Final Exam Flashcards

1
Q

Infection definition

A
  • the growth of pathogenic microorganisms in living tissue; it refers to the disease-producing process, not the routine multiplication of normal flora.
  • can have MOs without infection
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2
Q

Review of Microbiology

A
  • Pathogenic microorganisms are those that cause disease
  • Sepsis: a severe, toxic, febrile condition resulting from infection with pathogenic microbes, usually pyogenic (pusforming)
  • Bacterial infections most frequently cause “hospital-acquired” infections.
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3
Q

MRSA

A
  • Aerobic
  • Gram-positive Staphylococcus
  • Methicillin Resistant Staph Aureus
  • 20-30 % carry this
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4
Q

Group A Streptococcus

A
  • Aerobic
  • Gram positive streptococcus
  • (may cause necrotozing fasciitis)
  • not contagious
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5
Q

Mycobacterium Tuberculosis

A
  • Aerobic bacteria
  • A hardy bacillus- can live in soil for a long time
  • Most common transmission route/infection site: airborne/lungs
  • May be present as a “cyst” elsewhere in the body
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6
Q
  • Escherichia coli
  • Klebsiella sp.
  • Proteus sp.
A
  • Aerobic
  • Gram-negative bacilli
  • all normal flora of the GI tract
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7
Q

Clostridium difficile

A
  • Anaerobic
  • Gram-positive bacilli
  • pseudomembranous colitis
  • common nosocomial
  • contact precautions
  • antibiotics wipe out all the good bugs
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8
Q

Bacillus stearothermophilus

A

is used for testing autoclaves (AKA “Attest”)

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9
Q

*Bacteroides sp.

A
  • Anaerobic
  • Gram-negative bacilli
  • normal flora of the gut
  • cause gingivitis and periodontal disease
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10
Q

GRAM-NEGATIVE BACTERIA ARE THE PRIMARY CONTAMINANTS IN

A

NOSOCOMIAL INFECTIONS

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11
Q

Candida albicans

A
  • Fungi
  • AKA “thrush” (mouth), AKA “yeast” (vagina)
  • can be normal flora of the mouth
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12
Q

Sources of Contamination

A
  • Community-acquired infection:
    • Spontaneous
    • Traumatic
  • Nosocomial
    • Endogenous
    • Exogenous
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13
Q

Community-acquired infection

A
  • Spontaneous – Appendicitis, cholecystitis, peritonitis (kinda like endogenous)
  • Traumatic – Compound fractures, penetrating wounds (kinda like exogenous)
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14
Q

Nosocomial Infections

A
  • Endogenous:
    • Develops from sources within the body
    • This raises the issue of cross contamination, especially “bowel technique” (isolating, fix contaminations)
  • Exogenous:
    • Acquired from sources outside the body
    • ex: healthcare worker didn’t wash hands
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15
Q

FACTS about nosocomial infections

A
  • About 35% of all nosocomial infections develop in surgical patients
  • The majority of these are related to instrumentation of the urinary tract and the respiratory tract.– isolate
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16
Q

Sepsis

A
  • Definitions:
    – A severe, toxic, febrile state resulting from infection.
    – The presence of pathogenic microbes or their toxins in the blood or other tissues.
  • three stages:
    – invasion
    – localization
    – either resolution leading to recovery, OR, spreading of the infection.
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17
Q

Development of Infection

A
  • Cellulitis (invasion)- diffuse inflammatory response
  • Abscess formation (localization):
    • the result of tissue liquefaction with pus formation
    • body attempts to wall off an abscess by means of a membrane that produces surrounding induration
  • An abscess should be promptly drained.
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18
Q

Regional infection

A
  • Occurs when localization does not contain the infection, and it spreads
  • The spreading infection enters the lymphatic system, causing lymphangitis. lymphnodes can help
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19
Q

Systemic infection

A
  • Septicemia may develop if the lymph nodes fail to contain the infection
    • Veins in the infected area form thrombophlebitis, which sloughs septic emboli into the circulatory system
    • These emboli and pathogenic microbes seed abscess formation in remote tissues
    • Bacterial septicemia is called “bacteremia”.
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20
Q

