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NPLEX II - Lynda > Minor Surgery - Part 1 > Flashcards

Minor Surgery - Part 1 Flashcards

1
Q

What type of fluids from ALL patients should be considered infectious?

A

Blood and body, basically ALL fluids

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2
Q

The main components of Universal precautions include which 2 elements?

A
  1. Protective barriers

2. Sharps management

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3
Q

Accidents involving sharps (needle sticks, scalpels) are the greatest single cause of ______ infection in the workplace.

A

HIV

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4
Q

________ is the most frequently occurring work-related infectious disease in the U.S.

A

Hepatitis B

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5
Q

“________ ________” means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.

A

“Occupational Exposure”

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6
Q

“________” means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

A

“Parenteral”

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7
Q

What is the definition of Personal Protective Equipment?

A

Anything used to protect a person from exposure

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8
Q

What are 5 items that qualify as PPE (Personal Protective Equipment)?

A
  1. Latex/Nitrile gloves
  2. Goggles
  3. CPR mouth barriers
  4. Aprons
  5. Respirators
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9
Q

What are 4 rules to remember for PPE (Personal Protective Equipment)?

A
  1. Always check gear for defects or tears before using
  2. If torn or defective - GET NEW
  3. Remove PPE before leaving contaminated area
  4. DO NOT REUSE!
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10
Q

Which instrument is…

  • Tungsten carbide
  • Blunt nose
  • Ratchets
  • Smooth
  • Usually cross-hatched jaw (for better gripping)
A

Needle holder/driver

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11
Q

Which instrument is…

  • Very fine
  • Used for dissecting/trimming skin
  • May be curved or straight
  • Do NOT use to cut sutures or bandages
A

Iris scissors

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12
Q

Which instrument is…

  • Used for handling tissue
  • Does NOT crush skin/tissue
A

Toothed Adson

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13
Q

Which instrument is…

  • Used for grasping sutures, foreign bodies, picking things up, sterilely
  • NOT used for grasping skin/tissues
A

Toothless Adson

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14
Q

Which instrument is…

  • Used for removing scalpel blades
  • Holds tourniquets
  • Clamps vessels
  • Hold skin tags or toenails
  • May be curved or straight
A

Hemostats (AKA: clamps, forceps, Kelly’s, mosquitos)

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15
Q

Which scalpel is usu. disposable and attaches to sterile, reusable handles?

A

3

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16
Q

Which scalpel is used for stabbing/incising the skin? Commonly used during an I&D procedure.

A

11

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17
Q

Which scalpel is a standard blade for excision, trimming, or dissecting tissue?

A

15

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18
Q

Which scalpel is similar to a #15 (standard blade for excision, trimming, or dissecting tissue) but is for larger, thick, tough skin (like the back and scalp)?

A

10

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19
Q

To insure the effectiveness of any sterilization or disinfecting process, instruments must first be …

A

thoroughly cleaned of all visible contamination (retained foreign material can protect microorganisms from sterilization).

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20
Q

Initially, after instrument use, clean with a plastic brush under COOL water, why?

A

Hot water can coagulate blood, and make it harder to clean.

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21
Q

Instruments should be carefully dried, and lubricated with which type of lubricant?

A

a water-soluble lubricant like instrument milk. Oils or grease should NEVER be used.

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22
Q

What type of solution causes major pitting of instruments if allowed to soak or dry on them?

A

Saline

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23
Q

What is the term for:

The destruction of all living microorganisms, including bacterial spores

A

Sterilization

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24
Q

What is the term for:
The reduction of a population of pathogenic microorganisms without achieving sterility (not all bacterial spores are destroyed)

A

Disinfection

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25
Q

What is the term for:
A germicidal, chemical substance used on inanimate objects to kill pathogenic microorganisms, but not necessarily all other.

A

Disinfectant

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26
Q

What is the term for:

A chemical agent applied to the body that kills or inhibits the growth of pathogenic microorganisms.

A

Antiseptic

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27
Q

Differentiate between sterilization and disinfection

A

Instruments can be sterilized, people CAN NOT!

