Informed Consent, Standard Precautions, Urinary Cath, & Sutures

Question 1

informed consent

Answer 1

the moral, ethical, and legal obligation of the healthcare provider which is based on the principle of patient autonomy and is required before all procedures that involve potential risk

Question 2

consequences of not obtaining informed consent

Answer 2

negligence or battery

Question 3

negligence

Answer 3

the failure to provide the standard of care by failing to inform a patient properly on the risk and benefits of a procedure

Question 4

battery

Answer 4

the unlawful touching of patients without their expressed consent

Question 5

three conditions of informed consent

Answer 5

patient capacity and competence, clear information about risks, benefits, and alternative treatments or not doing anything, and voluntary consent without coercion or manipulation

Question 6

capacity

Answer 6

the ability to receive information, process and understand it, calculate options, make a decision, and articulate and defend the decision

Question 7

those considered incapacitated

Answer 7

those legally deemed incompetent, minors, those under the influence of substances, those with AMS, and those with impaired mental functioning

Question 8

professional standard for consent

Answer 8

compares providers of similar skill set to the care you provide

Question 9

reasonable person standard for consent

Answer 9

disclosure of anything a reasonable person may ask or would want to know to make an informed decision

Question 10

exceptions that do not require informed consent

Answer 10

emergencies, unconscious patients, minors or legally incompetent patients without a guardian present, waived consent, public health risk, therapeutic privilege - controversial and rarely holds up in court

Question 11

contact precautions

Answer 11

prevents transmission of microorganisms spread by direct/indirect contact with the source, includes the use of gloves, gown, and handwashing with soap and water!!! (MRSA, VRE, RSV, C. Diff, and contagious skin infections including lice and scabies)

Question 12

droplet precautions

Answer 12

prevents transmission of microorganisms spread by large, moist droplets inhaled by or landing on the mucous membranes of the susceptible host (coughing or sneezing), includes the use of a surgical mask within the 3-foot zone in addition to standard precautions (Influenza, COVID, Neisseria meningitis, some pneumonias, vaccine-preventable diseases like rubella, mumps, and pertussis)

Question 13

airborne precautions

Answer 13

prevents transmission of microorganisms spread by very small particles (< 5 um) that drift on air currents, includes the use of special air handling/ventilation (negative pressure room), door remaining closed, and a fit-tested N95 respirator in addition to standard precautions (COVID, pulmonary TB, varicella, smallpox, measles, and severe ARDS)

Question 14

sequence for donning PPE

Answer 14

gown > mask or respirator > goggles or face shield > gloves

Question 15

sequence for doffing PPE

Answer 15

gloves > goggles or face shield > gown > mask or respirator

Question 16

sequence for removing mask/respirator

Answer 16

untie or remove the bottom tie/elastic first followed by the top tie/elastic

Question 17

Coude catheter

Answer 17

catheter that has a curved tip for use with enlarged prostate

Question 18

Triple lumen catheter

Answer 18

catheter with an inflow lumen to use for bladder irrigation

Question 19

Councill tip catheter

Answer 19

catheter with a hole at the tip that can be threaded over a wire

Question 20

most common size urinary catheter

Answer 20

16 French (16Fr)

Question 21

indications for urinary catheterization

Answer 21

bladder outlet obstruction, urinary retention, accurate measurement of urinary output in critically ill patients, perioperative use in selected surgeries, to assist in the healing of open sacral or perineal wounds in incontinent patients, prolonged immobilization, or to improve comfort for end of life care

Question 22

contraindications to urinary catheterization

Answer 22

known or suspected urethral injury (such as pelvic fracture) causing gross hematuria, blood at the urethral meatus, perineal ecchymosis, high-riding prostate on DRE, any sign associated with urethral trauma, presence of artificial urethral sphincter, and lack of adequate indication

Question 23

urinary catheterization supplies

Answer 23

sterile gloves and drapes, povidone or iodine liquid and cotton balls or swabs, sterile catheter with 10 cc sterile water for inflating balloon, sterile lubricant, and appropriate size catheter with drainage bag attached

Question 24

risks associated with urinary catheterization

Answer 24

infection, bleeding, and injury to the urethra or surrounding structures

Question 25

lacerations with increased infection risk

Answer 25

wounds with debris, animal/human bite wounds, organic matter, old wounds (6-24 hours), wounds > 5cm, lower limb wounds, retained foreign body, and patient history of DM, malnutrition, smoking, and immunocompromise

Question 26

contraindications to wound closure

Answer 26

heavily contaminated wounds, evidence of infection already, old wounds, extensive tissue damage, bite wounds, and puncture wounds

