Study Guide Questions Flashcards

Question

Elements of SODH

Answer 1

* economic stability * education * social/community context * access to health care * neighborhood/built environment

Answer 2

Determine that we have the correct patient, correct sx. correct site, and that the patient understands what is being done, their NPO status, medical hx, sx hx , questions or concerns

Answer 3

* Cannabis can affect the tolerance to induction agents * unknown tolerance of anesthesia agents * hyperreactive airway * bispectral index elevation (BIS) - Uses state-of-the-art technology to process EEG information to provide a direct measurement of the patient's level of consciousness and insight into the effects of anesthesia on the brain. * Increased myocardial infarction risk within 1 hr after use

Answer 4

* lowered immunity * prolonged bleeding times * increased stress response * cardiac complications

Answer 5

The act of blowing gas into a body cavity for visual examination

Answer 6

* elevated BP * elevated CO2 in blood * acidosis * decreased C/O * decreased renal blood flow * decreased U/O * Cardiac arrythmias * Gas embolism * Peritoneal irritation * Gas embolism

Answer 7

* systemic hypotension * dyspnea * cyanosis * cardiac anomalies * tachycardia * bradycardia * arrhythmias * asystole * elevated pulmonary arterial pressure * elevated central venous pressure * hypoxemia * end-tidal CO2 changes

Answer 8

An inspection tool that is placed through an instrument's lumen and is used to inspect the internal element of the instrument

Answer 9

* hybrid OR * Designating a collision-free or “no-fly” zone in which personnel, monitors, and other ceiling-mounted equipment cannot be present while the C-arm is in motion limits opportunities for damage or injury. * Restricted area reserved for imaging equipment * Other necessary equipment is positioned outside of this area or moved to allow for imaging equipment use

Answer 10

Presence of air or gas within the peritoneal cavity

Answer 11

* Placing the insufflator above the level of the surgical cavity * Checking that the alarms are on and audible * Ensuring that a hydrophobic filter is between the insufflator and the insufflation tubing * Flushing the insufflator tubing with the gas that will be used for the surgery before the tubing is connected to the cannula * Setting the flow rate according to the manufacturer’s instructions for use and surgeon’s preference * **Maintain the pneumoperitoneum at a pressure less that 15mm Hg** * **Maintaining insufflation pressure at the lowest level necessary for the pneumoperitoneum and surgical site visualization**

Answer 12

Maintain the pneumoperitoneum at a pressure less that 15mm Hg

Answer 13

* Check that all cable connections are secure before turning on the light source * Ensure that the sterile cable end does not contact the patient’s skin or any flammable material or liquids * Ensure that the cable end does not rest on sterile drape * Turn off the light source or place it on standby when the cable is disconnected from the endoscope

Answer 14

* Is used for procedures performed using **monopolar instruments** * Is used for gynecological and urological procedures * Is **hypotonic** * **Can cause TUR syndrome if absorbed in large quantities** * Examples: * **1.5% glycine** * **5% mannitol** * **3% sorbitol**

Answer 15

Is often selected for use with **bipolar instruments** Is **isotonic** **Contains electrolytes** **safer than nonelectrolyte fluids if large amounts are absorbed**

Answer 16

* Is a plasma volume expander provides good visibility when bleeding occurs * Can draw six times its own volume into the bloodstream * **Can cause significant complications (eg, fluid overload, heart failures, pulmonary edema)** * Contains a **high glucose content** * Example * **Dextran** * **Note: rinse surgical instruments with sterile water for irrigation after use**

Answer 17

an infection that develops at or near the surgical site within 30 days of the procedure or within a year when the prosthesis is implanted.

Answer 18

Reservoir: the environment in which an organism grows, lives, and multiplies (source of infection). Dirty surfaces and equipment, people, water, animals/insects

Answer 19

Vehicle: infectious organism leaves reservoir via portal of exit

Answer 20

Mode of Transmission: organism transmitted to a susceptible host via contact, ingestion, and inhalation.

Answer 21

Infectious agent → Reservoir → Portal of Exit → Mode of Transmission → Portal of entry → Susceptible Host \* vehicle is the pathogen's transport to portal of entry. Mod of transmissionion describes the orgin of vehicle?

