Surgical Technology for the Surgical Technologist: A Positive Care Approach: Surgical Case Management Chapter 12 (Nicola) Flashcards
What is a type of surgical drape that is typically made of a thin, clear plastic material that has an adhesive backing and is applied to the skin; the drape may be impregnated with an antimicrobial iodine agent
What is it to foresee or prepare for a situation before it occurs, such as the surgical technologist anticipating the surgeon’s needs
What refers to an agent capable of killing some microorganisms and suppressing the growth of other types of microbes
What is the pulse taken at the apex of the heart
What is biologic material, which may be infective, that threatens humans or the environment
What is difficult or labored breathing
What is a position in which the patient lies face downward
What are microorganisms that live on and within the body and that are beneficial for health; typically refers to bacteria that live below the skin surface in hair follicles and glandular openings; also referred to as normal or resident flora
What is a state of being calm, usually effected by means of a sedative drug
What are members of the surgical team who has performed a surgical scrub, donned the sterile gown and gloves, and works within the sterile field
sterile team members
What is a hand and arm wash that is performed prior to donning the sterile gown and gloves; used for the purpose of removing as many microorganisms as possible
What are organisms that reside on the surface of the skin and are easily removed by hand washing
What are measurements of bodily functions essential to life, including temperature, pulse, respiration (TPR), and blood pressure
What is a sterile surgical gown that “wraps” around the individual to enclose the body from the neck to the middle of the lower leg, and is kept in place by ties and Velcro strips
The ability to .......... , or , ......the needs of the surgeon during case management is one of the most important skills of the surgical technologist
anticipate or predict
What is a surgical wound that begins 2 to 5 cm above the anterior superior iliac spine and runs parallel to the external oblique muscle of the abdomen. This incision is used for an appendectomy.
What must be removed because of the danger that they will fall into the pharynx and cause respiratory obstruction when the jaw relaxes under anesthesia
Surgeons may request that the patient shower with an antiseptic containing ............ in some cases where there is a particular risk of surgical site infection (SSI).
chlorhexidine or povidone-iodine
What is used at some medical facilities instead of shaving surgical sites
Who recommends not removing hair preoperatively unless it interferes with the operation, as microbial counts have been shown to be increased in pre-shaved areas of the skin.
Centers for Disease Control and Prevention (CDC)
What is not permitted prior to surgery to prevent the danger of aspiration should the patient vomit while under anesthesia, which can lead to pneumonia and death
No food or liquid by mouth for at least 6–8 hours
What consists of a scrub suit and hair cover. A mask and shoe covers may also be required.
The use of cosmetics (e.g., makeup, fragrance, nail polish, or artificial nails or tips) and wearing of jewelry of any type, including a wedding band, is restricted according to facility policy.
In OR attire
1.Apply hair cover prior to donning scrub suit.
2.Don scrub suit.
3.Remove body adornments and excess cosmetics, as needed.
4.Apply identification badge and radiation monitoring device, if necessary.
5.Change into shoes appropriate to the OR; apply shoe covers, if necessary.
6.Apply mask and protective eyewear, as needed.
Operating Room Attire technique
As part of ........ , gloves must be worn any time contact with broken skin or body fluids is expected.
Whatbe disposable or reusable and must be constructed of a lint-free woven or nonwoven fabric that offers a protective barrier
The front of the gown from the mid-chest level to the waist and the sleeves circumferentially
to 2 inches proximal to the elbows is considered ........
What is recommended for the following reasons:
•Fat is known to degrade latex.
•The barrier efficiency of latex decreases over time.
•The structure of latex is lattice-like, containing many spaces that fill with fluid during the surgical procedure.
What are these steps?
On entering the restricted area, a basic hand wash is performed. Depending on facility policy, application of the mask may be necessary at this time. All equipment and horizontal surfaces in the OR are wiped down with disinfectant solution and another hand wash should be performed after this activity
Preparing the OR
All tables that are to be set up as part of the sterile field should be placed at least ......
12 inches from the walls and as far away from OR doors as possible
What is being created at this point
A mask must be applied and must be worn by all individuals in the OR.
