Intraoperative patient care and safety pt. 4 Flashcards
(229 cards)
1
Q
What is perioperative asepsis (ie, aseptic/sterile technique)
A
a combination of techniques and protocols employed to prevent microorganisms from entering an open surgical wound or contaminated a sterile field during surgery
2
Q
What are 5 components of perioperative asepsis?
A
- performing surgical skin antisepsis
- wearing correct surgical attire
- performing hand hygiene and the surgical hand scrub
- gowning and gloving correctly
- maintaining the sterile field using aseptic technique, which includes preparing the sterile field, draping the surgical field, and moving within the sterile field
3
Q
What is the goal of perioperative skin antisepsis?
A
to reduce the risk of developing a surgical site infection by removing soil and transient microorganisms at the surgical site
4
Q
What are 2 other methods contribute to a reduction of microorganisms on the skin?
A
- preoperative bathing
- hair management
5
Q
What can also reduce transient microbes?
A
soap or antiseptic agent, such as CHG
6
Q
Where is hair removal most ideal?
A
Should be performed outside of the OR to limit the number of bacteria shed in the OR
7
Q
What should be used to remove hair at the surgical site?
A
an electric or battery-operated clipper or a depilatory
8
Q
What does using a depilatory require?
A
a pretest on a site removed from the surgical site to ensure that the patient does not have a skin reaction to the agent
9
Q
What is a consideration for hair removal with clippers?
A
should be performed with care to avoid nicking or cutting the underlying skin
10
Q
What can cuts or nicks in the skin cause?
A
may allow cutaneous bacteria to proliferate and contribute to a possible SSI
11
Q
What is the potential harm from providone-iodine antiseptics in patients with a burn?
A
repeated application leads to iodine absorption and possibly iodism
12
Q
What are 2 possible reactions from providone-iodine antiseptics in patients with a burn?
A
- induced hyperthyrodism
- metabolic acidosis
13
Q
What is the potential harm from providone-iodine antiseptics in patients with a thyroid disorder undergoing a thyroidectomy?
A
even a single application can result in iodism in patients with thyroid cancer or a goiter
14
Q
What are 2 possible reactions from providone-iodine antiseptics in patients with a thyroid disorder undergoing a thyroidectomy?
A
- intereference with radioactive iodine therapy
- thyroid dysfunction
15
Q
What is the potential harm from providone-iodine antiseptics in neonates?
A
neonates and premature neonates have increased skin permeability to iodine
16
Q
What is the potential reaction from providone-iodine antiseptics in neonates?
A
iodism that leads to either hypothyroidism or transient hypothyroidism
17
Q
What is the potential harm from providone-iodine antiseptics in women who are pregnant?
A
iodine crosses the placenta
18
Q
What is the potential reaction from providone-iodine antiseptics in women who are pregnant?
A
higher cord blood concentrations of iodine
19
Q
What is the potential harm from providone-iodine antiseptics in women who are lactating?
A
iodine is retained in the skin of the breast
20
Q
What is the potential reaction from providone-iodine antiseptics in women who are lactating?
A
transient hypothyroidism in the nursing newborn
21
Q
What are surgical scrub recommendations?
A
- scrubs donned daily should be clean and freshly laundered in a helath care accredited laundry facility
- scrubs should be changed if soiled
- tops should be tucked in or fit closely
- jackets, if worn, should be buttoned or snapped
- personal clothing that cannot be contained within the scrub attire should not be worn or should be laundered by a health care-accredited laundry facility
- personnel should change into street clothes when leaving the building
22
Q
What are recommendations for shoes?
A
- shoes should be clean and dedicated for the perioperative area
- shoes should be close-toed and have heels as identified by OSHA
- shoes should not have holes or openings
- Single-use shoe covers, or boots must be worn when the potential for gross contamination from fluid exists
- shoe covers should be removed after use
23
Q
What are surgical recommendations for masks?
A
- masks should be worn in conjunction with eye protection when there is a potential for exposure to fluids
- masks should fit snugly and co er the mouth and nose
- masks are singl-use and should eb changed for each new procedure
- masks should be replaced and discarded when soiled
- masks should not be allowed to dangle around the neck
24
Q
What are surgical recommendations for jewelry, stethoscopes, and personal identification?
