Nrs 120-Week 2

Front 1

1) Who is a person in the scrub role. What do they do?

2) What does a circulating nurse do?

3) Name several risks related to surgery (during intra op period)

4) Who is the patient advocate as surgery proceeds?

Pg 421

Back 1

1) either a nurse or a surgical technician. This person provides sterile instruments and supplies to the surgeon during the procedure by anticipating the surgical needs as the case progresses. "supplies person"

2) "coordinator"- coordinates care of person in the OR. works in collaboration w/ healthcare team to plan best course of action for pt.

3) Infection, failure of surgery, complications (temporary or permanent) of anesthetic agents and death. Additionally, sedation and anesthetic agents can cause losses in cognitive function and biologic self protective mechanisms. Loss of sense of pain, reflexes, and the ability to communicate subjects intraoperative to possible injury.

4) OR nurse

Front 2

1) Name some reasons why older adults are at a high risk for complications from anesthesia and surgery.

2) anesthetic agents: more or less required in older adults? Why?

pg 422

Back 2

1) progressive loss of skeletal muscle mass in conjunction w/ increase in adipose tissue. comorbidities, advance systemic disease, and increased susceptability to illness. Age alone is a clinical predictor of cardiovascular complications. Also, cardiopulmonary changes (heart and blood vessels have decreased ability to respond to stress). reduced cardiac output and limited vol. and blood level o2. rapid/excessive IV=pulmonary edema. sudden prolonged/decline in BP= cerebral ischemia, thrombosis, embolism, infarction and anoxia. reduced gas exchanged=cerberal hypoxia. Also, lower metabolism=risk for hypothermia. bone loss=careful need during positioning. reduced ability to adapt to stress

2) less. anesthesia is more potent b/c decreased tissue elasticity (lung and cardiovasc system) and reduced lean muscle mass. older adults feel more of the effects of medicine b/c of decreased plasma protein carrying less of the agent while more of the agent remains free in blood.

Front 3

1) name some patient advocate interventions nurses perform during intraop period.

2) name an intraop cultural consideration for muslim/jews and buddhist

3) name some duties of circulating nurses

4) who leads the team debriefing session?

pg422

Back 3

1) monitor factors that have potential to cause injury such as patient position, equipment malfunction, environmental hazards. protect patient dignity and interest while pt is under anesthesia. maintain surgical standards of care. identify and minimizing risk of complication

2) mulsim jews cannot use porcine products. buddhits bovine. heparin can be porcine or bovine

3) manages OR, protects pt by monitoring the activities of surgical team, check OR conditions, assess pt for signs of injury. also VERIFYING CONSENT, monitors the environment, monitors asceptic techinque, fire prevention, documents activity, etc. This is a leadership role

4) circulating nurse

Front 4

1) Who is qualified for scrub role? What are some activities scrub role performs?

2) Tissue specimen: who obtains them during surgery and labels them?

3) What does a registered nurse first assistant do (responsibilities)?

4) What are the three zones in surgical area?

pg 424

Back 4

1) rn, lpn, or surgical technologist assistant. perform surgical hand scrub, setting up sterile table, prepare sutures, ligatures and special equipment. hand over surgical equipment. count all needles, sponges, and instrument

2) labeling- scrub role; labratory-circulating nurses

3) handling tissue, providing exposure at operative field, suturing, maintaining hemostasis.

4) unrestricted zone (street clothes allowed, semirestricted (scrib clothes and caps), restricted (scrub clothes, shoe covers, cap, and masks). (Think about the practical implications of wearing each of these materials in some scenarios).

Front 5

1) how is hair removed during surgery?

2) what part of the gowns (of the surgical team) are considered sterile?

3) What part of sterile drapes are considered sterile?

4) what are the movements of surgical team in regards to observing sterile field?

Back 5

1) with clippers. its not shaved.

2) front (from the chest to level of sterile field). Sleeves must also be 2 inches above elbow

3) only the top surface of a draped table is considered sterile.

4) from sterile to sterile areas and unsterile to unsterile area.

Front 6

1) What is the definition of anesthesia?

2) What is general anesthesia?

3) What is anesthesia awareness? What are some risk factors?

4) name the 4 stages of anesthesia. list what happens during each stage.

5) When possible anesthesia induction (initiation) begins via ____ and mantained at desired stage by____

Back 6

1) a state of narcosis (severe CNS depression produced by drugs), analgesia, relaxation and reflex loss

2) pts under general anesthesia are not arousable (even to painful stimulii). Lose ability to maintain vent. function and require assistance in maintaining and patent airway. cardio vasc impairment as well.

3) its when pts are awake while under general anesthesia. risks factors are for obstetric, cardiac, and major trauma pts.

4) beginning anesthesia, excitement, surgical anesthesia, medullary depression (see pg 427 for reactions).

5) IV, inhalation.

Front 7

Defintion of: pg 429-433 (not incl in readings???)

