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Describe the minimal level of education required for an advanced practice nurse. - ANSWER-A Master's degree is required for advanced practice nursing. What is the nursing model created by the Association of periOperative Registererd Nurses (AORN) featuring domains that are in continuous interaction with the health system and encircling the focus of perioperative nursing practice—the patient? - ANSWER-The AORN model is referred to as the Perioperative Patient-Focused Model. Define the phase of the nursing process characterized by preparation for what will or may happen and determining the priorities for care. - ANSWER-The planning phase is characterized by preparation for what will or may happen and determining the priorities for care. Institutional standards are usually directive about specific actions in specific circumstances within a facility or system. What type of standards typically provide generalized authoritative statements that can be implemented in all settings? - ANSWER-National standards provide generalized authoritative statements that can be implemented in all settings. Define the phase of the nursing process characterized by performing the nursing care activities and interventions that were planned, and responding with critical thinking and orderly action. - ANSWER-The implementation phase is characterized by performing the nursing care activities and interventions that were planned, and responding with critical thinking and orderly action. Define the phase of the nursing process that focuses on identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care. - ANSWER-The nursing diagnosis phase focuses on identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care. What is the expanded perioperative role characterized by handling and cutting tissue, using instruments and medical devices, providing exposure and hemostasis, and suturing, all as components of assisting-at-surgery behaviors? - ANSWER-The registered nurse first assistant (RNFA) is an example of an expanded perioperative nursing role. The AORN publication, Standards of Perioperative Nursing, is an example of what kind of standard? - ANSWER-The AORN Standards are an example of process-based standards.
What is the specialty nursing language that provides a uniform and systematic method to collect and document the basic elements of perioperative nursing care? - ANSWER- Perioperative Nursing Data Set (PNDS) is the name of the specialty nursing language that provides a uniform and systematic method to collect and document the basic elements of perioperative nursing care. Define the phase of the nursing process typically associated with describing the desired or favorable patient condition that can be achieved through nursing interventions. - ANSWER-The outcome identification phase describes the desired or favorable patient condition that can be achieved through nursing interventions. What is the act of transferring the authority for a selected nursing task or tasks in a selected situation(s) to a competent person? - ANSWER-Delegation is the act of transferring the authority for a selected nursing task or tasks in a selected situation(s) to a competent person. What standards are based on and describe the application of the nursing process in perioperative nursing? - ANSWER-Standards of care are based on and describe the application of the nursing process in perioperative nursing. They include the collection and analysis of data, identification of expected outcomes, planning and implementation of care, and evaluation of outcomes. What is the initiative that encompasses improvements in quality and effectiveness, based on ethical and economic perspectives? - ANSWER-Performance improvement is the initiative that encompasses improvements in quality and effectiveness, based on ethical and economic perspectives. What are some examples of emerging roles in the OR? - ANSWER-Emerging roles include care coordinator, family liaison, robotics coordinator, and informatics specialist. Define the phase of the nursing process that focuses on the patient's progress in attaining identified outcomes. - ANSWER-The evaluation phase focuses on the patient's progress in attaining identified outcomes. What certification is available to perioperative nurses that demonstrates proficiency in support of quality patient care and sets a standard of commitment to the profession of OR nursing? - ANSWER-Certified Nurse, Operating Room (CNOR) is the certification for perioperative nursing. List the types of advanced practice nurses who may practice in the perioperative environment. - ANSWER-Nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs) are examples of nurses who may practice in the advanced role in the perioperative environment.
