CH. 18 & 19 Flashcards by Hannah Ross

surgical positions

Supine (Dorsal Recumbent)
Trendelenberg
Reverse Trendelenberg
Lithotomy
Fowler
Lateral (SIMS)
Prone
Kraske(Jack Knife)

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supine (dorsal recumbent)

patient on back

procedures: abdominal, thorax, facial & vascular

*patient head must be aligned with their spine
*feet must not extend over edge
*arms at side or on arm boards
*pillow and padding needed w/ shoulder roll

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Trendelenberg

head down feet up
-used to better view lower abdomen/pelvis, lower GI

**may use shoulder brace

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reverse trendelenberg

patient lays on back w/ feet down, head up

procedures: upper peritoneum, lower esophagus

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lithotomy

patient on back w/ thighs abducted and placed in stirrups (“allen” or “candycane”) ,one at a time, arms usually on arm boards
-hips and knees flexed

procedures: GYN, GU

*padding v important
*perineal nerve (back of knee)

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fowler (sitting)

patient lies on back with knees over knee break in table, 45-90 degrees

**restraint straps may be used to support upped body

procedures: facial, cranial & sometimes breast re-construction

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lateral (SIMS)

patient rolled onto side (operative side), bottom leg flexed and top leg straight
-bottom arm on board , top arm on arm support pillow/beanbag and padding

procedures: renal & cardio thoracic

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prone

patients lies face down on stomach
-patient begins in supine position but is then rolled onto abdomen AFTER anesthesia is given

Procedures: spine & cranial

**b/c pressure points and breathing: headrest, pillows and padding needed

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kraske (jack knife)

patient begins in supine and is log rolled onto abdomen, then OR table flexed to about 90 degrees(in middle of table)
-arms on arm boards at sides

procedures: rectal

**sometimes tape used to secure patient

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modifications for positions

any position can be modified into many variations based on patient and surgical team needs

eg. pillows, foam “egg cartons”, gel rolls for pressure , draw sheet etc

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3basic positions

supine, lateral, prone

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name for elbow area?

olecranon process

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hypoxia

lower than normal amount of O2 in the blood

**can be caused by excessive pressure to the chest if patient not positioned properly or obese etc.

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what are some positioning consequences?

skin break down (bedsores)
nerve injury
reduced respiration
musculoskeletal injury
lumbar injury

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SHEAR INJURY

tissue injury or necrosis that results when 2 tissue planes are forcefully pulled in OPPOSITE directions

** DIABETIC patients are prone to this

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POSTIONING CONTD.

perioperative

pre-op, intra op, post op

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pre surgical testing includes..

lab/diagnostic tests
complete H&amp;P
complet pre op assessment 
anesthesia clearance
med. clearance
CONSENT forms

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ambulatory surgery

same day surgery

-patient can go home same day of procedure (hospitals trying to make this more prevelant

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patient physical prep.

-hair removal
-pre shower (w antiseptic wash)
-ENEMA
-NPO (nothing by mouth, b/c of aspiration during surgery)
…worst case an NG tube is used to suck food/water out of patients stomach

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what happens in pre op holding area ?

patient interview by admitting RN, circ RN, anesthesia team, surgical team

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why is patients identification so important?

correct patient
correct surgeon
correct procedure
correct site/side

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why is it important for patients to not wear nail polish for surgery?

bc of CYANOSIS

-pulse oximeter on finger may not give accurate read

transport methods for patient

Gurney
stretcher
cart
bed (for icu patients usually)
wheelchair
crib/ isolette (babies, children, neonatal )
ambulation (orthopedic service)

safety features of transports methods

side rails
safety strap (2 in above knee)
wheel locks

*PUSH FROM HEAD; FEET FIRST
*IN ELEVATOR HEAD FIRST (so feet face door when exiting)

where should drainage and IV fluids be placed in relation to stretcher etc?

drainage: below stretcher level IV: above stretcher level

if a patient is on a ventilator, how are they transported?

there MUST be an MD or resident present during transfer,or they have to transfer themselves **patients who are ventilated must be transported on a BED

if patient is pre medicated , how should they be transported?

on a stretcher

crutchfield tongs

cervical traction device *goes around head to keep neck or spine in place

transfer equipment/devices

- slider board - roller board - lift sheet (also can use clean garbage bag)

PATIENT SKIN PREP. | what does I&D mean?

irrigate and drain

skin prep. supplies

- basins (for antiseptic soap/or solution) - applicators - gauze - sponges - cotton tip swabs - sterile gloves - towels for blotting/drying

Chloraprep (stick)

Chlorahexidene gluconate (CHG) - contains alcohol - solution soaks into attached sponge on stick * *takes 3 mins to dry (to avoid fire ) - very common

Duraprep

- contains alcohol (isopropyl 70%) - takes 3 mins to dry * *mostly used for orthopedic and spine surgeries - comes with two large cotton tip swabs

eschemia

loss of blood supply in tissue

iodine and iodophors

contains no alcohol | -comes in either a bottle or scrub brush

hexachlorophine

was one widely used as disinfectant , found in toothpaste now and soaps

hibiclens

used for tonsil removal

skin prep procedure:

1. assemble necessary equipment 2. establish sterile field 3. prepare solutions 4. expose site to be prepped 5. provide adequate lighting 6. place protective pads/drapes 7. Don sterile gloves 8. wet applicator with scrub solution 9. scrub skin (circular motion, dirty to clean or incision toward periphery) for min of 5 mins. (changing sponge through out each scrub) step 1:scrubbing step 2: painting 10. pat/blot dry with sterile towel

autograft

skin etc taken from patients own body | -donor site prepped 1st

types of drapes

- towels - fenestrated (with an opening) - non-fenestrated - adhesive - specialty (neuro etc) - incise drape - U-drape - leggings (for GYN,GU cases)

what are incise(sticky) drapes used for?

orthopedic cases ** extra drape on top w/ iodine infused in it

U-drape

for arms and legs | *wraps around so that only certain area is exposed

what is most common drape?

laparotomy drape

equipment draping

includes tables, ring stands, mayo stands, or anything that comes in contact wit sterile field

how are drapes stacked?

in order of use

name for towel clips?

BACKHAUS **towels clips become unsterile once used for draping bc they touch patient skin

what is done before draping with towels?

the towel square off | **usually done with surgeon or surgeon may do it himself , you would just hand them the towels

split sheet drape

back table cover, "half sheet"

lithotomy pack

comes with leggings for GYN, GU procedures

U-bar drapes

used for ortho. | -legs, knees etc

extremity drape

``` used for ... -fingers -toes -hands -ankle etc. ``` **used with stockinette

stockinette

used to pull finger or arm, foot THROUGH the extremity drape **goes on before extremity drape

if a drape gets wet or tears during procedure, what is done?

area gets covered by impervious drape or adhesive square tape

what is the point of draping?

- to create a sterile barrier - an extension of sterile field - to expose intended surgical site