Introduction Flashcards
1
Q
Name the four systemic disease to investigate in the potential surgical patient.
A
Diabetes,
Blood dyscrasias
Cardiac
Respiratory
2
Q
Name the key physical examinations prior to sx.
A
Height Weight All Vitals DTR's CN's Ophthalmic
3
Q
What are the two forms to be signed prior to sx?
A
Informed Consent
Authorization for sx
4
Q
Name the two key post sx care instructions.
A
- Rest after sx for at least 2-3 hrs.
2. Dr. must check on pt. 24 hrs p surgery.
5
Q
What is the first line of defense against secondary infection?
A
Establishment of a sterile field including you, instruments, and the patient.
6
Q
How are sterile fields are accomplished through what three areas?
A
- Sterilization of equipment
- Patient stabilization
- Maintenance of the sterile field.
7
Q
Name four methods of instrument sterilization.
A
- Steam Autoclave
- Gas Autoclave
- Dry sterilization
- Cold sterilization
8
Q
Only the gloved hands of the surgeon may contact the the area surrounding the Mayo stand. T/F
A
True
9
Q
The local anesthetic is applied prior to shaving the hair from the skin. T/F
A
True
10
Q
Name the body part where the hair is not removed.
A
Eyebrows
11
Q
Name the patient sterilization procedure in order. (4)
A
- Clean with green soap and H2O
- Scrub >5x with effective antiseptic (ie Bentadyne)
- Final step is to disinfect the skin with tincture of Merthiolate on cotton tip applicators (3), starting at the site and moving outward.
- Apply a sterile drape
12
Q
________ is the act of tearing, torn ragged, mangled wound
A
Laceration
13
Q
Define Laceration
A
the act of tearing, torn ragged, mangled wound
14
Q
_______ means not malignant, not recurrent, favorable for recovery.
A
Benign
15
Q
________ means to cut off.
A
Excise
16
Q
_________ means to cut into.
A
Incise
17
Q
_______ means to probe deep with a blunt instrument.
A
Sound
18
Q
_______ means to clean away damaged or necrotic tissue.
A
Debride
19
Q
_______ inhibits growth/development of microorganisms without necessarily destroying them.
A
Antiseptic
20
Q
____________ primary affect is to bring about temporary loss of localized sensory nerve function.
A
Anesthetic
21
Q
What is the number one complication to minor surgery?
A
PATIENTS ANXIETY LEVEL
22
Q
These two things can be prescribed within our scope!
A
Antiseptic:
Anesthetic:
23
Q
Which body type has the highest complication rate w/ minor sx?
A
Endomorph (short, heavy, large boned, lethargic, high BP–> slower to heal/greater risk factor)
24
Q
What is the acceptable age range for minor sx?
A
15-65 yrs old
25
These patients are VERY HIGH RISK, healing time increased, poor healers, prone to sec. infection.
Diabetics
26
Describe types and risks for minor sx for people with Blood Dyscrasias.
higher-risk,
| hemophilia, leukemia, simple anemia.
27
What is the special consideration for patient's with Heart Problems?
May be taking blood thinners (coumadin/heparin), can determine disease from medications.
28
Respiratory Complaints include ______.
asthmatics, emphysema, COPD (decrease in oxygen uptake --> acidosis)
29
What are examples of nervous disorders to think about with minor sx?
manic depression, schizophrenia, neurotics, psychotics, epileptics
30
Elective surgery must be preceded by proper lab analysis. Which labs are required? (3)
1) clotting time*
2) CBC
3) UA
* Prothrombin time (PT)AKA INR is a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working.
31
Prothrombin time (PT)AKA as _____?
A PT test may also be called an INR test. INR (international normalized ratio) stands for a way of standardizing the results of prothrombin time tests, no matter the testing method. It lets your doctor understand results in the same way even when they come from different labs and different test methods. In some labs, only the INR is reported and the PT is not reported.
32
_________ is reported to eliminate 50% of post sx complications.
Patient education
33
The number one complication to minor sx is______?
Infection is number one complication to minor surgery
34
The first line of defense against post op infection is?
Establishment of a proper sterile field for you, your instruments and your patient.
35
The best way to sterilize equipment is to use _____.
an autoclave
36
What is best described by - bacteria and spores, boiling water under pressure, 13 min/120 degrees/750mmHG (14.5 PSI), dulls sharpness
Steam Autoclaving
37
What is best described by -not cost effective and too dangerous, ethylene oxide (deadly), bacteria and spores, does not dull
Gas Autoclaving
38
What is best described by - dry heat (oven), 170 degrees/1 hour, WILL NOT KILL SPORES, used in emergency situations when others not avail.
