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Advanced Clinical Skills > Informed Consent, Standard Precautions, Urinary Cath, & Sutures > Flashcards

Informed Consent, Standard Precautions, Urinary Cath, & Sutures Flashcards

1
Q

informed consent

A

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

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2
Q

consequences of not obtaining informed consent

A

negligence or battery

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3
Q

negligence

A

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

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4
Q

battery

A

the unlawful touching of patients without their expressed consent

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5
Q

three conditions of informed consent

A

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

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6
Q

capacity

A

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

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7
Q

those considered incapacitated

A

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

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8
Q

professional standard for consent

A

compares providers of similar skill set to the care you provide

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9
Q

reasonable person standard for consent

A

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

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10
Q

exceptions that do not require informed consent

A

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

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11
Q

contact precautions

A

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)

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12
Q

droplet precautions

A

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)

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13
Q

airborne precautions

A

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)

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14
Q

sequence for donning PPE

A

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

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15
Q

sequence for doffing PPE

A

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

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16
Q

sequence for removing mask/respirator

A

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

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17
Q

Coude catheter

A

catheter that has a curved tip for use with enlarged prostate

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18
Q

Triple lumen catheter

A

catheter with an inflow lumen to use for bladder irrigation

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19
Q

Councill tip catheter

A

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

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20
Q

most common size urinary catheter

A

16 French (16Fr)

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21
Q

indications for urinary catheterization

A

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

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22
Q

contraindications to urinary catheterization

A

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

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23
Q

urinary catheterization supplies

A

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

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24
Q

risks associated with urinary catheterization

A

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

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25
Q

lacerations with increased infection risk

A

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

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26
Q

contraindications to wound closure

A

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

27
Q

primary intention wound healing

A

closure of a wound with sutures leaving a fine scar

28
Q

secondary intention wound healing

A

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

29
Q

areas to avoid using epinephrine

A

fingers, nose, penis, and toes

30
Q

lidocaine onset and duration of action

A

onset is 2 mins, lasts 30-60 mins

31
Q

bupivacaine onset and duration of action

A

onset is 5 mins, lasts 2-4 hours

32
Q

goals of suturing

A

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

33
Q

monofilament suture characteristics

A

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

34
Q

multifilament suture characteristics

A

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

35
Q

absorbable suture characteristics

A

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

36
Q

non-absorbable suture characteristics

A

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

37
Q

lines of Langerhans

A

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

38
Q

simple interrupted sutures

A

accounts for the majority of wound closure in uncomplicated wounds

39
Q

running sutures

A

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

40
Q

running locking sutures

A

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

41
Q

horizontal mattress sutures

A

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

42
Q

vertical mattress sutures

A

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

43
Q

figure of eight sutures

A

classically used more for hemostasis, great for bleeding vessel

44
Q

running subcuticular stitches

A

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

45
Q

simple buried sutures

A

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

46
Q

suture size for scalp

A

3-0 or 4-0

47
Q

suture size for face/ear

A

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

48
Q

suture size for neck

A

5-0

49
Q

suture size for trunk

A

4-0 or 5-0

50
Q

suture size for extremity

A

4-0 or 5-0

51
Q

suture size for overlying joint

A

3-0 or 4-0

52
Q

suture size for hands/feet

A

4-0 or 5-0

53
Q

suture size for nailbed

A

5-0

54
Q

scalp suture removal

A

7-12 days

55
Q

face/ear suture removal

A

4-6 days

56
Q

neck suture removal

A

7-8 days or allow to dissolve

57
Q

trunk suture removal

A

7-12 days

58
Q

extremity suture removal

A

7-14 days

59
Q

overlying joint suture removal

A

10-14 days

60
Q

hands/feet suture removal

A

7-12 days

61
Q

nailbed suture removal

A

allow to dissolve (absorbable)

62
Q

complications of leaving suture material for too long

A

stitch abscess, scar, or stitch mark

63
Q

wounds to consider prescribing antibiotics for

A

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)

Advanced Clinical Skills (1 decks)

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