Answer 22

Hand hygiene antimicrobial stewardship to reduce abx resistance. Dx and Tx

Answer 23

Infection prevention policies, cleaning , disinfection, sterilization, pest control.

Answer 24

PPE, Hand hygiene, control of aerosols, respiratory etiquette, proper waste disposal

Answer 25

Hand hygiene, PPE, cleaning, disinfection, sterilization, isolation, food safety

Answer 26

Hand hygiene, first aid, PPE, personal hygiene, safe removal of catheters and tubes.

Answer 27

Hand hygiene, immunization, treatment of underlying dz, patient education

Answer 28

microorganisms killed, **contact time** required, ingredients, cleaning instructions, removing gross materials, cleaning the surface with clean water and allowing time to air dry.

Answer 29

Clean from top to bottom Clean from less-soiled areas to dirty areas

Answer 30

to avoid missing areas

Answer 31

room is divided into zones/areas. One person focuses on their assigned area. The team cleans their respective zones until the whole room is clean.

Answer 32

Contaminated items moved to center of room and perimeter is cleaned and disinfected. Contaminated equipment is then cleaned and moved to the perimeter. Center of the room is cleaned after contaminated equipment is cleaned and moved to the perimeter.

Answer 33

Contaminated equipment moved to one side of the room. Empty side is cleaned and disinfected, and then the equipment is cleaned and moved to the clean side. Repeat with the second side.

Answer 34

Room decontamination can be done via UV light or hydrogen peroxide in addition to manual cleaning. Technologies are approved by multiple departments.

Answer 35

Terminal cleaning occurs at end of each day, should be cleaned x1 q 24 hrs. Through cleaning performed by special trained EVS.

Answer 36

Equipment, trash, contaminated laundry are removed after patient leaves the OR Methodical cleaning process is followed to limit microorganism transmission. Equipment is cleaned and disinfected before it enters OR or returned to storage Clean and disinfect high touch objects and surfaces Floor is always considered contaminated Reusable mop heads and cleaning cloths are soaked in cleaning solution and then put in laundry.

Answer 37

Review preference cards at least yearly Open only what is needed Hold items that are labeled as “hold items” on the preference card Ask the surgeon before opening Create spreadsheet comparing costs and show to surgeons → make surgeon aware of cost

Answer 38

Hand hygiene Don PPE → check type of precautions Check supplies, cleaning cloths, bed linens, mop buckets Remove large debris from floor Remove trash and linen Clean and disinfect all items used in patient care → remember transfer devices Mop floor → move bed Spot clean walls Place used cloths in trash or linen Remove PPE Hand hygiene Don appropriate PPE Take trash and linen out

Answer 39

Similar to turn over cleaning except * All exposed surfaces of items in OR are cleaned and disinfected including wheels and casters * Entire floor is mopped or wet vacuumed, including under bed/equipment

Answer 40

Areas of the sterile processing department (SPD) include the decontamination area, assembly area, sterilization of equipment area, and sterile storage areas.

Answer 41

When cleaning SPD the Deon room is cleaned last → most contaminated area of SPD

Answer 42

Clean the floors in all SPD areas every day the areas have been used.

Answer 43

Scheduled cleaning is cleaning of equipment (eg, appliances, air-handling systems, closets, cupboards) that occurs on a periodic, routine basis (eg, daily, weekly, monthly). Includes ice machines, fridge, sinks, vents (ducts/grilles), air filters

Answer 44

Enhanced cleaning when pts with MDROS or Spores occupy OR → these pathogens are hard to kill and need special measures. ex. C.diff → bleach Aspergillus found in air systems thus systems need to be cleaned and filters replaced as well as air handling testing

Answer 45

N95, PAPR,CPAR with aerosolizing procedures (Airborne transmission; TB, measles, chicken pox, COVID.

Answer 46

N95 creates negative pressure inside mask dt inhalation → must be fitted or else negative pressure will draw pathogens into mask.

