CNOR:AORN/ PNDS Nursing Application
Questions and answers 100% correct
2023/2024
*AORN Domains of Concern* - correct answer Following 4 areas are emphasized in
the AORN Patient-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
PNDS
What it is & Nursing Application - correct answer *What it is: *
- *Perioperative Nursing Data Set* (PNDS)
- Standardized nursing vocabulary for diagnoses, outcomes, and implementations r/t
perioperative nursing
- Focus is on prevention of problems instead of identification of problems
*Nursing Application: *
The PNDS, 3rd edition, contains *44* nursing diagnoses, *53* interventions, and *40*
nurse-sensitive patient outcomes.
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.
RNFA
What it is & Nursing Application - correct answer *What it is:*
- *Registered Nurse First Assist* (RNFA)
- Expanded role that includes direct assistance to the surgeon during the intraoperative
phase
- Not considered an "advanced practice" role
*Nursing Application: *
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 qualifications
are noted in the AORN Position Statement on RN First Assistants.
*Surgical Assistant* - correct answer - May be an RNFA, a PA, a resident, or another
surgeon
- Part of the sterile surgical team
- Practice of the assistant is governed by the state, medical 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
*Scrub Person* - correct answer - 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
*Circulating Nurse* - correct answer - Usually a nurse functions in this role due to its
elements 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 anesthesia
~Assessing the patient throughout needs prior to anesthesia
~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)
SCIP
What it is and Nursing Application - correct answer *What it is:*
- *Surgical Care Improvement Project* (SCIP)
- Includes *Surgical Infection Prevention (SIP)* measures
- Became effective July 1, 2006.
*Nursing Application: *
The SCIP is a national organization partnership designed to improve surgical care
safety by reduction post-op complications.
A core of committee of 10 organizations reviews scientific 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
performance measures for surgical patients.
*Universal Protocol* - correct answer The Joint Commission's NPSG identify three
steps to prevent (goal: 100% prevention) "wrong-site" surgery.
These steps are known as the *Universal Protocol* that should be followed for EVERY
surgery:
1. Preprocedural 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 equipment)
2. Mark the site (see "Mark the Site" card [#11])
3. Time-out (see "Surgical Time-Out" card [#12])
*Surgical "Rights"* - correct answer 1. Right *person*
2. Right *site*
3. Right *side* (laterality)
4. Right *procedure*
5. Right *documentation*
"Mark the Site" - correct answer - 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
*Surgical "Time-Out"* - correct answer - Perform the "time-out" right before the
procedure starts
- Conduct according to a standardized procedure
- Include all active participants in the procedure
- Require active communication from all active participants
- All participants must agree on (at minimum) the patient's identity, the site of the
procedure, and the type of procedure
, - If multiple procedures are to be performed, a new "time-out" must be performed prior
to each procedure *IF* the person performing the procedure changes
- Document the "time-out"
*Preoperative Teaching* (during preadmission workup) - correct answer Should
include following information about:
- Procedure(s), expected duration and outcome(s)
- Pre-procedure diagnostic tests
- IV placement and sedation procedures
- NPO instructions
- Showering/bathing
- Medication management (i.e., what to take, what not to take)
- Intraoperative events
- Maintenance of patient dignity
- Expected staff communication with family
- Recovery/PACU following the procedure
*Pediatric Preop Teaching* - correct answer *Learning Characteristics*
- *Toddler* (ages 1-3): short attention spans and oral fixations may require special
management
- *Preschooler* (ages 3-5): active imaginations may interpret surgery as punishment
- *School-age* (ages 6-12): logical thinking may benefit from knowing steps of the
surgical process
*Teaching*
- Allow pediatric patients to handle items such as a face mask to increase familiarity and
a sense of control
- Demonstrate application of devices on a doll similar in gender and ethnicity to the child
*Spaulding Classification* - correct answer Spaulding Classification of Devices (1986)
is used by CDC to determine if disinfection or sterilization is more appropriate.
*Critical Items (sterile)*
- Any item that penetrates internal tissues/organs or the vascular system
- *Examples: * sutures, cardiac catheters, surgical instruments
*Semi critical Items (sterile or high-level disinfected) *
- Items that do not penetrate internal tissues but may contact unbroken mucous
membranes (i.e., vagina, throat, bladder)
- *Examples: * laryngoscope blades, cystoscopes, speculums
*Noncritical Items (low-level disinfected) *
- Items that only contact intact skin
- *Examples: * otoscopes, stethoscopes, crutches
