Surgical Patient Positioning and Preparation
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Questions and Answers

What is the primary responsibility of the anesthesia provider during patient positioning?

  • To monitor the patient's physiologic status and provide input on positioning (correct)
  • To assist the circulating nurse in lifting the patient
  • To select the surgical position without consultation
  • To ensure sterile technique during draping

    • Which of the following actions should be taken when moving a patient from a transport cart to the OR bed?

  • Position the patient only on the OR bed
  • Securely lock both surfaces before the transfer (correct)
  • Transfer the patient without assistance if they are stable
  • Remove the patient's gown completely

    • What should be done to prevent choking when moving a patient?

  • Ensure the patient is lying flat at all times
  • Instruct the patient to hold their gown securely
  • Tie the neck of the patient's gown for safety during movement
  • Leave the neck of the patient's gown untied (correct)

    • What is essential to consider when positioning patients who are obese?

    <p>Using appropriate devices or positioning aids</p> Signup and view all the answers

    Which patient positioning is most commonly used after transfer to the OR bed?

    <p>Supine position</p> Signup and view all the answers

    Who shares the responsibility for patient positioning during surgery?

    <p>The circulating nurse, first assistant, and anesthesia provider</p> Signup and view all the answers

    What should be checked regarding the OR bed before moving a patient onto it?

    <p>Its weight tolerance and stability</p> Signup and view all the answers

    What is a critical consideration related to patient safety when they are under anesthetic?

    <p>Dependent parts must be monitored to prevent sliding off</p> Signup and view all the answers

    What is the primary risk associated with prolonged pressure on peripheral nerves during surgery?

    <p>Injury ranging from sensory loss to paralysis</p> Signup and view all the answers

    Which surgical position is specifically used to facilitate breathing during thyroidectomy?

    <p>Reverse Trendelenburg's position</p> Signup and view all the answers

    What type of strap is typically used to restrain leg movement during surgical procedures?

    <p>Nylon webbing strap</p> Signup and view all the answers

    Which injury is most commonly associated with prolonged positioning during surgery?

    <p>Pressure ulcers</p> Signup and view all the answers

    What is the purpose of positioning the arm on an arm board during surgery?

    <p>To facilitate intravenous fluid access</p> Signup and view all the answers

    In which position should the thighs be secured with a safety belt during surgery?

    <p>At the level of the knees</p> Signup and view all the answers

    What is likely the result of improper spinal alignment while turning a patient?

    <p>Increased musculoskeletal discomfort</p> Signup and view all the answers

    What anatomical area is at risk during operations involving extreme positioning greater than 90 degrees?

    <p>Brachial plexus</p> Signup and view all the answers

    Which complication can arise due to thoracic compression during surgical positioning?

    <p>Poor ventilation</p> Signup and view all the answers

    For what purpose are gel pads preferred over towels during surgery?

    <p>To provide cushioning against pressure</p> Signup and view all the answers

    What is a significant risk factor for developing pressure ulcers in surgical patients?

    <p>Obesity or malnutrition</p> Signup and view all the answers

    Which of the following complications is NOT typically caused by improper positioning during surgery?

    <p>Bleeding disorders</p> Signup and view all the answers

    Which positioning technique reduces the risk of nerve injury when handling or turning a patient?

    <p>Logrolling with proper spinal alignment</p> Signup and view all the answers

    What should be checked before bringing the patient into the OR?

    <p>The working parts of the OR bed</p> Signup and view all the answers

    Which body areas need padding when the patient is in a supine position?

    <p>Occiput, heels, and elbows</p> Signup and view all the answers

    When repositioning a patient, which factor does NOT influence the timing of the positioning?

    <p>The personal preferences of the surgery staff</p> Signup and view all the answers

    What is the primary responsibility of the physician during patient movement?

    <p>To protect any unsplinted fractures</p> Signup and view all the answers

    Which safety measure is essential when transferring an unconscious patient?

    <p>Four or more people assisting the transfer</p> Signup and view all the answers

    What should NOT extend beyond the edges of the OR bed?

