Chapter 5 Surgical Asepsis - Notes
any practice that helps reducer the number and spread of microorganisms
the complete removal of microorganisms and their spores fromt he surface of an object
When is surgical asepsis required?
Any medical procedure that involves penetration of body tissues.
including catherization, dressing changes
Surgical Suite - Zone 1
people may eneter in street clothes
Surgical Suite - Zone 2
only people dressed in scrub dress with hair and shoes covered
Surgical Suite - Zone 3
scrubbed hands and arms
only people dressed in scrub dress with hair and shoes covered, masks
Door must stay closed during procedures only people directly related may be there
What type of masks must be worn in OR
single high filtration
Who is in charge in the OR
plans and performs the surgical procedure
may be several
a physician who has special education in anesthesia
a RN who has special education in anesthesia
oversees the safety of the patient
sets up sterile field
performs imaging procedures
What are sulutions used to disinfect skin?
Spaulding Classification System
Disinfectants and items to be sterlized
How long must things be boiled to sterilize
How long must things be boiled to sterilize if sodium carbonate is added to the water.
disenfect theremonmeters and medication bottle
broad antimicrobial range
disenfect endoscopes, theremonmeters and rubber
to disenfect countertops, floors, and other surface
Low-level 6% solution
to disenfect work surfaces not used a lot
Iodine and lodophors
disenfectant or antiseptic
most viruses and fungi
toxic may be used enviromental
Steam under pressure
place item in an autoclave
used for items that can not withstand moisture or high-temp
can not unite with water or becomes toxic
can not be left unattended
unserile person can't reach over
ends at tabletop, or waist to shoulders
sterile people must past back to back
If not to scrub
wash for 3 minutes
arms bare 4 inches from elbow
wash all areas from 2 inches above elbows
firm rotary motion
When to open surgical gown
before surgical scrub
must be worn outside lead apron
applied and the opening leaves only the operative site
3 most common means of spreading microbes in OR
using contaminated instruments or gloves
What are vital signs also called
Vital signs include
baseline vital signs
under normal circumstances for patient
How long can person go without oxygen?
4 to 5 minutes
Is oxygen a volitile substance?
what must sonographer make certain is in the imaging room before each shift?
equipment necessary to administer oxygen
Is a physician's order required for vital signs?
When should vital signs be taken?
before invasive procedures
conditions suddenly change
balance between heat produced in body tissues and heat lost to the enviroment
When will physiologic changes occur due to body temp?
fluctuations of 2 to 3 degrees
What controls body temperature?
What happens when the bodies metabolism increases?
more heat is produced
What does fever indicate?
disturbance in the heat-regulating centers of the body
Usually result of disease process
As body temperatures increase the demand for oxygen?
What is the normal variation for body temperature?
Average body temp age 3 months - 3 years
97.5 - 99
Average body temp age 5 year - 13 years
97.8 - 98.6
What happens if high temperatures are allowed to remain for prolonged periods?
damage to CNS
What is low temperature called?
It is rare for a person to survive with a temperature between (high)
105.8 - 111.2
It is rare for a person to survive with a temperature between (low)
celcius to Fahrenheit
F = (C*9)/5 + 32
Where can temp be measured?
tympanic - ear
rectal - most accurate
axillary - least accurate
Average oral temp
Average rectal temp
2 inch for adult
1.5 for kids
1 for baby
Average tympanic temp
Average axillary temp
97.6 Ax - 98
What is a tympanic thermometer also called?
How can the pulse be felt?
holding the artery beneath the skin against a solid surface (bone)
Where can pulse be taken?
Apical - over heart
Radial - wrist
Carotid - neck
Femoral - groin
Temporal - ear
posterior tibial - inner ankle
Doralis pedis - great and 2nd toe
over heart w/ strthoscope
front of neck
front of ear
Doralis pedis pulse
between great and 2nd toe
posterior tibial pulse
between bicep and tricep
Usually if the pulse rate is high the blood pressure is?
Normal adult pulse rate?
Normal kid (4-10) pulse rate?
90 - 100 bpm
Normal baby pulse rate?
over 100 bpm
less than 60 bpm
When would pedal, popliteal and femoral pulses be used?
