Surgical Technique & Wound Care

Question 1

Define surgical asepsis

Answer 1

Aka “sterile technique”; it’s designed to render and maintain objects and areas free from microorganisms and strict adherence is mandatory

Question 2

When should a sterile field be set up? And where should it always be?

Answer 2

The field should be established immediately before any procedure and should always be in view

Question 3

What are the principles of surgical asepsis?

Answer 3

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

Question 4

What are the rules for sterile solutions?

Answer 4

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

Question 5

What are the sterile gloving procedure?

Answer 5

1. Glove dominant hand 1st using the thumb & first 2 fingers of your other hand, only touch inside of glove
2. Pull glove over hand leaving cuff in place, not letting cuff roll up
3. Use dominant, gloved hand, slip fingers under the 2nd glove’s cuff, touching ONLY the outside of glove (sterile-to-sterile)
4. Interlock fingers of gloves

Question 6

What are the 6 types of wounds?

Answer 6

Abrasions (scrape), incisions (surgical), lacerations (jagged, irregular), punctures (small, piercing hole), burns (1st, 2nd, etc), chronic (recurring I.e. diabetes, bedsores)

Question 7

What are the 6 wound categories?

Answer 7

Surgical, trauma (injury), diabetic (vessel/tissue damage), venous (pooling; stasis), arterial (artery blockage/hardening), pressure (decubitus ulcer; bedsores)

Question 8

What is dehiscence and some causes of it?

Answer 8

Staples/sutures pop open post-op; can be caused by coughing—>infection occurs

Question 9

What are the pressure injury stages?

Answer 9

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

Question 10

What is a wet to dry dressing used for?

Answer 10

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)

Question 11

What is debridement and it’s types?

Answer 11

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)

Question 12

What is a dry gauze?

Answer 12

A dressing that keeps moisture within the wound; it’s applied with ointment and keeps the periskin dry; fluff dressing prior to use

Question 13

What is a polyvinyl dressing?

Answer 13

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

Question 14

What is an absorptive dressing?

Answer 14

Absorbent (not moistened) non-woven material, forms gel when contacted with drainage, good for wounds with a lot of exudate

Question 15

What are the factors of wound assessment?

Answer 15

Location, wound approximation (edges), size/depth of tissue damage, undermining, drainage/exudate, pain (0-10), peri wound surface (red? Ecchymosis?); wound assesssments Q shift

Question 16

What are the 4 stages of wound healing?

Answer 16

1. Hemostasis (vasoconstriction, coagulation, growth factors released)
2. Inflammatory (1st 2-5 days, vasodilation, clean wound, fibroblasts>collagen, WBCs clean wound)
3. Proliferative (2 days-3weeks, granulation, pink color, epitelialization)
4. Maturation (3 weeks–2 years, scar forms/80% scar tissue strength, dermis strengthens)

Question 17

What are the types of healing?

Answer 17

Primary —approximation, minimal tissue loss, heals quick
Secondary — left open, scarred healing
Teritary— delayed primary intention or closure due to infection

Question 18

What are wound drains and the types?

Answer 18

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

Question 19

What are wound implications the LPN can send the PT home with?

Answer 19

Proper sterile technique, CCSM/infection awareness, dressing change/removal (slowly)

Question 20

What are Montgomery straps?

Answer 20

Abdominal straps that don’t need tape and protect skin from tears/blisters. For PTs with multiple dressing changes

Question 21

What is heat therapy’s responses and types?

Answer 21

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)

Question 22

What are the cons of heat and cold therapy?

Answer 22

Heat: burns, bleeding, dehydration, maceration, edema
Cold: chilling, tissue death (ischemia)

Question 23

What does cold therapy treat? What does heat therapy treat?

Answer 23

Heat: infected wounds, arthritis, inflamed areas, lower back pain, cramps, perianal pain
Cold: sprain, strains, fractured, spasms, minor burns

Question 24

What are RICE and RECIPE a part of?

Answer 24

Cold therapy treatments

Question 25

What are cold therapy items?

Answer 25

Cold compress, ice bags, iced gel packs, ice baths

Question 26

What are the exudate types?

Answer 26

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

Question 27

How would the LPN apply and maintain a hydrocolloid dressing?

Answer 27

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

Question 28

What does a wound vac do?

Answer 28

Uses suction/negative pressure
Removed wound fluids
Removed exudate
Reduce edema
Stimulate granulation tissue

Question 29

What kind of dressing is a hydrocolloid and what is its definition?

Answer 29

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

Question 30

how does anemia affect healing?

Answer 30

there’s limited oxygen in the blood, blood transfusion for HGB

Question 30

diabetic foot care

Answer 30

pt should wear white socks for bleeding and drainage