Question 27

primary intention wound healing

Answer 27

closure of a wound with sutures leaving a fine scar

Question 28

secondary intention wound healing

Answer 28

closure of a wound naturally through the formation of new epithelial cells and scar tissue

Question 29

areas to avoid using epinephrine

Answer 29

fingers, nose, penis, and toes

Question 30

lidocaine onset and duration of action

Answer 30

onset is 2 mins, lasts 30-60 mins

Question 31

bupivacaine onset and duration of action

Answer 31

onset is 5 mins, lasts 2-4 hours

Question 32

goals of suturing

Answer 32

wound edge approximation, adequate wound tension, hemostasis, wound healing, prevention of infection, aesthetically pleasing scar

Question 33

monofilament suture characteristics

Answer 33

smooth, glides easily through tissue, has good tensile strength, difficult to knot, can be damaged by gripping it with needle driver or forceps, less infection risk

Question 34

multifilament suture characteristics

Answer 34

composed of several filaments twisted or braided together creating better tensile strength, less smooth passage through tissue, easy to knot, increased inflammatory risk, and increased risk of infection due to grooves

Question 35

absorbable suture characteristics

Answer 35

elicits a marked inflammatory response and is degraded by enzymes, hydrolysis, and phagocytosis, loses most of its tensile strength within 2 months (typically absorbed in about 60 days), good for use in deep spaces such as subcutaneous wounds, mucous membranes, kids, tongue, and nailbeds

Question 36

non-absorbable suture characteristics

Answer 36

encapsulated or walled off by fibrosis, usually inert with minimal tissue reactivity, used to suture at sites where tensile strength needs to be maintained, good for use on the skin

Question 37

lines of Langerhans

Answer 37

topological lines drawn on a map of the human body parallel to the natural orientation of underlying collagen fibers - if skin is disrupted parallel to the long axis of the fibers, the wound tends to reapproximate

Question 38

simple interrupted sutures

Answer 38

accounts for the majority of wound closure in uncomplicated wounds

Question 39

running sutures

Answer 39

aka baseball stitch used for quick closure, one break causes entire stitch failure

Question 40

running locking sutures

Answer 40

used for quick closure but provide a bit more pressure compared to running sutures which helps with hemostasis, keeps the tension equal across the wound

Question 41

horizontal mattress sutures

Answer 41

used to close gaping wounds to disperse tension and good at wound eversion, avoid tying too tight or can lead to necrosis

Question 42

vertical mattress sutures

Answer 42

used to close wounds where tension is a concern such as with thin fragile skin and will evert wound edges more, near-near-far-far

Question 43

figure of eight sutures

Answer 43

classically used more for hemostasis, great for bleeding vessel

Question 44

running subcuticular stitches

Answer 44

used frequently for post-op incision closure and ensure even distribution of wound tension - often used in plastic surgery

Question 45

simple buried sutures

Answer 45

used for deep wounds/incisions where the wound is closed in layers to take tension off wound edges, knot is buried

Question 46

suture size for scalp

Answer 46

3-0 or 4-0

Question 47

suture size for face/ear

Answer 47

6-0 (4-0 or 5-0 for deep)

Question 48

suture size for neck

Answer 48

5-0

Question 49

suture size for trunk

Answer 49

4-0 or 5-0

Question 50

suture size for extremity

Answer 50

4-0 or 5-0

Question 51

suture size for overlying joint

Answer 51

3-0 or 4-0

Question 52

suture size for hands/feet

Answer 52

4-0 or 5-0

Question 53

suture size for nailbed

Answer 53

5-0

Question 54

scalp suture removal

Answer 54

7-12 days

Question 55

face/ear suture removal

Answer 55

4-6 days

Question 56

neck suture removal

Answer 56

7-8 days or allow to dissolve

Question 57

trunk suture removal

Answer 57

7-12 days

Question 58

extremity suture removal

Answer 58

7-14 days

Question 59

overlying joint suture removal

Answer 59

10-14 days

Question 60

hands/feet suture removal

Answer 60

7-12 days

Question 61

nailbed suture removal

Answer 61

allow to dissolve (absorbable)

Question 62

complications of leaving suture material for too long

Answer 62

stitch abscess, scar, or stitch mark

Question 63

wounds to consider prescribing antibiotics for

Answer 63

heavily contaminated wounds, wounds involving tendons/joints/fractures, punctures in the foot, oral wounds, bite wounds, deep wounds on hands or in immunocompromised patients (also apply dressing for 24-48 hours)