Term
| What type of knot should be used to control hemostasis? What about high risk vessels? |
|
Definition
| Use a square knot or suture/double ligation for high risk vessels. |
|
|
Term
| Name and describe the 3 phases of recovery from major surgery. |
|
Definition
Immediate/Postanesthetic phase
Intermediate phase - encompasses the hospitalization period.
Convalescent phase - transition from hospital discharge to full recovery. |
|
|
Term
| What are the 3 major causes of early complication and death following major surgery? |
|
Definition
| Acute pulmonary, cardiovascular and fluid derangements. |
|
|
Term
| In the postoperative orders how often and how long should a patient be turned that is unconscious and conscious? What are we trying to prevent? |
|
Definition
| Turn every 30 min until conscious and then every hour for the first 8-12 hours to minimize risk for atelectasis. |
|
|
Term
| What is the major cause of GI bleed in postoperative patients? What do you give to prevent it? |
|
Definition
| Stress ulcer, give a H2 blocker to prevent it. |
|
|
Term
| What are some causes of early (within 1-2 hours) and late (beyond 48 hours) respiratory failure after surgery? |
|
Definition
Early = major chest/abdominal operation, pre-existing lung disease and too much anesthesia.
Late = cardiac failure, pulmonary edema, pulmonary embolism, or narcotic overdose. |
|
|
Term
| What is the most common postoperative pulmonary complication and how is it manifested? |
|
Definition
| Atelectasis, manifested as fever, tachypnea and tachycardia. |
|
|
Term
| What is the most common cardiac complication after operation under general anesthesia? Most common cause of cardiac death during the operation? Most common cardiac cause of death in those with a heart condition? |
|
Definition
PVC's is most common complication.
MI is the most common cause of death during.
V Fib is the most common cause of death in those with heart conditions. |
|
|
Term
| What is the most common cause of PVCs after a surgical procedure? |
|
Definition
|
|
Term
| Wound infections usually occur 5-10 days postoperative, what should you suspect if a would infection occurs in 12-24 hours? |
|
Definition
| Clostridium or streptococcal infection |
|
|
Term
| Describe the 3 types of operative wound classifications w/ examples (clean, clean contaminated and contaminated) by risk percentage of infection. |
|
Definition
Clean - (hernia repair, soft tissue bx) incidence of wound infection is less than 2%.
Clean contaminated - (gastric or biliary surgery) potential exposure to bacteria, incidence is about 5%.
Contaminated - (colorectal or vaginal surgery) incidence is 7-10%. |
|
|
Term
| In which cases are prophylactic antibiotics used for clean operative wounds? |
|
Definition
| cardiovascular, neurosurgical or orthopedic cases |
|
|
Term
| Which class of antibiotic is typically used as a propylactic antibiotic for surgery? |
|
Definition
| 3rd generation cephalosporin |
|
|
Term
| Which organ system is the most commonly affected to cause postoperative death? What is the most common cause in that organ system? |
|
Definition
| Respiratory, pneumonia is the most common cause. |
|
|
Term
| If atelectasis is left untreated and unresolved after 3-4 days, what can result? |
|
Definition
|
|
Term
| What is the most common cause of aspiration? |
|
Definition
|
|
Term
| What is the most common cause of ARDS? |
|
Definition
|
|
Term
| What is the treatment for a PE? What is it is a large PE with noted hypoxia and hypotension? |
|
Definition
Treatment = immediate heparin followed by coumadin.
If severe, give thrombolytics. |
|
|
Term
| What is the most common cause of fat embolization? What is the most common cause of death due to fat embolization? |
|
Definition
| MCC is fracture of the shaft of long bones (particularly the femur) and the MCC of death is stroke. |
|
|
Term
| Describe the etiology of an air embolism, how it can be fatal, how much air in the circulation can be fatal, how to avoid this complication, how to manage a patient with this condition. |
|
Definition
Etiology = it is typically iatrogenic through insertion of a central line.
It can be fatal bc air mixes with blood in the right heart causing frothy blood to block pulmonary blood flow.
200cc of air can be fatal.
Avoided by placing the patient in the Trendelenberg position (head below feet) when a central venous line is placed.
A patient with this condition should be placed right side up with their head lower than their feet, which will help dislodge the air from the right atrium. |
|
|
Term
| Name and describe the 5 W's of Postoperative fever. |
|
Definition
Wind - (Atelectasis), first 1-2 days.
Water - (UTI), after 1 day.
Wound - (Wound infection), 5-10th day.
Walking - (DVT/PE), 1-7th day.
Wonder drugs - (Drugs), fever of unknown origin = consider drugs that they are taking. |
|
|
Term
| What does a HEPA filter NOT filter? |
|
Definition
| It does not filter viruses. (does remove bacteria and fungi) |
|
|
Term
| What does iodine kill out of: fungi, virus, gram positive and gram negative bacteria? |
|
Definition
|
|
Term
| What is the most common site for perforation for gloves? |
|
Definition
| Non dominant index finger |
|
|
Term
| What are some consideration that should be made to prevent puncture holes in gloves? |
|
Definition
| Change gloves before 2 hours, reinforce the non-dominant index finger and double glove. |
|
|
Term
| What is the most important feature of the surgical gown? |
|
Definition
| It is impermeable to moisture |
|
|
Term
| When should you use a single layer gown, reinforced (double/triple) layer gown and plastic reinforced gown? |
|
Definition
Single = Under 2 hours duration and under 100mL blood loss.
