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CNOR Subject Area 3 Questions (Plus
Instruments, Suture, and Wound
Classifications) Questions and Answers
non-alcoholic iodine/iodophors (if not allergic to iodine) - \skin antiseptic of choice for the genitals incident (occurrence) report - - serves as an internal document for risk management
- should objectively, completely, and accurately describe the even without interpretation or opinion by the person(s) completing the form
- considered facility work documents used to improve processes, NOT to attach blame to an individual
- should NEVER be documented in the patient's record 1 hour - \antibiotic should be administered within ___ before skin incision 24 hours - \antibiotic therapy is discontinued within ___ after clean and clean-contaminated cases patient name, patient ID number, origin of specimen, laterality - \4 minimum requirements for labeling intraoperative specimens c - \A DNR order is revoked/suspended during the immediate perioperative period via a) automatic suspension of the order b) the surgeon c) pre-sedation discussion with the patient d) the anesthesia care professional clavicle, iliac crest - \When positioning prone, chest rolls should be place lengthwise from the ___ to the ___. peripheral pulses - \For repair of an abdominal aortic aneurysm, the perioperative nurse should anticipate having to assess ___. patient, medication, time, dose, route, reason, documentation -
\7 basic rights of medication administration internal carotid - \artery that supplies blood to the brain external carotid - \artery that supplies blood to the neck, face, and head external carotid - \The superior thyroid artery supplies the thyroid gland and originates from the ___ artery peroneal - \nerve on the lateral side of the lower leg obturator - \nerve responsible for the sensory innervation of the skin of the medial aspect of the thigh papaverine hydrochloride - \smooth muscle relaxer that inhibits spasm and potential closure of harvested vessels for bypass grafts Occupational Safety and Health Administration (OSHA) - \organization that created the Needlestick Safety and Prevention Act Needlestick Safety and Prevention Act (2000) - \mandates that employers provide safety-engineered devices in the health care setting to prevent sharps injuries (OSHA) dependent iliac crest - \For patients placed in the lateral position with the OR bed flexed and the kidney rest device elevated, the correct placement of the kidney rest is underneath the patient's ___. bookwalter, weitlander, cerebellar, gelpi, balfour, goligher, iron intern - \7 examples of self-retaining retractors self-retaining - \Bookwalter, weitlander, cerebellar, gelpi, balfour, goligher, and iron intern are all examples of ___ retractors. standard precations - \implementation of PPE, work practices, and engineering controls that are utilized to minimize exposure to potentially infectious agents is known as ___ standard precautions -
___ incision is made in the RLQ of the abdomen and is primarily used for an open appendectomy. 7-10 - \Surgical adhesives used for skin closure normally slough off the incision in - days. 50 - \no more than ___ mL of 1% lidocaine should be used per hour local - ___ anesthesia is preferred when cooperating during the procedure is necessary, because the patient will not lose consciousness peroneal - \lithotomy position and the use of stirrups is associated with injury to the common ___ nerves right subcostal - \most common surgical incision made for a hepatic resection surgical team - \most common source of contamination/infection in the operating room noncritical - ___ items (Spaulding):
- those that come in contact with intact skin but not mucous membranes
- bedpans, blood pressure cuffs, crutches, computers, etc. semicritical - ___ items (Spaulding):
- contact mucous membranes or non-intact skin
- require a minimum of high-level disinfection
- colonoscopes, bronchoscopes, vaginal speculums, respiratory therapy equipment, etc. critical - ___ items (Spaulding):
- confer a high risk for infection if they are contaminated with any microorganism
- objects that enter sterile tissue or the vascular system must be sterile because any microbial contamination could transmit disease
- surgical instruments, cardiac and urinary catheters, implants, ultrasound probes used in sterile body cavities, etc.