Answer 47

PAPR/CAPR provide positive pressure, HEPA filter in blower filters germs and provides clean air.

Answer 48

After Pt leaves room it must remain unoccupied for designated amount of time → depends on how many air exchanges in OR

Answer 49

Construction Flooding Condensation on surfaces Mold Pests Terminal cleaning must occur following correction of source of contamination

Answer 50

Temporary barriers and access paths created to decrease contamination ## Footnote **All areas under construction are cleaned before barriers are removed and terminally cleaned before returning to service.**

Answer 51

Rooms can be tested for cleanliness via visual inspection, fluorescent gel, markers, microbio tests, ATP testing

Answer 52

Cleaning: the removal of dust, debris, blood, and other infectious materials Disinfecting: the removal of pathogenic and other microorganisms from surfaces by using chemical or physical means

Answer 53

Prior to EVS entering OR contaminated with TB the RN should alert EVS and communicate that the OR must be unoccupied for the recommended amount of time based on the number of air exchanges in the facility. RN may encourage use of airborne PPE (N95 etc.) when entering room after waiting for recommended amount of time.

Answer 54

Room is checked for clean appearance. Used to assess cleaning routine and provide immediate feed back.

Answer 55

A gel is applied before cleaning. Blacklight illumination applied following cleaning. Presence of fluorescent gel shows that cleaning was not done per protocol or cleaning was performed with dirty cloth

Answer 56

ATP found in saliva, blood, etc. ATP monitoring shows residual organic material following cleaning. Surface is swabbed and swab is inserted into luminometer. Test results available within seconds.

Answer 57

ATP measured in RLUs (relative light units) as numeric value. Numeric value correlates with amount of ATP swabbed from service.

Answer 58

Support RN workflow Data capture Eliminate redundancy in data entry Reflecting patient focused care Contain infor for transitional care

Answer 59

Standardized nursing language focused on perioperative nursing and supports EBP practice → helps to standardize nursing care PNDS is inclusive of nursing process workflow and represents each phase (preadmission, preop, intraop, postop) Recognized by ANA and registered in National Library of Medicine

Answer 60

Helps develop computer databases Helps to shape policy Quality indicators for research Compare cost and performance

Answer 61

Process in place for alternate data entry during system downtime Be prepared → paper forms for documentation, how will new orders be documented?, potential loss of data, how will downtime data be reincorporated into EHR?

Answer 62

Verbal orders should be used only when required by clinical necessity

Answer 63

Enter/document as close to the time they were given as possible Verify by reading back orders Record the names and roles of all individuals involved in perioperative care Avoid abbreviations → write out name or unit of measurement Avoid trailing zeros → 2.0g should be 2g Use standardized names Preprinted and standing orders should be reviewed by physician according to facility policies/procedures

Answer 64

Single line through inaccurate info Write “error,” “mistaken entry,” “omit” next to incorrect text Provide rationale for correction above statement or in margin Sign and date entry Enter correct info next to inaccurate info

Answer 65

Versioning or “track corrections” function; electronic strike through with time stamp Automatic date, time, and author stamp feature EHR should feature a symbol or notation to identify when an alteration has been made and a new version of document was created Retain and link original to new version Reflect corrections in EHR in paper chart

Answer 66

FACT Factual Accurate Complete Timely

Answer 67

An occurrence can be an actual event or near miss; RSI (retained surgical item), patient injury or med error

Answer 68

Maintain open, honest, respectful communication with others Maintain patient confidentiality Maintain competence in your practice Attend nursing continuing professional development programs Know your job description and scope Know your strengths and weaknesses Discuss assignments with preceptor or manager Only accept duties that you can perform competently

Answer 69

provides legally binding rules and regulations that collectively describe the scope of nursing practice in that state or territory.

