needed, and provides medical services as needed Monofilament nylon (ethilon, dermalon) - ✔monofilament nylon microsurgery ophthalmic plastic/cosmetic skin closure Monopolar Electrosurgery - ✔uses dispersive electrode to remove current from patient in fluid filled cavity must be used with isotonic fluid ex. dextran 10, dextran 70, glycine 1.5%, sorbitol, mannitol near head/neck fire risk mosquito clamp - ✔used for superficial bleeding, delicate plastic or hand tissue, can be straight or curved MRSA - ✔one of the hardiest bacteria and most difficult to treat muscle biopsy - ✔requires special forcep that are applied to muscle before removal to keep it stretched during processing naloxone - ✔reversal agent for narcotics (fentanyl) Needle Aspiration - ✔a fine gauge needle and syringe are used to aspirate an area of abnormal appearing tissue or body fluid
neostigmine - ✔reversal for muscle relaxant (except succinylcholine) neovascularization (proliferation phase) - ✔2-7 days, when granulation tissue is formed, new vessels form and endothelial cells are replenished, red beefy granular appearance, most wound disruptions happen here! nonabsorbable suture - ✔derived from natural or synthetic material, no change to suture during healing, become encapsulated or are removed NONABSORBABLE sutures - ✔silk (3 types) surgical cotton linen stainless steel Nutritional deficiencies that affect wound healing - ✔protein carbs fat vitamin a vitamin b vitamin c zinc o'connor retractor (o'sullivan) - ✔used to hold abdominal wall open during abdominal surgery, consists of spreader and various sized blades occluding clamp - ✔used to clamp bowel, ducts, vessels, and other tissue that has a lumen, usually have vertical serrations or special jaws ex: kocher, oshsner, curved hemostat Occlusive dressing - ✔prevent drying of wound, increase proliferation of epithelial cells bioclusive, dermicell, duoderm hydrocolloids, opsite, dermagel, tagaderm, vasoline gauze, xeroform Of the following, which is not used to secure airway: a) ET tube b) LMA c) nasal cannula d) oral airway - ✔c) nasal cannula operative endoscope - ✔channeled scopes that provide the ability to irrigate, suction, insert, and connect a variety of accessories Organ Donation - ✔"organ" specimens obtained from a living donor or a cadaver
osteotome - ✔used to shape or mark bone, may remove periosteum from bone Otic Agents - ✔anesthetize, stop or slow bleeding, irrigate, anti-infective Oxidized Cellulose (nuknit, surgicell) - ✔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 pancuronium - ✔long-acting muscle relaxant Passive/mechanical hemostatic agent (wound healing) - ✔applied at bleeding site and provide barrier to stop blood flow (incl. collagens, cellulose, gelatins, polysaccharide spheres) PCMX - ✔chloroxylenol, cocamidopropyl PG dimonium chloride phosphate cationic phenolic mixture safe for mucus membranes Penrose Drain - ✔Usually placed in a "stab" wound that is made adjacent to the main incision or may be placed near an intestinal anastomosis abdominal surgery, peritoneal cavity or skin wound permanent swaged needle - ✔must be cut off phaco - ✔ultrasonic tool that breaks up and aspirates lens in cataract surgery Phagocytosis (inflammation phase) - ✔0-4 days, neutrophils and macrophages appear to digest and dispose of pathogens and debris, wound appears red and swollen Physical configuration (suture) - ✔monofilament = single strand multifilament = many strands Plain Catgut (Type A) - ✔Ligation of small vessels and to suture subcutaneous fat and tissue under tension while healing pliability (suture) - ✔bends easily Pneumoperitoneum - ✔air or gas introduced into the body cavity as a distention medium (ex. carbon dioxide, nitrous oxide, helium) polybutester (synthetic nonabsorbable) - ✔flexible and elastic, ex. novafil
polydioxanone sutures (ex. PDS) - ✔abdominal and thoracic closure, subcutaneous tissue, and colorectal surgery polyethylene (nonabsorbable synthetic) - ✔ex. dermalene polyglactin 910 sutures (ex vicryl) - ✔ophthalmic procedures and when absorption is desired polyglecaprone sutures (ex. monocryl) - ✔wound closure, bowel surgery (mucosa), cosmetic closure used in general and plastics polyglycolic acid sutures (ex dexon) - ✔peritoneal, fascial, and subcutaneous closure polyglyconate sutures (ex maxon) - ✔soft tissue except cardiovascular, neural, and ophthalmic polypropylene (synthetic nonabsorbable suture) - ✔when infection is present, long healing time ex. prolene, surgilene polysaccharide sphere (mechanical hemostasis) - ✔aristak, hemotase, vitsure Post Procedure Clean - ✔purpose is to break cycle of contamination from pt to environment to staff to subsequent patient Povidone Iodine - ✔Scrub (with detergent) Paint (without detergent) Iodophors are safe for mucus membrane use Preoperative wound factors - ✔inadequate nutrition physical condition meds age preop skin prep preop stress existing infection Pressure dressing - ✔minimize intracellular fluid, eliminate dead space, distribute pressure evenly fluffed gauze, non-radiopaque and gauze covered pads
