1
Q
How far away from a sterile field should un-sterile staff stay?
A
at least 1 foot
2
Q
Length of aeration time depends on what 4 factors?
A
- type of wrapper
- composition of the items
- temperature reached during aeration
- concentration of EO and flow rate
3
Q
Convection heat
A
- air currents passing over skin
* keep PT covered
4
Q
Radiation Heat
A
- when heat transfers from body surface to room atmosphere
* Increase room temp
5
Q
What nursing action will overcome conduction heat loss?
A
Use warming blanket on PT
6
Q
Evaporation Heat
A
- When skin becomes wet
* avoid excessive draping
7
Q
Glove perforation usually occurs when?
A
40 minutes into case
8
Q
SNIs occur most often when…
A
suturing of fascia or muscle with curved sharp needle
9
Q
WAGs
A
- Exposure levels measured every 6 mos
- Maintained at less than 25ppm for nitrous oxide
- 2 ppm for halogenated agents
10
Q
Most common cause of SSIs
A
Gram-Positive Cocci
* staphylococcal, enterococcal, pseudomonal and streptococcal
11
Q
Where is staphylococci found?
A
skin, nose, urethra and vagina
12
Q
Where is enterococci found?
A
GI flora and female genitalia tract
*can cause SSI, bacterial endocarditis, septicemia and UTIs
13
Q
Pseudomonads
A
- most common: Pseudomonas aeruginosa
- moist environments
- skin and intestines
- preventative measure: cleaning and strict aseptic tech
14
Q
Where is streptococci found?
A
Upper respiratory flora, genitourinary and GI tract
15
Q
How is Hep B spread?
A
- blood or body fluids
* incubation 6 wks- 4 mos
16
Q
How is Hep A spread?
A
- fecal-oral route
* hand hygiene important
17
Q
How is Hep C spread?
A
- direct exposure to blood
* incubation 7 weeks
18
Q
Where is spinal block med injected?
A
into subarachnoid space
19
Q
Pre-op PT has anemia. What potential side effects does this PT face?
A
hypoxia and hypotentsion
20
Q
When considering the thermoregulation of the infant ped PT, the peri-op nurse should remember that….
A
Infants under 3 mos do not shiver when cold
21
Q
St. Johns Wort
A
- Prolongs sedation
* interferes with calcium channel blockers, warfarin and some abx
22
Q
PT with bulimia nervosa. Notify anesthesia bc PT may have….
A
- inadequate kidney function
- unstable vitals
- electrolyte imbalances
23
Q
Low-level disinfectants
A
kills most vegetative bacteria and some viruses and fungi
24
Q
Intermediate level disinfectant
A
May kill tubercle bacilli, vegetative bacteria and most viruses and fungi but not bacteria spores
25
High level disinfectant
kills all microorganisms except high numbers of bacterial spores
26
Disinfection
The process that kills all microorganisms with the exception of high numbers of bacterial spores
27
Hydrogen Peroxide Vapor Sterilization
*Vapor is sterilant
* byproduct: water vapor and oxygen
* no aeration
BI--B. atropheus
28
Low Temp Hydrogen Peroxide Gas Plasma Sterilization
plasma is 4th state of matter
* Hydrogen peroxide vapor is charged with radio frequency and turns to plasma
* byproducts: water and oxygen
* replacing EO
* no aeration needed
* cold form
* STERRAD
* cycle time= 75 mins
* used for heat sensitive and moisture sensitive items
* dry sterilization
29
Percentage of OR needlesticks associated with carelessness
74%
30
Most common presenting sign of MH
unexplained ventricular dysrhythmia ( tachy or PVCs)
31
Which type of law encompasses malpractice and negligence?
Tort Law "personal injury law"
32
Concerning metal instruments, what type of sterilization is performed for 3 mins at 132C at 27lbs of pressure?
Immediate Use Steam Sterilization
33
You have prepared the sterile back table and the mayo stand. You receive word that surgery will be delayed due to an unanticipated emergency. You should....
Cover the table and stand with sterile drapes and leave them in their current position
34
Percent of all HAIs from S. aureus occuring in surgical PTs
35%
35
7 Rights of Med Administration
Right:
1. PT
2. drug
3. dose
4. reason
5. time
6. route
7. documentation
36
How often should water in the ultrasonic cleaner be changed?
at least once per shift
37
An individual who disperses significantly increased numbers of viable contaminated particles
Shedder
38
Which mask protects from aerosolized carcinogens?
A mask which can filter particles as small as 0.1mm
39
What is the difference between sterilization and High-Level Disinfection?
Sterilization kills all microorganisms including endospores while High-level disinfection kill microorganisms only
40
How do you know chemical indicator tape has been subjected to a successful sterilization cycle?
Tape starts out tan then turns dk brown or black
41
2 common ABXs for surgical prophylaxis
Rocephin and Keflex
42
Vascular surgeon schedules "cold leg" for surgery. Which procedures is the surgeon expected to perform?
