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Introduction to Perioperative Nursing

Learner Objectives
1. Define the three phases of the surgical experience.
2. Describe the scope of perioperative nursing practice.
3. Identify members of the surgical team.
4. Discuss application of the Perioperative Nursing Data Set (PNDS).
5. Discuss the outcomes a patient can be expected to achieve following a surgical intervention.
6. Describe the roles of surgical team members.
7. Describe the responsibilities of the perioperative nurse in the circulating role.

LessOn OutLine Phases of the surgical experience


I. Phases of the Surgical Experience
1. The perioperative period begins when the
A. Preoperative
patient is informed of the need for surgery,
B. Intraoperative
includes the surgical procedure and recovery,
C. Postoperative
and continues until the patient resumes his or
II. Nursing Process Throughout the Perioperative her usual activities. The surgical experience can
Period be segregated into three phases: (1) preopera-
A. Assessment tive, (2) intraoperative, and (3) postoperative.
B. Nursing Diagnoses The word perioperative is used to encom-
C. Planning pass all three phases. The perioperative nurse
D. Intervention provides nursing care during all three phases.
E. Evaluation
III. Perioperative Nursing Data Set Preoperative
IV. Patient Outcomes: Standards of 2. The preoperative phase begins when the
Perioperative Care patient, or someone acting on the patients
V. Roles of the Perioperative Nurse behalf, is informed of the need for surgery and
makes the decision to have the procedure. This
VI. Expanded and Advanced Practice Roles
phase ends when the patient is transferred to
VII. Practice Settings the operating room bed.
VIII. Members and Responsibilities of the 3. The preoperative phase is the period that is
Surgical Team used to physically and psychologically prepare

1
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2 cHaPter 1 Introduction to Perioperative Nursing

the patient for surgery. The length of the pre- For patients who undergo surgery in ambula-
operative period varies. For the patient whose tory surgery facilities, day surgery centers, or
surgery is elective, the period may be lengthy. office-based surgical settings where the expec-
For the patient whose surgery is urgent, the tation is that they will return home on the same
period is brief; the patient may have no aware- day they have surgery, it is not uncommon for
ness of this period. the perioperative nurse to provide care for the
4. Diagnostic studies and medical regimens are patient during all three phases.
initiated in the preoperative period. Informa- 12. Nursing activities in the immediate postopera-
tion obtained from preoperative assessment tive phase center on support of the patients
and interview is used to prepare a plan of care physiologic systems. In the later stages of
for the patient. recovery, much of the focus is on reinforcing the
5. Nursing activities in the preoperative phase are essential information that the patient and other
directed toward patient support, teaching, and caregivers require in preparation for discharge.
preparation for the procedure.
nursing Process throughout the
intraoperative
Perioperative Period
6. The intraoperative phase begins when the
patient is transferred to the operating room bed 13. The words perioperative and perioperative
and ends with transfer to the postanesthesia nursing are accepted and utilized in nursing
care unit (PACU) or another area where imme- and medical literature. Perioperative nursing
diate postsurgical recovery care is given. was formerly referred to as operating room
7. During the intraoperative period, the patient is nursing, a term that historically referred to
monitored, anesthetized, prepped, and draped, patient care provided in the intraoperative
and the procedure is performed. period and administered within the operating
room itself. However, as the responsibilities of
8. Nursing activities in the intraoperative period
the operating room nurse expanded to include
center on patient safety, facilitation of the pro-
care in the preoperative and postoperative
cedure, prevention of infection, and satisfac-
periods, the term perioperative was recog-
tory physiologic response to anesthesia and
nized as more appropriate. In 1999, the orga-
surgical intervention.
nization that represents perioperative nurses,
once known as the Association of Operating
Postoperative
Room Nurses (AORN), changed its name to
9. The postoperative phase begins with the the Association of periOperative Registered
patients transfer to the recovery unit and ends Nurses (AORN).
with the resolution of surgical sequelae. The 14. The perioperative nurse is a nurse who special-
postoperative period may be either brief or izes in perioperative practice and who provides
extensive, and most commonly ends outside nursing care to the surgical patient throughout
the facility where the surgery was performed. the continuum of care. The AORN Periop-
10. For patients who will remain in the hospital erative Patient-Focused Model identifies four
for an extended stay, the perioperative nurse specific domainspatient safety, physiologic
may not provide care beyond patient transfer response, behavioral responses, and the health
to the PACU, where postanesthesia care nurses systemthat are the areas of concern for the
assume responsibility for the patient. In an perioperative nurse.
effort to better utilize nursing resources, many 15. The domains of safety, physiologic response,
perioperative nurses, particularly in smaller and behavioral responses of patients reflect the
hospitals, have been trained in postanesthesia nature of the surgical experience for the patient
care and are assuming responsibility for pro- and serve as a guide for providing care.
viding care in both the operating room and 16. The fourth domain represents other members of
PACU. Care at home, if required, is delivered the healthcare team and the healthcare system.
by home healthcare nurses. Perioperative nurses work collaboratively with
11. The majority of operative procedures per- other healthcare team members to formulate
formed today are done on an outpatient basis. nursing diagnoses, identify desired outcomes,
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Nursing Process Throughout the Perioperative Period 3

