ch 4/5 delmar

  1. arterial blood gases (ABGs)
    a method of monitoring blood oxygenation levels
  2. autoimmune diseases
    a disease such as rheumatoid arthritis that attacks the bodys own tissue
  3. central venous catheter
    the venous BP within the right atrium, indicating the efficiency of blood leaving the heart
  4. diabetes millitus
    disorder of th endocrine system that affects the production of insulin in the pancreas; either type one or type two
  5. enterocolitis
    inflammation of small intestine and colon
  6. golden hour
    concept that medical treatment of a trauma victim with in the first hour following injury improves patient outcomes
  7. human immunodeficiency virus (HIV)
    the virus that causes aquired immune dificiency
  8. hypothermia
    abnormally low body temp., typically defined as a core body temp that is below 35 degrees F
  9. immunocompetence
    degree of function of an immune system thatis designed to keep a pt. from infection by pathogens
  10. intra-arterial measurement
    a method of ECG monitoring in which intra-arterial catheter is inserted directly into the artery
  11. kaposi's sarcoma
    a cancer that produces painful external and internal lesions
  12. kinematics
    an attempt to undestand the mechanism of injuy and the action and effect of a particular type of force on human body
  13. kernicterus
    an excess of bilirubin in the blood
  14. penetrating trauma
    a foriegn object that passes through tissue, such as a bullet of knife
  15. pneumothorax
    abnormal accumulation of air in pleural cavity
  16. revised trauma score
    a scoring system used to assess the severity of a traumatic wound and to determine the condition of a pt.
  17. septic shock
    a state of shockproduced by septicemia, when the body is over whelmed by the pathogenic microorganisms and cannot adequately fight the infection
  18. splenectomy
    removal of the spleen
  19. splenomegaly
    abnormal enlargement of the spleen
  20. torticollis
    an abnormal contracted state of a muscle(s)
  21. urine output
    an amount of urine collected and measured from a pt. over a given amount of tme; indicator of kidney function
  22. venous compression device
    used for pts. who are prone to the development of thrombophlebitis
  23. airborne bacteria
    transported or spread by airway; the surgical tech is primary concerned with airborne bacteria
  24. back table
    large movable table that is covered with a sterile, drape for placement of sterile instruments, supplies, and equipment
  25. decontamination room
    room that typically contains sinks for gross contamination an ultrasonic washer and washer-sterilizer to decontaminate instruments and equipment
  26. electrosurgical unit
    mechanical device which produces an electric current that is converted into thermal energy for the purpose of cutting/coagulating
  27. hamper
    four-wheeled stand that can be lined with biohazardous bag for the collection of linen or trash
  28. high-efficiency particulate air (HEPA) filter
    capable of removing bacteia as small as 0.5-5 um; utilized in the OR to aid in preventig the pt. from aquiring a post-op wound
  29. hypothermia
    abnormally high body temp.
  30. ionizing radiation
    process by which energy either directly or indirectly iduces ionization of radiation-absorbing ateial or tissues; x-rays
  31. laminar air flow
    the unidirectional positive pressure flow or air that captures microbe to be filtered
  32. mayo stand
    small portable stand with a tray on top that is coveed with a sterile drape and onwhich instruments, equipment, and supplies that are most frequently used for surgical procedure
  33. polymethyl methacrylate (PMMA)
    a chemical compound composed of a mixture of liquid and powder used for cementing prostheses during total joint arthropastics
  34. occupational safety and health administration (OSHA)
    federal organization that is dedicated to protecting the health of workes by establishing standards
  35. pathology department
    department responsible for testing and processing specimens, tissues, and body fluids to obtain a diagnosis
  36. perfusionist
    individual responsible for running and maintaining the cardiopulmonary bypass machine during open heart procedures
  37. personal protective equipment (PPE)
    attire worn to protect against exposure to physical and biological hazards
  38. plume
    smoke produced by laser or electrocautery that has been shown to contain biological material
  39. postanesthesia care unit (PACU)
    area where immediate post-operative care of the pt. takes place before transfer to the hosp. room
  40. prophylaxis
    prevention of a disease or condition
  41. restricted area
    areas of an operating department that require proper OR attire, including the wearing of a mask
  42. standard precauions
    quidelines established by the OSHA and CDC and prevention to reduce risk of disease transmission from blood and body fluids
  43. suction outlet
    a wall or ceiling connection for suction device
  44. surgical site infection (SSI)
    an infection of the surgical wound that was aquired during the course ofthe surgical procedure
  45. triboelectrification
    one of two processes by which static electricity can build; occurs by friction between 2 surfaces
  46. a patient is considered a pediatric pt. if he or she is between ____ and the age of _____ .