    <p>Any body part</p> Signup and view all the answers

    Why is unhindered diaphragmatic movement crucial for patients during surgery?

    <p>To prevent hypoxia and maintain respiratory function</p> Signup and view all the answers

    How should the patient's arms be positioned during the supine position for optimal respiratory function?

    <p>At the sides or on armboards</p> Signup and view all the answers

    What is the recommended approach to prevent dermal abrasion during patient transfer?

    <p>Moving the patient on a count of three</p> Signup and view all the answers

    In addition to ensuring patient identification and surgery site confirmation, what must be assessed before transferring the patient?

    <p>Patient's mobility status</p> Signup and view all the answers

    What is a significant concern when a patient is lay down in a horizontal position?

    <p>Reduction in functional residual capacity</p> Signup and view all the answers

    Which is NOT considered a body area that requires padding in a lateral position?

    <p>Occiput</p> Signup and view all the answers

    What is important to prevent during patient positioning to maintain adequate circulatory function?

    <p>Occlusion and pressure on blood vessels</p> Signup and view all the answers

    What is the risk associated with the patient's limbs being dependent during transfer?

    <p>Counterbalance causing the patient to fall</p> Signup and view all the answers

    Which of the following statements about hair removal before surgery is true?

    <p>Hair removal is performed after the anesthetic has been administered, following the surgeon's order.</p> Signup and view all the answers

    What is the recommended method for cleansing the skin at the surgical site?

    <p>A two-step skin prep with scrub soap followed by a paint.</p> Signup and view all the answers

    Which area should be considered as contaminated during a surgical procedure?

    <p>Umbilicus</p> Signup and view all the answers

    Which of the following qualities is NOT ideal for an antiseptic skin cleansing agent?

    <p>Must be flammable when dried.</p> Signup and view all the answers

    What type of skin prep involves the use of alcohol as a cleansing method?

    <p>Alcohol-based one-step skin prep.</p> Signup and view all the answers

    In the case of a surgical procedure involving the abdomen, which patient position helps to relieve lower back pressure?

    <p>Supine with arms secured.</p> Signup and view all the answers

    Which antiseptic solution is known to reduce microbial count and is typically in the range of 2% to 4% concentration?

    <p>Chlorhexidine gluconate.</p> Signup and view all the answers

    During which step of the surgical process is the dispersive electrode for the monopolar ESU placed?

    <p>When the patient is in their final resting position.</p> Signup and view all the answers

    What is a disadvantage of using iodine and iodophors that has led to a decline in their use?

    <p>It can cause skin irritations and burns.</p> Signup and view all the answers

    Which of the following is an appropriate action when performing the abdominal cleansing?

    <p>Avoid pooling of prep solutions under the patient.</p> Signup and view all the answers

    Which of the following is true regarding preoperative antiseptic preparations?

    <p>Heavily soiled skin requires more than basic antiseptic application.</p> Signup and view all the answers

    What is the correct order of action regarding contaminated areas during scrubbing?

    <p>Scrub the most contaminated area last.</p> Signup and view all the answers

    What should be done to handle stray hair during the shaving process?

    <p>Collect stray hair with adhesive tape.</p> Signup and view all the answers

    What is the primary purpose of securing the safety belt above the knees during a surgical procedure?

    <p>To prevent the patient from sliding down the operating table.</p> Signup and view all the answers

    In which position should the torso be supported with body straps during surgery?

    <p>Sitting position</p> Signup and view all the answers

    What should be utilized to prevent the patient's feet from dropping during a semi-Fowler position?

    <p>A padded footboard</p> Signup and view all the answers

    What is a potential complication specifically associated with the sitting position?

    <p>Air embolism</p> Signup and view all the answers

    What is the primary function of the padded footboard in the lithotomy position?

    <p>To prevent the legs from extending over the OR bed</p> Signup and view all the answers

    How should the hands be positioned during the Kraske (Jackknife) position?

