NURS3065 2024 PeriOperative Nursing Revision Questions PDF

**NURS3065** **PERIOPERATIVE NURSING** **REVISION SHEETS** **These sheets are provided to you as a means of reviewing the core concepts and theory content provided in lectures and lab sessions.** **It is NOT an all-encompassing summary of the NURS3065 course. You will need to read broadly, and i...

**NURS3065** **PERIOPERATIVE NURSING** **REVISION SHEETS** **These sheets are provided to you as a means of reviewing the core concepts and theory content provided in lectures and lab sessions.** **It is NOT an all-encompassing summary of the NURS3065 course. You will need to read broadly, and include all content presented in the prescribed text and via the Blackboard Learning Materials in preparation for your final exam.** C:\\Users\\207076\\AppData\\Local\\Microsoft\\Windows\\INetCache\\Content.MSO\\687B7B4A.tmp **Describe what the term 'operating theatre' means, and how this came about** The term 'operating theatre' is a specially equipped room in a hospital or medical facility where surgeries are performed. It is a sterile environment equipped with medical and surgical tools, as well as life support systems. The word theatre comes from the 1800s where surgery was often performed in an amphitheatre with tiered seating where physicians and students would sit and observe. **What aspects of the patient care journey are encompassed in the 'perioperative period'** The perioperative period encompasses pre-operative phase, intraoperative phase as well as postoperative phase. Preoperative incorporates patient education, pre admission and preparation. Pre-admission risk assessment is the assessment of a patient physically, psychologically, determining any allergies or medications they take, consent, prior tests and results, fasting, any special requirements or cultural considerations, a point of contact as well as discharge planning. Intraoperative includes anaesthetic administration, the procedure itself and monitoring. Finally, postoperative occurs once the surgery is completed so immediate postop care in the recovery unit, monitoring the patients sedation status, pain once awake and any other symptoms and concluding with discharge to a ward or home. **Admitting the patient into the perioperative environment, in advance of surgery, is a crucial aspect of care. Outline 6 pieces of information that the pre-op nurse ascertains using the pre-operative checklist, and why this information is important** What information/data is collected Why? --- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1 Patient ID Check patient name, date of birth and MRN to ensure the correct patient. 2 Allergies Check any known allergies, particularly to medications or materials to avoid anaphylaxis. Ensure all is documented 3 Surgical procedure / site Verify with the patient they are aware of the type of procedure and the site of incision to prevent incorrect procedures occurring or the patient not being aware 4 Medications Any current supplements or medications the patient takes OTC or prescribed as some may interfere with anaesthesia, affect bleeding risk etc 5 Fasting Status Knowing when the patient last ate and drank -- if the patient has not adhered to the requirements it can increase the risk of aspiration during anaesthesia which can lead to pneumonia among others 6 Baseline vitals BP, RR, HR, Temp, any new changes or omissions as they provide a baseline for during and after anaesthesia and can identify any changes in health status **List 5 design features expected of an operating theatre environment** 1. 2. 3. 4. 5. **Identify these operating theatre zones** Transition ----------------- ------------------------------------------------------ Unrestricted Reception, admissions, holding bay, stage 3 recovery Semi restricted PARU Restricted OT, anaesthetic bay **Why is the operating theatre environment maintained at 20-22 degrees, with a humidity of 50-60%** The temperature is kept at 20-22ºC to reduce metabolic demand, comfort of operating team and inhibits bacterial growth. As well, maintaining a 50-60% humidity further reduced bacterial growth and suppresses static electricity. **What methods can the perioperative nurse adopt to help maintain thermoregulation (ie prevent hypothermia) in the anaesthetised patient?