Chapter 21: Plastic and Reconstructive Surgery

Alexanders Care Of the Patient in Surgery 14th Edition Rothrock

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Chapter 21: Plastic and Reconstructive Surgery

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

  1. The science of plastic and reconstructive surgery, which means to mold or create form and shape, improves appearance and body image through an understanding of:
a. body geometry.
b. the anatomy and biology of tissue.
c. form and function.
d. body image.

 

 

ANS:  B

Plastic and reconstructive surgery is based on a thorough understanding of the anatomy and biology of tissue. Derived from the Greek word plastikos, which means to mold or give form, plastic surgery is a medical specialty that restores or gives shape to the body.

 

REF:   Page 885

 

  1. Denise Michaelson, a 46-year-old woman with an early-stage second primary cancer in her left breast, has elected to have a bilateral mastectomy with saline implants. She has requested that the surgeon also revise a small unsightly scar on her right knee and pierce her ears. While Denise’s breast tumor could be treated with an excisional biopsy, she has decided to have a mastectomy of both breasts, which is considered an appropriate preemptive (preventative) surgery for a woman of her age with two primary cancers of the breast. The saline implant insertion surgery is considered a _______________ procedure, the scar revision is considered a ___________ procedure, and the ear piercing is considered a _______________ procedure.
a. reconstructive; reconstructive; reconstructive
b. reconstructive; cosmetic; reconstructive
c. cosmetic; reconstructive; cosmetic
d. reconstructive, cosmetic and cosmetic

 

 

ANS:  D

There are two different subspecialties of plastic surgery. Cosmetic (aesthetic) surgery restores or reshapes normal structures of the body, to improve appearance and self-esteem. Reconstructive surgery treats abnormal structures of the body caused by birth defects, developmental problems, disease, tumors, infection, or injury, to restore function and correct disfigurement or scarring. Scar revision involves the rearranging or reshaping of an existing scar so that the scar is less noticeable; scar revision is considered an aesthetic procedure.

 

REF:   Pages 885, 916

 

  1. Marla, the perioperative nurse circulating for a skin contracture release of the ear on a 5-year-old boy, transfers 0.25% bupivacaine via syringe to the scrub person’s sterile back table. The scrub person, Jake, questions why she is not giving him bupivacaine with epinephrine, since there may be bleeding expected at the incision site. Marla’s reply to Jake is based on the fact that:
a. epinephrine is contraindicated in areas with limited vascularity, such as the ears.
b. Marla is complying with the surgeon’s standardized order on the preference list.
c. epinephrine-induced vasoconstriction may interfere with normal tissue planes.
d. pediatric heart rates are higher than adult heart rates and epinephrine can cause tachycardia.

 

 

ANS:  A

Use of epinephrine is contraindicated in areas with limited vascularity, such as digits, the penis, nasal tip, and ears.

 

REF:   Page 894

 

  1. The perioperative nurse should verify with the patient that all of the preoperative prescribed skin preparation regimens ordered by the surgeon have been performed. All body jewelry that pierces the skin should be removed before the skin prep. Select the statement that reflects a true special consideration for skin preparation before facial surgery.
a. Use chlorhexidine gluconate (CHG) around the ears and eyes.
b. Leave the eyebrows and eyelashes intact to preserve facial appearance and expression.
c. Prep the skin graft and donor sites together with the same prep set and drape immediately.
d. Isolate rashes, open sores, cuts, or lesions in the prep site with a sterile, clear adhesive patch.

 

 

ANS:  B

The eyebrows and eyelashes, in particular, are left intact to preserve facial appearance and expression. The use of CHG should be avoided around the ears and eyes. When prepping for a skin graft procedure, separate skin prep setups are needed for the graft and donor sites.

Inspect for any rashes, bruises, open sores, cuts, or other skin conditions.

 

REF:   Page 894

 

  1. During the planning phase of a procedure for liposuction or post–bariatric contouring procedures, the perioperative nurse will assemble and organize supplies and devices because the procedure may require:
a. repositioning one or more times during surgery.
b. meticulous accounting of fluid loss and blood replacement.
c. pressure dressings.
d. patient transfer to an alternating-pressure bed.

 

 

ANS:  A

Whereas a majority of plastic surgical procedures are performed in the supine position, many also take place with the patient prone or lateral. Liposuction and post–bariatric body contouring procedures may also require repositioning one or more times during surgery.

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