Surgical Nursing exam 1

History

-signalment
-ask reason for visit
-ask about specific complaint
-ask open ended questions
-ask about medications/fasting

Leading questions

-can influence owner's answer
-Has it been there for a long time?
-Has it gotten bigger?
-Is it causing pain?
-owner may feel compelled to answer in certain way

Open-ended questions

-questions that allow respondents to answer however they want
-Does Rex seem to notice it?
-Has it changed size?
-Have you noticed any changes in Rex?

Signalment

-age
-gender
-breed
-repro status

Consent form

-Identifies patient with name, signalment, and owner
-Specific procedure being done
-Potential risks
-Vet's name
-Estimate
-Signature of owner or agent
-cannot be signed by anyone under 18

Who is the only person who can sign a consent form?

owner/ agent

Surgical infection sources

-operating room
-operating team
-surgical instruments and supplies
-patients endogenous flora

What is the most common source of surgical infection?

patient's endogenous flora

Surgical PPE

-clean scrubs
-surgical cap that completely covers hair
-mask/beard covers
-Shoe covers
-No cell phones

How should nails be kept?

short/clean

open gloving

-not used for routine procedures
-used when only hands need to be sterile
-minor procedures, bone marrow biopsy, catherizations

closed gloving

-provides assurance against contamination because bare skin is not exposed
-preferred method for surgical procedures

Assisted gloving

-requires 2 people
-used if a glove is contaminated

surgical assistant responsibilities

-Maintaining sterile environment
-Handling instruments
-Passing sterile equipment
-monitoring patient
-Managing instrument table
-passing instruments
-maintaining tissues
-maintaining hemostasis
-counting instruments and sponges before and after surgery

handling scalpels

-needle holders to place on the handle
-never point towards anyone while removing
-cutting edge away from surgeon
-handed in way ready to use

ring intrument

-place rings firmly in palm of hands

How much blood does a 3 x 3 sponge hold?

6 mls

How much blood does a 4 x 4 sponge hold?

10 mls

How much blood does a laparotomy sponge hold?

100 mls

surgery guidelines

-eat and drink water before surgery
-shower and wash hair daily
-keep nails short and clean
-no overpowering fragrances
-clean scrubs
-turn on lights and heating devices
-unwrap sterile instruments

Pre-op work up

-signalment
-history
-PE
-consent form
-weight/BCS
-head and neck
-skin
-lungs
-heart
-rectal

clean

-surgically created wound
-no hollow viscus opened
-aspetic technique is maintained
-no infection
-closed with primary closure

What kind of closure would be used for clean and clean-contaminated wounds?

primary

clean-contaminated

-surgical wound that enters a hollow viscus
-minor break in technique
-closed with primary

contaminated

-operative wounds with major break in technique and hollow viscus opened with gross spillage
-traumatic wounds

dirty/infected

-contains purulent material
-contain contents of perforated hollow viscus
->100,000 organisms per gram of tissue

delayed primary

-wound left open for 2-5 days
-closed prior to granulation tissue formation
-permits repeated lavage and debridement to convert wound clean-contaminated

secondary

-granulation tissue allowed to form in wound prior to clean-contaminated status appropriate for closure
-direct apposition over granulation tissue for deep narrow wounds
-mobilize skin edges and advance over granulation tissue for wide wounds

second intention

-dirty or infected wounds
-large wounds
-granulation, epithelialization, and contracture

antibiotic use

-long surgeries (over 2 hours)
-orthopedic implants
-break in asepsis
-entering GI tract

cefazolin

-used for orthopedic procedures
-targets staphylocci
-good for skin

cefoxitin

-used for anus, colon, and liver
-targets E. coli, and klebsiella and other gram negative bacteria

________________ antibiotics are given to decrease the chances of postoperative infection of the surgical site

preioperative

perioperative antibiotics

-give at induction or 30 minutes before skin incision
-usually given every 90 mins
-may hold off on first dose if cultures being taken in surgery
-reconstituted with sterile water or saline

AAHA recommends which distinct areas for a surgical facility?

prep, scrub, surgical room

Where are procedures that are considered clean performed?

prep area

Which item is nonmovable surgery equipment?

surgery table

It is recommended to place a blanket or towel between patient and a circulating warm water blanket to

protect the patient from thermal burns

When warming a surgical, which item is contraindicated?

electric heating pad

bipolar electrocautery

allows surgeon to pick up tissue or blood vessels that need to be coagulated

Using a mechanical device to remove fluid or air from an area is called?

suction

Which suction tip has two pieces and is designed to suction a large amount of fluid?

