Final Exam

sterile

refers to environment and instruments

aseptic

refers to technique and procedures

The Joint Commission

hospitals and other health care facilities are accredited by

Aeger primo

the patient first

all doors into the restricted areas must remain closed during an operation to preserve_____ and help prevent contamination

positive air pressure

the roles of the surgical technologist in the state of Connecticut

scrub, assistant circulator, and second assistant

minimum of air exchanges per hour

15

What percent of air exchanges per hour should be from the outside air?

20%

range of relative humidity?

20-60%

temperature in the OR

68-73F

three most important factors in radiation safety

1.time

2.distance

3.shielding

distance an xray beam scatters

6 ft

most common location for surgical fires

patients airway

when a patient's body temperature drops during surgery, it increases the risk of

surgical site infections

when the tip of the smoke evacuator is held within 1 cm of the impact site, what percent of the plume is evacuated?

98%

PMMA

cement metal prostheses in place during total joint arthroplasties

standard precautions

all body fluids must be treated as if they are potentially infectious

RACE

R-rescue/remove

A- alert/alarm

C-contain the fire

E-evacuate/extinguish

first stage of grief

denial

minimum distance of sterile items from the wall

12 inches

when are most SSI's acquired

at the time of the procedure

exogenous

from perioperative personnel

endogenous

the patients own microflora

the fire triangle

ignition source, oxygen, fuel

PASS

P-pull

A-aim

S-squeeze

S-sweep

type I latex allergy

most serious

Waste Anesthetic Gases (WAG)

vapors that escape from anesthesia equipment

-gas scavenging system used

PMMA hazards

-bone cement

-noxious vapors

-self contained vapor evacuation systems used while mixing it

cardiac death

The irreversible loss of cardiac and respiratory function. This is the permanent absence of heartbeat and respiration

higher brain death

the irreversible loss of higher brain function. The brain stem continues to provide respiration, blood pressure and a heartbeat without the assistance of a respirator

whole brain death

the irreversible off of all functions of the entire brain.

5 stages of grief

1. denial

2.anger

3.bargaining

4.depression

5.acceptance

Donation after cardiac death

a candidate if it is predicted that the heart will cease functioning within 90 min of removal from mechanical support

donation after brain death

patient declared dead by the whole brain criteria

infection

multiplication of organisms in the tissues of a host

disinfection

the process by which most, but not all the microorganisms are destroyed

antisepsis

the process by which most, but not all mo's located on animate (living) surfaces are destroyed

semi critical

items that come in contact with mucous membranes or non intact skin

critical

items used for invasive procedures, surgical instruments, devices entering vascular and urinary systems

sterilization

the destruction of all mo's including spores, on inanimate surfaces

high level disinfection

kills all mo's except spores and prions

intermediate level disinfection

kills most mo's including bacteria, most viruses, and fungi, M.Tuberculosis and Hep B

ineffective against spores (Cdiff)

low level disinfection

kills some fungi and viruses, and most bacteria, notffective against spores and M.tuberculosis

if a wrapper is being used to establish a sterile field, how many inches below the four sides of a table or basin must it be?

6 inches

gravity displacement sterilizer

relies on gravity to passively remove air

takes longer

dynamic air removal steam sterilizer

vacuum pump to remove air which reduces cycle time

Gravity displacement steam sterilizer cycle times

Instrument set wrapped 250F 30 min 270F 15min drying time 15-30min

instrument set unwrapped no lumen 270F 3 min

instrument set unwrapped some lumen 270F 10 min

dynamic air removal steam sterilizer cycle times

instrument set wrapped 270F 4 min drying time 20-30

instrument set unwrapped no lumen 270F 3 min

instrument set unwrapped some lumen 270F 4 min

chemical indicator

validates contents have been exposed to sterilizing conditions

NOT that they are sterile

BI for steam sterilization

Geobacillus stearothermophilus

Why? Determined to be highly resistant to being killed by steam sterilization but is harmless to humans

most difficult place for sterilant to reach

bottom front

Ethylene oxide

gas used to sterilize heat sensitive instruments

can take up to 16 hours because it has b=to be aerated

hydrogen peroxide gas plasma

gas used to sterilize heat sensitive instruments

faster cycle time than EO and safer to use than EO

liquid chemical sterilization

peracetic acid and cider

often used for endoscopes

items cannot be stored- used immediately

supine

head an neck

anterior upper extremity

chest/breast

abdomen

pelvis

anterior lower extremity

in supine, the draw sheet should be over the arms extending how many inches above the elbows?

2 inches

Trendelenburg position

head down, used to displace abdominopelvic organs

pelvis

lower abdomen

reverse trendelenburg

head up, displace abdominal organs

upper abdomen

head and neck

fowlers and sitting position

breast

head and neck

shoulder

lithotomy

vagina

urethra

perineum

anus and rectum

prone

posterior cranium

dorsal body surface

spine

posterior lower extremity

-pressure on abdominal contents

-pressure on vena cava and abdominal aorta

kraske (jackknife)

anus

pilonidal area

lateral position

right lateral- right sided down, exposing left

left lateral- left side down, exposing right

retroperitoneal space

hip

hemithorax

bottom leg is flexed, top leg is straight

once a patient is moved to the OR table what is the first thing you do?

fasten the safety strap

curved instruments should be placed in the hand

with the point curving in the same direction as the surgeons fingers

surgeon is standing on the same side as you to your left, she is right handed, which hand do you pass with?

your right hand

what is the first action you take if a closing count is incorrect

notify the surgeon

counting sequence

1. field

2.mayo

3.back table

4.off field

catheter

hands below the level of the bladder and is filled with sterile water

minimum of how many suction unites required in OR

2

pressure for lower extremity

100-150mm Hg

pressure for higher extremity

30-70mm Hg

upper extremity time limit

60 min

lower extremity time limit

120 min

after recommended time deflate tourniquet for how long

10-15 minutes

non woven drapes

disposable

woven drapes

reusable

aperture drapes

clear plastic drapes with opening that are surrounded by an adhesive backing

incise drapes

applied to patients skin after squaring off incision site

fenestrated drapes

have openings for exposure of the area to be incised

tonsil sponges

5 per cardboard package

used for blunt dissection

always loaded onto a clamp

kittner sponges

blunt dissection of tissues

always loaded onto a clamp

5 per pack

neurosurgical sponges

protect neural tissue and assist with hemostasis

moistened with saline

10 per pack

homograft

come from another person or cadaver

xenografts and hetergrafts

tissue is transplanted from one species to another

self retaining catheter

foley

used to measure urinary output or provide bladder decompression

endotracheal tube

passed through the nose or mouth between the vocal v=cords and into the trachea

oral airway

inserted through the mouth to separate the jaws and depress the tongue

nasal airway

inserted through the nose to prevent obstruction of the airway due to relaxation of the soft palate

tracheotomy tube

1.outer cannula

2.inner cannula

3.obturator

passive drains

Penrose drain, cigarette drain, t tube, gastrostomy tube, custom tube, nephroostomy tube

active drains

hemovac, Jackson pratt, stryker

needle used for an ambule

filter

pharmacokinetics

the metabolic processing of a drug within the body

-absorption

-distribution

-biotransformation

-excretion

pharmacodynamics

the study or the interaction of drug molecules with the target cells of living tissue

enteral

through the gastrointestinal tract

parental

by injection

topical

applied to the skin or mucous membrane

side effect

an expected, undesirable, but tolerable effect

adverse effect

an undesirable and potentially harmful effect that can lead to organ damage or failure