List examples of physical risks to patients in the perioperative environment. - ANSWER- Physical risks include any damaging or noxious element that comes into contact with the patient to cause harm, such as: electrosurgical/laser beam, pooled prep solution, glutaraldehyde retained in an endoscope, or a retained foreign object. Describe the steps used when weighing sponges to estimate blood loss. - ANSWER- The procedure for weighing sponges is as follows: (1) Weigh a dry sponge in a plastic bag, and adjust the scale to register zero. (2) Place used, bagged sponges on the scale. (3) Record the scale reading: 1 g equals 1 mL of blood loss. (4) Note the blood loss on the record. (5) Add subsequent weight to the preceding weight each time sponges are weighed so that a running total blood loss, calculated from sponges, is available. (6) Measure blood in the suction canister(s) at regular intervals, subtracting the amount of any irrigating solution used. (7) Add the amount of blood loss calculated from suction canisters to the total recorded from sponges to obtain accurate blood loss estimates. What are the key elements of informed consent? - ANSWER-During informed consent, the patient must be informed about the proposed operation or other invasive procedure and its inherent risks, benefits, alternatives, and complications in terms that he or she can understand. How are first, second, and third spacing defined? - ANSWER-First spacing is the normal distribution of fluid in extracellular and intracellular compartments. Second spacing refers to excess accumulation of interstitial fluid (edema), while third spacing occurs when fluid accumulates in areas that normally have no fluid or only a minimal amount of fluid. Define the acronym SBAR. - ANSWER-SBAR stands for: S=Situation, B=Background, A=Assessment, R=Recommendation. What are the signs and symptoms of a transfusion reaction? - ANSWER-Signs and symptoms of a transfusion reaction include: increased intraoperative bleeding, hyperthermia, weak pulse, hypotension, visible hemoglobinuria, vasomotor instability, and greatly decreased or no urinary output. Define the term intracellular fluids. - ANSWER-Intracellular fluids (ICFs) are liquids within cell membranes that contain dissolved substances essential to fluid and electrolyte balance and metabolism. These substances comprise 70% of the body's fluid. Define the term osmosis. - ANSWER-Osmosis is the movement of a fluid through a semipermeable membrane from a solution that has a lower solute concentration to one that has a higher solute concentration. List the minimum information needed for a surgical specimen identification. - ANSWER- Information needed for a surgical specimen includes: correct patient name and
identification number, specific origin of the specimen, and laterality (e.g., Jane Doe, 100001, right breast biopsy). What actions should you take in the event of an incorrect sponge, sharp, or instrument count? - ANSWER-In the event of an incorrect count, you should notify the surgeon of the unresolved count. Search for the missing item, including the surgical wound, field, floor, linen, and trash. Ask all personnel to direct their immediate attention to locating the missing item. If the item is not found, an X-ray film may be taken and read by the radiologist or surgeon as specified in institutional policy. What is the process that is characterized by performing a preoperative verification process, marking the operative site, and conducting a ''time-out'' immediately before starting the procedure? - ANSWER-The Universal Protocol is characterized by performing a preoperative verification process, marking the operative site, and conducting a ''time-out'' immediately before starting the procedure. Define the term extracellular fluid. - ANSWER-Extracellular fluids (ECFs) are those fluids in compartments outside the cells of the body, including plasma, intravascular fluids, fluids in the gastrointestinal (GI) tract, and cerebrospinal fluid (CSF). ECFs comprise 30% of the body's fluid. Define the term "never events." - ANSWER-Never events are events resulting in unsafe patient outcomes that are no longer considered reimbursable under the Centers for Medicare & Medicaid Services (e.g., wrong-site surgery). What is the difference between blood typing and blood crossmatching? - ANSWER- Blood typing refers to the test to determine the ABO and Rh blood type. Crossmatching refers to testing the compatibility of the recipient's serum and the donor's red blood cells. Describe the Occupational Safety and Health Administration (OSHA) exposure control plan. - ANSWER-The OSHA exposure control plan is designed to provide guidelines to control risks and protect workers from sharps injury and bloodborne pathogens. What is the sequence of steps to take after a needlestick or occupational contact/exposure? - ANSWER-1. Wash the area, or in the case of a splash exposure, flood the area with water. 2. Report the injury. 3. Identify the source patient. 4. Report to employee health/ED as recommended per facility policy. 5. Get tested for HIV, HBV, and HCV. 6. Get postexposure prophylaxis. 7. Document the exposure. 8. Obtain an immediate evaluation and assessment. 9. Initiate a postexposure treatment plan to include follow-up, education, and counseling. Healthcare workers are routinely exposed to communicable diseases. What vaccinations are recommended by OSHA and the CDC for healthcare workers who provide direct care? - ANSWER-Recommendations include: HBV, influenza (annually), and Tdap (tetanus, diphtheria, acellular pertussis).
