Quiz 1 Flashcards
(142 cards)
1
Q
What is affirmative duty?
A
Providers have to volunteer all information up front and not just in response to questions from the patient
2
Q
What is negligence?
A
Failure to disclose sufficient information about risks or complications of treatment
3
Q
What are the essential components for a patient to make an informed decision?
A
- Patient must have capacity or competence to make informed decision
- Patient must be given sufficient information about the procedure
- Patient must consent to treatment voluntarily
4
Q
What is competency?
A
Ability to understand
Every adult is competent until it is declared that they are not
5
Q
What is a fiduciary relationship?
A
One party has more knowledge/power and thus it is their responsibility to share that information with the other party
6
Q
What are the four parts to adequate information?
A
- Diagnosis
- Nature of proposed procedure, risks, consequences, and benefits
- Assessment of likelihood that procedure will accomplish desired outcome
- Alternatives to treatment
7
Q
What is the PARQ acronym for adequate information?
A
Procedure
Alternatives
Risks
Questions
8
Q
What is subjective standard?
A
What would this patient need to know to make an informed decision?
9
Q
What are the different types of informed consent?
A
Implied
General
Special
10
Q
When is implied consent used?
A
When immediate action is required
Inaction can cause greater injury
Emergency room
11
Q
When is general consent used?
A
Upon hospital admission
Gives consent for routine procedures and touching by staff
12
Q
What is special consent?
A
Required for high-risk procedures and treatments
13
Q
Can verbal consent be given?
A
Yes
It should be documented in the medical record though
14
Q
Is written consent the same as informed consent?
A
No
Must ensure that the patient has received information fully and comprehends it
15
Q
What are the exceptions to informed consent?
A
Emergencies Patient is unable to consent Patient wavier of consent Public health requirements Therapeutic priveliege
16
Q
What are standard precautions?
A
Set of guidelines designed to minimize the spread of infectious diseases
17
Q
What should be used to clean your hands for routine use?
A
Plain non-antimicrobial soap
18
Q
How is reusable equipment cleaned?
A
Autoclave
19
Q
What are safety techniques for needles?
A
Do not manipulate with two hands
Never recap used needles
Recap using one hand scoop
Never point need directly at any part of the body
20
Q
What patients need isolation?
A
Vancomycin resistant enterococci MRSA TB Avian flu C. diff
21
Q
What are the benefits to wound closure?
A
Decrease time required to heal Reduce likelihood of infection Decrease amount of scar tissue Repair loss of structure or function Better cosmetic appearance
22
Q
What are the contraindications to wound closure?
A
Risk of infection and disruption of underlying structures
High likelihood of contamination
Presence of foreign bodies
Extensive wound injuries
23
Q
What are the lines called that you want to make incisions parallel to?
A
Langer’s lines
24
Q
What are the different wound classifications?
A
Clean
Clean-contaminated
Contaminated
Infected
25
What are the three methods of wound healing?
Primary intention
Secondary intention
Tertiary intention
26
What is primary intention wound healing?
All layers are closed
27
What is secondary intention wound healing?
Superficial layer is left open
| Normally due to infection
28
What is tertiary intention wound healing?
Similar to secondary but the wound is re-evaluated in 4-5 days and if clean it is closed
29
What wounds are tetanus prone?
Older than 6 hours and deeper than 1 cm
Puncture or crush injury
Burn or frostbite
30
When should patients get a tetanus shot?
5 years for tetanus prone
| 10 years for non-tetanus prone
31
What develops due to uneven closing?
Dog ear
| 45 degree laceration is made on longer side to fix
32
What is a vertical mattress suture used for?
Closing deeper wounds and high tensile area
| Gapping wounds
33
What is a horizontal mattress suture used for?
Flap of skin or tension on only one side
34
What are the benefits of multufiliment suture fiber?
Graded
Stronger
Greater tensile strength
35
What are the benefits of monofilament suture fiber?
Less likely to hold bacteria
| Easier to remove
36
What are the absorbable suture materials?
Natural: plain or chromic
Synthetic: Polyglactin (Vicryl), Polyglycolic (Dexon), Polydioxanone (PDS), and Polyglecaprone (monocryl)
37
What are the non-absorbable suture materials?
Natural: silk
Synthetic: nylon, stainless steel, Polyester, and Polypropylene
38
```
What size suture should be used in the following locations?
Scalp
Face
Trunk
Limbs
Hand/feet
Soles
```
```
Scalp: 4 - 5
Face: 5 - 6
Trunk: 2 - 4
Limbs: 3 - 5
Hand/feet: 4 - 5
Soles: 2 - 4
```
39
What are contraindications to a site for venipuncture?