Reinforced = 2-4 hours duration and 100-500mL blood loss.
Plastic = Over 4 hours duration and over 500mL blood loss. |
|
|
Term
| What are the sterile boundaries of the body when scrubbing into surgery? |
|
Definition
| Hands to elbows and waist to clavicle |
|
|
Term
| Name the 13 components of a clinical procedure note. |
|
Definition
1. Demographic data (identification, etc).
2. Name of procedure.
3. Indications.
4. Contraindications.
5. Informed Consent.
6. Personnel (who performed procedure).
7. Anesthesia used.
8. Description of procedure performed.
9. Findings recorded.
10. Description of any new findings.
11. Complications, if any.
12. Instructions/Follow up plans.
13. Time the procedure was completed w/ patient condition. |
|
|
Term
| Describe the indicated therapy for a red, yellow or black wound. |
|
Definition
Red = keep site moist, clean and protected.
Yellow = mechanical cleansing and excision to red wound and they will need antibiotics.
Black = surgical debridement and excision to red wound. |
|
|
Term
| What ABI results are indicative of mild/moderate PAD and severe PAD? |
|
Definition
Mild/Moderate = .41-.90
Severe = .40 and less |
|
|
Term
| What are the best non-invasive tests for arterial and venous insufficiency? |
|
Definition
Arterial = ABI.
Venous = venous Doppler. |
|
|
Term
| How should you initially treat venous insufficiency? |
|
Definition
| Diuretics and compression devices for the edema. |
|
|
Term
| Describe the 3 phases of wound healing (Reaction, Regeneration and Remodeling). |
|
Definition
Reaction - (first 3 days), inflammation.
Regeneration - (3 days to 3 weeks), granulation, epithelialization and contraction of tissue occur.
Remodeling (3 weeks to 2 years), scar formation. |
|
|
Term
| Which wound color indicates that a wound is healing? Healing is disturbed? Healing is impaired? |
|
Definition
Healing = red.
Disturbed = yellow (infection).
Impaired = black (necrosis). |
|
|
Term
| Describe the 4 stages of pressure ulcers. |
|
Definition
Stage 1 - limited to epidermis (erosion or abrasion).
Stage 2 - limited to epidermis and upper dermis (blister).
Stage 3 - may extend down to underlying fascia but not into it.
Stage 4 - May extend down to muscle or bone. |
|
|
Term
| Describe the 5 stages of Wagner Grading System for diabetic foot ulcers. |
|
Definition
Grade 1 = superficial ulcer.
Grade 2 = Involves ligament/tendon/joint capsule or fascia but NO abscess or osteomyelitis.
Grade 3 = Involves ligament/tendon/joint capsule or fascia WITH abscess or osteomyelitis.
Grade 4 = Gangrenous forefoot.
Grade 5 = Extensive gangrene to entire foot. |
|
|
Term
| What are the advantages of using a Vacuum Assisted Closure Device? |
|
Definition
| Decreases fluid and bacteria, increases capillary ingrowth and mechanically pulls edges of the wound together. |
|
|
Term
| What is the objective of mechanical wound dressings? |
|
Definition
| pressure reduction or edema management |
|
|
Term
| What is the objective of dynamic wound dressings? |
|
Definition
| Activation of the wound environment (granulation). |
|
|
Term
| What is the objective of topical wound dressings? |
|
Definition
|
|
Term
| What is the objective of passive wound dressings? |
|
Definition
| To control moist wound environments |
|
|
Term
| What is the function of Platelet-Derived Growth Factors (pdGF)? |
|
Definition
| To form new blood vessels after injury |
|
|
Term
| What are the indications for Enzymatic debridement? |
|
Definition
| A wound requiring debridement of fibrinous exudate, necrotic material or slough. |
|
|
Term
| Which type of bone is stronger and is used to protect? Which type is more flexible? |
|
Definition
Cortical = strong.
Tribecular = flexible. |
|
|
Term
| Discuss the pros and cons of plaster and fiberglass casts. |
|
Definition
Plaster offers more moldability but it is heavy and requires many layers.
Fiberglass offers less moldability but is lightweight and requires few layers. |
|
|
Term
| What are the 3 contraindications to casting? |
|
Definition
| Massive swelling, infections and open wounds. |
|
|
Term
| What are the potential complications to casting? |
|
Definition
| Compartment syndrome, dermatitis, pressure sores, nerve injuries and DVT. |
|
|
Term
| Describe the relationship between suture number and size. |
|
Definition
| The greater the number the smaller the suture. |
|
|
Term
| What are the benefits of monofilament and multifilament (braided) sutures? |
|
Definition
Monofilament = passes through tissue easier and resists harboring bacteria.
