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surgery 2 Flashcards

(48 cards)

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1
Q

when not to close a wound

A

superficial wounds
wounds open longer then 8 hours (exception is face, scalp, and neck)
grossly contaminated wounds

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2
Q

absorbable sutures

A

surgical gut
vicryl

mucosal areas and subcutaneous tissue (deep sutures)

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3
Q

non absorbable

A 
nylon
stainless steel
polyprolene
monofilament
braided

skin, ligament and tendon repairs

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4
Q

size of suture

A

larger the number the smaller the suture

4-0 foot, trunk, extremities
5-0 hand, scalp
6-0 face, ear, nose
7-0 eyelid

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5
Q

most common suture

A

simple interrupted

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6
Q

other options to close wounds

A

steri strips
glue
staples
butterfly bandages

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7
Q

scalp

A

6-8 days

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8
Q

face

A

4-5 days

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9
Q

chest/abdomen

A

8-10 days

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10
Q

back

A

10-14 days

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11
Q

arm/leg

A

8-10 days

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12
Q

hand

A

8-10 days

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13
Q

fingertip

A

8-12 days

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14
Q

foot

A

12-14 days

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15
Q

scip (surgical care improvement project) national goal

A

reduce preventable surgical morbidity and mortality 25% by 2010

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16
Q

surgical infxn prevention

A

glucose control in cardiac surgery pts (<200)
prophylactic abx (begin 1 hr before surgery and stop w/in 24 hrs of end of surgery)
proper hair removal
normothermia in colorectal surgical pts

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17
Q

prevention of ventilator associated pneumonia

A

ppl on ventilators need head of bed at 30 degrees

give these pts peptic ulcer prophylaxis

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18
Q

pulmonary risks

A

pneumonia
atelectasis
hypoventilation

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19
Q

physiology of respiratory during surgery

A

effects of surgery and opiods depress respiratory
vital capacity decresead 50-60%
functional residual capacity decreased 30%
chest and abdomen surgeries put you at higher risk of pulmonary complications

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20
Q

pulmonology risk factors

Study These Flashcards
A 
copd
>50
asthma (if NOT controlled)
smoking >20 pack year history
CHF
URI
albumin 30
21
Q

when to get pft

Study These Flashcards
A

Obtain for pts w/ COPD or asthma if clinically cannot determine if pt at their best baseline
Obtain for pts w/ dyspnea or exercise intolerance that remains unexplained

22
Q

how to reduce post op pulmonary comp

Study These Flashcards
A

copd:
bronchodilators, abx, systemic steroids
pts should receive daily ipratorium bromide (anticholinergic)
beta agonsit as needed

asthma:
well controlled w/ beta agonist and steroids if needed

uri:
delay elective surgery in presence of viral uri

23
Q

post op strategies to decreased pulmonary complications

Study These Flashcards
A

incentive spirometry
deep breathing strategies
adequate pain control so pt can ambulate early and makes it easier for pt to take deep breaths
use of NG tube has increased risk of pulmonary comp

24
Q

cardiac risks

Study These Flashcards
A

MI
CHF
HTN
increased mortality post op day 3

25
who is at risk for cardiac comp (major factors)
``` recent mi vascular heart disease decompensated heart failure unstable angina strongly positive stress test significant arrithmias (high grade av block, symptomatic ventricular arrhythmia, supra ventricular arrhythmia w/ uncontrolled rate ```
26
intermediate risk factors for cardiac
``` Mild Angina Previous MI by history or by Q-waves Compensated or prior CHF Diabetes Renal Insufficiency (Creat>2.0) ```
27
endocrine risk
thyroid storm adrenal insufficiency diabetic complication
28
dvt medical prophylaxis
low dose unfractioned heparin: 5000 Units SQ q8 or q12 hrs First dose pre-op or post-op low molecular weight heparin(lovenox)
29
post op fever immediate diff (during operation to a few hours after)
fever due to surgery (release of cytokines stimulate fever; fever >38 degrees common in first couple days after surgery) rxn to blood products or med malignant hyperthermia
30
post op fever acute (within 1st week0
``` Nosocomial infections Community acquired infections Surgical site infection Intravascular catheters Pneumonia UTI ```
31
post op fever sub acute 1st week to 4th week
``` Surgical site infection Central venous catheter related infections Thrombophlebitis Antibiotic associated diarrhea Drug Fever Deep Vein Thrombophlebitis Pulmonary Embolism ```
32
post op fever delayed (>1month)
wound infection | infection from blood products
33
orthopedic procedures post op fever diff
DVT/thrombophlebitis surgical site infxn hematoma
34
5 w's
``` wind water wound walking wonder drugs/whopper ```
35
wind
usually the cause of fever in first 24-48 hrs post op atelectasis pneumonia embolism (pe) Physical exam: bronchial breathing, deviated trachea, sob, etc
36
water
usually in 48-72 hours post op UTI usually due to indwelling urinary catheters or GU instruments physical exam: cloudy urine, positive urine cultures, dysuria, frequency, or urgency
37
wound
usually after 72 hrs (most common cause of fever after 72 hrs) Staph Aureua is most common cause physical exam: mild change in vital signs is seen early, and pain may or may not be present at site of infxn, look for drainage and erythema, swelling, and warmth
38
walking
after 72 hrs thrombophlebitis (usually associated w/ intravascular catheters. physical exam: superficial- purulent drainage around catheter w/ induration of the vein deep- can be associated w/ indwelling central lines or dot exam could show humans sign, unilateral edema is more specific of dvt
39
wonder drugs
anesthetics, sulfa containing abc, and others usually a diagnosis of exclusion persistent fever w/ negative cultures should raise suspicion of this
40
whopper
presence of postoperative abscess | intra abdominal abscesses may present w/ blood cultures that are polymicrobial
41
what to tx fever w/
tylenol
42
prevention of wound infxn
cefazolin 1-2 mg IV 60 min before surgery for bowl procedures cefoxitin or ampicilin/sulbactam vanco if pcn allergic
43
wound healing
initial inflammatory response (days) epithelialization (days) fibroplasia (weeks) maturation (weeks - months)
44
dehisence
wound bursting open
45
evisceration
a total separation of all wound layers and protrusion of internal organs through the open wound
46
hematoma
collection of blood in the wound
47
seroma
collection of fluid in the wound other then pus or blood
48
gangrene
complication of necrosis (cell death) characterized by decay of body tissues rick factors smoking, diabetes, decrease blood supply

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