A
- scrubbed team members that wear jewelry risk accidental contamination of the wound if the jewelry were to fall into the surgical site or become a retained foreign object
- stethoscopes should be cleaned after each use
- identification badges and lanyards should be cleaned with a low level disinfectant when soiled
25
What are surgical recommendations for hair and facial covering?
1. a clean surgical head cover should confine the hair and cover the scalp
2. a cover should be used for those with a beard
3. single-use coverings should be discarded at the end of the shift or when soiled
4. reusable head covering should be laundered daily by a health care-approved laundry facility
26
What are surgical recommendations for personal items?
1. backpacks, briefcases, and other items should be cleaned with a low-level disinfectant before entering the semi-restricted or restricted areas
2. if brought in, these items should not be placed on the floor
3. cell phoens and other devices should be cleaned according to the manufacturer's recommendations
27
What are surgical recommendations for cover apparel?
1. if worn, lab coats should be clean, and they are single use
2. evidence does not support the use of cover apprel to protect surgical scrubs
28
What are the special (sometimes conflicting) considerations an RN should keep in mind before using a surgical antiseptic agent?
1. No FDA approved antiseptic alternatives on the market for use in the vaginal vault when providine-iodine is contraindicated.
2. chlorhexidine gluconate with low alcohol content (4%) is recommended as safe by the American Congress of Obstetricians and Gynecologists for vaginal preps
3. Providine-iodine preparations should be used with caution or not at all in select patients, such as those who are susceptible to iodism
4. fish or seafood allergies DO NOT necessarily mean that a patient will have an allergic reaction to topical iodine preps
5. DO not use iodine or iodophors, CHG, or alcohol internally; they are intented for external use only
6. preoperative antisepsis of the vagina with a providone-iodine agent is effective for prevention of endometritis and SSIs for patients undergoing a c-section.
29
is the use of nonsterile gloves acceptable for prepping? if yes, then what are the conditions?
yes; if the length of the applicator prevetns the antiseptic and surgical site area from coming into contact with the nonsterile gloves
30
What should the person performing the surgical skin prep be wearing?
a scrub jacket to cover his or her arms
31
What can pooling of prepping agents cause?
1. skin maceration
2. increase the risk of fire
32
What does the manufacturer's recommendations include for prepping agents?
1. dwell time
2. pattern of use
3. dry time
33
What changes the recommended dry times for preps?
1. manufacturer
2. solution
3. presence of hair
34
What happens if alcohol fumes are trapped under the drape?
the potential for inadvertent fire increases
35
What sites require preventative measures to avoid overall contamination of the entire surgical site?
1. traumatic wounds
2. foreign substances
3. sites that are contaminated (umbilicus, stomas, draining sinuses, skin ulcers, perineum)
36
What cannot be exposed to alcohol preps?
1. mucous membranes
2. wounds
3. burns
37
What is the overall goal when establishing expectations for surgical attire?
to reduce the patient's potential risk of infection by the surgical team
38
What is the primary method of decreasing health care-associated infections?
hand hygiene
39
What are the 3 primary methods of hand hygiene
1. washing with soap and water
2. performing a surgical hand scrub
3. using surgical hand rubs
40
What are the 6 separate times health care personnel should perform hand hygiene?
1. upon arrival at and before leaving health care facility
2. before and after having contact with the patient
3. before donning and after removing gloves
4. before and after eating
5. before and after going to the rest room
6. anytime the hands are contaminated
41
What are 5 additional steps that decrease the liklihood for transmission of bacteria?
1. fingernails should be short and well groomed
2. chipped nail polish should be removed
3. artiifical nails and nail enhancements should not be wonr
4. rings and arm jewelry should not be worn in the periop area
5. health care providers should have intact skin when providing direct patient care
42
What is the goal of surgical hand antisepsis
to remove soil and transient microorganisms from the hands and arms
43
What are the 4 initial steps of the brush and brushless methods of surgical hand prep?