Multifilament = greater strength and they are pliable for easier handling and softer knots (good for eyes and corners of mouth). |
|
|
Term
| What is the difference between synthetic and organic sutures? |
|
Definition
| Synthetic is less reactive to the body and organic stimulates the inflammatory response. |
|
|
Term
| Name some examples of absorbable and non-absorbable synthetic sutures. |
|
Definition
Absorbable = Vicryl or (-cryl's)
Non-absorbable =
Ethilon/Nurolon (nylon)
Prolene (polypropylene) Mersilene/Ethibond (polyester). |
|
|
Term
| Name some examples of absorbable and non-absorbable organic sutures. |
|
Definition
Absorbable = Plain gut or chromic gut.
Non-absorbable = silk. |
|
|
Term
| Which suture is the gold standard to compare handling qualities? |
|
Definition
| Organic Non-absorbable (SILK) |
|
|
Term
| What are the indications for stainless steel staple or wire closure? |
|
Definition
| sternum, scalp, skull, or abdominal wall closure or bone fixation in orthopedics. |
|
|
Term
| Describe the filament type for Ethilon (nylon), Mersilene & Ethibond (polyester) and Prolene (polypropylene). |
|
Definition
Ethilon = nonabsorbable monofilament.
Mersilene = nonabsobable monofilament and braided.
Ethibond = nonabsorbable braided.
Prolene = nonabsorbable monofilament. |
|
|
Term
| Describe the body and swag/eye of a suture needle. |
|
Definition
Body = point of max curvature.
Swag/Eye = area of attachment for whatever it attached to needle. |
|
|
Term
| Describe the common Ethicon Needle codes for skin (FS, P, PS, PC, CPS). |
|
Definition
FS: for skin
P: plastic
PS: plastic surgery
PC: precision cosmetic
CPS: conventional plastic surgery |
|
|
Term
| What size suture is used for the face and fingertips? |
|
Definition
|
|
Term
| When are sutures typically removed for the: eyelids, face, scalp, trunk, upper extremities and lower extremities? |
|
Definition
Eyelids = 3 days
Face = 5 days
Scalp = 7-10 days
Trunk = 7-12 days
Upper Extremities = 7-14 days
Lower Extremities = 10-21 days |
|
|
Term
| What is undermining and what is the benefit of undermining a wound? |
|
Definition
| It is the technique of creating a plane of release beneath the skin edge of an open wound. It relieves tension and allows skin edges to be handled with greater ease. |
|
|
Term
| What are the complications of placing sutures too close together and too far apart? |
|
Definition
Too close = vascular compromise to wound margins.
Too far = may not secure adequate closure. |
|
|
Term
| What is the average width that sutures are placed apart from each other and how far from the edge of the wound? How about on the face? |
|
Definition
Average distance apart is 3-10mm and 3-4 mm from the edge of the wound.
On the face the average distance apart is 3-5 mm and 2-3mm from the edge of the wound. |
|
|
Term
| What are the advantages of a buried suture (subcuticular stitch)? |
|
Definition
| Eliminates dead space and reduces tension in the superficial closure. |
|
|
Term
| What is the advantage of Intradermal sutures? |
|
Definition
| If the approximation is good it can prevent the need for surface sutures. |
|
|
Term
| What is the advantage of a Running Locking Suture? |
|
Definition
| Maintains a more consistent tightness to the closure. |
|
|
Term
| Describe the Vertical Mattress Suture and what its tendency is. |
|
Definition
| It is far-far and then near-near. It has a tendency to be too tight. |
|
|
Term
| Describe the Horizontal Mattress Suture and its classic use. |
|
Definition
Interrupted suture involving a perpendicular pass, parallel pass, and perpendicular pass to the wound before tying.
Its classic use is to secure a tight seal around a drain tube that exits the skin. |
|
|
Term
| How many "throws" should be used for multifilament and monofilament knot tying? |
|
Definition
Multifilament = 3-4.
Monofilament = 4-5 or more if needed. |
|
|
Term
| How long should a typical "tail" of superficial sutures be to prevent chances for untying? |
|
Definition
|
|
Term
| What is the general rule for when not to use epinephrine as a local anesthetic? |
|
Definition
| Anywhere there is a single blood supply (fingers, toes, ears, nose, penis) |
|
|
Term
| What is the LACERATE mnemonic suturing and laceration repair? |
|
Definition
Look
Anesthetize
Clean
Equipment setup before wound assessment
Repair
Assess results/Anticipate complications
Tetanus prophylaxis
Educate the patient about wound care |
|
|
Term
| When is regional anesthesia (ex = nerve blocks) usually indicated for wound treatment? |
|
Definition
| Procedures lasting longer than 30 minutes |
|
|
Term
| What is the maximum dose for lidocaine when used as a local anesthetic? |
|
Definition
| 4mg/kg not to exceed 300mg |
|
|
Term
| What steps can you take to decrease pain when injecting lidocaine for local anesthesia? |
|
Definition
| Inject slowly, use small needle (27 gauge), add bicarbonate buffer to acidic lidocaine, and warm the lidocaine. |
|
|
Term
| What are the average needle gauges for blood withdrawals, IM injections, SubQ injections and Intradermal injections? |
|
Definition
Blood draw = 18g
IM = 19-22g
SubQ = 25-27g
ID = 27g |
|
|
Term
| What body sites should never be used for injections in infants? |
|
Definition
|
|
Term
| Rate the following routes in order of rate of absorption and duration of action(IM, IV and SQ). |
|
Definition
Rate of absorption slowest to fastest is SQ, IM and then IV.
