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
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.
3
Q
MRSA
A
- Aerobic
- Gram-positive Staphylococcus
- Methicillin Resistant Staph Aureus
- 20-30 % carry this
4
Q
Group A Streptococcus
A
- Aerobic
- Gram positive streptococcus
- (may cause necrotozing fasciitis)
- not contagious
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
6
Q
- Escherichia coli
- Klebsiella sp.
- Proteus sp.
A
- Aerobic
- Gram-negative bacilli
- all normal flora of the GI tract
7
Q
Clostridium difficile
A
- Anaerobic
- Gram-positive bacilli
- pseudomembranous colitis
- common nosocomial
- contact precautions
- antibiotics wipe out all the good bugs
8
Q
Bacillus stearothermophilus
A
is used for testing autoclaves (AKA “Attest”)
9
Q
*Bacteroides sp.
A
- Anaerobic
- Gram-negative bacilli
- normal flora of the gut
- cause gingivitis and periodontal disease
10
Q
GRAM-NEGATIVE BACTERIA ARE THE PRIMARY CONTAMINANTS IN
A
NOSOCOMIAL INFECTIONS
11
Q
Candida albicans
A
- Fungi
- AKA “thrush” (mouth), AKA “yeast” (vagina)
- can be normal flora of the mouth
12
Q
Sources of Contamination
A
- Community-acquired infection:
- Spontaneous
- Traumatic
- Nosocomial
- Endogenous
- Exogenous
13
Q
Community-acquired infection
A
- Spontaneous – Appendicitis, cholecystitis, peritonitis (kinda like endogenous)
- Traumatic – Compound fractures, penetrating wounds (kinda like exogenous)
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
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
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.
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.
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
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”.
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
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”
- Develop in response to:
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 .