    • birth
    • 12 years
  47. 2 types of shock:
    • hyprvolemic--dehydration is common cause in infants
    • septic--most common type seen in infants and children
  48. placing the obese pt in the ____________ position will help expand the total lung volume and aids in ventilation.
    reverse trendelenburg
  49. performing any abdominal procedures on a pregnant pt. is best done during the ___ trimester.
  50. when the pregnant surgical pt is positioned a ________ should be placed under the ________ to relieve pressure from the vena cava and the aorta.
    • roll or wedge
    • right hip
  51. immunocompromised pts. include ____,____, and ____ .
    • rheumatoid arthritis
    • organ transplant
    • HIV pts.
  52. a level one trauma center receives many MVA (motor vehicle accident) patients. the staff knows that the most common organ injured during a MVA is the _____.
  53. in the ____ area, all OR attire must be worn including a surgical mask.
  54. nitrous oxide
    medical air
    • blue
    • green
    • yellow
    • white
    • black
  55. pediatric patients
    • neonate- 1st 28 days
    • infant- 1-18 months
    • toddler- 18-30 months
    • preschooler- 30months- 5 years
    • school age- 6-12 years
  56. psychological factors of infants
    • neonates and infants are easily startled
    • feel anxiety due to separation from parents
    • allow them to bring a favorite toy to surgery
    • conduct a pre-op visit, introduce team
    • allow parents with child in holding room and in PACU once stable
    • fear of anesthesia
    • be truthful
    • allow child to hold mask
  57. monitoring the pediatric patient
    • temp.
    • urine output
    • cardiac function
    • oxygenation
  58. pediatrics temp.
    • little subcutaneous fat
    • poor thermal insulation
    • increased ratio of skin surface to body mass
    • in the OR skin temp is primary means of monioring
  59. maintaining pediatrics temp
    • keeping infant's extremeties wrapped and covered
    • raise temp of room to 80
    • use of radiant heaters for children less than 2 years old
  60. pediatrics urine output
    neonates and infants are not usually catheterized--high risk of trauma to small urethra
  61. pediatrics cardiac function
    least used rute of central venous catheter placement--saphenous vein
  62. pediatrics oxygenation
    standard for monitoring oxygenation--ABGs , pulse oximetry has taken the plce of ABGs
  63. septic shock
    • due to invasion of microbes
    • most common in pediatric pts.
    • usually caused by gram negative bacteria
    • sulfonamides, bactrim, hloromycetin,tetracycline are all antibiotics
  64. hypovolemic shock
    • low blood volume
    • dehydration is the most common cause in pediatrics
    • must monitor fluid and electrolytes
    • usually NPO less amount of time
  65. pediatric trauma concerns
    • accidents are the #1 cause of death in children
    • usually blunt trauma (head) in MVA
    • first priority: open airway
    • pneumothorax
    • bleeding must be controlled to prevent hypovolemia
    • birth trauma: most common fracture is clavicle
    • dystocia
  66. care of obese patients
    • body weight is 100 pounds over ideal weight
    • physiological disease conditions:
    • myocardial hypertrophy
    • coronary artery disease
    • hypertension
    • varicose veins
    • pulmonary function complications
    • liver and gallbadder disease
    • osteoarthritis
    • diabetes mellitus
    • arteriosclerosis
  67. diabetes mellitus
    • affects the production of insulin in the pancreas
    • origin is often genetic
    • type I: insulin dependent
    • type II: noninsulin dependent
    • complications: infection, poor circulation, ulcers won't heal, foot and leg amputations, nephropathy, retinopathy
    • positioning concerns
    • use of glucometer
    • antiembolitic stockings/SCQs
  68. pregnant surgical pt.
