Perioperative and skin integrity

Question 1

perioperative nursing involves the care of clients ___, ___, and ___ surgery and some other ___ ____
aka?

Answer 1

before, during and after
invasive procedures
aka operating room nursing

Question 2

Who governs perioperative nursing practice?

Answer 2

AORN, joint commmission, medicaid, national priorities partnership, institute for healthcare improvement

Question 3

These are called?

wrong patient, wrong site, wrong surgery, DVT or PE after knee or hip replacement; foreign body; surgical site infection

Answer 3

never events

Question 4

Surgeries are classified by:

Answer 4

body system
purpose
degree of urgency
degree of risk

Question 5

purpose...
ablative?
diagnostic?
palliative?
cosmetic?
transplant?
harvesting?

Answer 5

ablative-removal
diagnostic or exploratory-confirm diagnosis
palliative-relieves discomfort
reconstructive-restores fx
cosmetic-appearance improvement
transplant-replaces malfx. organ
harvesting-removing organ

Question 6

emergent surgery happens…

Answer 6

within 24 hours if not immediately

Question 7

urgent surgery happens within…

Answer 7

24-48 hours

Question 8

elective surgery

Answer 8

has more time

Question 9

risk? major or minor?

Answer 9

major-greater risk; higher infection risk

minor-lower risk

Question 10

factors that contribute to surgical risk?

Answer 10

age, personal habits; allergies; type of wound; preexisting conditions; mental status; medications

Question 11

preoperative screening tests

Answer 11

CBC, urinalysis (specific gravity tells hydration level), ECG (tells if heart rhythm is normal)

Question 12

Intraoperative team…

sterile team

Answer 12

made up of surgeon, surgical assistant, RN 1st assist

Question 13

Interoperative team…

clean team

Answer 13

anesthesiologist, CRNA, circulating nurse

Question 14

time out

Answer 14

final verification of correct client, procedure and site

Question 15

general anesthesia

Answer 15

most risk; loss of sensation; someone else maintaining airway; rapid unconsciousness

Question 16

conscious sedation

Answer 16

IV sedation without unconsciousness; not necessarily in OR; can maintain protective reflexes

Question 17

regional anesthesia

Answer 17

alert but numb; nerve block; spinal block, epidural; can’t feel (interrupts nerve impulses to and from area of procedure)

Question 18

local anesthesia

Answer 18

loss of pain sensation at the desired site; minor procedures

Question 19

PACU

Answer 19

postanesthesia care unit; immediate postoperative phase; aka post anesthesia phase
includes: recovery from anesthesia, airway management; vital signs/LOC; dressing assessment/drainage; fluid therapy; pain control

Question 20

post op risks

Answer 20

surgical site infection; pneumonia; fall; pain; DVT

Question 21

epidermis made up of

Answer 21

stratum corneum–outermost layer of skin

stratum germinativum–innermost layer; mostly new cells

Question 22

what maintains the skin, repairs minor defects and preserves intravascular volume?

Answer 22

protein

Question 23

what nutrition wise helps with the formation of collagen?

Answer 23

vit C, zinc, copper

Question 24

what leads to increased risk for pressure and breakdown?

Answer 24

diminished sensation

Question 25

what negatively affects tissue metabolism?

Answer 25

impaired circulation

Question 26

medications can cause what side effects to the skin?

Answer 26

itching | rashing

Question 27

Moisture leads to?

Answer 27

maceration--softening of the skin

Question 28

two most common sources of moisture are?

Answer 28

fever and incontinence

Question 29

fever depletes ___ and increases ___ ___

Answer 29

moisture | metabolic rate

Question 30

open wound

Answer 30

break in skin or mucous membrane

Question 31

closed wound

Answer 31

no breaks in the skin

Question 32

acute wound

Answer 32

s/t; heals quicker

Question 33

chronic wound

Answer 33

L/t; longer duration to recovery

Question 34

clean wound

Answer 34

expected to be short duration; heal spontaneously

Question 35

contaminated wound

Answer 35

open, traumatic wound or surgical incision in which a major break in asepsis occurred

Question 36

infected wound

Answer 36

bacteria counts in the wound tissues are above 100,000 organisms per gram of tissue

Question 37

superficial wound

Answer 37

involve only the epidermal layer of the skin

Question 38

partial thickness wound

Answer 38

extend thru the epidermis but not all the way through the dermis

Question 39

full thickness wound

Answer 39

extend into the subcutaneous tissue and beyone

Question 40

penetrating wound

Answer 40

wound involves internal organs

Question 41

serous exudate

Answer 41

straw colored

Question 42

sanguineous exudate

Answer 42

bloody drainage

Question 43

serosanguineous

Answer 43

mix of bloody and straw

Question 44

purulent

Answer 44

yellow, contains pus

Question 45

regenerative healing

Answer 45

when the wound affects only the epidermis and dermis, regenerative/epithelial healing takes place; no scar

Question 46

primary intention

Answer 46

clean surgical incision/ edges approximated; minimal scarring

Question 47

secondary intention

Answer 47

wound edges not approximated; tissue loss; heals from inner layer to surface

Question 48

tertiary intention

Answer 48

granulating tissue brought together; delayed closure of wound edges; increased risk of infection

Question 49

complications of wound healing

Answer 49

hemorrhage; infection; dehiscence (pops open); evisceration (emergency; things protrude thru like bowel); fistula formation (abnormal passage; most common between GI and GU tracts)

Question 50

Braden scale based on Total score.....= risk

Answer 50

``` sensory perception, moisture activity mobility nutrition friction or shear ``` <18

Question 51

debridement

Answer 51

removal of devitalized tissue or foreign material from a wound

Question 52

sharp debridement

Answer 52

uses a sharp instrument to remove devitalized tissue

Question 53

mechanical debridement

Answer 53

naturally remove with irrigation or hydrotherapy (book--lavage, wet to dry dressings or hydrotherapy (whirlpool))

Question 54

enzamatic debridement

Answer 54

uses proteolytic agents to break down necrotic tissue without affecting viable tissue in the wound (ointment with enzymes; clean first; cover with moisture containing dressing)

Question 55

autolysis debridement

Answer 55

use of occlusive moisture retaining dressing and the body's own enzymes and defense mechanisms to break down necrotic tissue; slow process

Question 56

Jackson Pratt drainage device or Hemovac

Answer 56

compress device to create suction and facillitate removal of drainage

Question 57

hydrocolloids/hydrogels

Answer 57

thick foamy dressing | gel dressing to retain moisture

Question 58

binders

Answer 58

hold abdominal wound together

Question 59

pressure ulcer

Answer 59

caused by unrelieved pressure to an area resulting in ischemia