Primary intention healing - ✔ideal condition, clean incision sutured or stapled, minimal tissue damage heals fastest, minimal scar, minimal dead space, no post op complications example: surgical incision, simple laceration proliferation phase - ✔epithelialization neovascularization collagen synthesis contraction Propofol - ✔IV induction agent Protein (wound healing) - ✔improves tissue integrity and collagen synthesis, deficiency increases risk of evisceration radiation (wound healing) - ✔large dose decreases blood supply to area, may affect healing and produce excess scarring rasp - ✔are used to smooth rough bone surfaces or to evacuate medullary canals in prep for insertion of orthopedic prostheses Reasons to avoid using radiopaque sponges in dressing - ✔1) possible invalidation of subsequent count if returns to OR with dressing 2) may appear as foreign body on post op x ray Rectal biopsy for ganglion cells - ✔FROZEN IMMEDIATE ANALYSIS Regional Anesthesia - ✔an injection of local anesthetics near nerve fibers to cause reversible loss of sensation over an area of the body, common examples include spinal, epidural, and peripheral nerve blocks remodeling phase - ✔collagen remodeling tensile strength Require special handling to preserve cells - ✔nerve muscle bone marrow testicular biopsies retractor - ✔used to pull aside tissue in order to provide the best exposure possible while inflicting a minimum amount of trauma to the surrounding tissue Reversal agent for succinylcholine - ✔none!
Reverse Cutting Point Needle - ✔triangular, cutting edge along body/outer curvature for fascia, ligaments, nasal oral mucosa, skin, tendon sheath Richardson retractor - ✔for abdominal surgeries, used to retract broad tissue such as subcutaneous tissue Rigid support dressing - ✔immobilize cast, splint rocuronium - ✔intermediate-acting muscle relaxant rongeur - ✔biting instrument used for cutting tough bone or tissue, often used on bones or heavy ligaments ropivacaine - ✔local anesthetic Routine Specimen - ✔specimen that does not require immediate processing by the pathologist saw - ✔any notched blade used for cutting bone Sedation can be used with any of the following types of anesthesia except: a) regional anesthesia b) monitored anesthesia care c) general anesthesia d) local anesthesia - ✔d) local anesthesia Select the correct statements about spray bottles a) spray bottles can aerosolize potentially infectious materials b) spray bottles are occasionally used to apply disinfectant c) spray bottles are not used to apply disinfectant d) spray bottles are an easy way to clean the environment - ✔a c Select the intraoperative factors that negatively affect wound healing: a) surgical complication b) failure to eliminate dead space c) implantation of orthopedic hardware d) incision in area of high mobility e) incision in highly vascular area f) use of x-ray - ✔a b c d
semi-rigid endoscope - ✔includes a deflectable-tip video laparoscope that will allow movement through the tip to allow a complete view from a variety of different angles senn retractor - ✔to maintain exposure in small areas such as carpal tunnel surgery sevoflurane with or without nitric oxide - ✔inhaled induction agent Side cutting point needle - ✔flat top and bottom, angulated edges, do not penetrate but rather split layers for ophthalmic Side effects of diagnostic imaging agents - ✔cell sickling renal failure Single armed swaged needle - ✔one needle swaged to one end of strand skin adhesive - ✔combo of liquid monomers form polymers in presence of water and act as liquid topical adhesive as replacement for suture skin closure strips - ✔approximate edges of superficial laceration or primary closure in conjunction w suture skin stapler - ✔used to approximate skin edges, single fire mechanism Slide Specimens - ✔specimens of tissue or fluid that is smeared on a slide for microscopic examination smooth forcep - ✔simple serration and smooth tapered point for holding delicate tissue and vessels ex. smooth adson, cushing, bayonet Spinal Anesthesia - ✔the subarachnoid space is entered and local anesthetic is injected directly into the spinal canal, pt sitting or lateral Sponge counts are done for all the following reasons EXCEPT a) account for used sponges b) prevent injury by retained foreign object c) bc state law requires specific count procedure - ✔C sponge forcep - ✔w. ring shaped jaw, used to hold gauze sponges, can be used for skin prep, retracting tissue, absorbing blood, soft tissue dissection ex. fletcher sponge forcep, forester sponge forcep, sponge stick