and provide care within the context of the day of surgery at the surgical facility. Often
healthcare system so as to achieve desirable the initial nursing assessment is performed
patient outcomes (AORN, 2012a, pp. 34). by a nurse who is not a perioperative nurse.
17. Perioperative nurses provide patient care within It is more likely that the perioperative nurses
the framework of the nursing process. They use assessment of the patient will take place just
the tools of patient assessment, care planning, prior to the patients entry into the operating
intervention, and evaluation of patient outcomes room. This assessment will include a brief inter-
to meet the needs of patients who are under- view, a quick physical inspection of the patient,
going operative or other invasive procedures. and a review of the patients record, including
Every patient is unique, and the plan of care the results of diagnostic testing and assessment
is tailored to meet the patients specific needs. data obtained previously by other caregivers.
The plan addresses physiological, psychological,
sociocultural, and spiritual aspects of care. nursing Diagnoses
18. Much of perioperative nursing involves tech- 23. Assessment data provide information that the
nical expertise, including responsibility for perioperative nurse uses to formulate nursing
equipment, instrumentation, and surgical tech- diagnoses and identify desired outcomes. Several
niques. Technical skills and responsibilities are nursing diagnoses, such as knowledge deficit and
purposeful within the nursing process during high risk for infection, are typical for the surgical
the implementation phase; however, the patient patient. Assessment data form the foundation
remains the focus of the perioperative nurses for patient-specific nursing diagnoses and plan-
activities. ning individualized care tailored to meet each
19. The goal of perioperative nursing is to provide patients individual and unique needs.
care to patients and support to their families,
using the nursing process to assist patients and Planning
their families in making decisions and to meet 24. The perioperative nurse uses knowledge of the
and support the needs of patients undergoing patient, the proposed procedure, identified
surgical or other invasive procedures. The patient needs, related nursing diagnoses, and
overall desired outcome is that the patient will
desired outcomes to plan care for each patient.
achieve a level of wellness equal to or greater
than the level prior to surgery. 25. The perioperative nurse begins care planning
20. Perioperative nursing care is provided in a before the patient is seen, based on knowl-
edge of the planned procedure, the resources
variety of settings, including acute care facili-
required, and the common nursing diagnoses
ties, ambulatory settings, and physician-based
office settings. Perioperative nurses provide related to surgical intervention. Knowledge
care to patients, their families, and others who of the individual patient obtained during the
support the patient. Three major activities of assessment process is combined with this
previous planning to prepare for meeting the
perioperative nurses are providing direct care,
unique needs of the patient and providing care
coordinating comprehensive care, and edu-
cating patients and their families. that is individually tailored to each patient.

