Exam (elaborations)
CNOR: Perioperative Nursing
- Institution
- Louisiana State University
CNOR: Perioperative Nursing
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CNOR: Perioperative NursingStudy online at https://quizlet.com/_ecfq7m
1. *What is Peri-
operative Nurs-
ing?*
2. *AORN Domains Following 4 areas are emphasized in the AORN Pa-
of Concern* tient-Focused Model:
1) *Patient safety*: right patient, right site, limb padding,
grounding
2) *Physiologic responses*: VS, allergic rxns, UOs
3) *Behavioral responses*: anxiety, depression, fear,
delirium, agitation
4) *Health System*: collaboration, multidisciplinary plan
of care
3. PNDS *What it is:*
What it is & Nurs- - *Perioperative Nursing Data Set* (PNDS)
ing Application - Standardized nursing vocabulary for diagnoses, out-
comes, and implementations r/t perioperative nursing
- Focus is on prevention of problems instead of identifica-
tion of problems
*Nursing Application:*
The PNDS, 3rd edition, contains *44* nursing diagnoses,
*53* interventions, and *40* nurse-sensitive patient out-
comes.
However, a periop nurse may also identify and include
additional relevant patient outcomes.
In other works, the PNS should be used as a guide, not
as a limitation.
4. RNFA *What it is:*
What it is & Nurs- - *Registered Nurse First Assist* (RNFA)
ing Application - Expanded role that includes direct assistance to the
surgeon during the intraoperative phase
- Not considered an "advanced practice" role
*Nursing Application:*
, CNOR: Perioperative Nursing
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The RNFA functions under the surgeon's supervision,
and may even be an employee by the surgeon instead of
the facility as part of surgical practice. The RNFA qualifi-
cations are noted in the AORN Position Statement on RN
First Assistants.
5. *Surgical Assis- - May be an RNFA, a PA, a resident, or another surgeon
tant* - Part of the sterile surgical team
- Practice of the assistant is governed by the state, med-
ical board, nursing board, and hospital policy, among
other regulatory bodies
- *Duties may include:*
~Suctioning the wound
~Exposing the operative site
~Handling tissue samples or organs
~Suturing
6. *Scrub Person* - May be an RN, LPN, or surgical tech
- Part of sterile surgical team
- Works with equipment and instruments
- *Duties include:*
~Gathering correct surgical kits for the procedure
~Establishing and maintaining the sterile field
~Placing instruments and supplies within the sterile field
~Anticipating needs of the surgical team
~Performing surgical counts of sponges, instruments,
etc.
~Preparing used instruments for terminal sterilization
7. *Circulating - Usually a nurse functions in this role due to its elements
Nurse* of assessment and teaching
- Part of the non-sterile surgical team
- Functions as care coordinator in the intraoperative
phase
- *Duties include:*
~Supporting patient's emotional needs prior to anesthe-
sia
~Assessing the patient throughout needs prior to anes-
thesia
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~Documenting patient care
~Teaching the patient and family
~Communicating with family and external health care
team members
~Administering medications
~Enforcing regulatory procedures (Time Out, surgical
checklists)
~Coordinating other non-sterile team members (lab,
pathology, radiology, materials management)
8. SCIP *What it is:*
What it is and - *Surgical Care Improvement Project* (SCIP)
Nursing Applica- - Includes *Surgical Infection Prevention (SIP)* measures
tion - Became effective July 1, 2006.
*Nursing Application:*
The SCIP is a national organization partnership designed
to improve surgical care safety by reduction post-op com-
plications.
A core of committee of 10 organizations reviews scien-
tific evidence and advisory panel recommendations and
aligns the standards of care accordingly.
The SCIP originated with the SIP measures from the Joint
Commission (TJC). TJC continues to work closely with
CMS (Medicare/Medicaid) to maintain up-to-date perfor-
mance measures for surgical patients.
9. *Universal Proto- The Joint Commission's NPSG identify three steps to
col* prevent (goal: 100% prevention) "wrong-site" surgery.
These steps are known as the *Universal Protocol* that
should be followed for EVERY surgery:
1. Preprocedure verification:
- Review the surgical "Rights" (see Surgical "Rights" card
[#10])
- Involve the patient in confirmation if possible
- Confirm availability of necessary items: signed consent,
test results, blood products, implants, specialty equip-
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ment)
2. Mark the site (see "Mark the Site" card [#11])
3. Time-out (see "Surgical Time-Out" card [#12])
10. *Surgical 1. Right *person*
"Rights"* 2. Right *site*
3. Right *side* (laterality)
4. Right *procedure*
5. Right *documentation*
11. "Mark the Site" - Must occur prior to the procedure
- Must be permanent enough to still be visible after skin
prepping and sterile draping
- Adhesive markers cannot be only site markers
- Not necessary for bilateral surgeries (tonsils, ovaries)
- When site marking is not possible, not necessary, or
refused by the patient, follow facility policy on alternative
procedures
Non-marked Procedure Examples:
-Cardiac catheterizations
-Tooth procedures
-Any procedure on premature infants (ink may leave a
permanent mark)
-Perineal procedures
12. *Surgical - Perform the "time-out" right before the procedure starts
"Time-Out"* - Conduct according to a standardized procedure
- Include all active participants in the procedure
- Require active communication from all active partici-
pants
- All participants must agree on (at minimum) the patient's
identity, the site of the procedure, and the type of proce-
dure
- If multiple procedures are to be performed, a new
"time-out" must be performed prior to each procedure *IF*
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