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Surgical Patient > Intra-op Paient > Flashcards

Intra-op Paient Flashcards

(58 cards)

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0
Q

Transient bacteria

A

Limited to exposed skin and easily removed by mechanical cleansing “hand washing”

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1
Q

Preparation of the surgical site:

A

Remove dirt, reduce resident microbes, prevent regrowth of bacteria, after special cleansing, hair removed from the site

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2
Q

Resident bacteria

A

Inhabit deep structure of dermis, sweat glands, hair follicles “surgical scrub”

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3
Q

Time between pre-op shave and sx has direct effect on:

A

Wound infection rates

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4
Q

Anti microbial agents:

A

“Soaps” emulsify and peptize skin bacteria and oils on skin surface to allow them to be rinsed away with running water

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5
Q

Blood loss and hemostasis:

A

Control of bleeding to prevent hemorrhage, allow visualization of sx field, and promote wound healing ( natural, artificial, or chemical)

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6
Q

Natural hemostasis:

A

Normal defense mechanism o fibrinogen, PT+factor V= thrombin, fibrinogen= fibrin, platelets (not as effective in large wounds)

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7
Q

Artificial hemostasis:

A

Control bloodflow/blood loss, instruments, manual pressure, cautery(heat), bone wax, ligating clips, tourniquets

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8
Q

Chemical hemostasis:

A

Thrombostat, electro cautery, and gel foam

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9
Q

Bone wax

A

Refined beeswax used to control marrow oozing (neuro and ortho)

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10
Q

Thrombostat

A

Enzyme extracted from beef blood accelerates clotting

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11
Q

Gelfoam

A

Gelatin sponge dipped in epinephrine or thrombostat placed on bleeding area, absorbed by the body

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12
Q

Sutures

A

Approximates tissue edges, absorbable and non-absorbable

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13
Q

Absorbable sutures

A

Natural/material digested or hydrolyzed by tissue in 7-10 days ex: collagen, vicril, ethilon

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14
Q

Non-absorbable sutures:

A

Must be removed before healing complete ex: metal, nylon, polyester

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15
Q

Staples

A

Uniform tension, faster to apply than sutures, must be removed <1 week.

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16
Q

Retention sutures:

A

Secondary sutures, large rubber encased wire sutures. Used in areas with increased pressure on incision, patients at high risk of dehiscence. (abd sx in obese)

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17
Q

Adhesive skin closure:

A

Steri-strips used on small wounds that need minimal tension. Fall off <10 days, not removed

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18
Q

Incision glue:

A

Liquid forms barrier over wound

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19
Q

When removing staples and sutures, remove every other one because:

A

Make sure the incision would not dehiscence then remove the rest

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20
Q

Surgical dressing - three layers

A

1: contact or primary drsg
2: absorbent layer
3: outer layer

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21
Q

Contact or primary dressing

A

Touches incision, skin, drainage, blood ex: 4x4 gauze and telfa

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22
Q

Absorbent layer

A

Reservoir for secretions. Wick-like action draws secretions away from wound ex: abd pad

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23
Q

Outer layer

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A

Keeps organisms out of wound ex: tape covering all material to prevent break in drsg

24
Drains provide exit for:
Serum, blood, and body secretions, unexpected bile, intestinal or vascular leaks ex: hemovac, JP/Blake, penrose, t-tube, gauze wick (Iodoform), chest tube
25
Anesthesia
Induced state of partial or total loss of sensation with or without loss of consciousness. (Blocks nerve impulse, suppresses reflexes, promotes muscle relaxation/paralysis, controlled level of consciousness)
26
General anesthesia
Total loss of all sensation an consciousness and protective reflexes, IV or inh, adv: easily regulated, adj to sx, age, physical status, dis: depression, fear, anxiety, long term effects, risk of death. Stages1-4
27
Stages of general anesthesia:
1: analgesia, relaxation, sedation 2: excitement, delirium, loss of consciousness 3: operative anesthesia, all sensation lost, *where sx occurs 4: danger
28
Regional anesthesia:
Interruption if nerve impulses to specify area of body, involves central nerve(sc) or group of nerves (plexus), always inj, adv: pain relief, safe, non-invasive. Dis: long term damages, patient still awake, difficult to hit right spot.
29
Types of regional anesthesia:
Topical, local, spinal, epidural
30
MAC-monitored anesthetic care or conscious sedation
Minimal depression of consciousness, airway maintained, quick emergence
31
Three phases of anesthesia:
Induction, maintenance, and emergence
32
Induction
Adm of agents
33
Maintenance
Maintain loss of consciousness during surgical procedure
34
Emergence
Awakening or "coming out", violent emergence-come out aggressively
35
Anesthesia preoperatviely
Patient assessed and pertinent info gathered by anesthesiologist
36
Intraoperatively
Induction/maintenance of anesthesia awake/sedation, unconscious, intubation
37
Postoperatively
Emergence in PACU, waking up, amnesia, HA, n/v, pain, complications
38
Complication of general anesthesia
Overdose, hypoventilation, intubation complications, aspiration, larygno/broncho spasms, sore throat, hoarseness, allergic reaction, hypotension
39
Complications of regional anesthesia
Nerve damage/ hematoma at injection site/spinal headache
40
Complication of local anesthesia
Safe with rare complications
41
Malignant hyperthermia
Genetic reaction to general anesthesia (altered control of Ca level in muscles = hypermetabolism of skeletal muscles > muscle contracture > acidosis, rapid rise in temperature (late sign), tachycardia/dysrythmia, muscle rigidity, hypotension/kidney failure, important to know family hx of anesthesia, can be reversed if recognized and treated (dantrene), can occur <24 hrs post op,
42
Gerontological considerations for anesthesia
Titrate for elderly, monitor closely, age affects anesthesia, blood loss, fluid loss, replacement, hypothermia, skin integrity, and pain
43
Teaching
Anxiety, anesthesia, advantages, disadvantages, what to expect/ what will happen, treatment of symptoms, therapeutic communication, answer all questions
44
Open wound
Break in skin or mm, ex: incisions, venipuncture, gunshot wound
45
Closed wound
No break in skin, ex: fracture, tear of visceral organ, ruptured spleen, lacerated liver
46
Intentional wound
Result from therapy, ex: sx incision, introduction of needle into body part
47
Unintentional wound
Occurs unexpectedly, ex: traumatic injury
48
Penetrating wound
Break in epidural skin layer, as well as dermis and deeper, ex: foreign object or instrument entering deep into the body tissue; gunshot, stab wound
49
Perforating wound
Foreign object enters and exists an internal organ, ex: perfed bowel
50
Clean wound
Closed surgical wound that did not enter GI, resp, or GU tract; low risk of infection
51
Clean/contaminated wound
Wound entering GI, resp, GU systems, risk of infection; ex: thoroectomy, colonectomy
52
Contaminated wound
Open, traumatic, surgical wound with break in asepsis, sx or accidental; high risk of infection
53
Infected wound
Wound site with pathogens present and signs of infection; infected
54
Clean wound
Closed surgical wound that did not enter GI, resp, or GU tract; low risk of infection
55
Clean/contaminated wound
Wound entering GI, resp, GU systems, risk of infection; ex: thoroectomy, colonectomy
56
Contaminated wound
Open, traumatic, surgical wound with break in asepsis, sx or accidental; high risk of infection
57
Infected wound
Wound site with pathogens present and signs of infection; infected

Surgical Patient (5 decks)

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