During special diagnostic imaging procedures to ascertain the patient's circulatory status in the lower extremities is satisifactory
How is the the monitoring of the pulse in the lower extremities during special procedures different?
The pulse is not counted, instead it is palpitated and assessed as present and strong, weak, regular or irregular.
Where is the bladder of the stethoscope placed when taking an apical pulse?
the fifth intercostal space 5 cm from the left sternal margin.
How long should the apical pulse be measured?
What is the rate of respiration for adults?
15 to 20 breaths/minute
What is the rate of respiration for an infant?
30 to 60 breaths/minute
What may result in cyanosis?
less than 10 breaths/minute
What is dyspnea?
using more than normal effort to breath
Explain the steps of checking respiration?
1. seated or supine position
2. Observe chest wall for symmetry movement
3. Observe skin color
4. count chest rising and falling per minute
Give an example of how respiration is charted.
R 20 labored and shallow
Define Blood Pressure
the amount of blood flow ejected from the left ventricle of the heart during systole and the amount of resistance the blood meets due to systemic vascualr resistance
What happens to BP when during hemorrhage or dehydration?
Due to diminished amount of fluid in the arteries the PB falls
What determines the viscosity of the blood?
the number of red blood cells
What can increase BP as you get older?
The build up of atheroscerotic plague which limits the flexibility of the arteries
When the peripheral blood vessels are in normal physiologic state they are partially _______.
What can happen if the physiologic state of arteries is changed?
vessel resistance may change which would cause and increase in BP or the opposite
What happens to BP as you get older?
it usually increases as the state of the circulatory system declines
When is the BP usually the lowest?
What happens to BP after eating a large meal
List in order from high to low BP
the top #
the highest point reached during contraction of the left ventricle
The bottom #
the lowest point to which the pressure drops during relaxation of the ventricles and indicates the lowest pressure exerted against the arterial wall.
What is the BP in adults?
120/70 mmHg - 90/50 mmHg
What is the BP in kids?
130/85 mmHg - 85/45 mmHg
What is the pulse pressure?
The difference between Systolic and Diastolic
What is pulse pressure an indicator of?
stroke volume of the heart
What happens if pulse pressure decreases?
greater 140/90 mm Hg
lower 90/60 mm Hg
What are the two types of Sphygmomanometers
Which Sphygmomanometer is more accurate?
Who holds the responsibility of making sure the equipment needed to administer oxygen is available and functioning at all times?
Where is the major supply of oxygen carried?
chemical combination with hemoglobin
How is the oxygen capacity of the blood expressed?
Percentage of the volume
CO2 = PCO2
What is the Percentage of the volume called?
oxygen tension (partial pressure)
What happens when there is an excessive build-up of carbon dioxide?
the pH of the blood changes
What is the normal pH
7.35 - 7.45
What is hypoxemia?
low oxygen in the blood
What is hypercapnia?
High carbon dioxide in the blood
when can we assume that adequate oxygenation of the blood is not taking place?
PaO2 is below 60 mm Hg
hemoglobin saturation is less than 90%
What is a pulse oximeter?
What is normal SaO2?
95% - 100%
less than 85% bad
Chronic obstructive pulmonary Disease
When oxygen is delivered with high flow rate what must be done?
humidified through distilled water so the mucus membrane does not dry out
What is the flow rate of oxygen pumped into patients rooms?
60 to 80 lbs pressure/squ inch
What do the valves on an oxygen tank measure?
1. the amount of oxygen in the tank
2. the rate of oxygen through the delivery tubing
What is the symbol for the air we breath normally and what is the oxygen %
oxygen thingy on face that goes up nose
most commonly used in radiology department
What is the concentration of oxygen from a Nasal Cannula?
What is the oxygen usually prescribed for adults?
1 - 4 LPM
What is the oxygen usually prescribed for children?
catheter inserted into nostral
not common high concentration
When is a face mask used to deliver oxygen?
no less than 5 LPM to flush out CO2
CO2 does not mix
partial rebreathing mask
oxygen mixed with room air
60-80% mixed with water
mostly used for children
used when someone needs to leave the house with oxygen