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Chapter 57
Surgical Asepsis and Assisting with Surgical Procedures
| Question | Answer |
|---|---|
| Cicatrix | early scar tissue that appears pale, contracted, and firm |
| Dehiscence | the separation of wound edges or rupture of a wound closure |
| Infection | invasion of body tissues by microorganisms, which then proliferate and damage tissues |
| Sterilization | complete destruction of all forms of microbial life |
| Asepsis | freedom from infection or infectious material |
| Medical Asepsis | destruction of organisms after they leave the body |
| Surgical Asepsis | complete destruction of organisms on instruments or equipment that will enter the patients body |
| Gravity (Fast Exhaust) Cycle | used to sterilize stainless steel instruments, glassware, etc. autoclave fills with steam and held at required temperature for a period. valve opens afterwards and returns chamber to atmospheric pressure. dry times may add to cycle. most used in ph office |
| Liquid (Slow Exhaust) Cycle | used to prevent sterilized liquids from boiling. steam is exhausted slowly at the end of the cycle to allow liquids to cool |
| Prevacuum Cycle | used for porous materials. the chamber is partially evacuated before the steam enters for more penetration; not available on all machines |
| Gas Sterilization | long processing times, ventilation requirements, and health hazards make it unrealistic to use in the physicians office |
| Chemical Sterilization | instruments that cannot be exposed to high temperatures are exposed to this |
| Electrosurgery | also know as electrocautery. high frequency currents cut through tissue and coagulate blood vessels. |
| Laser Surgery | Light Amplification by Stimulated Emission of Radiation. first use for diseases of the retina. now used for excision of lesions, removal of warts/moles, cauterization of blood vessels, cosmetic procedure |
| Microsurgery | uses a microscope to perform delicate surgery. major use in ophthalmology. also used in: otologic, rhinologic, sinus, laryngologic, neurosurgical, microvascular, gynecologic, and genitourinary procedures |
| Endoscopic Procedures | endoscope: medical device with miniature camera mounted on a flexible tube with a light source that is used to examine inside a cavity. used on the bladder, bronchus, larynx, colon, stomach, uterus, abdomen, various joints. specimen may be collected |
| Cryosurgery | uses a low temperature probe to kill tissue by freezing it on contact. usually below -20 degrees Celsius (4 degrees Fahrenheit) |
| Wound Care | several types: closed, incised, open, lacerated, perforated, abrasion, puncture, avulsion. |
| Dressing | a sterile covering placed over a wound for the purpose of: contamination protection, constant pressure, hold wound edges together, absorb drainage. |
| Bandages | hold dressings in place and support the affected area. may be gauze, cloth, elastic cloth rolls. kling (roller bandage that adheres to itself) is preferred |
| Iag Phase | blood vessel contract to control hemorrhage; blood platelet from network in wound to plug wound. fibrin release to close wound. 12 hr later, WBC arrive to clear bacteria/dead tissue. 1-4 days, fibrin thread contract, pull edge of wound together under scab |
| Proliferation | the wound heals and new growth begins. lasts 5-20 days. tissues repair themselves. if the wound is a surgical incision, a cicatrix usually forms |
| Remodeling | day 21 onward. large or mangled wounds require time and cellular activity to build new tissue to close gap of wound. cells produce collagen, forms scar tissue. scar tissue doesn't have elasticity of normal skin and devoid of normal blood supply and nerves |
| Closed Wound | do not involve any external bleeding (although there may be bleeding under the skin, which is called a bruise). ... broken bones) where blunt force trauma causes a contusion |
| Incised Wound | caused by a clean, sharp-edged object such as a knife, razor, or glass splinter |
| Open Wound | an injury involving an external or internal break in body tissue, usually involving the skin |
| Lacerated Wound | produced by the tearing of soft body tissue |
| Perforated Wound | associated with an entrance wound and an often larger exit wound. Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. penetrating injuries are commonly caused by gunshots and stabbings. |
| Abrasion Wound | caused by superficial damage to the skin, no deeper than the epidermis. less severe than a laceration, and bleeding, if present, is minimal. Mild, also known as grazes or scrapes, do not scar or bleed, but deep may lead to the formation of scar tissue. |
| Puncture Wound | An injury that is caused by a pointed object that pierces or penetrates the skin. carry a danger of tetanus. |
| Avulsion Wound | an injury in which a body structure is forcibly detached from its normal point of insertion by either trauma or surgery (from the Latin avellere, meaning "to tear off"). |
| Problem: Damp Linens | Causes: clogged chamber drain; goods removed to soon; improper loading. Correction: remove all lint; allow goods to sit in chamber add'l. 15 min. with door slightly open, place packs on edge |
| Problem: Stained Linens | Causes: dirty chamber Correction: clean chamber with calgonite. never use strong abrasives (steel wool); rinse thoroughly after cleaning |
| Problem: Corroded Instruments | Causes: poor cleaning; residual soil; exposure to hard chemicals; inferior instruments Correction: improve cleaning; don't allow soil to dry on instruments; sanitize first. don't expose instruments to salts, acids. |
| Problem: Spotted/Stained Instruments | Causes: mineral deposits on instruments; residual detergent; tap water Correction: wash with soft soap and detergent with good wetting properties. rinse with distilled water |
| Problem: Instruments with Soft Hinges/Joints | Causes: corrosion or soil in joint; instruments out of alignment Correction: clean with warm, weak acid. (10% nitric acid); rinse. realignment by instrument repairman. |
| Problem: Ebullition, or Caps that Blow Off Solutions | Causes: too rapid exhausting of chamber Correction: use slow exhaust, cool liquids, let autoclave cool while turned off |
| Problem: Steam Leakage | Causes: worn gasket; door closes improperly Correction: replace gasket; shut carefully; service if unable to close |
| Problem: Chamber Door doesn't Open | Causes: vacuum in chamber Correction: turn controls to starting steam pressure; wait until equalized, then vent/open door |
| Suture Repair Instruments | SIDE COUNTER: local anesthetic, dressings/ bandages, splints/guards, tape, drape, gloves, sterile normal saline solution. STERILE FIELD: syringe, needle, hemostats (three), scissors, sponges, suture material/needle, tissue forceps/skin hook, needle holder |
| Needle Biopsy Instruments | SIDE COUNTER: specimen container with prepackaged fixative or preserving solution, laboratory form/label, local anesthetic, gloves. STERILE FIELD: biopsy needle, syringe/needle, sponges |
| Cyst Removal Instruments | anesthetic, disinfect, lab form, dressing, gloves, drape, specimen container w/ preserve solution. Kelly hemostat, dressing forcep, suture, scissor, dissector, skin hook, syringe, disposable scalpel 11/15 blade, tissue/allis forceps, needle holder, sponge |
| Suture Repair Care | POSTOPERATIVE CARE: clean lacerations may not require a dressing. the patient may be instructed to keep the area clean and dry. some may be closed with steri-strips or an adhesive bond |
| Suture Repair Comments | if patient has dressing over laceration, follow standard procedure. don't remove pressure dressing until physician ready to suture. if must be removed, have sufficient sterile dressings available. ask pt approximate location, dpth, length of laceration. |
| Needle Biopsy Care | POSTOPERATIVE CARE: adhesive bandage strip sufficient. examination of tissue removed from living body. done to determine whether a growth is malignant or benign; may be used to diagnose other diseases. specimen sent to pathologist for exam |
| Cyst Removal Care | POSTOPERATIVE CARE: suture repair. sebaceous cyst benign retention cyst of sebaceous gland contain fatty substance from gland. cyst is attached to skin and moves freely over underlying tissue. incision should be made on the natural skin crease if possible |
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