1) reigional anesthesia

2) spinal anesthesia

3) epidural anesthesia

4) monitored anesthesia care

5) local anesthesia

6) moderate sedation

Back 7

1) anesthesia injected around nerves so that the reigon supplied by these nerves is anesthetizedl

2) achieved by injecting a local anesthetic agent into the epidural space that surrounds dura mater. meds diffuse across layers of spinal cord to provide anesthesia and pain relief

3) extensive conduction nerve block into subarachnoid space at L4 and L5. provides anesthesia to lower extermities, perineum and lower abd.

4) moderate sedation that may convert into general anesthesia

5) injection of anesthesia into the tissue of plan incsion site.

6) "conscious sedation". depresses a pt consciousness to a moderate level to enable procedure while ensuring pt comfort. pt is moderately conscious here. used to reduce pain and anxiety.

Front 8

1) Which is the only type of anesthesia meant to create a state of oblivion (complete unawareness)?

2) What is the difference between anesthesia awareness and simply being

aware during surgery due to certain types of anesthesia?

3) what intervention is performed when patient starts gagging (n/v) during intrap op period?

4) antiemetics, why are they delivered pre/intraoperatively? It's b/c N/V causes____.

Back 8

1) general anesthesia. all other anesthetics will eliminate pain but sensations of pulling and converstations may be heard during surgery. this is normal. This is not anesthesia awareness.

2) anesthesia awareness is unintended intraoperative awareness while under general anesthesia and then recalling the incident.

3) pt is turned to side, head of table lowered, basin provide to collect vomit. suction is used to remove saliva and vomited gastric contents.

4) risk for aspiration. n/v --> aspiration-->bronchial spasm/wheezing--> pneumonitis pulmonary edema--> extreme hypoxia

Front 9

1) What drugs are administered to control volume/acidity of aspirate of gastric contents (via n/v) during surgery?

2) What are s/s of latex allergies?

3) a pt states she is allergic to latex. She is wearing latex clothing and not responding allergically. How must treatment be performed?

4) What are some surgical products to look out for in regards to latex allergies?

Back 9

1) citric acid and sodium citrate (bicitria) are antacids to increase gastric PH. H2 receptors antagonists such as cimetidine (tagament), rantidine (zantic) or femotidine (pepcid) decrease gastric acid production

2) uticaria, asthma, rhinoconjucntivitis, and anaphylaxis.

3) Treatment must be latex free regardless.

4) fibrin sealants. also cyanoacrylate tissue adhesives (used to clothes wounds w/out use of sutures).

Front 10

1) name some potential intra op complications

2) anesthesia are associated w/ these basic complications.

3) What factor causes hypothermia during the intra op period? What other complications can hypothermia lead to?

pg 435

4) How is hair removal performed during surgery?

Back 10

1) anestheisa awareness, n/v, anaphylaxis, hypoxia, hypothermia, and malignant hypothermia

2) hypothermia and respiratory depression (which can also lead to aspiration)

3) anestheisa can cause hypothermia. during hypothermia metabolic acidosis may develop b/c glucose metaboism is reduced (??)

4) "using clippers to remove hair from surgical site as needed instead of shaving the site is recommended" pg 438

Front 11

1) What is malignant hyperthermia caused by during intra op period?

2) Who is susceptible?

3) What is the general patho behind it?

4) what are clinical manifestation?

5) What are the goals of treatment?

(pg 436-437)

Back 11

1) it is rare inherited muscle disorder chemically induced by anesthetic agents. also can be triggered by myopathies, emotional stress, heatstroke, neuroleptic malignant syndrome, strenuous exercise exertion, and trauma.

2) ppl w/ strong bullky muscles, h/o muscle cramps/weakness and unexplained temp elevation and unexplained death of family member during surgery that was accompanied by febrile response.

3) hypermetabolic condition that involves altered mechanism of ca function in skeletal muscle. interruption of ca causes hypermetaboism--> muscle contraction (rigidity)--> hyperthermia--> CNS damage

4) tachycardia, sympathetic stimulation-->dysrhythmia, hypotension, decreased cardiac output, oliguria, cardiac arrest. rigidity, tetanus like movement (mostly jaw). initial sign is generalized rigidity. core body temp exceeds 107 (increases 2-4 F every 5 min).

5) decrease metabolism, reverse met. and resp acidosis, correct dysrhythmia, decrease body temp, provide o2 and nutrition to tissue. correct electrolyte imbalance.

Front 12

List what these surgical positions most commonly used for. Describe them. Think about any misc info:

1) dorsal recumbent

2) trendelenburg/reverse trendelenbur

3) lithotomy

4) sims or lateral position

(pg 436-437)

Back 12

1) flat on back w/ arms stretched out (to facilitate IV's ettc.). usual position for surgery. used most for abd surgeries

2)decline position supported by padded shoulder brace. arms stretched. surgery of lower abd and pelvis to obtain good exposure by displacing the intestine into upper abd. Reverse trend-operate on upper abd by displacing intestines downward into pevlis

3) perineal, rectal, and vaginal surgery. remember that hips extend over edge of table

4) used for renal surgery. pt. placed on NON-OPERATIVE (unaffected side) w/ airpillow under loin.