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Surgery Test 1
| Question | Answer |
|---|---|
| define asepsis | series of techniques and procedures that are aimed at excluding all pathogenic organisms from the surgical sight |
| define sterilization | procedure which all forms of life are destroyed including spores. |
| define disinfection | procedure which only some forms of life are destroyed |
| define antisepsis | similar to disinfection but the chemical agents are applied to animate objects such as animals skin and human hands |
| why can you not mix ammonia and bleach? | you will make mustard gas |
| where should aseptic conditions be applied? | surgical suite and the patient |
| true or false: the patient and surgery staff prep is in the surgical suite? | false |
| always clean from _______ to ______ towards the exit | ceiling, floor |
| how often you clean the surgical suite | clean daily before surgeries begin and between cases |
| 3 things in operating room conduct? | 1. talking in the operating room should be minimal 2. movement within the operating room should be minimal 3. an imaginary line should be drawn around the sterile field of the surgeon, operating table and instrument tray |
| how do you walk around in a surgical suite if you are sterile personnel? | walk back to back with your hands in your surgical square of your body |
| name the proper surgical attire that MUST be worn | - scrubs (shirt tucked in) -head attire bouffant cap -masks molded or flat -foot covers or surgery shoes |
| True or False: items are only sterile if they remain above waist height? | true |
| which part of the drape on the patient is considered sterile? | the top |
| anything ______ or ________ over a table is considered __________. | falling, extending, unsterile |
| What is strike through? | when bacteria and other agents gain access to the sterile field through wet portions such as condensation |
| packs should be kept ______ and ______. | cool, dry |
| True or False: you can never turn your back on a sterile field | true |
| What is considered to be sterile | drapes instrument field gown/linen field surgical gown (neck to waist)/gloved hands suture material/blade taken out of the package sterile saline insides of the animal |
| what is considered to be antiseptic? | -prepped animal skin -scrubbed human skin |
| what is considered to be disinfected? | items that have been in contact with disinfectants when cleaning |
| what is considered to be contaminated? | caps/masks gowns below waist outside of packs undraped parts of an animal surgical lights |
| what can sterile surgical assistant perform? | -receive sterile equipment -keep table organized and clean -anticipate and pass needed equipment and instruments -maintain hemostasis for the surgeon -provide retraction of muscles and tissue -cut suture material |
| rules of packing instruments | -pans should have perforations -heavier instruments on the bottom -instruments used first on the top -box locks and ratchets left open -sharp objects locked with one click |
| wraps are considered sterile for ________ if stored correctly | 2 months |
| what should be used inside and outside of every pack | indicator strip and autoclave tape |
| What is labeled on the autoclave tape | -contents of item (IP, DP, GP) -date it was sterilized -initials of technician who prepared and sterilized it -group letter at UGRC |
| What are sterilization pouches used for | sterilizing individual items |
| How long are pouches considered sterile? | for 1 year if stored correctly |
| 3 types of sterilization monitors and what they do | 1. Chemical Indicator Strip: changes colour when exposed to steam 2. Bowie-Dick test: verifies steam penetration 3. Biological indicators: test sterility and effectiveness of an autoclave |
| IV fluids should always be ____ before surgery | warmed |
| who cleans the surgery suite before a surgery | circulating nurse |
| what do you do before entering the surgical suite> | take off lab coat and put on a cap and mask |
| when cleaning the surgical suite you work from _____ to _____ and from _____ to ______. | high, low, back, door |
| the instrument person must always count the _______ squares before surgery | gauze |
| when do fluid bottles get refilled | when they are 2/3-3/4 empty |
| when should suture material be re-ordered | when only 5 individual packets remain |
| solutions in the autoclave room must be changed after ____ days | 7 |
| Any linen with fresh blood on it should be cleaned with _________ _______ soaked in cold water for ____ minutes. | hydrogen peroxide, 10 |
| Who is in charge of doing laundry? | surgeons |
| materials waiting to be packed are placed in the...... | grey bin |
| What should be in a student gown pack? | - 3 gowns each with a hand towel placed on top of the gown |