Duration of action shortest to longest is IV, IM and then SQ. |
|
|
Term
| What are the 3 principle sites for IM injections? |
|
Definition
| gluteal, deltoid or vastus lateralis |
|
|
Term
| What considerations should be made when doing a Deltoid IM injection? |
|
Definition
| Do not go below the humoral tuberosity bc of risk of hitting nerve, artery or vein. |
|
|
Term
| In what group is the vastus lateralis the perferred target for IM injections? |
|
Definition
|
|
Term
| What is the major consideration when considering using the gluteal for an IM injection? |
|
Definition
| It cannot be used for immunizations |
|
|
Term
| Describe the 18 steps for how to give an IM injection. |
|
Definition
1. Identify patient
2. Wash hands
3. Put on gloves
4. Select 2-5 mL syringe with 19-22 gauge needle
5. Using aseptic technique, withdraw medication from vial.
6. Prep injection site with alcohol
7. Press down and stretch skin at injection site with thumb and index finger of nondominant hand
8. Hold syringe like a dart at 90 degree angle to site
9. Insert needle straight into skin
10. Hold barrel with nondominant hand
11. Aspirate to check for blood
12. Slowly empty syringe
13. Remove needle quickly
14. Apply gentle pressure with cotton
15. Bandage
16. Discharge needle and syringe
17. Comfort patient
18. Record date, time, dose, purpose and site. |
|
|
Term
| What are the common sites for SQ injections? |
|
Definition
| upper arm, anterior thigh or lower abdomen |
|
|
Term
| What are the only 2 injectable medications that should not have aspiration before injection because they are so highly soluble? |
|
Definition
|
|
Term
| Describe the 17 steps to giving a SQ injection. |
|
Definition
1. Identify patient
2. Wash hands
3. Put on gloves
4. Select 2-3 mL syringe and 23-25 gauge needle
5. Prep injection site with alcohol
6. Using aseptic technique, withdraw medication from vial
7. With non-dominant hand, pinch SQ tissue between thumb and index finger
8. Insert needle with bevel up at 45 degree angle
9. Advance needle to about 3/4 length
10. Release skin
11. Aspirate to make sure not in vessel
12. Inject slowly
13. Withdraw needle quickly at same angle
14. Cover site with gauze and gently massage to distribute medication (except Heparin)
15. Bandage site
16. Depose of needle and syringe
17. Record type of injection, date, time and site. |
|
|
Term
| How should insulin be mixed before it is injected? |
|
Definition
| Gently between the palms of your hands |
|
|
Term
| What are the most common sites for intradermal injections? |
|
Definition
| ventral surface of the forearm (TB) or the back (skin allergen testing) |
|
|
Term
| What is the maximum volume that can be injected for IM, SQ and ID injections? |
|
Definition
IM is 2cc (except gluteal is 3cc)
SQ is 2cc
ID is 0.1cc |
|
|
Term
| Describe the 14 steps to giving an Intradermal injection. |
|
Definition
1. Identify patient
2. Wash hands
3. Put on gloves
4. Select correct syringe (1cc) and needle (27 gauge)
5. Prep injection site with alcohol
6. Using aseptic technique, fill syringe with desired amt of solution
7. With non-dominant hand, hold skin taut between thumb and index finger
8. Insert needle with bevel up at 10-15 degree angle
9. Advance needle into dermis to about 2/3 length
10. Inject slowly
11. Withdraw needle quickly at same angle
12. Cover site with cotton ball
13. Depose of needle and syringe
14. Record type of injection, date, time and site. |
|
|
Term
| How is seepage of medication after an IM injection prevented? |
|
Definition
| By drawing a 0.2cc air bubble into the syringe |
|
|
Term
| An ampule contains how many doses of a medication? |
|
Definition
| Generally 1 but it depends on the size of the ampule |
|
|
Term
| What are the 2 most common veins used for venipuncture? |
|
Definition
| median cubital and cephalic veins of the arm |
|
|
Term
| What are some areas to be avoided when doing a venous blood draw? |
|
Definition
| Scars, hematomas, ipsilateral arm of a previous mastectomy, or ipsilateral arm of a current IV. |
|
|
Term
| Describe the 12 steps to venipuncture. |
|
Definition
1. Identify patient
2. Check requisition form for any special requirements
3. Select a site
4. Apply tourniquet 3-4 inches above selected site and have patient make a fist
5. Prep site with alcohol
6. Perform venipuncture by inserting needle at a 15-30 degree angle
7. Collect sample
8. Remove tourniquet before removal of needle
9. Remove needle and place gauze pad
10. Dispose of contaminated materials
11. Label collection tubes at patient bedside
