OR
State where the hands need to be after sterile washing and putting on sterile gloves
Above the hips and in front of the person so we can visualize that we have not broken sterile field
State which member of the surgical team is responsible for marking the surgical site
The surgeon! The nurse can and should be involved in this process. The patient needs to be alert and oriented and able to tell the surgical team which site is operated on
Reversal for opiates
Naloxone. What are common opiates used DURING surgery? What are side effects of opiates?
How does the anesthesia provider choose what medications to use for anesthesia?
This is an art and science. There is no one-size-fits-all solution. It is a fine science that is multifactorial
What kinds of special equipment might a very elderly and cachectic patient need vs a bariatric patient?
Elderly cachectic-may need extra padding and special attention to skin issues
Bariatric-will need bariatric bed with possibility of specialized equipment such as longer instruments etc
Describe the roles/differences between the scrub nurse and the circulating nurse (look these up) who is sterile? Who is not? What is the scope of each (what can they do vs. what does an advanced practice nurse do in the OR. What types of Advanced Practice nurses might we see in the OR? Can any RN be trained on the job to be an APRN, or does this require ADDITIONAL training and years of additional schooling?
Scrub nurse-sterile
Circulating nurse-not sterile
RNFA and CRNA-require additional schooling
Must be RNFA to close, CRNA to push anesthesia
State how we care for hearing aids, dentures, glasses and how long are they typically kept on the patient
We securely mark them in a container listed with the patient's sticker on the container. If possible, it is very important to give them to a trusted family member to hold onto while they are in the OR. It is imperative to keep them on the patient as long as possible-especially hearing aids and glasses. Why would this be???
State the medication used to treat malignant hyperthermia
Dantrolene
Describe MDROs, what contributes to this issue?
Multi Drug Resistant Organism-misuse of antibiotics! Please refer back to antibiotic stewardship and review the correct procedure for why antibiotic use
Describe a sentinel event:
Something that can cause serious harm to the patient, items left during surgery, baby kidnapped from nursery
Look this up friends. Why do we care about these events? How does this change our practice moving forward? How does this affect the patient?
Describe info that may be contained in a SBAR handoff from OR to PACU
pt name, surgery/procedure done with which provider, meds given, blood loss? if so, how much? complications, vital signs/patient status
Why would an older individual be at higher risk of complications after surgery compared to a younger person?
Natural aging alters kidney and liver function which affect how surgical medications are metabolized-often taking longer for them to process and be excreted. Older individuals are at higher risks for surgical complications.
Tell me which medications are commonly held (not given) before a surgery
Anticoagulants, NSAIDS, herbal supplements
Tell me how we do a surgical scrub!
What parts do we do first?
When do we do this?
Fingernail, scrub distal to proximal
The circulating nurse is responsible for skin integrity during the procedure, what types of things do they look out for and how do we mitigate these risks
Elderly pts, bony prominences, malnourished pts, we must provide adequate padding during a procedure to ensure pt does not have skin breakdown. How long does it take for a pressure ulcer to develop?
Describe the differences between conscious sedation, local anesthesia, nerve blocks/regional anesthesia, general anesthesia. Why would we use one type of anesthesia vs another? What types of surgeries/procedures might you see with each type of anesthesia. Describe how these affect the patient.
Moderate (Conscious)- loss of sensation, patient responsive and breathing
Local- loss of sensation, awake, topical application
Regional- loss of sensation to a region of body, awake
General- loss of sensation and consciousness, requires artificial airway, inhalation agent and IV medications
If a patient is ordered to get oral Tylenol 1000 mg before going to the OR, and the tablets available are 200 mg tablets, how many tablets will the nurse administer?
5 tablets
The LVN understands that RNs can administer which type of anesthesia:
Conscious sedation: fentanyl and versed
Tell me about the surgical checklists and their importance
What do checklists do? Are they different everywhere, or do surgical facilities keep standardized checklists? Why or why not?
Look up signs symptoms of malignant hyperthermia!
Is this a medical emergency?
How can healthcare professionals screen for this?
What types of medications can trigger this?
reaction to anesthesia, tachycardia, fever, rapid breathing
yes, it can be life threatening
family history/personal history
desflurane (Suprane), isoflurane (Forane), sevoflurane (Ultane), succinylcholine (Anectine)
Tell me about a surgical time out
Done BEFORE the surgery, should involve the patient's input, all members of the team STOP what they are doing and participate in time out. Identifying patient using which identifiers? Right procedure, allergies to meds, is consent signed etc.
Tell me about Succinylcholine
When is this used? Why is it used? What does it do for the patient? Can the patient breathe on their own? Which type of muscles are paralyzed?
Used in emergencies for intubation, causes short term skeletal muscle paralysis, does not necessarily make the patient unconscious but if the patient is paralyzed and not ventilated, they can die
Tell me about local anesthesia. Why is it used? What complications can occur, s/s for those complications, and how they are treated
lidocaine-temporary numbness for a small specific area, patients can stay awake
LAST- local toxicity, metallic taste, confusion
How do we take off sterile attire? (I'm sorry, I said you didn't need to know this, but this important to know)
Pull the gown off, gloves, then mask