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Study Guide Flashcards

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1
Q

Who can provide anesthesia services?

A
  1. Anesthesiologists
  2. Certified RN Anesthetists (CRNAs)
  3. Anesthesiologist Assistants (AAs)
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2
Q

Factors to consider before determining what anesthetic to use for a patient

A
  1. Age
  2. Length and type of surgery
  3. Patient and surgeon preferences
  4. Patients co-existing diseases
  5. Patients mental and psychological status
  6. Patients previous experience with anesthesia
  7. Plans and protocols for post op pain management
  8. Position for surgery
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3
Q

How long before surgery can you have clear liquids?

A

2 hours

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4
Q

How long before surgery can you have breast milk?

A

4 hours

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5
Q

How long before surgery can you have infant formula

A

6 hours

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6
Q

How long before surgery can you have a light meal?

A

6 hours

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7
Q

How long before surgery can you have fried foods, fatty foods or meat?

A

8 hours

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8
Q

Phases of General Anesthesia

A
  1. Induction
  2. Maintenance
  3. Emergence
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9
Q

What is the reversal agent for fentanyl?

A

Naloxone

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10
Q

What is the reversal agent for Rocuronium, Vecuronium and Pancuronium?

A

Sugammadex

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11
Q

What is the reversal agent for Midazolam?

A

Flumazenil

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12
Q

What triggers HM?

A

inhalation anesthetic gases and succinylcholine

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13
Q

What is the most specific sign of MH?

A

Increased end-tidal carbon dioxide

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14
Q

Other signs of MH?

A

Skeletal muscle rigidity
Ventricular dysrhythmia
Skin mottling
Hyperthermia

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15
Q

How is hypothermia defined?

A

Temp less than 36

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16
Q

Two actions the RN should take when confronted with an MH crisis

A 
Get the HM cart
Call for help
Ventilate with 100% O2
Give Dantrolene 
Cool the pt if >39 stop at <38
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17
Q

Role of an RN during a local only procedure

A 
Monitor:
BP
EKG
O2
HR
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18
Q

Role of the RN during moderate sedation surgery

A 
Assess for an provide mod sedation and analgesia 
Cardiac monitoring
Able to administer reversal meds
Airway assessment
CPR
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19
Q

After spinal anesthesia, what complication should the nurse watch out for?

A

Hypotension

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20
Q

Complications that can occur during administration of anesthesia

A 
Difficult airway
Laryngospasm
Cardiac Problems
Hemorrhage
Anaphylaxis
Hypothermia
MH
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21
Q

Patients risk factors due to alcoholism

A

Lowered immunity
Prolonged bleeding times
Increased stress response
Cardiac complications

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22
Q

Physiological effects of cannabis

A 
Anxiety, euphoria, memory dysfunction
Tachycardia, atherosclerosis
Airway edema, chronic bronchitis
Increased appetite, hyperemesis
Paranoia 
BS elevation
unknown tolerance to analgesics
Potential increase in pain
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23
Q

The SDOH

A 
Economic stability
Education
Social and Community Context
Health and Health Care
Neighborhood and Build environment
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24
Q

