Fund Ch 37 + 38 Flashcards
the loss of sensory perception
anesthesia
collapsed or airless part of the lung; collapse of alveoli
atelectasis
transfusion from one’s own body
autologous transfusion
surgery that alleviates or cures a problem
curative surgery
separation of the layers of the surgical wound; spontaneous opening of an incision
dehiscence
clot that travels and lodges in a vessel
embolus
extrusion of the viscera through a surgical incision; protrusion of an internal organ through the incision
evisceration
acronym for light amplification by the stimulated emission of radiation
laser
surgery to relieve pain or complications
palliative surgery
obstruction of the intestines from inhibition of bowel motility
paralytic ileus
period from the time of the decision to have surgery through recovery from the procedure
perioperative
inflammation and consolidation of the lung with exudate
pneumonia
artificial body part
prosthesis
stoppage of flow
stasis
blood clot causing inflammation of a vessel
thrombophlebitis
formation of a thrombus (blood clot)
thrombosis
localized infection consisting of an accumulation of purulent material made up of debris from phagocytosis when microorganisms have been present
abscess
fibrous band that holds parts together that are normally separated
adhesion
to close together, as in wound healing
approximate
degree of closure of a wound
approximation
support bandage that wraps around the breasts or abdomen and is secured with ties, Velcro, or elastic
binder
acute, spreading inflammation of the deep subcutaneous tissues and sometimes muscle, which may be associated with abscess formation
cellulitis
fibrous structural protein of all connective tissue
collagen
redness of the skin caused by congestion of the capillaries in the lower layers of the skin that occurs with any skin injury, infection, or inflammation
erythema
fluid in or on tissue surfaces that has escaped from blood vessels in response to inflammation, and that contains protein and cellular debris
exudate
insoluble protein essential to clotting
fibrin
type of wound healing (closure) for wounds with little tissue loss, such as a surgical incision
first intention
abnormal, tubelike passage within body tissue, usually between two internal organs or leading from an internal organ to the body surface
fistula
connective tissue with multiple small blood vessels
granulation tissue
arrest of the escape of blood by natural (clot formation or vessel spasm) or artificial (compression) means, or the interruption of blow flow to a part
hemostasis
permanent raised, enlarged scar
keloid
breakdown, disintegration; also reduction or abatement
lysis
the softening of tissue that increases the change of trauma or infection
maceration
local death of tissue from disease or injury
necrosis
clumping of platelets during wound healing
platelet aggregation
containing thick typically white-yellow or yellow exudate, caused by infection
purulent
bloody
sanguineous
type of wound healing for wounds with tissue loss, as in pressure injuries; the wound remains open and fills with scar tissue
second intention
composed of serum and blood
serosanguineous
canal or passageway leading to an abscess
sinus
when a layer of dead tissue separates from living tissue; to shed dead tissue
sloughing
the formation of purulent matter
suppuration
type of wound healing; delayed or secondary closure, such as a draining abdominal wound
third intention
begins with the administration of the anesthetic agent and ends when the patient becomes unconscious. Hearing is amplified at the end of this stage.
Stage 1 The stage of analgesia
muscles become tense, but swallowing and vomiting reflexes are still present. Breathing may become irregular or the breath may be held. The environment should be kept quiet during this period
Stage 2 The excitement phase
begins with the return of regular breathing. Vital functions are depressed; eyes are fixed; and reflexes are lost or temporarily depressed. The surgical procedure is begun during this stage
Stage 3 surgical anesthesia state
spontaneous respirations are absent. The patient is maintained by the anesthesia machine, which supplies oxygen and a set rate of breaths
Stage 4 complete respiratory depression
When can an illiterate person sign a consent with an X
only legal if they are not capable of writing their name and it needs to be witnessed by the nurse or doctor
If you have a minor that needs emergency surgery you need to know about consent involving that situation
If the patient is a minor another responsible party such as a parent or guardian must be present for the explanation and may need to sign the consent form. The signature of the patient or the responsible party is witnessed by another party, often a staff member
What do you do if someone is unconscious and they need emergency surgery, how would you obtain consent
try to contact family and if you cannot get ahold of them, receive a second surgeons opinion
If the operative permit, consent form for operation, has a misspelled name what happens?
you cannot perform surgery on a consent form that is not valid, everything needs to be spelled correctly
(know) Someone is coming out of that PACU and onto the surgical unit, they are wanting a drink of water, before you give them a drink of water you want to make sure they have a gag reflex and can swallow before you give it to them
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(know) To Prevent errors in the surgical procedure, before presurgical medication each patient much participate with marking the surgical site
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(know) If someone wants to wear a wedding band into the Operating Room, tape it
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(know) Very young and older adult surgical patients have hydration issues
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Pre Admission testing before a patients surgery and they are wanting to know how long they will be in the recovery unit
2 to 6 hours
Circulating nurse, what is she responsible for?
ruling out contamination, breaking sterile field
If you want to maintain an airway, what is the easiest way to position your patient
in a side lying position
If there is drainage on the dressing right out of surgery, what are you supposed to do?
outline the area with a pen and mark it with the date and time
Sequential compression boots…
DVT, a squeeze may help with keeping your circulation from pooling
(know) If they have a urine output of 52 ml in the last 2 hours, that’s a problem, let the doctor know
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(know) Before you can advance a diet you need to check for bowel sounds, make sure that they have peristalsis
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One of the ways to help with gas pains after surgery is to..?
get them to walk around, early ambulation
(know) You are preparing to get a patient out of bed for the first time since surgery you need to let them sit with the head of the bed raised to high fowlers then let them sit for a minute, then let them dangle for a minute, take the process slow to avoid orthostatic hypotension
…
If the patient had surgery, what do you NOT want them to do within the first 24 hours?
