surgically create an opening, outlet
*Key word= Maintenance
Osteo
refers to the bones
Oto
ear, hearing
thorax
chest
Pneumo
air, lungs
algia
pain
sub
under
Ab
away from
Ad
toward, in direction of
Dys
difficult, painful
Anti
against
BX
biopsy
I&D
incision and drainage
Colostomy
creation of an artificial opening into the colon
hypertension
higher than normal blood pressure
ectomy
surgical removal
plasty
surgical repair
pexy
surgical fixation
reno
kidney
cardio
heart
neuro
nerve
hemo
blood
oma
tumor
brady
slow
tachy
fast
OS
left eye
FX
fracture
AAA
abdominal aortic aneurysm
Hemicolectomy
surgical removal of half (a portion) of the colon
endoscopy
visual examination of body organs/cavities
interrupted stitches
Slower and stronger type of suturing, one stitch may break without compromising the entire suture line. Each suture or stitch is tied separately.
continuous stitches
fastest and easiest, if one breaks then the entire wound can come open
eviceration
protrusion of organs through an incision
dehiscence
wound separation exposing tissue, no organs
clean wounds
1-5% infection rate, ideal conditions and elective surgeries (Class I)
contaminated wounds
15-20% infection rate, open traumatic wounds less than 4 hours old. Major break in technique (Class III)
Primary intention healing
wound closed after procedure with sutures or staples resulting in minimal scarring
Second intention healing
wound left open and allowed to heal from the inside out due to tissue loss or presence of infection
Third intention healing
wound left open a few days and cleaned multiple times to ensure no infection and then closed (delayed process)
Inflammatory phase
starts right after injury, blood clots form, White blood cells kill bacteria, and scab forms
Fibroplastic/proliferative phase
starts a few hours after injury, Actual healing begins. Cells divide and tissue is repaired
Maturation-Remodeling Phase
2-4 weeks after injury, wound/scar shrinks and gains strength. May last a year or more
Collagen Fibers
strong/resistant to stretch. Hold structures together
hyaline cartilage
Most common type of cartilage; it is found on the ends of long bones and soft part of nose
Adipose tissue
Fat. provides protection for joints/organs. ENERGY STORAGE
elastic cartilage
capable of stretching and returning to original position
serous membrane
Membrane that lines a cavity without an opening to the outside of the body
parietal serous membrane
line cavity walls
visceral serous membrane
cover surfaces of organs
mucous membrane
line cavities and tubes that open to the outside of the body
epithelial tissue
forms membranes that line hollow organs, body cavities and ducts
Nucleus
located centrally. large number of DNA. Controls ALL cellular structure/activity
Cartilage
intercellular material made of connective tissue embedded in semi-solid ground substance. Provides support/framework. Slow healing due to lack of blood supply
Mitosis
process by which nucleus divides into 2 identical nuclei
Cell
the structural and functional unit of all living things
Fibrous connective tissue
closely packed, thick collagenous fibers that bind body parts together because they can withstand pulling forces
Simple cells
single layer of cells in areas of minimal friction that provide minimal protection ex. heart, intestines, alveoli
Tissue
A group of similar cells that perform the same function.
ligament
attach bone to bone to prevent undesired motion
tendon
attach muscle to bone to produce motion during contraction
inferior
below or toward the feet
Median
middle, midline
proximal
nearer to the point of reference, usually the point of attachment
Adduction
toward the midline
Abduction
away from the midline
transverse (horizontal) plane
plane running from anterior to posterior, parallel to the ground dividing body into superior and inferior portions
Sagittal
divides the body into left and right portions
midsagittal plane
divides the body into equal right and left sides
frontal (coronal) plane
lengthwise cut that is perpendicular to the ground, dividing into anterior and posterior portions
Anatomy
The study of body structure
Physiology
The study of body function
Homeostasis
tendency to maintain a stable internal environment
anatomical postion
Standing erect with feet flat on the floor, face and eyes facing forward and arms at their sides with palms facing forward
collagen fibers
strong and resistant to stretch. holds structures together ex. ligaments tendons
Hyaline Cartilage
Most common type of cartilage; it is found on the ends of long bones, ribs, and nose
adipose tissue
fat, provides protection and stores energy
elastic cartilage
capable of stretching and returning to original position
Aponeurosis
broad, fibrous tissues that attach adjacent muscles
Recruitment
as intensity of stimulation increases, more motor units are "recruited" to lift that specific weight
Atrophy
muscle tissue decreases in size
Synergists
aid prime movers in performing desired ask
Hypertrophy
muscle tissue increases in size
orbicularis oculi
head/neck
pectoralis major
upper extremity
deltoid
upper extremity
biceps femoris
lower exrtemity
rectus abdominis
trunk
rectus femoris
lower extremity
orbicularis oris
head/neck
Semitendenosus
lower extremity
Soleus
lower extremity
Psoas major
lower extremity
external oblique
trunk
brachialis
upper extremity
semimembronosus
lower extremity
Gastrocnemius
lower extremity
Gracilis
lower extremity
transversus abdominis
trunk
Sternicleidomastoid
head/neck
latissimus dorsi
upper extremity
triceps brachii
upper extremity
internal oblique
trunk
masseter
head/neck
vastus lateralis
lower extremity
sartorius
lower extremity
tibialis anterior
lower extremity
Origin
less movable end of muscle, usually proximal
What nervous system controls internal orgins?
autonomic nervous system
List the order of the Meninges if cutting into the skull?
Durma, Arachnoid, Pia
What controls higher thought processes?
frontal lobe
what lobe controls sight and recognition?
occipital lobe
How many pairs of cranial nerves are there?
12
What protects the CNS?
cerebralspinal fluid (CSF)
Thalamus
relays all sensory impulses (except smell) to cerebral cortex
lumbosacral plexus
T12-S5. innervates lower extremities
Brachial plexus
C5-T1, innervates muscles/skin of arms/forearms/hands
Hypothalamus
controls/innervates autonomic nervous system
Central Nervous System (CNS)
brain and spinal cord. function is to process sensory information and produce muscular response
Reflex arc
structural and functional basis for simplest involuntary actions
Pons
separates midbrain from medulla. works with the medulla to regulate rate and depth of breathing
lateral thoractomy
access to lungs with best visualization
subcostal incision
below rib cage. liver access with best visualization
McBurney incision
An incision in which the oblique right muscle is manually split to allow removal of the appendix.
Midline incision
vertical, in the middle of the abdomen. access to uterus, bladder
Sternal Split incision (Mediansternotomy)
vertical, down the middle of the breast bone. used for open heart surgery
paramedian incision
An abdominal incision lying parallel to the midline. used to avoid belly button and normally for exploratory incisions
Oblique incision
inguinal hernia repair
Pfannenstiel incision
Transverse; across the lower abdomen. Used for C-sections
Cornea
clear membrane on front of eye
Sclera
white of the eye
choroid
vascular membrane that lines inside of sclera containing blood vessels
pericardium
Membrane surrounding the heart
pleura
Membrane surrounding the lungs
What is Surgeons ultimate goal during closure?
To hold several tissues together (in proximity) with mechanical means until the wound has healed enough to withstand stress without mechanical support.
hypertrophic scar
raised scar due to suture being too tight or infection
contractures
reduce or prevent movement of joints especially from burns
keloid formation
"overhealing". bubble-like scars most common among people of color
negative feedback
return a system to reference or set point ex. body temp, blood sugar regulation
positive feedback loop
Causes a system to change further in the same direction. reinforces change until other force stops it. example: childbirth
Mediastinum
space between the lungs; contains the heart, esophagus, trachea
crural
lower leg
Insertion
more movable end of muscle, usually distal
neuroglial cells
not excitable. supporting cells of nervous system
White matter
myelinated axons
gray matter
unmyelinated axons
How many pairs of spinal nerves are there?
31
kidney
-bean shaped
-located retroperitoneally between T12 and L3 vertebral areas
Why is the left kidney higher than the right?
the liver is on the right side
Nephron
functional unit of the kidney located in the cortex
Renal sinus
hollow chamber within kidney on concave medial side
Renal pelvis
funnel shaped sac at the superior end of the ureter
cortex of kidney
outer reddish area of tissue which forms a shell around medulla
functions of kidney
-eliminate waste products
-regulation of red blood cell formation
-blood pressure regulation
What does kidney do when it senses low blood pressure?
Releases renin into blood. Renin activates hormone called angiotensin which contacts the arterioles causing blood pressure to rise
What percentage of cardio output is supplied to kidneys each minute?
about 20-25%
Kidney stones
small, hard deposits that form inside the kidneys made of mineral and acid salts
composition of urine
95% water, electrolytes, amino acids, urea, uric acid, and other organic compounds
fluid intake, environmental factors, certain changes within the body
Flow of urine
Kidney -> ureter -> bladder -> urethra -> outside body
Ureters
tubes leading from kidney to bladder
How does muscular wall move urine?
peristaltic contractions. these are wavelength movements with a squeezing motion to move urine
what determines shape of bladder?
dependent on volume of urine and pressure of surrounding structure.
Trigone
triangular area containing 2 openings for ureters and one opening for urethra
detrusor muscle
contains bundles of smooth muscle fibers. forms the internal urethral sphincter at the bladder neck
male urethra
8 inch tube that is lined with mucous membrane. transports semen and urine
prostatic urethra
male urethra. portion that is enclosed in the prostate gland
membranous urethra
male urethra passes through the pelvic diaphragm
penile urethra
portion of urethra contained within penis
female urethra
approximately 1.5 inches long. transports urine out of body
What is a result of females having a shorter urethra?
more susceptible to infection because bacteria can find its way to bladder easier
micturition
urination
Where is the micturition reflex center located?
spinal cord
Explain the micturition reflex
bladder wall stretches. micturition reflex center receives signal. This causes contractions of detrusor which relaxes internal sphincter. Contractions become more powerful when urine volume increases
what volume of urine causes desire to urinate?
150 ml. becomes more uncomfortable at 200-400 ml
when does voluntary control of external sphincter occur?
24 months old
Pericardium
encloses and holds the heart in place allowing it sufficient freedom of movement to contract
cardiac tamponade
extra fluid in the pericardial cavity restricts movement of the heart by compressing it
epicardium (visceral pericardium)
protective layer on the outer surface. Serous membrane consisting of connective tissue covered by epithelium
Myocardium
Thick middle muscle layer of the heart
Endocardium
lining of the heart that covers all internal structure of the heart
Right atrium
Receives deoxygenated blood from the body
left atrium
receives oxygenated blood from the lungs
interatrial septum
divides the atria
Right ventricle
pumps deoxygenated blood to the lungs. thinner muscular wall since only pumping short distance
Left ventricle
pumps oxygenated blood to the body. Thicker muscular wall because it forces blood to ALL parts of the body against a great resistance to flow
Tricuspid valve
located between the right atrium and right ventricle. Composed of three leaflets or cusps
Mitral (bicuspid) valve
located between the left atrium and left ventricle. Composed of two leaflets or cusps
Significance of Atrioventricular heart valves
Allow flow of blood in one direction only
pulmonary semilunar valve
located at the beginning of the pulmonary trunk. Allows blood to flow out of the right ventricle into the lungs
aortic semilunar valve
located at the beginning of the aorta. Allows blood to flow out of the left ventricle into the aorta
Significance of semilunar valves
prevents backflow of blood into respective ventricles
Flow of blood through the heart
Right atrium -> tricuspid valve -> right ventricle -> pulmonary semilunar valve -> pulmonary trunk pulmonary artery -> lungs -> pulmonary vein -> left atrium -> bicuspid valve -> left ventricle -> aorta -> rest of body
What structure returns deoxygenated blood to the right atrium?
Superior and inferior vena cava
coranary arteries
provide nutritive blood to the heart
myocardial infarction
heart attack. occurs when coronary arteries are blocked preventing oxygen from reaching the heart
Arteries
carry blood away from the heart
veins
carry blood to the heart
What are the smallest blood vessels?
capillaries
function of capillaries
exchange of nutrients and waste between blood and tissue cells.