The door of the OR is closed and should remain closed as much as possible
Creating and Maintaining the Sterile Field
What are these steps for?
1. Pick up gown after drying hands and arms
2. lift gown while keeping body away from Mayo stand
3. identify collar and orient gown
4. release lower portion and identify arm openings
5. enter sleeves, (F) flex arms to hold gown in place
What are these steps for?
A) Disengage the tag and hand it to the circulator,
B) circulator moves behind the surgical technologist,
C) surgical technologist rotates shoulders to receive the tie with the left hand
NEVER turn your back to the sterile field
Turning the gown
What are these steps for?
•Move about as little as possible
•Keep the body centered in a “box” and move just the shoulders and hands
•Work in sections at the table
•Handle each item only once
•Learn a logical and efficient pattern for back table organization and repeat it case after case
•Be aware of the total environment, especially the movement of others
Principles of back table setup
What are these steps for?
(A) Place the small basins near, but not over, the edge of the table
(B) move drapes, gowns, and gloves to the large basin area
(C) remove instrument tray from container; verify exposure to sterilization process
(D) back table setup complete
Organizing the back table
What is the process if you have an incorrect sponge/sharps count?
1. Sponges/sharps Count twice
2. if still incorrect
3. remove entire package from OR
4. document problem, open new package
5. and count again
Problems with Sponge/sharps Counts
The initial count is accomplished by showing the circulator the needle picture on the .......... . However, needle packets with multiple needles must be opened and the needles counted.
What will the sharps count include
hypodermic needles, free needles, scalpel blades, and ESU tip(s).
What is loss of heat from the patient’s body to the environment
What is loss of heat into the air currents (the “wind chill” effect)
What is loss of heat from the patient’s body into a cooler surface such as the operating table
What is loss of heat via perspiration or respiration
What are the 2 major modes of patient heat loss
Radiation and convection
What is common and can cause serious cardiovascular and respiratory complications as well as discomfort, dental damage, and damage to the surgical repairs
What increases muscle metabolism, increasing oxygen consumption
Increased oxygen demand puts undue strain on the respiratory and cardiovascular systems. This undue stress may cause bradycardia and ..............
premature ventricular contractions.
What caused by hypothermia slows metabolism of medications, which in turn slows emergence from anesthesia.
The central nervous system depression
The most effective, albeit most extreme and invasive, means of warming core temperature are direct treatments like ........
warmed gastric lavage, peritoneal irrigation, and fluid warmers for blood and blood products and IV fluids
Where should the safety strap be securely placed
2 inches proximal to the knees
The arm boards should not be abducted more than ...... to avoid nerve damage
What are the Normal Temperature Values for oral
What are the Normal Temperature Values for Rectal
What are the Normal Temperature Values for Axillary
What are the normal pulse values at birth
What are the normal pulse values in adults
What may also be monitored apically, or at the apex of the heart, by using a stethoscope to listen at the level of the fifth and sixth ribs just to the left of the sternum and just below the nipple
The apical pulse
What pulse abnormality presents for Tachycardia
What pulse abnormality presents for Bradycardia
What is noted when monitoring respiration,
rate, rhythm, and depth are noted
What is a measure of the pattern of breathing
Rhythm of respiration
What is the amount of air taken in and exhaled with each respiration, an amount that is easily measured by anesthesia equipment in the OR.
The depth of respiration
What is recorded, along with whether respirations are shallow or deep
What disorder is a result of a disruption or damage to lateral medulla oblongata (breathing center)
Apnea No breathing
What disorder is a result of
Normal during sleep
Depression of respiratory center
Slow, even respirations
What disorder is a result of respiratory pathologies, cardiovascular pathologies
What disorder is a result of pneumonia, respiratory insufficiency, respiratory center lesions
breaths that rise with body temperature
When taking blood pressure - on hearing two initial tapping sounds, the gauge is read and the number is recorded as the .......
When taking blood pressure - sounds disappear altogether. The point at which these sounds disappear is recorded as the ........