vagotomy - \procedure performed to reduce gastric acid secretions by interrupting parasympathetic innervation rinsed with sterile saline - \Surgical gut suture comes in a package moistened with alcohol. If it is removed from the package and allowed to dry out, it should be ___ before use. flumazenil (Romazicon) - - benzo antagonist
- has a shorter half-life than most benzos
- contraindicated in patients with long-term use of benzos for life-threatening conditions
- nurse should monitor for signs of re-sedation, as the duration of action may be shorter than benzos freeze, cryo, subcutaneous pocket - \3 ways to preserve autologous cranial bone flap Hank's BSS, milk, water (if only option) - \3 ways to preserve avulsed tooth cryo - \way to preserve autologous parathyroid tissue normal saline, cryo - \2 ways to preserve autologous skin in NS or LR and then refrigerated - \how to preserve autologous veins remove both gloves and re-glove using an assisted gloving technique - \What should be done in regard to gloving if a glove is punctured? ankle - \When supine, should a pillow be place under the patient's ankle or heel? penrose, t-tube - \2 types of open, or gravity, drains used to evacuate surgical wounds esmark - \soft rubber bandage that is used to expel venous blood from a limb (exsanguinate) that has had its arterial supply cut off by a tourniquet exsanguinate - - to expel venous blood from a limb that has had its arterial supply cut off by a tourniquet by using an esmark or by elevation of the limb alone
kocher - - traumatic, toothed clamp
- used for grasping dense, tough tissue with its large teeth allis - - clamp that is similar to babcock
- has teeth
- can be used to grasp intestine mayo - - heavy scissors available in multiple varieties
- straight scissors are used for cutting suture ("suture scissors")
- curved scissors are used for cutting heavy tissue (i.e., fascia). metzenbaum - \lighter scissors used for cutting delicate tissue (i.e., heart) and for blunt dissection iris - - scissors that are used for fine dissection and cutting fine suture
- originally for ophthalmic procedures, but now serves multipurpose role tissue - \non-toothed forceps used for fine handling of tissue and traction during dissection adson - \forceps that are toothed at the tip and used for handling dense tissue, such as in skin closures debakey - \forceps that are used for atraumatic tissue grasping during dissection deaver - \retractor used to hold back the abdominal wall army-navy - \retractor used to gain exposure of skin layers weitlander - \self-retaining retractor used for exposing deep or smaller surgical sites richardson - \retractor used to hold back deep tissue structures bookwalter - \self-retaining retractor than is anchored to the operating table
malleable - - retractor that can be bent and customized
- also used to protect intestines during abdominal closure rake - \hand-held retractor with sharp teeth used to hold back surface structures yankauer - \suction used primarily for surface suction and some intra-abdominal suction poole - \suction used to remove large amounts of fluid from the surgical field, as well as intra- abdominal suction frazier - - suction used primarily in ENT surgeries and neurosurgery
- usually angled 10 - \blade used for making large skin incisions (i.e., laparotomy) 11 - \blade used for making precise or sharply angled incisions 15 - \smaller version of the 10 blade used for making fine incisions sutures and needles -
vicryl - \polyglactin monocryl - \poliglecaprone PDS - \polydiaxanone prolene - \polypropylene absorbable - \absorbable or non-absorbable?:
clean - \Which wound classification?:
- elective C-section with no pre-rupture of membranes or trial of labor
- exploratory laparotomy/laparoscopy without bowel involvement
- hernia repair
- thyroidectomy
- eye surgery
- skin
- vascular/cardiovascular procedures clean-contaminated - ___ wounds are those in which the respiratory, alimentary (GI), or genitourinary tract is entered under controlled conditions clean-contaminated - \Which wound classification?:
- GI procedures that are controlled and have no significant spillage
- GYN
- GU
- ENT/ear contaminated - \Which wound classification?:
- non-sterile debris in field
- cholecystectomy with bile spillage or acute inflammation
- appendectomy for inflamed appendicitis
- open, fresh (<4 hours) accidental wounds from a clean source contaminated - \Which wound classification?:
- acute, non-purulent inflammation
- spillage of bile
- infarcted/necrotic bowel or other tissue
- unplanned entrance into GI/GU/respiratory tract
- major break in sterile technique clean-contaminated - \Which wound classification?:
- hysterectomy
- lobectomy
- laryngectomy
- small bowel resection
- TURP dirty/infected - \Which wound classification?:
- gross purulence or existing infection
- perforated viscera
- traumatic open wound
- retained devitalized tissue
- penetrating injury dirty/infected - \Which wound classification?:
- I&D
- wound debridement
- perforated bowel dirty/infected - \Which wound classification?:
- retained devitalized tissue
