Intra-op Paient Flashcards Preview

Surgical Patient > Intra-op Paient > Flashcards

Flashcards in Intra-op Paient Deck (58)
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0
Q

Transient bacteria

A

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

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

2
Q

Resident bacteria

A

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

3
Q

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

A

Wound infection rates

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

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)

6
Q

Natural hemostasis:

A

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

7
Q

Artificial hemostasis:

A

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

8
Q

Chemical hemostasis:

A

Thrombostat, electro cautery, and gel foam

9
Q

Bone wax

A

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

10
Q

Thrombostat

A

Enzyme extracted from beef blood accelerates clotting

11
Q

Gelfoam

A

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

12
Q

Sutures

A

Approximates tissue edges, absorbable and non-absorbable

13
Q

Absorbable sutures

A

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

14
Q

Non-absorbable sutures:

A

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

15
Q

Staples

A

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

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)

17
Q

Adhesive skin closure:

A

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

18
Q

Incision glue:

A

Liquid forms barrier over wound

19
Q

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

A

Make sure the incision would not dehiscence then remove the rest

20
Q

Surgical dressing - three layers

A

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

21
Q

Contact or primary dressing

A

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

22
Q

Absorbent layer

A

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

23
Q

Outer layer

A

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

24
Q

Drains provide exit for:

A

Serum, blood, and body secretions, unexpected bile, intestinal or vascular leaks ex: hemovac, JP/Blake, penrose, t-tube, gauze wick (Iodoform), chest tube

25
Q

Anesthesia

A

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
Q

General anesthesia

A

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
Q

Stages of general anesthesia:

A

1: analgesia, relaxation, sedation
2: excitement, delirium, loss of consciousness
3: operative anesthesia, all sensation lost, *where sx occurs
4: danger

28
Q

Regional anesthesia:

A

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
Q

Types of regional anesthesia:

A

Topical, local, spinal, epidural

30
Q

MAC-monitored anesthetic care or conscious sedation

A

Minimal depression of consciousness, airway maintained, quick emergence

31
Q

Three phases of anesthesia:

A

Induction, maintenance, and emergence

32
Q

Induction

A

Adm of agents

33
Q

Maintenance

A

Maintain loss of consciousness during surgical procedure

34
Q

Emergence

A

Awakening or “coming out”, violent emergence-come out aggressively

35
Q

Anesthesia preoperatviely

A

Patient assessed and pertinent info gathered by anesthesiologist

36
Q

Intraoperatively

A

Induction/maintenance of anesthesia awake/sedation, unconscious, intubation

37
Q

Postoperatively

A

Emergence in PACU, waking up, amnesia, HA, n/v, pain, complications

38
Q

Complication of general anesthesia

A

Overdose, hypoventilation, intubation complications, aspiration, larygno/broncho spasms, sore throat, hoarseness, allergic reaction, hypotension

39
Q

Complications of regional anesthesia

A

Nerve damage/ hematoma at injection site/spinal headache

40
Q

Complication of local anesthesia

A

Safe with rare complications

41
Q

Malignant hyperthermia

A

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
Q

Gerontological considerations for anesthesia

A

Titrate for elderly, monitor closely, age affects anesthesia, blood loss, fluid loss, replacement, hypothermia, skin integrity, and pain

43
Q

Teaching

A

Anxiety, anesthesia, advantages, disadvantages, what to expect/ what will happen, treatment of symptoms, therapeutic communication, answer all questions

44
Q

Open wound

A

Break in skin or mm, ex: incisions, venipuncture, gunshot wound

45
Q

Closed wound

A

No break in skin, ex: fracture, tear of visceral organ, ruptured spleen, lacerated liver

46
Q

Intentional wound

A

Result from therapy, ex: sx incision, introduction of needle into body part

47
Q

Unintentional wound

A

Occurs unexpectedly, ex: traumatic injury

48
Q

Penetrating wound

A

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
Q

Perforating wound

A

Foreign object enters and exists an internal organ, ex: perfed bowel

50
Q

Clean wound

A

Closed surgical wound that did not enter GI, resp, or GU tract; low risk of infection

51
Q

Clean/contaminated wound

A

Wound entering GI, resp, GU systems, risk of infection; ex: thoroectomy, colonectomy

52
Q

Contaminated wound

A

Open, traumatic, surgical wound with break in asepsis, sx or accidental; high risk of infection

53
Q

Infected wound

A

Wound site with pathogens present and signs of infection; infected

54
Q

Clean wound

A

Closed surgical wound that did not enter GI, resp, or GU tract; low risk of infection

55
Q

Clean/contaminated wound

A

Wound entering GI, resp, GU systems, risk of infection; ex: thoroectomy, colonectomy

56
Q

Contaminated wound

A

Open, traumatic, surgical wound with break in asepsis, sx or accidental; high risk of infection

57
Q

Infected wound

A

Wound site with pathogens present and signs of infection; infected