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Surgery > part 2 > Flashcards

part 2 Flashcards

1
Q

Adult animals are generally fasted up to _ hours prior to surgery, to reduce the risk of __ or __ during or after surgery and development of ____.

A

12
regurgitation, vomiting
aspiration pneumonia

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2
Q

Surgical procedures involving the large intestine may require __ hours of fasting to allow emptying of the intestinal tract.

A

48

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3
Q

dogs are _____ just prior to surgery, to promote defecation and urination.

A

walked

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4
Q

If the animal cannot be walked, the bladder may need to be ______ before abdominal surgery.

A

expressed manually

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5
Q

Patients are placed in a variety of positions depending on the procedure to be performed. The most common position is _______.

A

dorsal recumbency

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6
Q

The bladder should be ____ and ____ if full prior to abdominal procedures

A

palpated, expressed

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7
Q

bladder expression should not be done in what type of patient?

A

-pyometra

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8
Q

Hair is usually removed from ____ cm on either side of the proposed incision site using clippers and a number 40 blade.

A

10-15

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9
Q

why is extra clipping is recommended beyond either end of the expected site?

A

permit extension of the incision without entering an unclipped area in case of emergency.

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10
Q

once hair is clipped, you should remove what from yourself? why?

A

Once the hair is clipped, you should remove (or replace) your lab coat prior to performing the remainder of the patient preparation since hair will likely have stuck on the lab coat and the loose lab coat sleeves might accidently drag on the surgical field during prepping.

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11
Q

Most protocols recommend to don _____ as well as a __ and ___ during clipping

A

non sterile exam gloves, hat, mask

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12
Q

steps for skin preparation

A

Step 1: Soap Scrub
STEP 2: Wipe Suds
Step 3: Alcohol
Step 4: Disinfectant
Sterile Draping
Final Skin Preparation (Performed After Scrubbing, Gowning and Gloving)

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13
Q

The goal of patient skin preparation is to:

A

reduce the transient bacterial flora on the skin surrounding the surgical incision site to decrease the risk of incisional infection.

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14
Q

Typical skin preparation includes a _____ followed by ____ and finally _____.

A

5 minute soap scrub
the application of alcohol
an alcohol based disinfectant such as chlorhexidine

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15
Q

When disinfecting a wound or a surgical site that is close to, or includes mucous membranes, ___ is not used and the disinfectant used is typically ___ instead.

A

alcohol, water (aqueous) based

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16
Q

what should you prepare for your patient skin prep? ie. what materials should you have ready?

A

In a kidney dish, place two chlorhexidine soaked scrub brushes in warm tap water. In another, place two piles of gauze sponges and thoroughly soak each one with isopropyl alcohol and with a chlorhexidine based tincture respectively in preparation for patient preparation.

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17
Q

A _____ is used in the first step of skin preparation. Commonly used soaps for preparing surgical patients contain ___ or _____ as the main antibacterial agent.

A

disinfectant soap
chlorhexidine
povidone-iodophors

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18
Q

at OVC, how many soap scrubs do we do as the first step in patient prep?

A

two consecutive, using two separate brushes soaked with tap water

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19
Q

during step one of patient prep, what is the role of the first sponge/brush?

A

A first brush is used to create a lather and remove superficial dirt and debris. Prior to discarding it, the first brush is also often used to wet and comb (this time using the bristle side of the brush) the hair adjacent to the field so it is oriented away from the surgical site.

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20
Q

after the first soap scrub, what do we do with the lather?

A

remove with paper towel or gauze

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21
Q

in the 1st step of patient skin prep: While still doning exam gloves, a second ______ soaked scrub brush is used to perform the second soap scrub.

A

water and chlorhexidine

22
Q

do you need to scrub the soap into the skin during patient prep?

A

As long as the soap is in contact with the skin, you do not need to physically scrub the skin for the entire time period if the skin is clear of debris as this may abrade the skin excessively

23
Q

after the soap scrub is complete, perform the circumferential preparation using _____ swabs (or ____ swabs if that is what your practice uses).

A

alcohol and tincture of chlorhexidine
(alcohol and tincture of iodine)

24
Q

the circumferential preparation (step 2) should be performed a minimum of ___ times for each solution

A

three

25
Q

after soap and alcohol, what do we prep the skin with? what do these products usually contain?

A

Disinfectant
-These products usually contain the same active agents as the soaps used for the surgical scrub (e.g. chlorhexidine), but are more concentrated and usually contain alcohol as a base

26
Q

when do we perform the final skin prep? who does so?

