Chapter 5 Surgical Asepsis - Notes

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1

Medical Asepsis

any practice that helps reducer the number and spread of microorganisms

2

Surgical Asepsis

the complete removal of microorganisms and their spores fromt he surface of an object

3

When is surgical asepsis required?

Any medical procedure that involves penetration of body tissues.

including catherization, dressing changes

4

Surgical Suite - Zone 1

unrestricted zone

people may eneter in street clothes

5

Surgical Suite - Zone 2

semi restricted

only people dressed in scrub dress with hair and shoes covered

6

Surgical Suite - Zone 3

restricted

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

7

What type of masks must be worn in OR

single high filtration

8

Who is in charge in the OR

Surgeon

9

Surgeon

plans and performs the surgical procedure

10

Surgical Assistant

another surgeon
surgical resident
may be several

11

Anesthesiologist

a physician who has special education in anesthesia

12

Nurse Anesthesiologist

a RN who has special education in anesthesia

13

Circulating Nurse

oversees the safety of the patient

14

Scrub Nurse

sets up sterile field
hands instruments

15

Radiologic Tech

performs imaging procedures

16

What are sulutions used to disinfect skin?

antiseptics

17

Spaulding Classification System

Disinfectants and items to be sterlized

18

How long must things be boiled to sterilize

30 minutes

19

How long must things be boiled to sterilize if sodium carbonate is added to the water.

15 minutes

20

Alcohol

intermediate

disenfect theremonmeters and medication bottle

bactericidal
tuberculocidal
fungicidal
virucidal

21

Glutaraldehyde

High-level

broad antimicrobial range

disenfect endoscopes, theremonmeters and rubber

22

Chloride Compounds

1:50

high-level

to disenfect countertops, floors, and other surface

23

Orthopthalaldehyde

High-level

clean endoscopes

bactericidal
fungicidal
virucidal

24

Hydrogen Peroxide

Low-level 6% solution

to disenfect work surfaces not used a lot

bacteria
fungi
viruses

25

Iodine and lodophors

intermediate

disenfectant or antiseptic

most viruses and fungi

NO sporicidal

26

Phenolics

intermediate-low

toxic may be used enviromental

bactericidal
tuberculocidal
fungicidal
virucidal

27

Quaternary Ammonuim

non-critical areas

28

Steam under pressure

place item in an autoclave

29

Chemical sterilization

low-temp sterilization

30

Ethylene Oxide

used for items that can not withstand moisture or high-temp

can not unite with water or becomes toxic

31

Sterile field

created just-prior
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

32

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

33

When to open surgical gown

before surgical scrub

34

radiation badge

must be worn outside lead apron

35

Fenstrated drape

applied and the opening leaves only the operative site

36

3 most common means of spreading microbes in OR

using contaminated instruments or gloves

become damp

air currents

37

What are vital signs also called

cardinal signs

38

Vital signs include

temperature
pulse
repiration
blood pressure

39

baseline vital signs

under normal circumstances for patient

40

How long can person go without oxygen?

4 to 5 minutes

41

Is oxygen a volitile substance?

yes

42

what must sonographer make certain is in the imaging room before each shift?

functioning sphygmomanometer
stethoscope
equipment necessary to administer oxygen

43

Is a physician's order required for vital signs?

NO

44

When should vital signs be taken?

before invasive procedures
conditions suddenly change

45

Body Temperature

balance between heat produced in body tissues and heat lost to the enviroment

46

When will physiologic changes occur due to body temp?

fluctuations of 2 to 3 degrees

47

What controls body temperature?

hypothalimus

48

What happens when the bodies metabolism increases?

more heat is produced

49

pyrexia

fever

50

What does fever indicate?

disturbance in the heat-regulating centers of the body

Usually result of disease process

51

As body temperatures increase the demand for oxygen?

increases

52

What is the normal variation for body temperature?

1.5 degrees

53

Average body temp age 3 months - 3 years

97.5 - 99

54

Average body temp age 5 year - 13 years

97.8 - 98.6

55

What happens if high temperatures are allowed to remain for prolonged periods?

damage to CNS

56

What is low temperature called?

hypothermis

57

It is rare for a person to survive with a temperature between (high)

105.8 - 111.2

58

It is rare for a person to survive with a temperature between (low)

below 93.2

59

celcius to Fahrenheit

F = (C*9)/5 + 32

60

Where can temp be measured?

oral
tympanic - ear
rectal - most accurate
axillary - least accurate

61

Average oral temp

98.6 O

62

Average rectal temp

99.6 R

2 inch for adult
1.5 for kids
1 for baby

63

Average tympanic temp

97.6 T

64

Average axillary temp

97.6 Ax - 98

65

What is a tympanic thermometer also called?

aural thermometer

66

How can the pulse be felt?

holding the artery beneath the skin against a solid surface (bone)

67

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

68

Apical Pulse

over heart w/ strthoscope

69

Radial Pulse

wrist

70

Carotid Pulse

front of neck

71

Femoral Pulse

groin

72

Temporal Pulse

front of ear

73

Doralis pedis pulse

between great and 2nd toe

74

posterior tibial pulse

inner ankle

75

Brachial

between bicep and tricep

76

Usually if the pulse rate is high the blood pressure is?

high

77

Normal adult pulse rate?

