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Nursing Arts and Skills
Test#5: Surg. asepsis/Drsng changes/sutures&staples/bandages&binders/hot&cold app.
121
Health Care
Undergraduate 1
11/12/2008

Additional Health Care Flashcards

 


 

Cards

Term

 

 

How often  do you check the label when pouring sterile solution?

Definition

3x's

  •  1st when gather off shelf
  • 2nd before pouring
  • 3rd after pouring
Term

 

 

Always check for what on normal saline or sterile solution?

Definition
  • expiration date
  • date and time opened( if none throw away)
Term

 

 

Sterile h20 & normal saline good for how long after opening

Definition
  • 24 hours
  • should have date and time opened ( if not throw away)
Term
Palm of pouring hand should ....
Definition
  • cover label of bottle
  • prevents dripping of contents over label
Term

 

 

keep what between bottle and sterile/clean container your pouring into

Definition
  • 1 inch distance
Term

 

 

purpose of wet to dry dressing

Definition
debridement
Term

 

nosocomial infection

Definition
  • hospital acquired
  • most bacterial: catheters,sugical,wounds,pneumonia

 

 

Term

 

 

antiseptic

Definition
  • stops growth of microbes
Term

 

 

germacidal

Definition
  • kills germs ( think homocide)
Term

 

 

Fomite

Definition
  • contaminated object that transfers pathogen
Term

 

 

Abcess

Definition
  • local, walled off, collection of puss
Term

 

 

cellulitis

Definition
  • spreading of bacterial infection of skin&sub-q tissues.
Term

 

 

Empyema

Definition
  • Collection of inflamed,infected fluid in 2 body cavity (usually pleural space) 
Term

 

 

 

fistula

Definition
  • abnormal tube-like passage between 2 body cavities or cavity and skin
Term

 

 

granulation

Definition
  • fleshy projections formed on the surface of a gaping wound that is healing by secondary intention
Term

 

 

Medical asepsis

Definition
  • clean technique
  • inhibits growth/spread of pathogens
Term

 

 

 

surgical asepsis

Definition
  • sterile technique
  • destroys all microorganisms and their spores
Term

 

 

 

spores

Definition
  • reproductive cells of some microorganisms
Term

 

 

 

disinfection

Definition
  • application of disinfectant to destroy all pathogenic microorganisms
Term

 

 

Chemical disinfectent

Definition
  • May cause metal corosion
  • used on non-living surfaces
  • lysol, cidex, bleach 1:10
Term

 

 

1:germicide

2: bactericides

Definition
  1. destroy germs
  2. destroy bacteria
Term

 

 

Antiseptics

Definition
  • used on tissue pre-op
  • used as post-op scrub
Term

 

 

 

Sterilization

Definition
  • process-completely removes-destroys all organisms and their spores
Term
Types of sterilization
Definition
  1. physical methods: chemical,autoclave, gas
  2. boiling
  3. dry heat
Term

 

 

physical sterilization

Definition
  • chemical
  • autoclave
  • gas
  • most common, dependable,economical, quickest
Term

 

 

autoclaving

 

Definition
  • steam under pressure
  • most rubber & plastic devices damaged by this process
Term

 

 

Boiling sterilization

Definition
  • clean then boil 15-20 min
  • spores/some viruses still alive after
Term

 

 

dry heat sterilization

Definition
  • heat oven to 350° for 2 or more hours
  • this disinfects> does not kill all organisms
Term

 

 

sterile phrase

Definition
only sterile to sterile is sterile
Term

 

us surgical asepsis when protecting patnt.from pathogenic microorganisms in the enviroment:

Definition
  • Inserting/irregating catheter*
  • Iv insertion
  • sterile dressing changes
  • injections of medication
  • trach care*
Term

 

 

Never leave a:

Definition
  • a sterile field
  • always keep it within your vision range
Term

 

 

throw sterile package out if:

Definition
  • missing expiration date*
  • outdated
  • label blurred
  • have touched contaminated object
Term

 

 

position & open sterile package..:

Definition
  • so you dont touch or reach across the package
  • person and clothing considered contaminated
Term

 

 

Keep sterile gloved hands....:

