PeriOp 101 AORN Test what is an appropriate action for a nurse assisting anesthesia? - ✔Apply cricoid pressure if needed during intubation What is not considered a basic monitor for anesthesia? - ✔Arterial line What drug is used to reverse valium and midazolam (Versed) ? - ✔Flumazenil What method is used to prevent aspiration during endotracheal intubation? - ✔ How can the perioperative nurse assist eh provider with placement of a spinal or epidural block? - ✔Calm the patient During intravenous regional anesthesia (Bier Block), the tourniquet should be deflated slowly to prevent which of the following from the entering circulation? - ✔Bolus of anesthetic What is the most consistent indicator of malignant hyperthermia during a surgical intervention? - ✔unexplained increase in end title CO2 Which of the following can be provided without an anesthesia provider? - ✔ Which assessment factor is important to include when screening patients for potential risk of malignant hyperthermia? - ✔Family history of problems with anesthesia What are complications associated with laparoscopic surgery? - ✔CO2 embolism, Umbilical hernia Identify some methods used to maintain a sterile camera head - ✔ which pieces of equipment are used in laparoscopic surgery? - ✔ Which options can the scrub person take to help prevent accidental thermal burns? ✔inspect laparoscopic instrumentation for excessive wear replace instruments that have damaged insulation clean all instruments with sterile water identify one characteristic difference between laparoscopic surgery instruments and those used in open procedures - ✔Laparoscopic instruments have long thin shafts to accommodate trochar cannulas
What region of the patients abdomen is traditionally used to establish pneumoperitoneum for laparoscopic surgery? - ✔ What is an important safety consideration when using a light source? - ✔Place the light in standby mode when not in use Carbon Dioxide is the gas used for abdominal insufflation because it - ✔is inexpensive suppresses combustion is rapidly eliminated from the body The single most Important factor in preventing the spread of infection is - ✔Hand hygiene Damp dusting of the OR as part of the preliminary room preparation should be done ✔in the morning before bringing in surgical supplies Which methods are most effective for terminal cleaning the floors in the OR? - ✔damp mop with two mop system Which of the following is correct regarding the disposal of contents from reusable suction systems? - ✔Done by federal state and local regulations What is true regarding spray bottles? - ✔spray bottles can aerosolize potentially infectious materials spray bottles are occasionally used to apply disinfectant The proper device for the disposal of blades, needles and stapling devices should be ✔sharps disposal container The goals of preforming post-procedure cleaning of the OR include - ✔it renders the environment safe for the patient following in that room to prevent cross contamination it is the patients right to a clean and safe environment it breaks the cycle of contamination from the patient to the environment to the OR personnel and subsequent patients Terminal cleaning must be done - ✔Once during each 24 hour period During post procedure cleaning what must be done - ✔all kick buckets, hampers, and similar receptacles must be emptied and disinfected as needed OR bed should be moved to clean floor transport vehicles are considered dirty after patient contact all horizontal surfaces of tables, and equipment should be wiped down with a lint-free cloth moistened with a hospital approved disinfectant
Identify pathogens that can be commonly found in the OR environment - ✔ Sponge counts are not done for - ✔state law requirements What should the periop nurse ensure when positioning a patient? - ✔use additional precautions as appropriate based on unique patient considerations what physiological effects are most likely to result from positioning a patient in lithotomy? - ✔Circulatory and respiratory compromise due to compression on the abdomen What are safety measures to take into consideration when placing the patient in a lateral position? - ✔Upper leg is straight and supported with pillows between the legs Lower arm on same plane as OR mattress; forearm and wrist in neutral positions; palm up The patients dependent ear should be assessed to ensure that it is not folded Documentation should include but is not limited to - ✔type of positioning devices used names of persons positioning the patient what are factors that should be considered in the periop assessment - ✔age nutritional status pre-existing conditions The use of PNDS helps a nurse to: - ✔Plan the nursing interventions assess and develop nursing diagnosis' assess and evaluate the patients status Evaluate responses to positioning A table flexed 90 degress for the _______ position is a variation of the _____ position ✔jack-knife (kraske), prone What response is the result of tissue layers moving on each other - ✔Shearing What surgical positions adversely affect diaphragmatic movement? - ✔Trendelenberg, prone and lateral The purpose of National patient safety goals is to - ✔Promote specific improvements in safety highlight problematic areas in healthcare describe evidence and expert-based system wide solutions to the problems
