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Surgery - Misc

Midterm exam

Taper needle vs. cutting needle taper - soft tissues and fascia (deep) cutting - skin, periosteum, perichondrium
Why square knot? retains 80-90% of tensile strength
When use antecubital IV vein? Only in emergency situations - decreases mobility, requires armboard, increased change of thrombosis
When should armboards be used with IVs? When IV is near a joint
Tourniquet should not be left on longer than... 3 minutes
The most common complication assoc with IV therapy is... Infiltration
What is infiltration (of an IV)? Fluids leading into veins (most common problem of IV therapy)
Signs and Sx of infiltration swelling, leaking at site, coolness of tissue at site, blanching
Peripheral IVs should be changed every .... 7 days (or it pt complains of pain)
Arterial puncture - size of needle (gauge and inch), size of syringe Short small needed (25 gauge - 5/8 inch) is commonly used with a 5 mL syringe
What is treatment for C. diff? PO FLAGYL, Po vancomycin if unable to give PO may give IV but PO preferred
What is treatment for Proctosigmoiditis (and definition)? Vanc enemas, type of C. diff colitis
What is treatment for recurrent colitis (and definition)? long course (1 mo) PO flagyl or PO vanc; type of C. diff colitis
What is treatment for fulminant colitis (and definition)? Emergent laparotomy; type of C. diff colitis
What is a clean surgery and what type of ABs used? The respiratory, alimentary, genital or infected urinary tract is not entered, no inflammation; ABs: gram positive coverage
What is a Clean-contaminated surgery? Respiratory, alimentary, genital or urinary tracts are entered under controlled conditions, no unusual complications
What is contaminated surgery? Open fresh, accidental wound; operations with major breaks in sterile technique or gross spillage from the GI tract; e.g. GSW to colon
What is dirty surgery? old traumatic wounds with retained devitalized tissue; those that involve existing clinical infection or perforated viscera; e.g. abscess
5 types of bandages gauze, muslin, flannel, cotton elastic, and elastic adhesive
Outing flannel bandage largely replaced by cotton elastic bandage ; Flannel no longer used
Muslin bandage primarily used as straps and to hold traction tape in place on extremities
*Elastic adhesive bandage preferred for fixation of dressings in areas where it is difficult to hold a bandage in place and where expansion and contraction is necessary (i.e. chest)
Gauze bandage generally used to hold dressing in place. Usually available in one, two or three inch rolls
Cotton elastic bandage support, even pressure, conform to any part of the body
circular bandage used where? Tubular structure; arm
Figure of eight bandaging used where? Joints
Recurrent bandage used where? stumps
Reversed bandage used where? Tubular structures of changing diameters like forarm or leg
spica bandage used where? two parts of unequal size such as the shoulder and chest or thumb and hand and the groin
commonly used for extensive lacerations of the head recurrent dressing
commonly used for infected wounds, which are left open and treated with regular irrigations wet dressings
what is important not to do with a wet compress? not to use wet compresses continuously for more than 24 hours or skin maceration may occur
Penrose drains on ? small (think rose on a pen is small)
Sum drains are used on Large abscesses (think Sum, Pump = big)
what size blade to remove sutures #11 or suture scissors
1st and most important principle of wound care The solution to pollution is dilution! Copious irrigation and adequate debridement
Excessive wound tension is best handled by using subcutaneous absorbable sutures
*which suture closure is the most effective in accurate skin edge approximation with minimal wound edge tension? vertical mattress Note: excessive tension use subQ; skin approx and minimal tension use vertical mattress
Which is better for ease of molding, fresh fractions, open fraction (for ea. separately, plaster of paris or fiberglass?) Plaster of paris better for ease of molding and fresh fractions, fiberglass better for open fractions (think open you dont' want plaster to touch, fresh you want to be able to mold)
if significant swelling is present or anticipated, fresh fractures are immobilized in splints anywhere from ?? days before casts are applied 10-20
What width of stockeninette is used for arm casts and which for leg casts? 3 for arm, 4 for leg
How many layers of webroll (soft cotton roll) and how many layers of plaster or fiberglass? 2-3 layers webroll 4-6 layers plaster 3 layers fibroglass
Define levels I-V in the OR Level I: "STAT" to the OR w/in 1 hr Level II: w/in 4 hrs Level III: w/in 12 hrs Level IV: w/in 24 hrs Level V: Elective procedure
What part of teh gowns and sleeves are considered sterile gowns are considered sterile in front from shoulder to table level. Sleeves are sterile from 2 in above the elbow to the cuff
How many inches should be allowed b/w sterile and unsterile sites? 12 in