Goals of Enhanced Recovery after surgery

A
  1. Reduce patients stress response
  2. Optimize physical function
  3. Facilitate recovery
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25
What is the no-fly zone?
A zone designated for the safe use of imaging and other equiptment
26
Potential complications with gas insufflation
``` Increased BP Increase in blood CO2 levels Acidosis Decreased cardiac output Arrhythmias Gas Embolism Peritoneal Irritation Decreased renal blood flow/urine output ```
27
What is a boreoscope
An inspection tool that is placed through the instruments lumen and is used to inspect the internal element of the instrument
28
A rare but serious complication of insufflation
Gas embolism
29
When should damp dusting be done in the OR?
Before the first surgical case of the day
30
When does terminal cleaning occur?
At the end of the day in each OR that was used.
31
What are the areas of MDR?
Decontamination Assembly Sterilization Storage
32
What area in MDR is cleaned last?
Decontamination
33
3 ways to measure cleanliness of the perioperative environment
Visual Inspections Fluorescent gels/markers with black light ATP monitoring
34
What IFU info in most important in the OR?
The contact time (time product remains wet on surface)
35
Documentation in the patients health care record includes:
Current and past health status Nursing diagnoses and interventions Expected patient outcomes Evaluation of patients response
36
For surgical consent, what is the nurse responsible for?
Reinforce what has been discussed Ensure the consent is correct Ensure the consent is signed and witnessed
37
When taking a history, what should be noted?
``` Allergies Implants, piercings Discharge plans Medications Nutritional status Cultural considerations ```
38
Patient health record is a:
Tool for monitoring and evaluating Resource to determine compliance Method to review for reimbursement for services
39
Who can obtain informed consent?
Surgeon or licensed practitioner performing the surgery | Anesthesiologist or Anesthesia provider
40
Info from the pre-op nurse should include:
``` Patient identifies Planned procedure Operative site NPO status Allergies Diagnostic test results Current meds Blood products available Mobility issues Family contact ```
41
Info from the OR nurse to post-op nurse
``` Current condition for ABCs Type of anesthesia Procedure Surgical issues Skin condition Pressure injury risk Hypothermia status EBL Input/output Drains/Dressings/Packing ```
42
Informed consent should include:
``` Name of facility Name of intervention Indications for intervention Name of the HCP performing Risks/Benefits Discussion of Risks/Benefits Signature Date and time it was signed Date and time of the witness ```
43
What are the 3 methods of hemostasis?
Mechanical Thermal Chemical
44
Examples of Mechanical Hemostasis
``` Pressure Clamps Sutures Staples Clips Ligatures (tie) Pledgets (non-absorbable suture) Bone wax ```
45
Examples of Chemical Hemostasis
``` Epi Vitamin K Protamine Vasopressors Lysine Active agents (thrombosis) Passive agents (collagen, flowable agents, sealants) ```
46
Examples of Thermal Hemostasis
``` Electric current Bipolar Laser Ultrasonic energy Argon gas ```
47
Goals of hemostasis
``` Decrease and control bleeding Minimize the need for blood replacement Optimize the surgical field view Avoid organ damage Shorten length of stay Decrease risk of infection Decrease costs ```
48
Issues associated with surgical bleeidng
``` Visualization Surgical time Blood transfusion Hypothermia SSI Thrombocytopenia Hemodilution Lactic acidosis ```
49
How can you determine how much blood was lost?
Suction canisters Sponges Drapes Lab values
50
4 types of surgical drains
Simple Closed suction (JP, hemovac) Chest Negative pressure wound therapy
51
6 steps of medication use
``` Procuring Prescribing Transcribing Dispensing/Preparing Administering Monitoring ```
52
Symptoms of anaphylaxis
``` Headache Anxiety Stridor Abd pain Tachycardia Hypotension Itchy Swelling ```
53
Precautions to avoid med errors
Using single dose vials Prefilled syringes Limiting the number of medication concentrations Buying meds in a size close to typical dose Securing stored meds
54
Side effects of extravasation
Edema Abd distension Intraabdominal compartment syndrome
55
Side effects of intravasation
Hyponatremia Hypervolemia Cardiovascular complications Pulmonary edema
56
How to handle hazardous materials
``` Contain spills Dispose of materials in designated container Store correctly Use correct amount in the correct way Wear PPE ```
57
A culture of safety is promoted by:
A health care organizations commitment to patient safety A commitment to safety at all levels of the organization A focus on systems, process improvement, and individual accountability Sufficient resources Ability of providers to discuss near miss events without reprisal
58
3 steps for preventing wrong site, wrong procedure, wrong patient
Conducting a pre-procedure verification process Marking the site Performing a time out
59
The 3 types of errors that a team member can make:
Skill-based Knowledge-based Situational-based
60
What is a skill-based error
The provider has the knowledge for the action | There is little or no attention or attention is diverted
61
What is a knowledge-based error?
Mistakes include errors in perception, judgement or interpretation
62
What is a situational-based error
Lack of attention and situation factors play a role
63
What is the 3 goals of ERAS?
Reducing a patients stress Optimizing physiological function Facilitating a patients recovery
64
What is an accountable care organization (ACO)
a model of care that includes physicians, heath care organization representatives, and other health care providers joining togethers to: - give high quality coordinated care - avoid duplication of services - decrease errors
65
Intraoperative factors to consider for positioning
Anesthesia Length of surgery Position required
66
What are the 3 basic surgical positions
Supine (dorsal recumbent) Lateral Prone
67
In the supine position, arms are extended less than 90 degress to avoid compression of the:
Brachial Plexus
68
What are the pressure points in a supine position
``` Occiput Scapulae Thoracic Vertebrae Olecranon process (elbow) Sacrum/coccyx ```