| What should be in a instructor gown pack? | - 1 gown with 1 hand towel |
| What should be in a drape pack? | - 1 lap sheet - 4 tissue drapes placed on top of the lap sheet |
| how do we maintain patients fluids | - fluids are pre warmed - fluids are warmed during anesthesia - hard plastic heating pad on induction table - hotdog warmer in surgical suite - bubble wrap and socks - Bair hugger post anesthesia |
| what type of knots do you use to secure the legs | quick release |
| where do you tie the leg ties on the body? | -just above and below the carpus and Tarsus - distal to any IV catheter |
| order of placing drapes on the patient | head, tail, near , far |
| What is ethylene oxide | very toxic gas that kills all bacteria, viruses, and spores |
| How ethylene oxide used? | supplied as a liquid in vials, break vial and put into locked box. put box in fume hood or vent chamber |
| what are the potential short term hazards of ethylene oxide | burns of skin, eyes and respiratory tract |
| what are the potential long term hazards of ethylene oxide | Mutagenic: DNA mutations Teratogenic: birth defects Carcinogenic: cancer causing |
| What are the Ontario Ministry of Labour Regulations regarding ethylene oxide | - hospital must have a joint health and safety committee - must keep records of use for 40 years - must have a fume hood or vent enclosure -must have a copy on provincial regulations -staff must be trained in use |
| When do you fill out the drug log? | immediately after acquiring the drug |
| when do you fill out the amount injected and discarded of the drug | immediately after the lab |
| when starting a new page in the log book what must you bring forward to the new page | balance forward entry |
| how often are controlled drugs audited | weekly written in red pen |
| each poke to a bottle results in how much hub loss | 0.10 mls |
| what is applied to all open bottles | tamper tape |
| why do we use tamper tape? | reduce work and need to audit a drug that has not been used since the last audit |
| red tops with _____ drug are to be treated at _______ _______ bottles | decanted, multi draw |
| do not use larger than a ______ needle to draw up drugs | 22g |
| the plunger of any drug should NEVER be _______ unless in a ________ or a _______ | pushed, patient, bottle |
| True or False: spills must be double signed by witness and calculate by auditing the remaining drug volume | True |
| what is the most important section on the monitoring surgery sheet | depth |
| what is the pH of blood | 7.4 |
| what does "strung" mean in regards to instruments | instrument does not align properly |
| how should curved instruments be passed? | with the curve facing up |
| True or False: the rings or handle should be passed into the surgeons hands | True |
| If maintained well how long can stainless steel instruments last | a lifetime |
| why is stainless steel used for instruments? | it combines hardness, strength, corrosion resistance and durablity |
| Surgical instruments can be damaged when cleaned if solution is too ________ or _______. | alkaline or acidic |
| hard water can leave what on instruments | mineral deposits |
| All scissors should be able to cut _______ layers of _______ at the tips | 4, gauze |
| Why must an instrument be cleaned with a detergent prior to sterilization | the instrument will not be autoclaved properly if there is blood and other foreign material present |
| What is a type of detergent you can use on instruments | Asepti-Zyme |
| Why is ultrasonic cleaning useful? | it removes small debris and microorganisms by mechanical energy |
| Ultrasonic cleaning is ______ times for effective than __________ _________. | 16, manual cleaning |
| What is standard time and temp for steam sterilization | 15 mins at 121°C (250 °F) |
| In emergencies what is the standard time and temp for steam sterilization | 3 mins at 121°C (250 °F) |
| True or False: you must open the door 1/2 way for 15 mins after cycle is complete | True |
| At UGRC how long does the steam sterilization cycle take and how long to dry | 45 mins to run and 60 mins to dry |
| Why has cold sterile diminished? | due to its instability of solution after 24 hours |
| Procedure for Cleaning Instruments | 1. soak in hot water w detergent for 5 mins. 2. use brush to scrub 3. rinse with hot water 4. place in ultrasonic cleaner 5. rinse with tap water 6. place in milk solution 7. allow instruments to dry 8. add lubrication 9. exam each instrument b4 packing |
| How long should the instruments sit in the milk bath? | 5 minutes |
| True or false: you should rinse the milk off? | FALSE |
| How often should the milk bath be changed? | every 7 days at minimum) |
| Surgical Instrument anatomy includes | -teeth, serrations, jaws, box block, shank, ratchet, and finger rings |
