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Surgery

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Question
Answer
3 designated operating room ‘areas’   restricted area, semi-restricted, & free  
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Principles of Aseptic Technique I   Surfaces contact: (Sterile: sterile, Unsterile: unsterile); sterile never w/unsterile; permeated sterile barrier is unsterile; edges of sterile container are unsterile once open  
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Principles of Aseptic Technique II (gowns)   gowns sterile in front (shoulder to table level); sleeves sterile from 2 in. above elbow to cuff  
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Mayo tray versus back table   Mayo: used in scrub prep & initial incision; back table:  
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surgical scrub: timed method   2-1/2 min each hand; wrist to fingertips; 1/2 min wrist; 1 min on hand; 1/2 min on fingers; 1/2 min on fingertips  
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surgical scrub: counted stroke method   nails: 30 strokes (rinse after 10 strokes to remove dislodged dirt); all sides of each finger(s) & web spaces: 30 strokes each; palm & dorsum of hand: 20 strokes each; all surfaces of arm: wrist to 2 in. above elbow: 20 strokes each  
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Betadine Scrub   soap solution of iodophor used first to remove dirt and oils, diluted with sterile saline. Used cautiously in patients allergic to seafood or IV dyes(iodine).  
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Alcohol (as scrub soln)   removes soap, not to be used on open wounds  
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Betadine Solution (Providone Iodine)   iodine complex, should not be wiped off because off cidal activity. Use cautiously with patients allergic to seafood, IV dyes.  
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Iodine 2% (scrub)   -can cause skin irritations and burns, must be rinsed with alcohol after it is applied. Contraindicated in iodine-allergic patients. Used infrequently in neuro.  
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Chlohexidine (Hibiclens) (scrub)   prevents staining. Substitute for iodine allergic patients. Can not be used on eyes and ears.  
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Benzalkonium Chloride (Zephiran) (scrub)   available in single use bottles; usually for the face. Nonstaining.  
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2 solutions for surgical hand scrub   Chlorhexidine gluconate or povidone idodine solutions (rapid-acting, broad-spectrum antimicrobials)  
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Part of gown that is sterile   in front, from shoulder to waist level, and the sleeves to 2 inches above the elbow  
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Types of drapes   towels, sheets, split sheets, fenestrated sheets, stockinette, and plastic incision drapes  
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Intrinsic factors that may increase the risk of infection   Malnutrition; Age; Obesity; Chronic dz; Remote focus of infection; Impaired Defense Mechanisms (eg, on steroids / immunosuppressants); Stress  
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Extrinsic factors that may increase the risk of infection   Duration of Preop hospn; Types of Ops (esp GI / GU); Duration of Procedure; Op Technique; Wound Site; catheters / drains; Abx use; Breakdown of isolation techniques  
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Wound Sites that are more infxn resistant b/c of vascularity   Chest, face, scalp  
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Wound Sites that are more infxn susceptible b/c of amount of fat tissue   Abdomen, thighs, calves, buttocks  
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Most common cause of wound infections in a surgical pt =   Acute bacterial infections  
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2 most common pathogens   Gram Neg bacteria and Staph aureus  
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Define wound classification: Clean   no inflammation; no break in technique; GI, GU, and respiratory tracts not entered; Expected Rate of Infection: 1-3%  
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Define wound classification: Clean-contaminated   no inflammation or infection; GI, GU, respiratory tracts entered under controlled conditions (no heavy spillage or unusual contamination); Expected Rate: 8-11%  
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Define wound classification: Contaminated   acute non-purulent inflammation, gross spillage or contamination from GI, GU tracts; open fresh trauma wounds less than 4 hours old; Expected Rate: 15-20%  
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Define wound classification: Dirty and Infected   existing clinical infection; abscesses; organisms present prior to surgery  
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Name 4 sources of wound contam   People (major source): skin / hair (staph) / Nasopharynx; Fomites; Air (dust); Human Errors (breaks in sterile technique)  
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Methods used to control infections:   Barriers; Good Housekeeping Techniques; Isolation; Abx tx; UV Radiation  
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Factors Determining Type of Position   Type of Anesthetic; Pain; Site of Operation; Age and size of patient  
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Safety considerations in pt positioning   Maintain good resp fn; good circulation; Prevent pressure on mx, nerves, bony prominences; Good exposure of op field; access for admin of anesthetics  
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Positioning Accessories   Armboards; Pillows; Sandbags; Body rolls; Stirrups, canvas straps; Foot board; Shoulder braces; Kidney rest or braces; Tape (pref non-allergenic); Head rests; Blankets and towels  
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Abd incision: Right Subcostal   gallbladder, biliary system  
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Abd incision: Left Subcostal   spleen  
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Abd incision: Median Upper Abdominal   stomach, duodenum, pancreas  
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Abd incision: Right Upper Paramedian   stomach, duodenum, pancreas  
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Abd incision: Left Lower Paramedian   pelvic structures, colon  
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