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28
Q

T/F: Alcohol (70%)/Chlorhexadine (5%) can be used for “emergency disinfection”.

A

True; Two (2) minutes of immersion; but it does not sterilize

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29
Q

What is the liquid disinfectant of choice (the only disinfectant solution that has shown some degree of reliability)?

A

2% Glutaraldehyde

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30
Q

2% Glutaraldehyde disinfects after soaking for ____ minutes and sterilizes (destroys spores) after ____ hours.

A

10 minutes; 10 hours

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31
Q

T/F: 2% Glutaraldehyde has high tissue toxicity so it should not be used for rubber, plastic, heat sensitive equipment.

A

FALSE! 2% Glutaraldehyde has low tissue toxicity; can be used for rubber, plastic, heat sensitive equipment (Cidex, Sonicide).

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32
Q

Which method is simple, quick, and effective method of disinfecting instruments (100°C [212°F] for 5 minutes), but should not be used for sterilization unless better methods are not available (may not destroy certain spores, viruses).

A

Boiling

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33
Q

To sterilize with boiling, instruments should be boiled at least _______ minutes at sea level (longer at higher altitudes).

A

30 minutes

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34
Q

Hot Air Ovens (Dry Heat) will sterilize instruments at ___°C (320°F) for how long? Works for glassware and things that would be damaged by moisture. What items should not be sterilized by hot air ovens?

A

160°C (320°F) for one hour

Cannot use for rubber, plastic, cloth, paper.

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35
Q

What is the most efficient and reliable method of sterilizing? Works for most materials and is easy and quick. Can sterilize wrapped instrument packs.

A

Autoclave

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36
Q

What is the steam pressure for autoclave? ____ psi (121C) for ____ minutes will destroy all forms of life.

A

15 psi (121C) for 15 minutes will destroy all forms of life.

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37
Q

What indicates suture size? What does that mean? The more O’s the ______ the thread.

A

O; finer

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38
Q

The smaller the size suture, the _____ tensile strength it has.

A

Less

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39
Q

T/F: NB: 3/0, 3-0, 000 are all the same size suture

A

True

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40
Q

Natural sutures are made from ______ _______, and are eventually digested by _______ ______, which attack and break down the suture strand.

A

mammalian collagen; body enzymes

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41
Q

Synthetic absorbable sutures are polymers, which are _________.

A

Hydrolyzed (water gradually penetrates the suture filaments, causing breakdown of the polymer chain)

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42
Q

_________sutures are used for temporary approximation of wound edges, particularly subcutaneous tissues and mucous membranes, dentistry, obstetrics, deep skin wounds.

A

Absorbable

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43
Q

________ sutures are made of a single strand of material which means there is less resistance as they pass through tissue and are less likely to harbor microorganisms. These sutures tie easily, but knots may slip and may break easily.

A

Monofilament

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44
Q

______ sutures are several strands braided or twisted together. They are stronger, more pliable and flexible, and slip less easily, but may harbor organisms, which can lead to infection.

A

Multifilament

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45
Q

Which natural suture is rapidly absorbed and has some problems with tissue reaction, antigenicity; but good for tissues, which heal rapidly, need minimal support (mouth).

A

Plain catgut

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46
Q

What is the tensile strength half life of plain catgut?

A

7-10 days

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47
Q

Chromic catgut is treated with ______ _____ to delay absorption by body enzymes

A

chromium salts

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48
Q

What is the tensile strength half life of Chromic catgut?

A

2-3 weeks

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49
Q

Which has less tissue reaction, plain catgut or chromic catgut?

A

Chromic catgut

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50
Q

Synthetic polymers; absorption is by ________, therefore minimal tissue reaction; easy to tie, increased tensile strength

A

hydrolysis

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51
Q

Which synthetic polymer is braided and monofilament. Coated to allow smooth passage through the skin. Easy to tie.
What is the tensile strength half life?

A
  • Polyglactic acid (Vicryl)

- Tensile strength half life is 4-7 weeks

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52
Q

Which synthetic polymer is monofilament; almost no tissue reaction.