perioperative setting? - ANSWER-Suture needle injuries are the most common cause of PI in the surgical setting. What are the three main routes of exposure to toxic chemicals for perioperative staff? - ANSWER-Exposure to chemicals occurs through several routes. The three main routes of exposure to toxic chemicals are inhalation, skin contact, and exposure through mucous membranes and ingestion. When should Standard Precautions be used? - ANSWER-Standard Precautions apply to all patients receiving care, regardless of diagnosis or presumed infection status. Standard Precautions apply to (1) blood; (2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; (3) mucous membranes; and (4) nonintact skin. What are the sources of radiation exposure in the OR? - ANSWER-Sources of radiation exposure in the OR include: (1) ionizing sources such as portable radiography machines and portable fluoroscopy units, and (2) nonionizing sources such as lasers. The use of personal protective equipment is effective against transmission of pathogens in the OR. What are the two most effective practices? - ANSWER-For prevention of infection among OR nurses, two practices are particularly useful: double-gloving and the use of eye protection. According to the American Nurses Association (ANAs) Handle with Care campaign, when should an assistive device be used in lifting a patient? - ANSWER-Any time manual lifting will put the caregiver at risk, an assistive device should be used. Describe a strategy for reducing risk of allergic reaction to latex. - ANSWER-A best practice for minimizing the risk of latex allergy development in nonallergic patients, and the risk of reaction in sensitive or allergic patients, is the use of powder-free gloves that have low levels of protein and chemical allergens. What are the risks of exposure to WAGs? - ANSWER-Short-term exposure to WAGs causes lethargy and fatigue, and long-term exposure may be linked to spontaneous abortion, congenital abnormalities, infertility, premature births, cancer, and renal and hepatic disease. What are the most common preventable factors that cause slips, trips, and falls (STF)? - ANSWER-Wet floors, uneven floor surfaces, obstructed pathways, inadequate lighting, and improper footwear. Define the neutral zone. - ANSWER-The neutral zone is a location on the surgical field where sharps are placed in a predesignated sterile basin or tray, from which the surgeon or assistant can retrieve them. It eliminates hand-to-hand passing of sharps.
List the different forms that workplace violence may take. - ANSWER-Bullying, verbal abuse, physical abuse, and homicide. What work-related injury or illness is responsible for the most lost work time? - ANSWER-More than any other work-related injury or illness, musculoskeletal disorders (MSDs) are responsible for lost work time, the need for protracted medical care, and permanent disability among healthcare workers. What is the causative agent of what is referred to as infectious hepatitis? - ANSWER- Hepatitis A virus causes infectious hepatitis. When are Contact Precautions implemented? - ANSWER-Contact Precautions are implemented for patients known or suspected to be infected or colonized with epidemiologically important organisms that can be transmitted by direct or indirect contact. Define the term virulence. - ANSWER-Virulence describes the potency of a pathogen measured in the numbers required to kill the host. What is the causative agent for what is sometimes referred to as serum hepatitis? - ANSWER-Hepatitis B virus causes serum hepatitis. What is the purpose of a chemical indicator? - ANSWER-A chemical indicator is used to detect failures in packaging, loading, or sterilizer function, such as the presence of cool air pockets inside the sterilizing chamber. List the risk factors for vancomycin-resistant enterococci (VRE) infections. - ANSWER- Risk factors for VRE include: prolonged stays in the critical care unit, intra-abdominal or cardiothoracic surgical procedures, presence of indwelling central venous catheters, presence of urinary catheters, extended hospital stays, multiple antimicrobial therapies, and proximity to infected individuals. What are the time and temperature parameters for steam flush/pressure pulse sterilizers? - ANSWER-Recommended time and temperature settings for flash sterilizers are: 121-123° C (250-254° F) for 20 minutes, or 132-135° C (270-275° F) for 3-4 minutes. What factors must be present to achieve steam sterilization? - ANSWER-Time, temperature, and saturated steam are necessary for steam sterilization. List the sequence of steps to remove a soiled surgical gown. - ANSWER-To remove a soiled gown: (1) Wipe gloves. (2) Bring the neck and sleeve of the gown forward and off the gloved hand, turning the gown inside out and everting the cuff of the glove.