Venules
small vessels that drain blood from the capillaries into the veins
Veins
thin-walled vessels that carry blood toward the heart under low pressure
Factors affecting blood pressure
heart action, blood volume, peripheral resistance
branches of aortic arch
brachiocephalic artery, left common carotid artery, left subclavian artery
brachiocephallic artery
branches into a right common carotid artery and a right subclavian
External corotid arteries
supply the face and scalp
internal corotid arteries
supply the brain
intercostal arteries
Branch from thoracic aorta and pass between ribs
Popliteal arteries
Behind knee, supply leg
coronary artery bypass graft (CABG)
great saphenous vein is harvested from the leg and grafted to a coronary artery bypassing a blocked portion returning blood supply to coronary circulation
Foramen ovale
a hole in the interatrial septum that shunts oxygenated blood from the right atrium directly into the left atrium
ductus arteriosus
connects the pulmonary artery to the aorta, bypassing the lungs
cardiac tamponade
Compression caused by fluid buildup / swelling of the pericardium
cardiac tamponade
extra fluid in the pericardial cavity restricts movement
digestive system
organs that promote digestion and absorb the products
digestion
breaking of food into pieces small enough to be absorbed into the circulatory system and utilized by the cells of the body
mechanical digestion
actions which prepare food to be mixed with enzymes that digest foods ex. chewing
chemical digestion
series of chemical reactions that break down the large molecules into smaller molecules that are absorbable and usable by body
Ingestion
taking of food into the mouth
Absorbtion
movement of nutrients into the bloodstream
Assimilation
utilization of nutrients by living tissues
Bolus
rounded mass of food that is ready to be swallowed. held together by saliva
chyme
semi-fluid mixture of food and digestive enzymes found in the alimentary canal
Alimentary canal
parts of the digestive system through which food passes through
Peristalsis
muscular action that propels food materials through the alimentary canal. "push and squeeze"
Segmentation
muscular action that causes food substances to be mixed with the digestive juices
What are the 4 layers of the alimentary canal?
mucosa, submucosa, muscularis, serosa
Mucosa
mucous membrane forming inner lining of the wall. responsible for absorption of nutrients and secretion of mucus/enzymes
Submucosa
consists of areolar connective tissue that binds the mucosa to the muscularis
Muscularis
two layers of smooth muscle responsible for movements of the tube and its contents
Serosa
outermost layer. serous membrane composed of areolar connective tissue and simple squamous epithelium
What is the route food takes in the digestive system
first portion of alimentary canal. Receives food and starts mechanical digestion (chewing)
Pharynx
Connects nasal and oral cavities with the larynx and esophagus
Esophagus
straight, collapsible tube descending through the thorax behind the trachea responsible for secreting mucus and transporting food to the stomach
gastroesphageal sphincter
ring of muscle located in the inferior portion of esophagus that relaxes during swallowing to allow passage of bolus into stomach
Stomach
J-shaped pouch located under the diaphragm divided into 4 parts: Cardia, Fundus, Body, Pylorus
Cardia
portion surrounding entrance of esophagus
Fundus
rounded portion above and to the left of the cardia. temporary storage site when too much food is ingested
pyloric sphincter
regulates the amount of chyme released from the pylorus of the stomach into the duodenum of the small intestine
components of small intestine
duodenum, jejunum, ileum
duodenum
shortest and most fixed portion of small intestine
Jejumen
proximal two-fifths of the free, mobile portion of the small intestine
ileum
remainder of free, mobile portion of small intestine. Joins the large intestine at the ileocecal valve
function of small intestine
Completes digestion of most nutrients in chyme, absorbs various products of digestion, and transports remaining residues to the large intestine
ileocecal valve
muscular ring that regulates the passage of chyme into the large intestine
components of large intestine
cecum, appendix, colon, rectum, anal canal
Cecum
dilated pouch-like structure that begins large intestine and receives chyme from small intestine
vermiform appendix
no known digestive function
asceding colon
begins at cecum and travels up to a point just below liver and turns sharply
transverse colon
longest and most mobile part of large intestine crossing the abdomen from left to right
Descending colon
begins at transverse colon and passes down to the brim of pelvis
sigmoid colon
S-shaped. begins at descending colon and extends to midline of the body
Rectum
lies next to sacrum. temporary storage site for undigested material before deification
Anal canal
distal end open to outside
Anus
opening of the anal canal to the exterior
functions of large intestine
Absorption of water and electrolytes. no digestion occurs
Accessory structures of digestion
salivary glands, liver, gallbladder and bile duct system, pancreas
parotid salivary glands
largest salivary glands in front of and below each ear and between skin of cheek and masseter muscle
sublingual salivary glands
smallest of the salivary glands located under the tongue
submandibular salivary glands
located in floor of mouth on the inside surface of lower jaw. Secrete a more viscous fluid
functions of salivary glands
secrete saliva which moistens food to help bind it together and begin digestion of carbohydrates
Pancreas
secretes insulin and glucagon to aid in maintaining normal blood sugar levels. Also helps neutralize acid from the stomach
Liver
largest gland in the body divided by connective tissue into 2 lobes
functions of liver
-metabolism of carbohydrates, lipids, proteins
-storage of glycogen, minerals, vitamins
-filtration of blood
-detoxification
-secretion of bile
Gallbladder
pear-shaped sac that stores bile between meals and releases bile into the duodenum
bile duct system
2 hepatic ducts from the liver and 1 cystic duct from gallbladder form common bile duct which empties bile into duodenum
Testes
paired, bilateral oval shaped structures that produce sperm and testosterone
Epididymis
tightly coiled tube that stores sperm while it matures
vas deferens
muscular tube that ends behind the urinary bladder where it joins the duct from the seminal vesicle to form the ejaculatory duct. Acts as a highway and transports sperm
seminal vesicles
secrete an alkaline fluid rich in fructose and other nutrients for the sperm cells
ejaculatory duct
short tube beginning at seminal vesicle and ending at urethra. Function is to transport sperm into urethra
Prostate gland
chestnut-shaped structure surrounding the beginning of the urethra. Function is to secrete a thin, milky alkaline structure, enhance sperm mobility, and neutralize acidic secretions of the vagina
benign prostatic hyperplasia (BPH)
enlargement of the prostate gland
transurethral resection of the prostate (TURP)
most common surgical treatment for BPH
bulbourethral glands
two small structures located below the prostate gland that secrete mucus to partly lubricate end of penis in preparation for intercourse
Scrotum
encloses, protects, and regulates temperature of testes
Penis
A cylindrical organ that conveys urine and semen through the urethra to the outside
corpora covernosa
dorsally located cylinders of erectile tissue
corpus spongiosum
single cylinder of erectile tissue that surrounds urethra and forms glans penis (head of penis)
Ovaries
solid, oval structures that produce egg cells and sex hormones (estrogen/progesterone)
uterine (fallopian) tubes
cilia in the tube and peristaltic contractions move egg cell to uterus
tubal ligaiton
interruption of fallopian tubes resulting in sterilization of female patient
vasectomy
bilateral surgical removal of a part of the vas deferens resulting in sterilization of male patient
Uterus
hollow, pear-shaped organ that receives embryo and sustains its life during development
endometrium
inner lining of the uterus. sloughs off during menstrual cycle
myometrium
muscle layer of the uterus. contracts during childbirth
perimetrium
outer layer of uterus
Vagina
fibromuscular tube that extends from the uterus to the outside of the body. receives erect penis, conveys uterine secretions, and transports offspring during birth
stores ADH (regulates concentration of urine) and oxytocin (affects smooth muscle contractions, childbirth)
thyroid gland
Thyroxine (T4) and triiodothyronine (T3) hormones regulate metabolic rate
parathyroid gland
secretes parathyroid hormone (PTH) which regulates levels of calcium, magnesium, and phosphate ions
Adrenal cortex
secrete mineralocorticoids (regulate sodium/potassium), glucorticoids (regulate glucose metabolism), and certain androgens (weak male sex hormones)
adrenal medulla
deeper region of adrenal gland. synthesizes epinephrine, norepinephrine, flight or fight response
pancreas
both endocrine and exocrine gland. secretes hormones that regulate glucose levels
insulin
lowers blood glucose levels
glucagon
increases blood glucose levels
somatostatin
hormone that inhibits release of glucose and insulin
pancreatic polypeptide
Inhibits Somatostatin, gall bladder secretion, and secretion of digestive enzymes
pineal gland
secretes melatonin, regulates circadian rhythms
Thymus
T-cell reproduction for the immune system and slows the aging progress
ovaries produce:
Follicle stimulating hormone and luteinizing hormone. Regulate menstrual cycle, maintain pregnancy, prepare mammary glands for lactation, secondary sex characteristics
Testes produce:
testosterone. regulates production of sperm and maintenance of male secondary sex characteristics
Cushing
father of neurosurgery, reduced mortality rate for Meningiomas from 96% to 5%
Reed
Demonstrated that malaria was caused by a mosquito-transmitted virus
Kocher
Advanced knowledge of thyroid function
Cooley
Perfected the heart-lung machine; performed first US heart transplant and first total artificial heart implant
Enders
Propagated the poliovirus in primary human cell cultures
DeBakey
Developed the first ventricular assist pump
Surgical Technologist
allied health professional who works closely with surgeons, anesthesiologists, registered nurses, and other surgical personnel delivering patient care and assuming appropriate responsibilities before, during, and after surgery
What does AST stand for?
Association of Surgical Technologists
1940's
Britain- Formulation of the Operating Theater Technicians
What happen in the 1980s that changed the way surgery was performed?
technological revolution, endoscopic surgery became routine.
1985 - code of ethics published
1970's
1970 - AORT provided first certification and first examination
1978- AORT changed name to Association of Surgical Technologists
Objectives of HIPAA
-ensure health insurance portability even in the face of preexisiting medical conditions
-Guarantee the privacy of health information of all patients
-Decrease the incidences of fraud and abuse in the healthcare community
What year did HIPAA come into existence?
April 14, 2003
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
perioperative nurses
patient advocate during surgical procedures. anticipate needs of the patient and surgical team and initiate safe and appropriate nursing interventions.
working conditions in the operating room environment
Brightly lit, relatively quiet, temperature controlled
Requirements for working in operating room
-standing for long periods of time
-ability to lift and move heavy objects
-40 hour work weeks common
-may be required to work evenings, night shifts, weekends, holidays
-enter the sterile field
-scrub their hands and arms completing surgical scrub
-Don sterile gown, gloves, mask, and shoe covers
duties of non-sterile team
-do not enter the sterile field
-handle supplies and equipment not considered sterile
-keep sterile team supplied and equipment
What does the design of any surgery department revolve around?
environmental control, traffic control, desire to prevent surgical site infection
scrub sink area
restricted area
utility room
semi-restricted area
sterile supply room
restricted area
hallways
semi-restricted area
dressing room
unrestricted areas
street clothes are allowed
unrestricted area
supply processing area
semi-restricted area
operating suites
restricted area
proper OR attire required (without mask)
semi-restricted area
usually located near the entrances
unrestricted areas
proper OR attire required (with mask)
restricted areas
what separates restricted areas from unrestricted areas
signage and red lines painted on floor
pathologist
physician who specializes in the cause and effect of disease
radiologist
highly-skilled individual who comes in the surgical suite and takes radiographs during procedure
copyright infringement
users should be aware of this when importing graphics into their document
printer
produces paper versions of documents and images
Central Processing Unit (CPU)
responsible for coordinating operations of computer, manages computer systems, and facilitates exchange of data with computer memory
monitor
screen that displays the output of the computer
hard drive
contains the most storage space (memory). stores computer programs and files
Malpractice
professional misconduct; unreasonable lack of skill or judgement; illegal conduct resulting in harm of another
battery
carrying out bodily harm
liable
legally bound to compensate for injury or loss
defemation
injury to a person's reputation/character by willful statements made to a third party
-Libel: written defamation
-Slander: oral defamation
abandonment
Caregiver leaves patient knowing there may be a need for care during their absence
advance directive
patient self-determination act. requires that patients be informed of their rights regarding their own healthcare to be able to make decisions for themselves
tort
civil wrongs which may result in lawsuits which award MONEY to injured party
surgical conscience
Chosen behavior that places patient's well being above all else
Fear of criticism
primary deterrent in admission of fault
peer apathy
type of attitude that can cause a whole department to lose sight of its primary goal (safe patient care)
"No one else cares, why should I?"