A
  • Polyglycolic acid (Dexon)

- Tensile strength half life is 2-3 weeks

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53
Q

Which synthetic polymer is amonofilament polyester polymer.
What is the tensile strength half life?

A
  • Polydioxanone (PDS)

- Tensile strength 4-6 weeks

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54
Q

Which non-absorbable suture is braided, easy to tie, but has increased (high) risk of infection? Tensile strength approximately 1 year, therefore actually very slowly absorbing suture (vessel ligation, not used much for skin anymore).

A

Silk

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55
Q

Which non-absorbable suture is a polyamide polymer; monofilament? Low tissue reactivity, low risk of infection, high tensile strength, easy to handle but need extra knots to prevent slippage (skin, subcuticular tissues).

A

Nylon (Ethilon)

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56
Q

Which non-absorbable suture is monofilament? Similar to nylon (Ethilon). More supple, longer retention, slick; more expensive (skin, sub-Q tissues, heart valves, contaminated, INFX wounds).

A

Polypropylene (Prolene)

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57
Q

Which non-absorbable suture is permanent; minimal tissue reaction (abdominal and sternal wound closure, tendon repair).

A

Stainless steel

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58
Q

What other non-absorbable, natural sutures have a high tissue reactivity?

A

Polyester (Mersilene, Ethibond), Polybutester (Novafil)

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59
Q

What is an alternative/adjunctive closing item is especially useful in high tissue areas? What application method should be avoided? What should be applied with this?

A
  • Steri-strips
  • DONT ENCIRCLE DIGITS (can have a tourniquet effect)
  • Apply w/ Benzoin
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60
Q

Which suture is better tolerated and has less risk of INFXN (Natural or synthetic)?

A

Synthetic

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61
Q

Which tissue adhesive is a sterile “Krazy Glue”? How many layers should be applied? How long does it take to set?

A

Cyanoacrylate tissue adhesive (Dermabond)
3 layers
50 seconds

62
Q

How long does it take Dermabond to be as strong as sutures? How does the Dermabond come off and how long does that take?

A
  • 2 1/2 minutes

- sloughs off of skin as wound heals within 5-10 days

63
Q

Which areas of the body can Dermabond NOT be used?

A

Areas of excess motion or moisture (knees, elbows, hands/feet, inside mouth, groin areas)

64
Q

What are the 3 basic components of stainless steel w/silicone coating needles?

A
  • the attachment end (“swaged end”, i.e., the attachment of the suture to the needle)
  • the body
  • the point
65
Q

Conventional Cutting needle is not used so much anymore. Where is it most commonly seen used?

A

cosmetic surgery

66
Q

Which needle is the MOST COMMON for skin? Cuts through tough, difficult to penetrate tissue. Leaves good tissue bridge (skin, tendon sheath, oral mucosa).

A

Reverse Cutting needle

67
Q

Which type of needle pierces and spreads tissue without cutting it. For easily penetrated tissue such as bowel, myocardium, fascia, muscle.

A

Tapered needles

68
Q

Which type of needle can dissect friable tissue as opposed to cutting it. Used for friable tissues and in deep cavities for safety considerations (liver, kidney, spleen, cervix).

A

Blunt needle

69
Q

Which part of the needle should be grasped with the needle holder? Which area should not be grabbed?

A
  • Body (shaft)

- DO NOT grasp the swaged end

70
Q

What is the rule of thumb for knots and sutures?

A

Use one more knot than gauge of suture

71
Q

Which suture size should be used on the face/neck and when should it be removed?

A

5-0 to 6-0

Remove after 3-5 days

72
Q

Which suture size should be used on the arm/hands and when should it be removed?

A

4-0 to 5-0

Remove after 7-10 days

73
Q

Which suture size should be used on the trunk/legs/feet/scalp and when should it be removed?

A

3-0 to 4-0

Remove after 7-14 days

74
Q

Which type of knot is the most secure and reliable; easiest to make knots “square”?

A

Two-handed tie

75
Q

Which type of knot is the fastest, don’t have to put down needle holder? Good for deep spaces.

A

One-handed tie

76
Q

Which type of knot is useful for conserving suture, working with short ends.