    <p>Flexed and positioned on angled armboards</p> Signup and view all the answers

    What is crucial to document regarding the patient during a surgical procedure?

    <p>Preoperative limitations in the patient's range of motion</p> Signup and view all the answers

    Before which type of surgical procedure is urinary catheterization typically performed?

    <p>Vaginal or abdominal procedures</p> Signup and view all the answers

    What is one of the main principles of patient skin preparation before surgery?

    <p>To provide a sterile environment</p> Signup and view all the answers

    Which step is crucial when donning sterile gloves using the open glove method?

    <p>Avoiding contact between sterile and non-sterile surfaces</p> Signup and view all the answers

    Why should patients avoid using body oils and creams post-washing for surgical preparation?

    <p>It can decrease the efficacy of antimicrobial soap</p> Signup and view all the answers

    Which anatomical position is primarily indicated for procedures with a dorsal approach?

    <p>Prone position</p> Signup and view all the answers

    What position is used occasionally for some neurosurgical procedures?

    <p>Sitting position</p> Signup and view all the answers

    What action is advised if hair removal is necessary for a surgical site?

    <p>Using clippers or razors with care</p> Signup and view all the answers

    What is a common reason for avoiding hair removal before surgery?

    <p>It may injure the skin</p> Signup and view all the answers

    Study Notes

    Patient Positioning, Prepping, and Draping

    • Responsibility: Surgical positioning is a shared responsibility among surgeons, anesthesia providers, circulating nurses, and first assistants. Anesthesia providers have final say regarding patient positioning when physiological status is a concern. Additional help is needed for complex cases and obese patients, possibly using special devices or positioning aids.

    • Timing: Ensure surfaces like the transport cart and OR bed are locked. Clear pathway and personnel are required to prevent falls. Untie patient gown ties. Transfer to supine position is common after anesthesia and transport.

    • Preparations: Circulating nurses must review the procedure, consult the surgeon if unsure, assess patient needs, check the OR bed and attachments, and assemble protective pads. They also review the plan of care to address any unique patient needs.

    Padding Considerations

    • Supine: Pad occiput, heels, elbows, and sacrum.

    • Prone/Face-Down: Pad anterior knees (if kneeling), face (forehead and ears), dorsal foot/toes, genitalia, and breasts.

    • Lateral: Pad face and ears, medial knees, axilla, ankles/feet, and arms.

    Safety Measures

    • Identification: Identify patient and confirm surgical site as per facility policy with labeled site from the surgeon. Assess patient mobility. Do not move patients toward affected limbs or blinded eyes.
    • Stability: Secure OR bed and transport cart. Use mattresses stabilizers. Untie patient gown/blanket to prevent entanglement. Use Velcro or equivalent for mattress stability.
    • Assistance: Two people help awake patients transfer, one to guide the patient to the OR bed, and one to prevent falls. Four or more people assist unconscious, anesthetized, obese or weak patients, with transfer devices/lifters. Transfer only on the count of three, with the anesthesia provider signalling. Protect fragile areas and maintain body alignment while turning.
    • Anesthetized Patients: Anesthesia providers are responsible for monitoring and protecting the head of anesthetized patients (maintain neutral axis and minimize head turns). Do not move patients without anesthesia provider permission. Move them slowly and gently.
    • Positioning: No body parts should extend beyond the OR bed edges or contact unpadded surfaces. Minimize body exposure to prevent hypothermia and maintain patient dignity. Avoid kinking tubing or dislodging devices.

    Anatomic and Physiological Considerations

    • Respiratory: Maintain a patent airway, unhindered diaphragmatic movement, and chest excursion to avoid hypoxia. Horizontal position reduces anteroposterior diameter and tidal volume. Support arms to avoid limiting chest expansion. Patients with obesity and/or pulmonary issues are at higher risk.

    • Circulatory: Avoid pressure on peripheral blood vessels; use supporting straps appropriately. Anesthesia can alter blood pressure. Careful consideration for positioning with regards to this effect is imperative.