poole

An advantage of using a monopolar electrosurgical unit to make an incision is:

better hemostasis

In what instance would a clean abdominal surgery precede a noninfective thoracic surgery on the surgery schedule?

emergent abdominal surgery

split top table

-adjustability for different sized patients
-split and tray allow fluid to flow away from surgical field and patient

Which type of electrocautery unit doe not require a ground plate?

bipolar

good surgical lighting

-wide lateral and vertical motion
-easily manipulated
-removable handles
-ceiling or wall mounted

suction during orthopedic surgery

-lavage a joint
-clearing bone dust when drilling
-flushing a septic area

What other equipment is needed when a suction machine is used?

tubing, suction tip

Which surgical instrument has both horizontal and vertical serrations of the jaw?

Rochester Carmalt

Which part of a ringed instrument locks an instrument in a closed position?

ratchet

The jaw of which instrument has one raised jaw and one recessed jaw?

ferguson angiotribe

Which of these tissue forceps is atraumatic?

Russian thumb forcep

Which is handheld retractor?

senn retractor

Which type of towel clamp has penetrating tips and a squeeze handle?

jones

Which needle holders have scissors included in the jaws?

Olsen-Hegar

To properly handle ringed instruments, the digits should be placed in the rings:

distal to first knuckle of thumb and ring finger

Which instrument is used to find and exteriorize the uterine horn during an ovariohysterectomy?

snook hook

Which forceps are a vascular clamp?

90 degree mixter

A bone biopsy may be taken using which instrument?

michele trephine

Which type of needle would be preferred for an intestinal resection and anastomosis?

taper

Which of the scalpel blade grips allows for better stabilization and a finer, more precise incision?

pencil

A function of the bone rongeurs is to:

break up bone

During production of suture, wax would be used to coat a suture to:

decrease capillarity

Which suture diameter is the largest?

0

What is an advantage of using suture on a reel?

inexpensive

Which scissors is designed to be used on delicate tissues?

metzenbaum

What is an advantage of suture that is dyed?

easy removal/ID

What would be used for a bovine skin closure post rumenotomy?

double curved needle

swaged needle

needle with suture directly attached to it

The patient's signalment includes which info?

age, gender, breed

A consent form should include:

description of surgical procedure

What is a method of interrupting a cat's purring during thoracic auscultation?

alcohol soaked cotton ball under nose

Decreased plasma proteins on a preanesthetic bloodwork may be due to:

inadequate albumin

What blood test is used to assess the patient's kidney function?

BUN

It is best to administer analgesics:

prior to painful procedure

Combining different classes of analgesics to maximize the pain relief is called

multimodal

Where does the modulation portion of the nociceptive pathway occur?

spinal cord

Which drug class has the ability to provide complete abscence of pain, at least temporarily?

local anesthetics

Sedatives are used as part of a premedication anesthesia protocol because they reduce:

fear and stress

combines smaller doses of multiple medications to minimize side effects

balanced anesthesia

Thoracic auscultation is best performed with the patient in what position?

standing

The reason for a patient's visit is also called

chef complaint

Which description could be used to appropriately note a patient's mentation?

depressed

When microscopically examining a PCV tube to assess for heartworm microfilaria, where on the sample would you find it?

just above buffy coat

Which drug class is an NSAID?
a. maropitant
b. Robenacoxib
c. Buprenorphine
d. dexmedetomidine

b. Robenacoxib

Which drug is a partial opioid agonist?

buprenorphine

A contraindication to using an opioid in a patient is:

head trauma

review all medications

-to avoid possible drug interactions
-to known whether other diagnostics tests are indicated
-to make any necessary adjustments to the anesthetic protocol

What monitoring device is used to detect heart arrhythmia?

ECG

Agonal breaths occur when the patient has suffered ________ _________

cardiac arrest

Assisted ventilation helps to prevent

atelectasis

Blue color to the MMs suggest?

poor oxygenation

Which drug will cause a slowing in CRT?

Medetomidine

Cardiac insufficiency leads to hypotension due to
a. dehydration.
b. excessive blood loss.
c. excessive vasodilation.
d. poor pumping action of cardiac muscle.

d. poor pumping action of cardiac muscle.

What drug may contribute to the developemnt of malignant hyperthermia?

sevoflurane

What is an automatic response to a stimulus made by a patient without conscious awareness?

reflex

Which reflex is elicited by touching the medial canthus of the eye?

palpebral

When a patient has undergone cardiac arrest, you would expect the pupils to be

fully dilated

Which device measures the percentage of oxygen saturation of the patient's hemoglobin?

pulse ox