Question 1

The perioperative nurse and his orientee have returned from an airway fire simulation exercise with the otorhinolaryngologic surgeon,fellow,and anesthesia provider.They were amazed at the statistics for OR fires and the threat of serious injury to the patient and team.Patients undergoing otorhinolaryngologic procedures are at greater risk for fire injury because of the proximity of the surgical field to high concentrations of oxygen.The team discussed a plan to change their practices.An example of a valid fire prevention strategy that involves the entire surgical team during otorhinolaryngologic surgery would be:

Accepted Answer

Patients undergoing otorhinolaryngologic procedures are at greater risk for fire injury because of the proximity of the surgical field to high concentrations of oxygen.Devices used in this specialty (e.g.,lasers,fiberoptic light cables,electrosurgical unit,high-speed surgical drills and burrs)further contribute to risk by providing a heat source and fuel.Specific recommendations that the perioperative team should consider include:
·Awareness of risk factors.Oxygen vents into surgical field from face masks,nasal cannulae,and uncuffed endotracheal tubes which can then accumulate under surgical drapes.This creates an oxygen-enriched atmosphere within the proximity of the surgical site for otorhinolaryngologic procedures.
·Anticipating risk.The perioperative nurse and scrub person should collaborate prior to procedures to plan for risk and ensure that sterile saline is available on the surgical field,a holster is used for the active ESU electrode (and not placed on the drapes),and that the volume of extraneous noise is kept to a minimum so that the audio from the ESU or laser can be heard.The team should be well versed on how to extinguish a fire and evacuation routes if necessary.

Question 2

Surgical removal of hypertrophic adenoids to relieve upper airway obstruction is often performed to create a patent nasal airway.The highly vascular adenoids are treated by which method(s)of hemostasis to control bleeding?

Accepted Answer

Children with polysomnogram-proven sleep disorder breathing and hypertrophic adenoids should have their adenoids assessed as a complete workup.Adenoidectomy by curette,ablation,radiofrequency,and powered microdebriders has been described in the pediatric otolaryngology literature.Hemostasis is achieved depending on the method chosen,by electrocautery,radiofrequency,or direct pressure (using angled mirrors or endoscopic visualization).

Question 3

An experienced perioperative nurse is orienting a new perioperative nurse to otolaryngologic surgery.The experienced nurse and the new nurse are the scrub persons and are preparing the sterile back table with instruments,accessory devices,and the medications used for the local anesthetics.They also set up a prep table with the initial local anesthetics to be given before the start of the procedure.The experienced nurse is determined to impart the critical nature of patient safety and prevention of medication errors during these procedures.The back table contains multiple medications that will be used for local anesthesia,vasoconstriction,and hemostasis.As a perioperative registered nurse (RN)scrub person,it is necessary that both the experienced and new nurse:

Accepted Answer

The perioperative nurse should be aware of the maximum recommended dosage of local anesthetics and be alert for signs of allergic reactions or toxic responses.In addition,the perioperative nurse should demonstrate an understanding of safe medication practice such as adhering to the seven rights of medication administration,using appropriate communication when delivering medication to the sterile field and using appropriate ancillary supplies.

Question 4

FESS provides a more physiologic type of drainage by reducing trauma to normal tissues.FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses.Select the appropriate indications for FESS.

Accepted Answer

If there is obstruction of outflow (e.g.,allergy,septal deflection,spurs)between the mucosa and the sinus,mucociliary clearance is inhibited,and secretions are retained in the sinus.This predisposes the patient to sinus infections and mucocele.The purpose of FESS is to ensure adequate drainage of the sinuses by resecting tissue and creating increased aeration of the sinuses.

Quiz 19: Otorhinolaryngologic Surgery

Surgical removal of hypertrophic adenoids to relieve upper airway obstruction is often performed to create a patent nasal airway.The highly vascular adenoids are treated by which method(s) of hemostasis to control bleeding?

FESS provides a more physiologic type of drainage by reducing trauma to normal tissues.FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses.Select the appropriate indications for FESS.