60-90 bpm

78

Normal kid (4-10) pulse rate?

90 - 100 bpm

79

Normal baby pulse rate?

120 bpm

80

Tachycardia

rapid

over 100 bpm

81

bachycardia

slow

less than 60 bpm

82

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

83

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.

84

Where is the bladder of the stethoscope placed when taking an apical pulse?

the fifth intercostal space 5 cm from the left sternal margin.

85

How long should the apical pulse be measured?

1 minute

86

What is the rate of respiration for adults?

15 to 20 breaths/minute

87

What is the rate of respiration for an infant?

30 to 60 breaths/minute

88

What may result in cyanosis?

less than 10 breaths/minute

89

What is dyspnea?

using more than normal effort to breath

90

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

91

Give an example of how respiration is charted.

R 20 labored and shallow

92

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

93

What happens to BP when during hemorrhage or dehydration?

Due to diminished amount of fluid in the arteries the PB falls

94

What determines the viscosity of the blood?

the number of red blood cells

95

What can increase BP as you get older?

The build up of atheroscerotic plague which limits the flexibility of the arteries

96

When the peripheral blood vessels are in normal physiologic state they are partially _______.

contracted

97

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

98

What happens to BP as you get older?

it usually increases as the state of the circulatory system declines

99

When is the BP usually the lowest?

Mornings

100

What happens to BP after eating a large meal

increase

101

List in order from high to low BP

Men
Women
Children
Infants

Infants
Men
Women
Children

102

Define Sphygmomanometer

BP cuff

103

Systolic

the top #
the highest point reached during contraction of the left ventricle

104

Diastolic

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.

105

What is the BP in adults?

120/70 mmHg - 90/50 mmHg

106

What is the BP in kids?

130/85 mmHg - 85/45 mmHg

107

What is the pulse pressure?

The difference between Systolic and Diastolic

108

What is pulse pressure an indicator of?

stroke volume of the heart

109

What happens if pulse pressure decreases?

Hypovolemic shock

110

Hypertension

greater 140/90 mm Hg

111

Hypotension

lower 90/60 mm Hg

112

What are the two types of Sphygmomanometers

mercury
aneroid

113

Which Sphygmomanometer is more accurate?

mercury

114

Who holds the responsibility of making sure the equipment needed to administer oxygen is available and functioning at all times?

The sonographer

115

Where is the major supply of oxygen carried?

chemical combination with hemoglobin

116

How is the oxygen capacity of the blood expressed?

Percentage of the volume

PO2

CO2 = PCO2

117

What is the Percentage of the volume called?

oxygen tension (partial pressure)

118

What happens when there is an excessive build-up of carbon dioxide?

the pH of the blood changes

119

What is the normal pH

7.35 - 7.45

120

What is hypoxemia?

low oxygen in the blood

121

What is hypercapnia?

High carbon dioxide in the blood

122

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%

123

What is a pulse oximeter?

Pulsox

SaO2

124

What is normal SaO2?

95% - 100%

less than 85% bad

125

COPD

Chronic obstructive pulmonary Disease

126

When oxygen is delivered with high flow rate what must be done?

humidified through distilled water so the mucus membrane does not dry out

127

What is the flow rate of oxygen pumped into patients rooms?

60 to 80 lbs pressure/squ inch

128

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

129

What is the symbol for the air we breath normally and what is the oxygen %

FiO2
21%

130

Nasal Cannula

oxygen thingy on face that goes up nose

most commonly used in radiology department

131

What is the concentration of oxygen from a Nasal Cannula?

21-60%

132

What is the oxygen usually prescribed for adults?

1 - 4 LPM

133

What is the oxygen usually prescribed for children?

1/4-1/2 LPM

134

Nasal catheter

catheter inserted into nostral

not common high concentration
1-5 LPM

135

When is a face mask used to deliver oxygen?

short periods

30-50%

no less than 5 LPM to flush out CO2

136

Nonrebreathing mask

100% oxygen

CO2 does not mix

137

partial rebreathing mask

60-90%

CO2 mixes

138

Venturi mask

24-50%

oxygen mixed with room air

139

aresol mask

60-80% mixed with water

140

Oxygen tent

mostly used for children

141

Liquid oxygen

used when someone needs to leave the house with oxygen

EXPENSIVE