A

Instrument tie

77
Q

What are 5 components of the sterile field?

A
  1. Drapes
  2. Gloves
  3. Syringes/needle/sutures
  4. Instruments
  5. Wound/skin prep
78
Q

T/F: Hairy areas should be shaved during wound/skin prep to limit risk of INFXN

A

FALSE! DO NOT shave hairy areas

79
Q

When disinfecting intact skin which 2 preparation agents can be used?

A
  1. 10% povidone-iodine (Betadine)

2. 4% chlorhexidine gluconate (Hibiclens)

80
Q

T/F: Betadine, Hibiclens, and hydrogen peroxide are the best choices for use in open wounds

A

FALSE!!! DO NOT use these in any open wound! However, they can be used for intact tissue AROUND the open wound

81
Q

Open wounds should be irrigated with ________. How should that be administered?

A
  • Normal saline

- 35ml syringe with a 19 gauge needle

82
Q

Hemostasis (coagulation):
Injury results in disruption of blood vessels, extravasation of blood constituents, initiation of the coagulation cascade, formation of a ______ _____.

A

fibrin clot

83
Q

What are the 5 components of inflammation?

A
  1. Platelets
  2. Neutrophils
  3. Macrophages
  4. Re-epithelialization
  5. New keratinocytes
84
Q

Platelets secretes ______. Clot formation triggers _______ ______

A

cytokines; complement cascade

85
Q

Neutrophils arrive w/in ___-___ hours to destroy bacteria and lasts __-___ days (or longer if wound is significantly contaminated)

A

5-6 hours

3-4 days

86
Q

_____ transition from inflammation to repair and phagocytize and remove fibrin clot.

A

Macrophages

87
Q

Re-epithelialization begins w/in hours of injury as _____ cells begin to migrate over the gap. The gap is bridged in ___-___ hours in a repaired wound. In a wound left open epithelialization occurs at about __mm per day.

A

Basal cells
24-48 hours
1mm

88
Q

New keratinocytes begin to proliferate ___-___days after injury at margins of wound.

A

1-2 days

89
Q

Granulation or Proliferation begins __-__ days after injury; and lasts ~ __ weeks)

A

3-4 days

3 weeks

90
Q

Fibroblasts migrate to the wound (attracted by cytokines from macrophages, platelets, other fibroblasts), produce a fibronectin matrix, then produce ______ and other components of new connective tissue (elastin, proteoglycans).

A

collagen

91
Q

________ occurs by endothelial budding and anastomosis of capillaries across the defect; the new vessels bring oxygen and nutrients to the healing wound.

A

Angiogenesis

92
Q

The newly formed capillaries surrounded by fibroblasts give the wound surface a characteristic appearance referred to as ______ ______.

A

granulation tissue

93
Q

Remodeling and wound contraction happens from ___ weeks to ___-___ months

A

3 weeks to 6-18 months

94
Q

What is the % strength by 3-4 weeks and what % by 1 year

A

30-40% by 3-4 weeks

80% by 1 year

95
Q

Wound contraction is normal and occurs due to _________ and _______of _______.

A

myofibroblasts; orientation of collagen

96
Q

What is abnormal formation of a tight scar due to excessive contraction which limits motion and causes deformity?

A

Contracture

97
Q

What is the single most important cause of delayed wound healing?

A

Wound infection

98
Q

If equilibrium between collagen production and lysis does not occur at ___-___weeks, the wound will expand and become elevated, wider and deeper than normal, forming an abnormal scar.

A

3 to 4 weeks

99
Q

What is the most common type of abnormal scar: wide, red, elevated, but do not involve previously uninjured tissue?

A

Hypertrophic Scars

100
Q

Which scar is similar in appearance to hypertrophic scars, but continue to enlarge beyond the original dimensions of the wound in psuedotumor fashion; genetic predisposition to ______ formation (more prevalent in dark-skinned people); exact etiology is unknown?

A

Keloid Scars; keloid

101
Q

What is Vitamin C’s function in wound healing?