1. remove jewelry
2. don a surgical mask
3. wash hands and arms with soap and water if visible soil is present
4. clean under the fingernails
44
What 2 things can be used for surgical hand prep using the brush method?
1. sponge
2. brush
45
What are the 5 steps used to complete the brush method?
1. to prevent dermatitis, the surgical hand scrub should not be performed using a scrub brush
2. Wash for 3-5 minutes to allow for adequate coverage of the hands and arms with the product selcted
3. wash with an anatomical approach to cover all 4 sides of each finger and both hands and arms
4. Rinse hands and arms thoroughly by holding the hands higher than the elbows to prevent contamination from water dripping from less clean areas to cleaner areas
5, Dry hands with a sterile towel before gowning and gloving
46
What are the 4 steps for surgical hand prep using the brushless method?
1. Dispense the manufacturer's recommended amount of the product
2. Apply the product to the hands and forearms according to the manufacturer's written instructions
3. Rub the hands thoroughly until completely dry
4. Don a sterile gown and gloves
47
What technique is used when donning sterile gows and gloves?
sterile technique
48
Where should gowns and gloves be donned?
from a surface away from the instrument table
49
Who should perform closed gloving?
by the scrubbed eprson
50
What describes closed performing?
keeping hands inside the sleeve of the gown until gloves have covered the gown cuff
51
What is the preferred method when gloving team members during intial gowning and gloving
closed- assisted gloving
52
What is also recommended for gloving?
double gloving
53
What are the parameters of the surgical gown of which perioperative nurses should be aware?
1. front of the gown, from the chest to the level of the sterile field
2. sleeves of the gown, from 2 inches above the elbow to the cuff circumferentially
54
What are the 5 areas of the unsterile gown?
1. back of the gown
2. neckline
3. shoulder
4. axilla
5. sleeve cuff after the hand has passed through the cuff
55
What is vital to the role of the RN when maintaining the sterile field?
surgical conscience
56
What are the 3 roles for the RN for maintaining the sterile field?
1. monitors the sterile field for any breaks in teachnique
2. speaks up
3. corrects any identified compromises
57
What is key to time and location for preparing the sterile field?
as close to the time of the procedure as possible in the location in which the procedure will be performed
58
What is the managers role in preparing the sterile field?
are responsible for establishing a defined process and providing personnel with a detailed description of this process
59
What is an important consideration for surgical procedures that involve both the abdominal and perineal areas?
caution should be taken to maintain separate setups to reduce the chance of transferring microorganisms from the perineal area to the abdominal area
60
When performing bowel surgery, nurses should establish a standardized technique known as what?
isolation technique
61
What 3 steps are included in the isolation technique?
1. instruments and equipment that have contacted the inside of the bowel should not be used after the lumen of the bowl has been closed
2. Clean instruments should be used for closure
3. Contaminated instruments should be removed or covered so that the surgical team does not touch them after closure begins but remain visible for completing instrument counts
62
What are the most common type of health-care associated infections?
infections of the urinary tact as a result of passing transurethral instruments and catheters during gynecologic laparoscopic procedures
63
What are sterile drapes used for?
used to establish a barrier and minimize the passage of microorganisms from the unsterile to the sterile area
64
Besides invasive surgical procedures, according to the CDC, where should full barrier precautions be used?
central venous catheters and peripherally inserted central catheters
65
What are 5 concepts related to the use of sterile drapes?
1. unsterile equipment or furniture in or adjacent to the intended sterile field should be covered with a sterile drape
2. Gloved hands should be protected by using a cuff when placing the sterile drape
3. Drapes are placed from the surgical site out peripherally
4. Once a sterile drape has been placed on the patient, it should not be moved or adjusted
5. Items falling below the level of the sterile field are consider contaminated
66
What is one method to prevent contamination of the established sterile fields?
to control and reduce the amount of movement in and around the sterile field
67
What are 5 important considerations for scrubbed personnel as far as movement within the sterile field?
1. wear appropriate protective devices to allow scrubbed personnel to remain at the sterile field
2. Do not leave the sterile field to retrieve items from an autoclave
3. Ensure that hands and arms remain above wast level
4. Avoid changing position levels during the procedure
5. Sit only when the entire surgical team is seated for a procedure
68
What are 2 important considerations for changing positions, as far as movement within the sterile field?