Answer 70

Failure to: * Communicate * Document * Assess and monitor * Follow standards of care * Act as patient advocate use equipment in a reasonable manner * Top 10 Safety Issues of Concern * wrong site/procedure/patient * RSI * Med errors * Instrument reprocessing failures * Pressure Injuries * Specimen management errors * Surgical Fires * Perioperative hypothermia * Burns from energy devices

Answer 71

For procedure itself Any research interventions Patient’s wishes listed in advanced directive

Answer 72

Requesting or refusing treatment

Answer 73

* Facility name * Name of intervention * Indication for intervention * Name of health care professional performing intervention * Risks and benefits of intervention * Discussion of risks vs. benefits with pt or pt representative * Patient or Pt rep. Signature along with date and time * Signature of witness along with date and time

Answer 74

No. The surgeon or anesthesiologist is You may be asked to witness the patient’s or patient rep’s signature on informed consent Review informed consent forms during preoperative interview

Answer 75

HIPAA ORs should have policies to limit product reps or other visitors in the OR → policies must have revisions for pt consent

Answer 76

Protect patient from unnecessary exposure Comments about pt appearance, lifestyle, or social status are never appropriate unless necessary to provide safe care.

Answer 77

* Preoperative → decision for Sx is made * Informed consent obtained * See documentation elements for specific documentation guidelines * Handover → ends when patient is transferred to OR bed * See documentation elements for specific documentation guidelines * Intraoperative → Starts when pt on OR bed and end at PACU * See documentation elements for specific documentation guidelines * Handover * Postoperative → return home or be admitted to hospital

Answer 78

Patient identifiers Planned procedure Operative side/site NPO status Allergies Diagnostic test results Current medications Blood products available Patient mobility issues Family contact information

Answer 79

Current condition on airway, breathing, and circulation Type of anesthesia administered Procedure performed Any surgical issues/complications and corrective actions taken Skin condition Pressure injury risk Hypothermia status Estimated blood loss Input and output Presence and location of drains, wound packing

Answer 80

Surgeon’s view is obstructed → longer Sx times Blood replacement therapy and associated risks →multiple organ failure, SIRS, TRALI, increased risk for infection and mortality Hypothermia and associated coagulopathies → as temp nears 34C (93.2F) platelets do not stick to each other as well Altering pharmacodynamics of anesthesia Hypothermia and acidosis reduces thrombin generation due to altered function of enzymes. Low O2 levels and Cl- in fluids contribute to acidosis Aggressive fluid resuscitation can cause hemodilution decreasing O2 carrying capacity and diluted coagulation factors/ platelets Progressive coagulopathy leads to further hemorrhage and shock Thrombocytopenia can occur to massive blood loss Hypovolemic shock may occur → reduces cardiac output and affects pulmonary gas exchange

Answer 81

1. Decrease and control bleeding 2. Minimize the need for blood replacement 3. Optimize the surgical field view 4. Avoid major organ damage 5. Shorten the length of surgery and length of facility stay 6. Decrease the risk of infection 7. Decrease health care costs for patients and facilities

Answer 82

Inspect surgical drapes, suction canisters, sponges Weigh surgical sponges Monitor lab values Circulator and scrub can help by: Communicating amount of irrigation solution used during Sx for accurate I&O Place used sponges in visible location

Answer 83

Hold pressure Electrosurgery or energy generating devices Suturing and ligating Trad methods are usually mechanical, chemical (pharmaceutical), or Thermal (energy)

Answer 84

Direct pressure → applied with surgical sponges Sutures, staples, clips → Pressure or ligation will stop bleeding Dressings → Placed once Sx is complete

Answer 85

Small V-shaped devices placed around lumen of vessel ## Footnote **Countable item**

Answer 86

* used to promote hemostasis * ignition source * include: * Lasers * Monopolar Electrosurgery device * Ultrasonic Devices * Bipolar electrosurgery devices * Vessel sealing devices

Answer 87

Epinephrine → A hormone that causes direct vasoconstriction and increases HR Vitamin K → administered preop to reverse warfarin Protamine → Heparin reversal agent Vasopressors → (Desmopressin) Administered preop to patients with hemophilia A

Answer 88

Used when Trad methods fail or are impractical Requires physician’s order Not medications and not intended for IV use

Answer 89

Topicals can be divided into 4 categories: * Mechanicals (Passive hemostatic agents) → collagen, cellulose, gelatin, polysaccharides * Actives → Thrombin products * Flowables → Thrombin + Gelatin * Fibrin Sealants → Thrombin + Fibrinogen