How does the Spaulding classification define semi-critical items? - ANSWER-Those items that contact nonintact skin and mucous membranes, but do not ordinarily penetrate the blood barrier are considered semi-critical under the Spaulding system. When are liquid peracetic acid sterilant systems used? - ANSWER-Liquid peracetic acid systems are used for devices that are heat sensitive, can be immersed, and have been validated by the device manufacturer for use in these systems. They are suitable for devices that cannot be sterilized with terminal sterilization methods. Which organism is most frequently implicated in surgical site infections? - ANSWER- Staphylococcus aureus is most frequently implicated in surgical site infections. What is the retrovirus that attacks the immune system by destroying T-helper lymphocytes? - ANSWER-Human immunodeficiency virus (HIV) is the retrovirus that attacks the immune system. What non-spore-forming, nonmotile, aerobic bacillus is responsible for tuberculosis? - ANSWER-Mycobacterium tuberculosis is responsible for tuberculosis. Define the term bioburden. - ANSWER-Bioburden is the amount of microbial load and organic debris on an item before sterilization. List the sequence for surgical incision draping. - ANSWER-Draping begins at the area of the intended incision and proceeds outward to the periphery. Always drape from a sterile area to an unsterile area by draping the near side first. What are the human body's three lines of defense against infection? - ANSWER-The three lines of defense against infection are: (1) external barriers, such as the skin and mucous membranes; (2) the inflammatory response, which prevents an invading pathogen from reproducing and possibly involving other tissue; and (3) the immune response, which is triggered after the inflammatory response. List the categories of microbial resistance. - ANSWER-Microbial resistance can be divided into three categories: (1) presence of a naturally resistant strain of an organism before any drugs are administered, (2) acquisition of a drug-resistant strain from an external source, and (3) drug resistance from treatment-related causes. Define the purpose for Gram staining. - ANSWER-Gram staining is a procedure for staining bacteria that is the first step in classifying and differentiating them into two large groups (gram-positive and gram-negative) based on the chemical and physical properties of their cell walls. What gram-positive organisms are responsible for necrotizing fasciitis? - ANSWER- Group A streptococci are responsible for necrotizing fasciitis.
List agents identified by the Centers for Disease Control and Prevention (CDC) that could pose a threat to national and world security and safety through bioterrorism. - ANSWER-The CDC has identified anthrax, smallpox, plague, botulism, and tularemia as bioterrorism threats. Which heat-resistant, spore-forming microorganism is used to test steam sterilizer effectiveness? - ANSWER-Geobacillus stearothermophilus is used for steam sterilizers. List the sequence for surgical skin preps. - ANSWER-Surgical skin preps are conducted in the following manner: Prepare (''prep'') the cleanest area first and then move to the less clean areas (clean to dirty). What are the time and temperature parameters for gravity displacement steam sterilizers? - ANSWER-Recommended time and temperature settings for gravity displacement sterilizers are: 121-123° C (250-254° F) for 15-30 minutes, or 132-135° C (270-275° F) for 10-25 minutes. Define the term airborne transmission. - ANSWER-Airborne transmission occurs by dissemination of an infectious agent by evaporated droplets or dust particles suspended in the air that can be inhaled or deposited on a host. What are the methods of air removal used by sterilizer units? - ANSWER-Gravity displacement and dynamic air removal are methods of air evacuation from a sterilization chamber. What is the primary mode of transmission implicated in methicillin-resistant Staphylococcus aureus (MRSA) infections? - ANSWER-The primary mode of transmission for MRSA is via direct contact from the hands of healthcare personnel. What is the human prion disease that is a fatal neurodegenerative disease of the central nervous system? - ANSWER-Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease of the central nervous system. What is the transmission route for Hepatitis C virus? - ANSWER-Hepatitis C virus is transmitted via direct exposure to blood or other infectious materials. Describe standard precautions - ANSWER-hand hygiene; personal protective equipment (PPE; gloves, gowns, mouth/nose/eye protection); respiratory hygiene/cough etiquette; patient placement; patient-care equipment and instruments/devices; care of the environment; textiles and laundry; worker safety What gram-positive anaerobe proliferates and causes symptoms of diarrhea, colitis, toxic megacolon, dehydration, and colonic perforation? - ANSWER-Clostridium difficile causes symptoms of diarrhea, colitis, toxic megacolon, dehydration, and colonic perforation.
