Positioning
A safety strap should be placed _____ inches above the patient's knees while in the supine position.
2 inches
These are examples of areas where using a chlorhexidine skin prep are contra-indicated.
- Mucous membranes
- Eyes/ears (above the neck)
- Open wounds
This phase of the Surgical Safety Checklist is initiated by nursing
Debriefing
True or False:
A specimen that is not passed off the sterile field immediately should be set aside and kept dry.
False.
Specimen should be moistened with a small amount of saline.
These are essential for every medication that has been removed from it's original packaging
Labels - include medication name, strength, and dose
Arm extension should be less than 90 degrees to avoid compression of this:
Brachial plexus
For trauma, visibly dirty, or cases that are higher risk for surgical site infection, this may be performed using a Chlorhexidine scrub brush and sterile water/saline.
Trauma scrub or pre-scrub
These are some examples of charting/documentation that need to be completed at the end of the case.
- Results of counts (and signed for)
- Times (Surgery end, patient out of room)
- Skin integrity after removal of devices (Cautery Pad, Tourniquet etc.)
- Operation Performed
- Wound Classification
- Insufflation Volume Delivered
- Medications Administered
These 3 things should be verified with the surgeon prior to handing off the specimen
Name of the specimen
Preservative/handling required
Whether it can be passed off the sterile field
This is the risk of improper or excessive use of irrigation or distention media - most commonly seen in cystoscopy or hysteroscopy.
Hypervolemia or hyponatremia
When positioning the patient in lithotomy, how should the legs be moved into/out of the stirrups? Why?
Move both legs together and slowly to reduce risk of hip dislocation.
Do not allow prep solution to pool
Use sterile towels to absorb excess solution
Remove saturated linens or towels before the patient is draped
Allow 3 minutes dry time (minimum)
Do not use above neck, on open wounds, or if patient has a CHG allergy
This is the wound class for a ruptured appendix:
Class 4 - Dirty
These are the risks of errors in specimen management
- Inaccurate diagnosis
- Improper therapy
- Delayed treatment
- Need for a second procedure
These are symptoms of anaphylaxis
Headaches
Anxiety
Stridor
Abdominal pain
Tachycardia
Hypotension
Itchiness
Swelling
List 3 physiological effects of trendelenburg positioning:
Increased intracranial pressure
Respiratory deterioration
Decreased limb perfusion to lower extremities
Shearing forces may cause skin breakdown
What things should you consider when planning to do skin prep?
- Allergies
- Skin condition
- Hair removal
- Location and size of incision (moist/dry site)
- Type/placement of drapes
- Type of solution
- Potential to extend incision or insert drains
Where should you dispose of clean, unused plastic items such as syringes, suction tubing, or graduated cylinders.
Regular garbage.
Cannot recycle items that could be perceived as harmful or infectious.
These tissues are not routinely sent to pathology and can be discarded (always verify with the surgeon)
- Tonsils or foreskin (for patients <16y/o)
- Bone from total joint replacements or spine surgery
- Digits removed for non-viability
- Excess skin or fatty tissue
True or false:
Medications and solutions listed on the DPC are considered a standing order and do not need to be verified for every patient.
False.
Medications must be verified for every patient.
An area of painful skin that is abraded, blistered, or has shallow craters is classified as this stage of pressure injury
Stage 2
What is the difference between the 3M prep method and the traditional method?
The 3M method is used for 3M products. 15sec x 15sec back and forth motion over the incision site (1min x 1 min for moist site) and extending prep to the periphery.
The traditional method utilizes a concentric circle, beginning at the incision site and extending to the periphery, and is used with products such as Povidone Iodine.
You are counting out instruments at the end of the case and cannot find a kelly clamp. What should you do?
Notify the surgeon
Recount
Perform a search for the item
Notify charge nurse
If the item is not found:
List 3 responsibilities of the scrub nurse when transferring the specimen off the sterile field:
Confirm with the surgeon ok to pass off specimen
Review the verify specimen label with circulating nurse
Verify correct container type and size
Pass specimen off using a non-critical instrument (monitor this instrument for contamination from the non-sterile container, and consider this instrument "contaminated" since it has been in contact with the specimen ie. do not use it again)
These are actions the perioperative nurse can take to reduce the risk of medication errors
Prepare medications for one patient at a time
Label all medications promptly when added to the sterile field
Use single-use/dose vials or pre-filled syringes whenever possible
Follow documentation standards - acceptable use of abbreviations, tall man lettering, write down read back method of verifying information
Check the "Rights" of Medication administration