Stainless Steel Suture - ✔high tensile strength, closing abdominal wall or sternum, 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 sternal - ✔designed to cut through sternum for cardiac or thoracic surgery steroids (wound healing) - ✔suppress inflamm response, delay contraction and collagen synthesis, chronic use decreases tensile strength, pt will have debilitated immune response straight scissors - ✔used for cutting suture Styptic (epi, tannic acid, silver nitrate) - ✔chemicals that cause vasoconstriction Succinylcholine - ✔short-acting muscle relaxant Suction Drain - ✔to drain accumulated blood and fluid from operative site sugammadex - ✔reversal agent for rocuronium, vecuronium, and pancuronium Surgical Cotton Suture - ✔weakest nonabsorbable, stronger when wet, for ligating and suturing (no advantage over silk) Surgical Gut Suture (absorbable suture) - ✔obtained from collagen (submucosa layer of small intestine of sheep or serosa of cattle) absorbed <21 days types a and c (plain catgut and chromic gut) Surgical Silk Suture - ✔made from silkworm, noncapillary, good for early ambulation and rapid healing GI tract and to close non-infected fascia Symptoms of LAST - ✔-ringing in ears -tingling lips -metallic taste in mouth -dizziness Synthetic Absorbable Suture characteristics - ✔-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
synthetic absorbable suture TYPES - ✔polyglyconate poliglecaprone polyglactin polyglycolic polydioxanone Synthetic Nonabsorbable - ✔monofilament coated uncoated T Tube - ✔inserted into biliary tract to allow for drainage of bile, left for 10 days or more to develop tract through which bile can drain after removing tube Taper cut needle - ✔cutting edge at point only, used for bronchus, calcified tissue, fascia, ligament, nasal cavity, oral cavity, ovary, perichondrium, periosteum, pharynx, tendon, trachea, uterus, vessels Taper point needle - ✔no cutting edge, push tissue aside, for aponeurosis, biliary tract, dura, fascia, GI, muscle, myocardium, nerve, peritoneum, pleura, subcutaneous fat, vessels tenacula - ✔usually penetrates tissue and is used to retract or pull tissue into position for dissecting Tensile Strength (wound) - ✔ability of healed wound to withstand the stresses of normal activity, will reach only 80% of original intact tissue tensile strength gain (remodeling phase) - ✔over years, scar tissue remodels as fibroblasts disappear from wound only 80% of original strength can be regained Terminal Clean - ✔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 tetracaine - ✔for long-acting spinal anesthesia The perioperative team should know the location of equipment stored in the OR and in the department. Equipment that the anesthesia provider may request includes: a) video laryngoscopy devices b) fiberoptic bronchoscopes c) suction tips and devices d) all of the above - ✔d) all of the above
The phases of general anesthesia, in order, are: a) induction, maintenance, emergence b) emergence, maintenance, induction c) maintenance, emergence, induction d) induction, emergence, maintenance - ✔a) induction, maintenance, emergence 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 - ✔b) be competent in the use of emergency resuscitation procedures Thermal Hemostasis - ✔application of extreme cold or heat to body tissues third intention healing - ✔safest method for contaminated, dirty, infected traumatic wound 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 Thrombin - ✔extracted from dried beef blood, topical agent, accelerates coagulation and controls capillary bleeding, often used w/ gelatin sponge, should be used immediately Tissue forcep - ✔with teeth and long jaws, used when firm grip is needed, ex. tough skin, fascia, cartilage ex. adson, russian total iv anesthesia (TIVA) - ✔a technique for maintaining anesthesia using infusions of short-acting IV agents without inhalation anesthetics. Propofol and remifentanil are often used for TIVA. towel forcep - ✔used to attach and secure drape material can be perforating or nonperforating trephine - ✔used to cut bone from skull, has circular, sharpened edge trocar cutting point needle - ✔three cutting edges at tip used to penetrate tough tissue Tuberculocidals are a special class of disinfectants. In order to be labeled 'tuberculocidal', products need to have demonstrated potency against: a) Pseudomonas b) Staphylococcus c) Mycobacteria d) Salmonella - ✔C