RN duties that may exceed scope of practice for STCR
delivery of medications, patient assessment, charting
What behaviors undermine surgical conscience?
fear of reprisal; insecurities of feeling stupid
Elements of Negligence
-duty owed to person
-dereliction or breach of duty
-action could be foreseen to cause harm
-direct causation
-damages
The surest way to avoid risk and liability and protect the patient from harm is to:
-develop constant awareness of one's actions
-acquire knowledge about every phase of the job
-avoid "Not thinking"; major cause of tragic accidents
who may not witness the surgical consent form?
members of the surgical team
What does the witness attest to?
-identification of the patient or legal guardian
-voluntary signature without coercion
4 "P's" of abuse prevention under detainee operations
Priorities, Policies, Procedures, Practices
Association of Perioperative Registered Nurses (AORN)
promote quality patient care by providing its members with education, standards, services, and representation
Joint Commission on Accreditation of Healthcare Organizations (JC)
performance-based standards that focus on direct patient care provided
National Fire Protection Association (NFPA)
Publishes NFPA standards which apply to environmental safety to reduce hazards to patients and personnel
The Association of Surgical Technologists (AST)
ensures that surgical techs have the knowledge and skills to administer patient care of highest quality through accreditation, certification and education
incident report
mechanism for reporting an accident or unusual occurrence
Grave breaches
Murder, Mutilation, Torture, willful acts that cause great suffering/injury
simple breaches
Abuse of flag of truce, maltreatment of corpses, poisoning of wells and streams, pillaging
What type of detainee is health care personnel
Retained personnel (RP)
4 categories of detainee abuse
psychological, sexual, physical, neglect
who is responsible for informing the patient about risks, benefits, possible complications, and alternatives to proposed procedure?
surgeon
4 categories of death
Accidental
terminal
prolonged (chronic)
sudden
palliative procedures
secondary to progressive local disease. provide the patient with symptom relief which can improve quality of life for those with a terminal illness
therapeutic procedures
used to treat or manage a disease
life support systems
preserve patients life when body systems are not functioning to sustain life (ex. heart/lung bypass)
life sustaining therapy
Medical procedures that would only prolong the process of dying OR sustain a condition of permanent unconsciousness
Treatments:
Respirators, CPR, Dialysis, Surgery, etc.
living will
patients state in writing exactly what medical interventions they are willing to endure to sustain life
durable power of attorney
a legal agreement that allows an agent or representative of the patient to act on behalf of the patient
5 responses to loss/grief
denial, anger, bargaining, depression. acceptance
3 definitions of death
cardiac, higher brain, whole brain
physical need
any need or activity related to genetics, physiology, or anatomy (water, oxygen, food, temperature regulation)
psychological need
any need or activity related to the identification and understanding of oneself
-to be respected
-family issues
-perception that environment is safe
-fear
social need
any need or activity related to one's identification or interaction with another individual or group
-love and belonging needs
spiritual need
any need or activity related to the identification and understanding of one's place in an organized universe
-recognizing and supporting religious beliefs
most common fears in operating room
Death, exposure, mutilation, pain
best approach to understanding characteristics of behavior and patient needs is to study:
human development
first step to take to identify if patient is alert and awake
basic language skills, bond to mother, foundational control of body, perceive self as member of family
Age 2-6
take solid food, learn to talk and walk, learn basic right from wrong, learn basic gender differences and modesty
Age 6-12
distinguish gender role differences, adjust to school, relate to peer group, increase number of relationships outside of family
Adolescent
adjust to changes in body, begin to plan for career, form sense of identity, separate from parents emotionally
early adult
Select lifelong partner; begin expressing civic responsibility (join military)
middle adult
assist children to become adult, adjust to aging or death of parents
late-middle adult
Reach pinnacle of power in career; let children become responsible for themselves
late adult (over 70)
Review life as you have lived it; prepare for death
Trauma patient
severely injured patients most likely require multiple procedures, performed all at once or in succession
Physically challenged patient
may require the surgical team to take extra precautions when moving the patient from the stretcher to the operation table, and when positioning the patient after the administration of anesthesia
Immuncompromised patient
Strict adherence to sterile technique is imperative
isolation patient
may include frequent hand washing, wearing gloves, gowns, eye protection and mask
pregnant patient
immediate operative intervention is done for emergencies only and elective procedure are definitely delayed until after the mother has had time to recover
hearing impairment/ deafness
greet the patient without wearing a mask and look directly at the patient when speaking
bariatric patient
a mechanical lifting device may be required if the patient can no longer move themselves and two operating tables are situated next to each other to accommodate the patient. Do so before they enter the room to avoid embarrassing the patient
visual impairment / blindness
always speak to the patient before touching them and guiding the patient's hand will help them feel secure
language barrier
every effort should be made to obtain an interpreter
pediatrics patient
let the patient bring a favorite toy or stuffed animal into surgery
Geriatric patients
patients are often arthritic, and suffer from restricted movements of extremities and fragile skin that require special consideration when lifting, transporting, and positioning
diabetic patients
procedure should be the first case of the day so these patients can get back on their regular dietary schedule as soon as possible
Mentally challenged patient
patience is of the utmost importance as well as slow, deliberate movements so as not to startle the patient
substance abuse patient
the surgical team and patient would benefit from the presence of a counselor or social worker to provide assistance
how many people are needed to transfer an unconscious person?
4
Where is the safety strap placed on patient during transport
2 inches above the knee
how should a patient be transported through the hallway on a gurney?
stand at the head and push them feet first
How should a patient under 5 years old be transported
crib; appropriate sized cart/wagon
What is the first thing you do when transporting a patient to the operating room?
tell the patient what is about to happen
Where should you position yourself when passing through swinging doors or elevators?
When transporting a patient, push them feet first EXCEPT when entering an elevator, then head first. This allows for better control of litter's movement and easier observation of the patient
What is the first step in transferring the patient from gurney to hospital bed
introduce yourself and state your intentions. Identify the patient
Where do you position yourself when transporting a patient on an incline or decline?
stop movement of litter at least 2 feet from start of incline/decline. place yourself on the lower side of the slope to prevent roll away
biomedical equipment technician
highly-skilled technologist that ensures medical equipment is serviceable, safe, and working properly
Aerobic Gram Negative Cocci
Neisseria gonorrhoeae - gonorrhea leading to salpingitis
Bordetella pertussis - Whooping cough
seemingly healthy person who harbors pathogenic organisms
Sepsis
severe toxic febrile state resulting from infection
contamination
soiled or infected by microorganism
Aerobes
Microorganisms that need oxygen to grow
spores
formed under conditions of nutritional depletion and capable
Coccus
Round, spherical in shape
Anaerobes
microorganisms that grow best in the absence of oxygen
viruses
smaller than bacteria and have many shapes
sterile
free of microorganisms and spores
bacillus
rod, cylindrical in shape
fomite
Inanimate object that may be contaminated with infectious organisms
droplet
particle of moisture which carries microorganisms
exogenous
infection acquired from seeding of microorganisms outside of the body
endogenous
infection resulting from seeding of microorganisms within the body
Bacteriology
study of bacteria
Mycology
study of fungi
transient microorganisms
Organisms that reside on the surface of the skin and are easily removed by washing
Resident (Normal) Flora/Microorganisms
habitually lives in deep cracks/crevices and folds of the skin or body orifices, such as the oral cavity or intestinal tract
How is Hepatitis B (HBV) spread?
percutaneous or permucous in blood, serum, or other fluids
What coexists with HBV?
Hepatitis D
Where is Candida albicans normally found?
oral cavity, digestive tract, vagina. it is the normal flora found in these areas
Clostridium perfringens, Anaerobic Gram-positive
food poisoning and gas gangrene
nosocomial infection
hospital acquired infection
percentage of surgical patients who develop nosocomial infections?
35%
air filtration system in OR:
15 volume exchanges per hour
Humidity within surgical suite:
20-60%
What kind of filters are used in OR?
HEPA filter
temperature in OR
68-73 degrees Fahrenheit
Pressure in operating room:
positive
Traffic in the OR should be kept to a ________.
minimum
double gloving
Does not prevent puncture wounds but may be appropriate for procedures in which the risk of glove tears is high
masks
used to protect personnel from aerosols and patients from droplets and should be changed immediately if grossly contaminated by a splash of blood/bodily fluid
T/F sharps should be manipulated by hand
false
What do you use to attach blade to knife handle
instrument
All laundry is considered __________ and should be handled only by gloved hands
contaminated
all ________ should be contained to prevent leaking during transport to the laboratory
specimens
Blood and suctioned fluids should be safely poured down a drain connected to:
sanitary sewer
What color are biohazard bags?
red
Perioperative personnel are encouraged to know status of these two diseases:
HIV and Hepatitis B (HBV)
steps if skin is punctured or cut
-remove both gloves
-squeeze skin to release blood
-wash out contaminants with antiseptic
-irrigate wound with veridical disinfectant
subungual
pertaining to under the fingernail
reasons fingernails should be kept short in OR
Bacteria can easily be trapped under fingernails and on artificial nails, damaged nails, chipped nails, etc.
jewelry
should be removed when entering restricted areas because they harbor microorganisms that may fall off during surgery and contaminate the sterile field
All personnel in OR should be in good health meaning:
personnel with acute infections, sore throat, scalp infections, etc. should not enter sterile field
4 items that make up OR attire
OR head cover, scrub suit, shoe covers, face mask
What item of OR attire should you don first?
OR cap
When should surgical masks be worn?
whenever sterile supplies are open
when should masks be changed
between all cases
how should face masks be removed?
only ties should be handled; face piece highly contaminated
what should non-sterile personnel wear?
long sleeve warm up jackets that are buttoned to reduce microbial shedding and protect them from splashes
cleaning
the physical removal of blood, body fluids, and/or gross debris (bioburden) from an inanimate object
disinfection
process in which most but NOT all microorganisms located on INANIMATE surfaces are destroyed
antiseptis
process in which most, but NOT all microorganisms located on ANIMATE surfaces such as skin are destroyed
Sterilization
process which destroys all microorganisms, including spores by steam, chemical agents, high velocity electron bombardment, or ultraviolet radiation
bioburden
Blood, body fluids and gross debris found on an inanimate object; also called microbial load
low-level disinfection
Kills some fungi and viruses, and most bacteria, but is NOT effective against spores and TB
Intermediate-level disinfection
kills most microorganisms including bacteria, most viruses and fungi, and TB and HBV; NOT effective against spores
High-level disinfection
kills all microorganisms except spores and prions
critical items
-items used within a body cavity or on a tissue
-MUST be sterilized
-ex. surgical instruments, implants, needles
semi-critical items
-Items that come in contact with mucous membranes or non-intact skin but are not used within a body cavity
-must be free of all microorganisms except spores, mucous membranes resist bacterial spores
-high-level disinfection used for these items
-ex. cystoscopes, colonoscopes, laryngoscopes
Non-critical items
-items that come in contact with intact skin and environmental surfaces
-do not make contact with mucous membranes
-low level disinfection used
-ex. blood pressure cuff, furniture, table
MSDS
Material Safety Data Sheet
Who's directions should be followed when diluting or altering solution
manufacturer's directions
expired solutions should be thrown away according with
1. hospital policy
2. manufacturers recommendations
3. state law
Prevents accidents or mitigates hazards
time, distance, shielding
What protects you and patient during X-rays?
-lead protection when necessary
-avoid overexposure
-leave room when possible
technique used to clean electrical equipment in OR:
damp dusting technique
What can anesthetic agents cause?
