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SURGICAL POSITIONS/PERIOPERATIVE INFO. > CH. 18 & 19 > Flashcards

CH. 18 & 19 Flashcards

1
Q

surgical positions

A 
Supine (Dorsal Recumbent)
Trendelenberg
Reverse Trendelenberg
Lithotomy
Fowler
Lateral (SIMS)
Prone
Kraske(Jack Knife)
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2
Q

supine (dorsal recumbent)

A

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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3
Q

Trendelenberg

A

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

**may use shoulder brace

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4
Q

reverse trendelenberg

A

patient lays on back w/ feet down, head up

procedures: upper peritoneum, lower esophagus

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5
Q

lithotomy

A

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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6
Q

fowler (sitting)

A

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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7
Q

lateral (SIMS)

A

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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8
Q

prone

A

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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9
Q

kraske (jack knife)

A

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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10
Q

modifications for positions

A

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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11
Q

3basic positions

A

supine, lateral, prone

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12
Q

name for elbow area?

A

olecranon process

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13
Q

hypoxia

A

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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14
Q

what are some positioning consequences?

A
  • skin break down (bedsores)
  • nerve injury
  • reduced respiration
  • musculoskeletal injury
  • lumbar injury
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15
Q

SHEAR INJURY

A

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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16
Q

POSTIONING CONTD.

perioperative

A

pre-op, intra op, post op

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17
Q

pre surgical testing includes..

A 
lab/diagnostic tests
complete H&P
complet pre op assessment 
anesthesia clearance
med. clearance
CONSENT forms
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18
Q

ambulatory surgery

A

same day surgery

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

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19
Q

patient physical prep.

A

-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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20
Q

what happens in pre op holding area ?

A

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

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21
Q

why is patients identification so important?

A
  • correct patient
  • correct surgeon
  • correct procedure
  • correct site/side
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22
Q

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

A

bc of CYANOSIS

-pulse oximeter on finger may not give accurate read

23
Q

transport methods for patient

A
  • Gurney
  • stretcher
  • cart
  • bed (for icu patients usually)
  • wheelchair
  • crib/ isolette (babies, children, neonatal )
  • ambulation (orthopedic service)
24
Q

safety features of transports methods

A

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)
25
Q

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

A

drainage: below stretcher level

IV: above stretcher level

26
Q

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

A

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

27
Q

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

A

on a stretcher

28
Q

crutchfield tongs

A

cervical traction device

*goes around head to keep neck or spine in place

29
Q

transfer equipment/devices

A
  • slider board
  • roller board
  • lift sheet (also can use clean garbage bag)
30
Q

PATIENT SKIN PREP.

what does I&D mean?

A

irrigate and drain

31
Q

skin prep. supplies

A
  • basins (for antiseptic soap/or solution)
  • applicators
  • gauze
  • sponges
  • cotton tip swabs
  • sterile gloves
  • towels for blotting/drying
32
Q

Chloraprep (stick)

A

Chlorahexidene gluconate (CHG)

  • contains alcohol
  • solution soaks into attached sponge on stick
  • *takes 3 mins to dry (to avoid fire )
  • very common
33
Q

Duraprep

A
  • contains alcohol (isopropyl 70%)
  • takes 3 mins to dry
  • *mostly used for orthopedic and spine surgeries
  • comes with two large cotton tip swabs
34
Q

eschemia

A

loss of blood supply in tissue

35
Q

iodine and iodophors

A

contains no alcohol

-comes in either a bottle or scrub brush

36
Q

hexachlorophine

A

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

37
Q

hibiclens

A

used for tonsil removal

38
Q

skin prep procedure:

A
  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
39
Q

autograft

A

skin etc taken from patients own body

-donor site prepped 1st

40
Q

types of drapes

A
  • towels
  • fenestrated (with an opening)
  • non-fenestrated
  • adhesive
  • specialty (neuro etc)
  • incise drape
  • U-drape
  • leggings (for GYN,GU cases)
41
Q

what are incise(sticky) drapes used for?

A

orthopedic cases

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

42
Q

U-drape

A

for arms and legs

*wraps around so that only certain area is exposed

43
Q

what is most common drape?

A

laparotomy drape

44
Q

equipment draping

A

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

45
Q

how are drapes stacked?

A

in order of use

46
Q

name for towel clips?

A

BACKHAUS

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

47
Q

what is done before draping with towels?

A

the towel square off

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

48
Q

split sheet drape

A

back table cover, “half sheet”

49
Q

lithotomy pack

A

comes with leggings for GYN, GU procedures

50
Q

U-bar drapes

A

used for ortho.

-legs, knees etc

51
Q

extremity drape

A 
used for ...
-fingers
-toes
-hands
-ankle 
   etc.

**used with stockinette

52
Q

stockinette

A

used to pull finger or arm, foot THROUGH the extremity drape

**goes on before extremity drape

53
Q

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

A

area gets covered by impervious drape or adhesive square tape

54
Q

what is the point of draping?

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

SURGICAL POSITIONS/PERIOPERATIVE INFO. (1 decks)

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