intervention
assessment 26. In the intervention stage of the nursing process,
21. Nursing assessment of the patient may take the perioperative nurse provides, coordinates,
place in a number of settings and time frames. supervises, and documents care within the
Assessment may be performed a week or more framework of accepted standards of nursing
before surgery or just prior to the procedure. care, as identified by the AORN standards and
It may occur in the patients inpatient hospital recommended clinical practices (AORN, 2012).
unit, the surgeons office, the preadmission
testing unit of the surgical facility, or the same- evaluation
day/ambulatory surgery unit. 27. In the final evaluation stage of the nursing
22. In some instances, the assessment process is process, the perioperative nurse evaluates the
initiated in a telephone conversation with the results of nursing care in relation to the extent
patient prior to surgery, and completed on the that expected patient outcomes have been met.
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4 cHaPter 1 Introduction to Perioperative Nursing

section Questions
1. Define the perioperative experience. [Ref 1]
2. Identify the primary nursing focus in the preoperative phase of the perioperative experience. [Refs 25]
3. Identify the primary nursing focus in the intraoperative phase of the perioperative experience. [Refs 68]
4. Identify the primary nursing focus in the postoperative phase of the perioperative experience. [Refs 912]
5. Discuss the significance of the term perioperative. [Ref 13]
6. Identify the four domains of the AORN Perioperative Patient-Focused Model. [Ref 14]
7. Identify four aspects of patient care addressed in the plan for each patient. [Ref 17]
8. In which settings is perioperative nursing provided? [Ref 20]
9. Where and when does the assessment of the surgical patient take place? [Ref 21]
10. When does planning for the surgical patient begin? [Ref 25]

Perioperative nursing Data set 31. Examples of nursing diagnoses using the PNDS
include the following:
28. In 2000, AORN published the first Periopera- Risk of infection
tive Nursing Data Set (PNDS) (AORN, 2011). Impaired transfer ability
The PNDS is a controlled, structured nursing
Imbalanced nutrition: more than body
vocabulary that can be used to describe peri-
requirement
operative nursing practice. Following revisions,
the PNDS, Third Edition, includes 40 nurse- 32. Examples of desired patient outcomes include
sensitive patient outcomes, 44 nursing diag- the following:
noses, and 53 interventions. The PNDS may The patient is free of signs and symptoms
be used for the following purposes: of infection.
Provide a framework to standardize The patient is free of signs and symptoms of
documentation. injury related to transfer/transport.
Provide a universal language for periopera- The patient demonstrates knowledge of
tive nursing practice and education. nutritional requirements related to opera-
Assist in the measurement and evaluation of tive or other invasive procedures.
patient care outcomes. 33. Examples of implementation include the
Provide a foundation for perioperative following:
nursing research and evaluation of patient Implements aseptic technique, protects from
outcomes. cross-contamination
29. A primary benefit in day-to-day practice is the Evaluates for signs and symptoms of skin
use of a universal language for nursing diag- and tissue injury as a result of transfer or
noses, interventions, and expected outcomes. transport
30. In some facilities, the PNDS has been entered Provides instruction regarding dietary needs
into the documentation database, allowing
nurses to access the common language via Patient Outcomes: standards of
computer. Even when the documentation is
Perioperative care
not computerized, the perioperative nurse
should refer to the PNDS when planning
patient care. The PNDS is available through 34. Perioperative nursing is patient oriented, not
AORN. task oriented. Perioperative nurses focus on
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Patient Outcomes: Standards of Perioperative Care 5