| What is instrument is used to open surgical packs? | Allis Tissue Forceps |
| Why do doyen intestinal forceps have a hole in the middle | allow peristalsis to continue and not stop blood flow |
| What is the difference between the allis forceps and the babcock intestinal forceps? | -babcocks dont have teeth and therefore more delicate on tissue |
| what are the different needle shapes for suturing | straight, curved (most common) , half curved |
| what needle point is the most damaging to tissue and what is it used for? | cutting point (trocar), used to cut through skin |
| What is the needle point that is more delicate and what is it used for | taper point (non cutting) used for delicate tissue such as bladder or intestinal wall |
| the more _______ the needle the _______ the space i am working in | curved, smaller |
| Which needle size is used the most | 3/8 circle |
| which needle points are the most common | tapered and reverse cutting |
| What are the 2 types of needles available to buy | eyed (unattached/reusable) swaged (suture material already connected) |
| True or False: swaged needle is more expensive than the eyes needle | true |
| 2 formats of suture material available | cassettes Individually wrapped packages packaged in alcohol spools |
| which form of suture material is not commonly seen in Canada anymore | alcohol packs |
| which is the most expensive suture material format | individual packet |
| which needle pack format does not guarantee sterility | cassettes |
| What is the largest commonly used suture size | 2 |
| what is the smallest suture size | 12-0 |
| which species is more prone to suture reactions | cats |
| what does absorbable suture material mean | when left in the body it will be slowly degreases, absorbed and excreted through the kidneys |
| what does non-absorbable suture material mean | must be removed by scissors 7-14 days post op |
| What is a monofilamant suture along with its benefits and disadvantages | material which only has one thread. does not conduct infection well, causes less trauma but it less strong |
| What is multifilament suture along with its benefits and disadvantages | multiple threads are intertwined to form a braid very strong but is a great spot for infection to occur in the strands |
| where should you never use multifilament suture | in infected areas unless they are coated |
| What are 2 suture materials that have capillary action? and what is capillary action | silk and catgut absorbs water and swells |
| Why should you not use silk or catgut in infected areas | allows for the transmission of bacteria by wicking the bacteria along its length |
| how long can non-absorbable suture material retain its tensile strength | 60 days or more |
| Common non-absorbable suture types | silk, cottons/linens, stainless steel, prolene, ethilon, vetafil |
| Which non- absorbable suture material is likely to give a patient stitch granulomas | Nylon/Ethilon |
| Types of Absorbable suture materials | catgut, dexon, vicryl, P.D.S, Moncryl, Maxon |
| Which absorbable suture material is most expensive and why | P.D.S because it has little tissue reaction |
| Which absorbable suture is the synthetic version of catgut | Monocryl |
| what is the definition of suturing | use of suture material to tie tissues together |
| what are 3 examples of basic knots that a surgeon must know | -surgeons knot -half hitch -square knot |
| how far apart should sutures be | 1/2 inch and 1/2 inch away from edge of incision |
| What is a fistula | any abnormal passage within body tissue. can be caused by a bit of suture material left behind in the body |
| Which type of suture technique do you use on the Linea alba | simple interrupted |
| What is a disadvantage of a simple continuous suture | If it brakes the incision dehises which causes the entire suture to become undone |
| which suture technique is used primarily for large animals | Ford (interlocking) continuous |
| What suture technique is Ms.Tallons Fav? | Horizontal Mattress because it is a 2 for 1 and the knots are not over the incision |
| Subcuticular technique can be used for what procedure | dog castration |
| what problems may occur if sutures are too tight | rip out, irritate animal |
| What are common suture reactions | foreign body reaction or may get very large swelling that looks like a hernia |
| Control options to avoid animal removing their own sutures | -e.collar, tshirts, ointments, bite-not collars, etc |
| who developed the DAISY | Dr.Homeberg |
| What are anesthetic machines used for | provide inhalant maintenance anesthesia to a patient but also can be used via induction of anesthesia or oxygen support |
| which species can you use nitrous oxide with | birds |