** **Describe how air moves in/out/around the operating theatre environment** Air moves in, out and around the OT through positive pressure gradients and directional airflow, specifically air vents with laminar flow. The air vents push air down directly onto the operating table, patient and team, forcing an outward flow where it then travels up and recirculates. **Identify 6 members of the intraoperative team (3 of which must be defined nursing roles), and describe what their job entails** +-----------------------------------+-----------------------------------+ | Circulating Nurse (Scout) | Anticipates the needs of the team | | | | | | Advocates for the patient | | | | | | Monitors aseptic technique and | | | any breaches | | | | | | Performs surgical count with | | | Instrument nurse | | | | | | Ensures correct handling | +===================================+===================================+ | Anaesthetist | Manages patients anaesthesia | | | during surgery | | | | | | Selects appropriate anaesthetic | | | | | | Monitor patient vital signs | | | throughout procedure | | | | | | Note any changes from baseline | | | | | | Assist with patient positioning | | | and safety | +-----------------------------------+-----------------------------------+ | Instrument Nurse (Scrub) | Prepare instruments and necessary | | | equipment | | | | | | Perform surgical count with scout | | | | | | Adhere and maintain aseptic | | | technique and sterility | | | | | | Work directly with surgical team | +-----------------------------------+-----------------------------------+ | Surgeon | Perform procedure | | | | | | Work with team | | | | | | Ensure sterility and aseptic | | | technique | | | | | | Manage any complications | +-----------------------------------+-----------------------------------+ | Anaesthetic Nurse | Contact PACU and handover | | | | | | Support and assist with | | | anaesthesia management | | | | | | Communicate any concerns with | | | anaesthetist and team | | | | | | Maintain accurate records of | | | medications | +-----------------------------------+-----------------------------------+ | Operating Assistant | Communicates with team | | | | | | Transports/transfers/positions | | | patient | | | | | | Supply equipment for patient | | | positioning | | | | | | Assist with waste disposal | +-----------------------------------+-----------------------------------+ **Describe the role of the anaesthetic nurse** Direct contact with theatre floor Contact PACU and handover Monitor vital signs Prepare patients for anaesthesia Explain procedure, ensure consent **What does the term asepsis mean, and list 5 ways this is achieved through nursing interventions in the operating theatre?** Asepsis: the absence of pathogenic microorganisms that can cause infection. Notably it is pivotal in OT's as patients are in at increased risk of infection. 1\. **Hand hygiene** : performing a surgical scrub including the appropriate and necessary hand wash to minimise the presence of microbes, as well as ABHR where necessary. **2. Sterile** **techniques** : including wearing sterile gloves and non-sterile gloves (to double glove), donning the necessary PPE as well as surgical drapes for the patient and surgical site to prevent contamination and limit microbes. 3\. **Environment control** : maintain a sterile environment and sterile field, ensure proper and adequate ventilation 4\. **Instrument sterilisation** : ensure all instruments have been adequately sterilised -- when the package of instruments are received they should be returned with a black strip across the opening as an indication the instruments have been sterilised 5\. **Limiting traffic** : minimise the number of personnel entering the OT i.e. only authorised personnel being the surgical team to prevent and stop additional healthcare workers entering which increases the risk of contaminants being introduced **A patient is assigned a class III Mallampati score. What does this mean (as compared with class I, II, IV)** Mallampati score is used to determine the difficulty of endotracheal intubation during a procedure. Class I is the complete visualisation of the soft palate including the uvula, and fauces indicating intubation should be free from difficulty. Class II is complete visualisation of the soft palate and uvula but not the fauces suggesting minimal difficulty. In Class III only the base of the uvula and soft palate are able to be visualised indicating potential likelihood of difficulty as there is limited room to access the larynx. Class IV indicates a higher risk of difficulty with an increased risk of potential complications as the soft palate and uvula are **not** visible at all, only the tongue. Class III suggests there is moderate risk of a difficult intubation which can influence the anaesthetic plan and require the team to have additional equipment sourced and accessible for use. **Perioperative nurses need to adopt an ethos of "surgical conscience" What does that mean?