preventive practice rather than on the iden- The patients musculoskeletal status is main-
tification of problems (AORN, 2011, p. 4). tained at or improved from baseline levels.
They must use knowledge, judgment, and skill The patients endocrine status is maintained
based on the principles of biological, physi- at or improved from baseline levels.
ological, behavioral, social, and nursing sci- The patient is free from signs and symptoms
ences to plan and implement care to achieve of infection.
desired patient outcomes. AORN has identi-
The patient is at or returning to normo-
fied patient outcomes that describe the results
thermia at the conclusion of the immediate
a patient can expect to achieve during sur-
postoperative period.
gical interventions. These standards reflect
the responsibilities of the perioperative nurse The patients fluid, electrolyte, and acid
and may serve as a framework with which base balances are maintained at or improved
to evaluate patient response to perioperative from baseline levels.
nursing interventions. The patients respiratory status is main-
35. The PNDS describes 40 outcome relationships tained at or improved from baseline levels.
(AORN, 2011, pp. 139391): The patients cardiovascular status is main-
The patient is free from signs and symptoms tained at or improved from baseline levels.
of injury related to thermal sources. The patient demonstrates and/or reports
The patient is free from unintended retained adequate pain control.
foreign objects. The patients neurological status is main-
The patients surgery is performed on the tained at or improved from baseline levels.
correct site, side, and level. The patient or designated support person
The patient is free from signs and symptoms demonstrates knowledge of expected psy-
of injury caused by extraneous objects. chosocial responses to the procedure.
The patients specimen(s) is (are) managed The patient or designated support person
in the appropriate manner. demonstrates knowledge of nutritional man-
The patients status is communicated agement related to the operative or other
throughout the continuum of care. invasive procedure.
The patient is free from signs and symptoms The patient or designated support person
of electrical injury. demonstrates knowledge of medication
The patient is free of signs and symptoms of management.
injury related to positioning. The patient or designated support person dem-
The patient is free from signs and symptoms onstrates knowledge of pain management.
of laser injury. The patient or designated support person
The patient is free from signs and symptoms demonstrates knowledge of wound
of chemical injury. management.
The patient is free from signs and symptoms The patient or designated support person dem-
of radiation injury. onstrates knowledge of expected responses to
The patient is free from signs and symptoms the operative or invasive procedure.
of injury related to transfer/transport. The patient or designated support person
The patient receives appropriately adminis- participates in decisions affecting his or her
tered medication(s). perioperative plan of care.
The patient has wound perfusion consistent The patient or designated support person
with or improved from baseline levels. participates in the rehabilitation process.
The patient has tissue perfusion consistent The patients value system, lifestyle, eth-
with or improved from baseline levels. nicity, and culture are considered, respected,
The patients gastrointestinal status is main- and incorporated in the perioperative plan
tained at or improved from baseline levels. of care.
The patients genitourinary status is main- The patients care is consistent with the indi-
tained at or improved from baseline levels. vidualized perioperative plan of care.
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6 cHaPter 1 Introduction to Perioperative Nursing

The patients right to privacy is maintained. Maintenance of asepsis


The patient is the recipient of competent Ongoing monitoring of the patients physi-
and ethical care within legal standards of ological and psychological status
practice. Supervision of ancillary personnel
The patient is the recipient of consistent and 38. Additional responsibilities that promote per-
comparable care regardless of the setting. sonal and professional growth and contribute
36. Other desired patient outcomes not specifically to the profession of perioperative nursing
listed in the AORN outcome standards may include, but are not limited to, the following:
be identified by the perioperative nurse and Participation in professional organization
included in the plan of care. New knowledge activities
regarding patient responses to surgery and the Participation in research activities that sup-
effects of nursing interventions may lead to the port the profession of perioperative nursing
identification of new desired patient outcomes Exploration and validation of current and
that have implications for perioperative nursing future practice
practice. The perioperative nurse who plans
Participation in continuing education pro-
patient care should be guided by, but not lim-
grams to enhance personal knowledge and
ited by, established patient outcome standards.
to promote the profession of perioperative
nursing
roles of the Perioperative nurse Functioning as a role model for nursing stu-
dents and perioperative nursing colleagues
37. Perioperative nurses function in various roles, Mentoring, precepting, and instructing
including those of manager/director, clinical other perioperative nurses
practitioner (e.g., scrub nurse, circulating
nurse, clinical nurse specialist, registered
nurse first assistant [RNFA]), educator, and expanded and advanced Practice roles
researcher. In these roles, the perioperative
nurses responsibilities include, but are not 39. The RNFA is an expanded role of periopera-
limited to, the following: tive nursing. The RNFA practices under the
Patient assessment before, during, and after direction of the surgeon and assists the sur-
surgery geon during the intraoperative phase of the
Patient and family teaching surgical experience. A more complete defini-
Patient and family support and reassurance tion of the RNFA and the qualifications for
Patient advocacy this role are outlined in the revised AORN
Performing as scrub or circulating nurse Position Statement on RN First Assistants
during surgery (AORN, 2012b).
Control of the environment 40. The perioperative nurse with a graduate degree
may function in an advanced role. Examples
Efficient provision of resources
of advanced practice roles include the clinical
Coordination of activities related to patient nurse specialist and nurse practitioner. Respon-
care sibilities and job descriptions may vary with
Communication, collaboration, and consul- employment settings and individual states
tation with other healthcare team members legislation.