A

Promotes collagen formation and healing of connective tissue

102
Q

What is Zinc’s function in wound healing?

A

DNA/RNA synthesis, collagen synthesis, and cross-linking as well as immune function

103
Q

What is Vitamin B’s function in wound healing?

A

Collagen, cross-linking, DNA synthesis

104
Q

What is Copper’s function in wound healing?

A

Collagen cross linking

105
Q

What is Vitamin E’s function in wound healing?

A

Reduce scar formation, adhesions

106
Q

What is Flavonoid’s function in wound healing?

A

Reduce scar formation

107
Q

What type of wound healing is… “sutured wounds”, produced when the edges of a full-thickness wound are re-approximated
can be used in clean wounds with minimal tissue loss, less than 6-12 hours old, caused by shearing forces such as a knife

A

Primary/First Intention

108
Q

What type of wound healing is…
Full thickness wounds which are allowed to heal “naturally”, or left “open”, not closed with sutures
Allowed to heal by granulation and eventual re-epithelialization, they contract significantly over time
Should be used in wounds with significant tissue loss, devitalization, or contamination/infection (avulsions, ulcerations, abscesses)

A

Secondary Intention

109
Q

Sometimes wounds which were sutured, then become infected, need to be re-opened and left to heal by ____ ______

A

Secondary Intention

110
Q

What type of wound healing is…
Wounds that are grossly contaminated but have not suffered significant tissue loss or devitalization (> 12 hours old, animal bites, large puncture wounds) may be treated with delayed primary closure
The wound must be cleaned, irrigated and debrided as much as possible during the initial encounter. Pack the wound with sterile fine-mesh gauze or gauze sponges soaked in normal saline. Cover the wound with a bulky absorbent dressing. Oral antibiotics should be considered after initial care and before delayed closure is performed.

A

Tertiary Intention

111
Q

What is the disadvantage with using simple interrupted stitch?

A

Railroad track scarring and it may be difficult to evert the edges. It can also be time consuming.

112
Q

The vertical mattress stitch is slightly more complicated than simple interrupted, but much better for ______ _____ ____ ; allows precise approximation of the wound with little tension, better for ________.

A

everting skin edges; cosmesis

113
Q

Vertical mattress stitch is good for which wounds?

A

Wounds under tension, thick skin (palms, soles), or loose skin, which tend to invert

114
Q

What are disadvantages with using the vertical mattress stitch?

A

Railroad track scarring and can be time consuming

115
Q

Deep or buried stitch is good for…

A

decreasing tension and dead space in larger, deeper wounds (such as removal of lesions)

116
Q

Knots for deep or buried stitches are “______”, so will be below skin margins.

A

inverted

117
Q

Subcuticular/Intradermal Running Stitch is placed _____ ___ ____, so is not visible.

A

in the dermis; cosmetically nice, eliminates “tracks”.

118
Q

Subcuticular/Intradermal Running Stitch works best in wounds where there is ______ tension, and in clean, linear wounds (i.e., surgical incisions as opposed to lacerations).

A

minimal

119
Q

Continuous running stitch is rapid, non-cosmetic, ____ secure, and has a _____ risk of INFXN

A

Less; higher

120
Q

What is the horizontal mattress stitch used for? Which area of the body are they best for?

A

High tension wounds and fragile tissues; palms or soles

121
Q

What are 3 advantages to using the horizontal mattress stitch?

A
  1. Optimizes wound edge eversion
  2. Increased closure strength (distributes tension)
  3. Spreads tension along wound edge
122
Q

For post-op care, how long should a wound be kept dry? How often should wounds be redressed?

A

24-48 hours

3-4 days

123
Q

When does infection tend to set up? What is the most common offending bacteria?

A

4-10 days post-op

Staph Aureus

124
Q

What are 4 reasons for dressing?

A
  1. Absorption of drainage
  2. Provides support
  3. Moisture for epithelialization
  4. Limits movement
125
Q

From least invasive to to most what is the order of 5 dressings?

A
  1. Non-adherent
  2. Gauze
  3. Elastic
  4. Tape
  5. Occlusive
126
Q

What is blood collection following surgery and may lead to INFXN or dehiscence? What is the time frame for this?

