Midterm Week 4 (Effective Management of Surgical Instrumentation)

Question 1

Main Nursing Diagnosis

Answer 1

Risk for injury/infection rt surgical instrumentation

Question 2

Potential injury can include (3)

Answer 2

• Tearing of tissue
• Retention of a foreign body (part of instrument that breaks off inside pt)
• Infection or foreign body reaction from improperly cleaned/sterilized instrument

Question 3

Patient Outcome

Answer 3

Free from S/S of INJURY/INFECTION

Question 4

Where are most surgical instruments made/manufactured?

Answer 4

Germany

Question 5

Majority of surgical instruments made of?

Answer 5

Stainless steel**

Question 6

High quality stainless steel = (3)

Answer 6

= resists rust and corrossion, good tensile strength (amount of pressure it can withstand) and maintains keen edge

Question 7

Is stainless steel totally stainless?

Answer 7

No, although stainless steel resists corrosion and staining, over time and with repeated use, some spotting and/or staining will occur

Question 8

3 common types of instrument Finish

Answer 8

1) Bright highly polished/shiny/mirror
2) Stain or Dull
3) Ebony

Question 9

What is the most common finish?

What is the least common finish?

Answer 9

Bright highly polished/shiny/mirror

Ebony

Question 10

Bright highly polished/shiny/mirror =

Answer 10

= Resists surface corrosion, shiny and reflects light, which can distract surgeon or obscure visibility. Most common finish

Question 11

Stain or Dull =

Answer 11

= More susceptible to corrosion but eliminates glare

Question 12

Ebony =

Answer 12

= Black in color and also elminates glare. Black surface is useful in laser surgery to prevent reflection of laser beam. Least common finish

Question 13

Other Types of Finish (3)

Answer 13

1) Titanium instruments
2) Extra Finish (Gold)
3) Electrosurgery isolated instruments

Question 14

Titanium instruments =

Primarily used for what types of surgery?

Answer 14

have a bluish finish. Stronger and lighter than stainless steel and more corrosion resistant.

Microsurgical (neurosurgery) bc tend to be very delicate

Question 15

Nursing Responsibilities rt surgical instrumentation

• Proper ___ and _____ → pt safety
• Scrub nurses → setting up for surgery, adequately prepared, functioning properly
• Loaner instruments (ie. orthopedic) ->

Answer 15

• care and handling -> pt safety
• setting up for surgery, adequately prepared, functioning properly
• always be inspected, inventoried, cleaned, packaged and sterilized in-house before use

Question 16

Types of Instruments (5)

Answer 16

1) Dissecting Instruments
2) Clamps
3) Grasping Forceps
4) Retractors
5) Suction

Question 17

Dissecting Instruments (2)

Answer 17

Scalpels, Scissors

Question 18

Scalpels =

• The handle has a ____ at the tip for attaching the blade → makes it possible to?
• How to pass a scalpel?
• What should you do when replacing dull blades?

Answer 18

= consists of a handle and a blade

• grove -> change blades as needed
• Hands free technique: only one person touching sharp at one time, using emesis basin to transfer
• just make sure to count

Question 19

Scissors =

Answer 19

= many shapes and styles (most general surgery uses mayo and metzenbaum)

Question 20

Mayo Scissors =

2

Answer 20

= straight or curved tip (heavier than metzenbaum)

Curved Mayo → to cut heavy, tough tissue
Straight tip Mayo → to cut sutures, gauze, disposable drape

Question 21

Metzenbaum Scissors =

Answer 21

= rounded tip, more delicate than Mayo used for → delicate tissue

Question 22

Clamps =

Finger rings:
Shafts:
Joints:
Ratchet:

Answer 22

= to hold tissue

• for holding instrument
• of varying length
• joins two halves of instrument and permits opening and closing
• at proximal end for locking instrument closed or partially closed

Question 23

Types of Clamps (4)

Answer 23

1) Hemostatic Clamps
2) Noncrushing Vascular Clamps
3) Occluding Clamps
4) Grasping & Holding Clamps

Question 24

Hemostatic Clamps =

Answer 24

= (hemostats) to control bleeding, the clamping jaws of instrument are horizontally serrated → allows clamp to compress vessel with enough force to stop bleeding

Question 25

Noncrushing Vascular Clamps

Answer 25

= to occlude vessel without crushing it, jaws of these have opposing rows of fine serration

Question 26

Occluding Clamps =

Answer 26

= used to clamp tissue (ie. bowels)

Question 27

Grasping & Holding Clamps =

Answer 27

= for retracting tissue, aids during dissection and suturing

Question 28

Grasping Forceps (pickups)

Toothed forceps =
Nontoothed forceps =

Answer 28

to lift and hold tissue (think tweezers) have two arms and spring

= to hold thick tissue
= holds more delicate tissue and cause minimal trauma (ie. addisons)

Question 29

Retractors =

Answer 29

= to facilitate visualization of operative field while preventing trauma to surrounding tissue (ie. Deavers, Army-Navys, Malleables)

Question 30

Suction =

Answer 30

= to remove blood and other fluids from operative field (ie. frazier, yankauer, poole)

Question 31

Cleaning of instruments starts when? with what?

Answer 31

= instruments contaminated with blood, body fluids, or tissue should be rinsed or wiped with a sponge/lap and irrigated with a syringe during and immediately following the procedure with STERILE WATER*

Question 32

What happens when instruments are cleaning during the procedure?

Answer 32

= blood or other debris dry on instrument, it can harden in joints and become trapped in lumens or serrations or between scissor blades → causing malfunction, rusting and pitting and make final cleaning more difficult

Question 33

Ultrasonic Cleaners =

Answer 33

= used to move debris once it gets down to central sterile processing → by generating ultrasonic waves to make tiny bubbles that collapse or implode creating tiny vaccums that pull soil from the instrument

Question 34

Who are the experts when it comes to cleaning/sterilization?

Answer 34

Central Sterile Processing

Question 35

All instruments should be handled and cleaned according to what?

Answer 35

manufactures instructions

Question 36

General Guidelines for Care and Cleaning

1) Instruments used for?
2) During use, kept clean by wiping and frequent rinsing in?
3) Instruments handled how?
4) Should not be?
5) How to stack instruments?
6) Opened instruments are considered?
7) All hinges and joints should be?
8) All instruments with removable parts are?
9) What kind of detergent should you use?
10) During manual cleaning, use only what to clean serrations and joints?
11) Only ____-____ lubricants

Answer 36

1) only for purpose for which they are designed
2) sterile water
3) gently, individually or in small lots
4) tossed
5) Lighter more delicate placed on top of heavy
6) whether or not was used are considered contaminated → must be decontaminated
7) opened to expose box locks and serrations where blood and debris may be concealed
8) disassembled for lceaning
9) non-corrosive, low sudsing, free-rinsing detergent with as neutral pH as possible
10) only soft brushes to clean serrations and joints
11) water-soluble

Question 37

What happens to an instrument if it fails inspection?

Answer 37

Failed inspection inspected by scrub person just prior to surgery → removed and sent to repair

Question 38

Inspection should include but is not limited to

1) Clamps, scissors, forceps checked to ensure that tips are ____ and _____
2) Ratchest, joints, hinges must ___, close ____, hold ____
3) Box locks inspected for ____ and _____
4) All instruments inspected for (3)
5) Needle holders should?
6) All parts of instrument _____ and ____

Answer 38

1) even, approximate
2) move, close easily, hold firmly
3) cracks, looseness
4) chips, nicks, dents
5) hold needle securely without slipping/rotating
6) present and intact