Definition
  • above waistline & within eyesight
  • hands together w/fingers intertwined
Term

 

 

A wet sterile field is:

Definition
  • considered contaminated
Term

 

 

when opening package and setting up sterile field:

Definition
  • stay within 1 inch margin from outer edge
  • outer edge considered contaminated
Term

 

 

Opening sterile packages

Definition
  1. wash hands
  2. check for:
    •  dampness
    •  holes
    • tears
    • expiration dates
    • autoclave tape
    • sterile indictor inside
  3. open 1st w/ flap away from you,dont reach across
  4. anything off table is considered contaminated
Term

 

 

type of wrappers

Definition
  • agency wrapped item
  • commercially packaged item
Term

 

 

glove what hand first in sterile gloving

Definition
  • Glove dominant hand first using thumb & 1st 2 fingers of non-dominant hand>grasp inside surface of folded cuff of sterile glove
Term

 

 

when removing sterile gloves...:

Definition
  • 1st use dominant gloved hand to grasp non-dominant hand glove near cuff end.(remove>turning inside out)
Term

 

 

primary intention

Definition
  • Surgical wounds/small lacerations
  • little loss of tissue
  • straigt line>minimal scarring
  • edges of wound well approximated
Term

 

secondary intention

Definition
  • a lot of tissue loss- edges cant be approximated
  • heals w/granulation tissue
  • gr8er chance of infection, longer healing,large scars
Term

 

 

tertiary intention

Definition
  • extended time btwn. occurrance and sutureing*
  • left open to prevent infection
Term

 

 

how aging affects wound healing

Definition
  • vascular changes impair circulation
  • liver function reduced>alters clotting
  • inflammatory response slowed
  • antibody/lymphocyte formation reduced
  • less pliable collagen
  • less elactic scar tissue
Term

 

 

Nutrition affecting wound healing

Definition
  • stress from wounds increase nutrition requirments
  • offer fluids q hour
Term

 

 

undernourished are...

Definition
  • suceptible to infection & poor wound healing
Term

 

obesity affecting wound healing

 

Definition
  • fatty tissue:
    • lacks adequate blood supply
    • difficult to resist infection
    • difficult to deliver nutrients&cellular elements
    • hard to heal
Term

 

 

impaired oxygen affecting wound healing

Definition
  • causes decreased hemoglobin>reduces arterial o2 levels in capallaries>interferes w/tissue repair
Term

 

 

 

Smoking affecting wound healing

Definition
  • reduces amnt. of hemoglobin in blood>decreases tissue O2
  • can cause hypercoagulability>prevent tissue oxygenation
Term

Drugs affecting wound healing

(sterroids)

Definition
  • reduce inflammatory response>
  • suppresses:
    • protein synthesis
    • wound shrinking
    • epithelialization
    • inflammation
Term

 

 

 

drugs affecting wound healing

(antibiotics)

Definition
  • Lead to increase risk for superinfection
Term

 

 

drugs affecting wound healing

(chemo drugs)

Definition
  • depress:
    • bone marrow function
    • # of luekocytes
    • inflammatory response
Term

 

 

Diabetes affecting wound healing

Definition
  • causes small blood vessel disease>bad circulation
  • hemoglobin hold on to O2>doesnt get2 tissues
  • phagocytosis altered
  • allows for fast or fungal infections
Term

 

 

Rafdiation treatment affecting wound healing

Definition
  • causes fibrosis & vascular scarring
  • tissues become fragile & poorly oxygenated
Term

 

 

symptoms of wound infection appear:

Definition
2-7 days
Term

 

 

symptoms of wound infection are:

Definition
  • Purrulent/increased drainage W/foul smell
  • increase WBC count
  • fever
  • pain, redness,swelling in or around wound
  • (PIFP)
Term

 

 

Check dressing how often

Definition
  • Frequently for 1st 48 hrs.
  • q 8 hrs after that
Term

 

 

serosanguineous drainage

Definition
  • combo of bloody fluid and plasma
Term

 

 

signs and symptoms of dehiscence and evisceration

Definition
  • Increased serosanguineous drainage Btwn. post-op days 4-5(dehiscence)
  • ptnt. verbalizes, something loose given way
Term