| what should the ratio of nitrous oxide and oxygen be | 2:1 |
| What does the flow meter do and its units | reduces the pressure coming in from the oxygen tank from 50 PSI to 15 PSI. Measured in L/min |
| What is the minimum flow rate for any animal | 30 ml/kg |
| What does PSI stand for | pounds per square inch |
| What does the vaporizer do and its units | holds the liquid anesthetic agent. oxygen picks it up and delivers fresh gas. Measured in % |
| What is "fresh gas" | oxygen containing an anesthetic agent |
| What is the max % ISO will go up too? | 5% |
| What do the flutter valves do? | allow air to exit and enter the machine |
| what does the oxygen flush valve do? | bypasses vaporizer to deliver pure oxygen (EXTREME HIGH PRESSURE) |
| What does patient tubing do? | delivers fresh gas to you patient and returns exhaled gas from patient to the machine |
| What does the pop of valve do | "circle of destiny" controls fate of expired gas from patient |
| Where does the gas go if the pop off is open vs closed | open= scavenger, closed+ = patient via rebreathing bag |
| What does the resevoir bag hold | extra oxygen flow |
| what is atelectasis | partial or complete collapse of a lung lobe due to alveoli becoming deflated |
| how often do we "bag" a patient and why | every 5 minutes to prevent atelectasis |
| How do we calculate the size of rebreathing bag | calculated as a range 60-100 ml/kg if its not exactly in a range size up |
| What does the manometer do and its units | measures the pressure of the gas exiting the system, measured in cm/water |
| What is the max cm/water for cats and dogs | 15 cm of water for cats 20 cm of water for dogs |
| During a leak test the manometer should maintain a pressure of ____________ and drop no more than ____________ in 15 seconds | 20-30 cm/water, 10 cm/water |
| what does the scavenger do | removes waste gas from system and releases it outside of the building |
| what are the 2 types of scavengers and there functions | active: vacuum out gas passive: gravity flow |
| when should a leak test be performed? | every time anesthesia machine is set up or used on a patient |
| 3 common reasons to fail a leak test | - hold in resevoir bag -human error -pop off valve not closed |
| what is the concept of the leak test | close the entire anesthetic system fill it with oxygen and maintain it at a desired pressure over a period of time to ensure it is a contained system |
| ET tube functions | -ensures patent airway, emergency ventilation, reduce dead space, protects airway, accurate admin of O2 and anesthetic, emergency drugs IT route |
| Methods to select size of ET tube | -chart (not very accurate) -philtrum -palpate trachea -previous records -experience |
| what size of ET tubes are cats generally | 3.5-4.5 |
| How far should the ET tube reach in the body | tip of the nose to the thoracic inlet |
| Two types of ET tubes | cuffed and non-cuffed |
| Advantages of cuffed tubes | prevent leakage of gas, reduce aspiration, better control of resps |
| disadvantages of cuffed tubes | may damage lining of trachea or kill an animal if inflated too much |
| 3 ET tube designs/names | Magill: uncuffed or cuffed Murphy: uncuffed or cuffed, has an eye to allow an extra place to breath Cole: smaller end, not cuffed |
| which ET tube design is used on exotics and neonates? | cole |
| What equipment is needed for an ET tube intubation procedure | -ET tubes (3 sizes) -Laryngoscope -Lubricating gel (Xylocaine in cats) -Tie -Syringe -Gauze square |
| How to check if your cuff does not have a hole in it | Leave it inflated over night and in the morning if it hasn't deflated it is working properly |
| How to know when the patient is ready for intubation | absence of swallowing reflexes and decreased jaw tone |
| What species should the epiglottis never be moved down with the laryngoscope and why | cats, Laryngospasm |
| What is Laryngospasm | closure of arytenoids due to mechanical or chemical stimulation |
| Where is the tube tied on a dog and cat | Dog around the muzzle except for brachiocephalic and around the head in cats |
| Should the tube be tied first or should the cuff be inflated first? | Tube tied |
| techniques to check ET placement | condensation in the tube, breath on your hand, palpate throat, visualize tube in mouth |
| How to inflate the cuff? | intubater uses a syringe to slowly inflate the cuff while the anesthetist mags the animal. once intubater does not hear anymore air moving around the ET tube they stop inflating. |
| When do you extubate a dog? | when they swallow |
| when do you extubate a cat? | when there is purposeful movement |
| How long do you leave the tube in a brachiocephalic dog | as long as the dog will tolerate it |
Created by:
jscott41
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