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closed drain Correct Answers used to remove fluid in an airtight circuit that prevents environmental contaminants from entering the wound or cavity
- most create a negative pressure in a reservoir that is attached to the drain. Fluid is then gently drawn out of the wound. open or gravity drain Correct Answers Drainage of blood or pus is primarily along the outside surface of the drain by capillary action and gravity ( penrose )into a dressing. T-tube drain Correct Answers used after gallbladder surgery Placed in common bile duct to allow passage of bile ( passive drain / gravity drain) Gravity drains Correct Answers Gravity drains: Passive movement from high pressure to low pressure - urinary -Penrose: Short-term drain to give fluids under the wound a channel to drain to the surface; prevents pressure on suture lines -T-tube: Drain directly through a tube from the surgical area Hemovac drain Correct Answers Used to drain wound after extensive dissection or where moderate to large amounts of drainage are expected; has self-contained collecting device and manual suction (Mostly used for ortho)
Malecot, pezzer catheters Correct Answers Used to drain hollow organs such as bladder, may be used as gastrostomy tube, and may be placed in large abscess site; connected to drainage bag and drained by gravity Red Rubber Correct Answers May be used as a jejunostomy tube to deliver postoperative enteral nutrition. Non-absorbable monofilament suture Correct Answers most drains are held in place by Broviac, Hickman, Grosshong, Quinton, & Swan-Ganz Correct Answers What are some types of indwelling intravenous catheters? Swan-Ganz catheter Correct Answers A soft, flow-directed catheter with a balloon at the tip for measuring pulmonary arterial pressures. Active Drainage Mechanisms Correct Answers Mechanism of an external source evacuates body fluids -Manual suction - Self-contained negative pressure device Examples: Hemovac, Jackson-Pratt, Blake -External suction - Machine or wall mount Examples: Salem sump, chest tubes Jackson-Pratt drain Correct Answers collects wound drainage in a bulblike device that is compressed to create gentle suction, consists of perforated tubing connected to a portable vacuum
pain and discomfort Correct Answers What happens when you don't let smoke out of the belly in a laparoscopic case? Femur (patellafemoral joint) Not with the tibia Correct Answers The patella only articulates with? Popliteal Fossa Correct Answers Mostly fat filled compartment located posterior to the knee joint -Medial and lateral femorotibial -Femoropatellar Correct Answers What are the three articulations of knee joint: Posterior cruciate ligament (PCL) Correct Answers • Posterior intercondylar area of tibia (runs on medial side of ACL) to lateral surface of medial condyle of the femur
- Prevents hyperflexion • Limits anterior rolling of femur on tibial plateau during extension, converting to spin
- Prevents posterior displacement of tibia (95%) • In weight-bearing, flexed knee, ______ is main stabilizing factor for femur Anterior cruciate ligament (ACL) Correct Answers Weaker/ 40% longer then PCL
- Anterior intercondylar area of tibia to medial surface of lateral femoral condyle (in intercondylar notch)
Prevents hyperextension
Limits anterior displacement of tibia relative to femur (85%) Genu varum Correct Answers Bowed Legs
- Abnormally straight femur, small Q-angle
- Line of weight bearing falls medial
- LCL overstressed Genu valgum Correct Answers Knocked knees ( knees touching )
- Exaggeration of Q-angle • >17 degrees • MCL overstressed • Patella pulled laterally due to vastuslateralism. • When leg extended, patella-femur articulation abnormal knee Correct Answers Varus & Valgus pertain to what body part? meniscus Correct Answers The ____________ functions to help distribute force across the joint and is important in cushioning and protecting the cartilage of the knee. bucket handle tear Correct Answers A __________________ tear of the meniscus occurs on the outer portion of the meniscus cartilage and causes a vertical slice through the meniscus. The attachments of the meniscus remain intact, and the torn portion of the meniscus pulls into the center of the joint. Bucket handle tear Correct Answers A longitudinal meniscal tear of the central segment that can displace into the joint, leading to locking of the knee.
