Perioperative Care: Intraoperative 2 Of 3 (Nac1)

Front 1

(def)

a controlled environment designed to minimize the spread of infectious organisms and allow a smooth flow of patients, personnel, and the instruments and equipment needed to provide care

Back 1

surgical suite

Front 2

What are the 3 distinct areas of the surgical suite?

Back 2

- unrestricted
- semirestricted
- restricted

Front 3

Which area of the surgical suite?

Personnel in street clothes can interact with those in scrub clothes

Back 3

unrestricted

Front 4

Which area of the surgical suite?

typically includes the points of entry for patients, staff, and information

Back 4

unrestricted

Front 5

Which area of the surgical suite?

peripheral support areas and corridors; only authorized personnel are allowed

Back 5

semirestricted

Front 6

True/False:

All personnel in the semirestricted areas must wear surgical attire and cover all head and facial hair.

Back 6

True

Front 7

Which area of the surgical suite?

Surgical attire must be worn. Head and facial hair must be covered and masks must be worn.

Back 7

Restricted

Front 8

What is the holding area?

Back 8

a special waiting area inside or adjacent to the surgical suite

Front 9

In what location does the perioperative nurse make the final ID and assessment before the patient is transferred into the OR for surgery?

Back 9

the holding area

Front 10

What is considered the central "clean" area in a surgical setting?

Back 10

the patient's incision site

Front 11

Ideally, the operating room is adjacent to what other units?

Back 11

PACU and the surgical intensive care unit (allows for close monitoring by anesthesia personnel if complications arise)

Front 12

List some of the methods used in the OR setup to prevent the transmission of infection. (3)

Back 12

- filters and controlled airflow (for dust control)
- positive air pressure to prevent outside air from entering the OR
- materials resistant to strong disinfectants are used

Front 13

(def)

a registered nurse who implements patient care during the perioperative period based on the nursing process

Back 13

perioperative nurse

Front 14

If a perioperative nurse is not scrubbed, gowned, and gloved and remains in the unsterile field, the _______ ___ ________ is implemented.

Back 14

function of circulating

Front 15

If a perioperative nurse follows the designated scrub procedure, is gowned and gloved in sterile attire, and remains in the sterile field, the _______ ___ ________ is implemented.

Back 15

function of scrubbing

Front 16

In addition to the RN, many institutions employ what other 2 professionals for the scrubbed function (assists the surgeon, passes instruments, other technical functions)?

Back 16

- LPN
- Surgical Tech

Front 17

The surgeon is primarily responsible for what 3 things regarding the surgical procedure?

Back 17

1. preoperative med history and physical assessment, need for surgery, procedure, preoperative workup, and discussion with the patient
2. patient safety and management in the OR
3. postoperative management of the patient

Front 18

True/False:

A RN or nonphysician can function in the role of a surgical assistant, and in some instances even perform some aspects of the surgery.

Back 18

True- this person is under the direct supervision of the surgeon; additionally, each institution defines this role.

Front 19

Define the role of a RNFA and list 5 responsibilities in this position.

Back 19

A RNFA (registered nurse first assistant) works in collaboration with the surgeon to produce an optimal outcome for the patient.

- handles tissue
- uses instruments
- providing exposure to the surgical site
- assists with hemostasis
- sutures

Front 20

The CRNA scope of practice includes what responsibilities? (10)

Back 20

- performing and documenting preanesthetic assessment and evaluation
- developing and implementing an anesthetic plan
- selecting and initialing the planned technique
- selecting, obtaining, and administering the anestheisa, adjunct and accessory drugs and fluids
- selecting, applying and inserting monitoring devices
- managing airway and pulmonary status
- managing emergence and recovery from anesthesia
- d/c patient from PACU
- ordering, initiating , or modifying pain relief therapy
- responding to emergency situations

Front 21

The nurse is caring for a 32 year old female who lists her religion as Jehovah's Witness. The nurse recognizes that this patient may object to what possible surgical intervention?

Back 21

blood transfusion

Front 22

The nurse is caring for a 43 year old male who identifies himself as Muslim. What special consideration should the nurse make when giving the patient forms or administering medication to this patient?