Dry Sterilization
39
what is best described by - least effective method, iodine bath (providyne, beta dyne), when other methods cant be used
Cold Sterilization
40
What term is defined as a drug or compound used to prevent the invasion of the body by bacteria, do not necessarily kill bacteria all but prevent multiplication of it (bacteriostasis), if it kills all outright (germicidal)
Antiseptics
41
All antiseptics are compared to ________.
phenol
42
The strength or effectiveness of an antiseptic is called the __________,
Phenol coefficient
43
Name five Coal Tar Antiseptics.
1. Phenol- (AKA Carbolic Acid)
2. Cresol- Creolin, Cresolin and Lysol
3. Resorcinol
4, Thymol
5. Trinitrophenol (aka picric acid)
44
__________ is a coal tar antiseptic very powerful when above 80% (used for counters-caustic, not pt), precipitates the proteins in coat of bacteria, mild
anesthetic, camphorated (chest rub), calamine lotion (itching), concentrations of 2-20% for topical applications where bacteriostasis is desired.
Phenol- (AKA Carbolic Acid)
45
______ is a colorless/odorless crystal (turns pink with light) coal tar antiseptic, -1X coeff., chief use in ointment of 5-15% concen. for tx of psoriasis, eczema, erysipelas./
Resorcinol
46
This coal tar antiseptic is colorless, very soluble in alcohol, primary use for additive to mouth wash/astringent gargles (due mostly to odor/taste), antiseptic lotion for tx of diseases caused by fungi (ex. management of hookworm)
Thymol
47
This coal tar antiseptic is aka picric acid. A yellow powder, bitter taste/odorless, will stain skin, 7X coeff. (use is very dilute concen.), tx of burns and superficial
wounds, CANNOT be applied to large areas of the body
Trinitrophenol
48
This group of antiseptics are organic compounds, some contain mercury, antiseptic/chemotherapeutic agents.
Dye Group of Antiseptics
49
Name the dye group antiseptic that no longer is commonly used, isotonic saline 1:1000 concen., used before antibiotics (pack wound cavities, gonorrhea,
otitis media)
Proflavine dihydrochloride
50
Name the dye group antiseptic that aka gentian violet: 3% concen., extremely effective against gram positive bacteria (staph. mainly), in jelly form (cystitis, fungi, burns), MC usage today is for ringworm.
Methylrosaniline
51
This dye group antiseptic contains up to 50% mercury, effective against spores, fungicide, tx of lacerations/abrasions, antiseptic of choice for final scrub in pre-op skin prep --> 1:2000 concentration.
Merthiolate AKA: thymerol or thymersol,
52
Name the group of antiseptics that contains chlorine, iodine, or bromine.
Halogen group
53
Name the halogen antiseptic that is a yellowish irritant gas, inhaled=death, most widely used disinf. for drinking water?
Sodium hypochloride or Dakin's solution.
54
This antiseptic is It is made from bleach that has been diluted and treated to decrease irritation. Chlorine, the active ingredient, is a strong antiseptic that kills most forms of bacteria and viruses.
Sodium hypochloride or Dakin's solution.
55
MC choice for surgical scrubs/skin preps, effective as wound lavage,
Iodine aka Beta Dyne or Providyne
56
Iodine as a 5% vaginal pack is called _______.
Lugol's Solution
57
This miscellaneous antiseptic is commonly applied with a wooden stick applicator for the tx of wart/ulcer/canker sore/cauterization, 0.25-1.0% concen. inf of mucous membrane, conjunctival gonorrhea, was a tx in the eyes of newborns.
Silver nitrate
58
Name the poor quality antiseptic, used in 20-70%, concentration. Greater than 80%=hardens protein coat of bacteria, less than 80%=dehydrates.
Alcohol, ethanol is the most common form.
59
This miscellaneous swelling reducing antiseptic is mild, 10% concentration for skin irritation, 2%=conjunctivitis, 2-4% irrigation of wounds, burns, abscesses.
Boric acid
60
This very weak miscellaneous antiseptic, 3% concen., washing/lavaging wounds/ulcers, debrides tissue, tissue damage in open wounds, 1:5 parts with water = eff. mouth rinse for gingivitis.
Hydrogen peroxide
61
This miscellaneous antiseptic can be used to transfer biopsy specimens, oxidation of proteins, extremely powerful antiseptic, never applied to pts, is used for equipment sterilization.
Formaldehyde: aka formalin
62
Name three antiseptics mentioned int he course for wound lavage. Know this...
```
Antiseptics for Wound Lavage
1. Boric acid 2%
2. hydrogen peroxide 3%
3. sterile saline
(were the most commonly used, now are obsolete).
```
63
______________ aka melaleuca alternifolia, oil form that must be diluted with neutral oil (ex. mineral oil), not fully understood but eff. for tx of various infections (primarily staph).