Septic Shock

A
  • Exists in a state of widely disseminated infection, usually borne by the bloodstream, ie septicemia
  • last stage before death
  • Early symptoms of septic shock:
    • Hypotension
    • Tachycardia
    • Rapid breathing
  • Symptoms of Advanced septic shock:–decompensation– NOT GOOD
    • Respiratory insufficiency
    • Cardiac decompensation
    • Diminished urinary output
    • DIC
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21
Q

Clinical Factors contributing to infection:

A
  • Pathogenic microbes
  • Local factors
  • Host Defense Mechanisms
22
Q

Pathogenic microbes

A
  • Must reach the host to cause infection
  • The size and virulence of the inoculum is VERY important.
  • can we stop it from reaching a new host?
23
Q

Local factors

A
  • Various body tissues have different powers of resistance
    • The face, scalp, and chest are more resistant than the abdomen, thigh, calf, and buttocks
    • Vascularity of the tissue is a major factor–more vascular= more able to fight off infection
24
Q

Host Defense Mechanisms

A
  • The general health of the patient is very important- how sick is your pt?
  • The virulence of the infecting organism is very important
  • Proper treatment plays a big part
25
Q

Diabetes and host defense mechanisms

A
  • The DIABETIC PATIENT DOESN’T HEAL WELL
  • Compromised vascular system
    • develop peripheral vascular disease
    • loss of sensation (can’t feel the injury, then gets infected)
  • Prone to infection
26
Q

Adjuvant factors to infection

A
  • Duration of pre-op hospitalization
  • Contaminated wounds
  • Procedures involving GI or GU tracts
  • Duration of the procedure- the longer it goes, the more things could go wrong
  • Surgical technique
    • injured tissues– don’t retract super hard
    • Implants
    • Excessive use of electrocautery creates necrotic tissue
  • Intravascular devices
  • Catheters
  • Drains- inspect
  • Any Implantable device
27
Q

Post-op Wound Infections

A
  • Incisional :
    • Infection occurs at the site of the incision
    • Involves skin, subcutaneous fat, or muscle
  • Deep :
    • Infection occurs in the surgical area
    • Involves tissues at or beneath the fascia
28
Q

Intra-operative Complications

A
  • Hemorrhage
  • Friable Tissue
  • Incidental Injury to other organs
29
Q

Intra-operative Complications (Hemorrhage)

A
  • Definitions:
    • Shock: A state of inadequate blood perfusion to parts of the body (most likely intraoperatively) hypovolemic
    • DIC: Disseminated Intravascular Coagulation – a condition in which the normal clotting mechanisms do not function (most likely postoperatively)
  • Treatment of intra-op hemorrhage (larger vessel)
    • Surgeon locates source and applies digital pressure
    • Clamps put in place
    • Vessel is then ligated or sutured
    • Blood volume may need to be replaced with transfusion, or with “Cell Saver”
30
Q

Friable Tissue

A
  • AKA: “Readily crumbled”
  • Tend not to hold suture well
  • Can be lacerated by vigorous retracting
  • Treat with chemical hemostatic agents
  • NSAIDS break down tissue
    • also radiation, smokers
  • Tumors (may be highly vascular): grow own blood supply
    • Malignant tumors
    • Hemangiomas
  • Friable Organs:
    • Liver, spleen, kidney, pancreas, thyroid
31
Q

Incidental Injury to other organs

A
  • Friable organs
  • Major Vessels
  • Ureters
  • Bowel
  • Urinary Bladder
32
Q

Incidental injury to Friable Organs

A
  • Injuries may result from:
    • Retractors- don’t retract hard
    • Dissection- delicate, slow
    • Sutures/ligatures- can tear through
33
Q

Incidental Injury to Major Vessels

A
  • Veins
    • Thin; tear easily
    • Difficult to suture effectively
  • Arteries– clamp off well
    • High pressure
34
Q

Incidental injury to Ureters

A
  • Anatomic relationship to pelvic structures
  • Surgeon must identify the ureters to prevent accidental clamping, ligating, or cutting- check for peristalsis
  • Ennervated smooth muscle; to identify, use a forceps, etc.
35
Q

Incidental injury to Bowel

A
  • May be cut during lysis of adhesions
  • May be torn by pulling and tugging– we will be in charge of retracting
  • Spillage of intestinal contents can cause infection & peritonitis (esp. large intest- colon)
36
Q

