Chapter 05 Positioning the Patient for Surgery

Chapter 05  Positioning the Patient for Surgery

MULTIPLE CHOICE

1. Albert Janson, a 325-pound patient, is scheduled for a 6-hour abdominal surgery. While assessing Mr. Jennings in the preoperative holding area, the perioperative nurse is concerned about the risk for pressure injury because of the weight of the patient’s body pressing against the surface of the OR bed for a long surgery. Which of these other factors may also produce pressure?

1. The scrub person leaning with his or her forearm on the Mayo stand
2. A self-retaining retractor post clamped to the OR bed rail and tightened against the

   patient’s side

3. A Deaver retractor and two right angle clamps placed on the patient’s thighs when

   draped

4. Full-leg sequential compression wraps on both legs throughout the entire surgery

ANS: B
Pressure is the force placed on underlying tissue. Pressure can occur from the weight of the body as gravity presses it downward toward the surface of the bed. Pressure also results from the weight of equipment resting on or against the patient, such as drills, Mayo stands, surgical instruments, rigid edges of the OR bed or its attachments, or vertical posts for self-retaining retractors.

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2. After Mr. Jennings was asleep and intubated, the surgeon requested the patient to be placed in lithotomy position for a sigmoidoscopy before the open procedure. The team of five nonscrubbed persons lifted the patient with the lift sheet, slid the patient down toward the foot of the OR bed, and placed him into position. After the sigmoidoscopy, the perioperative nurse had the team roll the patient to his side for a skin assessment of his back before he was repositioned supine. What injury was the perioperative nurse concerned that she might see?

1. A shearing force injury to the tissue from having been slid into position
2. Skin creases from wrinkled sheets
3. Incontinence from an inadequate bowel prep
4. Side-to-side striations across his back and buttocks from the lifting sheet

ANS: A
Shear is the folding of underlying tissue when the skeletal structure moves while the skin remains stationary. A parallel force creates shear, unlike the perpendicular force created by pressure. As gravity pulls the skeleton down, any stretching, folding, and tearing of the underlying tissues, as they slide with the skeleton, can occlude vascular perfusion, which can lead to tissue ischemia.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 5-2

REF: Page 144

3. The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on his elbows. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. This skin injury was probably the result of which physical force?

1. Heat and moisture from prolonged bed rest
2. Pressure of his elbows resting on the bed for 2 days
3. Friction from his elbows rubbing over the sheets when slid up in bed
4. Negativity from the bath blankets the nurses stacked to make arm rests for Mr.

   Jennings

ANS: C
Friction is the force of two surfaces rubbing against one another. Friction on the patient’s skin can occur when the body is dragged across bed linen instead of being lifted. Friction can denude the epidermis and make the skin more susceptible to higher stage pressure ulcer formation, pain, and infection.

REF: Page 144

4. Select the nursing activity that would reduce the impact of an extrinsic factor that could cause a pressure injury to the patient.

1. Assisting the anesthesia provider with checking and hanging albumin before

   anesthesia induction

2. Washing the patient’s back, heels, scapulae, and elbows with CHG wipes before

   transfer to the OR bed

3. Fluffing the surface of the OR bed with warm bath blankets and eggcrate foam

   before patient transfer to the OR bed

4. Removing all but one layer of linen from the dry polymer elastomer gel mattress

   surface of the OR bed before patient transfer

ANS: D
Negativity can override the pressure-relieving properties of mattresses and padding. Placing a warm blanket under a patient may be soothing initially, but if a surgical procedure is long, pressure to the bony prominences resting on the blanket will be higher than if only a sheet and draw sheet are used. Additionally, wrinkles and folds can cause further pressure points.

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5. Maria Faulkner is a 92-year-old frail nursing home patient admitted for dehydration, anemia, and respiratory symptoms. She has type 2 diabetes and low albumin levels, is underweight, and continues to smoke cigarettes when she is at home. Mrs. Faulkner is on complete bed rest in a hospital bed with an alternating pressure mattress overlay. She is not able to turn herself in bed and must be assisted to change position. Based on this description of Mrs. Faulkner, which factor classification dominates her vulnerability and risk for injury?

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 5-3

1. Shearing force factors
2. Intrinsic factors
3. Bed rest precaution factors
4. Extrinsic factors

ANS: B
Intrinsic factors can lower a patient’s tissue tolerance to pressure and decrease the time and pressure required for tissue breakdown. Certain preexisting conditions are regarded
as intrinsic risk factors for OR-induced pressure ulcer development. These conditions include respiratory and circulatory disorders, diabetes mellitus, anemia, malnutrition (serum albumin levels 3.5 g/dl or less), advanced age, body size (obesity; thin, frail build), body temperature (hypothermia), impaired mobility, and smoking.

REF: Page 147