1. possible fetal injury (first trimester)
2. possible liver damage
fire triangle
fuel, oxygen, ignition source
RACE
Remove/rescue from fire or smoke danger
Alert/sound alarm
Contain fire
Extinguish/evacuate
All medical equipment must be plugged into an outlet with a _____ dot.
green
who is responsible for checking alarm systems
Surgical technologists; systems should be checked daily
biomedical engineering department
responsible for inspecting all electrical equipment, including surgeon's personal property
all anesthetic machines should have a ____________ to reduce amount of anesthetic waste gas released in OR
waste gas scavenging machine
safety guidelines for gas cylinder storage:
-well ventilated
-cool
-isolated
how should large gas cylinders be stored?
placed upright with protective valve caps in place
What shouldn't anesthetic gases be stored next to?
oxygen cylinders
When transporting gas tanks:
valve cap must be on tight and tank secured to the cart
wall clock
used for certain procedures that are time sensitive, cardiac and respiratory arrest
computer terminals
used for patient charting, view previous or current laboratory studies, or to order x-rays, or further tests for the patient. normally used by nurses
Suction units
2 units per room one for surgical team and one for anesthesia
side rails of operating table
attachment for arm boards and other attachments
kick bucket
place where soiled sponges are placed during the surgical procedure
pneumatic tourniquet
used during surgical procedures on extremities to create a bloodless operative site
sequential compression device (SCD)
sleeves that are applied to the patient's legs during surgery to prevent venous stasis, thereby reducing the risk of development of a deep vein thrombosis
Ultrasonic (Harmonic) Scalpel
consists of a single use titanium blade that moves by rapid ultrasonic motion that simultaneously cuts and coagulates tissue without creating smoke plume
Electrosurgical unit (ESU)
used to apply electrical current to cut and/or coagulate tissue and requires the use of a grounding pad
nerve stimulator
used to produce very small electric currents that, when applied to tissue, help identify and preserve essential nerves
surgical drape
made of natural of synthetic material and are used by the surgical team to isolate and protect the operative site from contaminants that cause surgical site infection
half sheet
square or rectangular in shape; may be placed as a base for further draping
Graduated pitcher
used to hold irrigation used during larger abdominal or chest cases
Neurosurgical sponges
referred to as patties or cottonoids assist with hemostasis during NEUROSURGICAL PROCEDURES to protect delicate neural tissue, 10 per package
Vessel loops
flat silicone, placed around vessels or nerves for retention
Raytec sponges
smaller and less absorbent, 10 sponges per pack
Kitners
small rolls of cotton tape that are used for blunt dissection
umbilical tape
Used for tying umbilical cord on newborn, or retracting portion of bowel or great vessel
pledgets
Small pieces of Teflon felt, used as buttress under sutures in friable tissues
laparotomy sponges
Largest and most absorbent of the surgical sponges. Used on procedures requiring large incisions. Assembled 5 per package
ligating clips
thin, serrated wire placed on blood vessel and pinched shut
Passive drains
allows fluids to flow from areas of high pressure to areas of low pressure relying on gravity for drainage
Active drains
makes use of an external vacuum source for aspiration of fluids from the wound into a reservoir
Pressure utilized by active drains
negative
2 examples of active drains
Jackson Pratt (Grenade Bulb) & Hemovac (spring loaded)
2 examples of passive drains
Penrose & T-tube
Three way Foley catheter
Allows for irrigation or medications to enter the bladder while also allowing for drainage or urine or irrigation fluid
Suprapubic catheter
placed into the bladder through a surgical opening in the abdominal wall
Robinson catheter
used for urine specimen, or decompress the bladder prior to surgical procedure, commonly called "red rubber" or "straight cath"
Polypropylene strips
adhesive backed strips used to reinforce a subcuticular skin closure. referred to as "steri-strips
Pressure dressing
type of dressing is used to eliminate dead space and prevent edema and hematoma
Wet to dry dressing
Used on burn wounds to promote new tissue growth.
2 examples of suprapubic catheters
Prezzer (mushroom) & Malecot (winged tip)
Mission of SPD
to create a system whereby supplies and equipment are properly controlled, maintained, and utilized assure bacteriologically safe sterilization
SPD has what type of flow?
One-way
Manual cleaning
The first step in the decontamination process, physically remove debris and bioburden that was not removed during the presoak
Bone cutting instruments
consist of osteotomes, currettes, periosteal elevators, chisels, gouges and ronguers.
Gooseneck Rongeur
Angular, double action rongeur
Lowman Bone Holding Clamp
reduce/stabilize fractured bone during internal fixation
Self-retaining retractors
Gelpi, Weitlaner, Balfour, Mastoid
Probing instruments
Malleable, wire-like instruments for examining body cavities, such as: fistulas, ducts, or vessels
Tip
point of the instrument, should approximate tightly when the instrument is closed
Jaws
Hold tissue securely
Box lock
Controls the opposing jaws of the instrument
Shanks
area between the box lock and the finger ring
ratchet
interlock to keep the instrument locked shut when the instrument is closed. Should mesh together smoothly
finger rings
Used for ease of holding
If unclean instrument is discovered in processing or assembly area:
return to cleaning area for ultrasonic cleaning
When instruments cannot perform function:
remove from processing area, put in designated area to send off for instrument repair
Stringers/holders
where ringed instruments should be placed when assembling an instrument set. designed to keep the hinges and box locks opened to allow the sterilant to contact all instrument surfaces.
What do you do with instruments after surgery?
- DISASSEMBLE all instruments with removable parts to expose all surfaces for cleaning
-OPEN all hinged instruments to expose box locks and serrations
power instruments
should NEVER be submerged or placed in any type of mechanical decontaminating equipment
ultrasonic cleaner
piece of equipment that is used for delicate instruments and used high-frequency sound waves known as cavitation to remove debris
washer sterilizer
piece of equipment requires instruments to be prewashed by hand in germicidal solution at 110 degrees F. temperatures range from 250-280 degrees F
washer decontaminator temperature range
140-180 degrees F
water sterilizer temperature range
250-280 degrees F
Ultrasonic cleaner temperature range
100-140 degrees F
instrument tray weight limit
25 pounds
basin set weight limit
7 pounds
T/F When assembling basins and other solid utensils, ensure that items are separated by absorbent materials, like a towel, to allow steam to have contact with all surfaces
True
What must wrapping materials permit?
-penetration of the sterilizing agents
-resist tears, punctures, abrasions
-aseptic delivery of product to point of use
3 things load control number typically contains
1. sterilizer number
2. cycle run
3. Julian date of sterilization
Wrapper labels should contain:
-contents of package
-initials of packager
-load control number
-department to which package is sent to
DBS
Double Basin Set
HTP
hand towel pack
LH
light handles
thermal sterilization
Most commonly used method of steam under pressure, referred to as autoclave
5 factors critical to outcome of sterilization process
1. time
2. contact
3. temperature
4. moisture
5. pressure
Bowie-Dick Test
test is unique to pre-vacuum sterilizer and detects air leaks and air entrapment
two modes of immediate use steam sterilizer (IUSS)
Gravity displacement & pre-vacuum
chamber
must meet the standards of the American Society of Mechanical Engineers Boiler and Pressure Vessel Code
Doors
weakest part of the autoclave
jacket
part of the autoclave surrounds the sides, top, and bottom of the chamber and allows steam to circulate
Chamber drain
located at the front or center of the chamber floor of most steam sterilizers and needs to be cleaned daily
9 parts of the autoclave
1. chamber
2. jacket
3. doors
4. chamber drain
5. steam trap/pressure regulator
6. steam filters
7. air filter
8. pressure relief valve
9. monitoring and control devices
placement of flat packs in autoclave
on their sides
placement of large packs in autoclave
2-4 inches apart in one layer, below smaller packs
placement of smaller packs in autoclave
shelf above the larger packs, 1-2 inches between them. Placed loosely in a wire basket or placed crosswise over each other
When unloading autoclave, items should be free of _________ on the outside of the package or the rails of the cart
droplets of water
commercially sterilized products
sterilized indefinitely, as long as integrity of packaging is maintained
What should the temperature of items be before they are touched and unloaded from autoclave?
room temperature
Sterility is _____________ not time related unless there is an expiration date clearly marked
event-related
temperature in storage room
below 80 degrees F
humidity in storage room
30-60%
The biological testing uses two biological units from same ________
lot number
incubation period for steam biological tests
24 hours
incubation period for Ethylene Oxide (ETO) biological tests
48 hours
chemical indicator
a paper strip or specialty treated tape that changes color when exposed to a specific temperature, pressure, or sterilant
Mechanical (physical) indicator
physical monitors found on the sterilizers that indicate proper time, temperature, and pressures were reached
Biological indicator
only test that ensures items are sterile and the conditions necessary for sterilization were met
legal requirement that all documentations regarding sterilization cycles be maintained according to what:
1. Joint Commission (JC)
2. Hospital's Standard Operating Procedure
3. Local, state, federal regulatory agents
ethylene oxide gas (Eto)
A toxic gas used to sterilize items that are sensitive to heat or moisture and items with low melting points
Hydrogen peroxide plasma/vapor
type of sterilization that uses a low temperature process consisting of a combination of hydrogen peroxide vapor and gas plasma
Low temperature gas plasma sterilization
connected to a standard electrical outlet, has restrictions on dead end channels and lumen size
Cidex OPA soak time
12 minutes
Irradiation/Ionization
Method of sterilizing prepackaged equipment and manufactured packages utilizing beta particles and gamma rays
insufflator
A device that regulates the flow and amount of gas during insufflation of the abdominal cavity
Veress needle
provides initial access to peritoneal cavity to create pneumoperitoneum
CO2
gas used to create pneumoperitoneum
insulation
needed on endoscopic electrosurgical instrumentation to ensure that the electrical energy stays within the instrument unit until it reaches exit area
lower risk of postoperative infection
advantage of endoscopic surgery since the patients are ambulatory
hyopthermia
disadvantage of endoscopic surgery caused by the fact that carbon dioxide gas is cold and may reduce patients body temperature
appropriate eye protection
most important step in laser safety
4 advantages of remote manipulation
1. eliminates hand tremors
2. perform complex interventions within a confined space
3. better visualization of the operative site
4. fosters telesurgery, benefits small rural hospitals
Surgeons use surgical robots to improve what?
Surgical patient care by helping overcome limitations in human precision/reliability
3 surgical robots
1. da Vinci surgical system
2. AESOP 3000
3. ZEUS robotic systems
3 aseptic technique principles
principle 1: a sterile field is created for every procedure
principle 2: sterile team members must be appropriately attired prior to entering the sterile field
principle 3: Movement in and around the sterile field must not compromise the sterile field
coagulant
agent, physical or chemical, that acts to promote or accelerate blood clotting
coagulation
blood clotting
anticoagulant
an agent used to prevent the formation of blood clots
topical
applied to the surface of the skin
antibiotic
agent used to destroy or suppress the activity of microorganisms
ampule
small sealed glass container containing medication, usually a liquid
vial
plastic or glass container that has a rubber stopper at the top that is held in place with a metal retaining ring; may contain liquid, powder, or compressed powder
Pharmocology
study of drugs and their actions
Pharmocokinetics
study of the movement of drugs through the body
absorbtion
occurs at the sight of administration, where the substance is taken into the bloodstream by the capillaries
distribution
transport of the medication within the body once it enters the circulatory system
excretion
waste product from the body
pharmacodynamics
interaction of drug molecules with target cells, resulting in biochemical and physiological action
onset
period of time required for the effects of the medication to begin
peak effect
period of time when the maximum effects of the medication are demonstrated in the patient
duration of action
overall period of time when the effect from a medication can be demonstrated in the patient
synergist
agent that increases the effectiveness of another agent when combined with it
agonist
medication that binds to a specific receptor site in the body producing an alteration in biological function and resulting in desired effect
antagonist
agent used to block the action of another drug without producing an effect of its own
therapeutic actions
The concentration or dose of a medication used to produce the desired result without producing harm
side effects
undesirable, but tolerable effects
adverse effects
undesirable and potentially harmful effect of a medication that can lead to organ damage or failure
perioperative nurse
responsible for all medications added to the surgical field (not according to SSG Mburu)
what is identified on medication label
Name, strength, amount, expiration date
6 "Rights" of patient drug administration
right drug
right dose
right documentation
rigt patient
right route of administration
right time
chemical name
precise chemical composition and molecular structure of medication
Generic name
nonproprietary name of drug, shortened version of the chemical name
brand name
name assigned to a medication and copyrighted by the manufacturer for marketing purposes
what is identified on medication label?