- traumatic wound with delayed treatment (>4 hours)
- traumatic wound from dirty source
- fecal contamination Pocket Prep Questions -
20, 4 - \The American Institute of Architects in collaboration with the U.S. Department of Health and Human Services recommend recirculation of filtered air at a minimum rate of ___ volume exchanges per hour, at least ___ of which are fresh air. aerobic, anaerobic - ___ cultures should be collected using a sterile swab, while ___ cultures should be obtained through the use of a sterile syringe conduction - \putting a warming blanket on the patient helps prevent ___ heat loss conduction - ___ heat loss occurs when a patient is placed on a cold operating bed and body heat is transferred to the surface of the cold bed
excitement/delirium - \Which of the 4 stages/levels of anesthesia?:
- uncontrolled movements
- hyperactivity
- irregular respiration
- HTN, tachycardia
- N/V
- airway reflexes remain intact and are often hypersensitive to stimulation
- airway manipulation should be avoided in this stage
- higher risk of laryngospasm surgical anesthesia/operative - \Which of the 4 stages/levels of anesthesia?:
- the targeted anesthetic level
- ceased eye movements and respiratory depression are the hallmarks of this stage
- regular respiration and maintained BP
- no pain reflexes medullary depression/danger/overdose - \Which of the 4 stages/levels of anesthesia?:
- when too much anesthetic agent is given relative to the amount of surgical stimulation, which results in worsening of an already severe brain depression
- begins with respiratory cessation and ends with potential death
- flaccid skeletal muscles
- fixed and dilated pupils
- significantly lower BP
- weak, thready pulses
- without cardiovascular and respiratory support, this stage is lethal petroleum - \hand lotions for use in the perioperative setting should not contain ___, which can damage the integrity of latex gloves water - \hand lotions used in the perioperative setting must have ___ listed as the first ingredient pneumatic tourniquets - \Multiple studies show that ___ can cause pain, post-op swelling, temperature changes, and ischemia-related systemic changes. Some surgeons are choosing to decrease usage or apply but not use unless it is needed. room air -
\85% of the microbial contaminants located in an open surgical site originate from ___. first incision, surgical wound is closed - \airborne particle contamination increases significantly before ___ and after ___ direct person-to-person contact (OR staff) - \most common source of transmission of pathological microorganisms in the OR Sellick's maneuver - - aka cricoid pressure
- applying pressure to the cricoid cartilage to occlude the esophagus and immobilize the trachea
- prevents regurgitation and aspiration of stomach contents 6 - \Sellick's maneuver (cricoid pressure): exerting pressure with one or two fingers to compress the cricoid cartilage against the body of the _th cervical vertebrae to occlude the esophagus Durant - _ position or maneuver is performed in the event an air embolus enters the patient's right atrium during a surgical procedure. It involves immediately repositioning the patient into left lateral position and tilting the bed into steep Trendelenburg to cause the air embolus to move from the right ventricular outflow tract. The anesthesia provider can then aspirate the trapped air bubble via a central venous catheter placed into the right atrium. air embolus, right atrium; left lateral, Trendelenburg, air embolus, right ventricular; central venous catheter, right atrium - \Durant position or maneuver is performed in the event a(n) ___ enters the patient's ___ during a surgical procedure. It involves immediately repositioning the patient into ___ position and tilting the bed into steep ___ to cause the ___ to move from the ___ outflow tract. The anesthesia provider can then aspirate the trapped air bubble via a(n) ___ placed into the ___. alkalosis - \A patient with ___ (acidosis or alkalosis?) might exhibit seizures, convulsions, tremors, twitching of the muscles, confusion, and CNS excitement 3, 6 - \tourniquet cuff should overlap by at least ___ inches but no more than ___ inches one hour - \tourniquet should not be inflated for over ___ on an upper extremity hour and a half -
\3 best tools/assessments recommended by the ASA to be combined and used intraoperatively to monitor oxygen saturation ketamine - \psychological manifestations of ___ that may occur during emergence:
- delirium
- vivid imagery
- hallucinations