List the risk factors for hypothermia. - ANSWER-Age extremes (elderly and pediatric patients), comorbidity, length of surgical procedure, cachexia, fluid shifts, cold irrigating fluids, and general and regional anesthesia are all considered as risk factors for hypothermia. List the symptoms of malignant hyperthermia. - ANSWER-Hypercarbia, tachypnea, tachycardia, hypoxia, metabolic and respiratory acidosis, cardiac dysrhythmias, and elevation of body temperature at a rate of 1 to 2° C every 5 minutes are symptoms associated with malignant hyperthermia. What is monitored anesthesia care? - ANSWER-Monitored anesthesia care is local anesthesia provided by the surgeon supplemented with monitoring and intravenous (IV) drugs administered by an anesthesia provider to provide sedation and systemic analgesia. Define the ASA P6 status. - ANSWER-An ASA P6 status is defined as a patient declared brain dead whose organs are being removed for donor purposes. Define the ASA P3 status. - ANSWER-An ASA P3 status is defined as a patient with a severe systemic disease that limits activity, but is not incapacitating. What devices are used to monitor and display the patient's CO2 concentration? - ANSWER-A capnometer and capnograph are used to monitor and display the patient's CO2 concentration. Describe Stage I anesthesia. - ANSWER-Stage I spans from the initial administration of anesthetic agents to loss of consciousness. Define the ASA P2 status. - ANSWER-An ASA P2 status is defined as a patient with mild systemic disease. List the symptoms of local anesthetic toxicity. - ANSWER-Local anesthetic toxicity may be manifested by the following symptoms: perioral numbness, metallic taste in the mouth, ringing in the ears, visual disturbances, and/or dizziness. Define the term moderate sedation/analgesia (conscious sedation/analgesia). - ANSWER-Moderate sedation/analgesia (conscious sedation/analgesia) is a drug- induced depression of consciousness achieved by the administration of sedatives or the combination of sedatives and analgesic medications, most often administered intravenously, and titrated to achieve a desired effect. List the possible complications of spinal anesthesia. - ANSWER-Complications of spinal anesthesia include: hypotension, total spinal anesthesia, positioning problems, and postdural puncture headache.
Describe the emergence phase of anesthesia. - ANSWER-Emergence begins as the patient begins to ''emerge'' from anesthesia and usually ends when the patient is ready to leave the operating room (OR). Define the ASA P1 status. - ANSWER-An ASA P1 status is defined as a normal healthy patient. Describe Stage III anesthesia. - ANSWER-Stage III spans from the onset of a regular breathing pattern until cessation of respiration. List the populations at increased risk for intraoperative awareness (IOA). - ANSWER- Obstetrics, major trauma, and cardiac surgery are all at increased risk for IOA. Define the ASA P5 status. - ANSWER-An ASA P5 status is defined as a moribund patient who is not expected to survive 24 hours with or without an operation. List examples of regional anesthesia techniques. - ANSWER-Regional anesthesia includes: spinal anesthesia (subarachnoid block [SAB]), epidurals, caudals, and major peripheral nerve blocks. Describe Stage IV anesthesia. - ANSWER-Stage IV spans from cessation of respiration to circulatory failure that leads to death. List the possible complications of epidural or caudal anesthesia. - ANSWER- Complications of epidural or caudal anesthesia include: inadvertent dural puncture, vascular injection, and subarachnoid injection. Describe the induction phase of anesthesia. - ANSWER-Induction begins with administration of anesthetic agents and continues until the patient is ready for positioning or surgical prepping (surgical prep), surgical manipulation, or incision. What hydantoin skeletal muscle relaxant is used to treat malignant hyperthermia? - ANSWER-Dantrolene (Dantrium) is used to treat malignant hyperthermia. Describe the maintenance phase of anesthesia. - ANSWER-Maintenance continues from the incision (or earlier) until near completion of the procedure. Define the term general anesthesia. - ANSWER-General anesthesia is a reversible, unconscious state characterized by amnesia (sleep, hypnosis, or basal narcosis), analgesia (freedom from pain), depression of reflexes, muscle relaxation, and homeostasis or specific manipulation of physiologic systems and functions. List examples of intermediate-acting nondepolarizing muscle relaxants. - ANSWER- Mivacurium, atracurium, cisatracurium, rocuronium, and vecuronium are intermediate- acting nondepolarizing medications.