What is a practice that implements Joint commissions universal protocol for preventing, wrong site, wrong person, wrong procedure - ✔using a timeout procedure before beginning case The elements require to create a culture of safety include - ✔a sense of trust among team members a sincere commitment to affirming safety as the first priority development and support of a proactive approach rather than a reactive approach dissemination of receipt of information to all levels The IOM report describes the importance of setting standards and expectations for patient safety the report states that setting standards can .... - ✔Set expectations for the health professionals Establish consistency when it comes individuals and organizations Help set expectations of consumers and purchasers Individual staff members play the biggest role in marinating a safe OR environment they are required to: - ✔monitor identify and report safety hazards Understand and comply with the emergency power outage plan Practice sound, basic and OR specific electrical and fire safety What is true regarding AORN position statement on correct site surgery? - ✔The staff member should verbally verify the correct site with each member of the surgical team Professional organizations and societies as well as individual organizations can proactively create a culture that supports patient safety through - ✔Convene and communicate with members about safety Incorporate attention to patient safety into training programs collaborate across disciplines when a count discrepancy occurs, what should be the FIRST action by the RN circulator? - ✔inform the surgical team of the discrepancy sponge and instrument counts are performed according to facility policy and procedure. Generally, the times during sx procedure that sponges are counted are: - ✔at skin closure before procedure begins when new items are added to the field when wound closure begins Which of the following actions should be included in the perioperative nursing care of a patient with a suspected latex allergy? - ✔assess the patients cross-sensitivities and previous latex reactions indicate latex precautions on door signs for every room that patient occupies use latex-free supplies for IV's, hair coverings and dressing materials
Verify that surgeon is aware of allergy when using chemical products the perioperative nurse should - ✔use skin prep solutions according to manufacturers recommendations ensure the prep solution does not pool on drapes apply blotting towels before performing a skin prep allow skin prep to dry before draping which of the following factors increase the patients risk for skin injury? - ✔unusual positions or positioning devices use of electrical equipment use of chemical agents prolonged length of surgery AORN guidelines for the time out recommend that all team members verbally verify the agreement on: - ✔the name of the patient the site of the procedure including side distinction the procedure to be preformed Mechanical issues and problems that can cause skin injury include - ✔placing heavy items on the patient dragging the patients body across the sheets Improperly applying sequential compression stockings Which of the following practices is recommended to reduce the patients risk of intraoperative skin injury - ✔protect sensitive areas of the skin with appropriate padding Which of the following is recommended when transferring a patient from an OR bed to a stretcher/gurney - ✔Lock the wheels of the stretcher and the OR bed prior to transfer Which activities should the transport person complete before transferring a patient? ✔Identify the patient and the surgical procedure verbally confirm the preoperative orders have been completed Reconcile any medications the patient may have been taking preoperatively IN addition to back-up electrical power in the case of a power outage, ORs may plan for outage by - ✔identifying which outlets in the OR are connected to emergency power Maintaining batter powered lights in each OR routinely checking the operating and availability of backup equipment Indirect fire hazards and risks specific to the OR include - ✔anesthetic complication risks postoperative infections postoperative surgical complications