    • emergencies: ectopic pregnancy, appendicitis, trauma, incompetent cervix
    • avoid surgery in first trimester
    • abdominal procedure best in 2nd trimester
    • abdominal organs displaced
    • anesthesia affects fetus
    • use short acting drugs, avoid nitrous
    • --prevent preterm labor!
  69. autoimmune diseases
    • multiple sclerois
    • lupus erythematosus
    • rheumatoid arthritis
  70. special care with immunocompromised pts
    • positioning concerns , difficult intubation
    • IV placement, ESU pad placement
    • spenectomy due to splenomegly
    • antineoplastic agents
    • multiple lesions due to kaposi's sarcoma
  71. pts with disabilities
    • hearing ipairments: hearing aid is removed
    • communicate with hand signals, sign language, written commads, don't yell
    • visual: contacts and glasses are removed
    • isolation pts: routes of transmission; vector
    • basic fundamntals: hand washin and PPE
    • pt. with TB: N-95 respirator must be fitted
  72. geriatric pts
    • usually over 65
    • skin prone to shearing
    • increased BP
    • increased rigidity of chest wall
    • decreased bladder capacity
    • visual impairments
    • hearing impairments
    • prone to hypothermia
    • slow circulation
  73. trauma pts
    • "golden hour"
    • trauma centers: level I-IV
    • blunt trauma
    • spleen is #1 organ injured in MVA
    • penetrating trauma
    • order priority: head, chest, abdomen, extremities
  74. preservation of evidence
    • violent crime items must be preserved for law enforcement (clothes, knife, bullet, etc)
    • physical evidence must be handled carefully
    • facility policy must be strictly followed
    • cut clothes at seam--give to police
    • hands bagged and taped
    • bullets not handled with metal instruments
    • chain of custody must be documented in writing and is a legal document
  75. considerations for the ST
    • avoid hypothermia
    • puls-lavage to irrigate wound
    • emergencies case cart ready
    • anesthesia provider directs all moves and guards the head and neck
    • may have multiple mayos and back tables
    • have adequate suplly of sponges, suture, hemostatic agents on table especially abd.
    • may not have time to do counts--must document with post-op X-ray
  76. chance of preterm labor in 3rd trimester
  77. vital signs are altered in...
    preg. pt
  78. bladder distention can cause....
    ptl (pre term labor)
  79. neonates with hyppovelemic =
    physicalogical response -- bradycardia
  80. 3 most common complications ager gastric bypass:
    • abd. catastrophies
    • internal hernia
    • acute gastric distention
  81. race track design
    a series of ORs around a clean central core
  82. phsical design
    • location: easy access to support dpts.
    • limited traffic--often a distal location
    • controlled traffic supplies
    • access to necessary supplies
    • seperation of clean and dirty work area to prevent SSI
  83. hotel plan
    ORs are situated along a central corridor
  84. specialty grouping
    • ORs are grouped by specialty (neuro, ortho) with its own storage area.
