Perioperative Case Study
NRSB 335
start
Disclamer: content retrieved from Evolve/HESI
Introduction
Welcome to the perioperative escape room. You will be answering questions within this activity on the computer and in the classroom. Use the knowledge you recieved from lecture to answer the questions. Work in a group of 2. Start by clicking on the information tab below to get your first set of directions.
+ info
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Final Test
Test 4
Test 5
Test 1
1/3
Which option is the correct sequence for how clean surgical attire is donned?
1. hat/hood 2. scrub clothes 3. shoe covers 4. mask
1. mask 2. scrub clothes 3. hat/hood 4. shoe covers
Test 1
2/3
You're doing great. Next question:Before starting in the OR each shift, what actions are important for the circulating nurse and scrub person to implement?
Check artificial nails to ensure they are intact
Remove all jewelry
If nail polish is chipped, apply a clear coat over top
Test 1
3/3
You're almost there.Which action will the scrub person ensure is completed while performing a surgical hand scrub?
Areas under the nails are avoided while washing
Jewelry is brought above the wrist
Clean scrub clothes are donned after washing
Hands and forearms are held higher than the elbows
Tests
Complete each test to beat the game: there is no other way to escape!
Test 2
Test 1
Test 3
Test 5
Final test
Test 4
1/3
Test 2
Listen to the audio by clicking on the audio then answer the question:Lee asks you if you like his 'hat,' referring to the OR cap that has been placed on his head. You smile and ask him if he knows what it's for. How will you respond as the nurse when Lee says he does not know why?
Provide a sterile area for his head
Prevent hair from contaminating his incision
Decrease risk of electrical shock in the OR
2/3
Test 2
Listen to the audio by clicking on the phone and review the assessmentThe consent for surgery was signed by his mom. What is the rationale for this?
He is not legally old enough to sign his consent
He does not feel comfortable signing himself
Anyone under the age of 21 must have a parent sign
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Test 4
Test 5
Final Test
Test 3
1/3
Click on this interactive to see what happens to Lee next. Then answer this question:A pneumatic tourniquet is also used for arthroscopy. A pneumatic tourniquet is used to do what?
Reduce risk for hypovolemic shock by preventing blood from leaving major organs & pooling in distal extremities
Occlude flow of blood into the operative site, allowing for a clear field of vision
Immobilize the leg and allow for optimal manipulation of the knee
Engorge leg veins so that they are readily identified and not incised during surgery
2/3
Test 3
Click on the monitor for an update on Lee then answer the question.
Test 3
3/3
You are about to get it:Which medication might the anesthesiologist use before intubation?
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Test 4
Test 5
Final Test
1/6
Test 4
Listen to the audio first then answer the question: Which of the following apply when using the pneumatic tourniquet with Lee.
1. Use the narrowest possible cuff to decrease risk of tissue damage
Applies
Does not apply
2. Tourniquet pressure should be set at approximately 50-75 mm Hg above Lee’s systolic blood pressure
3. Use the least amount of pressure necessary to suppress arterial circulation
4. Check tourniquet pressure periodically
5. Inform the surgeon regarding the duration of tourniquet application time periodically
continuE
Solución
SOLUTION
2/6
Test 4
Read the update on Lee and surgery
A wide cuff is preferred when a pneumatic tourniquet is used. A wide cuff allows for distribution of pressure over a wide area and carries least risk for injury to nerves and soft tissues. Cuff ends should overlap approximately 3-6 inches. Prior to incision, the surgical team takes a pause or 'time out' to verify the patient's name, surgical procedure, and surgical site/laterality. This pre-incision 'time out' is a necessary check to ensure patient safety and avoid wrong site, wrong procedure, and wrong person surgery. A procedural pause (time out) immediately before starting a surgical procedure is an important component of Universal Protocol. Universal Protocol (UP) also includes marking of the surgical site before surgery, and a preoperative verification process that involves a review of all patient identification, documents, and tests to be sure they are consistent with the patient’s expectations and the surgical team’s understanding of the intended patient and procedure. Universal Protocol is required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and is used for all operative and other invasive procedures that expose patients to more than minimal risk. UP is based on expert consensus from clinical specialties and professional disciplines. After verifications are completed, the surgeon makes three stab wounds in Lee’s knee. In one, he places an inflow cannula. In another he places an outflow/instrument cannula. In the third, he places a cannula for a camera. One of the scrub persons connects Lactated Ringer's to the inflow cannula. In doing so, he notices a small hole (1/2' in diameter) in his sterile gown at the sleeve, just above the glove.
