Environmental Cleaning
This procedure should be completed prior to the first case of the day (and before supplies are placed around the room)
Damp Dusting of all horizontal surfaces.
These patients may be able to bypass Phase 1 and go directly to Phase 2
Patients who have had Local Anesthetic Only, or Minimal Sedation
This phase of the Surgical Safety Checklist is initiated by nursing
Debriefing
Upon entering the abdomen, the surgeon encounters purulent inflammation of the appendix and asks for a culture. What it the wound class for this case?
Class IV - Dirty
CO2 is the most commonly used gas for insufflation. Why?
- Easily dissolves into the bloodstream
- Colorless
- Odorless
- Non-flammable
- Inexpensive
This is the best way to prevent vermin (ie mice and flies) from entering the perioperative environment
- Removing all food sources
- Enforcing bans on foods and liquids in the semi-restricted areas
- Keeping doors and windows closed
Most post operative complications occur during this time frame
48 hours
This can occur if the patient is overly stimulated during emergence and may require administration of succinylcholine and reintubation as treatment.
Laryngospasm
This type of wound healing has the following features: Significant tissue loss, wound remains open to heal from the bottom up, and may result in weak tissue approximation or herniation
Secondary Intention or Granulation
List 3 things to look out for when inspecting endoscopic instruments before use
- Missing parts
- Correct alignment and functioning
- Wear/corrosion
- Cracks in insulation
- Cleanliness
This type of cleaning is recommended for patients on MRSA precautions
Enhanced Cleaning
(which at our sites is the same as a Terminal Cleaning)
These are the levels of Post Anesthesia Care - it is based on the type and focus of care provided, not the physical location
Phase 1 - focus on life-sustaining asssements and interventions
Phase 2 - focus on education, preparation for discharge home
Phase 3/Extended Care - for patients requiring additional assessments or interventions, or those requiring a longer than usual stay.
Of the following end of case duties:
- Calling PACU
- Completing Documentation
- Assisting Anesthesiologist with extubation
This should be your priority.
Assisting with extubation
A wound which is cleaned, debrided and packed initially, but closed at a later date is an example of this type of wound healing
Third Intention or Delayed Primary Closure
You are checking in the patient for an MIS chole procedure, why is it important to ensure the patient has voided immediately prior to entering the OR?
An empty bladder assists in visualization and to avoid injury.
Which of the following is the most appropriate product for cleaning and disinfecting an OR?
a) EPA Registered Product
b) High level disinfectant
c) Alcohol
d) Chemical sterilant
EPA Registered Product
This is the purpose of the post-operative phone call
- Check on the patient
- Reinforce instructions
- Ask for questions
- Give reminders (ie. follow-up appointments)
What information should you provide when calling PACU to request a spot?
Where you are calling from, which patient, any special needs (precautions, monitors, acuity concerns), time-frame if it's a "heads up" call.
These are patient factors that affect wound healing
- Respiratory and circulatory status
- Age
- Pre-existing conditions
- Immune system response
- Nutritional status
The recommended pressure setting to maintain a pneumoperitoneum is:
These are components of the chain of infection - and an example of each
Infectious agent - the disease causing pathogen. Bacteria, fungi, viruses or parasites
Reservoir - human, animal or environment where the disease causing pathogen multiplies. Dirty surfaces
Portal of Exit - how the pathogen leaves the reservoir. Open wounds (drainage), body fluids,
Mode of Transmission - contact, ingestion, inhalation
Portal of Entry - broken skin, mucus membranes, invasive medical devices (central lines, catheters)
Susceptible host - our patients (or us) - unvaccinated individuals, immune compromised, comorbidities
True or False : Perianesthesia nurses can provide regional anesthesia
False - they can assess and monitor patients who have received regional anesthesia, but do not initiate
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
Negative Pressure Wound Therapy improves wound healing through these actions.
Reducing swelling/edema
Reducing bacterial load
Promoting wound contracture
Encouraging formation of granulation tissue
These are safety checks specifically related to the use of gas cylinders
check that you have the correct gas
ensure you have enough gas - don't start with an empty tank and be sure to have a spare full tank immediately available
check that you have a cylinder key, and that it is the right one - open the tank before use, and close it when you are done
bleed the gas lines at the end of the case (turn off, then run the insufflator)
general tank safety - should be secured in a tank rack - not laying on the floor, leaning against a wall, or at risk of being dropped/damaged