Standards
Non-sterile as well as scrubbed, but ungloved, personnel shall not reach over the sterile field.
A) True
B) False
A) True
Invisible shedding of the skin laden with microorganisms may contaminate your field.
This includes re-gloving your surgeons, residents, med students, etc. Gloves are to be removed facing away from the sterile field, and when re-gloving, it should not occur over the sterile field. Skin cells, sweat, hair from hands, etc., may fall on your sterile field causing contamination.
What are some of the aims of Enhanced Recovery After Surgery (ERAS) program?
A) Reduce surgical recovery time (reduce physical stress, quicker mobilization)
B) Minimize surgical complications (pain and infection)
C) Reduce hospital stay (lowers risk of hospital acquired infections, lower costs)
D) All of the above
D) All of the above
Enhanced Recovery After Surgery: is a program designed to improve surgical outcomes by promoting a standardized, evidenced based approach to perioperative care.
Which of the following is the primary purpose of maintaining NPO before surgery?
a) To prevent malnutrition
b) To prevent electrolyte imbalance
c) To prevent aspiration pneumonia
d) To prevent intestinal obstruction
c) To prevent aspiration pneumonia
There are many avoidable complications for aspiration pneumonia such as: Respiratory failure, sepsis, Acute Respiratory Distress Syndrome (ARDS), chronic lung disease, empyema (infection that spreads to the pleural space causing pockets of pus), and lung abscesses.
The proper use of cricoid pressure can decrease incidence of aspiration pneumonia
One of the most important factors in the prevention of postop infection is:
a) Proper administration of antibiotics
b) Fluid intake of 2-3L/day
c) Practice of strict aseptic/sterile technique
d) Frequent change of wound dressings
c) Practice of strict aseptic/sterile technique
This includes thorough hand washing and the use of gloves, masks and sterile equipment by all healthcare providers, this minimizes the introduction of pathogens into surgical wounds.
You are the circulating nurse in the OR where the surgeon is performing an E1 Bentall/hemiarch procedure for a Type A dissection. Upon aortic cannulation, the aortic cannula pierces through the posterior wall of the aorta and begins to dissect. Your patient has lost 30% of their blood volume, bleeding has not been controlled and the patient is hemodynamically unstable. How do you call a Massive Hemorrhage Protocol, per anaesthesia's request?
- STAY CALM - Dial "55": State "transfusion 25" and your location, twice (confirming they have correct information).
- Call your charge nurse and state an MHP has been initiated.
When is the most appropriate time for the surgeon to mark the patient's surgical site?
A) In the OR when the pt is awake and sedated
B) In the OR when the pt is asleep
C) In preop when the pt is alert and involved in the marking.
D) All of the above are correct
C) In preop when the pt is alert and involved in the marking.
When pt's are involved with marking of surgical sites, this decreases the probability of wrong site, wrong side surgeries, which is a "never-event".
According to ERAS guidelines, antibiotics, namely Cefazolin, should be given within the hour before surgical incision and again 3 hours later, to prevent...what?
Postoperative surgical infections
Cefazolin is used for it's high efficacy and cost effectiveness.
Giving the recommended does of Cefazolin within the hour prior to surgical incision decreases the rate of postoperative infection from skin flora. Re-dosing of Cefazolin every 3 hours (if applicable) after that decreases postoperative infections significantly, according to ERAS guidelines.
A patient is receiving general anesthesia for surgery. The nurse knows that general anesthesia affects which body system the most?
a) Cardiovascular
b) Respiratory
c) Gastro
d) Central Nervous System
D) the Central Nervous System (CNS)
General anesthesia affects the CNS by slowing down its activity, it is a "controlled" state:
1. Loss of consciousness
2. Reduced pain perception
3. Muscle relaxation
4. Slowed breathing and heart rate
5. Decreased reflexes
The proper way to pour sterile water into sterile basin is:
A) Directly over sterile basin, with interrupted stream and splashing
B) Held high above but away from sterile basin, pouring slowly with no splashing
C) Not directly over sterile basin, pouring slowly with a constant stream from a height that minimizes splashing or spillage
D) All of the above are incorrect
C) Not directly over sterile basin, pouring slowly with a constant stream from a height that minimizes splashing or spillage
This decreases the risk of contamination. The stream must not be stopped and restarted. A small amount (30cc)of fluid should be maintained in bottle to prevent introduction of bacteria from the rim/neck of bottle into the sterile field.