continuE
2/6
Test 4
What action will the scrub person implement due to the break in sterile barrier?
Change his/her gown
Change his/her scrub clothes, rescrub, and regown
Change his/her gown and gloves
Do nothing, since there is little risk of infection with arthroscopy
3/6
Test 4
Lets give our mind a break. Drag and complete the series correctly
Series 1
Series 2
Check answer
continuE
4/6
Test 4
Read the update on Lee and then answer the question
The surgical team is able to visualize Lee's joint. The lateral meniscus appears normal. The medial meniscus, however, has a tear. The surgeon repairs the meniscus by doing a partial medial meniscectomy. The repair is accomplished using both disposable shaving/cutting heads and nondisposable biting forceps.
Scrub person remains close to the sterile field
When pouring solutions, pour all solution or discard the remaining
Sharp objects will be placed in a neutral zone
Scrub person can change between sitting and standing during surgery
continuE
5/6
Test 4
During surgery, the surgeon's special meniscal forceps is dropped on the floor. The forceps is still needed for surgery. What is the appropriate action next?
a. Place in flash sterilizer for 2 minutes at 250 degrees F
b. Wash, rinse, and dry then place in flash sterilizer following manufactures recommendations
c. Open a new pack for surgeon
d. Wash, rinse, and dry then place in flash sterilizer for 1 minutes at 270 degrees F
6/6
Test 4
During surgery, sharp instruments must be passed between scrub persons. To avoid injuries from sharp instruments during surgery which action is best to prevent injury?
a. Passed by hand with the sharp of the instrument facing the person receiving the instrument
b. Pass by hand between team members only when they are double gloved
c. Pass by hand with the sharp part of the instrument facing the person passing the instrument
d. Lay it on the appropriate surface between the two scrub persons
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Test 4
Test 5
Final Test
Test 5
1/2
Go to station 4 in the classroom then listen to the audio below
2/2
Test 5
A bulky dressing and ace wrap are placed on Lee's knee and he is transferred to Phase I Post Anesthesia Care Unit (PACU). You give report to the receiving nurse and review your notes for accuracy, completeness, and legibility.
1. Identification number on tourniquet box
2. Verification of consent for tourniquet use
Needs Documented
Does not documented
3. Name of the person who applied the tourniquet
4. cuff loaction
5. Pre and postoperative skin condition under the tourniquet cuff
6. Times of cuff inflation and deflation
7. Cuff pressure
continuE
Solución
SOLUTION
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Final Test
Test 5
Test 4
1/2
Test 6
Surely you know the answer to this question:What fluid would have been infusing for this patient
Dextrose 5%
Lactated Ringers
3% Sodium Chloride
2/2
Test 6
You sign your notes and return to the OR to assist in room decontamination, preparation, and setting up for the next procedure. Listen to the correct audio below to tell you the final step.
Respuesta incorrecta
Option B
Respuesta incorrecta
Option A
Respuesta correcta
Option D
Respuesta incorrecta
Option C
Completed
Congratulations, you have successfully completed the escape room!
Start over?
Way to go!
Great job! Now head to the section 3 station in the classroom
Click here for next section
Oh oh!
That answer is not correct...