1. Scrubbed personnel should move back-to-back or front-to-front.
2. Non-scrubbed personnel should always face the sterile field and maintain a minimum distance of 12 inches from the sterile field
69
What are 4 important general considerations, as far as movement within the sterile field?
1. limit talking at the surgical field
2. keep the number of personnel to a minimum
3. Use methods of communication to reduce entering and departing the room when a procedure is under way.
4. Limit the number of door openings for breaks and retrieving supplies
70
What are the 3 things should perioperative personnel inspect each sterile item for?
1. the item has been sterilized
2. the packaging remains intact and has not been compromised
3. if there is an expiration date, the item is not expired
71
Sterility is related to what instead of what?
event related, not time related
72
An item is considered sterile if...
1. the item has been exposed to the parameters of sterilization
2. the integrity of the package remain intact
3. the item's packaging has not been compromised by excessive handling or unreliable conditions
73
define event-related sterility
used to describe a sterile item that will remain sterile regardless of time
74
When is sterility compromised?
if the item is exposed to events such as excessive handling, humidity, or alterations in there required temperature range
75
How are items most often sterilized at the health care facility?
1. using steam under pressure
2. form of plasma using hydrogen peroxide
76
What are the 2 forms of sterilization used by companies?
1. ethylene oxide
2. irradiation
77
What does the FDA require that manufacturers do for packaging?
label their packaging with the method of sterilization as well as with the phrase "sterile unless damaged or opened"
78
true or false; before presenting sterile items to the field, perioperative personnel need to confirm that the package is labeled with the method of sterilization as well as with the phrase "sterile unless damaged or opened"
true
79
What are the 3 packaging methods?
1. wraps
2. peel packs
3. rigid containers
80
Before presenting a sterile item to the surgical field, the nurse must check what?
the integrity of the package
81
to verify sterile integrity of sterile items what should the RN do?
1. inspect all packaging for any compromise caused by moisture, tearing, or rough handling
2. Ensure that the sterile contents of a wrapped package do not come in contact with the edges of the wrapper or peel pack before placing them on the sterile field
3. Verify the presence of external locks, filters, or valves when opening items in rigid containers and ensure that all are intact and free of moisture before opening and placing them on the sterile field
82
true or false; specimen management is an unessential component of the RN's scope of practice
false; it is essential
83
what happens to errors in specimen management?
can lead to incorrect diagnoses and medical management
84
What are the four ways a specimen can be sent to pathology?
1. frozen
2. fresh
3. permanent
4. culture
85
Please read the specimen managment policies"
1. assessing for needed supplies and processes during the briefing
2. notifying applicable personnel
3. specifiying the requirements for specimen collection and handling
4. identifying the correct method of transfer and transport needs
5. delineating the requirements for containment
6. verifying the method of preservation
7. clarifying the correct disposition of the specimen
8. including the correct specimen and disposition in the debriefing
9. documenting all of these specifics in the intraoperative record
86
What is really important with specimen management?
they must be collected and handled in a manner that protects and preserves the integrity of the specimen
87
What are 3 considerations for forensic specimens?
1. placing them in dry plastic containers
2. not allowing them to come in contact with metallic basins if they contain metal
3. handling them as little as possible
88
What does an RN need to do if a specimen has markers - sutures and paint?
RN must annotate those markers on the label and requisition form for orientation for pathology so appropriate diagnoses may be made
89
Each specimen needs to be labeled with what?
1. the patient's name, ID number, and DOB
2. the origin of the specimen and laterality
3. the date and time the specimen was obtained and placed in preservative
4. the surgeon's name
5. preservative and biohazard info
6. any other info the facility requires
90
What 2 things are under implantable materials?
1. biologic
2. synthetic
91
What is the RN's responsibility for implants and explants?
responsible for complying with tracking regulations for implantable materials and devices and must use meticulous aseptic technique with minimal handling
92
do patients have the right to refuse tracking on their medical devices?
yes
93
What is the minimum documentation for implantable devices?