Back 22

The nurse should use her right hand. In Muslim culture, the left hand is considered dirty.

Front 23

During which phase of perioperative care is a full physical assessment, including history, performed?

Back 23

the preoperative phase

Front 24

True/False

Required chart data is standard from institution to institution.

Back 24

False- Required chart data varies with policy, patient, and/or specific procedures.

Front 25

What is the purpose of complementary therapies for surgical patients, such as music therapy, guided imagery, aromatherapy, etc.?

Back 25

- may decrease anxiety, promote relaxation, reduce pain, and accelerate the healing process

Front 26

What are some examples of things done to prepare the OR for surgery?

Back 26

- check all equipment
- use aseptic technique and place tools in systematic order on table
- place and count sponges, needles, etc

Front 27

Who is responsible for maintaining and monitoring aseptic practice and initiating corrective action when the field is compromised?

Back 27

Every person on the surgical team

Front 28

Surgical hand _______ is required of all sterile members of the surgical team.

Back 28

antisepsis

Front 29

What are inanimate items in the sterile field?

Back 29

surgical items and equipment that have been sterilized by appropriate sterilization methods

Front 30

All materials that enter the sterile field must be ________.

Back 30

sterile

Front 31

True/False:

If a sterile item comes in contact with an unsterile item, it is contaminated.

Back 31

True

Front 32

What should be done if a sterile item becomes contaminated?

Back 32

it should be removed from the sterile field

Front 33

A nurse is assisting a surgeon in the OR. The nurse understands that once dressed for the procedure, the only parts of the gown considered sterile are what?

Back 33

the front from chest to table level and the sleeves to 2 inches above the elbow

Front 34

What part of a table is considered sterile in the OR?

Back 34

only the tabletop level (anything extending beneath this is considered contaminated)

Front 35

True/False:

The edges of a sterile package are considered contaminated once the package has been opened.

Back 35

True

Front 36

Why are excessive air movements and currents avoided in the OR?

Back 36

b/c bacteria travel on airborne particles and will enter the sterile field with excessive air movements

Front 37

Why are moist fabrics avoided in the OR?

Back 37

b/c bacteria travel by capillary action through moist fabrics

Front 38

Is is ever possible to remove all bacteria from an OR?

Back 38

No, bacteria harbor on the patient and team members' hair, skin and respiratory tracts. They must be confined by appropriate attire.

Front 39

What knowledge must a nurse in the OR have regarding the anesthesia a patient is receiving?

Back 39

- the nurse should understand the mechanism of action and effects of the anesthesia
- the nurse should know the location of emergency drugs and equipment in the OR

Front 40

Who functions as a communicator between the ACP/surgeon and ancillary departments (such as the lab or blood bank)?

Back 40

the circulating nonsterile perioperative nurse

Front 41

What are 2 risks associated with laser procedures?

Back 41

- respiratory irritations from smoke particles *these particles are known to have mutagenic and carcinogenic potential as well*
- risk for burns

Front 42

What is the "universal protocol" and who developed it?

Back 42

Developed by JCAHO, universal protocol is a surgical time-out just before the procedure is started to verify patient identification, surgical procedure, and surgical site.

Front 43

The position of the patient during surgery should allow for what 3 things?

Back 43

- access to the operative site
- administration and monitoring of anesthetic agents
- maintenance of the patient's airway

Front 44

What (6) guidelines should be followed when positioning a patient for surgery?

Back 44

1. provide correct skeletal alignment
2. prevent undue pressure on nerves, skin over bony prominences, and eyes
3. provide for adequate thoracic excursion
4. prevent occlusion of arteries and veins
5. provide modesty in exposure
6. respect individual needs such as aches, pains, or deformities

Front 45

What is the most common surgical position used?

Back 45

supine

Front 46

General anesthesia causes peripheral nerves to dilate. The nurse understands that this has an impact on positioning why?

Back 46

b/c blood can pool due to vessel dilation. The areas where the blood pools depends on the patient's position.

Front 47

What is the purpose of skin preparation, or "prepping"?