    • supply room: sterile packs not stored close to floor ceiling
  85. unresticted
    dressing rooms and main desk: street cothes are allowed
  86. semi-restricted
    • hallways and storage: OR attire is required, scrub suits, hats, shoe covers
    • **separated by red line on floor
  87. restricted
    OR: OR attire is worn, including mask when opening supplies and during surgery
  88. physical components of OR
    • 400-600 square feet --average size
    • electrical outlets: 5 feet above floor
    • suction outlets: at least 2, 1 for sterile field and 1 for anesthesia provider
    • lights: not on tracks, sterile handle
    • X-ray viewing box
  89. OR criteria
    • positive air pressure
    • laminar air flow: unidirectional, up to 600 air exchanges per hour
    • minimum of 20 air exchanges per hour
    • HEPA filters
    • OR temp: 65-75
    • OR humidity between 50-55% to prevent static electricity and reduce microbial growth
  90. substerile room
    • workroom located outside the OR:
    • contains a sink, flash sterilizer, blanket and solution warmer
    • located so the circulator and STSR can remove instruments from the flash sterilizer without carrying down hall
  91. direct support service
    • preop holding area: where the pt waits before enteringthe OR. IVs are started
    • PACU: located adjacent to OR where pt recovers from effects of aneshesia
    • each cubicle has: BP cuff, suction, oxygen, EKG, pulse oximeter, emesis basin
  92. other hospital departments
    • laboratory: provides lab valves
    • radioloy: radiologic pt studies
    • pathology: where specimens are sent
    • enviornmental services: cleans OR
    • sterile processing: reprocesses instruments
  93. hazard categories
    • physical: noise, ionizing radiation, eectricity, injury to body,fire, explosion
    • biologic: laser/electrosurgical plume, pathogens, latex sensitivity, sharps injury
  94. ergonomics
    proper posture andgood body mechanics
  95. fire triangle
    • source of ignition: RED--lasers, esu, fiberoptics
    • oxygen: GREEN
    • fuel: YELLOW
  96. LASER
    • --Light Amplification by the Stimulated Emission of Radiation
    • fire prevention is critial when using laser
    • sterile water to wet towels around incision
    • during oral surgery- flame resistant ET tube
    • can't prep with flammable agent(alcohol)
    • care around head & hair
    • for anorectal surgery: water soaked sponge in rectum to prevent methane gas explosion
  97. laser safety precautions
    • eye safety
    • use non-reflective insturments
    • warning signs posted
    • appropriate eye protection
  98. other safety guidelines
    • fiber optic beam of scopes not on drapes
    • no extension cords or power stirps
    • plug and unplug with the plug not the cord
    • keep movement around head to a min.
    • cotton blankets to prevent static electricity
    • cover pts hair
    • don't use towel clip to attach bovie pencil
  99. 3 classes of fire extinguishers
    • class A: water for wood, paper, textiles
    • class B: dry chemical for flammable liquids and gas
    • class C: halon for electrical and LASER fires
    • in OR: protect pt, contain fire, move anestesia equipment--RACE
    • **carbon deoxide--used on pts only
  100. electrical hazards
    • follow manufacture's instructions
    • use of 3 prong ground plug
    • static electricity
    • prevent friction between 2 surfaces
    • avoid rubbing drapes together
  101. ionizing radiation
    • x-rays, c-arm fluroscopy
    • lead lined gloves, lead aprons, lead sheilds, thyroid collar and glasses
    • protect the pt and surgical team
    • 3 most important factors: time, distance, shielding
    • use of film badge
    • lead aprons should be laid flt or hung on racks to avoid cracks
    • floroscopy turned off when not in use
  102. biolgical hazards
    • standard precautions: bood and body fluids
    • wear gloves at all times
    • sharp injuries
    • use of PPE
    • neutral zone
    • never recap needles
    • use on handed tech.
    • sharps in central location and in same place
    • sharps container
    • bloody sponges in red biohazard bags
  103. management of exposure
    • post exposure prophylaxis
    • sharps injury in OR:
    • remove glove to inspect
    • wash area with soap and water
    • flush with water if exposure to eye,oral,nasal
    • report
    • evaluate pt and worker
  104. laser and electrosurgical plume
    • target tissue can become aerosolized
    • wear special laser mask and eye protection
    • use of smoke evacuator
    • care when changing filiter
    • position the evacuation tip within 1 cm of tissue
    • 98% of plume is captured
  105. latex allergy
    • 2 types:
    • type I- most serious
    • type IV-is less serious and more localized
    • individuals at risk include health care workers, pts who have had multiple surgeries.
    • schedule first case of the day
    • label chart and wear special bracelet
    • no cure or desnsitization
  106. chemical hazards
    • MSDS
    • waste anesthetic gases: scavenging system
    • polymethyl methacrylate (PMMA) bone cement using self contained evacuation system
    • formalin: preservative for specimens
    • use in well ventilated area with mast and glove
    • EtO: gas sterilization
    • cidex: liquid disinfectant
    • keep in covered container
Card Set
ch 4/5 delmar
special populations and enviornment and safety standards