```
Skin infection
Arm with fistula
Extensive scarring
Ipsilateral side of mastectomy
Hematoma
Arm with IV line
```
40
What are the exceptions for doing a venipuncture on an arm with an IV?
Distal to IV
IV turned off for at least 2 mins
Use different vein
Discard first 5 mL
41
What is the most common complication of venipuncture?
Hematoma
42
How can a hematoma be prevented after a venipuncture?
Insert needle at 15-30 degrees
Slower needle insertion
Smaller gauge needle
Maintain pressure for 10 mins
43
What are the three main types of blood cells?
Red cells - erythrocytes
White cells - leukocytes
Platelets - thrombocytes
44
What vein is most commonly used for venipuncture?
Median cubital vein
Cephalic
Basilic - close to artery and nerve
45
What are some strategies for if a vein is difficult to find?
Warm towel
Arm below level of heart
Us BP cuff as a tourniquet
Carefully rub and tap vein
46
What are the 7 "rights" when giving a parenteral medication?
```
Right drug
Right patient
Right dose
Right route
Right time
Right site
Right documentation
```
47
What are some ways to diminish injection pain?
```
Relax muscles
Avoid extra-sensitive area
Wait until antiseptic is dry
Use new needle
Insert rapidly
Massage muscle after
Use ice or topical spray
```
48
What are intradermal injections good for?
Allergy testing
| Little systemic absorption
49
What are disadvantages of intradermal injections?
Only small amounts can be given at a time
| Require aseptic technique
50
What are advantages of subQ injections?
Faster onset than oral route
51
What are the disadvantages of subQ injections?
```
Aseptic technique
Small amounts
Painful
More expensive than oral
Anxiety
Irritate tissue
```
52
What locations can subQ injections be given?
```
Outer aspects of upper arm
Anterior thigh
Upper butt
Upper back
Lower abdomen
```
53
What locations can intramuscular injections be given?
Deltoid
Dorsogluteal
Ventrogluteal
Vastus lateralis
54
What are the advantages to IM drugs?
Minimize pain from irritating drugs
Larger volumes
Rapidly absorbed
55
What are the disadvantages of IM drugs?
Aseptic technique
Possibility of vessel/nerve damage
Anxiety
56
How is needle length determined for IM injections?
Size and weight of patient
57
How is gauge of needle determined?
Depends on viscosity of fluid
58
What size and gauge needles do SQ injections require?
IM?
Intradermal?
SQ: 25 - 29 g and 0.5 to 5/8 in. 45 degrees
IM: 18 - 22 g and 1.5 in. 90 degrees
ID: 25 - 27 g and .5 to 5/8 in. 15 degrees
59
What is the difference between the venous and atrial system looking at gasses?
Gas concentration is equal throughout the entire arterial system
Most accurate assessment of ventilation and oxygenation
60
What are contraindications for an arterial puncture?
```
Pulse not palpable
Negative allen test
Landmarks not visible
Arterial disease
AV shunt
Infection, rash, or burn
```
61
What are the most common sites for an arterial puncture?
Radial artery - MC
Brachial - 2nd
Femoral - 3rd
62
What are the signs of infection?
Fever/chills
Change in mental status
Low BP
Elevated WBC
63
What are the contraindications to a blood culture?
No true contraindications
- patient taking Coumadin
- active skin infection
64
What are signs that you should suspect contamination?
Common skin flora obtained
Several kinds of bacteria
Growth in only one tube
65
What should you use during an arterial puncture if the patient is allergic to iodine?
Chlorhexidine or 70% isopropyl alcohol
66
What are the indications to input an IV?
Administration of fluids
Rapid medication delivery
Administration of blood
67
What are the contraindications for IV?
Avoid site of active skin infection
Do not insert distal to thrombophlebitis
Avoid lower extremities in elderly
68
What determines what vein you use in an IV?
Duration of therapy
Condition of extremity
Condition of patient
Condition of vein
69
What is the most common complication of an IV?
Phlebitis
70
How long does it take for topical anesthesia to begin working?
about 20 - 30 mins
71
What are some indications for local anesthesia?
```
Minor surgical procedures
Laceration repair
Incision and drainage
Removal of lesions
Biopsies
Nail removal
```
72
What is the MOA for local anasthetics?
Binding to voltage gated sodium channels
73
What are the ester anesthetics?
Benzocaine
Cocaine
Procaine
Tetracaine
74
What are the amide anesthetics?