What is in the first transfusion pack in an MHP?
BONUS 100 points: How many minutes should it take to get to you?
4 units of RBC's
15 minutes
You should not wash or wipe off Chlorhexidine (CHG) prep solution postoperatively, after wound is closed?
A) True
B) False
A) True: CHG should not be wiped or washed off postoperatively, it should be allowed to wear off over time as it provides prolonged residual antimicrobial effects and remains active in the presence of blood and body fluids.
CHG is proven to be active on skin for 7 days
What is done pre-operatively in enhanced recovery colorectal surgery to prevent malnutrition?
Carbohydrate loading
Instead of fasting, patients are often given a carbohydrate-rich drink a few hours before surgery. This improves energy stores, helps maintain muscle mass, reduces insulin resistance, and improves recovery
What is a dangerous complication during induction of spinal anesthesia?
a) Tachycardia
b) Hypotension
c) Hyperthermia
d) Bradypnea (slow breathing)
b) Hypotension
A sudden drop in blood pressure due to the anaesthetic blocking the nerves that control blood vessel tone in the lower body. When these nerves are blocked, the blood vessels relax and widen, which leads to a drop in BP.
The skin is clipped prior to surgery in order to:
a) Facilitate skin incision
b) Indicate the site to be draped
c) To prevent wound infections
d) Reduce post-op scarring
c) To prevent wound infections
This minimizes the number of bacteria on the skin. Hair traps bacteria and makes it harder to properly clean the skin. Removing the hair allows the antiseptic solution to be applied directly and more effectively, which creates a cleaner surgical field.
You are in charge on night call and a AAA is booked, (vascular) what are some good questions to ask the person calling you (paging)?
1. Where is the patient?
2. Who is the surgeon?
3. Have you called perfusion? (cell saver)
Regarding surgical site marking:
Does the marked surgical site have to be seen on the pt after drapes are applied?
A) Yes
B) No
A) Yes
The marked site must be seen within the planned surgical site. It must be a clear, visible mark. This promotes correct surgery site. If no mark is seen after draping,it defeats the purpose of marking the site.
According to ERAS standards when should a patient start fasting?
A) 8 hours prior to surgery
B) 6 hours of fasting from solid foods and 2 hours of fasting from clear fluids.
C) 2 hours prior to surgery
D) Fasting is not required
B) 6 hours of fasting from solid foods and 2 hours of fasting from clear fluids.
Carbohydrate drinks are recommended to take during the clear fluid phase or preoperative fasting.
Fasting prior to surgery decreases the risk for aspiration
The anaesthetist is intubating the patient and asks the nurse for BURP, what does the nurse do?
A) Apply FULL cricoid pressure at the cricoid cartilage
B) Move esophagus to the left using 2 fingers
C) Apply backward and upward pressure to the patients right side
D) None of the above
C) BURP is a modified cricoid pressure technique. Using two fingers, find the cricoid cartilage, apply backward pressure, push the cartilage up toward the chin and move it to the patient's right. Facilitates viewing of the larynx when the trachea is in an anterior anatomic position.
B- Backward
U- Upward
R- Rightward
P- Pressure
According to the Chlorhexidine prep stick manufactures instructions, what is the correct use when prepping a dry surgical site, such as an abdomen, or arm:
A) Do not go over the same area more then once, let dry 3 minutes
B) Use repeated back and forth strokes for 30 seconds, let dry 3 minutes
C) None of the above
B) Dry sites- Use repeated back and forth strokes for 30 seconds
Moist sites- (inguinal fold, axilla, pannus fold)- Use repeated back and fourth strokes for 2 minutes
*Must allow area to dry completely for 3 minutes for dry and moist sites.