12. Promptly send specimen with requisition to laboratory |
|
|
Term
| What are the best fingers to do a fingerstick on? |
|
Definition
| 3rd or 4th fingers of the non-dominant hand because the 5th doesn't have enough soft tissue overlying the bone and the 2nd is usually callused |
|
|
Term
| How can prolonged tourniquet application (over 2 minutes) affect the venous blood sample? |
|
Definition
| Hemoconcentration of non-filterable elements causing an elevated total protein, AST, total lipids, cholesterol, iron, etc. |
|
|
Term
| What effect may exercise have on venous blood samples? |
|
Definition
| Elevated CK, AST, LDH and platelet count |
|
|
Term
| What affect might stress have on venous blood samples? |
|
Definition
| Elevated WBCs, cortisol, catecholamines and lactate if hyperventilation. |
|
|
Term
| Which artery is most commonly used for ABG's? |
|
Definition
|
|
Term
| What are the absolute and relative contraindications for ABG collection? |
|
Definition
Absolute:
No pulse
Poor collateral circulation
Local infection
Aneurysm at puncture site
AV fistula above puncture site
Relative:
Chronic renal disease
Presence of arterial disease
Bleeding disorder |
|
|
Term
| Describe where the radial artery can be found in relation to other neighboring landmarks. |
|
Definition
| Lateral aspect of the volar forearm between the styloid process of the radius and the flexor carpi radialis tendon. |
|
|
Term
| Describe the 15 steps to collecting ABG's. |
|
Definition
1. Perform the Allen test
2. If using a heparinized syringe, pull plunger all the way back and then expell all heparin
3. Palpate the point of maximal radial pulsation
4. Prep site with iodine or alcohol
5. Place 2nd and 3rd fingers of nondominant hand proximal to point of needle entry
6. With bevel up insert needle through skin at 45-60 degree angle slowly until blood is seen
7. Obtain at least 2mL of blood
8. Remove needle and apply pressure with gauze for at least 5 minutes
9. Insert needle tip into rubber stopper and remove needle from the syringe
10. Evacuate all air bubbles from syringe within 30 seconds by holding the needle side of the syringe upright/tapping and then evacuating the air
11. Cap the syringe once air is evacuated
12. Roll the syringe between fingers to ensure that the blood does not clot
13. Cap syringe and discard needle
14. Label sample and place it in ice
15. Deliver to lab |
|
|
Term
| What sites could be selected for ABG sampling if the radial artery is contraindicated? |
|
Definition
| Femoral artery or Brachial artery |
|
|
Term
| What are the possible indications for IV therapy? |
|
Definition
Fluid/Electrolyte balance
Administer medication
Administer fluid to KVO
Administer blood/components
Anesthesia
Correct nutritional state
Diagnostic reagents
Monitor hemodynamic functions |
|
|
Term
| What are the contraindications for IV therapy? |
|
Definition
| Skin infection, any proximal thromboplebitis, or compromised veins (insufficiency). |
|
|
Term
| What are the typical gauges used for IV therapy? |
|
Definition
|
|
Term
| How will hyper and hypo tonic solutions affect cell size? |
|
Definition
Hypertonic will cause them to shrink.
Hypotonic will cause them to swell. |
|
|
Term
| Describe the differences between Crystalloids vs Colloids. |
|
Definition
Crystalloids are isotonic and examples are LR and NS.
Colloids are hypertonic and are better at reducing edema but are much more expensive. |
|
|
Term
| What are the possible complications to IV therapy? |
|
Definition
Brusing
Cellulitis
Phlebitis
Septicemia
Pulmonary Embolism
Air embolism
Infiltration out of the back of vein |
|
|
Term
| What is the patient education for the patient to notify a clinician after they have received IV therapy? |
|
Definition
| Notify the clinician if they notice any burning, stinging, redness, bleeding or swelling at the insertion site. |
|
|
Term
| What are the main indications for urinary bladder catheterization? |
|
Definition
Obtain a sterile urine sample
Monitor urine output
Facilitate urinary drainage
Bypass obstructive processes |
|
|
Term
| What are the contraindications to Urinary bladder catheterization? |
|
Definition
Previous urethral surgery
Urethral trauma
Inability to transverse the urethra to the bladder for any reason |
|
|
Term
| What is the main difference between a Robinson and Foley catheter? |
|
Definition
| Robinson is designed for one time use and Foley has an inflatable balloon and is meant to be left in. |
|
|
Term
| How long can plastic, latex and rubber urinary catheters be used? |
|
Definition
Plastic = only one time in and out use.