section Questions
1. Describe the purpose of the PNDS. [Ref 28]
2. What is the purpose of the outcome statements described in the PNDS? [Ref 34]
(continues)
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Practice Settings 7

section Questions (continued)


3. How are the outcome statements developed? [Ref 36]
4. Which activities promote personal and professional growth and development as a nurse? [Ref 38]
5. What distinguishes an expanded role in nursing from an advanced practice role? [Refs 3940]

Practice settings Members and responsibilities of the


surgical team
41. Technological advances have resulted in dra-
matic changes in surgical technique. Many 45. Safe and effective care of the surgical patient
procedures that once required a hospital- requires a team effort. Desired patient out-
based operating room, that necessitated a comes depend on the effective coordination
large incision, and that involved a hospital of the unique skills of each member of the
stay and an extended recovery can now be surgical team.
performed in same-day, outpatient, or ambu- 46. Team members may be categorized based on
latory settings. their responsibilities during the procedure.
42. Minimally invasive surgical techniques encom- Sterile team members are those who scrub their
pass surgery performed through small puncture hands and arms, don sterile attire, contact sterile
holes with specialized instruments and equip- instruments and supplies, and work within
ment. This surgical approach facilitates rapid the sterile field (i.e., the area immediately sur-
recovery and same-day discharge. Innovations rounding the surgical site). They are referred to
in technology are making this approach appli- as the scrubbed members of the team.
cable to increasingly more complex procedures. 47. Members of the sterile surgical team include the
Reimbursement guidelines also encourage primary surgeon, assistants to the surgeon (i.e.,
same-day surgery and early discharge. As a other surgeons, residents, physician assistants,
result, many surgical procedures have moved and RNFAs), and the scrub person who may be
into settings outside the acute care hospital- a registered nurse, a licensed practical nurse, or
based operating room. a surgical technologist.
43. Many complex procedures are performed 48. Members of the nonsterile surgical team carry
in freestanding surgical centers, satellite out their responsibilities outside the sterile field
surgery facilities, mobile surgical units, sur- and do not wear sterile attire. Members of the
geons office-based operating rooms, and nonsterile surgical team include the anesthe-
clinics. In addition, some procedures once siologist, the nurse anesthetist, the anesthesia
performed exclusively in the operating room assistant, the circulating nurse, and others.
are now performed in the radiology unit 49. The primary surgeon is responsible for the pre-
using interventional techniques rather than operative diagnosis, selection of the procedure
open surgery. As long as reimbursement to be performed, and the actual performance
favors outpatient surgery and technological of surgery.
advances in instrumentation and procedures 50. The assistants work under the direction of
continue to emerge, the number and type of the primary surgeon and are responsible for
surgeries performed in the physicians offices providing assistance during surgery, such as
will continue to increase. exposing the site, suctioning, handling tissue,
44. The needs of the patient undergoing surgery and suturing. The nature of the surgery, the
transcend the setting in which the surgery takes state in which the surgery is performed, the
place. In every setting, the perioperative nurse medical board and the board of nursing, the
brings specialized skills, technical competence, surgeons preference, and hospital policies are
knowledge, and caring that are essential to a factors that determine who may function as an
successful surgical experience. assistant.
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8 cHaPter 1 Introduction to Perioperative Nursing

