Pre-Operative and Pre-Procedure Orders
After reviewing PAES documentation, you find that the patient with a history of OSA has a STOP/BANG score of 5. Their plan is to be admitted for observation after surgery.
What should you do?
What is place an order for RCP Evaluation and Treatment?
What is the required verification step before performing a nerve block?
What is a Time-Out?
How often should you monitor vital signs, oxygenation, ventilatory status, and level of sedation during a nerve block?
Q5 minutes during the procedure
Monitor for 30 minutes after the procedure
Where do you document restraint education and assessments in the EHR?
Where is the Flowsheets -> Restraints (NV) or Restraints (V) (Depends on the active order/indication)?
What does LAST stand for?
What is Local Anesthetic Systemic Toxicity?
What is All patients?
*Unless the provider orders against PIV insertion (Cajas fistulograms)
For a nerve block, when should a time-out be performed?
When is
Immediately before a patient is sedated/before a needle is inserted
What is the term to describe when local anesthetics leak into unintended areas adjacent to the injection site?
What is diffusion?
Infiltration?
What is the time duration for a nonviolent restraint order?
What is 24 hours?
What is the rescue drug for LAST?
What is Intralipid 20%
While reconciling home medications, you notice that your patient is currently taking Semaglutide. What symptoms should you assess the patient for?
What are
Symptoms of nausea, vomiting, fullness?
Notify the anesthesiologist of any findings?
Name 3 required provider documentation elements to validate prior to moving the patient to the surgical suite.
What are
Interval H&P
Physician Verification
Paul Gann Blood Safety Act (if applicable)
Anesthesia Note
Which nerve block can cause a hemidiaphragm?
What is a Interscalene Block?
This governing body may cite an organization if staff fail to document alternatives attempted prior to restraint application
Who is The Joint Commission (TJC)?
What is the loading bolus of intralipid for a patient weighing 90kg?
What is 100ml!
Attachment A: 100ml intralipid for patients weighing greater than 65 kg
A 40F scheduled for a laparoscopic cholecystectomy reports to Pre-op. They have a history of DM2, CHF (on diuretics), DVTs (on Coumadin), which POC/lab tests to do you anticipate to monitor for/obtain? (4)
What are?
Glucose
BMP
PT/INR
ICON - Pregnancy test
Name at least 4 critical safety elements to identify during a time-out.
What is
Correct patient (full name and DOB)
Correct procedure (read from the surgical consent)
Correct site
Correct laterality and visibility of site mark
Administration of antibiotics within the appropriate time frame if applicable
Name the procedures/approaches that Exparel is currently approved for use at SGH.
What are
Total knee replacements? Adductor canal
Shoulder surgeries? Interscalene
Lumbar fusions? Transverse Abdominus Plane, Erector Spinae
How often do you need to document restraint education and restraint assessments/reassessments respectively?
What is
Education - once per shift?
Assessment - q2h?
Name 3 objective signs and 3 subjective symptoms of CNS excitation with LAST
Signs: What is agitation, confusion, muscle twitching, seizures
Symptoms: What is metallic taste, tinnitus, circumoral numbness, diplopia, dizziness
Name 4 actions you take when a patient arrives to Pre-Op with an insulin pump in place?
What are
Notify the anesthesiologist for guidance on continuing/discontinuing?
Notify a Diabetic Nurse Educator
Order "Consult to Diabetic Nurse Educator" for planned inpatients?
POC glucose q hour and prn while in pre-op?
Chart on avatar
Name 3 key assessment findings to escalate to the anesthesiologist which may contraindicate regional anesthesia
What is
Allergy to local anesthetics
recent DOAC use
abnormal anticoagulation lab studies
signs of infection on or near surgical procedure/block site
pre-existing neurological deficits in the affected limb - i.e numbness, weakness, neuropathy
Name 3 solutions that Exparel can be mixed with?
Bonus 100 if you can name the 4th!
What is
Bupivicaine
NS
LR
Bonus - Bupivicaine with Epi
Name 5 patient well-being factors and needs you are required to assess and reassess.
What is
observed behaviors/emotions
circulation
range of motion
hydration
food
elimination
Name 3 medications/ medication classes to avoid administering to a patient experiencing LAST
What is
Propofol - cardiovascular depressant
Vasopressin - increases afterload which further progresses cardiac depression
calcium channel blockers - impairs heart contractility and conduction
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