1. device identification
2. date of manufacture
3. patient info
4. implant location
5. surgeon contact info
94
What is a sterilization process for unwrapped items that are intended to used immediately, not stored and used later?
Immediate-use steam sterilization
95
Is IUSS recommended for implantable devices?
NO
96
When should IUSS be used?
should only be used in a defined emergency with no other option
97
What should happen if IUSS is required for an implant?
a biological indicator must be used, and the cycle determined by the IFU must be selected
98
explants are sent where?
to pathology laboratory for evaluation and gross examination
99
What determines final disposition of an explant?
facility policy
100
What are RNs responsible for complying with implants and explants? and must use what?
complying with tracking regulations from the US food and drug admin for implantable materials and devices and must use meticulous aseptic technique with minimal handling
101
What is autologous tissue?
tissue that is harvested and preserved for later replantation into the donor's own body
102
What are examples of autologous tissue?
1. cranial bone flaps
2. parathyroid gland
3. skin
4. vessels
5. femoral heads
103
What does the autologous tissue process provide for?
the process - keeping tissue in-house and replanting it into the same patient - provides an exemption from the US food and drug admin requirement to register the facility as a tissue establishment
104
What are the AORN guidelines for cranial bone flaps?
may be frozen, cryopreserved, or placed in a tissue pocket
105
What are the AORN guidelines for parathyroid gland tissue?
may be cryopreserved
106
What are the AORN guidelines for skin?
may be refrigerated and stored in a storage medium or normal saline, or it may be cryopreserved
107
What are the AORN guidelines for vessels?
may be refrigerated and stored in normal saline, lactacted ringer solution, or a storage medium
108
What are the AORN guidelines for femoral head?
may be placed in a tissue pocket
109
How long can vessels be stored?
14 days
110
Who should determine the appropriate methods for storing and preserving and time until expiration of all autologous tissue?
an interdisciplinary team of physicians, infection preventionists, and nurses
111
What is a safety risk to patients undergoing surgical or other invasive procedures?
RSI's
112
What must be conducted consistently for every operative or invasive procedure according to the facility's policies and procedures?
surgical counts
113
What 3 things should the RN and scrub do when counting?
count them audibly, visually, and concurrently
114
Who is responsible for documenting counts?
RNs
115
Are RSIs events that are reportable to TJC?
they are never events that are reportable to TJC
116
Counted items include what?
surgical soft goods, sharps, and instruments
117
What is the flow of counting?
from the sterile field to the mayo stand to the back table and then off the field
118
When are the 7 times a count should be performed?
1. at the time of instrument assembly for sterilizaion
2. before the procedure begins to establish the baseline
3. when new items are added to the field
4. at the time of permanent relief of either the scrub person or the RN
5. before the closure of a cavity within a cavity (uterus, bladder)
6. when a cavity closure begins
7. when final closure begins
119
What are the 8 steps to take if the count is not correct at any point?
1. the rn circulator or scrub person informs the surgeon immediately
2, the RN circulator or scrub person repeats the entire count procedure
3. The RN circulator searches for missing items in the trash, under furniture, on the floor, in the laundry, and in any other receptacle in room
4. the scrub person searches the sterile field
5. the surgeon searches the wound
6. the RN circulator notifies the supervisor
7. the surgical team follows the facility's policy for x-rays to be taken before the patient leaves the OR if all search options have been exhausted and the discrepancy has not been resolved
8. The RN circulator documents the incorrect counts and all actions taken in the record.
120
What should the nurse complete and submit once turning care over to PACU nurse when there has been a count discrepancy?
should complete and submit an incident report ASAP
121
Should the RN mention the incident report in the chart?
no
122
What should be put in the chart following a count discrepancy?
any interventions performed - intraoperative x-ray and its findings
123
What are the responsibilities of the manager when it comes to counts?
1. responsible for developing and periodically reviewing and revising the policies and procedures for performing counts and preventing the need for RSIs.