What 2 forms must you fill out to receive cross-matched blood if a patient is positive for antibodies?
-CM 077 - must be faxed to Canadian Blood services before our in-house blood bank can send units to OR.
-Request for release of red cells - must be filled out after blood products have arrived from CBS so our blood bank can send to OR
How does the scrub nurse ensure blood/tissue and other debris is removed from instruments during/after surgery to prevent biofilm and instrument breakdown?
A) Soaking instruments in basin with sterile water or saline
B) Using sponge and sterile water to wipe instruments, as used
C) Flushing or irrigating cannulated or lumened instruments with sterile water
D) All of the above
E) B and C
F) None of the above
E) B and C
Soaking instruments in a basin of sterile water is correct, but never use saline/ringers to clean instruments as it is highly corrosive and can cause pitting, rusting, and will damage instruments.
Use a "Point of use Cleaning" approach after each use, meaning, wipe/flush instrument after you get it back to ensure blood and debris are removed. Blood is highly corrosive and will damage instruments.
What is the one of the most important things WE can do (as perioperative nurses) to comply with ERAS standards?
A) Maintain patients normothermia
B) Ensure pre-op antibiotics given 2 hours pre-incision
C) Ensure patient has been NPO for 12 hours
D) All of the above
A) Maintaining patient normothermia:
Normothermia is maintaining a core temperature between 36 - 38 degrees.
Hypothermia: mild- 34-36 degrees;
Moderate- 30-34 degrees;
Severe- at or below 30 degrees
Maintaining normothermia helps to prevent surgical site infections. Patients are often challenged to maintain normothermia as hospitals/operating rooms are often colder then private homes. Patients lose body heat due to being uncovered during surgery with large amounts of skin exposed, exposure of open body cavities, loss of behavioural and thermoregulatory responses (shivering) and anesthesia-induced peripheral vasodilation.
Normothermia is a HIGH priority for perioperative nurses. If procedure is more then 30 minutes, use a thermal warmer, warm blankets are not enough. Warm OR bed before patient gets to OR.
What is one gas and one muscle relaxant present in our OR's that could trigger Malignant Hyperthermia (MH)?
A) Nitrous oxide and Rocuronium
B) Sevoflurane and Succinycholine
C) Isoflurane and Sugammadex
D) All of the above
B) Sevoflurane and Succinycholine
Inhaled general anaesthetic gases that can trigger MH: - desflurane, isoflurane, sevoflurane, Halothane
Muscle relaxant - succinylcholine (Depolarizing muscle relaxant)
Some patients will only have 1 anaesthetic to trigger an MH event, while others may undergo multiple anaesthetics and eventually trigger an MH event. MH is unpredictable, so we must be diligent.
Treatment: Dantrolene - antedote for immediate treatment
What food allergies are associated with latex allergies/sensitivities?
A) bananas, avocado, kiwi
B) chestnuts, potatoes, strawberries
C) Tomatoes, papayas, pitted fruits
D) none of the above
E) all of the above
E) all of the above
There are proteins in these foods that are chemically similar to the proteins found in natural rubber latex, so if your patients have these food allergies, ensure latex precautions.
Upon reading the blood gas it seems your patients HGB has dropped to 65. Anesthesia has asked you to order two units of packed cells (RBCs). They arrive to the OR but they are unchecked and need to be given quickly but you are the only nurse in the room. What do you do?
A) Check the blood yourself, its an emergency.
B) Call your other circulator back from their lunch to check the blood with you
C) Ask the unoccupied anesthesia resident to check the blood with you
D) No need to check it all, your patient needs blood now
C) Ask the unoccupied anesthesia resident to check the blood with you. No need to call your other circulator back from their well deserved lunch.
When checking blood and blood products, the information shall be confirmed by two healthcare professionals. This includes: nurses, surgeons, anaesthetists, and their residents, and perfusionists. Students cannot check blood products.