Alcohol must be avoided 24 hours after surgery and patients should not drive or make important decisions for 24 hours after anesthesia
begins immediately after injury and lasts 3 or 4 days. Swelling or edema of the injured part. Erythema (redness) resulting from the increased blood supply. Heat or increased temperature at the site. Pain stemming from pressure on nerve receptors. A possible loss of function resulting from all these changes.
The inflammatory phase
begins on the third or fourth day after injury and lasts 2 to 3 weeks. In this phase the wound is filled with new connective tissue, and new epithelium will cover the wound
the proliferation or reconstruction phase
the final stage of healing, maturation, begins approximately 3 weeks after injury. Scar begins to form
the maturation or remodeling phase
When you have a wound, it’s going to be inflamed for 48 to 72 hours.. How does that work?
vessels dilate and allow plasma to leak into the wound site
The reduction of functional hemoglobin, which limits the hemoglobins oxygen carrying ability, how do you improve this situation for your patient
stop smoking
If you have a patient that is fresh out of surgery, you will see internal hemorrhaging within 48 hours, you need to know the signs and symptoms for that
Internal hemorrhage is evidenced by swelling or distention in the area of the wound and perhaps bloody drainage from a surgical drain. If internal hemorrhage is extensive, hypovolemic shock may occur with a fall in blood pressure, rapid and thready pulse, increased respiratory rate, restlessness, diaphoresis, and cold clammy skin
Hemorrhaging results in what?
fluid volume deficit, hypovolemia
What causes dehiscence?
a soggy wound, decreased tissue perfusion, excessive serosanguinous drainage. When a surgical wound opens up because its too wet
The patient has had abdominal surgery and they say they feel like something just let go, that is a sign of dehiscence, what do you do about that?
Quickly place the patient supine and place large sterile dressings, or towels soaked in normal saline, over the incision and viscera. Notify the surgeon immediately and prepare the patient for return to surgery
Jackson pratt wound drain, know how to clean it and maintain it, and procedure for emptying
Plastic drainage tube connected to a drainage system that is compressed and closed, applying slight suction to the drainage tube to help to evacuate wound fluids. The fluid in a drainage device is measured and then emptied at the end of each shift ,and the amount drained is entered on the intake and output record. The skin around the drain is cleansed during each dressing change.
(know) Know about non adherent dressings like telfa, put the shiny side down so all the drainage can go through the shiny side and absorb on the opposite side so its not excessively wet
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You need to know about montgomery straps
because an abdominal wound requires frequent abdominal changes the abdomen begins to show signs of skin irritation from repeated tape removal, use montgomery straps to prevent from using tape over and over, they allow the dressing to be changed without constantly reapplying tape
If you have a stage 1 pressure ulcer what would be an appropriate wound care measure
put a thin film dressing over it to keep the shearing force from opening it
(know) Pooling of blood under unbroken skin, you suspect deep tissue injury or hematoma
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(know) You’re cleaning a wound, you always start in the center and work you way out in a circular motion so you don’t contaminate the wound
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How do you remove tape from an old dressing
pull towards the wound to prevent alteration of the wound
Hydrocolloid dressings
include (exclude?) air and promote breakdown of necrotic tissue
(know) Don’t ever debris a heel, you can get the dressing wet but no debridement of any kind
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Eye irrigation, how are you going to position the patient
supine with the head tilted toward the right eye if the right eye is what is affected — position them toward the affected eye
(know) When removing staples bend it in the middle and pull it straight out
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(know) Back in assisted closure, wound vacs, it draws the wound edges together tight by negative pressure
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You need to know what all needs to be on an informed surgical consent, select all that apply, a medical status does not need to be on there, neither does consent to blood transfusion because blood transfusion is its own separate consent
The need for the procedure, a description of the procedure to be performed, its risks and benefits, and alternative treatments available and their possible consequences
If you are preparing a surgical patients room for a return from the PACU, how do you prepare the room
Make the bed with fresh linen, including a draw sheet placed at shoulder height. Place an underpad at the hip area. Fanfold the top covers to the far side of the bed or to the bottom of the bed. Have the bed in a raised position at the height of the gurney that will return the patient, and arrange furniture so that the gurney can be pulled up alongside the bed. Gather an emesis basin, tissues, a workstation on wheels, frequent vital signs sheet or postoperative record, an intake and output sheet, a small towel and washcloth, and a pencil and place them on the bedside table or console. Place an IV pole at the head of the bed. Connect oxygen and suction equipment if their need is anticipated. A thermometer, BP cuff and stethoscope, and pulse oximeter should be nearby on the patient’s return to the unit. If a PCA pump, sequential pneumatic compression devices, or a passive range of motion machine will be needed, see that they are obtained and ready
If someone is HIV immunocompromised the patient’s ability to heal will be hindered, why?
they have inadequate fibroblast functions, lack of adequate phagocytosis and lack of synthesis of collagen
Know medications that contribute to delayed healing
Antineoplastic drugs, heparin, and steroids
Age related changes that cause slower healing for the elderly
?? sclerosis, diminished or decreased lung function, and slow metabolism
If someone has diabetes, where do you want their blood glucose level at?
Less than 200ml per vessileter
What does dakin’s solution do
it debris’
A raised scar, colloid overgrowth and seen primarily in dark pigmented skin what are those called?
keloid