2. managers should conduct a review of policies concerning the processes in place to deal with unretrieved device fragments and the use of adjunct technologies that supplement the manual cont procedures
3. ensure that all surgical personnel are educated and trained on these policies and procedures intially and for ensuring ongoing competency evaluation
4. promoting ongoing quality improvement of the count process anywhere that operative or other invasive procecures are performed to prevent the occurrence of RSIs and improve outcomes for surgical patients
124
How are wound classifications determined?
determined by the probability that hte patient will sustain a postoperative infection based on predetermined criteria
125
what is class I?
clean
126
What are class I wound classifications examples?
knee arthroscopy, breast biopsy
127
What is class II?
clean contaminated
128
What are class II wound classifications examples?
laryngoscopy, appendectomy
129
What is class III?
contaminated
130
What are class III wound classifications examples?
appendectomy for rupture, traumatic wound with bowel involvement
131
What is class IV?
dirty-infected
132
What are class IV wound classifications examples?
amputation of gangrenous extremity, delayed primary closure
133
Why is it important to verify the wound classification at the end of the procedure?
in the event that during the procedure there was a break in technique or process that changed the planned wound classification
134
When a penrose drain is initially placed what is the class?
there is a fresh, open wound so class III/contaminated
135
What happens if the drainage from a wound is purulent after a penrose drain is placed? what is the class?
class IV/dirty-infected wound
136
What is the arrest or stoppage of blood flow?
hemostasis
137
What are 3 ways surgical hemostasis can be achieved?
1. external means - application of a tourniquet to an extremity
2. manual pressure - holding pressure with packing laparotomy sponges
3. chemical or internal mechanical agents that assist in the arrest of active bleeding
138
What are the 2 types of bleeding that we encounter in surgery?
1. active bleeding from arteries and/or veins
2. venous oozing from cut surfaces
139
What are 2 crucial factors in successful closure of a wound?
1. hemostasis, without wound formation
2. eliminated of dead space
140
What is the most common type of internal mechanical hemostasis?
the use of hemostats or other clamping instruments, ties, or electrosurgery employed by the surgical team
141
What is another means of mechanical hemostasis
thermal agents
142
other mechanical means of achieving hemostasis involve the use of what kind of pressure?
external pressure
142
What are examples of thermal agents
cryosurgeryy, diathermy, handheld electrocautery, argon beam coagulator, hemostatic scalpel, ultrasonic-harmonic scalpel, laser photocoagulator
143
What does external pressure do for hemostasis?
occludes or creates a barrier to the flow of blood
144
What are examples of external pressure devices?
1. pneumatic or simple tourniquets
2. medical antishock trousers (MAST)
145
What is a MAST device?
an extreme compression device has been used for trauma victims to prevent shock
146
When is a MAST device deflated?
only after a victim is in the OR, anesthesia is induced, and the means to control hemorrhage are immediately available
147
Use of porcine- or bovine-sourced agents may be what as chemical agents for hemostasis?
contraindicated by the patient's faith or by allergy to porcine or bovine derivatives
148
Hemostatic materials should not be what?
should not be packed into closed spaces where they could cause undue pressure on nerves or other tissues, such as the spinal canal
149
When are chemical agents absorbed?
either during the wound healing process, others are long lasting
150
What is absorbable gelatin material?
powder or compressed pad from porcine gelatin
151
What is the action of absorbable gelatin?
provides a framework for fribrin deposition and clot formation in areas of capillary bleeding
152
What are 4 nursing considerations for absorbable gelatin?
1. not soluble and swells to up to 40 times its own weight
2. the sponge or pad form may be used dry or with warm saline solution, epi, or thrombin
3. the powder form is mixed with saline to create a paste, which is then applied to the bleeding source
4. should not be used in presence of infection or in small closed spaces such as the spinal canal
153
What is absorbable collagen material?
sponges made from bovine collagen
154
What are 2 actions of absorbable collagen?
1. applied dry to oozing or bleeding sites
2. activates the coagulation cascade, especially platelet aggregation
155
What are 3 nursing considerations for absorbable collagen?