51. The scrub person works primarily with instru- Idaho, Iowa, Kansas, Minnesota, Montana,
ments and equipment. The scrub person has the Nebraska, New Hampshire, New Mexico,
following responsibilities: North Dakota, Oregon, South Dakota, Wash-
Selecting instruments, equipment, and other ington, and Wisconsin (about.com Health
supplies appropriate for the surgery Careers, 2012).
Preparing the sterile field and setting up the 56. The perioperative nurse in the circulating role
sterile table(s) with instruments and other coordinates the care of the patient, serves as
sterile supplies needed for the procedure the patients advocate throughout the intraop-
Scrubbing, and then donning a gown and erative experience, and has responsibility for
gloves managing and implementing activities outside
the sterile field. Activities are directed toward
Maintaining the integrity and sterility of the
assuring patient safety and achieving desired
sterile field throughout the procedure
patient outcomes. The nursing process is used
Having knowledge of the procedure and as a framework for these activities. Examples of
anticipating the surgeons needs throughout activities performed by the perioperative nurse
the procedure
in the circulating role include the following:
Providing instruments, sutures, and supplies Providing emotional support to the patient
to the surgeon in an appropriate and timely prior to the induction of anesthesia
manner
Performing ongoing patient assessment
Preparing sterile dressings Formulating a nursing diagnosis
Implementing procedures that contribute Developing and implementing a plan of care
to patient safety (e.g., surgical counts for
Documenting patient care
instruments, sponges, and sharps)
Evaluating patient outcomes
Cleaning and preparing instruments for ter-
Teaching patient and family
minal sterilization
Obtaining appropriate surgical supplies and
52. Factors that determine the most appropriate equipment
scrub person include the nature of the sur-
Creating and maintaining a safe environment
gery, the skills required for the procedure, the
staffing skill mix, and hospital policy. Administering drugs
53. The anesthesiologist is responsible for assessing Implementing and enforcing policies and
the patient prior to surgery and for adminis- procedures that contribute to patient safety,
tering anesthetic agents to facilitate surgery and such as surgical checklists, time-out pro-
provide pain relief. The anesthesia assistant tocols, surgical counts for instruments,
administers anesthesia under the direct super- sponges, and sharps, as well as performing
equipment checks
vision of the anesthesiologist or, in some cases,
the surgeon. In some cases, the certified regis- Preparing and disposing of specimens
tered nurse anesthetist (CRNA) also adminis- Communicating relevant information to
ters anesthesia under the direct supervision of other team members and to the patients
the anesthesiologist or the surgeon. family
54. Effective November 13, 2001, the Centers for 57. Perioperative nurse managers assume a variety
Medicare and Medicaid Services (CMS) estab- of roles. In a very small facility, the periop-
lished an exemption for CRNAs from the phy- erative nurse may serve as manager and also
sician supervision requirement. This exemption scrub or circulate on cases as needed. In very
recognizes a governors written request to CMS large facilities, it is common to have several
attesting that he or she is aware of the states clinical and administrative managers. Budgets
right to an exemption of the requirement and for surgical care in excess of $20 million are
that it is in the best interests of the states citi- not uncommon and are often administered by
zens to exercise this exemption. a dedicated business financial manager.
55. As of October 2012 16 states had chosen to 58. In addition to administrative department
opt out of the CRNA physician supervision managers, other leadership/management
regulation: Alaska, California, Colorado, positions include team leaders and managers
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Members and Responsibilities of the Surgical Team 9

or coordinators who assume responsibility to rooms, assigning staff to procedures, and


