Surgical Technique & Wound Care Flashcards
Define surgical asepsis
Aka “sterile technique”; it’s designed to render and maintain objects and areas free from microorganisms and strict adherence is mandatory
When should a sterile field be set up? And where should it always be?
The field should be established immediately before any procedure and should always be in view
What are the principles of surgical asepsis?
Only table or waist level clothing/surfaces are sterile, sterile-to-sterile and clean-to-clean touching ONLY, do not cough or reach over the sterile field, and open sterile packages only have a 1 inch sterile border
What are the rules for sterile solutions?
They’re only good for 24 hours, should be dated and time stamped, and the lid should be placed UP next to the solution and cannot touch the bottles edge
What are the sterile gloving procedure?
- Glove dominant hand 1st using the thumb & first 2 fingers of your other hand, only touch inside of glove
- Pull glove over hand leaving cuff in place, not letting cuff roll up
- Use dominant, gloved hand, slip fingers under the 2nd glove’s cuff, touching ONLY the outside of glove (sterile-to-sterile)
- Interlock fingers of gloves
What are the 6 types of wounds?
Abrasions (scrape), incisions (surgical), lacerations (jagged, irregular), punctures (small, piercing hole), burns (1st, 2nd, etc), chronic (recurring I.e. diabetes, bedsores)
What are the 6 wound categories?
Surgical, trauma (injury), diabetic (vessel/tissue damage), venous (pooling; stasis), arterial (artery blockage/hardening), pressure (decubitus ulcer; bedsores)
What is dehiscence and some causes of it?
Staples/sutures pop open post-op; can be caused by coughing—>infection occurs
What are the pressure injury stages?
1–skin intact, nonblanchable redness, painful
2–partial thickness, skin loss/intact or open blister, exposed dermis
3–full thickness, skin loss, adipose seen, no fascia
4– full thickness, skin loss, exposed bone, tendon, muscle, fascia
Unstageable– depth of wound blocked by slough/eschar
What is a wet to dry dressing used for?
Mechanical debridement of dead, wound tissue. Applied (packed) wet on wound and dries,put dry, fluffed gauze on top; causing the slough/eschar to peel off with dressing. Be cautious of maceration (breakdown of healthy tissue from improper application)
What is debridement and it’s types?
Removing dead tissue/slough/eschar from wound: autolytic—uses bodily ability to dissolve necrotic tissue (hydrogels, hydrocolloids, alginates), biochemical (ointments/gels [Santyl] with enzymes), mechanical (wet to dry), sharp (surgical)
What is a dry gauze?
A dressing that keeps moisture within the wound; it’s applied with ointment and keeps the periskin dry; fluff dressing prior to use
What is a polyvinyl dressing?
A transparent adhesive dressing for shallow wounds, semipermeable to oxygen, moisture, impermeable to bacteria; can be left in place for days, used with stage 1 or 2 wounds NOT for infected wounds;3rd/4th degree burns
What is an absorptive dressing?
Absorbent (not moistened) non-woven material, forms gel when contacted with drainage, good for wounds with a lot of exudate
What are the factors of wound assessment?
Location, wound approximation (edges), size/depth of tissue damage, undermining, drainage/exudate, pain (0-10), peri wound surface (red? Ecchymosis?); wound assesssments Q shift
What are the 4 stages of wound healing?
- Hemostasis (vasoconstriction, coagulation, growth factors released)
- Inflammatory (1st 2-5 days, vasodilation, clean wound, fibroblasts>collagen, WBCs clean wound)
- Proliferative (2 days-3weeks, granulation, pink color, epitelialization)
- Maturation (3 weeks–2 years, scar forms/80% scar tissue strength, dermis strengthens)
What are the types of healing?
Primary —approximation, minimal tissue loss, heals quick
Secondary — left open, scarred healing
Teritary— delayed primary intention or closure due to infection
What are wound drains and the types?
Path of waste fluid escape via skin, without it granulation is inhibited; JP— compress bulb, for sm. Amt. of drainage, suctions, PT can have multiple; Hemavac—a lot of drainage, record output, used foam; Penrose— sm. open drain, cover with dry gauze, sm. to zero amt. drainage
What are wound implications the LPN can send the PT home with?
Proper sterile technique, CCSM/infection awareness, dressing change/removal (slowly)
What are Montgomery straps?
Abdominal straps that don’t need tape and protect skin from tears/blisters. For PTs with multiple dressing changes
What is heat therapy’s responses and types?
Vasodilation, reduced blood viscosity, increased tissue metabolism & capillary permeability, and reduced muscle tension; there’s moist (compress, sits bath; can cause burns/swelling if left on too long) & dry (heating packs & pads)
What are the cons of heat and cold therapy?
Heat: burns, bleeding, dehydration, maceration, edema
Cold: chilling, tissue death (ischemia)
What does cold therapy treat? What does heat therapy treat?
Heat: infected wounds, arthritis, inflamed areas, lower back pain, cramps, perianal pain
Cold: sprain, strains, fractured, spasms, minor burns
What are RICE and RECIPE a part of?
Cold therapy treatments
What are cold therapy items?
Cold compress, ice bags, iced gel packs, ice baths
What are the exudate types?
Serous— sm. amt., clear/pale yellow
Sanguineous—med. amt., bright red, clots, fresh bleeding
Serosanguineous- Lg. amt., pale, red, more watery than sanguíneous
Purulent—Lg. amt., thick, yellow/brown/green
How would the LPN apply and maintain a hydrocolloid dressing?
By cutting the duoderm to the wound’s size, ensuring the would is a clean non-infected stage 2-4, applying it directly over the wound, assessing the dressing for several days, and dating it
What does a wound vac do?
Uses suction/negative pressure
Removed wound fluids
Removed exudate
Reduce edema
Stimulate granulation tissue
What kind of dressing is a hydrocolloid and what is its definition?
a transparent dressing-autolytic- that it is cut to the wound’s size, not on periskin area, can be applied for several days; use on stage 2-4 wound with no infection/drainage
how does anemia affect healing?
there’s limited oxygen in the blood, blood transfusion for HGB
diabetic foot care
pt should wear white socks for bleeding and drainage