Calcium Chloride Correct Answers What drug affects heart contraction? It can cause precipitating digital ischemia and necrosis Correct Answers Why don't you inject lidocaine in hands and feet? 100-120 Correct Answers What is the compression rate for an adult? post dural puncture headache Correct Answers Leakage of CSF from the site of puncture of the meninges during the insertion procedure of an anesthetic often results in ___ ___. Chevron incision Correct Answers What incision would you use for surgery on the gallbladder and the spleen? Right subcostal/Kocher Correct Answers What incision is commonly used for a gallbladder procedure? Proximally Correct Answers Where do you first clamp the cystic duct? cystic artery Correct Answers What do you clamp and ligate first? The cystic artery or cystic duct? Fowler's position Correct Answers What surgical position can cause hypovolemia? BETA-BLOCKERS (Beta Antagonists) ACE INHIBITORS (ACEIs) AND ARBs CALCIUM CHANNEL BLOCKERS
ALPHA-BLOCKERS Correct Answers What are the treatments for high blood pressure? vasopressors Correct Answers What are the treatments for low blood pressure? proximally Correct Answers When applying digital pressure to an artery, pressure is applied _______ to the area of bleeding. linear stapler Correct Answers Inserts 2 straight, staggered, evenly spaced, parallel rows of staples predominantly used to close the ends of a hollow organ or vessel. They are claimed to give easier access to narrow anatomic sites such as the pelvis. Correct Answers What are the benefits of a linear stapler? McArdle's disease Correct Answers Muscle phosphorylase deficiency - glycogen storage disease) one hour Correct Answers Continuous tourniquet pressure on an arm should be less than two hours Correct Answers Continuous tourniquet pressure on an thigh should be less than 300-350 and 250-300 Correct Answers Tourniquet pressure should not exceed the maximum cuff pressure of ___________ for thigh and _________ for arm and lower leg.
compartment syndrome, McArdles disease, hypertension or other vascular problems. Correct Answers When should you not use a tourniquet? kocher Correct Answers What is another name for a subcostal incision? A surgeon must approximate the falciform ligament first if divided. Then the peritoneum , posterior rectus fascia, and anterior rectus fascia is closed. Correct Answers Closure of the kocher incision is in layers. What layer is closed first? Nondisplaced fractures of the proximal portion of metatarsals 1 through 4 can be managed acutely with a posterior splint followed by a molded, non-weight-bearing, short leg cast. Correct Answers What splint is used for a metatarsal fracture? radical mastectomy Correct Answers excision of the entire breast, all underarm lymph nodes, and chest wall muscles under the breast axillary vein Correct Answers During radical mastectomy what artery/veina do you preserve mammography Correct Answers a radiographic examination of the breasts to detect the presence of tumors or precancerous cells. Palpable and non palpable
Needle-wire localization Correct Answers in some instances when a lesion previously detected on mammogram is too small to palpate, a ______________ might be done protamine sulfate Correct Answers reverses effects of heparin Heparin Correct Answers Anticoagulant - thins blood and prevents blood clots used more in emergency cases. Fast working To drain fluid Correct Answers What is a chest tube used for after lung surgery colon Correct Answers If you have liver cancer where did it most likely come from reinsert the needle Correct Answers If verse needle is inserted and doesn't work what do u do Jackson-Pratt drain Correct Answers Radical neck dissection uses what type of drain loop colostomy Correct Answers What type of colostomy uses a rod or tube? colostomy Correct Answers After a pelvic exteneration what will u need? colpotomy which is an incision into the vagina Correct Answers Pftstannial excision not used for
biomedical Correct Answers Surgical equipment pertains to what Meckel's diverticulum Correct Answers During a surgery an appendectomy is ruled out what does Pt have Meckel's diverticulum Correct Answers outpouching of distal ileum blood loss Correct Answers A Patient takes Ginseng and fish oil what do you expect during surgery open Correct Answers A patient needs Hysterectomy for bleeding and has had multiple c sections. Would you do this as a laparoscopic or open? 1mL Correct Answers 1g = biomedical engineer Correct Answers Who do u report a broken bed to Colles fracture Correct Answers complete fracture of the radius bone of the forearm close to the wrist resulting in an upward (posterior) displacement of the radius and obvious deformity. Smith fracture (reverse Colles) Correct Answers It is caused by a direct blow to the dorsal forearm or falling onto flexed wrists, as opposed to a Colles' fracture which occurs as a result of falling onto wrists in extension. Smith's fractures are less common than Colles' fractures.