Answer 90

Aka Adhesives (glues tissue together): * Cyanoacrylates * Synthetic Skin sealants * Tissue sealants * Glutaraldehydes * PEG polymers

Answer 91

Some patients may have allergies to sealants Cultural beliefs may limit use of some products Some products may be limited in use of some pt populations Topical products may have requirements for transport, storage, handling, and disposal Product may only be good for specific amount of time

Answer 92

Allergies to hemostatic agents, bovine, porcine products Active prescriptions Is patient taking anticoagulants, antiplatelets, aspirin, NSAIDS? Taking vitamin E, bilberry, ginkgo biloba, garlic, ginseng, fish oil, grape seed extract, dandelion root, saw palmetto, and quinine → increased bleeding time Results of coag profile Hx bleeding gums, easy bruising, excessive superficial bleeding, severe nosebleeds Anemia? Hx of renal/hepatic dz Proposed Sx procedure Blood products ordered? Has pt expressed cultural, ethical, or religious beliefs against blood or blood product use?

Answer 93

⭐ **Thrombin** is the principal enzyme for hemostasis ⭐

Answer 94

Only sponges with radiopaque indicator should be used during Sx Different sponges have different uses during Sx, (ex. Packing, removing blood from field) All sponges must be accounted for before procedure, during procedure, and before closing wound

Answer 95

Laps X-ray detectable 4x4 Surgical peanuts Cottonoids Tonsil sponges

Answer 96

Room survey → check for open countable items from previous Sx before next case “Reset” count boards and sheets prior to new case Initiate count View items while counted Record count items in a visible area Record instrument counts on preprinted count sheets If item is passed or dropped from sterile field put on gloves, show it to scrub, isolate it from field, and include it in final count. Ask team members if any items will be needed before closing count Separate and point out items off of sterile field while audibly counting Participate in count reconciliation Report discrepancies Document counts

Answer 97

Maintain sterile field according to P&P Maintain awareness of the location of each countable item on sterile field and in the Pt. Know function configuration of all medic devices used during procedure Verify integrity and completeness of items returned from surgical site Consult with surgeon whether supplies will be needed before closing count Count audibly and point out items on sterile field (SF) so circulator can see Speak up when discrepancy occurs Participate in count reconciliation

Answer 98

Plan anesthetic milestones (induction and emergence) to allow for proper counting Tell team when bite blocks, throat packs, and other devices inserted in oropharynx, nose, or nasopharynx Verify removal of above listed items and communicate to team when removed

Answer 99

before the patient enters the room

Answer 100

1. Sponges on or in the patient 2. Mayo stand 3. Back table 4. Kick bucket 5. Pocketed sponge bag

Answer 101

If count is interrupted, restart count for item type that was being counted

Answer 102

During the initial count and when adding items to the SF, count packaged items according to the number in which the item is packaged Verify the package contains # of items on label

Answer 103

Exclude them from the count Remove them from the field Isolate them from the rest of the countable items in OR

Answer 104

Immediately after each type of item is counted On a standardized template In a location that is visible to the surgical team In agreement with the scrub person

Answer 105

Count items immediately Record item and number added on the count board in a standardized format as defined by the health care organization Verify # with scrub

Answer 106

account for items in use and perform structured handover communication of accounting procedures

Answer 107

Perform complete count when there is permanent relief of the RN circulator or scrub person Account for all items → even those not seen

Answer 108

Do not perform counts or actions requiring counts (breaks) during critical moments (time outs, critical dissections, confirming and opening implants, induction and emergence, care and handling of specimens)

Answer 109

Do not remove counted items from room until counts complete and reconciled Do not remove linen and waste containers from the room until all counts are completed and reconciled and pt has been transported from room

Answer 110

Do not consider final count complete before all items removed from patient and returned to scrub

Answer 111

use radiopaque and count them Inspect vagina for radiopaques following vaginal procedures

Answer 112

Do not use Radiopaques for dressings unless it is left in wound intentionally

Answer 113

Do not use regular towels in surgical wound

Answer 114

Hold non-radiopaque sponges from field until surgical incision is closed and final count complete