Describe the supine position. - ANSWER-In the supine position, the patient lies with the back flat on the operating room (OR) bed with their arms tucked at the side or placed on armboards. What peripheral nerve is at risk during lithotomy positioning? - ANSWER-The common peroneal nerve is at increased risk for injury during lithotomy positioning. Describe the Trendelenburg position. - ANSWER-In the Trendelenburg position, the patient is supine with the upper torso lowered and the feet raised. List the characteristics of Stage III pressure ulcer. - ANSWER-Stage III is characterized by full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle is not exposed. Define the term friction. - ANSWER-Friction is the force of two surfaces rubbing against one another. Describe the lithotomy position. - ANSWER-In the lithotomy position, the patient is supine with the legs raised and abducted, usually in stirrups. Describe the Fowler position. - ANSWER-In the Fowler position, the patient is supine with the upper body flexed at approximately 90 degrees and the leg section is lowered. What risks are commonly associated with Fowler position? - ANSWER-Venous thromboembolism (VTE) and air embolism are risks associated with the Fowler position. List the characteristics of Stage IV pressure ulcer. - ANSWER-Stage IV is characterized by full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. List the characteristics of deep tissue injury. - ANSWER-Deep tissue injury is characterized by a purple or maroon localized area of discolored intact skin or a blood- filled blister. Define the term pressure ulcer. - ANSWER-A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, that results from pressure or pressure in combination with shear and/or friction. Describe the lateral position. - ANSWER-In the lateral position, the patient lies on his or her nonoperative side. List the characteristics of Stage II pressure ulcer. - ANSWER-Stage II is characterized by partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed without slough.
What is the capillary pressure threshold that, when exceeded, is associated with tissue trauma? - ANSWER-The threshold for capillary pressure is 32 mm Hg. Describe the prone position. - ANSWER-In the prone position, the patient lies on his or her abdomen. What nerve complex easily damaged by extending the arms more than 90 degrees during positioning? - ANSWER-The brachial plexus can be injured by positioning the arms more than 90 degrees. Describe the reverse Trendelenburg position. - ANSWER-In the reverse Trendelenburg position, the patient is supine with the upper torso elevated and the feet down. Define the term extrinsic factors. - ANSWER-Extrinsic factors are the physical forces and conditions to which the patient is subjected during surgery. List examples of nonabsorbable sutures. - ANSWER-Silk, nylon, polyester fiber, polypropylene, and stainless steel wire are examples of nonabsorbable sutures. Describe how sutures are measured. - ANSWER-Suture size is measured in millimeters, and expressed in USP sizes with zeroes. The smaller the cross-sectional diameter, the more zeroes; sizes range from #7, the largest, to 11-0, the smallest. List the different types of endomechanical staplers used for internal stapling. - ANSWER-Ligating and dividing staplers (LDSs), gastrointestinal anastomosis (GIA) staplers, thoracoabdominal (TA) staplers, end-to-end anastomosis (EEA) staplers, laparoscopic hernia mesh staplers, open hernia mesh staplers, and endo-GIA devices are used internally. Define the secondary suture line. - ANSWER-The secondary suture line is composed of those sutures that supplement the primary suture line. Define the term continuous suture. - ANSWER-A continuous suture consists of a series of stitches, of which only the first and last are tied. Define the term retention suture. - ANSWER-Retention sutures are placed at a distance from the primary suture line to provide a secondary suture line, relieve undue strain, and help obliterate dead space. Define the term ligature. - ANSWER-A ligature is a strand of suture material used to tie off (seal) blood vessels for the prevention of minor bleeding, or to isolate a mass of tissue for excision (cut out). Describe the "no touch" sharps technique. - ANSWER-Sharps are placed in a predesignated basin, tray collection device, or safe ''neutral'' zone on the field, from