 

 

treatment for dehiscence or evaseration

Definition
  • cover with sterile towels soaked in normal saline
  • notify physician ASAP
Term

 

 

assess wound

Definition
  • apporximated
  • color of wound and surrounding areas
  • drains/tubes
  • sutures/staples
Term

 

 

When assessing wound should appear :

Definition
  • Edges clean/well approximated
  • crust around edges
  •  red/swollen in beginning
  • by end of week 1>bruising, but skin normal
Term

 

 

serous drainage

Definition
  • clear/watery
Term

 

 

 

sanguineous drainage

Definition
  • bloody
Term

 

 

purulent drainage

Definition
  • made of
    • liquified dead tissue
    • WBC's
    • debris
    • live & dead bacteria
Term

 

 

 

Assessment of drainage check:

Definition
  • on wound
  • in drains
  • under patient
Term

 

 

  1. increasing pain
  2. incisional pain
Definition
  1. indicates need for futher assessment
  2. unsually most sever 1st 2-3 post-op
Term

 

 

 

clean dressing change is:

Definition
  • most often used method
  • can be used in home care
Term

 

 

 

Montgomery straps

Definition
  • Used to secure main dressings
  • prevents skin breakdown
Term

 

 

Need dr. order for:

Definition
  • Suture/staple removal
  • binders used for support(not if holding bandage in place)
Term

 

 

 

Sutures/staples generally removed

Definition

7-10 day after surgery W/ dr. order

  • Head/neck-3-5 days after insertion
  • chest/abdmn.- 5-7 days "            "
  • extremeties- 7-10 days"              "
Term

 

Staples popularly used:

Definition
  • places where scarring not important
  • Jnts.
  • abdominal/orthopenic surgerys
Term

 

 

Suture/staple/incision care

 

Definition
  • Use aseptic technique
  • use clean gloves
  • use sterile tools
Term

 

 

When done removing staples

Definition
  • count staples/sutures
  • staples go in sharps container
Term

 

 

specifics for suture removal

Definition
  1. grasp knot
  2. lift
  3. cut under
  4. repeat
Term

 

 need to have how much space btwn. bone & suture

Definition
  • Need 5 millimeter space
Term

 

 

 

banages

Definition
  • cloth strips
  • gauze(kurlex,kling)
  • self stick wrap( coban)
  • elastic bandage( ace)
  • very 1-6 inch. in width
Term

 

 

 

binders

Definition
  • designed for specific body part
  • used for support & hold bandages in place
  • slings
  • chest & abdm. binders
  • t- binders: 4 inbetween legs
Term

 

 

 

purposes of bandages and binders

Definition
  • Secure dressings
  • apply pressure
  • support
  • immobalize part
Term

 

 

S&S of impaired circulation

Definition
  • cold
  • cyanosis
  • decreased pulse/capillary refill/movement
  • numbness/tingling
  • pain
Term

 

 

with bandages/binders...leave what exposed?

Definition
  • leave fingertips, toes exposed, but not larger body parts
Term

 

 

skin surfaces

Definition
  • should not be bandaged directly together
Term

 

 

use what kind of material for bandages

Definition
pores material to allow for air circulation
Term

 

 

heat/moisture may cause skin to:

Definition
breakdown
Term

 

when bandaging/binding place/support body part in:

Definition
  • normal functioning position
Term

 

 

bandage extremities :

Definition
from distal to proximal to promote veinous return
Term

 

 

before bandaging do what to extremity?

Definition
  • elevate 15-30 min if possible
Term

 

 

types of applicating roller bandages

Definition
  • circular
  • spiral-for fingers/wrists/trunk
  • figure 8- jnts.
  • recurrent stump
Term

 

To remove bandage:

Definition
  • cut up length of bandage away from injured site
Term

 

 

t-binder

Definition
  •  single 4 women, DBL for men,
  • used to secure dressings
    • rectum
    • perineum
    • groin
Term

 

 

slings

Definition
used to support arm
Term

 

 

straight binder

Definition
  • usually 6-8 inches
  • 4 chest or abd. support
  • also to secure dressings
  • held together by pins/velcroe
Term