A

Hematoma

24-72hours

127
Q

What is a wound rupture along an incision after sutured closed? When should the wound be re-sutured?

A

Dehiscence

Re-suture w/in 48-72 hours

128
Q

What are 4 almost certain signs of wound infection?

A
  1. Purulent discharge
  2. Regional lymphangitis
  3. Dehiscence
  4. Fever
129
Q

When does wound infection become evident?

A

4-10 days

130
Q

Local anesthetics block _____ reuptake to prevent ________ and ___________ of pain stimuli.

A

Na+; depolarization and propagation

Because depolarization is prevented this is called a non-depolarized block.

131
Q

What are 4 main pharmacological properties to consider when choosing a local anesthetic?

A
  1. Rate of onset
  2. Degree of action
  3. Duration of action
  4. Allergic potential
132
Q

What are the 2 main classifications of anesthetics?

A
  1. Amides

2. Esters

133
Q

Amides are metabolized in the _________ by microsomal enzymes.

A

Liver

therefore patients with decreased hepatic function are predisposed to adverse effects of amide anesthetics

134
Q

Most of the time allergic reactions are due to the antibacterial additive ________, related to PABA, a highly allergenic compound.

A

methylparaben

135
Q

What is the math of anesthetics?
10cc of 1% = ____mg
1cc of 1% = _____mg

A

10cc of 1% = 100mg
1cc of 1% = 10 mg
(Hint: what ever the cc, add a 0 to determine mg!)

136
Q

Esters are metabolized in the _______ by ____________

A

plasma by pseudocholinesterase

therefore patients with genetically abnormal pseudocholinesterase are predisposed to adverse effects

137
Q

A principle metabolite of esters is _____________, which is strongly associated with allergic reactions.

A

para-aminobenzoic acid PABA

138
Q

What is the degree angle of injection for: IM, SubQ, and ID?

A

IM: 90 degrees
SubQ: 30-45 degrees
ID: 5-10 degrees

139
Q

Epinephrine is added to cause vasoconstriction in order to do what 3 things?

A
  1. Decrease oozing
  2. Prolong the duration of the anesthetic effect (by limiting absorption and enhancing the local neural membrane uptake),
  3. Decrease risk of toxic reactions (by reducing circulating levels of LA)
140
Q

What are 3 types of adverse RXNs of anesthetic?

A
  1. Toxic Rxn
  2. Allergic/hypersensitivity Rxn
  3. Autonomic Rxn
141
Q

Which type of adverse reaction is inadvertent intravascular injection or dose (MC cause). It will be a CNS depressant that may cause HYPOtension first, then BRADYcardia or cardiac arrest?

A

Toxic Rxn

142
Q

How is a toxic reaction treated?

A

O2

143
Q

Which type of adverse reaction is similar to allergic presentation with TACHYcardia, sweating, dizziness, HYPERtension, and syncope?

A

Autonomic Rxn

144
Q

How is an autonomic reaction treated?

A

Usually resolves w/in minutes and requires minimal intervention

145
Q

What is the most common type of adverse reaction?

A

Autonomic Rxn

146
Q

True allergic reactions/anaphylaxis are extremely rare with LAs (less than 1% of all adverse reactions).
When do Type I (IgE) reactions occur?

A

after a sensitizing dose

147
Q

How is an allergic reaction treated? Mild and severe…

A

Mild cases: Benadryl

Severe cases: Epinepherine and O2

148
Q

Which type of anesthetic has the most common allergic/hypersensitive reaction?

A

Esters (Procaine)

149
Q

What are 5 side effects from use of Epinephrine?

A
  1. Anxiety
  2. Restlessness
  3. Tremors
  4. Palpitations
  5. Tachycardia
150
Q

What is the dose ____-____concentrations w/ MAX of ________mg.

A

1:100,000-200,000;

less than 0.2mg

151
Q

What is the antidote for epinephrine?

A

IV push of magnesium and vitamin B6 to increase COMT metabolism

NPLEX II - Lynda (29 decks)

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