** An individual's professional honesty and inner morality system which allows no compromise in practice whether a breach occurs within the team or when working alone. This includes during scrubbing, gowning, gloving and instrument sterility. **At the beginning of the day, how long should a surgical scrub last? What process can scrub nurses adopt for second and subsequent scrubs on the same day?.** At the beginning of the day, a surgical scrub should last between 5-10 minutes. It is essential the scrub be strictly within this timeframe to effectively reduce transient microorganisms on the hands and forearms before performing sterile procedures. Second and subsequent scrubs can be between reduced to 3 minutes so long as the hands and forearms are not visibly soiled. **What is the difference between a *surgical hand scrub* and *surgical hand rub* and identify when they may be used in the operating room** Both achieve surgical asepsis but differ in application and technique. The surgical hand scrub: involves the use of antimicrobial soap applied with a specific technique with an E-Z scrub brush to scrub all surfaces of the hands and forearms including under the nails. It lasts for 5-10 minutes and is performed at the beginning of the day or when a surgical team is preparing to enter the OT. The surgical hand rub: involves the application of an alcohol based hand rub or antiseptic that is rubbed into the hands and forearms until dry by ideally for 1-3 minutes. **Define "strike-through". Is this a good thing? Why or why not?** When liquid (body fluids, blood, saline) soaks through a barrier (drapes, sterile wraps, gowns) from sterile to unsterile area and vice versa. Provides a passage of microorganisms through the barrier, and therefore contents must be considered contaminated. It compromises sterility, increases risk of infection, hence is not a good thing. List 5 actions that the scrub nurse needs to undertake to ensure maintenance of the 'sterile field' 1\. **proper gowning and gloving**: scrub nurse must wear sterile PPE and ensure the gown is fully closed and donned using a sterile technique to avoid contamination 2\. **monitoring movement**: scrub nurse should be vigilant about movements within the OT ensuring only sterile personnel i.e. scrub touch the sterile field 3\. **handling instruments and supplies**: all instruments and supplies should be handled carefully and appropriately according to correct protocol. For example avoid any contact with non sterile fields. The scrub nurse should pass any and all sterile instruments and supplies to the surgeon without reaching over non sterile items and fields that could cause contamination 4\. **sterile draping**: properly draping the patient and the surgical site with sterile covers is crucial. The scrub nurse is responsible for ensuring the drapes are placed correctly and that they remain intact throughout the procedure. 5\. **monitoring for contamination**: scrub nurse is required to regularly maintain and observe the sterile field to ensure it remains free from contamination such as strike through and take appropriate action following this **Describe the purpose of the following pieces of theatre attire** 1. Theatre hat/cap: keeps hair covered and contained preventing loose hairs from falling into the sterile field. Adds to overall cleanliness 2. Surgical scrubs: designed to be easily cleaned and disinfected -- they provide a barrier against pathogens or fluids as well as proving beneficial in identifying staff. 3. Goggles / eye covers: protect the teams eyes from fluids and other potentially infectious material. They prevent any materials from reaching the mucous membranes of the eyes and potentially causing infection. 4. Surgical mask: they cover the nose and mouth of the surgical team to prevent the spread of respiratory droplets further reducing the risk of infections in the surgical site. Additionally, a surgical mask prevents the wearer from inhaling airborne agents. 5. Shielded mask 6. Theatre gown 7. Surgical gloves 8. Protective footwear (eg clogs) Describe the following types of anaesthesia, and give examples of each What is this? Examples Complications -------------------------- --------------- ---------- --------------- General anaesthetic (GA) Regional Anaesthesia Local Anaesthesia Sedation / Analgesia What is a 'pre-medication' and why is it sometimes used? Describe why the following drug groups might be used in the perioperative course. Give 3 examples of each Why used? Examples --------------------------- ----------- ---------- Sedatives / Tranquilisers Narcotics Anticholinergics Antiemetics Muscle relaxants Inotropes Blood products Reversal Agent A general anaesthetic (GA) is divided into four phases....Induction, Maintenance, Emergence and Recovery. Describe the key components/elements of these phases Induction ------------- -- Maintenance Emergence Recovery You are the anaesthetic nurse for the day. List the sequence and expectations in the administration of a general anaesthetic. Describe the function of these pieces of airway equipment Endotracheal Tube (ETT) -------------------------------------- -- Laryngeal mask (LMA) Oropharyngeal airway (OPA) Nasopharyngeal airway (NPA) Face mask Self inflating bag / anaesthetic bag Laryngoscope Cuff manometer Stylet Bougie Video Laryngoscope What is the 'gold standard' with determining that an ETT has be positioned correctly in the trachea? RSI (Rapid Sequence Induction) of anaesthesia is sometimes used. Why is this done? Describe the process of "Cricoid Pressure" and why it is performed. A **scrub nurse** is setting up the instrument trolleys in preparation for surgery. What things does the nurse need to be aware of (and check) with regard to these instruments? What is a team "Time Out" Who participates in this process? What is a "Surgical Safety Checklist", and what is the nurses role in using this checklist What is a surgical count? When do surgical counts occur? Who performs the surgical count? What is counted? Surgical haemostatsis occurs naturally or artificially. What actually is this concept, and describe the 3 artificial methods that are used to achieve this? Describe the process of Diathermy (Electro Surgical Unit), and the role of the nurse in ensuring this is **safely deployed** What is the difference between Monopolar and Bipolar diathermy Monopolar ----------- -- Bipolar What are the two main reasons for using sutures? 1. 2. What is the difference between absorbable and non-absorbable sutures, and when might one be used over the other? What are the 3 basic components of a suture needle? 1. 2. 3. Describe the following characteristics of the various needle points Needle point Role / function Use -------------- ----------------- ----- Tapered Cutting Spatula Trocar What methods are used to prevent venous stasis in the intraoperative phase? Define / Describe the following LA Toxicity -------------------------------------- -- Laryngospasm Bronchospasm Atelectasis Aspiration Formaldehyde Perioperative hypothermia Malignant hyperthermia Fasciculation Perioperative Professional hierarchy Perioperative Situational awareness Perioperative nurses assume the following roles in patient care. Identify which nurse performs each of the listed tasks, and describe how/why/when the these actions need to occur Perioperative patient care Which perioperative nurse? How/why/when? --------------------------------------------------------- ---------------------------- --------------- Skin preparation ("prepping) Surgical shave Remove LMA Draping the patient Applying the diathermy pad Application of flowtrons (pneumatic compression device) Determination of fasting status Inflating the ETT cuff Monitoring & record intraoperative blood loss What is the difference between *spinal anaesthesia* and *epidural anaesthesia* Spinal: Epidural: List the pressure area and nerve considerations in the following surgical positions Pressure area considerations Nerve considerations ----------------------- ------------------------------ ---------------------- Lithotomy Supine Trendelenburg Reverse trendelenburg Prone Lateral Fowler Sitting / Reclining Using the ISBAR format, describe how the theatre nurse may handover to the recovery room nurse. The patient has had an open appendicetomy, with 1 abdominal drain. Pt has an LMA and normal vital signs I S B A R Describe 8 key roles of the recovery room nurse in managing the post operative patient 1. 2. 3. 4. 5. 6. 7. 8. Hazards like LASER plumes, surgical plumes, volatile gas emissions and latex allergies can cause grief for theatre staff. What are these, and how can they be managed? LASER plume ---------------------------- -- Surgical plume Volatile anaesthetic gases Latex allergy The following drugs are 'reversal' agents or 'antidotes', and are often used in the perioperative environment. Nurses need to be aware of these, and know where they are kept and how to use them!. Identify the effect/use/intent of the following Dantrolene -------------------- -- Neostigmine Naloxone Flumazenil Lipid Emulsion 20% Protamine sulphate Vitamin K Sugammadex Nurses are responsible for the safe discharge of patients from PACU. Describe the protocols and criteria that need to be considered for discharge, factoring in variables like anaesthetic used, surgical procedure and age. *(You should come up with at least 6 criteria)*