But don't lose your balance, continue on your way and try again!
back
In the OR, Lee moves himself to the OR bed and lies in the supine position. You place a safety belt two inches above his knees and introduce him to the other members of the surgical team. Lee has met the anesthesiologist who will administer general anesthesia. There will be two scrub persons. Lee has never been in an OR before and he notices all of the equipment in the room. You briefly explain their purpose. As the circulating nurse, you prepared the OR with all supplies specifically anticipated for arthroscopy with possible medial meniscus repair. Supplies include video equipment, which attaches to the arthroscope. Video equipment provides the entire surgical team a view of the surgical field. Video equipment can also be used to record and store images. Other supplies include an irrigation system, and a suction system. For arthroscopy, the knee joint is distended with fluid so joint structures can be visualized. Shaving and abrading systems are available for meniscal repair as necessary.
The arthroscopy instrument to be used for surgery has been properly prepared, as dictated by manufacturer's recommendations. All metal components of the arthroscopy instrument have been steam sterilized. Other components have been sterilized according to manufacturer's recommendations. According to Centers for Disease Control (CDC) guidelines, any item that enters sterile tissue, breaks the mucosal barrier, or comes in contact with the vascular system, is classified as 'critical' and must be sterile.
- Lee will be intubated and receive general anesthesia for arthroscopy.
Needs Documented
1, 3, 4, 5, 6, 7
Does not need documented
Applies
Does not apply
2 3 4 5 6
In the OR, Lee moves himself to the OR bed and lies in the supine position. You place a safety belt two inches above his knees and introduce him to the other members of the surgical team. Lee has met the anesthesiologist who will administer general anesthesia. There will be two scrub persons. Lee has never been in an OR before and he notices all of the equipment in the room. You briefly explain their purpose. As the circulating nurse, you prepared the OR with all supplies specifically anticipated for arthroscopy with possible medial meniscus repair. Supplies include video equipment, which attaches to the arthroscope. Video equipment provides the entire surgical team a view of the surgical field. Video equipment can also be used to record and store images. Other supplies include an irrigation system, and a suction system. For arthroscopy, the knee joint is distended with fluid so joint structures can be visualized. Shaving and abrading systems are available for meniscal repair as necessary.
NRSB 335 Escape Room- Katie
Katherine Ferrell
Created on August 29, 2023
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Transcript
Perioperative Case Study
NRSB 335
start
Disclamer: content retrieved from Evolve/HESI
Introduction
Welcome to the perioperative escape room. You will be answering questions within this activity on the computer and in the classroom. Use the knowledge you recieved from lecture to answer the questions. Work in a group of 2. Start by clicking on the information tab below to get your first set of directions.
+ info
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Final Test
Test 4
Test 5
Test 1
1/3
Which option is the correct sequence for how clean surgical attire is donned?
1. hat/hood 2. scrub clothes 3. shoe covers 4. mask
1. mask 2. scrub clothes 3. hat/hood 4. shoe covers
Test 1
2/3
You're doing great. Next question:Before starting in the OR each shift, what actions are important for the circulating nurse and scrub person to implement?
Check artificial nails to ensure they are intact
Remove all jewelry
If nail polish is chipped, apply a clear coat over top
Test 1
3/3
You're almost there.Which action will the scrub person ensure is completed while performing a surgical hand scrub?
Areas under the nails are avoided while washing
Jewelry is brought above the wrist
Clean scrub clothes are donned after washing
Hands and forearms are held higher than the elbows
Tests
Complete each test to beat the game: there is no other way to escape!
Test 2
Test 1
Test 3
Test 5
Final test
Test 4
1/3
Test 2
Listen to the audio by clicking on the audio then answer the question:Lee asks you if you like his 'hat,' referring to the OR cap that has been placed on his head. You smile and ask him if he knows what it's for. How will you respond as the nurse when Lee says he does not know why?
Provide a sterile area for his head
Prevent hair from contaminating his incision
Decrease risk of electrical shock in the OR
2/3
Test 2
Listen to the audio by clicking on the phone and review the assessmentThe consent for surgery was signed by his mom. What is the rationale for this?
