Exam 21: Plastic and Reconstructive Surgery

Mohs' surgery is a specialized excision used to treat basal and squamous cell skin cancers.Select the statement about Mohs' surgery that best reflects the process,procedure,and outcome goal.

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:

Microsurgery,a fundamental tool in reconstructive plastic surgery,allows an almost unlimited choice of reconstructive methods,replacement of lost tissue with similar components,and optimal selection of donor sites with minimal morbidity.Reconstructive microsurgical procedures include replantation of amputated body parts,repair of facial nerves,repair of lacerated nerves and blood vessels,treatment of extensive trauma to extremities and hands,reconstruction following removal of extensive cancers,and female to male transsexual reassignment.Today's surgeons skilled in microsurgery can successfully anastomose the ends of a vessel or nerve measuring less than:

In addition to the individualized nursing diagnoses that apply to surgical patients,the patient scheduled for plastic or reconstructive surgery can typically be expected to have the following nursing diagnosis:

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.

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:

Marissa Walton is a 6-year-old girl with full-thickness burns involving both lower legs,circumferentially,excluding her feet,over less than 2% of her body surface area (BSA)and partial-thickness burns over less than 15% of her BSA,after her clothes caught fire during a camping trip when she stepped into the campfire.Based on the American Burn Association and the "Rule of Nines" classifications,Marissa's burns would be classified as __ with a burn surface area percentage of approximately __.

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.

When coverage for a defect cannot be achieved through skin grafting,plastic surgeons rely on other techniques to replace tissue.After mastectomy,reconstruction with a transverse rectus abdominis myocutaneous (TRAM)flap is one of several options for nonsynthetic prosthetic reconstruction.Another descriptive term for the TRAM flap is the:

There are approximately 1 million reported cases of skin cancer per year with the majority being the highly curable basal or squamous cell cancers,accounting for more than 50% of all cancers.Not as common is the most serious skin cancer,malignant melanoma,with an estimated 68,720 cases per year.Select the individual who is at the highest risk for skin cancer.

Facial fractures are classified according to a system developed by Rene Le Fort in the early 1900s.A fracture that starts at the nasal bones,crosses the frontal process of the maxilla and lacrimal bones,and extends through the orbital floor,infraorbital rim,and lateral maxillary sinus wall is known as a:

Margaret Slayton,a 52-year-old woman with a left mastectomy followed by a TRAM flap reconstruction,was beginning to emerge from anesthesia after her procedure.The perioperative nurse gently moved Margaret's arms from the abducted position on the armboards in preparation for her transfer to her postoperative bed and admission to the PACU.What risk reduction maneuver did the nurse employ to Margaret's bed before transferring her?

Franklin Hardy,a 46-year-old man with multiple moles and skin lesions,was undergoing skin lesion excision surgery performed using a local anesthetic.After 90 minutes of surgery and multiple field block injections of 1% lidocaine with epinephrine 1:100,000 and 0.5% bupivacaine,Franklin told the perioperative nurse that he felt dizzy with ringing sensations in both ears,a metallic taste in his mouth,and numbness of the tongue and lips.He became confused and restless and showed an increased heart rate and blood pressure.The perioperative nurse recognized his signs and symptoms of _ and began immediate treatment with ___.

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:

Skin grafting provides an effective way to cover a wound if vascularity is adequate,infection is absent,and hemostasis is achieved.Skin from the donor site is detached from its blood supply and placed in the recipient site.The best description of a successful skin graft outcome is:

Josh Tremain,a 28-year-old firefighter,sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire.What surgical treatments may Josh need before he is discharged from the burn center to home?

Sherrel Farmer,a 49-year-old post-bariatric surgery patient,is scheduled for a Vaser-Assisted LipoSelection with tumescent infiltration.The tumescent is a solution of lactated Ringer's,lidocaine,and epinephrine.The perioperative nurse is aware that using more than 70 mL/kg of wetting solution for infiltration can lead to fluid overload.Select an appropriate nursing action related to minimizing the risk of tumescent solution overload or disproportion to lipoaspirate.

A broad range of implant materials are used in plastic and reconstructive surgery.Select the implant that represents a biologic composition of a surgical implant.

One of the most popular lasers used in plastic and reconstructive surgery is attracted to the water in the skin cells and ablates the cells at a predetermined depth.Collagen material beneath the skin surface is also heated,resulting in smoother and slightly tighter skin.Several lasers are attracted to areas of darker pigmentation.This treatment has virtually replaced dermabrasion,because of its consistency in terms of depth of penetration and also because this technique is less dependent on user technique or skill.Select the laser modality that would be the best option for ablation or removal of a pigmented red tattoo.

A variety of implantable devices are used in aesthetic and reconstructive plastic surgery procedures.Tracking of these devices is critical to patient safety.Institutions must report any incident of death or serious injury relating to the use of a medical device.What regulatory agency,commission,or act mandates this process when medical devices fail or cause injury?