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OR Nurse:
doi: 10.1097/01.ORN.0000450125.78894.2b
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Preventing skin injury in the OR

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INSTRUCTIONS Preventing skin injury in the OR


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Preventing skin injury in the OR

General Purpose: To provide information on techniques to prevent skin injury in the OR. Learning Objectives: After reading this article and taking this test, you should be able to: 1. Identify NPUAP classifications of pressure ulcers. 2. Recognize risks to patients' skin integrity in the OR. 3. Select techniques to prevent skin injury during OR procedures.

1. A Stage II pressure ulcer is characterized by

a. full-thickness tissue loss involving damage to subcutaneous tissue.

b. intact skin that appears as a defined area of nonblanchable redness.

c. full-thickness tissue loss with possible damage to muscle, bone, or supporting structures.

d. an intact or ruptured serum-filled blister.

2. A pressure ulcer that is full-thickness tissue loss with necrotic tissue but without visible muscle, tendon, or bone is

a. Stage II.

b. Stage III.

c. Stage IV.

d. Stage V.

3. An unstageable pressure ulcer has

a. full-thickness tissue loss with damage to muscle, bone, or supporting structures.

b. partial-thickness tissue loss involving the dermis that presents as a superficial open ulcer.

c. full-thickness skin loss with a wound bed covered with slough or eschar.

d. pressure-related alterations of intact skin that differ from adjacent tissue.

4. For Stage III or IV pressure ulcers, the CMS

a. has classified them as unpreventable conditions.

b. has provided guidelines for patient positioning in the OR.

c. will not provide reimbursement if they are hospital-acquired.

d. will provide reimbursement for wound debridement.

5. Risk factors for impaired skin integrity in the OR can come from all of the following except

a. prolonged hypothermia.

b. dry air.

c. increased heat from warming blankets.

d. moisture.

6. Most pressure ulcers occur how long after surgery?

a. 1–3 hours

b. 8–16 hours

c. 1–3 days

d. 5–7 days

7. All surfaces that touch the patient's skin should be

a. smooth.

b. moist.

c. warm.

d. cool.

8. One of the most common injuries with the supine position is

a. greater trochanter injury.

b. peroneal nerve injury.

c. pressure ulcers on the iliac crest.

d. back pain.

9. In the supine position, the patient's hands should be placed with the

a. palms up.

b. palms down.

c. thumbs down.

d. fifth fingers down.

10. One of the most serious risks for a patient in Trendelenburg position is

a. pressure ulcers on the heels.

b. a decrease in air exchange.

c. compartment syndrome.

d. pressure ulcers on the elbows.

11. To prevent foot drop in a patient in reverse Trendelenburg position, the feet should

a. be elevated off the OR table.

b. be left uncovered.

c. be positioned on a well-padded foot board.

d. hang free from the OR table.

12. Areas of greatest concern for pressure ulcer formation in patients in the lateral position include all of the following except

a. acromion process of the scapula.

b. occiput.

c. greater trochanter.

d. malleolus.

13. For a patient in Fowler position in the OR, padding should be used at the

a. knees.

b. iliac crest.

c. scapulae.

d. thoracic vertebrae.

14. What is a common risk for patients in the lithotomy position?

a. falling or sliding

b. brachial plexus injuries

c. respiratory compromise

d. hip dislocation

15. After anesthesia is administered, a patient may be rolled to the prone position with the help of at least

a. two staff members.

b. three staff members.

c. four staff members.

d. five staff members.

16. What special OR equipment should be used to allow proper lung expansion of patients in the prone position?

a. gel padding on the OR table

b. axillary rolls under the arms

c. pressure-relieving mattresses

d. two chest rolls from the clavicles to the iliac crests

17. For a patient in the prone position, the arms should be

a. placed above the head.

b. flexed with palms facing down.

c. straight with palms facing up.

d. placed laterally with the radial side down.

18. Once the patient is in the final resting position, what should the circulating nurse check before and after the procedure?

a. peripheral pulses

b. respiratory rate and depth

c. range of motion

d. patient comfort

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