```
Lidocaine
Mepivacaine
Bupivacaine
Dibucaine
Prilocaine
All have an i somewhere before the caine
```
75
How does myelination affect anesthesia?
Myelinated fibers have slower onset but longer duration (pressure, touch, and motor)
Unmyelinated fibers are more easily blocked (pain and temp)
76
What are some factors that influence the effects of anesthesia?
Conduction rate of sodium channels
Myelination
Nerve diameter
Vascularity
77
What areas need to be cautioned with epinephrine use due to tissue necrosis?
```
Pinna of the ear
Fingers
Toes
Penis
Nose
```
78
What are the contraindications for topical anesthesia with cocaine?
Avoid in infants and neonates
| Avoid on fingers, toes, penis, ear, and nose
79
What are the contraindications for local anesthetics?
```
Unstable blood pressure
Allergies
Liver disease: amides
Renal disease: esters
Mental instability
```
80
What are the absolute contraindications for epinephrine?
Untreated hyperthyroidism or pheochromocytoma
| Single vessel blood supply
81
What are the relative contraindications for epi?
```
HTN
CAD or PVD
Prego
Narrow angle glaucoma
Beta blockers
```
82
What are potential complications of anesthesia?
```
Bruising
Edema
Infection
Nerve damage
Nerve paralysis
Bradycardia
Hypotension
CNS depression
```
83
What are the four symptoms of a true allergy?
Skin rash
Urticaria
Angioedema
Anaphylaxis
84
What size needle should be used for injecting anesthesia into a wound?
27 - 30 gauge
1 - 3 ml syringe
0.5 - 1.25 inch needle
Insert between dermis and subQ fat
85
What are the three digital block agents?
1% Lidocaine
Mepivacaine
2% Lidocaine
0.1 ml injection, move to bone 0.5 ml......
86
What are the indications for catheterization?
```
Obtain sterile samples
Monitor urinary output
Facilitate urinary drainage
Bypass obstructive processes
Act as traction device to control bleeding after prostate surgery
```
87
What are the contraindications for catheterization?
Blood at urethral meatus in patient with pelvic trauma
| Allergy
88
What are the most common causes of complications for male catheter patients?
Improper lubrication
| Excessive force
89
What is the distance from bladder to urethral meatus?
Female - 1.5 - 2 inches
| Male - 6 - 7 inches
90
What is a coude catheter used for?
Has bend at distal tip that allows the catheter to follow anterior surface of male urethra
For males that have issues getting past prostate
91
What is the purpose of a foley catheter?
Designed to inflate and remain in place
| A 5 ml type takes 10 ml of water to inflate
92
What is the Charriere French Scale for catheter sizing?
1 mm = 3 French
93
What size catheters should be given to peds?
Men?
Women?
Post op?
Peds - 5 - 12 French
Men - 16 - 18
Women - 16 - 18
Post op - 20 - 30
94
What are short term complications of catheters?
Irritation
| Infection
95
What are long term complications of catheters?
Trauma
| Infection
96
What are the signs of infection?
AMS
Fever
Change in urine appearance
97
What does an arterial bleed look like?
Bright red blood
Pulsating
Pressurized
98
What does a venous bleed look like?
Darker red blood
Low pressure
Non-pulsatile
99
What is a secondary hemorrhage?
Occurs 7 -10 days post op
| Usually occurs from infection
100
What are the indications for topical hemostats?
Capillary oozing
Hard to reach areas
Oozing from suture lines
CSF leaks
101
What are the factors that affect wound healing?
```
Age
Weight
Nutrition
Proper hydration
Chronic illness
Smoking
```
102
What is wound strength at two weeks
One month?
10 weeks?
Two weeks: 10 %
One month: 40%
10 weeks: 80%
103
Where are foreign bodies most commonly located in the nose?
Below the inferior turbinate or anterior to the middle turbinate
104
What are the different techniques for a foreign body of the nose removal?
```
Direct instrumentation
Positive pressure
Balloon catheter
Glue
Suction
```
105
How does most epistaxis occur?
Anterior from mechanical trauma (90%)
Most located in Kiesselbach plexus
Posterior (10%)
106
What are some drugs that predispose to epistaxis?
Aspirin
NSAIDs
Warfarin
Heparin
107
When should you suspect a posterior epistaxis bleed?
Fail to visualize an anterior source
Hemorrhage from both nares
Visualization of blood draining in the posterior pharynx
108
How long should you maintain pressure for treatment of epistaxis?
15 mins
109
Why is only one side of the septum cauterized at a time?