He is not legally old enough to sign his consent
He does not feel comfortable signing himself
Anyone under the age of 21 must have a parent sign
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Test 4
Test 5
Final Test
Test 3
1/3
Click on this interactive to see what happens to Lee next. Then answer this question:A pneumatic tourniquet is also used for arthroscopy. A pneumatic tourniquet is used to do what?
Reduce risk for hypovolemic shock by preventing blood from leaving major organs & pooling in distal extremities
Occlude flow of blood into the operative site, allowing for a clear field of vision
Immobilize the leg and allow for optimal manipulation of the knee
Engorge leg veins so that they are readily identified and not incised during surgery
2/3
Test 3
Click on the monitor for an update on Lee then answer the question.
Test 3
3/3
You are about to get it:Which medication might the anesthesiologist use before intubation?
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Test 4
Test 5
Final Test
1/6
Test 4
Listen to the audio first then answer the question: Which of the following apply when using the pneumatic tourniquet with Lee.
1. Use the narrowest possible cuff to decrease risk of tissue damage
Applies
Does not apply
2. Tourniquet pressure should be set at approximately 50-75 mm Hg above Lee’s systolic blood pressure
3. Use the least amount of pressure necessary to suppress arterial circulation
4. Check tourniquet pressure periodically
5. Inform the surgeon regarding the duration of tourniquet application time periodically
continuE
Solución
SOLUTION
2/6
Test 4
Read the update on Lee and surgery
A wide cuff is preferred when a pneumatic tourniquet is used. A wide cuff allows for distribution of pressure over a wide area and carries least risk for injury to nerves and soft tissues. Cuff ends should overlap approximately 3-6 inches. Prior to incision, the surgical team takes a pause or 'time out' to verify the patient's name, surgical procedure, and surgical site/laterality. This pre-incision 'time out' is a necessary check to ensure patient safety and avoid wrong site, wrong procedure, and wrong person surgery. A procedural pause (time out) immediately before starting a surgical procedure is an important component of Universal Protocol. Universal Protocol (UP) also includes marking of the surgical site before surgery, and a preoperative verification process that involves a review of all patient identification, documents, and tests to be sure they are consistent with the patient’s expectations and the surgical team’s understanding of the intended patient and procedure. Universal Protocol is required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and is used for all operative and other invasive procedures that expose patients to more than minimal risk. UP is based on expert consensus from clinical specialties and professional disciplines. After verifications are completed, the surgeon makes three stab wounds in Lee’s knee. In one, he places an inflow cannula. In another he places an outflow/instrument cannula. In the third, he places a cannula for a camera. One of the scrub persons connects Lactated Ringer's to the inflow cannula. In doing so, he notices a small hole (1/2' in diameter) in his sterile gown at the sleeve, just above the glove.
continuE
2/6
Test 4
What action will the scrub person implement due to the break in sterile barrier?
Change his/her gown
Change his/her scrub clothes, rescrub, and regown
Change his/her gown and gloves
Do nothing, since there is little risk of infection with arthroscopy
3/6
Test 4
Lets give our mind a break. Drag and complete the series correctly
Series 1
Series 2
Check answer
continuE
4/6
Test 4
Read the update on Lee and then answer the question
The surgical team is able to visualize Lee's joint. The lateral meniscus appears normal. The medial meniscus, however, has a tear. The surgeon repairs the meniscus by doing a partial medial meniscectomy. The repair is accomplished using both disposable shaving/cutting heads and nondisposable biting forceps.
Scrub person remains close to the sterile field
When pouring solutions, pour all solution or discard the remaining
Sharp objects will be placed in a neutral zone
Scrub person can change between sitting and standing during surgery
continuE
5/6
Test 4
During surgery, the surgeon's special meniscal forceps is dropped on the floor. The forceps is still needed for surgery. What is the appropriate action next?
a. Place in flash sterilizer for 2 minutes at 250 degrees F
b. Wash, rinse, and dry then place in flash sterilizer following manufactures recommendations
c. Open a new pack for surgeon
d. Wash, rinse, and dry then place in flash sterilizer for 1 minutes at 270 degrees F
6/6
Test 4
During surgery, sharp instruments must be passed between scrub persons. To avoid injuries from sharp instruments during surgery which action is best to prevent injury?