When working with electrical equipment the perioperative nurse must: - ✔ensure the warming therapy devices are used at appropriate settings ensure that users are educated in the safe use of all electrical equipment never place the hose of a patient warmer directly under the patients blankets Radiation exposure safety controls include: - ✔Nonessential personnel should leave the room pregnant health care workers should avoid or limit exposure lead protective aprons, gloves and thyroid covers should be worn Nursing documentation for pneumatic tourniquet use includes - ✔identification/serial number and model of the specific tourniquet location of the cuff skin and tissue integrity time of inflation and deflation of cuff Safety measures to prevent complications or injury due to the use of pneumatic tourniquet includes - ✔keep fluids form pooling under cuff only minimal effective pressure should be used to create a bloodless field there should be a complete preoperative assessment the cuff should fit properly on the patient the inflation time should be monitored which of the following is a correct application of the AORN guidelines for proper eyewear during laser use - ✔the eyewear should match the type of laser, optical density and wavelength Volatile liquid - ✔a liquid that evaporates quickly combustible skin agent - ✔a skin antiseptic agent that will burn with a flash point of grater than 100 degrees, 38.7 C Flammable skin agent - ✔a skin antiseptic agent that has a flash point of less than 100 degrees, 38.7 C Combustible rating - ✔an established rating used with skin antiseptic solutions that can be found by reviewing MSDS sheets The nominal hazard zone for laser use is the - ✔space where direct scattered or reflected laser radiation exceeds maximal permissible exposure risks to patients and staff members associated with laser use include - ✔eye injury fire hazards inhalation of laser plume
potential sources of fuel for surgical fires include - ✔draping materials the concept of standard care related to documentation includes - ✔the nurse required to document and act as a reasonably qualified nurse would in a similar situation The primary reason for documenting sharp and sponge count is - ✔to prevent injury to the patient from a retained foreign object an individual patient care plan that was initiated during the preoperative phase includes - ✔a cultural or religious experience emotional considerations psychosocial considerations what statements are true about informed consent - ✔needs to state the indication for the proposed intervention is a physicians duty and RNs are witnesses to the patients signature must contain the name of healthcare facility When documenting the nurse should include - ✔document in a timely manner use nursing diagnoses use patient statements to verify nurses findings the primary purpose of documentation is to - ✔record the chronological order of events during the nursing care of a patient which of the following is true about the use of abbreviations in documentation - ✔they put patients at risk for medication errors accurate perioperative documentation includes - ✔patient identification perioperative orders patient assessment when documenting a surgical drain what should be included - ✔where the drain was placed on the patient Components of the electrical surgical unit include - ✔Active electrode, dispersive electrode and generator to reduce the possibility of injury related to burn where should the nurse place the dispersive electrode - ✔as close to the operative site as feasible which statement best describes the path for bipolar surgical current? - ✔current leaves the generator, is applied to tissue using two poled instrument and returns to the generator
if the surgeon continuously asks for higher power settings what is the first action the perioperative RN should take - ✔check the circuitry for possible disruption Alternate pathway burns can occur because of improper placement, where should the dispersive electrode not be places - ✔hairy skin surfaces burn tissue bony prominences When using argon-enhanced coagulation AEC there is a risk of - ✔gas emboli what are considered exhaust ventilation LEV devices - ✔central suction systems with 0.1 micrometer in line filter central suction system with HEPA in-line filter Smoke evacuator unit Which precautions should be take for a patient with an implanted Electronic device ✔all team members should be informed about the ED the active and dispersive electrodes should be located as close together as possible What is needed for documenting with an electrical surgical device - ✔location of dispersive electrode serial or biometric device number patients kin condition before and after applying the dispersive pad during laparoscopic surgery perioperative RNs can reduce the chance of capactivecoupling injuries by - ✔using the lowest power setting and the low-voltage cutting wave form AORNS guidelines for perioperative practice provides - ✔information on administrative topics information that can be used to develop institution specific guidelines scientific evidence for clinical practices what is true regarding AORN's guidelines for perioperative practice - ✔they are based on what nurses do in ideal situations they may be fulfilled in varying degrees in different situations why is it important for perioperative nurses to have a basic understanding of business principles? - ✔to enable them to plan safe and effective care that is also cost effective to facilitate competition for patient volume to manage and allocate resources wisely gross revenue - ✔all monies received by the facility for goods and services
fixed expenses - ✔medical records and administration net revenue - ✔gross revenue minus expenses variable cost - ✔costs directly related to patient volume