Back 47

to reduce the number of organisms available to migrate to the surgical wound

Front 48

The task of prepping is usually the responsibility of whom?

Back 48

the circulating nurse

Front 49

When "prepping" the surgical site, the areas is scrubbed with an antimicrobial agent in a circular motion from ______ to ______.

Back 49

inside to outside (or site of incision to periphery.

Front 50

What area is left exposed after cleaning and draping the patient for surgery?

Back 50

only the site to be incised

Front 51

The patient's response to nursing care is evaluated by the OR nurse based on what?

Back 51

outcome criteria established during the development of the patient's plan of care

Front 52

The anesthetic technique and agents are selected by the ACP in collaboration with whom? Who is ultimately responsible for the choice in anesthetics?

Back 52

the surgeon and the patient, however the ACP is ultimately responsible

Front 53

What does it mean if an "E" is added to an anesthesia risk scale rating?

Back 53

that the procedure is an emergency deemed necessary to save life or limb

Front 54

What are the 4 levels of sedation and anesthesia? (give brief description of each)

Back 54

1. minimal sedation (patient responds normally)
2. moderate sedation/analgesia aka- conscious sedation (airway and cardiovascular function are maintained)
3. deep sedation/analgesia (patient is not easily aroused)
4. anesthesia (patient requires assisted ventilation)

Front 55

What level of sedation would be standard for a patient undergoing a colonoscopy?

Back 55

Moderate sedation/analgesia (aka- conscious sedation)

Front 56

What is a common combination of drugs used to provide moderate sedation?

Back 56

- an anxiolytic (ex. midazolam) and opioid (ex. fentanyl)

Front 57

True/False:

Conscious sedation, aka moderate analgesia, may be administered by personnel other than the anesthesiologists.

Back 57

True- under the direct orders of a physician

Front 58

A 58 year old man is undergoing a colonoscopy. The nurse is administering a mix of midazolam and fentanyl to achieve conscious sedation. The nurse understands that risks associated with this type of sedation are? (4)

Back 58

- airway obstruction
- respiratory depression
- hypoxia
- hypotension

**all can develop into clinical emergencies**

Front 59

What classification of anesthesia results in a loss of sensation with loss of consciousness?

Back 59

General Anesthesia

Front 60

What classification of anesthesia causes skeletal muscle relaxation?

Back 60

General Anesthesia

Front 61

What classification of anesthesia may possible impair ventilatory and cardiovascular function?

Back 61

General Anesthesia

Front 62

What classification of anesthesia may cause the elimination of somatic, autonomic, and endocrine responses, including coughing, gagging, vomiting, and sympathetic nervous system responses?

Back 62

General Anesthesia

Front 63

What classification of anesthesia is the loss of sensation without loss of consciousness?

Back 63

Local anesthesia

Front 64

What are the methods of administering local anesthesia? (3)

Back 64

- topically
- intracutaneously
- subcutaneously

Front 65

What classification of anesthesia causes the loss of sensation to a region of the body without loss of consciousness?

Back 65

regional anesthesia

Front 66

How does regional anesthesia work?

Back 66

blocks a specific nerve (or group of nerves)

Front 67

What are 3 examples of local anesthetic?

Back 67

1. spinal
2. epidural
3. peripheral

Front 68

General anesthesia is usually the technique of choice for patients in what 4 situations?

Back 68

1. having long duration surgery, or those that require control of respiration of skeletal muscle relaxation
2. are extremely anxious
3. refuse or have contraindications for local or regional anesthesia
4. are uncooperative for various reasons (emotional state, age, head injury, intoxication, head injury, pathophysiology)

Front 69

What are 3 methods of general anesthesia administration?

Back 69

- IV
- inhalation
- rectally

Front 70

Virtually all routine IV general anesthesia begins with what?

Back 70

IV induction agent

Front 71

A single dose of an IV induction agent lasts how long? What is done during this period?

Back 71

a single dose only lasts a few moments. During this time, an endotracheal tub is placed and an inhalation agent may be administered

Front 72

What is total IV anesthesia?

Back 72

general anesthesia where all medications are delivered IV, thus eliminating the need for inhalation agents

Front 73

True/False:

With total IV anesthesia, an endotracheal tube does not need to be implemented.