Incidental injury to Urinary Bladder

A
  • May be cut or torn, causing leakage of urine into the pelvic cavity, and bleeding
  • thin walls-easy to cut/tear
  • Hematuria: blood in the urine– check UDB
37
Q

Foreign material left in the patient

A
  • Sponges- worst thing-porous-MOs!
  • Instruments and Needles
  • Anything accidentally left in the patient must be removed!
  • all scrub’s job
38
Q

Post Operative Complications

A
  • Hemorrhage
  • Pain
  • Scarring
    • Keloids
    • Adhesions
  • Extravasation
  • Wound Disruption
  • Thrombosis
  • Incisional Hernia
39
Q

Post-op complications Hemorrhage

A
  • May occur any time after the wound is closed
  • Ties and hemoclips may slip off vessels
  • Clots can become dislodged (from chemical hemostatic agents)
  • Remember previous definitions
    • DIC–bigger risk post-op
    • Shock– more likely to happen intraoperatively
40
Q

Post-op complication Pain

A
  • Local Anesthetic-very acidic- burning sensation
    • Must be injected
  • General Anesthetic – many tradeoffs:
    • Intra-op – If improperly administered, patient may sometimes feel pain, but can be unable to respond
    • Post-op – nausea, vomiting, sore throat.
  • Retractors – bruising of tissues, tearing of muscles
  • Knives
41
Q

Post-op complication: Scarring

A
  • Keloids: hypertrophic skin scarring
  • Adhesions:
    • Develop in response to:
      • Previous abdominal or pelvic surgery
      • abrasion
      • Appendicitis or peritonitis.
      • Ischemia.
    • most common cause of post-op intestinal obstruction.
    • can cause infertility and chronic abdominal pain.
    • Lysis of adhesions: a common surgical procedure.
    • “Once Adhesions, Always Adhesions”
42
Q

Extravasation

A
  • Definition:The passage of blood, serum, or lymph into tissues. (fluid outside a vessel)
  • Edema: Abnormal accumulation of fluid in interstitial spaces of tissues. (plasma)
  • Hematoma: A collection of extravasated blood in tissue. (blood)
43
Q

Wound Disruption

A
  • Definition: separation of wound edges.
  • Occurs when:
    • wound fails to heal, sometimes due to:
    • suture material fails to secure wound
  • Acute wound disruption most frequently follows abdominal laparotomy
  • Wound Disruption is usually caused by distention (intra-abdominal pressure), or a sudden strain such as vomiting, coughing, or sneezing
44
Q

Types of wound disruption

A
  • Dehiscence: Splitting open of the layers of the wound.
  • Evisceration: Protrusion of viscera completely through the abdominal incision.
45
Q

Thrombosis

A
  • Definition: the development of a thrombus
  • Thrombus def: an aggregation (clump) of blood factors, especially platelets and fibrin; essentially, a “blood clot”
  • Thrombophlebitis def : Inflammation of a vein, associated with thrombosis.
46
Q

Venous Stasis

A
  • Definition: stagnation of normal flow; ie static instead of dynamic
  • The venous return of blood from the lower extremities can be slowed by:
    • The effects of general or spinal anesthesia
    • The position of the legs during prolonged surgical procedures.
47
Q

Effects of Venous Stasis

A
  • Thrombosis
  • Thrombophlebitis
48
Q

Deep Vein Thrombosis (DVT)

A
  • The majority of thrombi occur in the deep veins of the legs and pelvis, (aka”Deep Vein Thrombosis“).
  • These thrombi can become detached and be carried to the
    • lungs (pulmonary embolism),
    • heart (MI), or (heart attack)
    • brain (CVA) (stroke)
49
Q

Prevention of Thrombosis

A
  • Anti-embolic stockings (TED hose)
  • Elevation of legs
  • Sequential Compression Devices- attach to a unit
50
Q

Incisional Hernia

A
  • After a surgical wound has completely healed, a weakness can develop in the fascia at the incision site.
  • Segments of bowel can protrude through this weak spot, causing a hernia.
  • This is usually the result of impaired healing of a previous surgical incision, usually a ventral midline abdominal incision.
  • It must be surgically repaired .