69
If a patient is pregnant, what side would you place a wedge under?
Under the right side
70
What happens if you return a patients legs down from lithotomy too fast?
A significant drop in blood pressure
71
What nerves can be damaged in the lithotomy position?
Femoral Obturator Perineal
72
What 3 forces can act upon the patient during positioning?
Pressure Shearing Friction
73
Name the 3 zones in the perioperative environment
Unrestricted Semi-Restricted Restricted
74
What medication is used in an HM crisis?
Dantrolene
75
How do you mix dantrolene?
With 60ml of sterile water
76
What med do you provide to a patient experiencing LAST?
20% Lipid emulsion therapy
77
Goals of surgical skin prep
To remove soil and transient microorganisms from the skin To reduce the resident microbial count To inhibit rapid rebound growth of microorganisms
78
Commonly used antimicrobial agents
``` Chlorhexidine gluconate (CHG) 4% Chlorhexidine gluconate (CHG) and alcohol Povidone - Iodine Alcohol ```
79
What to use for a patient with an allergy to oidine?
Baby shampoo and a balanced salt solution
80
Examples of EARS protocols
Strengthening exercises Smoking cessation Improved nutrition Additional pre-op education
81
Factors that determine the level of the patient care in post-anesthesia
``` Type of surgery Length of surgery Type of anesthetic Comorbid conditions Anticipated postanesthetic requirements and interventions ```
82
What is Capnography
Capnography is the monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases
83
Elements of the nursing process
``` Assessment Nursing diagnosis Outcome identification Planning Implementation Evaluation ```
84
What is research
Systematic inquiry or investigation
85
What is quality improvement
A method of creating a change to a current process and then measuring the effectiveness of the change
86
Policies and procedures are created to protect:
Patients Personnel Organization
87
What is an Indemnity Payment
Payment made on behalf of the policy holder
88
What is Liability
Legal responsibility
89
What is malpractice
A nurses negligence or any intentional act that causes physical, financial, emotional, psychosocial and/or cognitive harm
90
What is standard of care
Actions of a reasonable and prudent professional
91
What is tort
A breach of duty to another person as outlined by law
92
What are the 4 elements of malpractice
Duty Breach of duty Breach caused an injury The injury was harmful to the patient
93
3 tenets of radiation safety
Time Distance Shielding
94
NIOSH (National Institute for Occupation Safety and Health's Hierarchy of controls:
Eliminate Substitute Engineering controls (smoke evac, needles IV) Administrative controls (policies, education, testing) PPE
95
Factors that affect event-related sterility
``` Packaging material quality Storage conditions How an instruemnt is transported How the instrument in handled Environment conditions ```
96
Asepsis is:
The absence of pathogenic microorganisms
97
Sterility is:
The absence of virtually all microorganisms
98
What is used to monitor a sterilizers efficiency and effectiveness ?
A biological indicator
99
What does a negative biological indicator mean?
Sterilization conditions were met
100
If a sterilization load has an implant, what must the load have?
A biological indicator
101
What are the 3 testing methods that can be done during instrument sterilization?
Swab/strip Solution vial ATP
102
How does the swab/strip testing method work?
A swab/strip that tests for specific contaminants (protein, blood, carbs) A wet swab is wiped on a surface, if it changes color, the instrument is not clean
103
How does the Solution Vial testing method work?
Individual vials test for specific contaminants A water moistened swab is wiped on the surface, swab and placed into the vial, if the vial turns a color, that contaminant is present.
104
How does the ATP testing work?
Tests for ATP which is in all organic material A pre-treated swab is wiped on a surface then placed in a test device. If ATP is present, a bioluminescence is created and can be read by the testing device
105
What are the two types of steam sterilizers?
Dynamic Air Removal: Pre-Vacuum | Gravity Displacement
106
How does the Dynamic Air Removal Pre Vacuum sterilizer work?
A vacuum pulls out the air which is replaced by steam
107
How does the Gravity Displacement Sterilizer work?
Air is removed by gravity in which incoming steam replaces. The air is pushed down and pushed though a port or drain at the bottom of the sterilization chamber
108
What is the bowie-dick test?
A quality assurance test that detects if any air is trapped in the sterilizer
109
How long should you wash your hands for?
20 seconds
110
What are instruments typically made out of?
Stainless steel Titanium *can be plated, but prone to chipping, peeling, rupture and corrosion*
111
What are 3 categories for stainless steel instruments
``` Anodized plating -satin finish -glare proof -prone or corrosion Ebony -black finish -prevention glare and reflection Mirror plating -shiny -impedes visibility ```
112
What are some qualities of titanium instruments
``` Inert: doesn't react with other substances Nonmagnetic Lighter/Stronger Used in microsurgery Blue anodized finished reduces glare ```
113
4 types of instruemnts
Cutters Clamps Retractors Other
114
3 classifications of endoscopes
Rigid Semi-Rigid Flexible
115
What is the chain of infection
``` Causative organism Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host ```
116
Define Pathogenicity
Proportion of infect people who develop clinically apparent disease
117
Virulence
Proportion of clinically apparent cases that are severe or fatal
118
Suture classification system elements
Natural or Synthetic Absorbable or Nonabsorbable Monofilament or multifilament
119
Suture material characteristics
Physical configuration Handling Potential tissue retraction
120
Suturing methods
``` Interrupted Continuous or Running Retention Subcuticular (suture line under the epidermis) Purse string ```
121
SSI catergories
``` Superficial -epidermis/dermis/subcutaneous (30 days) Deep Incisional -fascial/muscle (30-90 days) Organ/Space -organ, space (30-90 days) ```

Periop 101 (1 decks)

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