AORN Periop 101 Final Exam-Questions and answers. 100% Accurate. Rated A

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AORN Periop 101 Final Exam, Questions and answers. 100% Accurate. Rated A Indemnity Payment - ✔✔Payment made on behalf of the policy holder Liability - ✔✔A legal responsibility Negligence... - ✔✔An act or failure to act that deviates from the standard of care Nursing Malpractice - ✔✔A nurse's negligence or any intentional act that causes physical, financial, emotional, psychosocial, and/or cognitive damage to the person in the nurse's care Respondeat Superior - ✔✔An employer is legally responsible for the nurse employee only when: o The nurse acts within the scope of practice o Any allegations brought against the nurse occurred during the nurse's employment o The nurse's actions were within the employer's best interests. Tort - ✔✔A breach of duty to another person as outlined by law What are the four elements of malpractice? - ✔✔• Duty • Breach of duty • The breach of duty caused an injury • The injury was harmful to the patient Elements of Informed Consent - ✔✔• Must be obtained by the licensed professional who is performing the procedure • The patient must give consent voluntarily with the full understanding of all implications • Must include o Diagnosis o Proposed treatment o Treatment alternatives o Consequences of accepting or declining the proposed treatment Five Rights of Delegation - ✔✔Right task Right circumstance Right person Right communication and direction Right supervision and evaluation Four types of patient privacy health care providers and personnel have an ethical and legal responsibility to always maintain - ✔✔• Medical information • Physical exposure • Personal privacy • Electronic privacy Eight factors to consider before determining what anesthetic to use for a particular patient - ✔✔• Patient's age • Length & type of surgery • Patient & surgeon preferences • Patient's co-existing diseases • Patient's mental & psychological status • Patient's previous experiences with anesthesia • Plans & protocols for postoperative pain management • Position of the patient during surgery The American Society of Anesthesiologist's NPO Guidelines - ✔✔• Clear liquids - stop 2 hours before surgery • Breast milk - stop 4 hours before surgery • Infant formula - stop 6 hours before surgery • Light meal (toast & a clear liquid) - stop 6 hours before surgery • Fried foods, fatty foods, meat - stop 8 hours before surgery Circulator RN duties during Induction of anesthesia and assisting anesthesia professional with Cricoid Pressure - ✔✔• Cricoid pressure application is not released until the endotracheal (ET) tube cuff is inflated, tube placement is confirmed, and anesthesia provider has given a verbal confirmation to the nurse that the cricoid pressure can be released. • If intubation or ventilation of the patient becomes difficult, the perioperative nurse should retrieve additional airway equipment and supplies. General anesthesia - ✔✔• A drug-induced reversible state of unconsciousness • Results in amnesia, analgesia, and loss of responsiveness, decreased stress response, and loss of skeletal muscle reflexes to a varying degree Regional anesthesia - ✔✔• An injection of local anesthetics near nerve fibers that causes reversible loss of sensation over an area of the body • Examples include spinal, epidural, and peripheral nerve blocks. Monitored anesthesia care (MAC) - ✔✔An anesthesia provider monitors the patient, administers sedatives and other agents as needed, and provides medical services as required. Moderate sedation - ✔✔• The administration of sedative, analgesic, and/or anxiolytic agents by a physician or by a nurse under physician supervision • Depending on state laws and hospital policies, an RN may administer moderate sedation. Local anesthesia - ✔✔• The infiltration or topical administration of agents to anesthetize a part of the body • The perioperative nurse provides patient monitoring and supportive care. Phases of general anesthesia - ✔✔• Phase I: Induction o IV medications and inhalational agents are administered by the anesthesia provider. • Phase II: Maintenance o Medications and inhalational agents are administered to keep the patient anesthetized. • Phase III: Emergence o At the end of the procedure, the anesthetic agents are discontinued or reversed to allow the patient to wake up. Anesthesia Reversal agents: Muscle relaxants: - ✔✔1. neostigmine 2. edrophonium. Note: There is no reversal agent for succinylcholine Anesthesia Reversal agents: Sugammadex: - ✔✔reversal agent for rocuronium, vecuronium, and pancuronium Anesthesia Reversal agents: Benzodiazepines: Midazolam - ✔✔Flumazenil Anesthesia Reversal agents: Narcotics: Fentanyl: - ✔✔Naloxone Patients at Increased Risk for Hypothermia - ✔✔• Older adults • Infants and children • Women • Patients with lower-than-normal body weight Medical Conditions Associated with Increased Risk for Hypothermia - ✔✔• Hypothyroidism • Hypoglycemia • Burns • Trauma • Hypotension • Congestive heart failure • Cardiac vessel disease Signs of Malignant Hyperthermia (MH) - ✔✔• ΜΗ is triggered by inhalation anesthetic gases and succinylcholine • Increased end-tidal carbon dioxide is the most specific sign of MH. • Other signs include skeletal muscle rigidity, ventricular dysrhythmia, skin mottling, and hyperthermia. Medical professionals who can provide anesthesia services are: - ✔✔• Anesthesiologists • Certified registered nurse anesthetists (CRNAs) • Anesthesiologist assistants (AAs) Surgical Safety Checklist Includes: - ✔✔• Μοbility • Preexisting health conditions • Planned duration of the procedure. • Type of anesthesia The Preoperative Nurse Visit Should Include: - ✔✔• Introduce yourself and ask your patient how they would like to be addressed. • Confirm your patient's identity with two patient identifier • If your patient discusses suicidal thoughts during the preoperative visit, report this immediately by following your facility's policy and procedure. • Use the same scale for pain assessment throughout all patient care areas. • Consider all elements of patient care needs prior to surgery. • Consider how the required surgical position may impact a current condition that the patient contends with. A Medication Assessment Should Include: - ✔✔• Prescription medications • Herbal preparations: o may accentuate the toxicity of anesthetics. o interfere with drug metabolism or clearance. o might affect bleeding times. • Recreational/street drugs *It is also important to ask if the patient is using any recreational/street drugs. Close observation must be maintained for symptoms of withdrawal, especially during and after long procedures. • Drugs, alcohol, and smoking can alter lab values or system assessment. A chemically dependent patient who is recovering may have concerns about medication he or she is given. • Patient risk factors due to alcoholism include: - Lowered immunity - Prolonged bleeding times - Increased stress response - Cardiac complications Physiological Effects of Cannabis Include: - ✔✔- Tachycardia - atherosclerosis - Airway edema - chronic bronchitis - Increased appetite - hyperemesis - Paranoia - BIS elevation - unknown tolerance to analgesics - Potential increase in pain Elements of SDOH (Social Determinants of Health) include: - ✔✔• Economic Stability • Education • Social and Community Context • Health and Health Care • Neighborhood and Built Environment A patient's risk factors for hypothermia include: - ✔✔• Extremes in the patient's age (eg, pediatric, elderly) • History of diabetes • Low body weight • Peripheral vascular disorders • Thyroid disorders - An example of a procedural risk for hypothermia is open-cavity surgery (eg, laparotomy, open thoracotomy). Potential benefits of minimally invasive surgery include: - ✔✔• Decreased risk of surgical site infections • Decreased tissue trauma • Reduced intraoperative blood loss • Decreased postoperative pain • Shorter hospital stay • Faster recovery • Lower potential for formation of adhesions Gases used for insufflation include: - ✔✔• Carbon dioxide (CO2) o The most used gas for insufflation - Dissolves easily into the bloodstream - Is colorless, odorless, nonflammable, and inexpensive • Air • Nitrogen • Nitrous oxide • Argon • Helium Gas is insufflated into the peritoneal cavity to create a __________________, allowing for visualization of the abdominal organs and providing room in which to work. - ✔✔pneumoperitoneum Potential complications associated with gas insufflation include: - ✔✔• Elevation in blood pressure • Increase in CO2 blood levels • Acidosis • Decreased cardiac output • Cardiac arrythmias • Gas embolism • Peritoneal irritation • Decreased renal blood flow • Decreased urine output An inspection tool that is placed through the instrument's lumen and is used to inspect the internal element of the instrument - ✔✔Boreoscope Infiltration or effusion into surrounding tissues - ✔✔Extravasation Gas that is blown into a body cavity for visualization - ✔✔Insufflation No-fly zone - ✔✔• Restricted area reserved for imaging equipment • Other necessary equipment is positioned outside of this area or moved to allow for imaging equipment use Practices to reduce the risk for patient injures and complications associated with gas insufflation are: - ✔✔• Placing the insufflator above the level of the surgical cavity • Checking that the alarms are on and audible • Ensuring that a hydrophobic filter is between the insufflator and the insufflation tubing • Flushing the insufflator tubing with the gas that will be used for the surgery before the tubing is connected to the cannula • Setting the flow rate according to the manufacturer's instructions for use and surgeon's preference o Maintain the pneumoperitoneum at a pressure less than 15 mm/Hg • Maintaining insufflation pressure at the lowest level necessary for the pneumoperitoneum and surgical site visualization Clinical