1. must be kept dry
2. scrubbed team members should handle it with dry gloves and dry instruments because it has an affinity for wet surfaces
3. keep away from the skin incision, as it will form a barrier to wound healing
156
What is the material of microfibrillar collagen?
loose or nonwoven pad
157
What is microfibrillar collagen made from?
bovine corium collagen
158
What are the 2 actions for microfibrillar collagen?
1. activates the coagulation cascade, especially platelet aggregation
2. applied dry to the bleeding surface with firm pressure, then any excess material is removed
159
What are 2 nursing considerations for microfibrillar collagen?
1. may swell up to 20% its volume within 10 min.
2. considerations are the same as for absorbable collagen
160
What is oxidized cellulose made from?
oxidized cotton cellulose or oxidized regenerated cellulose (rayon)
161
What is oxidized cellulose material?
pad or knitted fabric that is either low- or high-density
162
What are the 2 actions of oxidized cellulose?
1. applied dry and may be sutured in place
2. creates a gel when in contact with blood, forming a clot rapidly
163
What are the 5 nursing considerations for oxidized cellulose?
1. absorbs 10 times its own weight
2. has some bactericidal properties
3. use only the minimum amount needed
4. inactivated in the presence of thrombin
5. not recommended for use on bone
164
What is thrombin?
enzyme extracted from human or bovine blood
165
What does thrombin promote?
coagulation of blood and controls capillary bleeding by activating the coagulation cascade
166
What is the action of thrombin?
topical thrombin may be sprayed on areas that are hard to access with other methods
167
What are 4 nursing considerations for thromin?
1. contraindicated fo ruse in sites with active bleeding
2. contraindicated for patients with bovine allergies
3. human recombinant product may contain viral or prion contamination
4. used as topical hemostatic agent along with other agents or alone
168
How is synthetic oxytocin prepared?
as an injection
169
How can synthetic oxytocin be delivered?
either intravenously or injected directly into the uterine muscle
170
How does oxytocin related to child birth?
pituitary hormone used to initiate or augment uterine contractions after the baby is born
171
What are 4 nursing considerations for oxytocin?
1. commonly used in c-sections
2. controls uterine hemorrhage but can also be used to induce labor for vaginal birth
3. ergonovine has demonstrated cases of sustained contractions lasting more than 3 hours
4. ergonovine is contraindicated if the patient has preeclampsia or eclampsia causing seizures
172
What is ergonovine used to treat?
can be used to treat uterine bleeding after childbirth or abortion after the placenta is delivered
173
What are the 2 actions of phenol and alcohol?
1. cauterizes tissue by coagulating proteins
2. used on a cottons wab to cauterize tissue
174
What are 3 nursing considerations for phenol and alcohol?
1. used in some podiatric surgeries
2. neuralized by 70% alcohol
3. can cause severe burns
175
What is epi?
adrenal hormone that caues vasoconstriction
176
What is epi used with and to do what?
used with local anesthestics to prolong the anesthetic effect by increasing the time for the anesthetic to be cleared from the surgical area
177
What is a nursing consideration for epi?
excess can be absorbed systematically, causing a rapid heart rate
178
How are silver nitrate sticks packaged?
packaged as applicator sticks with modled silver nitrate in 20% to 50% silver chloride solution
179
What are silver nitrate sticks used to treat?
1. burns or other moist wounds
2. to seal areas of previous surgical incision that are left open to heal by secondary intention
180
What are 2 nursing considerations for silver nitrate sticks?
1. should not be used on the face because it may cause discoloration of the skin
2. staining darkens to black int he presence of light
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What do drains promote?
the wicking of fluid away from the surgical site by capillary action and gravity
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Tubes placed in the chest tubes, common bile duct, or bladder allow what?
fluids to be captured in a closed container for accurate measurement
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Open drains desposit what?
collected fluid directly onto dressings
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Closed drains collect what?
collect fluid in reservoir
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true or false; drains can be fenestrated or have one long tube
true
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Primary dressings are placed where?
placed directly on the surgical wound
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What should primary dressings be made of?
an absorbent material that will wick drainage from the wound and move it toward the periphery
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What can primary dressings be made of?
cotton or synthetic materials
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What are 2 other things that primary dressings can contain/be made of?
they can contain antimicrobial properties and can be made of non-adherent material if no debridement is desired
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secondary dressings are placed where?
directly over primary dressings to absorb additional drainage
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What are often used as secondary dressings?
pads with cotton filling
192
What is the purpose of a secondary dressing?
to add a layer of protect of the wound to decrease liklihood of further trauma
193
Who is typically responsible for securing the dressing at the end of the procedure?
