Chapter 10- Keypoints and study guide Flashcards PDF

Chapter 10- Keypoints and study guide Penrose Gravity drain uses capillary action Jackson Pratt Active closed drainage "grenade" Hemovac Active closed round collection device Sump Utilizes air to displace fluid Water Seal Chest tube device T-Tube Passive drain placed in CBD after a CBDE What type of...

Chapter 10- Keypoints and study guide Penrose Gravity drain uses capillary action Jackson Pratt Active closed drainage "grenade" Hemovac Active closed round collection device Sump Utilizes air to displace fluid Water Seal Chest tube device T-Tube Passive drain placed in CBD after a CBDE What type of power source uses a pressure gauge on a regulator? Nitrogen Identify the types of motion: (A) An oscillating saw uses a(n) _____ motion. (B) A reciprocating saw uses a(n) _____ motion. (C) A drill, driver, or reamer uses a(n) _____ motion. (A) Side to side (B) Back and forth (C) Rapid rotary Insufflators: (A) What kind of gas does the laparoscopic insufflator use? (B) How is the gas initially introduced? (A) Carbon Dioxide Co2 (B) A verres needle or a Hasson blunt trocar Secures dressing for frequent dressing changes Montgomery straps Used to secure dressings when a digit is involved Tube gauze Most frequently used to secure dressings Tape (paper, silk, adhesive) Used for intermediate absorbent layer ABD pad Secures a splint dressing on an extremity Kerlix, coban, ace wrap Prevents movement by incorporating proximal and distal joint Fiberglass Occlusive dressing around chest tube Vaseline gauze or Xeroform gauze Semipermeable dressing on chronic wounds to debride Hydrocolloid dressing or inspections Example of a complete three-layer dressing Band-aid Nonadherent- painless when removed Telfa or Adaptic distal joint Describe the following properties of drapes and relate why each is important to the patient. (A) Lint free (B) Fluid resistant (C) Porous (D) Flame retardant Identify one advantage and one disadvantage of each type of fabric: (A) Nonwoven fabrics (B) Woven fabrics (A) Prevent airborne particles from entering the surgical wound. (B) Prevent strike-through contamination. (C) Body heat is not retained, resulting in hyperthermia. (D) Prevent them from igniting if exposed to the beam of laser or spark from an ESU. (A) Advantage: Disposable; Disadvantage: May need extra fabric around the fenestration. (B) Advantage: Cheaper and impermeable to liquid; Disadvantage: Need to be washed, folded, inspected and sterilized after each use. (A) Have an adhesive backing that may be impregnated with an antimicrobial iodine agent Describe each the following types of drapes: (A) Incise drape (B) Aperture drape (C) Isolation drape (D) Fenestrated drape (E) Split drape (F) Stockinette that is slowly released after application. (B) Small, clear, plastic drapes with openings surrounded by an adhesive backing. (C) Large, clear plastic drapes with an adhesive backing surrounding the fenestration. (D) Have openings for exposure of the area to be incised. (E) One end it open down the center, creating a "U" shape. (F) Stretchable gauze tubes to cover extremities; One end is closed to cover distal end, open end for proximal end. Identify the types of sponges in Figure 10-5, the usual number in a pack, and where they are (A) Laparotomy; 5; On large incisions, such laparotomy and in the abdomen typically used. (A) Name; Number; Used (B) Raytec (4x4); 10; On small incisions, also used as a sponge stick for sponging and retracting (B) Name; Number; Used within an abdominal wound. Neurosurgical Sponges: (A) Name of sponge (B) May be moistened with (C) Number in a pack (D) Where are they arranged on the field? (A) Patties/Cottonoids (B) Saline (C) 10 (D) Kidney basin Describe each one and identify the usual number in a package: (A) Cotton-filled gauzes with a string attached; 5 (B) Dissecting sponges, small rolls of cotton (A) Tonsil sponge (B) Kittner tape; 5 (C) Small gauze sponges used for blunt (C) Peanut dissection; 5- picked up with Kelly or vandy Identify the proper type of dressing for the situation: (A) Dressing that prevents unidirectional movement (B) Large three-layer dressing with additional absorbent material but no pressure (C) Dressing that eliminates dead space (D) Dressing layer that provides and airtight and watertight seal (E) Dressing layer that allows passage of