A

Following initial skin preparation and transport to the surgical suite, the gowned (and gloved) surgeon performs final skin preparation prior to applying the surgical drapes.

27
Q

how is the final skin prep performed?

A

A sterile gauze sponge is grasped using sterile sponge forceps. The sponge is then dipped in an antiseptic solution (iodine or chlorhexidine based tincture depending on the solution used for skin preparation) and the site is prepared using a concentric pattern

28
Q

disadvantage to commonly used drape materials

A

can allow easy passage of bacteria when wet

29
Q

The first drape is generally applied at the ___ edge of the proposed incision site.

A

cranial

30
Q

remember that the drape that is _____ is no longer sterile and should not come into contact with the surgical field.

A

below the surgeon’s waist

31
Q

Because the paw is generally difficult to clip, when the proposed incision is far enough from the paw, it is often left intact and the hair is covered with ____ to prevent gross contamination.

A

tape and elastic wrap

32
Q

Face masks actually do little to prevent ______ but are useful in blocking ______ which may be expelled when talking, coughing or sneezing.

A

-bacterial contamination caused by breathing
-droplets of moisture and other debris

33
Q

The purpose of the surgical hand scrub is to:

A

reduce the amount of bacteria that could possibly come in contact with the patient during surgery should a glove puncture occur.

34
Q

The soaps or detergents used for surgical scrubbing should be ______, ______, ______ and ideally have good residual activity to prevent a rapid rebound of microbial growth on the gloved skin.

A

-non-irritating to the skin
-fast acting
-have a broad spectrum of activity
-good residual activity

35
Q

most commonly used surgical hand scrubs (3)

A

Chlorhexidine gluconate, povidone-iodine, and hexachlorophene

36
Q

length of time to scrub hands

A

5-6 min

37
Q

why should we not scrub our hands for longer than 5-6 minutes?

A

this will result in damage to the cornified layer of the skin and subsequent release of bacteria. Studies have shown that bacterial cultures of the skin after 10 minute scrubs result in more positive cultures than after a normal 5-6 minute scrub.

38
Q

If scrubbing multiple times in the same day, a __ minute scrub is sufficient between consecutive cases.

A

3-5

39
Q

Be certain not to touch your hands or arms on any part of the sink or tap during the scrubbing procedure as this will require additional scrubbing time to that area (______) due to contamination

A

1 extra minute

40
Q

what are a newer alternative to hand scrubbing?

A

Alcohol-Based Hand Rubs

41
Q

Alcohol-Based Hand Rubs are proven to provide _____, to _____, to _____, and to _____

A

-rapid and wide spectrum antimicrobial activity
-decrease skin irritation
-improve compliance
-reduce the risk of hand contamination by rinsing water

42
Q

steps for cleaning hand with alcohol based rub

A

1) Wash hands with soap (not a soap scrub brush) and clean nails with the nail pick (under running water)
2) Dry hands completely (very important)
3) Apply the first dose into one palm
4) Soak opposite fingertips and rub into fingernails, then the palm and hand, and along the arm to just above the level of the elbow.
5) Repeat on the other hand (second dose)
6) Apply a third dose and spread over all areas of both hands and wrists
7) Continue to rub until dry (*do NOT use a towel)

43
Q

The gown wrist cuff should always be covered by gloves as it accumulates ___ and is considered ___ after gloving is performed.

A

moisture, unsterile

44
Q

when can closed gloving be performed?

A

only at the onset of surgery

45
Q

Various parts of the gown are considered unsterile such as:

A

-the wrist cuff, back, neck, shoulder and underarm areas.
-Also considered unsterile are any parts of a gown located below the waist or 2 inches above the elbow.

46
Q

how common are surgical glove punctures?

A

-occurs in over 10-18% of procedures

47
Q

in what type of procedures are glove punctures the most common?

A

orthopedic

48
Q

Open gloving is performed when ____ or when ____ and when _____.

A

-not wearing a gown
-replacing gloves intraoperatively
-a sterile assistant is unavailable to reglove you sterilely.

49
Q

in open gloving, when both gloves must be changed, it is best to open the glove pack on a:

A

separate table or sterile field to avoid contamination of the surgical instrument table.

50
Q

once we are gowned and gloved, where should we not put our hands, in relation to our bodies?

A

Gloved hands should not be elevated close to the neck line or shoulders or placed below the waist line and underarm area.

Surgery (8 decks)

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