 

 

general documenting

Definition
  • date/time
  • what used, why, and how many
Term

 

 

documenting for staples/sutures

Definition
  • how many removed
  • cleanses with what
  • what aseptic used
  • drainage (should be little to none)
  • condition of wound edges
Term

 

 

documenting with bandages & binders

Definition
  • Type used
  • CMS check
Term

 

 

aims of nursing in applying heat/cold

Definition
  1. promote wound healing
  2. facilitate comfort
  3. use knowledge & skill
  4. follow safety measures
Term

 

Heat causes

Definition
  • vasodialation>causing increased circulation
Term

 

 

Heat results in

Definition
  • Accelerated inflammatory response to promote healing
Term

 

 

 

viscocity

Definition
  • thickness of fluid
Term

 

 

Will see what in systemic effects of heat?

Definition
  • ↑ pulse,cardiac output
  • ↓BP
  • sweating
Term

 

 

systemic effects with heat occur because:

Definition
  • When heat applied to large body area>increases blood flow to that area>depressing it to other areas
Term

 

 

Heat/cold generally=

Definition
  • 15-20 min
  • need dr. order
Term

 

 

cold application causes

Definition
  • vasoconstriction>reduces blood flow
  • ↓ local release of pain producing sub.(histamine,saratonin,bradykinin)
  • reduces edema/inflammation
  • increases coagulation @ wound site>controls bleeding.
Term

 

 

Systemic effects of cold app.

Definition
  • ↑ BP
  • shivering/goosebumps
  • prolonged may cause injury
Term

 

 

rebound phenomenon

Definition
  • Heat: max. dialation in 15 min.>then constricts
  • COLD: max vasoconstriction in 15. min>then dialates
Term

 

 

Moist heat/cold

Definition
  • more penetrating/intense than dry
Term

 

 

heat shouldnt be applied :

Definition
  • to open wound imme. after trauma(cause bleeding)
  • to localized malignant tumors
  • over metalic implants
  • to testes
  • abdomen of pregnant women
Term
Cold shouldnt be used:
Definition
  • for open wound
  • 2 ptnt. with impaired peripheral vascular circulation
Term

 

 

application of hot water bottle

Definition
  • Advantages:
    • easy
    • inexpensive
  • Disadvantages:
    • leaks
    • weight, uncomfortable
    • danger of burns
Term

 

 

 

application of electric heating pad

Definition
  • Advantages:
    • easy
    • relativly safe
    • constant/even heat
  • Disadvantages:
    • can cause burns
Term

 

 

Aquathermia pads

Definition
  • water-flow pads
  • attached to H2O container(distilled),has fill line
  • looks like heating pad but rubber(cover w/pillowcase)
  • temp. not above 105 degrees
  • allow to warm for 2 min
  • should go over person>Not under
Term

 

 

 

aquathermia pad used for:

Definition
  • 20-30 min
  • for back pain, muscle spasms,thrombophlebitis,inflammation
Term

 

 

heat lamps placed:

Definition
18-30 inches away from area for 15-20 min
Term

 

 

Heat cradle

Definition
  • semi-circular metal cradle>fits on bed
  • 16-18 inches from ptnt. for 15 min
Term

 

 

sitz bath

Definition
  • moist heat to pelvic/perineal area
  • 105-110 degrees
  • 20-30 min
Term

 

 

 

warm soaks

Definition
  • like whirlpool
  • can have medicated solution
Term

 

 

Ice bag

Definition
  • Simple/inexpensive
  • but leaks
  • apply only 20 min>remove for 1 hour>reapply
Term

 

 

Cold packs

Definition
  • commercially prepared
  • gel remains pliable
  • molds to area
Term

 

 

cooling blanket

Definition
  • Place Under ptnt*
  • reduces high temps.>reduce BMR 
  • place another blanket over them
Term

 

 

cold compress

Definition
  • cold washcloth
  • put on 20 min> take off 1 hour> reapply
Term

 

 

 

Documentation of heat/cold application*

Definition
  • What applied
  • why doing, how often, and how long.
  • responses & toleration'
  • results/effectivness
  • signature
  • vital signs
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