Tea tree
64
______________ is defined as the interruption of sensory nerve conduction without subjecting the patient to unconsciousness.
Local Anesthesia
| is any technique to induce the absence of sensation in a specific part of the body
65
Any answer above __% on the board exam is incorrect if it is an injectable anesthetic (above would take away touch and pressure too).
2%
66
Name the three main pharmacologic properties/ "rules" to consider in delivering local anesthesia.
1) Onset of action
2) Effectiveness
3) Duration
67
T/F
| The higher the concentration of the anesthetic, the greater the risk .
True
68
The most common maximum dose of an antithetic is _____ cc.
30cc
69
The max dose of 1% lido w/ epi is ____cc.
50cc
70
Don't use this anesthetic with pregnant patients.
Lido w/ epi
71
This anesthetic add on acts as vasoconstrictor, holds the anesthetic at site longer (so less is needed/less toxic effect), minimizes amount of bleeding, but should not be used in fingers, toes, nose or the penis.
Epinephrine
72
Epinephrine concentration is _____ or _____.
1:100,000 or 1:200,000
73
____________ stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action.
Lidocaine
74
Name two complications of epinephrine.
1. Vasoconstriction
| 2. Can potentiate wound infection
75
Select the gauge of needle for administration of an antithetic.
25, 26, or 27 gauge needle
76
Needle length sizes start at ______ to ____ inches with 1/4 inch increments.
3/8 inch to 2 inches
77
What are the six precautionary rules to consider when injecting a patient?
1. Never inject in an upright position(fainting)•
2. Extensive or multiple wounds should be referred to ER.
3. After insertion pull back on plunger of syringe to check for blood - if solution turns pink = in artery/vein.
4. Inject "on the move" (in case you pierced vessel and a larger area can be numbed with fewer injections).
5. Keep syringe hidden.
6. Wait up to 5 min for effect
78
_______ _______ acts by anesthetizing an area supplied by a nerve; produced by an anesthetic agent applied to the nerve.
Conduction anesthesia
79
_______ ______ is a technique of local anesthetic where portal of entry has been created by trauma.
Direct infiltration
80
Name the anesthetic technique that most freq. type, preferred if wound is dirty,
Field Block or Parallel Margin Infiltration (swung in arc two areas supplied before coming out, repeated at new entry 180 degrees from original inj. site)
81
______ aka ____ is when the patient is injected directly into or immediately around a particular nerve or nerve plexus, longer periods of time/larger areas,
requires more skill and accuracy, damage neural tissue.
Nerve block aka Volar Block
82
_______________ is used in all types of anesthesia, w/ or w/o E, slightly higher risk of toxic reaction, 0.5/1.0/1.5/2.0% concen., ester based.
PROCAINE
83
Name this common type of procaine used for minor surgery purposes, highest concen. needed is 1.0%.
Novocaine
84
This anesthetic solution is very potent and toxic (10x more than procaine), longer lasting effect, ester based medication that is limited to few procedures such as spinal blocks.
TETRACAINE / PRONTOCAINE
85
This anesthetic solution is most popular and frequently used, same concen as procaine, w/ or w/o E, amide based (low toxicity, rapid diffusibility, topical activity, chemical stability, immediate onset of action, readily penetrates nerve sheaths.
LIDOCAINE / AKA Xylocaine
86
This anesthetic solution is amide based, widely used when longer time frames needed, does not come with Epi b/c it is a vasoconstrictive itself, therefore caution is indicated with its application into distal end organs.
MEPIVACAINE / CARBOCAINE
87
This long acting anesthetic solution is amide based, has a slow onset of action, but the duration of action surpasses both lidocaine and mepivacaine.
BUPIVACAINE AKA Marcaine
88
_______ is a topical anesthetic for simple lacerations and minor wound care (esp. in children), the preferred local anesthetic for repairing skin lacerations in pediatric patients.
TAC
89
TAC stands for these three chemicals ___ ____ ____.
TAC stands for tetracaine, adrenaline, and cocaine,
90
_________ is a 0.5% solution with glycerine for topical eye application, foreign body removal or ocular pressure testing (AKA Proparacaine hydrochloride) approx 13 sec to affect, last 15-20min, prolong=corneal opac./loss of vision.
OPHTHAINE
91
T / F Any topical anesthetic can damage corneal epithelium; prolonged use not recommended.
TRUE
92
Name the topical anesthetic for use on mucous membrane but not conjunctiva, lasts 1-5min, effective with overriding gag reflex.
CETACAINE
| AKA Rostra spray
93
Name the topical skin refrigerant, highly flammable, MC for pre-injection, lancing furuncles/carbuncles, effective for 15-30s.
ETHYL CHLORIDE
| don't blow yourself up!