- unpleasant dreams diazepam (Valium) - \reactions to ketamine during emergence can be reduced by giving pre-anesthetic ___ and allowing the patient to lie quietly and undisturbed during the recovery period sporicidal - \any equipment being brought into the OR for a case should be wiped down using an approved ___ agent damp dusted - \OR lights, articulated arms of any equipment, any flat surfaces, any wall-mounted items, and sometimes even the floor in the OR should be ___ before bringing sterile supplies into the room for the first case of the day to remove any dust that may have settled overnight after the terminal cleaning of the previous day was completed TEE - \most useful way to evaluate the heart during open-heart surgery gossypiboma - \medical term for a retained foreign object made of woven textile (i.e., sponges) CO2 - ___ gas insufflation is preferred by most surgeons performing laparoscopic procedures because it has a high diffusion coefficient and is a normal metabolic end product, rapidly cleared from the body. It is highly soluble in blood and tissues, does not support combustion, and provides the lowest risk of gas embolism. false - \T/F: Bipolar requires a bovie pad. true - \T/F: Bipolar electrosurgery is safe for patients with pacemakers and internal defibrillators (since the electrical current is not passing through the body, causing potential disruption in such devices). coblation -
\creates a high-frequency plasma field for ENT and plastic specialties jaw tightness (masseter muscle rigidity) - \During intubation, what symptom that is often seen in pediatric patients is also often apparent in MH in adult patient? iodophor/iodine, sterile water or NS - \Prep for the eyes typically involves cleaning with a non-irritating septic agent, such as ophthalmic strength ___ followed by a rinse with warm ___ or ___. pasteurization - - disinfectant process that kills bacteria, but no spores
- used to disinfect reusable respiratory devices and anesthesia breathing circuits
- utilizes hot water and chlorine detergents prone - \a serious complication of the ___ position is blindness caused by ischemia of the vascular system of the eye the length and weigth of the trachea - \ET tube size is selected based on ___ 30 seconds - \if intubation for a neonate takes longer than _, the patient needs ventilation at 100% before re-attempting mid-trachea - \Where should the tip of the ET tube be positioned? short - _-acting muscle relaxants:
- succinylcholine (Anectine)
- mivacurium (Mivacron) intermediate - ___-acting muscle relaxants:
- rocuronium (Zemuron)
- atracurium (Tracrium)
- vecuronium (Norcuron) long - \pancuronium (Pavulon) is a(n) ___-acting muscle relaxant 27-40 -
- shivering
- impaired speech
- cyanosis
- muscle rigidity
- dizziness
- weak pulse
- falling blood pressure
- dysrhythmias MH - \s/s of ___ in PACU:
- tachycardia
- fever
- muscle rigidity bier - \ideal type of block for the reduction of a distal radius fracture bier block - \regional intravenous injection of a local anesthetic to an extremity below the level of a double-cuffed tourniquet and is used for upper extremity procedures and for those that last an hour or less nerve - ___ blocks are performed to interrupt sensory, motor, and/or sympathetic transmission and are given for prolonged pain relief intercostal - ___ blocks are a type of nerve block generally used for relatively superficial intraabdominal procedures, such as drain placement field - \A(n) ___ block is when the surgical site is blocked off with a wall of anesthetic drug, providing a wide area of anesthesia, as in an abdominal wall block for herniorrhaphy. geriatric - \drug interactions, aspiration, and infection are POST-operative concerns for ___ patients Aspiration - ___ is an increased risk for older adults because may have difficulty swallowing due to dry mucous membranes, reduced salivation, and esophageal peristalsis. Muscular atrophy in the chest and rigidity of the ribcage equates to less productive coughing, further attributing to the risk.
geriatric - \Hypothermia, potential for emboli, monitoring of fluid/blood losses, and positioning to avoid injury are INTRA-operative concerns for ___ patients. damp dust - \In preparing the OR prior to surgery, ___ should be done to flat equipment surfaces where dust may have settled. Doppler; doppler - ___ studies can be performed intraoperatively to evaluate both anastomoses and the microvascularization of reconstructive tissue flaps and grafts. When preparing for surgeries in which these procedures will be performed, the surgical team should plan to obtain ___ instrumentation which has been decontaminated and prepared for use in the sterile environment of the OR. (same word) under the patient - \When using a c-arm, where should the patient's protective shield be placed/reside? true - \T/F: Pregnant staff members should ask not to be assigned to cases involving radiation exposure. cottonoid - - sponge that is primarily used on delicate tissues
- moistened with LR or a topical hemostatic agent, such as thrombin, for use on delicate structures (e.g., nerves, brain, spinal cord)
- are pressed out flat after moistening and before being handed to the surgeon lap - - sponge used for retaining viscera and keeping them moist and warm
- used for internal use, surgical incision, bleeding control, fluid absorption, and internal organ protection raytec - - sponge used during blunt dissection
- used to absorb blood and other fluids, as well as clean wounds kittner - \sponge that is held in a kelly clamp for use during blunt dissection true - \T/F: Skull caps do not cover all hair and should not be worn. 85 - \the OR temperature can be increased to ___ degrees F