Name, concentration, amount, expiration date
controlled substance
A drug with a high potential for addiction and abuse
prescription medication
medication that, if used inappropriately can cause significant harm
nonprescription medication
pharmacologic agents that are prepared in a dosage safe to administer with the direction of a physician
biotechnology
newest source of drugs from the laboratory comes to us from genetic engineering. New technology referred to as recombinant DNA technology
Suspension
type of liquid preparation. solids are suspended in a liquid
Emulsion
type of liquid preparation. combination of two liquids that cannot mix. small droplets of one liquid are dispersed throughout the other
topical coagulants
provide a good surface for and aids in clot formation. applied directly to bleeding areas.
ex. Thrombin, bone wax, absorbable gelatin sponge
anticoagulants
interfere with blood clotting mechanism
ex. Heparin- used to prevent blood clot formation during vascular procedures (given intravenously)
Anticoagulant antagonist
given if heparin causes too much bleeding
ex. Protamine sulfate: binds with heparin to inactivate heparin's effects
Oxytocics
contracts the uterus during and following childbirth or abortion; helps to control hemorrhage after delivery.
Corticosteroids
decrease inflammation; treatment of many inflammatory diseases and conditions
ex. decadron, Solu-Medrol
contrast media
aids in visualization of structures during radiographic procedures
ex. renografin, cardiografin
dyes
leave a visible tract by staining an area of tissue, enhanced visualization that helps follow a tract
ex. gentian violet, methylene blue
Dantrolene
Emergency drug. only known drug effective in the treatment of Malignant Hyperthermia crisis
autotransfusion
re-infusion of the patient's own blood
Diuretics
prevent reabsorption of water and certain electrolytes in tubules
Gastric medication
neutralize stomach acids (sodium citrate) and inhibit hydrochloric acid secretion in the stomach
narcotic antagonist
Naloxone hydrochloride (Narcan). displacement of narcotics form CNS receptor sites
tranqualizers
depress the CNS
analgesics
pain relievers
general anesthesia
patient is unconscious and the muscles are completely relaxed given through inhalation of gas or intravenous
inhalation agents
Inhaled and pass into the blood stream via the respiratory system, cross the alveloar membrane and enter the circulatory system for delivery to the brain
intravenous agents
-delivered directly into the bloodstream
-Largest group of agents in use today
-Act quickly
topical anesthesia
involves the placement of a nerve conduction blocking agent onto a tissue layer; comes in contact with peripheral nerve endings preventing transmission of nerve impulses
local anesthesia
injection of a nerve conduction blocking agent into the tissues surrounding a peripheral nerve or only nerves that serve specific tissue area
ex. Litocaine
regional anesthesia
blocks nerve impulse conduction from all tissues distal to the injection site. larger area compared to local anesthesia
patient factors affecting anesthesia
age, weight, height, general health, co-morbid factors
intubation
cricoid pressure may be needed; have suction available and ready
beir block
provides anesthesia to the distal portion of the upper extremity by injecting an anesthetic agent into a vein at a level below a double tourniquet
spinal block
used to anesthetize the lower portion of the body below the diaphragm
Monitored Anesthesia Care (MAC)
combination of nerve conduction blockage on the topical level that is supplemented with analgesics
Stage 1: Amnesia stage
from initial administration of an anesthetic agent to loss of consciousness
Stage 2: Excitement or Delirium stage
from loss of consciousness to the return of regular breathing and loss of eyelid reflex
Stage 3: Surgical Anesthesia stage
"operative stage of anesthesia" consists of period between the onset of regular breathing and loss of eyelid reflexes to the cessation of breathing
Stage 4: Overdose stage
dilated and nonreactive pupils with cessation of respiration and marked hypotension leading to circulatory failure. leads to death if not corrected
induction phase
critical time; loss of consciousness occurs. Intubation occurs and noise should be kept to a minimum
maintenance phase
surgical intervention takes place
emergence phase
Extubation takes place; patient wakes up.
recovery phase
Patient gradually returns to optimum level of consciousness
Malignant hyperthermia
rare hypermetabolic crisis triggered by anesthesia agents causing severe increase in heart rate/respirations
Patient warming device that utilizes warm air blown into a special blanket
What is the main role of the ST in scrub role if patient goes into cardiac arrest?
primary responsibility is to protect the sterile field from contamination
factors that influence patient positioning
-site of incision
-age/size of patient
-type of anesthesia administered
-presence of pain with movement
*Anesthesia provider indicates patient positioning
stirrups
Supports legs in lithotomy position; candy cane and Allen
safety belt
first thing applied to patient after put on table. necessary for all cases; should never be placed over abdomen to avoid compressing abdominal structures
Supine (dorsal recumbent)
most common position; patient on back with legs extended. arms along body, palms down
surgeries done: appendectomy, hernia repair, cardiovascular
Trendlenburg
similar to supine except head lies lower than the feet. patient remains in position for short period of time to prevent excessive blood flow to the head
surgeries done: hysterectomy, cystoscopy, some bowel procedures
Reverse Trendelenburg
supine with head higher than feet; used for head and neck surgeries
surgeries done: thyroidectomy
prone
patient is lying face down, safety strap over posterior thigh, protection of genitalia and breast
surgeries done: laminectomy, spinal fusion
Kraske's (jackknife)
prone with the table broken in half in the center
surgeries done: hemorrhoidectomy, pilondial siuns
lateral (Sims)
patient on the unaffected side with lower leg flexed and upper led straight. arm supported on arm board with other arm on mayo stand. bean bag in place to keep patient from rolling
surgeries done: kidney procedures, hip procedures
lithotomy
patient on back legs in stirrups with hips at edge of lower break in the table
surgeries done: vaginal, rectal
Modified Fowler's (sitting position)
supine with upper section of table raised, arms at side
anesthesia screen
Separates sterile field from unsterile field
Objective of surgical skin preparation
to prepare the operative site by rendering the area as free as possible from bacteria to ensure surgeon can make an incision with minimal danger of infection to the patient
preferred method of shaving
clipping
when using disposable clippers:
hand piece should be disinfected after each use
Betadine (povidone-iodine)
most commonly used antiseptic prep solution that is nonirritating to skin or mucous membranes; contains iodine
Chlorhexidene Gluconate (Hibiclens)
Not absorbed though skin; significantly reduces and maintains reduction of microbial flora for at least 4 hrs; used when patient is allergic to iodine solutions
Isopropyl alcohol 70%
sometimes used during ortho cases, NOT used on mucous membranes or open wounds
Verbal communication between patients and health care providers does not constitute legal evidence in a court of law
True
Surgical Consent Form - Optional Form 522
informed consent to administer anesthesia and perform operative procedure
Operation Report - SF 516
Completed by surgeon, hardcopy is put on the chart; dictated report of operation may take a few days to be put on the chart
intraoperative nursing record
Documentation by registered nurse, facility specific; may be computerized or handwritten, record of all personnel in the room
Right patient, right surgery, correct side. completed in the operating room with all team members present and in agreement. also referred to as "time out"
incident report
-used to document an injury to a patient or caregiver
-part of departmental quality improvement and risk management program
-also used to record near miss/close calls for in-house performance improvement
Sentinel Event Report
All incidents meeting the current JC definition of a sentinel event will be reported to Medical command;
-Wrong site, wrong patient, wrong surgery
-suicide in a 24 hour facility
-infant abduction or infant discharged to wrong family
-Rape
"Buck" slip
Scheduling form, facility specific
Routine (permanent) specimen
stays in room until case is over then it is taken with paperwork to specimen cart.
ex. tissue, appendix, gallbladder
Fresh/Frozen sections
prevent deterioration of specimen; send lab slip with specimen immediately
Amputations
Fingers and toes may be treated as routine specimens; whole limbs are sent to morgue ASAP; make sure entry is made in morgue log
biopsy
excision of tissue or aspiration of fluid to determine the nature or treatment of a disease/condition
foreign bodies
-must follow a legal chain of evidence
-evidence of any criminal act must be safeguarded (stabbing, shooting, rape)
blood specimens
usually collected by anesthesia and delivered to lab immediately with lab slip
Rules when accepting specimen from scrub person:
-NEVER touch specimen with bare hands, wear gloves on both hands
-do not allow specimen to dry out
-handling specimens should be minimal
specimen containers
should be large enough to contain the specimen so that the fluid can circulate freely. NEVER place specimen on a counted sponge
Standard Form 515- Tissue Examination
-Intraoperative record of any tissue or item removed from patient during procedure
-Can be used for more than one tissue specimen
-Specimens are labeled in the order they are removed
Specimens are labeled using what?
letters
Cultures are labeled using what?
numbers
Sponges
-counted on all surgical cases
-additional counts done before cavity or cavity within a cavity is closed
sharps
-Needles or other sharp objects
-counted on all procedures, passed to surgeon on an exchange basis "one-for-one swap"
-must be kept in a needle book or magnetic pad on control table
if sharp is broken during procedure:
must be accounted for in their entirety; 1 becomes 2
Instruments
counted on all procedures in which likelihood exists that an instrument could be retained
Additional guidelines
-All counts should be audibly and visually performed according to hospital policy
-Omitted counts due to extreme emergency should be documented on nurse's notes
preoperative count
Initial count, taken before procedure begins
intra-operative count
taken as closure of cavity begins
final count
Taken as skin closure begins
Counting of sponges and sharps only
additional counts
taken whenever there is a question about accuracy, a change of scrubs or circulators, closing a cavity within a cavity
identify and count items in this sequence:
1. FIELD
2. MAYO TRAY
3. BACK TABLE
4. BASIN RING STAND
blood transfusion
whole blood or cells are taken from a donor and infused into a patient, used for anemia and low blood volume
blood bank
a stored supply of blood for future use
hemorrhage
escape of blood from a ruptured blood vessel
Hematopoiesis
the production of blood cells in the bone marrow
dehydration
excessive loss of water from the body
overhydration
Excess fluid volume
isotonic
concentration of water in the fluid outside red blood cells is the SAME as inside. NaCl 0.9% is isotonic for RBCs
hypotonic
water molecules enter the cell faster than they leave causing red blood cells to swell and rupture. Called hemolysis
Hematocrit
percentage of blood volume occupied by red blood cells
pH
symbol of measurement of the concentration of hydrogen ion in a solution with a scale from 0-14
pH below 7
acidic
pH higher than 7
alkaline
pH of 7
neutral
diffusion
Movement of molecules from an area of higher concentration to an area of lower concentration until pressure is equal on both sides
Osmosis
movements of fluid through a semi-permeable membrane from a solution that has a LOWER solute concentration to one that has a HIGHER solute concentration (going against concentration gradient)
active transpot
process by which molecules are moved across a cell membrane against a concentration gradient with the use of external energy
electrolytes
substances found in intracellular and extracellular fluids that when dissolved in water can carry a charge
cation
positive charge
anion
negative charge
Normal saline (0.9% sodium chloride)
Commonly used in most surgical cases, keeps tissues from drying out
sterile water
used in similar situations as normal saline but has hemolytic properties, good to use on cancer cells
Lactated Rings (LR)
irrigation of choice for arthroscopic procedures to provide clear visualization of structures in the joint capsule
Balanced Salt Solution (BSS)
Irrigation solution used by Ophthalmology surgical specialty to keep tissues of the eye from drying out during a procedure
Sorbitol 3%
Common irrigating fluid used in Genitourinary procedures, used to distend bladder. has NO hemolytic properties and does NOT conduct electricity
Glycine
common irrigating fluid used during electrophoretic procedures and for internal examination using fiber optic instruments
calculating blood loss
1. fluid collected in suction container is measured
2. subtract irrigating fluid used during procedure
3. remaining measurement is estimated blood loss
albumin
generally used as whole blood and contains all blood components except red blood cells
dextrose
similar to lactated ringers but with added nutrients
hespan
expands the plasma volume slightly in excess of the volume infused
what part of a wrapper is considered sterile?
inside of wrapper to within one inch of the edges
Tables are sterile only at _________
table level
After sterile bottle is open:
contents are either used or discarded. cap cannot be replaced without contaminating pouring edges
how much distance should non-sterile members stay from field?
at least one foot from any area of the sterile field
Where should self-gowning and gloving be done?