The patient lies flat on the back with the arms extended on arm boards with the palms facing upward. Arms slightly bent,. Donut under head. Toes up
The draw sheet is placed over the arms extending 2 inches above the elbows and the sheet is tucked under the mattress
Is a modification of the supine position, but head down positioning. It is used to displace the abdominopelvic organs cephalad to provide better visualization of the surgical site. Blood flow to lower body is reduced.
Is a modification of the supine position, but head up position. It is used to displace the abdominal organs caudad to provide better visualization of the surgical site. Blood flow to the upper body is reduced
The reverse Trendelenburg
Is a modification of the supine position, (can also be a sitting position for neuro), and reduces blood flow to the upper body, promotes venous drainage, and facilitates respiration
The Fowler’s position
Is a modification of the supine position that uses candy-cane-style stirrups
The lithotomy position
Prior to placement in this position the patient is anesthetized on the stretcher. All preoperative procedures, such as Foley catheter insertion, must be performed prior to placement.
This position is a modification of the prone position. Body regions that may be accessed with the patient in the prone position include the anus and the pilonidal area.
The Kraske (jackknife)
The patient in this position is placed on the operating table with the right side downward, exposing the left side of the body or vice versa.
lateral recumbent or lateral decubitus position
This is a modification of the lateral position which the body regions that may be accessed with the patient in the kidney position include the retroperitoneal space.
The kidney position
This is a modification of the left lateral position. This is the preferred position for endoscopy performed via the anus. Typically, the patient remains on the stretcher (rather than being transferred to the operating table) and is awake and able to assist with positioning.
Certain areas are considered contaminated and may require special attention. The general rule in prepping these areas is to prep the surrounding areas first and the contaminated area last and to use a separate sponge for each area. These areas are:
Skin prep consideration
Areas classed as contaminated for prepping - clean last
Which skin prep provides a rapid and significant reduction in skin microbial counts.
Which skin prep is less likely to cause skin irritation and does not need to be removed.
What skin prep does not provide as rapid a reduction in skin microbial counts as alcohol, but provides a longer residual effect (5–6 hours).
Which procedure do you prep the shoulder, upper arm extending down to the elbow, axilla, and chest to the table line and to the shoulder opposite from the affected side
For procedures in the area of the chest and breast
When prepping for this procedure as much of the area surrounding the incision site should be prepped and the prep should always extend to the hairline
Eyes, Ears, Face, and Nose
Foot and ankle procedures you should prep
Foot and leg from ankle to knee
Bilateral leg procedures you should prep
Both legs from toes to waist level
Hip procedures you should prep
Abdomen on affected side, entire leg and foot, buttocks to the table line, groin, and pubis
Hand procedures you should prep
Hand and arm to 775 cm (3 inches) above the elbow
Shoulder procedures you should prep
Base of neck, shoulder, scapula, chest to midline, and circumference of upper arm down to the elbow
Arm procedures you should prep
Entire arm, shoulder, and axilla, including hand
Which prep should begin at the pubic area, using a downward motion toward and over the genitalia and perineum. Each sponge should be discarded after going over the anus
The perineal prep
Which prep may forceps will be necessary for the internal portion of the prep. The pubis, vulva, labia, perineum, and anus are prepped, including the upper thigh. begin over the pubic area and move downward over the vulva and perineum. Each sponge should be discarded after going over the anus
•All four towels and the four non perforating towel clips, if needed, are carried together to the individual applying the drapes.
•Towels are presented one at a time to the individual applying the drapes.
•Towels are placed with the folded edge down and the gloved hands protected from contamination.
•The first towel is placed on the side of the patient nearest the individual applying the drapes.
•The second and third towels are placed superiorly and inferiorly.
•The fourth towel is placed opposite the first towel
What is this draping procedure
(A) Place the under-the-buttocks sheet
(B) place the leggings
(C) place the fenestrated sheet
Draping the perineum
What is this draping procedure
(A) Place the split sheet under the extremity
(B) place the cylindrical covering (stockinette)
Draping an extremity
What phase of case management begins when the incision is made
What are passed by holding the box lock of the instrument and placing the rings in the palm of the surgeon’s open receiving hand.
What are moved away from the operating table and kept sterile until the patient is out of the OR, being transported to the PACU.
The sterile back table, Mayo stand, and basin set