a. Passed by hand with the sharp of the instrument facing the person receiving the instrument
b. Pass by hand between team members only when they are double gloved
c. Pass by hand with the sharp part of the instrument facing the person passing the instrument
d. Lay it on the appropriate surface between the two scrub persons
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Test 4
Test 5
Final Test
Test 5
1/2
Go to station 4 in the classroom then listen to the audio below
2/2
Test 5
A bulky dressing and ace wrap are placed on Lee's knee and he is transferred to Phase I Post Anesthesia Care Unit (PACU). You give report to the receiving nurse and review your notes for accuracy, completeness, and legibility.
1. Identification number on tourniquet box
2. Verification of consent for tourniquet use
Needs Documented
Does not documented
3. Name of the person who applied the tourniquet
4. cuff loaction
5. Pre and postoperative skin condition under the tourniquet cuff
6. Times of cuff inflation and deflation
7. Cuff pressure
continuE
Solución
SOLUTION
Tests
Complete each test to beat the game: there is no other way to escape!
Test 1
Test 2
Test 3
Final Test
Test 5
Test 4
1/2
Test 6
Surely you know the answer to this question:What fluid would have been infusing for this patient
Dextrose 5%
Lactated Ringers
3% Sodium Chloride
2/2
Test 6
You sign your notes and return to the OR to assist in room decontamination, preparation, and setting up for the next procedure. Listen to the correct audio below to tell you the final step.
Respuesta incorrecta
Option B
Respuesta incorrecta
Option A
Respuesta correcta
Option D
Respuesta incorrecta
Option C
Completed
Congratulations, you have successfully completed the escape room!
Start over?
Way to go!
Great job! Now head to the section 3 station in the classroom
Click here for next section
Oh oh!
That answer is not correct...
But don't lose your balance, continue on your way and try again!
back
In the OR, Lee moves himself to the OR bed and lies in the supine position. You place a safety belt two inches above his knees and introduce him to the other members of the surgical team. Lee has met the anesthesiologist who will administer general anesthesia. There will be two scrub persons. Lee has never been in an OR before and he notices all of the equipment in the room. You briefly explain their purpose. As the circulating nurse, you prepared the OR with all supplies specifically anticipated for arthroscopy with possible medial meniscus repair. Supplies include video equipment, which attaches to the arthroscope. Video equipment provides the entire surgical team a view of the surgical field. Video equipment can also be used to record and store images. Other supplies include an irrigation system, and a suction system. For arthroscopy, the knee joint is distended with fluid so joint structures can be visualized. Shaving and abrading systems are available for meniscal repair as necessary.
The arthroscopy instrument to be used for surgery has been properly prepared, as dictated by manufacturer's recommendations. All metal components of the arthroscopy instrument have been steam sterilized. Other components have been sterilized according to manufacturer's recommendations. According to Centers for Disease Control (CDC) guidelines, any item that enters sterile tissue, breaks the mucosal barrier, or comes in contact with the vascular system, is classified as 'critical' and must be sterile.
Needs Documented
1, 3, 4, 5, 6, 7
Does not need documented
Applies
Does not apply
2 3 4 5 6
In the OR, Lee moves himself to the OR bed and lies in the supine position. You place a safety belt two inches above his knees and introduce him to the other members of the surgical team. Lee has met the anesthesiologist who will administer general anesthesia. There will be two scrub persons. Lee has never been in an OR before and he notices all of the equipment in the room. You briefly explain their purpose. As the circulating nurse, you prepared the OR with all supplies specifically anticipated for arthroscopy with possible medial meniscus repair. Supplies include video equipment, which attaches to the arthroscope. Video equipment provides the entire surgical team a view of the surgical field. Video equipment can also be used to record and store images. Other supplies include an irrigation system, and a suction system. For arthroscopy, the knee joint is distended with fluid so joint structures can be visualized. Shaving and abrading systems are available for meniscal repair as necessary.