peri-op nursing I
peri-op nursing 2
worlds collide
skin integrity I
skin integrity II
100

what is the goal of intra-operative nursing care

keep patient injury free and infection free; SAFETY

100

which of these is not a pre-op protocol

1. turning schedules

2. NPO diet

3. informed consent

4. skin preparation

1. turning schedules

That is used post-op to prevent complications (DVT and skin breakdown)

The rest are pre-op protocols to prepare the patient for surgery

100

name 2 reasons why infants need extreme caution with surgery

extra points for a 3rd reason

low blood volume makes them more likely to fatally hemorrhage, cannot thermoregulate or deal with cold well, skin and mucous membranes are thin and easily traumatized, everything (doses, equipment, instruments) need to be adjusted for size

100

what is the first thing you do with a minor burn patient?

remove the patient from the source of the burn

100

What type of pressure injury is this?

The nurse in the long-term care facility observes that a client has developed a sacral pressure wound, which is very red and surrounded by blisters. Which stage of pressure injury does this client present?

Stage II 

Skin is not intact by the blisters. No subcutaneous tissue or bone/muscle/fascia is present

200

What is the last step or final verification that all healthcare members in the operating room have the correct information before surgery?

pre-procedural pause or the "Time Out"

200

True or False

if the HCP hasn't already gotten written informed consent from the patient, the nurse may do so

False

The nurse can witness the patient sign a consent form or be informed by the HCP, but they cannot obtain consent themselves

200

The nurse needs to apply a dressing of a highly absorbent nature. Which type of dressing should the nurse use for this client?

hint: 1 of the 3 in the slides

gauze

200

what is the best environment for a wound to heal in?

consistently moist environments

- products used to add moisture if dry or absorb excessive drainage without making it dry

200

True or False?

Dermatitis is a nonmalignant, chronic skin disorder that is characterized by increased skin production rate and patches of thick red skin with silvery scales

False

Dermatitis (aka eczema) is an inflammatory response of the skin to irritants, allergy, or trauma characterized by erythema, pruritis (itchy), and skin lesions

Psoriasis is what is being described above 

300

what is the difference between the scrub nurse and circulating nurse?

extra points: what are they both accountable for?

scrub nurse is STERILE and provides the surgeon with instruments they need and try to anticipate their needs

circulating nurse is not sterile, manages patient care, make sure their rights/safety are being protected, monitor aseptic practices and coordinates activites

both responsible for instrument and sponge count at the end

300

Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?

antiembolism stockings or SCD/foot pumps

300

true or false

The surgeon, not the CRNA or anesthesiologist, is responsible for administering local anesthetics

True!


300

most wounds heal by which type of process?

hint: 2 words, second word starts with letter I 

secondary intention

Most wounds heal by secondary intention, which is where edges cannot be approximates so granulation tissue is built and fills wound to heal

300

when do you use heat and cold therapy?

extra points: describe at least 1 thing heat and cold does to injuries

cold should be used in the 1st 24 hours of an injury

- controls hemorrhage, edema, pain, swelling, and vasconstricts

heat used after the first 24 hours

- vasodilates, increases blood/oxygen/nutrient/antibiotic/leukocyte supply to wound, promotes muscular relaxation, relieves spasms

400

why is there pre-op testing for 

1. CBC

2. urinalysis

3. ECG

1. notice changes in WBC (infection), platelets (risk for hemorrhage), and RBCs (anemia)

2. BUN, creatinine, kidney function to make sure the pt can handle anesthesia (many are excreted in kidney)

3. identify any cardiac risk before surgery

400

An otherwise healthy surgical client has developed sharply increased muscle tone and rapid increase in heart rate and core body temperature. The operating room team should proceed with assessments and interventions that address what health problem?

extra points: what should be used to treat this

malignant hyperthermia

should be treated STAT with datrolene sodium

400

match the type of debridement to the description

types: sharp, mechanical, autolytic, enzymatic

1. removes debris and necrotic tissue by using the body's cells and fluid

2. use of surgical objects in the OR or at the bedside to remove tissue

3. use of chemical products to breakdown necrotic tissue

4. use of wet-to-dry dressings or other nonselective use of force that removes bad tissues

1. autolytic

2. sharp

3. enzymatic

4. mechanical

400
match the wound type to the description

types: abrasion, puncture, laceration, contusion

1. closed wound; bleeding in underlying tissues from a blunt blow; major bruising

2. intentional or unintentional penetrating trauma by a sharp/pointed object that penetrates the skin and tissues

3. cut in skin with either smooth or jagged wound edges; can be shallow or deep; high infection risk

4. wound involving friction; superficial; shearing of top layers of skin

1. contusion

2. puncture

3. laceration

4. abrasion

400

match the complication with the description

evisceration, dehiscence, infection, hematoma, hemorrhage

1. pain, fever, redness, edema, heat, purulent damage

2. swelling, vital signs change, hypovolemia, increased HR

3. bowel or organ pops out from wound, must cover with a moist dressing

4. swelling, bruising, blood-filled cyst that may need drainage

5. wound edges separate due to swelling, obesity, pressure, poor nutrition, inadequate suturing 

1. infection

2. hemorrhage

3. evisceration

4. hematoma

5. dehiscence

500

What is the most commonly assessed postanesthesia recovery emergency?

respiratory obstruction or respiratory failure (atelectasis, pneumonia, hypoventilation due to anesthesia, etc)

500

match drug to description

drugs: propofol, isoflurane, midazolam, vecuronium

1. most widely used IV anesthetic, produces amnesia, euphoria, hypnosis, blocks perfection of pain but DOES NOT produce analgesia; 1 minute onset and 10 minute recovery after discontinued

2. benzodiazepine, used as a sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant; adjuvant med

3. muscle relaxant that prevents spasms and muscle stiffness; suspends nerve impulses and produce anything from weakness to complete paralysis; 3-5 minute onset

4. potent inhalation anesthetic; coherent in 15-30 minutes; adverse effect of airway irritation; amnesia, muscle relaxant, hypnosis

1. propofol

2. midazolam

3. vecuronium

4. isoflurane

500

DAILY TRIPLE

what are the 4 components of balanced anesthesia?

extra extra points: name a drug or class that does one of these things

1. amnesia or memory loss 

2. analgesia (reduction or absence of pain)

3. hypnosis or unconsciousness

4. muscle relaxation or immobility

propofol, isoflurane, vecuronium, midazolam, fentanyl

500

match the wound healing steps to the time period when each happens

steps: proliferative, hemostasis, maturation, inflammation 

1. immediately after

2. up to 3 days

3. 4-21 days

4. 3 wks - 6 mo

1. hemostasis

2. inflammatory phase

3. proliferative phase

4. maturation

500

name whether these injuries are acute or chronic? 

extra points if you name whether its surgical or not

1. burn wounds

2. incision

3. dehisced wound

4. venous pressure ulcer

1. acute/nonsurgical

2. acute/surgical

3. chronic/surgical

4. chronic/nonsurgical