RN
194
A wound that cannot be closed by primary intention may be dressed with what?
a negative pressure dressing that serves to promote granulation of tissue and remove excess secretions simultaneously
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What are contraindications for negative pressure wound therapy?
1. exposure of vital organs within the wound
2. inadequate wound debridement
3. untreated osteomyeletis or sepsis within the vicinity of the wound
4. untreated coagulopathy
5. necrotic tissue with eschar
6. malignancy in the wound
7. an allergy to any component of the dressing
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What is wound healing?
is the body's response to repair tissue disruption that has occurred through surgical intent, traumatic events, or a chronic condition that occurs over time
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What are the 3 phases of wound healing?
1. infalmmatory
2. proliferative
3. remodeling
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What are the 3 types of wound closures?
1. primary intentions
2. secondary intention
3. delayed primary closure, third intention
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What is primary intention wound closure?
which occurs when wounds are created with aseptic technique and then closed as soon as possibel with sutures, staples, tape, or surgical adhesives
200
What is secondary intention or granulation and contraction?
occurs in wounds with tissue loss and the inability to proximate edges
201
What typically happens with secondary intention wounds?
typically left open so that they can heal from the inside out
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Are dressing changes normally required for secondary intention?
yes
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What do delayed primary closure or third intention involve?
involves wounds that require debridement first and then later require primary or secondary closure
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What is suture a generic term for?
all materials used to repair and re-approximate incised or torn tissue
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Suture materials have what 3 characteristics?
1. physical -tensile strength, memory
2. handling - pliability
3. tissue-reaction - absorption
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Sutures fall into what 2 categories?
1. absorbable
2. nonabsorbable
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What are some examples of absorbable sutures?
1. surgical gut sutures
2. collagen sutures used in eye surgeries
3. synthetic absorbable sutures used in laparotomies
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What are 3 class of non-absorbable sutures?
1. class I: silk and synthetic fibers
2. class II: cotton or linen fibers
3. Class III: sutures with a composition of monofilament or multifilament metal wire
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What are examples of nonabsorbable sutures?
1. silk
2. cotton
3. nylon
4. polyester fiber - used for general closure of fascia
5. polypropylene - often used in the presence of infection
6. barbed suture - used extensively in plastic surgeries; resists know-related issues
7. stainless steel
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What are the 3 basic components of surgical needles?
1. the eye
2. the body
3. the point or tip
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Selection of closure material is determined by what?
1. lesion location
2. anticipated wound tension
3. defect size
4. type of repair
5. patient attributes
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What are taper point needles used for?
for most soft tissues below the skin's surface
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What are penetrating points used for?
for ligaments and tendons
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What are blunt points used for?
for friable tissues
215
What are protect points used for?
primarily for fascia
216
What are reverse cutting needles used for?
for skin closures
217
What are cutting tapers used for?
microsurgery
218
What are spatula side cutting needles used for?
eye surgery
219
What are regular cutting needles used for?
for general skin closures
220
What is the primary goal of the perioperative team?
safe patient care
221
What is essential to a culture of safety that supports a supportive environment?
communication
222
What is the primary role of the RN in patient advocacy?
to provide a safe patient care through advocacy, which is supported by the ANA and AORN
223
Part of being a patient advocate is to protect the patient's what?
privacy
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who is a common part of the perioperative team when it comes to privacy?
health care industry representative (HCIR)D
225
Do HCIR's need to be present while the patient is awake and being transferred and positioned?
no; unnecessary exposure of the paitnet
226
How can we promote privacy in the OR?what 3 things?
1. ensure exposure of only necessary anatomy
2. limited traffic in the room
3. limited talking
227
the RN collaborates with the patient how?
in a manner that preserves and protects the patient's autonomy, dignity, and human rights
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