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AORN FINAL Flashcards

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1
Q

Suture classification system elements

A
  1. natural or synthetic
  2. absorbable or non-absorbable suture strand
  3. monofilament or multifilament
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2
Q

Suture material characteristics

A

-physical configuration
-handling ability
-potential for tissue reaction

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3
Q

Suturing method: interrupted

A

single sutures that are tied independently

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4
Q

Suturing method: continuous or running stitch

A

uninterrupted suture line

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5
Q

Suturing method: retention suture

A

a heavy suture that reinforces the primary suture line

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6
Q

Suturing method: subcuticular stitch

A

a suture line under the epidermis

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7
Q

Suturing method: purse-string

A

suture placed around a circular wound

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8
Q

Staples: pros and cons

A

+
easy to use, provides uniform incisional tension, faster wound closure
-
require extraction unless staples are absorbable

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9
Q

Adhesives: pros and cons

A

+
reduced risk of infection, less scarring, eliminates skin closure device removal
-
limited to superficial wounds, higher allergic reaction rates, not optimal for slow-healing health conditions

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10
Q

Wound closure/Adhesive strips: pros and cons

A

+
less expensive than other skin closure methods
-
can loosen with moisture, causing wound compromise

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11
Q

Zipper: pros and cons

A

+
distributes skin stretching forces over a wide surface area and away from the wound edges, faster application than suturing, reduced costs related to the surgeon and OR time, eliminates the need for suture removal, provides more patient comfort, lower infection rate
-
cost of product

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12
Q

3 types of wound healing mechanisms

A

-primary intention: clean incision with no tissue loss, minimal wound trauma and drainage, the edges of the wounds are approximated, leaving no “dead” space
-secondary intention: wound heals by granulation, leading to wound contracture
-tertiary intention: delayed wound closure due to considerable tissue loss/gross infection, wound is not de-vascularized, deep sutures are not used to avoid granuloma formation

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13
Q

Wound class I:

A

clean wounds
-no inflammation or infection present
-the respiratory, alimentary, and genitourinary tracts are not entered

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14
Q

Wound class I examples

A

hernia surgery, breast surgery, and non-traumatic ortho, cardiac, or peripheral vascular surgery

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15
Q

Wound class II:

A

clean contaminated
-the respiratory, alimentary, or genitourinary tract is entered under controlled conditions and without contamination of the surrounding tissue
-there is no evidence of infection or major break in aseptic technique

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16
Q

Wound class II examples

A

D&C, total abdominal hysterectomy, gastrectomy, cholecystectomy without spillage, elective appendectomy, and lung wedge resection

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17
Q

Wound class III:

A

contaminated
-open, fresh, traumatic wounds
-major breaks in sterile technique
-gross spillage from the GI tract
-incisions in which acute, nonpurulent inflammation is encountered

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18
Q

Wound class III examples

A

laparotomy with significant spillage, traumatic wounds, acute inflammation of any organ without frank pus present (acute appendicitis, cholecystitis)

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19
Q

Wound class IV:

A

dirty/infected
-old traumatic wounds with retained devitalized tissue
-wounds that involve existing clinical infection or perforated viscera

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20
Q

Wound class IV examples

A

incision and drainage, total evisceration, perforated viscera

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21
Q

SSI categories: superficial incisional

A

epidermis, dermis, subcutaneous layers
30 days after surgery

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22
Q

SSI categories: deep incisional

A

fascial, muscle layers
30-90 days after surgery

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23
Q

SSI categories: organ/space

A

organ, space layer
30-90 days after surgery

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24
Q

Three components of NPWT/VAC:

A
  1. reduces edema
  2. promotes granulation tissue perfusion and formation
  3. removes exudate and infectious materials
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25
Drains are used to provide an exit for (6) They also create a portal of entry for (1)
-blood, serum, bile, air, intestinal secretions, and pus -pathogenic microorganisms
26
What technique is used for emptying closed systems and changing a wound drain dressing?
Aseptic technique
27
Open drain:
penrose
28
Closed drain: (2)
hemovac, jackson-pratt
29
RN-to-patient ratio PACU phase 1 1:1
patient with an unstable airway or who is hemodynamically unstable
30
RN-to-patient ratio PACU phase 1 1:2
one unconscious, stable patient without an artificial airway and one conscious, stable patient free of complications (patients aged 8 years or older) or two conscious, stable patients free of complications
31
RN-to-patient ratio PACU phase 1 2:1
one critical, unstable, complicated patient
32
Phase 2 RN-to-patient ratio
1:3 for patients older than 8 years
33
Phase 2 RN-to-patient ratio
1:2 for patient 8 years and younger
34
What method is best to provide education to the patient and family during Phase II in PACU?
teach-back method
35
Why is the patient follow-up call an important element of post anesthesia care?
-most complications occur within 48 hours -post-op instructions are reviewed and reinforced -questions are answered -reminders are provided concerning follow-up appointments
36
Professionals that can provide anesthesia:
Anesthesiologists CRNAs AAs
37
Factors to consider before determining what anesthetic to use for a particular patient:
-length and type of patient -patient and surgeon preferences -co-existing diseases -mental/psychological/physiological status -plans and protocols for post-op pain management -position of the patient during surgery
38
NPO status guidelines: clear liquids
stop 2 hours before surgery
39
NPO status guidelines: breast milk
stop 4 hours before surgery
40
NPO status guidelines: infant formula
stop 6 hours before surgery
41
NPO status guidelines: light meal
stop 6 hours before surgery
42
NPO status guidelines: fried, fatty foods, meat
stop 8 hours before surgery
43
OR nurse should be available during induction of anesthesia to assist with (2)
-cricoid pressure application -if intubation and ventilation become difficult, the RN should retrieve additional airway equipment and supplies
44
When can cricoid pressure be released?
when -the ET tube cuff is inflated -the tube placement is confirmed -anesthesia provider has given a verbal confirmation
45
The OR nurse should be familiar with and know the location of
-infusion pumps -patient warming units -laryngoscopes -oral and nasopharyngeal airways -endotracheal tubes
46
General anesthesia:
a drug-induced reversible state of consciousness
47
Regional anesthesia:
an injection of local anesthetics near nerve fibers that causes a reversible loss of sensation over an area of the body
48
Monitored anesthesia care (MAC)
an anesthesia provider monitors the patient, administers sedatives and other agents as needed and provides medical services as required
49
Moderate sedation
the administration of sedative, analgesic, and/or anxiolytic agents by a nurse under physician supervision RN may be able to administer moderate sedation
50
Local anesthesia
the infiltration or topical administration of agents to anesthetize a part of the body
51
General anesthesia results in
amnesia, analgesia, and loss of responsiveness, decreased stress response, and loss of skeletal muscle reflexes to a varying degree
52
Spinal, epidural, and peripheral nerve blocks are examples of
regional anesthesia
53
3 phases of general anesthesia
1/ induction 2/ maintenance 3/ emergence
54
An ET tube/laryngeal mask airway (LMA) is removed when ...
the patient is conscious and able to maintain their airway
55
Reversal for opioids (like fentanyl)
naloxone
56
Reversal for benzos (like midazolam)
flumazenil
57
Reversal for muscle relaxants (except for succ)
neostigmine or edrophonium
58
Reversal for rocuronium, vecuronium, and pancuronium
sugammadex
59
Patients at increased risk for hypothermia
-elderly -infants and children -women -patient with lower-than-normal body weight
60
Medical conditions associated with increased risk of hypothermia
cachexia hypothyroidism hypoglycemia hypotension burns trauma congestive heart failure cardiac vessel disease previous organ transplantation previous cardiac surgery
61
Signs of MH (5)
increased end-tidal carbon dioxide other signs: skeletal muscle rigidity, ventricular dysrhythmia, skin mottling, and hyperthermia
62
What is MH triggered by
inhalation anesthetic gases and succinylcholine
63
Enhanced recovery after surgery is a developed pathway that can be used for simple and complex surgical procedures with a primary focus on:
-reducing the patient's surgical stress response -optimizing a patient's physiological functions -facilitating a patient's recovery
64
Social Determinants of Health
economic stability education access and quality social and community context health care access and quality neighborhood and built environment
65
National patient safety goals for safe patient care include: (5)
1. patient identification 2. preventing mistakes in surgery 3. preventing surgical site infections 4. safe medication use 5. improving health equity
66
MH: muscle relaxant that triggers it
succinylcholine
67
MH: inhalational anesthetics that trigger it
1. desfluane 2. enflurane 3. isoflurane
68
What inhibits the MH crisis?
dantrolene
69
LAST=
local anesthetic systemic toxicity
70
LAST is a toxic reaction to
inadvertent, intravascular injection the slow systemic absorption of a large, extravascular volume of local anesthetic potentially fatal
71
LAST patient risk factors= (7)
1. female biological sex 2. low muscle mass 3. metabolic disease 4. age extremes 5. central nervous system diseases 6. cardiac disease 7. liver disease
72
S/S of LAST
-perioral numbness -metallic taste -agitation -dizziness -dysarthria -auditory changes -cardiac changes
73
Surgical care for the pediatric patient should be performed in a hospital for:
premature infants less than 37 weeks old full term infants less than 44 weeks old children with complex and serious medical problems, congenital heart disease, craniofacial abnormalities children younger than 3 years scheduled for a tonsillectomy
74
The Aldrete scoring system is used for ... What does it measure? (5)
to score a patient's readiness score to move to the next phase of care measures: activity level, respirations, circulation, level of consciousness, oxygen saturation
75
PONV affects what % of patients?
20-40%
76
Gases used for insufflation include:
CO2 (most common), air, nitrogen, nitrous oxide, argon, helium
77
Potential complications of gas insufflation:
hypercarbia increased diaphragmatic pressure decreased cardiac output and respiratory effort phrenic nerve irritation hypotension or hypertension gas embolism
78
An inspection tool that is placed through the instrument's lumen and is used to inspect the internal element of the instrument
borescope
79
Infiltration or effusion into surrounding tissues
extravasation
80
Gas that is blown into a body cavity for visualization
insufflation
81
Restricted area reserved for imaging equipment, other necessary equipment is positioned outside of this area or moved to allow for imaging equipment use
no-fly zone
82
Presence of air or gas within the peritoneal cavity
pneumoperitoneum
83
Safety practices that reduce the risk for patient injuries/complications associated with gas insufflation are:
-placing the insufflator above the level of the surgical cavity -checking that alarms are on and audible -hydrophobic filter is between the insufflator and in the insufflation tubing -flushing the insufflator tubing with the gas that will be used for the surgery before the tubing is connect to the cannula -setting the flow rate according to the manufacturer's instructions for use and surgeon's preference -maintaining insufflation pressure at the lowest level necessary for the pneumoperitoneum and surgical site visualization -maintain the pneumoperitoneum at a pressure less than 15 mmHg
84
A rare but potentially serious complication of insufflation
gas embolism gas increases abdominal pressures, open blood vessels allows the gas to enter the circulatory system, gas embolism enters the vascular system, embolism travels to the R ventricle or pulmonary artery
85
Clinical signs of gas embolism
decrease in end-tidal CO2 decrease in oxygenation saturation decrease in BP tachycardia, bradycardia, arrhythmias, or asystole increased pulmonary artery pressure a mill-wheel murmur
86
Interventions to manage a gas embolism
discontinuing the gas and anesthetic agents positioning the patient is Trendelenburg or left lateral position infusing a large amount of IV fluids administering medication specific to pulmonary circulation performing cardiopulmonary resuscitation
87
Gas cylinder safety
-verify that the correct gas is being used by checking the cylinder's label, connector, and color coding -enough gas/open position/second, full cylinder just in case
88
Low viscosity non-electrolyte fluid 1. examples 2. used with ... 3. can cause ... if large quantities are absorbed 4. is ...tonic
1. 1.5% glycine, 5% mannitol, 3% sorbitol 2. used with monopolar instruments, gynecological/urological procedures 3. can cause transurethral resection syndrome 4. hypotonic
89
Normal saline 1. used with ... 2. ...tonic
1. bipolar instruments 2. isotonic
90
High viscosity fluid 1. can cause significant complications (3) 2. examples 3. used for
1. fluid overload, heart failure, pulmonary edema 2. dextran 3. plasma volume expander
91
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