Latex and Rubber = up to 2 weeks. |
|
|
Term
| Describe the 19 steps to Urinary Catheterization. |
|
Definition
1. Ensure privacy
2. Wash genital area with warm soap and water
3. Position the patient (lithotomy for females and flat supine for males)
4. Position light
5. Wash hands
6. Open sterile pack
7. Add solution to cotton balls
8. Open catheter and place on sterile field
9. Open sterile gloves
10. Wash hands
11. Put on sterile gloves
12. Apply sterile drape to patient
13. Lubricate catheter tip
14. Cleanse urethral meatus
15. Pick up catheter with dominant hand 2 inches from the tip
16. Insert catheter until you see urine, then advance 2 more inches
17. Inflate balloon
18. Apply gentle traction to lodge the balloon
19. Secure the tubing to the patient |
|
|
Term
| What are the main indications for NG tube insertion? |
|
Definition
Sample gastric contents
Remove gastric contents
Intestinal decompression
Nutritional support |
|
|
Term
| What are the contraindications to NG tube insertion? |
|
Definition
Choanal atresia
Facial trauma
Gastrectomy
Recent UGI tract surgery
*Any condition that obstructs the pathway that the NG tube will follow |
|
|
Term
| Describe the 14 steps associated with an NG tube insertion. |
|
Definition
1. Place patient at a 45 degree angle or greater
2. Wash hands
3. Put on gloves
4. Place a protective sheet over the patients chest/abdomen
5. Check for nasal patency and use the one that is most patent
6. Measure tube from tip of nose to ear lobe and then to the xiphoid process and mark the end
7. Lubricate the first few inches of the tube with lidocaine jelly
8. Flex the patient head to their chest
9. Insert the tube nearest the septal side of the nare to avoid the turbinates
10. Have the patient takes small sips of water through a straw as you advance
11. Insert until predetermined length
12. Check placement with CXR or inject 10cc of air into the tube and listen for the "gush of air"
13. Tape the tube in place using a tincture of benzoin
14. Record procedure and sign off in chart |
|
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Term
| Describe the process of gastric lavage and indications. |
|
Definition
NG tube is placed and the stomach is filled with water and then the water is sucked out.
Used to diagnose gastric bleeding or ingestion of toxic substances (activated charcoal is more common though) |
|
|
Term
| What are the contraindications to gastric lavage? |
|
Definition
Insignificant overdose
Corrosive ingestion
Hydrocarbon ingestion
More than 1 hour post-ingestion
*All other NG tube contraindications |
|
|
Term
| What are the indications for arthrocentesis? |
|
Definition
Undiagnosed arthritis with effusion
Suspected infection
Joint effusion after trauma
Therapeutic injections |
|
|
Term
| What are the contraindications for arthrocentesis? |
|
Definition
Overlying infection
Overlying wound
Bacteremia
Neuropathic pain
Coagulopathies
Uncontrolled DM
Prosthetic joint
Inaccessible joints (Hip, SI, Pubic symphysis)
Lack of response to previous injections |
|
|
Term
| What should never be injected into a joint suspected of infection or hemarthrosis? |
|
Definition
|
|
Term
| Describe the WBC count and % PMNs for Noninflammatory synovial fluid analysis (osteoarthritis, trauma). |
|
Definition
| WBC count under 2000 and less than 25% PMNs |
|
|
Term
| Describe the WBC count and % PMNs for Inflammatory (RA, Reiter's, viral/fungal/TB arthritis) synovial fluid analysis. |
|
Definition
| 2,000-75,000 WBC's with more than 50% PMNs |
|
|
Term
| Describe the WBC count and % PMNs for Septic (bacterial) arthritis synovial fluid analysis. |
|
Definition
| WBC count over 60,000 with greater than 80% PMNs |
|
|
Term
| What is the maximum number of joint injections that you can receive per year? |
|
Definition
|
|
Term
| Describe the 10 steps to shoulder joint arthrocentesis. |
|
Definition
1. Obtain Consent
2. Identify all bony landmarks and mark the injection site
3. Wash hands
4. Put on gloves
5. Prep the area
6. Insert needle perpendicular to the skin, medial to the humoral head and distal to the clavicle, inferior to the coracoid process
7. Advance the needle posteriorly, distal to the coracoid and directed to the medial side of the humeral head
8. Aspirate fluid
9. Withdraw the needle and bandage the entry wound
10. Submit the synovial fluid for analysis
*Knee is the same but you insert the needle 1-2 cm from the medial or lateral edge of the superior third of the patella and direct it towards the intracondylar notch |
|
|
Term
| What is involved in your patient education after a joint injection? |
|
Definition
If pain returns after 2 hours it is due to the local anesthetic wearing off, use ice packs and avoid strenuous activity for 1-2 days. Seek advice if pain is getting worse after 2 days or if they develop systemic symptoms.