List examples of accessory and ancillary instruments. - ANSWER-Suction tips and tubing; irrigators-aspirators; electrosurgical devices; and special-use devices, such as probes, dilators, mallets, and screwdrivers. Describe when surgical counts (e.g., sponge, sharp, instrument) are performed. - ANSWER-Counts are performed initially, before the patient enters the operating room (OR), before closure of a body cavity or deep, large incision; after closure of a body cavity; and at skin closure. Define the term purse-string suture. - ANSWER-A purse-string is a continuous circular suture placed to surround an opening in a structure and cause it to close. This type of suture is often used around the appendix or in an organ such as the cecum, gallbladder, or urinary bladder before it is opened so that a drainage tube can be inserted. List examples of types of surgical clamps. - ANSWER-Clamps include hemostats, occluding clamps, graspers and holders, forceps, pickups, and needle holders. Describe the techniques used to ligate in deep tissues. - ANSWER-The following techniques can be used to ligate in deep tissue: (1) A hemostat is placed on the end of the structure; the ligature is then placed around the vessel. The knot is tied and tightened with the surgeon's fingers or with the aid of forceps. (2) A slipknot is made, and its loop is placed over the involved structure by means of a forceps or clamp. (3) In deeper cavities, ties are often placed on clamps with the long end extending from the tip. These are sometimes called ties on a pass or bow ties. The extending long end is held tightly against the rings by the surgeon (creating the bow), who then passes the tip of the clamp under the vessel or duct to be ligated. The first assistant grasps the extending tie with a forceps, the surgeon releases it, and the tie is pulled under and up to the wound surface and tied. (4) A forceps or a clamp is applied to the structure, and transfixion sutures are applied and tied. A suture ligature, stick tie, or transfixion ligature is a strand of suture material threaded or swaged on a needle. This is usually placed through the vessel and around it to prevent the ligature from slipping off the end. List examples of instruments or other devices used for blunt dissection. - ANSWER- Blunt dissectors include gauze dissectors (e.g., peanuts, pushers, kitners), a sponge on a stick, the back of a knife handle, and the surgeon's finger or hand. List the indications for using a surgical adhesive. - ANSWER-Surgical adhesives are used in place of subcuticular sutures 4-0 in diameter or less in areas that are not under high tension or subject to increasing tension with movement. Describe key features used to evaluate suture material. - ANSWER-Key features to evaluate when choosing suture material include: (1) physical characteristics, (2) handling characteristics, and (3) tissue-reaction characteristics.
List the types of lasers commonly used in the perioperative setting. - ANSWER-Lasers used in the perioperative setting include the CO2, erbium:YAG, holmium:YAG, Nd:YAG, KTP, argon, tunable dye, diode, and excimer lasers. Differentiate between fiberoptic endoscopes and videoscopes. - ANSWER-Fiberoptic endoscopes have an eyepiece with a lens for visualization; the image is carried through the endoscope via a bundle of tiny glass fibers. Videoscopes have, at their distal end, a video chip that provides an image that is directly viewed on a monitor; a videoscope does not have an eyepiece for direct viewing, the eyepiece is replaced with an endoscopic video camera. Define the term endoscope. - ANSWER-An endoscope is a tube inserted into a natural body orifice or through a small incision to access internal organs or structures. List the risks of overpressurization during pneumoperitoneum. - ANSWER- Overpressurization can cause hypercarbia, gastric regurgitation and aspiration, decreased respiratory effort, decreased cardiac output, and phrenic nerve irritation or damage. Describe examples of flexible endoscopes. - ANSWER-Flexible endoscopes include: angioscopes, bronchoscopes, choledochoscopes, colonoscopes, cystonephroscopes, hysteroscopes, mediastinoscopes, ureteroscopes, and ureteropyeloscopes. Describe examples of rigid endoscopes. - ANSWER-Rigid endoscopes include: cystoscopes, laparoscopes, sinuscopes, arthroscopes, bronchoscopes, laryngoscopes, and hysteroscopes. Describe the purpose of white-balancing. - ANSWER-White-balancing adjusts the camera to all other optical components (endocoupler, light cable, laparoscope) to enable the camera to reference white so that it can identify all primary colors properly. Define capacitative coupling. - ANSWER-Capacitative coupling occurs when energy is transferred through intact insulation on the laparoscopic instrument shaft to nearby conductive materials. List the advantages of high-speed ultrasonic device surgery. - ANSWER-Advantages of high-speed ultrasonic surgery include: no surgical plume or odor, minimal aerosolization, reduced damage to adjacent tissue, retention of tactile feedback, no nerve or muscle stimulation, no stray electrical or laser energy, and precise cutting and control. Describe the energy path in a monopolar system - ANSWER-In a monopolar system, electrical energy flows from the generator through an active electrode to the patient to a dispersive electrode (pad) or patient return electrode (PRE) to the generator, completing the circuit.