Embolectomy and possible Revascularization Grafting
43
Assault
Threat to do harm
44
Kasai Procedure
The construction of a bile drainage system by use of an intestinal conduit
45
The 5 Rights of Delegation
The Right:
1. task
2. circumstance
3. person
4. communication and direction
5. supervision and evaluation
46
Peracetic Acid
* STERIS I
* for items that can be immersed
* corrosive to instruments and people
* temp 120-130
* micron filtered tap water rinse
* for point of care use only - will be wet
47
Battery
Ex: Operating without consent
48
Tort
wrong committed against someone
49
Negligence
Failure to use reasonable care
50
ABX given pre-op that can potentiate neuromuscular blocking agents
Clindamycin
51
ABX usage and/or admin for C-Sections
Administer intraop after umbilical cord clamped
52
Primary ICF anion
Phosphate
53
Osmosis
Movement of fluid through a selective semipermeable membrane from a soln that has a lower solute conc to one that has a higher conc
54
isotonic
A soln that has same osmolality as blood plasma
* NS, LR
* prevent shift from IC compartments
55
Neonate heart murmurs
* Patent Foramen Ovale: closes in 3-12 mos
* Patent Ductus Arteriosis: up to 2 mos to close
* Undetected anomaly
* innocent flow murmur
56
Why are infants prone to dehydration?
* Renal function is immature
* ability of kidneys to concentrate urine is limited
* complete renal maturation at @ 2 yrs
57
Myelomeningocele
* form of spina bifida
* always associated with Chiari type II malformations
* Meninges, spinal cord and nerve roots protrude
58
Omphalocele
* intestines out through umbilical cord
* error in digestive tract development
* may be associated with other major congenital defects
59
Dry heat spore testing
Bacillus atropheus
60
Cloaca
single opening for the urethra, rectum and vagina
61
talipes
Deformities of the foot
62
Talipes Varsus
Clubfoot
| most common
63
Talipes Equinovarus
idiopathic true club foot deformity
64
Milwaukee Brace
brace for scoliosis
65
What gives the patient the right to chose not to be treated for an emergent event precipitated in response to normal anesthesia during surgery?
Self Determination Act
66
Most common childhood chronic condition
Secretory Otitis Media
67
Most common source of pathogens in the OR
Surgical staff ( S. aureus 25%)
68
When using bipolar delivery of electrical current remember....
One side of the bipolar forceps returns the current back to generator
69
Do not scrub longer than how many minutes?
5 mins
70
Who are qualified to perform and document H&Ps
* Physician
* NP
* PA
* RNFA
71
4 domains of the Perioperative Patient Focused Model
1. Behavioral Responses
2. Patient Safety
3. Physiological Responses
4. Health Systems
72
Nursing Process
```
Assessment
Nursing dx
Outcomes identified
Planning
Implementation
Evaluation
```
73
Spaulding Class "Critical"
* Will enter sterile tissue or the vascular system
* should be sterile
* Ex: caths, instruments, needles, etc
74
Spaulding Class "Non-critical"
* will come in contact with skin
* intermediate or low level cleaning
* linens, tourniquets
75
"Rule of Ten" and cleft palates
Pt is:
10 weeks old
10 lbs
hemoglobin = 10
76
LMA
1. provides an airway
2. forms a seal with trachea
3. used in place of ET tube
4. does not protect against regurg and aspiration
77
Where should gloved hand be placed when "buzzing the forceps"?
Covering as much of the forcep as possible.
| current is delivered below hand
78
Precordial thump can be used as a rapid measure to correct
V fib
79
Durant position/maneuver
* Left lateral with steep Trendelenberg
* air embolus enters right atrium during surgery
* anesthesia aspirates air bubble
80
Why do infants have an increased sensitivity to sedatives, opioids and hypnotics?
* immature blood-brain barrier
| * decreased protein-binding
81
What is LR good for intraoperatively?
Fluid replacement to help correct intraoperative third-space losses
82
inherent resistence
The bacteria can avoid absorption of the ABX by coating itself with asn impervious biofilm
83
Bacteria demonstrate their resistance to ABX through...
1. inherent resistance
| 2. Acquired resistance
84
Vertical Evolution
Bacteria can mutate spontaneously, transmitting a chromosome to one of its own population
85
Horizontal Evolution
A bacteria which already has an ABX resistant gene shares that gene with a member of a different bacgterial population
86
Instruments used on PT with Creutzfeld-Jakob disease should be...
1. Steam sterilized for 60 mins at 132C or 272F
| 2. after being soaked in bleach for 1 hour at room temp
87
Superficial Incisional SSI
* within 30 days
* only involves skin or subq
* must have one of the following:
1. purulent drainage
2. pain
3. tenderness
4. localized swelling
5. redness/heat
6. surgeon deliberately opens
7. surgeon dx
88
Complementing Action
using nonverbal communication to support or augment verbal communication
89
85% of the microbial contaminants located in an open surgical site originate from...
Room Air
90
Treatment of DIC
```
blood
plasma
dextran
blood thinners
replacement clotting factors
```
91
Ozone sterilization used for all types of devices except...
sealed glass ampules
implants
flexible scopes
92
3 Factors necessary to achieve steam sterilization
1. time
2. temp
3. saturated steam
93
Primary Hyperthyroidism is associated with...
Hypercalcemia
94
You are caring for a PT with breast CA who is scheduled for a lumpectomy followed by radiation therapy. When do you administer ABX?
Preop, intraop and post op
95
Central Venous catheters are threaded into...
Right Atrium
96
Ginseng may cause...
1. hypertension
| 2. bleeding
97
What is ectropion?
The eyelid is everted to expose conjunctival surface
98
Geriatric PTs need extra care with what aspects of the environment?
1. hypothermia
2. potential for emboli
3. monitoring fluid loss/blood loss
4. positioning to avoid injury
99
entropion
When eyelid margin is inverted causing eye lashes to abrade the cornea
100
Stye
infection of eyelash follicle