for a particular surgical specialty. Responsi- making adjustments to keep the schedule
bilities may include assigning staff, managing moving throughout the day. An unanticipated
and ensuring adequate inventory of specialty emergency often requires quickly altering the
supplies, ensuring availability of supplies and daily schedule. The scheduling coordinator
equipment needed for scheduled surgeries, must have knowledge of patient acuity and the
maintaining and updating preference cards skill level of the staff, and be able to utilize
that identify specific supplies and instruments resources appropriately.
needed by each surgeon for each procedure, 60. Perfusionists, radiology and laboratory tech-
creating preference cards for surgeons new to nicians, perioperative educators, pathologists,
the service, periodically reviewing the contents nurses aides, clerks, and personnel from mate-
of instrument trays for appropriateness, stan- rials management, environmental services, and
dardizing supplies and trays whenever possible, central service are among the nonsterile per-
and promoting or providing education. sonnel necessary to ensure safe patient care
59. Scheduling coordinators may or may not be and achieve desired patient outcomes. It is the
perioperative nurses. They run the desk, perioperative nurse who coordinates the contri-
which typically involves assigning surgeries butions of each of these team members.

section Questions
1. Which factors have spurred the transition from inpatient surgery to same-day, outpatient, and ambula-
tory surgery? [Refs 4142]
2. Describe the term minimally invasive surgical techniques. [Ref 42]
3. Where, besides operating rooms, are invasive procedures performed? [Ref 43]
4. Identify members of the sterile and nonsterile components of the surgical team. [Refs 4648]
5. What determines who may function as an assistant to the surgeon? [Ref 50]
6. Describe the responsibilities of the scrub person. [Ref 51]
7. Discuss the role of the circulating nurse. [Ref 56]
8. Describe the responsibilities of the circulating nurse. [Ref 56]
9. Which other roles do registered nurses fill in the perioperative setting? [Refs 5758]
10. What are some of the positions of the nonsterile personnel who function within the operating room? [Ref 60]

references Association of periOperative Registered Nurses (AORN)


About.com Health Careers (2012). Which States Allow (2012b). AORN Position Statement on RN First Assistants.
CRNAs to Practice Without Physician Supervision?. Accessed September, 2012: https://www.aorn.
Accessed online September, 2012: http://healthcareers.about org/WorkArea/DownloadAsset.aspx?id=21931.
.com/od/healthcareerissues/f/Which-States-Allow Association of periOperative Registered Nurses (AORN)
-Crnas-To-Practice-Independently-Without-Physician- (2011). Perioperative Nursing Data Set (PNDS). Denver,
Supervision.htm. CO: AORN.
Association of periOperative Registered Nurses (AORN)
(2012a). Perioperative Standards and Recommended
Practices. Denver, CO: AORN.
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10 cHaPter 1 Introduction to Perioperative Nursing

Post-test
Read each question carefully. Each question may have more than one correct answer.
1. The perioperative period beings when the patient
a. arrives in the holding area and ends in PACU.
b. arrives in the hospital and ends with discharge.
c. is informed of the need for surgery and ends with discharge from the hospital.
d. is informed of the need for surgery and ends with the patients return to his or her usual activities.
2. Which of the following is not a nursing focus during the preoperative period?
a. patient teaching
b. patient and family support
c. diagnostic testing
d. preparation for discharge
3. Intraoperative phase begins when
a. the patient arrives at the hospital for surgery.
b. the patient enters the operating room.
c. the anesthesia provider induces the patient.
d. the surgeon makes the initial incision.
4. Initial nursing focus in the postoperative period focuses on
a. transferring the patient to the PACU.
b. supporting the patients physiological systems.
c. preparing the patient for discharge.
d. making arrangements for the patient to return to normal activity.
5. Why was the term operating room nurse changed to perioperative nurse?
a. AORN decided it sounded more contemporary.
b. To eliminate the OR mystique and encourage more nurses to join the specialty.
c. The responsibilities of nurses in this specialty have expanded to support and care for the surgical patient
through the continuum of care.
d. Because PACU nurses wanted to be included.
6. AORNs Patient-Focused Model includes which of the following domains?
a. patient safety, physiologic response, behavioral responses, the health system
b. patient teaching, patient safety, behavioral responses, discharge planning
c. patient safety, patient assessment, discharge planning, the health system
d. patient assessment, plan of care, discharge planning, the health system
7. Perioperative nurses provide patient care
a. in collaboration with the surgeon and the anesthesia provider.
b. that primarily focuses on patient and family education and support.
c. within the framework of the nursing process: assessment, planning, intervention, and evaluation of
patient outcomes.
d. that is focused primarily on the patients surgical diagnosis.
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Post-Test 11