    • Nerve: Avoid prolonged pressure or stretching of peripheral nerves. Support extremities. Common injury sites include brachial plexus, ulnar, radial, peroneal, and facial nerves. Avoid extreme head and arm positions.

    • Musculoskeletal: Support muscle groups (especially in anesthetized patients). Avoid extended head positions when possible to minimize post-op discomfort and neck pain. Log roll when turning a patient.

    • Soft Tissue: Uneven weight distribution can cause pressure ulcers and deep tissue injury. Protect bony prominences, use gel pads instead of towels/rolls, re-position patients during lengthy procedures. Patients who are thin, malnourished, diabetic, or debilitated are especially vulnerable.

    Complications

    • Positioning: Potential complications are hemodynamic instability, poor ventilation, nerve injuries, tissue damage, ischemia (bald spots), compartment syndrome, pressure necrosis, amputation, blindness, corneal abrasion, ischemic limbs, venous emboli, vertebral injury, panic attacks, or claustrophobia.

    Equipment

    • OR Bed: OR bed attachments allow for diverse patient positions, including orthopedic, urologic, or fluoroscopic tables.

    • Anesthesia screen, arm boards, wrist/arm straps, hip restraints, stirrups, headrests, safety belts (thigh straps): Supports various patient positions during surgical procedures. Legs and thigh straps are secured to prevent movement.

    Surgical Positions

    • Supine: Patient lies flat on back with straight, parallel legs and secured arms, and a secured thigh strap.

    • Trendelenburg: Hip and knees over lower OR bed break. Tilted OR bed raises the head to allow the foot to dangle for lower abdominal or pelvic procedures.

    • Reverse Trendelenburg: Head elevated to enable decreasing blood supply to surgical site. Used for thyroidectomy and certain laparoscopic procedures.

    • Semi-Fowler: Patient is positioned supine, then the torso raised 45 degrees with slightly lowered legs to serve as a backrest. Legs over the lower bed break.

    • Sitting: Upright torso with shoulder/torso support straps for good respiration and circulation. Supported footboard is frequently used.

    • Lithotomy: Patient’s buttocks are on the break between the bed body and leg sections, legs in the air and supported by stirrups.

    • Prone: Patient lies face down for dorsal and posterior procedures, anesthetized in supine position in the transport cart, then turned over.

    • Kraske (Jackknife): Supine first then turned to prone, and hips over the center break.

    Physical Preparation

    • Urinary catheterization: Urinary bladder is emptied before OR transfer, or catheterization may be performed after anesthesia to maintain a non-full bladder. Foley catheter is inserted before vaginal or abdominal skin prep to avoid perineal splash.

    • Skin preparation: Skin prep renders surgical area free from bacteria, dirt, oil. Surgeons may advise patients to take showers using antimicrobial soap prior to their procedure. Avoid emollients, oils, lotions, creams, as these may interfere with disinfection effectiveness or prevent electrode adherence.

    • Hair removal: Hair removal, if needed, is performed per surgeon's order.

    • Surgical site cleansing: Areas around the surgical site are cleansed using antiseptic agents. Two-step or one -step skin prep procedures use scrub soap and paint or alcohol-based solutions.

    Antiseptic Solutions

    • Ideal Qualities: Broad spectrum antimicrobial action, virucidal, quick application for consistent efficacy, skin safety, non-toxicity, efficacy maintaining in the presence of other substances, non-flammability.

    • Examples: Chlorhexidine gluconate, iodine, iodophors, alcohol.

    Planning

    • Type of procedure: Different procedures (abdominal, sitting, prone, lateral) influence patient positioning, preparation sequences, and drape placement. This requires consideration of the unique needs of the procedure.

    • Documenting: The circulating nurse documents patient limitations, skin conditions, and final positioning plus any special equipment used.

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    Description

    This quiz covers the essential aspects of patient positioning, prepping, and draping in a surgical setting. It emphasizes the responsibilities of the surgical team and the importance of proper positioning aids and precautions. Understanding these principles is crucial for ensuring patient safety and comfort during operations.

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