Gowns are sterile only: in the front from wait to 2' below the neck and 2' above the elbows
To don gloves use what method and what method for REplacing contaminated glove ? Closed for initial, Open to replace
*How long is surgical consent valid for? H&P? Consent 90 days, H&P 7 days
Describe anatomical surgical hand scrub 5 minute scrub total; 2 1/2 min ea hand wrist to fingertips 30 sec wrist 60 sec hand 30 sec fingers 30 sec fingertips
Describe counted surgical hand scrub 30 strokes nails (rinse after 10 strokes to remove dislodged dirt) 30 stokes all sides of fingers and ea web space 20 strokes ea palm and dorsum of hand 200 strokes all surfaces of arm : wrist to 2" above elbow
describe Surface scrub the motions are the same as anatomical hand scrub except that both the hands and the arms are scrubbed for 2 min, rinsed, then scrubbed for 3 minutes
When is the open glove technique used? scrub assistant gloves surgeon, when someone gloves themselves, to change gloves mid-procedure
What glove type does the scrub assistant utilize? Closed
what are Incise drapes? plastic drapes with adhesive backing either clear or impregnated with betadine applied to skin over the op site to hold the towels in place and reduce contamination from skin
What are green towels? used for absorption over the prepped site and to "square off" the op site. Placed with a folded edge at the op site; must be secured
What do you do if a drape becomes contaminated? During operative procedure? Discard if contaminated, if during operative procedure, cover up the contaminated area
Must be sterilized, and will be used in the bloodstream or in the sterile areas or in a body cavity Critical items
Sterilization is preferred, high level of disinfection, items come into contact with intact mucous membranes, may or may not penetrate body surfaces semi-critical items
Items will only touch intact skin non-critical items
Who is responsible for instrument count? both scrub assistant and circulating nurse
Hexachlorophene side effect neurotoxicity
Chloroxylenol side effect prolonged skin contact increases risk of tocity
thoracoscopy definition medial procedure involving internal inspection of the pleural cavity
Murphys sign Gallbladder RUQ pain
McBurneys sign Appendex RLQ pain
After IV what are these a sign of? swelling, leading at site, coolness of tissue at site, blanching infiltration
After IV what are these signs of? pain, redness, corded vein Phelbitis
After IV what are these signs of? stinging, burning pain and/or warmth extravation - STOP IV immediately
What size suture should you sue for a saphenous vein - femoral artery anastamosis 6-0, 7-0
What size suture on skin? 3-0
If suture falls our w/in 8 hours of occurrence what do you do? redo suture
If suture falls out > 8 hrs of occurrence what do you do? Leave to heal by secondary intention
How long to absorbable stitches generally take to dissolve? 80 days
Pt complains of absorbable stitches coming out several weeks/mos after surgery - what do you do? tug on stitch and if it comes out (usually dissovles in 80 days) then ok, but it not, trim stitch and tell pt to leave it alone
two suture categories braided (multifilament) and monofilament
Suture size on chest? 7-4
Suture size on abdomen? 4- 2-0
Suture size on skin? 2-0 - 5-0
Suture size for CABG? 6-0 - 8-0
What is the most reactive suture? surgical gut (type of absorbable - plain and chromic gut are 2 types of this)
What is the tensile strength and absorption profile for plain gut vs. chromic gut absorbable sutures? Plain gut: 7-14 days, 70 days Chromic gut: 14-21 days, 90 days
Least reactive suture? Stainless steel
Should avoid topical skin adhesives (cyanoacrylate) to what type of wounds or under what type of conditions? Wet, Tension
What % of hospitalized pts suffer from some degree of malnutrition (depending on dz and population) 15-50%
Common finding in deficiencies in niacin, thiamine, vit B6, Vit B12 peripheral neuropathy
represents critical cellular mass necessary for cellular structure as well as fxn, represents how much % of total BW, depletion is a severe insult and defines pt morbidity and mortality Lean body mass - 40%
Lean body cell mass is made up of? 60% skeletal mm, 20% RBCs and connective tissue, 20% cell mass
What % of total body protein is contained in skeletal muscle? 60%
What is the major site of protein catabolism during starvation and/or illness skeletal muscle
What is the most widely used biochemical marker of muscle mass? 24 hr urine creatinine
Protein balance is used to determine what? if protein intake is sufficient to maintain lean body mass
Nitrogen balance is defined as? what does positive mean? negative? N intake - N loss; if positive (goal +2 - +4) net state of anabolism, if negative net state of catabolism
Bassini's repair hernia repair where NO MESH USED Bess wouldn't wear Mesh
Lictenstein repair Hernia repair where No MESH USED Lick the Mesh underwear!
Created by: eedavila
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