Normal local side effects include pain, flushing and swelling. |
|
|
Term
| Describe the process of finding where to give a Glenohumeral joint injection. |
|
Definition
| Have the patient sit with their arms by their sides and externally rotated. Find the sulcus between the humoral head and the acromion process. Palpate the posteriolateral corner of the acromion process and direct the needle anteriorly towards to coracoid process. Insert the needle to full length. |
|
|
Term
| Describe the process of finding where to give an AC joint injection. |
|
Definition
| Palpate the clavicle to its distal aspect, there is a slight depression where it meets the acromion process, insert the needle from the anterior and superior approach. |
|
|
Term
| Describe the process of finding where to give a Sub-acromial joint injection. |
|
Definition
| Insert just inferior to the posterolateral acromion process at the lateral shoulder directing the needle towards the opposite nipple, insert the needle to the full length. |
|
|
Term
| List the 14 steps to writing an Operative Note. |
|
Definition
1. Preoperative diagnosis
2. Postoperative diagnosis
3. Procedure performed
4. Surgeon
5. Assistants
6. Anesthesia used
7. Findings
8. Specimens obtained
9. Drains placed
10. Closure type
11. Fluids given (type and amount)
12. Estimated blood loss
13. Complications
14. Sign all notes |
|
|
Term
| Describe the 5 steps to performing an I&D. |
|
Definition
1. Administer local anesthesia
2. Incision
3. Wound dissection (use a hemostat wrapped in gauze to determine depth of abscess and collect sample)
4. Wound irrigation with NS
5. Packing and dressing |
|
|
Term
| What is involved with the post-splinting/casting instructions for the patient? |
|
Definition
Keep it clean and dry
Keep extremity elevated for the first 2-3 days to decrease swelling
Return for evaluation for pressure ulcer or infection if they develop pain or burning sensation
Assess for neurovascular compromise |
|
|
Term
| Describe the 18 steps to starting an IV. |
|
Definition
1. Identify patient
2. Connects tubing to IV bag and flushes the tubing
3. Apply tourniquet above the IV site
4. Have the patient open and close fist
5. Identify vein
6. Wash hands
7. Put on gloves
8. Prep the area
9. Hold catheter in dominant hand and apply traction with the other hand
10. Inserts IV at 15-30 degree with bevel up into vein
11. Stabilize the catheter with one hand and release the tourniquet with the other
12. Apply slight pressure above the IV site to remove stylet from the catheter
13. Attaches IV tubing and releases clamp
14. Verify flow of solution
15. Adjust flow rate if necessary
16. Apply antimicrobial ointment and secure IV
17. Dispose of sharps
18. Documentation |
|
|
Term
| What are the indications for chest tube placement? |
|
Definition
Drainage of hemothorax or pneumothorax
Prophylaxis in patient with chest wall trauma during transport
Flail chest |
|
|
Term
| What are the contraindications to chest tube insertion? |
|
Definition
| Overlying infection or uncontrolled bleeding |
|
|
Term
| What is the average chest tube size for an adult? NG tube? Urinary catheter tube? |
|
Definition
Chest tube = 28-32 Fr
NG tube = 10-18 Fr
Urinary cath = 14-18 Fr |
|
|
Term
| Describe the 15 steps to chest tube placement. |
|
Definition
1. Obtain written consent
2. Select insertion site (midaxillary between the 4th and 5th ribs)
3. Put on mask, gown and gloves
4. Prep and drape area for insertion
5. Have patient put their arm over their head to open up ribs
6. Anesthetize area with 2% lidocaine local anesthetic
7. Remove catheter, dilator, introducer wire and introducer needle from bag
8. Thread inducer wire through needle into chest
9. Remove needle leaving the inducer
10. Thread dilator over the inducer wire and advance into chest
11. Dilate so that a catheter can be inserted and then remove the dilator
12. Insert catheter and remove wire
13. Tape or suture catheter in place
14. Attach catheter to suction unit
15. Obtain CXR to confirm placement |
|
|
Term
| Describe what is meant by the Admission Orders mnemonic ADC VANDALISM. |
|
Definition
Admit
Diagnosis
Condition
Vital Signs
Allergies
Nursing
Diet
Activity
Labs
IV fluids
Special
Medications |
|
|
Term
| Describe the 14 step process of scrubbing into the OR. |
|
Definition
1. Put on facemask, cap and shoecovers
2. Clean nails with nail file
3. Wash nails, hands and forearms
4. Scrub all 4 sides of each nail (30 scrubs) and finger (20 scrubs)
5. Scrub the 3 sections of the ventral and dorsal hand (20 scrubs)
6. Scrub all 4 sections of each forearm to just above the elbow (20 scrubs)
7. Rinse with water always flowing from the hand to the elbow
8. Keep hands and elbows elevated above the forearms as you walk in backwards into the OR
9. Dry hands off from hand to elbow with sterile towels included in the gown pack
10. Grasp inside of gown and lift away from the table
11. Unfold gown by placing arms into the sleeves
12. Unsterile assistant will tie the neck and inside waist tie