Separate sterile field
laryngeal mask
inserted nasally or orally by direct laryngoscopy into the space between the vocal cords so that anesthetic vapor or gas inhaled directly into the trachea
furniture and equipment should be placed ________________
18 inches from the wall
IV poles
placed on both sides of the head of operating table
Standard I: Teamwork
good interpersonal and communication skills in all interactions with the healthcare team
Standard II: Individualized preoperative planning and preparation to meet needs of patient
Collaboration with RN in collection of data, preparation of equipment and supplies
Standard III: preparation of perioperative environment will ensure safety for patients and personnel
wearing appropriate attire, observing aseptic techniques, maintaining safe work area
Standard IV: Maintain current knowledge base for proficient performance of assigned functions
processes, equipment, supplies, emergency protocol, changes in technology
Standard V: The patient has a right to privacy, dignity, safety, and comfort is respected and protected
accountable morally and ethically to uphold patient's rights. be the patients advocate
Standard VI: Every Patient is entitled to the same application of aseptic technique within the physical facilities
application of sterile techniques at all times by all members
depilatory cream
Preliminary skin patch is tested on a forearm to determine any allergic reaction; should not be used around eyes or genitalia remains on skin from 20 min and then hair washed off with cream
Anti-microbial
Chemical or pharmaceutical agent that destroys or inhibits growth of microorganisms
Residual
Leaves an anti-microbial residue on the skin to temporarily prevent growth of microorganisms
Transient organism
Usually loosely attached to the skin surface, and almost completely removed by thoroughly washing with soap or detergent and water
mechanical washing
Process which removes soil and transient organisms with friction by use of mechanical means/equipment, as opposed to manual
chemical washing
The process that reduces resident flora and inactivates microorganisms with an anti-microbial or antiseptic chemical agent.
Avagard
example of chemical washing. rapid bactericidal action waterless one step process
resident organisms
resides below the surface of the skin. More adherent therefore more resistant to removal. Their normal growth is inhibited by chemical phase of the surgical scrub
subungual
under the fingernail
palmer
the palm
dorsal
back of the hand
grossly soiled
contaminant is visible with the eye
surgical hand scrub
the process of removing as many microorganisms as possible from the hands and arms; to render them surgically clean
timed scrub method
a prescribed amount of time is allotted for each designated plane of the hand and arms.
counted brush stroke method
A set number of strokes are allotted for each designated plane of the hands and arms
which surgical scrub method do we use in lab?
counted brush stroke method (tested Methodology)
three objectives of surgical hand scrub
1. decrease number of resident and transient microorganisms on skin to a minimum
2. keep population of microorganisms to a minimum during surgical procedure by suppression of growth
3. reduce hazard of microbial contamination of surgical wound by skin flora
Requirements of antimicrobial scrubbing agents
-broad spectrum anti-microbial
-fast acting/effective
-non-irritating and non-sensitizing
-prolong acting (leave residue on skin)
-independent non-cumulative
Fingernail requirements
-short
-no nail polish
-no artificial nails
appropriate surgical attire
Hair cover, mask, Eye pro, Designated shoes or shoe covers, All jewelry removed
scrub sink
should be deep and wide to prevent splashing, positioned adjacent to the OR, should have foot/knee operated faucet
Scrub brush
Disposable, may be impregnated with anti-microbial soap
nail cleaners
attached to the sponge portion of scrub brush; plastic
anti-microbial soap
Stored in foot or knee operated dispenser
Usually near sink
Purpose of Gowning and Gloving
Worn to exclude skin as a possible contaminant,
Creates a barrier between sterile and non-sterile areas
Reusable surgical gowns
-Moisture repellent finish
-can withstand about 75 launderings before losing barrier quality
fluid resistant gowns
Disposable (Class 1)
-cost effective
-provide low level of fluid protection
-long exposure to moisture may lead to strike through contamination
impervious gowns
Disposable (Class 2)
-contain fluid-proof reinforcements in the front and in the sleeves
Full Coverage Systems (Space Suits)
Disposable (Class 3)
-gown portion envelops the wearer's body to below the knees
-has hooded face shield or helmet that covers the head, neck, and shoulders
-contains ventilation system
-may have communication system because the ventilation system is noisy
Safety and barrier requirements of surgical gown materials
-provide a protective barrier from strike through
-comfortable without producing excessive heat buildup
-have stockinette cuff to snuggly fit wrist
-fire resistant gowns must be worn when doing laser cases
Class 1
fluid resistant gown, scrub can wear a single layer gown
Class 2
impervious gowns, surgeon and first assistant are at a greater risk and therefore should wear a gown with a least reinforced or plastic covered sleeves
Class 3
Full coverage systems, orthopedic and other high risk of infection procedures
Open method of gloving
used by non-sterile team member performing a sterile task. Greater risk of contamination
Closed method of gloving
gloves are handled through the fabric of gown sleeve. easier, faster method with less chance of contamination
What is the only acceptable method of regloving?
Open Method
Sutures
approximate tissue, packs are color coded
Needles
made of steel and should be strong enough not to bend or break during suturing
ligature
a strand of material used for ligating or approximate tissue in its normal position until healing takes place
suture ligature (stick tie)
A strand of suture with a needle on a needle driver that is used to tie off or seal blood vessels to prevent simple bleeding, or isolate a mass of tissue to be excised.
free tie
a single strand of suture passed by itself to the surgeon
tie on a passer
a single strand of suture attached to a right angle clamp
monofilament
single thread
multifilament
a strand of suture material consisting of more than one twisted or braided threads
hydrolysis
a chemical reaction that occurs in the presence of water to break down fibers in a suture
non-absorbable suture
suture that remains permanently in the body (encapsulated), or is used to approximate tissue and is later removed; suture does not dissolve
absorbable suture
Suture that can be digested (by body enzymes), hydrolyzed and assimilated by the tissue during healing, suture dissolves.
traumatic
A needle with an eye
atraumatic
An eyeless needle is crimped around one or both ends of a suture strand; also known as swaged
needle book
disposable container used to arrange used needles after use on the sterile field to allow for ease of counting and accountability
Monofilament Advantages/Disadvantages
Advantages
-does not readily harbor bacteria
-glides through the tissue easily
Disadvantages
-does NOT hold knots well
-not easy to handle
Multifilament Advantages/Disadvantages
Advantages
-holds knot securely
-handles well
Disadvantages
-harbors bacteria as it absorbs moistures
-should NOT be used in the presence of infection
name, concentration, amount, expiration, clarity, seal in tact
What is first thing scrub should do when setting up sterile field?
drape the mayo stand
principles of setting up instruments
-small to large
-right to left
-sharp to dull
-likes with likes
principles of sterile field
-move as little as possible
-handle each item only once
-keep body centered in a "box"
-logical and efficient pattern
Rational for performing counts
1. patient safety
2. legal purposes
3. should be done according to hospital policy
What two items are counted on all cases?
Sponges and sharps
Incorrectly numbered packages of sponges
isolated and not used during procedures
when to perform counts
-whenever cavity within a cavity is closed
-whenever there is a question about accuracy
-change of scrub techs
hand towels
Rectangular drape, used with cuffed or folded edge toward the operative sight to isolate that area
Lithotomy drape
Drapes for the lithotomy position, includes one under the buttocks sheet, two leggings and one abdominal area drape that is used for vaginal and some rectal/perineal procedures.
laparotomy drape
large sheet with a fenestration that is used for abdominal procedures may be altered or modified
craniotomy drape
drape sheet used for procedures of the head area and draping procedure encompasses the whole body
Fenestrated drape
Drapes with apertures or openings and available in a variety of sizes to allow flexible and specialized draping; folded so that the aperture is positioned at the proposed operative field
split sheet
drape sheet with one end split to form tails and is used for draping body parts that are not amenable to fenestrated sheets, available in a variety of sheet sizes and split lengths
Tube stockinette
draping component used on extremities in addition to drape sheets; woven, tube like drape used on arms and legs, may or may not have liquid resistant backing
purpose of surgical draping
To establish sterile fields by placing sterile towels and sheets in a specific position to maintain the sterility of surfaces on which sterile instruments and gloves may be places
characteristics of surgical drapes
1. resistant to blood and liquid penetration
2. resistant to tears/punctures
3. resistant to microbes
4. minimize passage of microbes between sterile and non-sterile
-100% cotton, thread count of 140 per square inch
-Must be washed, de-linted, inspected, folded, wrapped and sterilized after every case
muslin
not an effective barrier and does not retard the passage of fluid, cannot be absorbent
Purpose of surgical case review
method to document what you learn and detailed description of a procedure
Steps in preparation
1. Definition of Procedure
2. Definition in your own words
3. Anesthesia: Type
4. Common indications
5. position of patient
6. positioning of equipment
7. Draping procedures
8. incision sites
9. Prepping procedures
10. instrument set
11. specimen anticipated
12. dressing, drains, implants
13. potential complications
14. special duties
15. detailed description of operative procedures
peritoneum
membrane that lines the abdominal cavity
alimentary canal
digestive tube that extends from the mouth to the anus
Esophagus
A muscular tube that connects the mouth to the stomach.
stomach
large muscular sac that continues the mechanical and chemical digestion of food
omentum
an extension of the peritoneum attached to the stomach and connecting it with other abdominal organs
bilary tract
pathway for bile flow from the liver to the bile duct and into the duodenum
Major Laparotomy Set
Provides instrumentation for almost any procedure that can be performed in the abdominal cavity.
- Most thoracic, vascular, gynecologic, and genitourinary surgery use this set
Biliary Instruments
additional instruments used to explore common bile duct
-Ductal forceps
-Stone "scoops" (Mayo, Moynihan, Moore)
-Potts scissors (open duct)
-Lahey duct forceps (clamp duct)
-ductal dilators (Bakes #3-#10)
-Ochsner gallbladder trocar
Intestinal instruments
-Payr, Allen, Doyen, or Best bowel clamps
-may also include extra forceps and poole-type suction
McBurney incision
type of oblique incision, used for open appendectomy
vertical midline incision
Simplest abdominal incision, offers good exposure to any part of the abdominal cavity
right side subcostal incision
gallbladder, biliary system, and pancreas procedures
left side subcostal incision
spleen surgery
Pfannenstiel incision
used for c-sections, transverse incision
hernia
Protrusion of an organ through the wall of the cavity that normally contains it
inguinal hernia
protrusion of part of the intestine through lower abdominal wall into inguinal region
femoral hernia
A protrusion of part of the intestine through the canal that carries the femoral artery into the upper thigh, most common In women
ventral hernia
a hernia on the anterior abdominal wall at any point other than the groin
inciscional hernia
hernia located at the site (incision) of a previous surgery
Diaphragmatic hernia
hernia in diaphragm usually at the esophageal hiatus where the upper part of the stomach protrudes through the hiatus where esophagus passes
reducible hernia
Herniated contents can be returned to its organic region via manual manipulation
Irreducible hernia
Cannot be returned to its organic region via manual manipulation
Strangulated hernia
A protruding organ has become constricted and its vascularity is compromised. surgical emergency
Direct hernia
acquired hernia or one that results from a stressor such as trying to lift something heavy
indirect hernia
A congenital defect in the internal inguinal ring
Laparoscopic Nissen Fundoplication
Surgical procedure to correct a hiatal hernia and considered the preferred operative procedure
-special instrumentation: Maloney dilators
appendectomy
surgical removal of the appendix, performed for an acute appendicitis or during other surgery as a prophylactic measure
operative procedure of appendectomy
1. McBurney's incision is made
2. appendix is identified and grabbed with babcock
3. appendix is isolated from mesoappendix
4. appendix is removed
5. purse string suture is placed around the stump of appendix
6. incision is closed in layers
hemorroidectomy
remove abnormally enlarged veins in the lower rectum or anus
laparoscopic cholecystectomy purpose
-surgical treatment of gallstones and inflammatory gallbladder disease
-performed in up to 90% of all gallbladder removals
special equipment in laparoscopic cholecystectomy
-CO2 tank and insufflator with tubing
-Veress needle or blunt tip cannula (Hassan) to establish pneumoperitoneum
laparoscopic cholecystectomy operative procedure
the cystic duct and cystic artery are identified, and dissected free from surrounding tissue
Mastectomy with Axillary Dissection
Treat breast cancer and may be done in conjunction with chemotherapy/radiation treatments. entire breast tissue is taken and all fat/lymph is removed from axillary region
practical consideration of colon resection
"bowel technique": all contaminated instruments, sponges, and other equipment are kept separate from equipment used for closure
Purpose of thyroidectomy
surgical removal of one or more lobes of the thyroid gland
-important nerves must be preserved during dissection such as superior laryngeal nerve, inferior laryngeal nerve, and recurrent laryngeal nerve-bilaterally
pancreaticoduodenectomy (Whipple procedure)
treat tumors of the head of the pancreas, most common site of pancreatic cancer.