liability Correct Answers obligation to do or not do something Malpractice Correct Answers Failure by a health professional to meet accepted standards - professional misconduct that results in harm to another Negligence Correct Answers careless neglect, often resulting in injury Aeger primo Correct Answers the patient first Doctrine of borrowed servant Correct Answers the one controlling or directing the employee has greater responsibility than the one paying the employee Primum non nocere Correct Answers First do no harm res ispa loquitur Correct Answers "the thing speaks for itself" respondent superior doctrine Correct Answers The institution--employer--is legally responsible for the negligent or wrongful acts or omission of the employee even though the facility itself is committed no wrong; the negligence of the employee is imputed to, or placed on the employer. Unintentional Torts (Negligence) Correct Answers foreign body (sponge) left in Maslow's Hierarchy of Needs Correct Answers physiological, safety, love/belonging, esteem, self-actualization
most common aerobic species of pseudomonas in humans is... Aerobic Correct Answers Process that requires oxygen Anarobic Correct Answers metabolic process that does not require oxygen Gram stain Correct Answers A staining method that distinguishes between two different kinds of bacterial cell walls. Staphylococcus aureus Correct Answers -a form of staphylococci that commonly infects wounds and causes serious problems such as toxic shock syndrome or produces food poisoning -gram + cocci clean wound Correct Answers A wound that is not infected clean-contaminated wound Correct Answers occurs from the surgical entry of the reproductive, urinary, respiratory, or gastrointestinal system contaminated wound Correct Answers a wound with bacteria present resulting from trauma, a break in sterile technique during surgery or spillage of bowel contents or other bacteria-laden material during surgery
- less than 4 hours from penetrating trauma dirty wound Correct Answers -infected wound / old traumatic wound - -more than 4 hours old from penetrating trauma
inflammatory wound healing phase Correct Answers (reactive stage) - last 1 -4 days , starts immediately proliferative phase Correct Answers (regenerative) -granulation occurs during this stage
- starts within hours
- last 5 days to 2 weeks Remodeling phase of wound healing Correct Answers - maturation phase -3wks-2yr deposition of matrix materials, collagen deposition/ remodeling as long as scar or past ulcer site is erythematous, remodeling is occurring minimum of 15 total with at least 3 replacements of outside air Correct Answers What is the minimum amount of air exchanges in the OR? 30%-60% Correct Answers The humidity in the OR should be between what? 68-73 degrees Correct Answers The temperature in the OR is maintained at _______ Glutaraldehyde, OPA, hydrogen peroxide , peracetic acid Correct Answers High level disinfecting agents Sterilization Correct Answers Complete destruction of all forms of microbial life
1 kg Correct Answers 2.2 lbs Nitrous Oxide Correct Answers N2O PaCO2 Correct Answers partial pressure of carbon dioxide - 35-45 mmHg PaO2 Correct Answers partial pressure of oxygen - 80- Midazolam (Versed) Correct Answers class: Benzodiazepine Indication: sedation, conscious sedation, anesthesia, status epilepticus Action: Acts to produce CNS depression, may be mediated by GABA. Nursing Considerations:
- assess level of sedation during and for 2-6 hours following
- monitor blood pressure, pulse, respirations during IV administration
- The antidote for overdose is flumazenil Atropine Correct Answers Anticholinergic - given to dry secretions or to control cardia reflex that may cause bradycardia Reglan Correct Answers Metoclopramide Antiemetic - may be given to empty the stomach & to reduce nausea and vomitting Narcan (naloxone) Correct Answers opioid antagonist
Succhinylcholine (Anectine) Correct Answers standard depolarizing muscle relaxant
- Trigger for MH Rocuronium (Zemuron) Correct Answers Non-depolarizing neuromuscular blocker agent Fentanyl & Morphine sulfate Correct Answers Analygesics given marcaine (bupivacaine) Correct Answers local anesthetic - last the longest RSI (Rapid Sequence Intubation) Correct Answers If a procedure is emergent, anesthesia may do what type of intubation? place cricoid pressure Correct Answers If RSI is done, what might you need to do for anesthesia? Total spinal anesthesia Correct Answers -May cause paralysis to the respiratory muscles
- a more serious complication when the needle or catheter is advanced into the subarachnoid space and a large dose of LA is given directly into the CSF epidural space Correct Answers space between the dura mater and the wall of the vertebral canal ( dura and ligament flavum) Post Dural Puncture Headache (PDPH) Correct Answers Inadvertent dural puncture ( wet tap ) can cause a