13. Sterile gloving technique (open and drop on sterile field, left hand puts the glove on the right hand and then gloved right hand puts the glove on the left hand)
14. Outside tie with assistance (hand white tab to assistant and they pull it back around to tie) |
|
|
Term
| Describe how you will format your surgical clinical case written exam for each patient. |
|
Definition
Diagnosis
Assess the patient (Sx)
Treatment plan
Pick the procedure that needs to be done
Obtain Informed Consent (explain Indications, Contraindications, Risk and Benefits to the patient)
Write a Procedural Note (Demographics, Procedure, Indications, Contraindications, Informed Consent, Personnel involved, Description of the procedure, Findings, New/Unexpected findings, Complications, Follow up/Patient instructions, Time finished w/ patient condition noted)
Admit patient and write admission orders (ADC VANDALISM - Admit, Diagnosis, Condition, Vital Signs, Allergies, Nurse orders, Diet, Activity, Labs, IV fluids, Special, Meds) |
|
|
Term
| How much more fluid than is needed should be given during IV fluid replacement? |
|
Definition
| 500cc more because they lose it through breathing etc |
|
|
Term
| What is problematic about a seroma? |
|
Definition
| It is a great nidus for infection |
|
|
Term
| What are the values that are indicative for respiratory failure? |
|
Definition
Tachypnea over 25 bpm
Tidal volume under 4mL/kg
PO2 under 60mmHg
PCO2 over 45mmHg
and Low CO |
|
|
Term
| What should be checked if someone is having PVC's post-op? |
|
Definition
| Check oxygen levels first |
|
|
Term
| What are the causes of wound dehiscence? When is it most common postop? Where is a common place for it to occur? |
|
Definition
| MCC is technical problem in wound closure from excess wound tension, ischemia, improper suturing or knot tying. MC seen between the 5th and 8th postop day. Common on the abdomen |
|
|
Term
| What type of bacteria are primarily responsible for a wound infection that occurs more than 4 days post-op? |
|
Definition
| Enteric aerobes, anaerobes or staph |
|
|
Term
| What is the most common cause of postoperative abnormal coagulation parameters? |
|
Definition
| Hemodilution from the patient being given too much fluid |
|
|
Term
| What chemical is used in chemical sterilization and what surfaces is it good for? |
|
Definition
| Glutaraldehyde, it is good for rubber/plastic |
|
|
Term
| How do you prevent arterial ulcers? |
|
Definition
| Need to thin the blood so blood thinners (ASA, Plavix) |
|
|
Term
| What is the only enzymatic agent that is not compatible with topical antibiotics? |
|
Definition
|
|
Term
| What is the use for Hydrogel, Calcium alginate and foam for use as packing? |
|
Definition
Hydrogel for mildly exudating wounds.
Calcium alginate for wounds with large amounts of drainage.
Foam for highly exudative wounds requiring a non-stick surface. |
|
|
Term
| What kind of splint is used in a Colles fracture, scaphoid fracture, unstable ankle fracture and fracture to the 4th or 5th metacarpals or phalanx? |
|
Definition
Colles fx: sugar tong splint
scaphoid fx: thumb spica splint
unstable ankle fx: lower leg sugar tong splint
4th or 5th metacarpal/phalanx: Ulnar Gutter splint |
|
|
Term
| Which suture has the most inflammation? Highest rate of inflammation? |
|
Definition
Most = plain or chromic gut
Highest rate = silk |
|
|
Term
| Skin needs at least ___% tensile strength of original tensile strength to prevent dehiscence |
|
Definition
|
|
Term
| What is the tensile strength of vicryl at 3 weeks? |
|
Definition
|
|
Term
| What type of suture is used for intranasal and intraoral suturing? |
|
Definition
5-0 chromic gut for intranasal
4-0 chromic gut for intraoral |
|
|
Term
| Where should you never apply buried sutures? |
|
Definition
|
|
Term
| Which 3 local anesthetics do patients most commonly have allergies to? |
|
Definition
| Procaine, Novacaine and Tetracaine |
|
|
Term
| Describe the order of blood draws into vacutainers. |
|
Definition
first draw blood culture (yellow-black tube)
second draw non-additive (red tube) for serology (Ab or drugs)
third draw citrate (light blue tube) for coagulation (PT, aPTT)
fourth draw heparin (dark green tube) for chemistry (CMP)
EDTA (purple tube) for CBC
oxalate/fluoride (gray tube) for glucose |
|
|
Term
| Describe the ggt/cc for microdrips and macrodrips and what each is best suited for delivering/ |
|
Definition
Microdrip: 60 ggt/cc; good for meds or pediatric fluid delivery
Macrodrip: 10-15 ggt/cc; good for rapid or routine fluid delivery |
|
|
Term
| What is the complication that can arise if ABGs are not placed on ice in a timely manner? |
|
Definition
|
|
Term
| Which nerve is most commonly injured from brachial artery blood sampling? |
|
Definition
|
|
Term
| What is the average length of the female and male urethra? |
|
Definition
Female = 22cm
Male = 40 cm |
|
|
Term
| What is the name of the syringe used for NG tube used for gastric lavage? |
|
Definition
| Toomey irrigation syringe |
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