Islets of Langerhans
cells that produce insulin in the pancreas
Uterus
a pear-shaped organ inside a female's body where the embryo is protected and nourished
Oxytocin
used to contract the uterus following delivery controlling hemorrhaging
positioning for OB/GYN surgery
-supine for abdominal cases
-lithotomy for vaginal and combination procedures
episiotomy
intentional surgical incision in the vulva to ease the birthing process
perineal laceration
Unintentional laceration of the perineal area due to the birthing process
C-section operative preparation
supine position with a roll towel placed under the right hip to keep uterine pressure off the vena cava
C-section incision
incision is typically low transverse or pfannenstiel incision
Diagnostic indications of Dilation & Curettage
-Dysmenorrhea: problems with menstruation
-collection of abnormal cytology to rule out endometrial disease
-rule of pregnancy prior to elective sterilization
-determine a cause for infertility
Therapeutic usage of Dilation & Curettage
-removal of suspected pathology
-treatment of postpartum bleeding
-evacuate retained placenta
-retrieval of "lost" IUD
Dilation & Curettage operative procedure
-Auvard weighted speculum is placed into the vagina
-Uterine sound is introduced to measure the depth of the uterus in order to prevent perforation
oophorectomy
removal of ovaries
Salipingectomy
removal of the fallopian tube
total abdominal hysterectomy (TAH) and Vaginal hysterectomy
removal of the uterus and cervix due to malignancy, dysfunctional uterine bleeding, prolapse, pain, disease by entering the abdomen through an incision
Laparoscopy Assisted Vaginal Hysterectomy (LAVH)
Alternative to Total Abdominal Hysterectomy (TAH) and Vaginal Hysterectomy. Patient does not have large incision
tubal sterilization
tubal ligation or occlusion is an elective permanent sterilization procedure
tendons
Connect muscle to bone, transmits forces of bone and cartilage
ligaments
bone to bone
cartilage
a layer of elastic like supporting tissue found at the ends of bones
arthralgia
pain in a joint
arthroplasty
reconstructive surgery of a joint to restore motion or prevent excess motion
arthroscopy
visual examination of a joint
closed reduction
Fracture is manipulated and properly aligned without an incision into the skin
Immobilization
stabilization, act of holding, suturing, or fastening the bone in a fixed position with strapping or a cast
laminectomy
surgical removal of the posterior arch of the vertebra called the lamina to reduce pressure of the nerve root
osteoma
tumor of the bone
Osteomyelitis
bone infection/inflammation caused by a bacterial infection
osteotomy
surgical cutting of bone
reduction
realignment of broken bone ends into proper anatomical position
pneumatic tourniquet
provides a bloodless surgical site
traction
used to prevent or reduce muscle spasms, immobilize a joint, or reduce a fracture
Maxi driver
Used for large bones
Mini driver
used for small bones
sagittal saw
blade moves side to side
Oscillating saw
blade vibrates back and forth, it does not spin around
reciprocating saw
Blade moves forward and backward like a handsaw
Reamers
Used to enlarge the medullary canal of long bones
Polymethyl Methacrylate (PMMA)
bone cement, used in total joint arthroplasty
True/False implants should never be reused
True
Knee Arthroscopy
injuries or abnormalites within the joint such as torn meniscus and ligaments, loose bodies, damage from wear and tear
what is most common meniscus tear?
bucket handle tear
External K-Wire Fixation of a Colles Fracture
angulated fracture of the distal radius at the epiphysis approximately 1 inch from the wrist joint
Open Reduction Internal Fixation (ORIF) of radius
indicated if fracture cannot heal with closed reduction. incision is made into the arm and fixed with plate and screws
sequence of ORIF procedure
Drill -> tap -> depth gauge -> screw -> plate
ORIF Intertrochanteric Femur Fracture
classified as a hip fracture, most frequently occurs in elderly patients
ORIF Intertrochanteric Femur Fracture OR table
OR fracture table which allows adequate radiographic examination for placement of the internal fixation
Bankart Repair
recurrent shoulder dislocations using implants/anchors
surgical amputation due to trauma or disease that inhibits vascular supply to affected extremity
suprarenal gland
superior and medial portion of the kidney
vasectomy
surgical removal of small portion of the vas deferens
vasovasostomy
surgical reconnecting of the vasa deferens in a male with a vasectomy to restore fertility; vasectomy reversal operation
General instruments: Genitourinary
-long instrument set
-self-retaining abdominal retractor
-Mixter right angles
-Potts scissors
-vascular instruments
-bladder and prostate retractors
Kidney instruments: Genitourinary
-pedicle clamps
-stone/lithotomy forceps
Thoracic (Rib Resection) Instruments
-self-retaining rib retractor
-alexander periosteotome
-doyen rib elevator and rasp
-rib shears
-sauerbruch rongeur
-bailey rib contractor
specialized room for transurethral procedures
Cysto room, built in table that will accommodate a patient in the lithotomy position and allow for x-rays
Scrotal incision: Genitourinary
used for vasectomy, testicular biopsy, simple orchiectomy, orchiopexy
Abdominal incision: Genitourinary
used for open cystostomy or suprapubic prostatectomy
Gibson incision: Genitourinary
access to the lower portion of the ureter
Flank incision: Genitourinary
patient is in the lateral position providing access to adrenal gland, kidney, proximal ureter
lumbar incision: Genitourinary
provides limited exposure, used for adrenalectomy, renal biopsy, removal of small low-lying kidney
orchiectomy
removal of one or both testes
cystoscopy
visual examination of the urinary bladder
orchiopexy
surgical fixation of a testicle
transurethral resection of the prostate (TURP)
surgical removal of all or part of the prostate
transurethral resection of the prostate (TURP) instruments/supplies
-2-3 Ellik evacuators or Toomey syringes
-3-6 liters of nonelectrolyte irrigant (3% sorbitol or 1.5% glycine)
suprapubic prostatectomy
excision of the prostate gland through an abdominal incision made above the pubic bone and through an incision in the bladder and prostate capsule
-done when adenomas are too large to be removed endoscopically
First degee burn
affects just the epidermis (sunburn)
Second degree burn
affects the dermis (blistering)
Third degree burn
penetrates the full thickness of the skin, burns appear pearly white, threat of infection is great
fourth degree burn
Chars muscles/ tendons down to the bone
Body's first line of defense
skin
Autologous skin graft
transplantation of patients skin grown in culture
Hemograft
Allograft, same species graft
xenograft
obtained from a dissimilar species like a pig
full-thickness skin graft
a skin graft that contains the dermis and epidermis
split thickness skin graft
Involves removing the epidermis and a portion of the dermis for relocation to another part of the body.
Rule of 9's
Head and neck = 9%
Upper Ex = 9% each
Lower Ex = 9% each
Front trunk = 18%
Back trunk = 18%
Perineum = 1%
cleft
Split or a gap between two structures that are normally joined
dermatome
instrument used to cut thin slices of skin for grafting
Mesh graft device
a device used to expand the size of a split thickness skin graft
Mineral oil
donor area must be lubricated prior to removing tissue with dermatome
Blepharoplasty
surgical repair of the eyelid, used to remove excess skin or fat deposits of either the lower or upper eylids
Reconstructive mammoplasty with TRAM
transverse rectus abdominis muscle is most commonly used muscle to restore woman's appearance and quality of life after mastectomy
Rhinoplasty
reshaping of the bridge of the nose
Right pleural cavity
right lung: 3 lobes
Left pleural cavity
left lung: 2 lobes
Sternum
manubrium, body, xiphoid process
parietal pleura
lines inner surfaces of ribs, pericardium of heart, and superior surface of the diagram
visceral pleura
covers outer surface of each lung
Trachea
extends from the larynx to bronchi and functions as a passageway for air to and from the lungs
Bronchoscopy
procedure for the evaluation of hemoptysis, infection, carcinoma of the lung, and damage to the lungs due to smoke inhalation, Allows visualization of the bronchi
Medianstinoscopy
evaluation of the nodal involvement or mediastinal masses in patients with carcinoma of the lung, performed after CT scan has demonstrated hilar or paratracheal adenopathy
Thoracentesis
placement of a needle into a posterior portion of the pleural space for the analysis of pleural effusion which is the abnormal accumulation of fluid in intrapleural space of lungs
Thoracoscopy
Endoscopic procedure for examination of the thoracic cavity.
instruments needed to remove rib
-Bethune rib shears
-Matson rib stripper/elevator
-Sternal saw and retractor for median sternotomy
-Lebsche knife and mallet
Heparin
drug used for intra-arterial irrigation
Papaverine
drug used for vasoconstriction control (vasodilator)
Thrombin
drug used as a hemostatic agent
Video Assisted Thoracic Surgery (VATS)
use of a thorascope to visualize the thoracic cavity for diagnosis as well as treatment for select conditions like removal of cysts
Video Assisted Thoracic Surgery (VATS) equipment
-video monitors for viewing
-videocassette recorder
-light source
-electrosurgical unit
-suction/irrigation unit
-defibrillation unit
pneumonectomy
surgical procedure to remove the WHOLE lung
segmentectomy
removing a segment of the lung as a wedge resection
"heart-lung machine": used in cardiac surgery to remove unoxygenated blood from the venous system, oxygenate it, and return it to the arterial system
Cardiac instruments
-set of instruments for exposure to heart and great vessels
-set of instruments for saphenous vein harvesting
-coronary artery anastomosis instruments
-Sternal saw, sternal retractor, internal mammary artery (IMA) retractor
Coronary Artery Bypass Grafting (CABG)
most commonly performed cardiac procedure during the past 20 years
Coronary Artery Bypass Grafting (CABG) procedure
procedure where a segment of vein (commonly saphenous vein) is used to bypass a blocked area of a coronary vessel anastomosed from the aorta to a point distal to the obstruction in the artery
weak areas in an arterial wall most often occurring BELOW the renal arteries
carotid endarterectomy
small pieces of plaque break away from the common carotid or internal carotid artery and are flushed upstream blocking the flow to particular areas of the brain
carotid endarterectomy instruments
-Carotid set
-minor set
-Javid shunt clamps
-hemoclip applicators
-Potts-Smith scissors
-Freer elevator
arterial embolectomy
Surgical intervention to remove thromboembolic material (blood clot) from an artery.
secretes the tears that keep the conjunctiva moist
Globe
the eyeball in its entirety
Colibri forceps
microsurgical instrument, used for holding edges of corneal and scleral incision
bishop-harmon iris tissue forceps
microsurgical instrument, used for grasping and holding delicate eye tissue
Eye scalpels
Graefe cataract knife and Keratomes knife
Mydriatics
ophthalmic medication for pupil dilation
Miotics
ophthalmic medication for pupil contraction
strabismus correction-recession
corrects a misalignment or deviation of the eyes
Recession
lengthening of one of the six extrinsic muscles by detaching it from its original insertion and reattaching it more posteriorly on the sclera
Resection
shortening of one of the six extrinsic muscles by removing portion of it and then re anastomosis the cut ends
Cataract extraction
replacement of lens of the eye performed through small incision in which the lens is removed manually or by phacoemulsification
phacoemulsification
the use of ultrasonic vibration to shatter and remove the lens clouded by a cataract
Cataract extraction instruments
-Basic eye set with cataract extraction tray
-phacoemulsifier handpiece
-Intraocular lens implant (IOL)
Cataract extraction practical considerations
-powder is meticulously removed from gloves to prevent corneal irritation
-procedure performed under operating microscope which is brought over patient from side opposite of affected eye
Sclera buckle
Procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of a retinal tear to push the sclera towards the retinal tear
Outer ear
tympanic membrane or eardrum
middle ear
air-filled cavity located in temporal bone
-contains malleus, incus, stapes
inner ear
contains mastoid sinus
operating table for ENT
reversed operating table- head of bed placed at foot of the table to allow more room for equipment and medical personnel
ENT knife blade and handle
#12 knife blade is often used in oropharyngeal surgery in which the blade is curved.