Avoid septal necrosis or perforation
110
How should a rapid rhino be inserted?
Soak outer layer with water
Insert along the floor of the nasal cavity
Inflate slowly with air until bleeding stops
Go backwards, not up
111
What population is cerumen impaction common in?
Elderly and handicapped patients
112
What are the causes of cerumen impaction?
Cerumen overproduction
| Physical barriers to natural wax extrusion
113
What are the initial signs of a cholesteatoma?
Drainage from the ear canal and hearing loss
114
What are the contraindications to cleaning out a cerumen impaction?
TM perforation
Previous pain on irrigation
Surgery to middle ear
Uncooperative patient
115
When should a cerumen impaction be treated?
Difficulty examining the TM
Wax occlusion of the external ear canal
Pain or hearing loss
Patient request
116
What are the different techniques for cerumen impaction?
Direct instrumentation
Lavage
Cerumenolytics
Suction
117
How is a lavage performed for cerumen impaction?
Use warm water
| Aim jet of water toward superoposterior ear canal (don't hit TM)
118
What are the complications of cerumen impaction removal?
```
Vertigo
Bleeding
Discomfort
Hearing loss
Ossicle damage
Tinnitus
Push wax deeper into canal
```
119
What is the first step of treatment if a live insect is found in an ear?
Mineral oil or lidocaine (2%)
| Then irrigation
120
What are contraindications to eye exam?
Ruptured globe
| Eyelid laceration
121
What should be done when a ruptured globe is suspected?
Cover both eyes with fox shield or other dressing
Immediate referral to ophthalmologist
Suspected from high velocity injury
122
What is the exception for a eyelid laceration that doesn't need referral?
Superficial horizontal laceration
123
What needs to be done in the incidence of a splash exposure?
```
Flush immediately (Morgan Lens)
5 mins for mild
20 for most
60 for penetrating corrosives
Check pH and continue until pH is normal
```
124
What are complications to an eye exam looking for a foreign body?
Increased pain
N/V
Photophobia
125
What antibiotic can be used topically for eye injuries?
Erythromycin
126
What anesthetic can be used topically for eye injuries?
Proparacaine 0.5%
127
What are the techniques for removing a foreign body from the eye?
Flush
Moistened cotton swab
Small gauge needle (25 gauge)
Corneal spud
128
If right handed where should your hand be placed when removing an object from the left eye? Right eye?
Left eye: left maxillary bone
Right eye: bridge of nose
Approach from side and inferiorly
129
What is a Seidel's sign?
oozing aqueous humor from an abrasion during a fluorescein exam
130
What are the four main goals of follow up for eye foreign body removal?
Pain control
Reduce secondary infection
Promote corneal epithelization
Risk avoidance to reduce reoccurence
131
What are the different pain control methods for eye FB removal post op?
Topical anesthetics - slow healing
Opioid - help sleep
NSAID - don't slow healing
132
What are the antibiotics that can be used to reduce chance of secondary infection after FB removal from the eye?
Ointments (bacitracin or Cipro). Functions as lubricant too
| Solutions (sulfacetamide or ofloxacin). Easier to apply
133
What is a central line?
Venous catheter placed in the jugular, subclavian, or femoral vein
134
What is a PICC line?
Peripherally Inserted Central Catheter
135
Where is a PICC line most commonly inserted?
Basilic vein
| Has fewer complications vs central line
136
What is an implanted port?
Common in chemotherapy
Surgically placed catheter that is connected to vein
Remains in place for long periods of time
137
What are the indications for a central line?
```
Routine venous access
Hemodialysis
Infusion
Administration of medications
Routine venous access (if normal veins are difficult to get to)
Central venous pressure
Rapid fluid resuscitation
```
138
Where are central lines normally placed?
Subclavian (first)
Internal jugular (more risk)
Femoral (higher infection)
139
What are general contraindications for central lines?
```
Distorted local anatomy
Extremes of weight
Vasculitis
Bleeding disorders
Anticoagulation therapy
Combative patient
Infection
```
140
What are contraindications for a subclavian central line?
Chest wall deformities
Pneumothorax on contralateral side
COPD
141
What are contraindications for jugular central line? Femoral?
Jugular: IV drug use at this site
Femoral: Patient needs to be mobile
142
What is the Seldinger technique?
```
Way to insert PICC line
Insert needle into vessel
Insert J-wire into needle and advance to vessel
Remove needle and wire cover
Advance dilator
Advance catheter over guide wire into vessel
Remove guide wire
Secure catheter with sutures
```