air and fluids (A) Rigid dressing (casts and splints) (B) Bulky dressing (C) Pressure dressing (D) Occlusive dressing (E) Semi-occlusive dressing (F) Permeable or nonexclusive (Telfa) (F) Dressing layer that draws secretions from the wound by wicking action Wet-to-dry gauze Where does a heterograft come from? most commonly used Soaked in antibiotic/ saline mixture 3 layers of wet-dry gauze needs changed every 3-4 hours One species to another species that involves tissue that is transplanted. (A) Self-retaining; Remains in position within an Identify the catheters pictured in Figure 10-6 and what each is used for. organ w/o further support (B) Non-retaining; Withdraws fluid from a body cavity (C) 2-way Foley; Deflated balloon inflated with sterile water once inside the bladder, allows for retention (D) 3-way Foley; Irrigating, urine drainage (E) Pezzer (Mushroom); Nephrostomy drainage (F) Malecot (4-winged); Drainage of different bodily fluids such as bile, urine, pus (G) Robinson (Plain); Facilitate intermittent drainage (H) Coude; Urine drainage, easily move around blockages or narrow parts of the urethra (I) Whistle Tip; Access and catheterization of the urinary tract (J) Multi-eyed; Drainage Closed wound suction devices connected to active drains use ______ ______ to remove fluids and/or air. Passive drains use _______ or absorbent dressings to remove fluids and air. Vacuum System Gravity 20 Blade- C-section Most commonly used: Scalpel Blades and Handles 11- used to make holes for trochar 10- general 15- plastics- precise cutting A. Metzenbaum- used for medium to fine tissue Cutting and Dissecting Scissors B. Curved Mayo- often the scissors of choice for heavy tissue C. Potts- Smith- for incisions into ducts, veins, or arteries Designed to manipulate tissue  Reduce and stabilize  May or may not have ratchets: Grasping and Holding Instruments Tissue forceps Bone-holding clamps Allis Babcock Kocher What instrument is this What are bone holding clamps/forceps? Lane bone-holding forceps larger bone-holding forceps have working ends that are designed to either encircle a large or medium bone or firmly grasp and hold it with multiple serrated edges. Examples include Lane, Kern, Lowman, and Lewin Designed to occlude or constrict tissue Constructed with: Opposing ring handles for fingers Interlocking ratchets Two shanks Clamping and Occluding Box lock controls the opposing jaws What are some instruments used to clamp and occlude? What instrument is this? Curved Hemostat, Allis, Satinsky, curved Kelly clamp also called a needle driver , is made from stainless steel and is used to hold a suturing needle during surgical procedures. Used to hold a curved suture needle How/what is a needle holder used for Needle holders Vary in length Fine, regular, or heavy Choice depends on the needle Constructed as clamps also used to load blade on knife handles Probing – Malleable – Wire-like – Exploration of a structure – Used to gradually dilate an orifice or duct Dilating – Smallest to largest – Found in numbered sets Dilators Bougie, Heaney, Hegar, Von Buren Flexible Modern fiberoptic Maneuverable tip Channels Introduction of instruments Suction Fluid injection Endoscopes Rigid Hollow with telescopic lens system and eyepiece. Preferred for some procedures such as cystoscopy, or bronchoscopy for removal of a foreign body. Instruments used in the OR that are powered by compressed air, nitrogen, electricity, or battery Nitrogen Tank or wall. Pressure gauges are set by OR staff Power tools according to recommendations. Tank pressure of 500psi Typical operating pressure is 80 – 100 psi ALWAYS turn dial OFF before disconnecting Electric Many older dermatones. Electric stryker drill (oral surgery) – To remove blood and body fluids Drains – Prevents edema and hematoma formation – Helps prevent infection ALWAYS USING SILK SUTURE TO HOLD DRAIN Passive Drains allow a pathway for fluid or air to move from an area of high pressure to one of lower pressure Examples: Penrose drain—Latex tubing that is placed partially within the wound, allowing fluid to move out of the wound into the dressing by capillary action. Cigarette drain—Penrose drain with gauze inside encourages fluid to move out of the wound into the dressing by wicking action. T-tube—Placed within the biliary system, it drains bile via gravity into a specialized collection unit