#7 knife handle is often used due to its extended length and slim handle
ENT drugs
-Topical anesthetics: Cetacaine spray/cocaine
-local anesthetics for tonsillectomy on adults
-Lidocaine or bupivacaine
myringotomy/tympanostomy
incision into the tympanic membrane for removing accumulated fluid
functional endoscopic sinus surgery (FESS)
restores normal breathing and allows mucus to clear from sinuses, preventing sinus infections and mucoceles
tonsillectomy post-op care
-place in lateral or prone position with the head lower than the chest to avoid aspiration of saliva or blood
uvulopalatopharyngoplasty (UPPP)
removal of redundant tissue of the tonsils and portions of the soft palate including uvula. main treatment for intractable snoring and obstructive sleep apnea
SMR/Septoplasty
structures underlying the mucous membranes will be removed to help restore normal breathing
Sterile ENT procedure
Tympanoplasty
Le Fort I
most common maxilla fracture, low horizontal fracture
Le Fort II
Triangular or pyramid shaped
Le Fort III
located high in the mid face and extends transversely from the zygomatic arches through the orbits and to the base of the nose
techniques of facial fracture repair
-placement of arch bars/wires to immobilize the jaw
-send wire cutters with patients to cut wires in case of emergency
-application of plates and screws to reconstruct bone
Le Fort I fracture repair
to surgically repair a fracture to the maxilla
blunt trauma
Results from forces such as deceleration, acceleration, compression, and shearing. Breaks in the integrity of the skin are often not present
penetrating trauma
Results when a foreign object passes through tissue
order of operation for multiple surgeries
head, chest, abdomen, extremities
Preservation of Evidence
if patient is a victim of a violent crime, items are saved for law enforcement
Practical considerations of trauma procedure
may not be able to perform counts. circulator should document this and postoperative X-rays may need to be taken to confirm nothing was left in the body
Damage control
patients with severe trauma may not survive complex operative procedures so only surgeries to preserve life are done initially
incising the cranium for access to the brain usually for the removal of blood clots
Minimally invasive laminectomy
Surgical approach for herniated disk, spinal compression, or spinal cord tumor
Anterior Cervical discectomy (Cloward technique)
excision of one or more herniated cervical intervertebral disks and the placement of bone grafts between the vertebra to fuse them together
Carpel tunnel release
corrects condition of the hand in which median nerve is compressed by the transverse carpal ligament
pediatric patient
Between birth and 12 years of age
neonate
first 28 days of life outside the uterus
infant
1 month to 18 months
toddler
19-30 months
preschooler
31 months - 5 years
school age
6-12 years
Ethmoid & Maxillary Sinuses
only sinuses present at birth
frontal sinus
develop at 7 years of age
intra-arterial monitoring in neonates
umbilical artery is most commonly used due to easy accessibility
intra-arterial monitoring in infants/children
radial artery is most commonly used
Oxygenation of pediatrics
children are quick to become hypoxic
septic shock
most common type of shock in children, caused by infection
hypovolemic shock
caused by loss of blood or tissue fluid, dehydration is most common cause in infants
What is the leading cause of death in children 1-15?
accidents
specific needs of toddler
bond to mother and fear separation/abandonment. have fear of strangers
Drug dosages
based on body weight
hydrocephalus
accumulation of fluid in the spaces of the brain causing increased intracranial pressure. involves placement of multi-holed draining catheter into the lateral ventricle of the brain
Craniosynostosis
prevent the premature closure of the cranial sutures in infants
National Board of Surgical Technology and Surgical Assisting (NBSTSA)
responsible for credentials and national certification exams
Employment options
-surgical assistant
-medical sales person
-organ and tissue procurement technician
-veterinary assistant
-anesthesia technologist
-surgery scheduler
-private consultant
registered nurse working in a classic OR nursing role
circulator
surgical technologist who is gowned and gloved working at the back table functioning in the classic role of the surgical technologist
First scrub
recommended educational background for surgical technologist
graduated from an accredited surgical technology program
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
organization responsible for accrediting surgical technology schools
National Board of Surgical Technology and Surgical Assisting (NBSTSA)
Organization that is solely responsible for all the decisions regarding certification, from determining eligibility to maintaining, denying, granting, and renewing credentials
Accreditation Review Council on Education in Surgical Technology and Surgical Assisting (ARC/STSA)
A committee on accreditation that is under the large umbrella of the CAAHEP which oversees the accreditation process of surgical technology
Ambulatory Surgery Center (ASC)
Facility where patients are treated and released the same day; also known as outpatient surgery or same-day surgery center
Association of Surgical Technologists
non-profit national professional membership organization for surgical technologists and surgical assistants
FDA
Agency for promoting public health through the regulation of food safety, medications, medical devices, and blood transfusions
ACS
Professional organization for surgeons that promotes standards for surgical education and practice
AORN
Professional organization that establishes standards in perioperative nursing education and standards
The Joint Commission
organization that develops standards and accredits healthcare organizations that volunteer for review
WHO
Organization within the United Nations that provides leadership on global health issues
ASA
Professional organization that sets the standards for education and represents the interests of the SFA
AST
Nonprofit organization that represents the interests and provides continuing education for surgical technologists
ANSI
Nonprofit membership organization that accredits organizations that work together to develop the American National Standards regarding technology
CSPS
Council of seven organizations that promote safe surgical patient care
APIC
Professional organization that promotes worldwide wellness and infection control
OSHA
Governmental agency that issues and enforces standards for workplace safety and health
CDC
Governmental organization that provides a system of health surveillance to prevent outbreaks of disease or infection
AAMI
Nonprofit organization involved in setting standards for the safe use of medical technology and devices
Cushing
Father of modern neurosurgery
Debakey
Developed the first ventricular assist pump
Halstead
Developed methods of meticulous wound closure known as the principles of surgical technique
Vesalius
Father of modern anatomy, who performed dissections on human cadavers and created permanent records
Galen
The first great anatomist; biology was made to serve theology
Cooley
Perfected the heart transplant and the heart-lung machine
Pare
Surgeon who ligated arteries using "suture" after amputations
Pasteur
The father of microbiology sciences and immunology, who proved the germ theory of disease
Lister
Father of modern surgery, who used carbolic acid as a technique for antiseptic surgery
Jenner
Invented a vaccination for smallpox
Conducts the preoperative patient interview
non sterile
Provides additional items to the sterile field during the surgical procedure
non sterile
Performs a hand scrub and dons a gown and gloves
sterile
Maintains the patients operative record
non sterile
Organizes the Mayo stand and back table for use during the procedure.
sterile
applies sterile dressing to the wound
sterile
administers anesthesia and intubates the patient
non sterile
Passes instruments, equipment, and supplies to the surgeon
sterile
monitors vital signs during the procedure
non sterile
communication
must be effective to facilitate teamwork and shorten the forming and storming phase. The essential elements include clarity in delivering the message, active listening, and clear feedback
Lose-lose
Members of a storming team may have difficulty yielding toward each other's points of view, producing a situation where no one is satisfied with the outcome, which is called a _____________________ situation. This can lead to resentment by both parties.
Win-lose
collaboration and compromise that are practiced by only one side of the conflict may result in a _________________ situation. This can lead to resentment by one side of the conflict, causing a return to the storming phase.
Win-Win
When all members of the team accept change, yield toward other points of view, and practice collaboration and compromise, the individuals come to a solution that is acceptable to all parties, which is called a _______________ situation.
open-ended question
the best way to point out something in a nonthreatening way
The surgical technologist ____________ the sterile field until the patient is transported from the OR
maintains
The AST is the national___________ organization for surgical technologists
non-profit
The three ______ of surgical case management are preoperative, intraoperative, and postoperative
phases
The _________ phase of case management begins when the surgical procedure is terminated
postoperative
One of the Jobs of the circulator is to _____ the patient to the OR
transport
The anesthesia provider may be an MD, DO, or ______
CRNA
DPM
Doctor of Podiatric Medicine
Most surgical technologists are employed in hospital departments, _____________, and ambulatory care centers
labor and delivery departments
The AORT became the AST in _____.
1978
The ARC-ST directly oversees academic ___________ for the field of Surgical Technology
accreditation
associates degree
preferred academic credential for surgical technology
AST mission statement
"Enhancing the profession to ensure quality patient care"
Aegar primo
the patient first
SSA
administers a national program of contributory social insurance involving employers, employees, and self-employed
Emergent
surgical pathology threatening life or limb
urgent
Surgical pathology requiring treatment within a relatively short period of time
elective
Surgical intervention that does not have to be performed immediately or within a short period of time
optional
Surgical intervention that does not have to be performed to preserve life or function
What year was ARC-ST formed
1974
LCC-ST changed its name to:
NBSTSA
Parts of a job description
job title, nature of position, immediate supervisor
Who opens packages for sterile team member?
circulator
departments providing direct care
pharmacy, nursing care unit, medical laboratory
DDS
Doctor of Dental Surgery
Hospitals are only classified by profit philosophy, such as nonprofit or for-profit.
false
Components of Communication
sender, message, receiver, feedback
Juan (CST) is the STSR on the ORIF of a fracture ankle; the surgeon has requested he establish a neutral zone. Juan is working in the ___________ phase of case management.
intraoperative
Juan (CST) is preparing for an ORIF of a fractured ankle; he begins by selecting the surgeon's preference card and gathering supplies. At this moment he is in the _________ phase of case management.
preoperative
Roentegen
developed first Xray machine
Which of the following symbols on AST logo represents the surgical tech performing various roles?
black/blue triangle
surgical first assistant
Provides aid in the exposure, hemostasis, closure and other intraoperative technical functions that help the surgeon carry out a safe operation.
a private surgical technologist is usually hired by who?
surgeon or physician group
AST Clinical Ladder
Level l: Entry Level Practitioner(one year or less)
Level ll: Proficient Practitioner(one year or more)
Level lll: Expert Practitioner(performs preceptor role).
which term describes the relationship between the CST and other members of surgical team in OR
professional
what component of communication does decoding take place?
receiver
Surgical conscience
the surgical technologist's foundational commitment to professional honesty, confidentiality, fair treatment, cost containment, and attention to the highest level of surgical patient care
proprietary hospitals
physician group-owned
HMO (Health Maintenance Organization)
organization that serves was both an insurer and provider of medical services
Surgical technologists and other allied health professionals in preoperative services usually work under direction of
director of nursing
Which type of professional would have DO or DPM after name?
director
Through which hospital department or committee would the certified surgical first assistant (CSFA) submit a request for privileges to work in the operating room?
medical staff
DRG
diagnostic related group
federal governmental insurance programs under the general heading of CMS
Medicare Part A, Medicare Part B, Medicaid
When an ARC/STSA site visitor is sent to a surgical technology program to verify and clarify records and annual reporting information, to whom does he or she submit the findings?
CAAHEP
Which organization would employees of the central sterile processing department likely join?
IAHCSMM
Which specialist would likely have privileges to surgically treat diseases of the breast, hepatobiliary and gastrointestinal systems, and thyroid gland?
general surgeon
After which of the following military conflicts did Great Britain and the United States begin to train and employ allied health professionals predominantly in the scrub role in surgery?
WWII
Which national membership organization's House of Delegates proposed the creation of the Association of Operating Room Technicians (AORT) in 1969?
AORN
A physician who is a contracted provider in PPO or HMO will receive reimbursement for fees based on a capitated rate of payment