Back 73

False- endotracheal intubation may still be required for airway management

Front 74

The inhalation agents used for general anesthesia may be _______ _______ or ________.

Back 74

volatile liquids or gases

Front 75

Inhalation agents enter the body where?

Back 75

through the alveoli in the lungs

Front 76

What is the most undesirable characteristic of inhalation anesthesias?

Back 76

irritating effects on the respiratory tract

Front 77

What is the most common method of administering inhalation agents for general anesthesia?

Back 77

- endotracheal tube

Front 78

What are problems associated with endotracheal intubation? (5)

Back 78

- failure to intubate
- damage to lips, teeth
- laryngospasm
- larnygeal edema
- sore throat and hoarseness

Front 79

What are the 4 phases of general anesthesia?

Back 79

1. preinduction
2. induction
3. maintenance
4. emergence

Front 80

Drugs added to an inhalation anesthetic are termed what?

Back 80

adjuncts

Front 81

Adjuncts are added to the anesthetic regimen to achieve what? (5)

Back 81

- unconsciousness
- analgesia
- amnesia
- muscle relaxation
- autonomic nervous system control

Front 82

What are 4 types of adjuncts?

Back 82

- opioids
- benzodiazepines
- neuromuscular blocking agents (muscle relaxants)
- antiemetics

Front 83

The nurse is administering IV barbiturates as a general anesthesia. She understands that repeated doses of this medication may cause what?

Back 83

"hangover effect"

Front 84

The nurse is administering IV nonbarbiturate hypnotics. She understands that she will monitor the patient for what side effects of this medication? (5)

Back 84

- myoclonia
- nausea, vomiting, hiccups
- hypotension
- hypoglycemia
- plebitis

Front 85

The nurse is administering an inhalation volatile liquid. She understands that with this medication she will have to assess the patient for what? (5)

Back 85

- pain during early recovery
- cardiopulmonary depression
- hypotension
- respiratory depression
- nausea and vomiting

Front 86

A 56 year old female is undergoing a hysterectomy. The nurse is assisting the ACP in the OR. The nurse understands that the primary use of nitrous oxide is what?

Back 86

to potentiate volatile agents

Front 87

What type of postoperative environment is essential for recovery when a patient has been administered a dissociative anesthetic? Why?

Back 87

calm and quiet; drug is known to cause hallucinations and nightmares along with intracranial & intraocular pressure, increased HR, and hypertension

Front 88

Opioids are used as an adjunct to general anesthesia. What 3 effects are elicited when they are in use?

Back 88

1. induce and maintain anesthesia
2. reduce stimuli from nerve endings
3. provide analgesia during surgery and anesthetic recovery

Front 89

The nurse is administering an opioid as an adjunct to general anesthesia. She understands that what 4 nursing interventions should be in place when using this medication?

Back 89

1. assess respiratory status
2. monitor pulse oximetry findings
3. protect airway in anticipation of vomiting
4. use standing orders for antipruitics such diphenhydramine

Front 90

The nurse understands that the primary use of benzodiazepines as an adjunct to general anesthesia is what?

Back 90

- to induce and maintain anesthesia

Front 91

What 2 things should be monitored by the nurse when a benzodiazepine has been administered as an adjunct to general anesthesia?

Back 91

- cardiopulmonary status
- LOC

Front 92

The nurse understands that when a patient is given a neuromuscular blocking agent as an adjunct to general anesthesia she must monitor what?

Back 92

- respiratory rate and pattern until the patient is able to cough and regain muscle strength
- maintain a patent airway
- monitor temperature and muscle strength

Front 93

What should always be on hand when a patient is receiving a neuromuscular blocking agent?

Back 93

- depolarizing reversal agents
- respiratory support equipment

Front 94

The nurse understands that the primary use of antiemetics during surgery is what?

Back 94

to prevent vomiting during surgery

Front 95

What should be monitored in a patient receiving antiemetics as an adjunct to general anesthesia? (3)

Back 95

monitor cardiopulmonary status
monitor LOC
monitor ability to move limps

Front 96

Droperidol, an antiemetic, should be used cautiously in what type of patient?