called a bile bag. Gastrostomy tube—Inserted through the abdominal wall into the stomach; removes gastric contents or provides instillation of nourishment (tube feeding). Cystostomy tube—Inserted through the abdominal wall into the urinary bladder; removes urine. Nephrostomy tube—Inserted percutaneously into the kidney; removes urine. Active drains make use of negative pressure Examples: Hemo-vac—Typically used following orthopedic procedures when a moderate amount of drainage is expected. Jackson-Pratt—Typically used following Active Drains abdominal procedures when a moderate amount of drainage is expected. Also used in neurosurgery and other general surgery procedures such as a mammoplasty. Stryker—Typically used following orthopedic procedures. Effective in reducing dead space due to the strength of the battery-operated evacuation pump. Jackson-Pratt Drain Hemo-vac Drain Often used in plastics, abdominal surgeries Active Drain Typically used following orthopedic procedures when a moderate amount of drainage is expected. Active Drain Typically used following orthopedic Stryker Drain procedures. Effective in reducing dead space due to the strength of the battery-operated evacuation pump. Active Drain Latex tubing that is placed partially within the wound, allowing fluid to move out of the wound into the dressing by capillary Penrose Drain action Passive Drain Placed within the biliary system, it drains bile via gravity into a specialized collection T-Tube unit called a bile bag. Passive Drain plastic tube that is used to drain fluid or air from the chest collects drainage from a chest tube Chest Tube / Pleur-evac keep below chest level to promote drainage by gravity Both active and passive drains removes gastric contents or provides instillation of nourishment (tube feeding). Gastrostomy tube Passive Drain removes urine. Cystostomy tube bougie, heaney, hegar and van buren are types of? blades 11, 12 and 15 are usually loaded on to which knife handle? Passive Drain dilators #7 What size of blades fit on a #3,7 and 9 handle? What size of blades fit on a #4 handle? What is a #15 blade that is on a #3 handle used for? What is a #12 blade almost exclusively used for? #10(most frequently used on #3), 11, 12, and 15 (#11, 12, and 15 usually loaded on #7) #20-25 Superficial procedures requiring a small incision tonsillectomy _______ _______ scissors are freq used to cut fine sutures during ophthalmic or plastics procedures Delicate tissue is dissected with? ______-_____ scissors are used for incisions into ducts, veins or arteries ________ scissors used for a hysterectomy straight iris Iris, Jamison, Westcott, Stephen's tenotomy, or Potts-smith potts-smith jorgenson What is the name of the paired parts of a hemostat that spans between the box lock and shanks finger rings? What type of surgical sponges are prepackaged in 5s? What is the joint of a hemostat where 1 half of the instrument passes through the other? dissecting box lock _________ is used to examine the renal pelvis via natural body orfice ureteroscope What are the ports used for in a 3 way foley catheter? balloon inflation, urinary drainage, continuous irrigation What part of a microscope is most proximal to the target tissue? An #11 blade is a fine pointed tip used to? What type of syringe has no calibrations? objective lens incise blood vessels or create a stab wound for a drain bulb/ear penrose drains are ______ drains kerflix fluffs, ABD pads, and 4x4 sponges are examples of which part of a 3 layer dressing? aperature drapes are typically used for? what letter shape is used to accommodate a drain tube exiting a patients body? passive absorbant intermediate layer small anatomical structures such as eyes and ears Y A "cigarette" drain removes fluid from a wound by ________ action wicking op site, collodion, adhesive gels and steri strips are what type of dressing? 1 layer dressings why must chest tubes be attached to a water seal drainage system? to prevent air from re-entering the pleural space thereby maintaining negative pressure necessary for effective respiration A #20 knife blade fits on a # _____ knife handle. 4 A #15 knife blade fits on a # _____, _____, or ______ knife handle 3,7,9 A #11 or #12 blade typically is loaded onto a # _____ knife handle. 