Answer 115

Leave portion of radiopaque outside of wound to visualize if possible

Answer 116

Place sponges in kick bucket or pocketed holder, show scrub sponges that fall before placing in holder

Answer 117

Document # and type if possible Compare items removed to items that were charted as packing in prior case Isolate removed sponges and do not include in counts for procedure Surgeon should thoroughly explore wound and order X-ray Remove packing before final closure

Answer 118

Count all sutures regardless of size or procedure

Answer 119

Account for sharps and misc. Items used in the surgical wound in their entirety immediately after removal Notify perioperative team if broken or separated item is returned from surgical site Immediately attempt to locate and retrieve item Remove free clips from abd cavity when possible

Answer 120

Account for preparation sticks used in vaginal antisepsis

Answer 121

Count all instruments for open cases (eg, thorax, abd) Count instruments when sets are assembled for sterilization Do not consider the final count complete until instruments used to close wound are removed and returned to scrub Account for individual pieces of instruments Inspect instruments for all removable parts, breakage, fragmentation immediately on instrument’s removal Keep all counted instruments in room until all counts complete Standardize instrument sets

Answer 122

Inform team → team should acknowledge type and # missing Call for assistance Search room Recount with scrub

Answer 123

Organize SF Search SF including drapes and tables Recount with circ.

Answer 124

Suspend closure of wound if possible Perform a methodical wound exam Participate in attaining intraop x-rays Remain in room until item is found or determined not to be in pt

Answer 125

No breaks or relief until count is resolved Do not use empty packages to resolve count discrepancies When missing item is found recount item type If missing item is not recovered request x-ray, if unstable then obtain imaging ASAP once stable Document unresolved counts Description and location of item if known All measures taken to recover Patient notification and consultation Plan for f/u care \*Inform EVS and next team in room of discrepancy \*

Answer 126

Types of counts items counted Number of counts Names and titles of personnel performing counts Results of counts (eg correct, incorrect) Verification of removal and integrity of items Surgeon notification of count results Explanation for waived counts Number and location of any instruments/items intentionally remaining with patient as packing Actions taken for discrepancies Rationale if counts were not performed or completed as prescribed by P&P Outcomes of actions taken

Answer 127

Never events

Answer 128

Sutured in place and dressed with gauze 4x4 split dressing and 4x4s Connections secured with plastic zip ties at end of procedure

Answer 129

Type Size Serial # Location Description and amount of drainage Functionality → was it working when pt left OR?

Answer 130

applied directly over wound; usually nonadherent

Answer 131

cover primary dressing (eg 4x4 gauze sponges, abd pads, perineal pads)

Answer 132

Dressings may be secured with soft gauze rolls, elastic bandages, and tape

Answer 133

* Sterile single-use wound dressing consisting of a single cotton gauze strip impregnated with formulated Iodoform solution that are packaged in HDPE amber-colored jars. They are primarily used for sterile drainage of open and/or infected wounds. * Iodoform is the organoiodine compound with the chemical formula CHI₃. A pale yellow, crystalline, volatile substance, it has a penetrating and distinctive odor and, analogous to chloroform, sweetish taste. It is occasionally used as a disinfectant.

Answer 134

Flexible and allows for swelling post op → cast may be applied after swelling subsides

Answer 135

Type of dressing material and device used to secure it (eg tape, elastic bandage, wrap) Ointments/meds Location of dressing or packing Immobilization devices Elevation of limb, if applicable and equipment used (eg pillows) CMS (circulation, motion, and sensation) checks of affected extremity Functionality of a devices part of dressing

Answer 136

Specimen name, body location, tissue type, and side of body Correct spelling of anatomical parts Requested pathology exam Date and time specimen collection Electronic health records may include several of the necessary components that the RN circulator fills out with the specific details

Answer 137

* Handle the specimen as little as possible * Keep the specimen moist * Cover the specimen or place it into a container * Label the covered or contained specimen * Protect the specimen in a secure location on the back table or other sterile field location

Study Guide Questions Flashcards

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