signs of a gas embolism include: - ✔✔• Dyspnea • Systemic hypotension • Cardiac anomalies • Hypoxemia • End-tidal CO2 changes Intra-abdominal gas embolism is a rare but potentially serious complication of insufflation because it: - ✔✔• Gas increases abdominal pressures. • Open blood vessels allow the gas to enter the circulatory system. • The gas embolism enters the vascular system. • The embolism travels to the right ventricle or pulmonary artery. Gas cylinder safety include: - ✔✔• Verify that the correct gas is being used by checking the cylinder's label, connector, and color coding. • Make sure there is enough gas in the cylinder. • Check that the key can open the cylinder. • Ensure that the cylinder is opened before use. • Have a second, full cylinder of the same gas being used immediately available. Fluids can be used to create a surgical working space either by gravity or pump infusion. The fluid selected is based on the: - ✔✔• Surgical procedure • Patient assessment • Instruments used during the surgical procedure Low viscosity non-electrolyte fluid is used for: - ✔✔• Gynecological and urological procedures • Used with monopolar instruments • Hypotonic • Can cause transurethral resection syndrome if large quantities are absorbed Examples of Low viscosity non-electrolyte fluids include: - ✔✔o 1.5%glycine o 5% mannitol o 3% sorbitol Normal saline is used: - ✔✔• bipolar instruments • Isotonic • Contains electrolytes • Safer than non-electrolyte fluids if large amounts are absorbed High-viscosity fluid used as: - ✔✔• Plasma volume expander • Can draw six times its own volume into the bloodstream • Has a high glucose content High-viscosity fluid can cause significant complications such as: - ✔✔o Fluid overload o Heart failure o Pulmonary edema Type(s) of High-viscosity fluid include: - ✔✔Dextran Benefits of robotic surgery include: - ✔✔• Precision o Surgeon hand, wrist, and finger movements control the movements of the scope and the thin, lightweight robotic instruments within the patient's body. • Flexibility o Robotic instrumentation may have more flexibility and range of motion than the human wrist. o Each instrument performs a specific task (eg, coagulation, cutting, retraction). • Efficiency o The instrument's quick release from the robotic arm allows for faster instrument changes during surgery. • Safety o Safety features built into the robotic system prevent inadvertent or independent instrument or arm movements that may harm the patient. Energy-generating device safety practices include: - ✔✔• Use the lowest power setting possible. • The person controlling the hand piece is the only person who should operate the foot pedal. • Only use trocar systems that protect the patient from errant electrical current. • Inspect instrument insulation before, during, and after use. • Use a scanning device during the sterilization process to ensure the instrument's insulation is not compromised. Chain of Infection - Reservoir: - ✔✔- Dirty surfaces & equipment - people - water - animals - insects Chain of Infection - Mode of Transmission: - ✔✔- Contact - droplet - airborne (inhalation) - ingestion - water - Blood - contaminated instruments Chain of Infection - Infectious Agent: - ✔✔- Bacteria - Fungi - Viruses - Parasites Chain of Infection - Portal of Exit: - ✔✔- Open wounds - Splatter of body fluids - aerosols Chain of Infection - Portal of Entry: - ✔✔- broken skin - respiratory tract - mucus membranes - catheters & tubes Chain of Transmission: - ✔✔1. infectious agent 2. reservoir 3. portal of exit 4. mode of transmission 5. portal of entry 6. susceptible host What is used to clean the perioperative environment? - ✔✔• Cleaning agents for perioperative environment are selected based on the EPA registration, hospital grading, contact time of the cleaning agent, and targeted organisms. • Do not use spray bottles to apply cleaning agents in the perioperative environment. • Clearly label an environmental cleaning agent that is removed from its original container and placed into a secondary container. How do you clean in the perioperative environment? - ✔✔• Top to bottom. • Less-soiled areas to the dirtiest. • Move the OR bed and mop under that area. • Before the first surgical procedure of the day, damp dust all horizontal surfaces in the operating room. • Turnover cleaning, or between-case cleaning, occurs after a patient exits an operating room and before the next surgery setup begins. It is a standardized, methodical, cleaning process. • Terminal cleaning occurs at the end of each day the operating or procedure room are used. It is a more extensive, thorough cleaning that is performed by trained personnel. • Scheduled cleaning is cleaning of equipment (eg, appliances, air-handling systems, closets, cupboards) that occurs on a periodic, routine basis (eg, daily, weekly, monthly). • Enhanced cleaning measures are implemented for patients who a [Show More]

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