Back 96

those with heart disease

Front 97

Changes in a patient's temperature has a great impact on the effects of what general anesthetic? Does an increase or decrease in temperature increase the action of this drug class?

Back 97

Neuromuscular blocking agents - increase in body temperature increases the effects

Front 98

The nurse is instructed to administer an antiemetic to a patient listed at risk for nausea and vomiting. The nurse understands that the most common risk factors are what? (5)

Back 98

- gender
- age
- smoking history
- history of motion sickness
- history of postoperative nausea

Front 99

How do local anesthetics work?

Back 99

by blocking the initiation and transmission of electrical impulse along nerve fibers

Front 100

What are 3 disadvantages of local anesthetics?

Back 100

1. discomfort with injections
2. inadvertent IV administration producing hypotension and potential seizures
3. inability to precisely match duration of anesthesia with the duration of surgery

Front 101

What are three methods for administering local anesthesia?

Back 101

1. topical
2. local infiltration
3. regional infiltration

Front 102

Topical agents, such as EMLA cream, should be applied to the skin ____ to _____ minutes before a surgical procedure.

Back 102

30 to 60 minutes

Front 103

Regional (peripheral) nerve block is achieved how?

Back 103

by the injection of a local anesthetic into or around a specific nerve or group of nerves

Front 104

What is local infiltration?

Back 104

the injection of an anesthetic into the tissue through which the surgical incision will pass

Front 105

What are 4 types of regional anesthesias?

Back 105

- peripheral nerve block
- IV regional block
- spinal anesthesia
- epidural anesthesia

Front 106

Spinal anesthesia involves the injection of a local anesthesia where?

Back 106

into the CSF found in the subarachnoid space, usually below the level of L2

Front 107

The nurse is assessing a patient who has received a spinal anesthesia. The nurse understands that she must specifically watch for what adverse reactions? (2)

Back 107

- hypotension and bradycardia due to the autonomic block
- inadequate breathing or apnea due to administration of too much medication

Front 108

An epidural block involves injection of a local anesthetic into where?

Back 108

the epidural space via thoracic or lumbar approach

Front 109

True/False:

An epidural block works by mixing with CSF to achieve anesthetic effects.

Back 109

False- a spinal anesthesia works in this manner. An epidural block works by binding to nerve roots as they enter and exit the spinal cord.

Front 110

Which has a faster onset of action, a spinal anesthesia or an epidural block?

Back 110

a spinal anesthesia (however the end result is similar in both)

Front 111

True/False:

Headaches are a common side effect of spinal anesthesias.

Back 111

True- the leakage of CSF at the injection site can lead to headaches

Front 112

A nurse is assisting in a surgical procedure in which the surgeon has ordered "controlled hypotension". The nurse understands that the primary purpose for this order is what?

Back 112

- to decrease the amount of expected blood loss by lowering the BP during the administration of anesthesia

Front 113

The nurse understands that cooling the body (inducing hypothermia) during surgery serves what purpose?

Back 113

- decreases metabolism, thus reducing both the demand for oxygen and the anesthetic requirements

Front 114

What is cryoanesthesia?

Back 114

cooling or freezing a localized area to block pain impulses

Front 115

True/False:

Anesthetic drugs should be carefully titrated when given to older adults

Back 115

true

Front 116

What are 4 possible signs of anaphylactic shock?

Back 116

- hypotension
- tachycardia
- bronchospasm
- pulmonary edema

Front 117

(def)

a rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death

Back 117

malignant hyperthermia

Front 118

What are the 2 most likely items that will cause anaphylactic reactions?

Back 118

latex and antibiotics

Front 119

What specific neuromuscular blocking agent is the primary trigger for malignant hyperthermia?

Back 119

succinylcholine (esp. in conjunction with other volatile agents)

Front 120

What are 4 symptoms seen in malignant hyperthermia?

Back 120

- tachycardia
- tachypnea
- hypercarbia
- ventricular dysrhythmias

Front 121

What is the definitive treatment of MH?

Back 121

dantrolene (Dantrium) administration, along with symptomatic support