Hw/Wkbk
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| Breast biopsy frozen secion indicates cancer | Wound Classification
I
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| Laparoscopic cholecystectomy, gallbladder removed with endobag | Wound Classification
II
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| Cystoscopy with retrograde pyelogram (RPG); no stones found | Wound Classification
II
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| Scheduled bowel resection; scrub observes bloody hole in glove; regloved | Wound Classification
III
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| Emergency bowel resection; Feces noted during anastomosis | Wound Classification
IV
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| Laparoscopic assisted vaginal hysterectomy; purulent left ovary | Wound Classification
IV
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| Hernia repair; mesh utilized | Wound Classification
I
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| Open reduction internal fixation (ORIF) open fracture | Wound Classification
III
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| Incision & drainage of groin. STAT gram stains indicates gram-negative rods. | Wound Classification
IV
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| Gunshot wound to abdomen; bowel resection & liver laceration repaired | Wound Classification
III
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| Released from the damage cells to cause the inflammatory response | Histamine
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| Normal wound healing occurs | side to side
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| Five signs of the inflammatory response | pain
heat
redness
swelling
loss of function
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| 3 phases of normal (primary intention) wound healing | phase 1: Lag; inflammatory; last 3-5days
phase 2: proliferation; up to day 20
phase 3: maturation/remodeling; up to 12 mos.
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| Granulation tissue occurs from inside-out and bottom-upward | 2nd intention
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| Incision opened under ideal conditions; minimal scar | 1st intention
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| Delayed closure | 3rd intention
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| Produces a weak union with a wide irregular scar | 2nd intention
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| Wound debrided then closed 4-6 days later to heal | 3rd intention
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| Used for dirty wounds, produces intermediate scar/TS | 3rd intention
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| Incision made with rapid wound healing to 70%-80% original streangth | 1st intention
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| Routine negative breast biopsy closure (mammogram) | 1st intention
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| Which type of healing is most likely used for debucutis ulcer | 3rd intention
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| Which type of healing is most likely to be used initially for a ruptured appendix | 1st intention
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| Describe the appropriate tissue handling techniques that should be utilized during any case | -length & direction of incision -dissection technique -duration of surgery -elimination of dead space -amount of tissue handling -achievement of hemostasis -precise tissue approximation -suture wound closure
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| Five causes of wound dehiscence | 1.friable tissue
2.abdominal distention
3.too much tention on the wound
4.inappropriate type/strength of suture material
5.improper suturing technique
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| difference between dihiscence and eviseceration | dehiscence is partial or total separation of wound
evisceration is total separation & protrusion of viscral organs
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| most likely to be a factor in the cause of dehiscence | vertical incisions
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| Measures the STSR can take to prevent wound infections | -use scrupulous sterile technique
-close dead space
-handle tissue carefully
-remove gross material
-respond proactively to propable intective agents
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| Measures the STSR can take to prevent wound dehiscence | -avoid long paramedian incision
-provide careful, adequate closure
-retention suture on intra-abdominal pressure
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| when cutting suture for the surgeon on a monofilament suture for skin closure with a "tag", you would typically cut the suture approx. _________from the knot | 1/4 ends
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| when cutting suture for the surgeon on a multifilament suture inside the wound with a "tag", you would typically cut the suture approx. _________from the knot | 1/8 ends
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| large vessels are typiclly occluded with suture ligatures or ____________ to prevent hemorrhage | stick-tie
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| the most common sizes of suture ligatures are ______ and ______ and are made of _______ suture material | 2-0
3-0
silk
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| when passing ligature reels, check the size by the number of holes on the side of the reel & always pull the strand approx. ____ inch away from the reel | 1
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| the needle should be clamped approx. ___ of the distance from the swaged end of the needle. if tough tissue is anticipated, the needle should be clamped at the ___ mark of the needle | 1/3
1/2
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| Always wet ______ sutures prior to passing to the surgeons | cotton
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| If a muscle has been transversly incised and must be approximated, you would be prepared to supply the surgeon with an _______ suture | absorbable
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| the skin is usually closed with an interrupted or continuous _________,_________ suture on a ______cutting needle | monofilament
nonabsorbable
cutting
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| the preferred method of skin closure is _______ suture line to prevent bacteria and tissue from traveling the length of the wound | interrupted
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| skin closure tapes | reinforces subcuticular stitch-skin must be dry
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| stapler | approximation with noncrushing B-shaped steal
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| traction suture | nonabsorbable suture placed into a structure to retract
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| bridge or bolsters | device prevents pressure from secondary suture line loop
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| pursestring suture | circular stitch placed to close an opening or invert tissue
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| vessel loop | used for isolation, retention, temporary occlusion of vessels
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| umbilical tape | premoistened and loaded onto hemostat
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| button | device used for tendon repair
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| preknotted | endoscopic suturing
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| describe tensile strength & identify what factors affect the tensile strength of the suture | the maximum strength a material can with stand
factors: type of suture, pressence of infection, tissue sites, absorbtion
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| identify one suture with very strong tensile strength | stainless steel
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| describe pliability | how easily they pass through tissue
how easily they tie and
how secure the knots are
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| describe how to remove memory | sutures should be drawn between gloved fingers
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| identify one suture with memory | polyglycolic acid (dexon)
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| The type of stapler that delivers two double staple lines and contains a knife to transect tissue is called a | linear cutter
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| A device used to anastomose tubular structures such as the colon is called a(n) | intraluminal (circular) staples
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| synthetic material used for fascia defects as a reinforcement or bridge between structures is called | polypropelene mesh
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| when using ______eyed needles, pull the suture into a v-shaped area; however, there is more tissue damage than with use of a swaged needle | french
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| a suture with a needle on each end of the suture strand is called a | double arm attachment
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| a suture designed to be removed with a quick pull is called | eyeless needle
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| when using a needle on the skin, you would typically use a _______ needle | cutting
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| when using a needle on delicate gastrointestinal tissue, you would typically use a ________needle | tapered
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| when using a needle on friable tissue such as the liver or kidney, you could use a ________ needle | blunt
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| the most common used body shape is the _______ circle | 1/2
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| the most commonly used body shape for skin closure is the ____ circle | 3/8
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Created by:
E.Ochoa
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