8. The perioperative nursing assessment of the patient


a. takes place in a number of settings and time frames.
b. begins with a telephone call to the patient prior to surgery for teaching, support, and data gathering.
c. is based on data collected by other healthcare professionals.
d. usually takes place just prior to surgery and includes an interview, chart review, and physical inspection.
9. Typical nursing diagnoses for the surgical patient include
a. knowledge deficit and high risk for infection.
b. prevention of adverse outcomes and patient teaching.
c. high risk for infection and support of patient and family.
d. maintenance of normothermia and anatomical body alignment.

10. The perioperative nurses begins the patients care plan


a. prior to the procedure, based on information about the patient from the surgeon and other healthcare
providers.
b. in the holding area based on interview and assessment data.
c. prior to the procedure based on knowledge of the planned procedure, typical related nursing diagnoses,
and resources required.
d. when the patient enters the operating room and all attention is focused on supporting the patient.

11. The framework for the intervention stage of perioperative patient is based on
a. the surgeons preferences related to the surgical procedure.
b. the patients medical diagnosis and comorbidities.
c. the needs of the healthcare team participating in the surgical procedure.
d. identified standards of clinical practice and professional performance.
12. The criteria upon which the final evaluation is made is the extent to which
a. the goals of the surgical procedure were met and the patient was transferred to the appropriate
recovery area.
b. the desired patient outcomes have been achieved.
c. hospital policy and professional standards were upheld.
d. the patient and family express satisfaction with the entire surgical experience.
13. The Perioperative Nursing Data Set (PNDS) is
a. standardized nursing vocabulary used to describe perioperative nursing practice.
b. a collection of recommended practices to guide patient care.
c. used by all electronic health record systems to standardize patient records.
d. a set of evaluation tools to determine the extent to which patient care has been successful.
14. Perioperative nursing is
a. task oriented and designed to care effectively for surgical patients.
b. nursing science related to surgical patients.
c. patient oriented, using knowledge, judgment, and skill.
d. a framework to evaluate patients responses to surgical and other invasive procedures.
15. Which of the following is not a standard of perioperative care?
a. The patient is free from signs and symptoms of electrical injury.
b. The patient receives appropriately administered medications.
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12 cHaPter 1 Introduction to Perioperative Nursing

c. The patients wound perfusion is consistent with or improved from baseline levels.
d. The patients comorbidities are managed effectively during the operative or other invasive procedure.
16. Which of the following facilitate(s) personal and professional growth?
a. participating in research activities
b. participating in professional organization activities
c. mentoring and precepting other perioperative nurses
d. all of the above
17. Which of the following is a true statement about the registered nurse first assistant (RNFA)?
a. An RNFA is an advanced practice perioperative nurse, regardless of his or her academic level of
preparation.
b. The RNFA position is an expanded role in perioperative nursing.
c. The RNFA practices under the license of the physician.
d. The RNFA must have an advanced degree in nursing.
18. The transitioning of complex procedures from the traditional operating room to alternative settings is
primarily the result of
a. reimbursement guidelines.
b. technological advances in surgical technique.
c. patient preference.
d. the nursing shortage.
19. Who may function in the scrub role? [Select all correct responses.]
a. perioperative registered nurse
b. licensed vocational or licensed practice nurse
c. surgical technologist
d. RNFA
20. Who or what determines who may function as an assistant to the surgeon during the procedure?
[Select all correct responses.]
a. surgeon
b. facility policy
c. state board of medicine
d. state board of nursing
21. What is the primary focus of the perioperative nurse?
a. managing the operating room environment
b. patient safety and achieving the desired patient outcomes
c. supervising the scrub person
d. documenting intraoperative patient care
22. Which of the following roles is not part of the sterile surgical team?
a. perfusionist
b. RNFA
c. first assistant
d. surgical technologist