OR Residency 2022

Question 1

Answer 1

Taper Needle

• Spreads tissues as it goes between layers
• Used for soft tissue, bowel, vascular, nerves, head and neck

Question 2

Answer 2

Cutter Needles

• Cuts tissue as it is passed through → may cause damage
• Used for fascia, skin, tendons

Question 3

Suture Types

Answer 3

Question 4

Suture Sizes

Answer 4

Question 5

Suture Size and Use

Answer 5

Question 6

CT

Answer 6

• Circle Taper

Question 7

FS

Answer 7

• For Skin
• Fsx, FSlx → For skin extra large

Question 8

PS

Answer 8

• Plastic Skin

Question 9

LR

Answer 9

• Long Retention Suture

Question 10

SH

Answer 10

• Small half

Question 11

CP

Answer 11

• Circle Point

Question 12

Answer 12

• Keith (straight) needle
• The straight-body needle is used to suture easily accessible tissue that can be manipulated directly by hand
• Skin closure of abdominal wounds

Question 13

Absorbable Sutures

Answer 13

• Monocryl (Coral/Orange)
• PDS II (Grey) lasts months
• Fast Gut (Bright Yellow)
• Plain Gut (Yellow)
• Chromic Gut (Tan)
• Vicryl/Dexon (Purple)
• Maxon (Grey)

Question 14

Non-Absorbable

Answer 14

• Nylon (Green)
• Prolene (Light Blue)
• Gore-Tex (White)
• Silk (Blue)
• Cotton (Pink)
• Stainless Steel → Used for Sternum
• Ticron (Orange) → Mesh

Question 15

Braided Sutures

Answer 15

• Knots are more secure
• Germs can reside inside of braids
• Avoid vicryl (braided) if infection is present

Question 16

Monofilament

Answer 16

• has memory → Unravels (stretch to remove memory)
• must tie multiple knots to hold
• Better for infection

Question 17

Chromic Gut _____ ______ and is used in ________.

Answer 17

• absorbs quick
• head/neck

Question 18

Why might vicryl be appealing to gen surgery or ortho?

Answer 18

• long healing time

Question 19

Why is prolene/silk appealing to vascular?

Answer 19

• it keeps it’s integrity long term/over a life time

Question 20

Items to include with consent documentation

Answer 20

• Name of healthcare facility
• Specific name of the intervention to be performed
• Indications for the proposed intervention
• Name of the Health care professionals performing the intervention
• Risks and benefits associated with the proposed intervention
• Discussion of the risks and benefits with the patient or patient’s legal representative
• Signature of the patient or the patient’s legal representative
• Date and time the patient or the patient’s legal representative signed the informed consent document
• Date, time, and the signature of the person who witnessed the patient or the patient’s legal representative signing the informed consent

Question 21

Am I responsible for obtaining the informed consent?

Answer 21

• No. The surgeon, anesthesiologist, or other licensed practitioner obtains the informed consent.

Question 22

You may be asked to witness the patient or guardian’s signature on the informed consent …

Answer 22

• This is only okay if you are not directly involved in the case.

Question 23

Complications of surgical bleeding

Answer 23

• Obstruction of view of surgical field → longer operating times
• Need for blood replacement therapy → Multiple organ failure, systemic inflammatory response syndrome, transfusion-related lung injury (TRALI), increased infection risk, increased mortality
• Risk for hypothermia
• Hemodilution and Acidosis
  
  • lactic acid forms with decreased O2 levels
  • large amounts of banked blood, acidosis can occur due to lactate production in the tissues, along with excessive IVF administration of chlorides

Question 24

Surgical hypothermia

Answer 24

• Potential for coagulopathies
• When core body temp nears 34°C (93.2°F), platelets begin to lose their ability aggregate; AKA hypothermic coagulopathy
• Hypothermia alters the pharmacodynamics of anesthesia /meds, increased PACU stay, contributes to adverse myocardial outcomes.

Question 25

Methods for warming

Answer 25

* Active * Forced air, conductive heating blankets * Passive insulation * Warm blankets * Ambient room temperature * Warmed IVF

Question 26

Thrombocytopenia may occur due to \_\_\_\_

Answer 26

* Massive blood loss * After Heparin administration → HIT

Question 27

Hypovolemic shock

Answer 27

* Decreased CO → affects gas exchange →compensation mechanisms can fail if bleed doesn't stop → Patient death

Question 28

How to monitor I&O

Answer 28

* Communicate amount of irrigation solution used → Subtract from suction canister * Place used sponges in location where the anesthesia professional can visualize them * Weigh sponges

Question 29

How to stop surgical bleeding

Answer 29

* Hold pressure → with sponges * Electrosurgery * Energy generating devices * Suturing and ligaing * Turnoquets * Hemostatic agents and medications * Ligating clips

Question 30

Risks associated with energy generating devices

Answer 30

* ignition source and the most frequent source of OR fires

Question 31

Medications for Hemostasis

Answer 31

* Epinephrine → vasoconstriction * Vitamin K * Protamine * Vasopressors

Question 32

RN Circulator responsibilities rt RSI (Retained surgical items)

Answer 32

* Ensure no open, countable items are in the room from a previous procedure * Verify that count boards and count sheets do not contain information from a previous procedure * Initiate the Count * View the surgical items being counted * Record in a visable location (count board) the counts of soft goods, sharps, misc. items, and items placed in the wound * Record instrument counts on preprinted count sheets * Report any discrepancy * Primary responsibility: Prevent RSI

Question 33

Scrub person responsibilities rt RSI (Retained surgical items)

Answer 33

* Maintain organized sterile field and standardize instrument set ups * Perform counts in a manner that allows RN circulator to see the surgical items being counted * Know the location of soft goods, sharps, and instruments on the sterile field and in the wound * Know the character and the configuration of items used by the surgeon and first assistants * Speak up → for discrepancy * Inspect items for breakage or fragmentation before use and immediately after removal from the surgical site * Primary responsibiliy: accurately accounting for items used during surgical procedure

Question 34

Why are F/C always indicated for appendectomies?

Answer 34

* To help monitor for bladder perforation

Question 35

Counts are performed when?

Answer 35

* Before procedure * When adding new items * Before closure of a cavity within a cavity * When wound closure begins * Whenever RN/Scrub is permanently relieved

Question 36

How to document discrepancies

Answer 36

* All actions taken to recover the missing item * Description and location of the item if known * Patient notification and consultation * Plan for FU care

Question 37

Document to prevent RSI

Answer 37

* Who did the counts * Discrepancy? → What resolution? * Surgeon notification about the status of the count (if count is correct or if items are missing)