7 A #12 blade is typically used for a __________ Tonsillectomy The most frequently used beaver blade is the _______ #69 Proctoscope Rectum Hysteroscope Uterus Mediastinoscope Middle thoracic cavity Ventriculoscope Cranial cavity Fetoscope Pregnant uterus Choledochoscope Common bile duct Gastroduodenoscope Stomach and duodenum Laparoscope Abdomen Arthroscope Joint Colonoscope Large intestine Otoscope Ear Lasers used to cut and cauterize tissues Monochromic Laser When Laser light is collimated …. photons of which the light is composed are all the same color. waves are parallel to each other – allows for accuracy. What should you always have on the field if Appropriate protective laser glasses lasers are in use? sterile water Most frequently used Uses hollow tube with mirrors to form an articulated arm. Can be attached to a microscope or to a hand piece. Co2 Laser A helium-neon beam is used as an aiming device. Can be used on light or dark tissues. Heats tissue until the cell wall burst, producing steam (laser plume). Used for laser bronchoscopy. Absorbed by dark and red tissues, Argon laser Travels through clear tissues without heating them. Used for treatment of the retina. Has powerful and precise coagulating Nd:YAG Laser properties. Commonly used for gastrointestinal endoscopy. May be suspended from the ceiling or mounted on a mobile frame. Eyepieces and objective lenses are Microscopes interchangeable according to the needs of the surgeon. Objective lense F100 – Lumbar laminectomy F250 – Ear procedures. F400 – Larygoscopy Worn by surgeons for additional lighting Fiber-optic Headlights and Light Sources of the operative site. Most commonly worn by vascular and ENT surgeons. Pulsavac irrigation in and suction out used to clean bone Used during laparoscopic procedures to Insufflators infused CO2 into the abdominal cavity. The typical intraoperative pressure for laparoscopy is 12-15 mm Hg. Produce a small electric current. Used to identify nerves so that they can be Nerve Stimulators preserved. When the tip of stimulator is placed close to or on a nerve, a twitch response is generated Most OR’s are equipped with 2 OR lights OR lights Cardio- Thoracic Surgery, trauma and neurosurgical Rooms requires 3 lights or more Tourniquets Rubber band , Penrose drain ,Esmarch bandage , Pneumatic tourniquet restrict blood flow to the surgical site Tourniquets should not remain inflated for more than 60 minutes for an upper extremity, and 120 minutes for a lower extremity. pressure for the lower extremity is 100 to 150 mm Hg higher than the systolic blood pressure. pressure for the upper extremity is approximately 30 to 70 mm Hg higher than the patient’s systolic blood pressure. Esmarch Bandage-Types of Tourniquets Penrose Drain-Types of Tourniquets Rubber Band-Types of Tourniquets To exsanguinate extremity prior to tourniquet inflation or can be used alone as a tourniquet Used for surgical procedures of the digits, hand, lower arm, ankle Used for surgical procedures of the fingers and toes Automatically inflated with air, oxygen, or nitrogen to a preset pressure to compress the vessels Pneumatic -Types of Tourniquets Pressure settings for average adult Arm: 250 - 300 mm Hg (up to 6 pounds of pressure) Leg: 350 mm Hg Percutaneous biopsy needle has a sharp cutting cannula to facilitate insertion into the tissue and cutting the What s a Tru-Cut Needle used for? tissue; a removable stylet allows for multiple biopsies to be taken Bone marrow trocars introduced through cortical bone may be used to obtain bone marrow. Which nerves can be identified using a nerve stimulator during surgery? facial, acoustic, cochlear, vestibular nerves autologous graft comes from patients own body zenograft from another species like bovine or porcine homograft from another human donor heterograft one species o another, involves tissue needing to be transplanted Triage system used in disaster response START What type of drill power source uses a pressure gauge and regulator? Nitrogen Which type of chemical solution is made of catalysts that aid in breaking down protein enzymatic debris such as blood and fat The bowie-Dick test is performed for which sterilization method The delayed Immediate, minimal and expectant ( DIME) categories are used in pre-vacuum air removal steam disaster triage What substance is used against instrument corrosion? milky Finish recommended for instruments because its non reflective dull Jorgenson used in hysterectomy