Two main types of suture - ✔1) absorbable a-surgical gut b-collagen 2) nonabsorbable Two types of absorbable suture - ✔surgical gut collagen suture Ultrasonic Electrosurgery - ✔Converts electrical energy into mechanical energy uncoated multifilament nylon (neurolon) - ✔tightly braided, for all tissue that multifilament nonabsorbables are acceptable uncoated polyester fiber suture - ✔cardio and respiratory ex mersilene and dacron Vaginal Preps - ✔povidone-iodine scrub and paint or chloroxylenol 3% vecuronium - ✔intermediate-acting muscle relaxant Verres needle (blunt tipped trocar) - ✔used to deliver CO2 into the peritoneal cavity, creates working space Virgin Silk Suture - ✔natural fibers, for ophthalmic surgery viruses common to OR - ✔hep B and C HIV vitamin a (wound healing) - ✔accelerates healing of skin incision, collagen production, and resistance to infection, deficiency decreases tensile strength vitamin b (wound healing) - ✔necessary for carb metabolism vitamin c (wound healing) - ✔supports collagen formation, increases capillary formation volkmann retractor - ✔handheld rake retractor generally used in pairs to retract superficial tissue VRE (vancomycin-resistant enterococcus) - ✔usually spread by the hands of caregivers or patients and contaminated equipment or environmental surfaces
weitlaner retractor - ✔to maintain wound exposure during repair of inguinal hernia What actions can the scrub person take to help prevent incidental thermal burns a) inspect laparoscopic instrumentation for excessive wear or obvious breaks and replace when necessary b) clean all instruments with sterile water c) watch the surgery carefullt d) replace instruments that have damaged insulation - ✔a) inspect laparoscopic instrumentation for excessive wear or obvious breaks and replace when necessary d) replace instruments that have damaged insulation What are complications associated with laparoscopic surgery? a) umbilical hernia b) post surgical pneumonia c) wound infection d) CO2 embolism - ✔c) wound infection d) CO2 embolism 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 use c) 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 - ✔b) place the light source in standby mode whenever it is not in use What region of the patients abdomen is traditionally used to establish pneumoperitoneum for MIS? a) periumbilical b) supraumbilical c) subumbilical d) umbilical - ✔a) periumbilical 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 - ✔d) after the cuff of the ET tube is inflated and the position is confirmed Which are the major components of medical video imaging? a) electrosurgical unit b) fiber-optic light cable c) verres needle d) camera control unit - ✔b) fiber-optic light cable d) camera control unit
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 - ✔a) family history of problems related to anesthesia Which drug is used to reverse valium and midazolam? a) neostigmine b) pancuronium c) flumazenil d) succinylcholine - ✔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 - ✔a) applying cricoid pressure Which of the following is associated with increased risk for hypothermia? a) female sex b) higher than normal body weight c) hyperthyroid d) hypertension - ✔a) female sex 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 - ✔c) arterial line 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 - ✔d) endotracheal intubation Which of the following would be an appropriate action for the perioperative nurse when assisting 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 - ✔b) apply cricoid pressure if needed during intubation Which pieces of equipment are used during laparoscopic surgery?
a) CO2 insufflator b) ESU c) smoke evacuator d) fiberoptic headlight e) traction apparatus - ✔a) CO2 insufflator b) ESU c) smoke evacuator wound class I - ✔clean ex. thyroidectomy, mastectomy, ganglion excision, hemiorrhaphy, laminectomy wound class II - ✔clean contaminated ex. cholecystectomy, hysterectomy, c section, colon resection, tracheostomy, appy, cystoscopy wound class III - ✔contaminated ex. inflamed but unruptured appendix/gallbladder, open fracture, penetrating wound, unsterile instrument wound class IV - ✔dirty or infected ex. perforated viscera, infected wound, abscess Xenon light source - ✔emit pulsing high intensity white light, expensive but brigher zinc - ✔necessary for collagen synthesis and tissue repair