The study describes an effort to evaluate the speech difficulties as perceived by individuals with dysarthria. A self-report questionnaire, Living with Neurologically Based Speech Difficulties (Living with Dysarthria), was answered by 55 individuals with varying types and degrees of dysarthria. Results show that both type and degree of subjectively perceived communicative difficulties varied. Degree of communicative difficulties was not related to age, gender, diagnosis, disease duration or employment status in this group. Generally, the overriding problems were related to restrictions in communicative participation, possibilities to actively take part in work and studies and to express one’s personality were particularly affected. Communication was also affected by emotions and by the number and familiarity of people present in communicative encounters. The dominating speech difficulties were related to reduced speech rate and a need for repetition as a consequence of misunderstandings. A statistically nonsignificant difference was found between the higher mean of the group with moderate dysarthria compared to the groups with severe and mild dysarthria, indicating that severity of dysarthria does not necessarily predict extent of perceived communicative difficulties. It is concluded that systematic subjective reports should always be included in the assessment of individuals with acquired dysarthria.

Orthognathic surgery is performed to alter the shape of the jaws to improve dental occlusion stability, improve temporomandibular joint function, open the oropharyngeal airway, and improve the patient's facial proportions. Surgery must be coordinated with orthodontic treatment. The surgeon develops a plan based on the patient's measurements and performs the planned procedure on plaster models of the patient's jaw and teeth to obtain the proper jaw position. Surgical techniques include LeFort procedures and distraction osteogenesis. Possible complications of orthognathic procedures include airway compromise, numbness, and nonunion or malunion of the bones. Postoperative instructions include an emphasis on the need for the patient to consume a blended diet for six weeks after surgery.

Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Cleaning, decontaminating, and handling instructions for instruments vary widely based on the type of instrument and the manufacturer. Processing instruments in accordance with the manufacturer's instructions can help prevent damage and keep devices in good working order. Most importantly, proper cleaning and disinfection may prevent transmission of pathogenic organisms from a contaminated device to a patient or health care worker. The updated AORN "Guideline for cleaning and care of surgical instruments" provides guidance on cleaning, decontaminating, transporting, inspecting, and storing instruments. This article focuses on key points of the guideline to help perioperative personnel implement appropriate instrument care protocols in their practice settings. The key points address timely cleaning and decontamination of instruments after use; appropriate heating, ventilation, and air conditioning parameters for the decontamination area; processing of ophthalmic instruments and laryngoscopes; and precautions to take with instruments used in cases of suspected prion disease. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Performing preoperative skin antisepsis to remove soil and microorganisms at the surgical site may help prevent patients from developing a surgical site infection. The updated AORN "Guideline for preoperative skin antisepsis" addresses the topics of preoperative patient bathing and hair removal, selection and application of skin antiseptics, and safe handling, storage, and disposal of skin antiseptics. This article focuses on key points of the guideline to help perioperative personnel develop protocols for patient skin antisepsis. The key points include the need for the patient to take a preoperative bath or shower and the need for perioperative personnel to manage hair at the surgical site, select a safe and effective antiseptic for the individual patient, perform a safe preoperative surgical site prep, and appropriately store skin antiseptics. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.