PRLS Lab Final

rescrub the area with 10 strokes

If any part of the scrubbed hands or arms touches the sink or faucet during scrubbing, the person should:

only when the hand has never passed through the gown cuff

The closed glove technique is used:

-The front from 2 inches below the neck to the waist or table level

-the sleeves from two inches above the elbow to the cuff

-the surgical gloves

The sterile areas of the gown include:

false

T/F the use of an antimicrobial soap with brush is the only option for surgical hand scrubbing

Assist in gloving by stretching the cuff of the glove

During gowning the circulating nurse (non-sterile assistant) assists the scrub person by doing all of the following except:

A. Assist in gloving by stretching the cuff of the glove

B. Pulling the gown shoulders up and securing the back of the gown

C. Securing the waste ties by touching the inner part of the gown only

D. Help to completely unfold the gown for donning by pulling the inside bottom edge of the gown

open glove technique

In the event that the gloved hands need to be changed mid-procedure (keep in mind the hands have already passed though the cuffs), which technique must be used?

true

T/F Both the anatomical timed scrub and counted stroke scrub are accepted methods of the surgical hand scrub.

A. Once the drape is placed on a clean dry surface the outer 1-inch perimeter is no longer considered sterile

Once a sterile field is prepared it is important to know what areas of the bottom drape are considered sterile. Which of the following statements is true regarding your sterile field?

A. Once the drape is placed on a clean dry surface the outer 1-inch perimeter is no longer considered sterile

B. The entire drape is considered sterile as long as the surface that it is placed on is clean and dry

C. Once the drape is placed on any surface it is now considered "clean" and no longer considers "sterile"

D. Even a wet drape can be considered sterile as long as the causative liquid is also sterile (ex: sterile saline)

assisted gloving

When a team member other than the scrub nurse contaminates a glove during the surgical procedure, the scrub nurse will reglove the team member using which method?

two inches above the elbow

When scrubbing for surgery with an antimicrobial agent how far up the arm do you scrub?

suppress the growth of microorganisms

The purpose of the surgical hand scrub is to:

open the first flap away from the body

Which of the following is the FIRST STEP in opening a sterile linen wrapped package?

the inside front of the gown just below the neckband

Where would the scrubbed person hold onto his or her gown when lifting it up to don it?

a circular motion

what motion is used to scrub the palm and back of the hand to the wrist?

live in the hair follicles and sweat glands

resident microorganisms:

false

T/F it is permissible to scrub without removing rings

A. A sterile object remains sterile only if the objects that touch it are also sterile

Which of the following is true regarding maintaining a sterile field?

A. A sterile object remains sterile only if the objects that touch it are also sterile

B. Gloved hands can drop below the work surface and remain sterile

C. If a sterile field is breached the procedure must be stopped in order to fill out an incident report

D. A sterile object is contaminated after 5 full seconds of contact with a non-sterile object

Unacceptable because they may harbor microorganisms

Wearing artifical or acrylic nails in the surgical setting is:

glove to glove and then skin to skin

When taking off the gown at the end of the case, the gloved cuffs typically turn down as the sleeves pass over the arms. The wearer removes the gloves using which technique?

true

All of the following should be worn as protective gear in the OR: headgear that covers all the hair, protective eyewear, a face mask, protective shoes or shoe covers.

secured at the waist, tucked into the pants, or fit close to the body

how should the top of the scrub suit in a two piece be worn?

three to five minutes

how long should you scrub for

step back

what do you do after lifting the gown

yes

if the nurse uses a sterile instrument to tie the waist tie, should it be counted?

yes (minimizes risk of blood exposure)

should sterile team members double glove in all invasive procedures?

polyvinyl chloride or vinyl

what type of gloves should not be used during invasive procedures?

when initally donning sterile gown and gloves

when is the closed glove technique used?

when changing gloves

when is the closed glove technique not used?

Mexican American, non-hispanic black, and lower socioeconomic status.

early childhood caries is most prevalent in which groups?

Upper incisors affected first, then first molars, then second molars (mandibular incisors generally not affected)

in what order are teeth affected by ECC?

bacteria, teeth, and sugars

-Bacteria metabolize dietary sugars into acids

-Acids demineralize tooth enamel

what is the triad for the etiology of ECC? what does this mean?

less frequent consumption of sugars

what can allow for more time for teeth to fully remineralize?

§ Pain

§ Impaired chewing and nutrition

§ Infection

§ Increased caries in permanent dentition

§ School/work absences/more likely to have poor school performance

§ Difficulty sleeping

§ Poor self esteem

§ Extensive/expensive dental work

what are some consequences of ECC?

Knee-to-knee

what method should you use for performing an oral examination on an infant or toddler?

White lines and white spots are the first signs of caries, then progress to larger brown cavities

what are early signs of caries on oral examination?

start at 6 months, do at every WCC

when should caries risk assessment tools be used?

twice a year for all children and 4 times a year for those at high risk

AAP recommends fluoride varnish how often?

AAP

what is the most widely used and easy to implement risk assessment tool for ECC?

the child is at an absolute high risk for caries

with the risk assessment tools, questions marked with yellow triangle mean what?

Caregiver with active tooth decay

Caregiver does not have a dentist

what are examples of items on the risk assessment tool that indicate an absolute high risk for caries?

having a dental home, tooth brushing, fluoride use

protective factors for dental caries

Plaque, gingivitis, brown or white spot lesions, evidence of treated decay

what are clinical findings that would place a child at an increased caries risk?

Inhibits demineralization and promotes remineralization, inhibits bacterial metabolism, reduces enamel solubility

effects of fluoride

toothpastes, gels, foams, mouthwashes, fluoride varnish

topical sources of fluoride

water fluoridation, dietary fluoride supplements

systemic sources of fluoride

starting at tooth emergence

when is fluoridated toothpaste indicated?

every 3-6 months starting at tooth emergence through age 5

when is fluoride varnish indicated?

if high risk and over age 6, if child can swish/spit

when is fluoridated mouth rinse indicated?

recommended for everyone

when is water fluoridation indicated?

if drinking supply is not fluoridated

when is dietary fluoride supplementation indicated?

§ Blot teeth dry with gauze

§ Apply varnish to dried teeth starting posterior, thin layer to all tooth surfaces

§ Apply to anterior teeth last (may need to modify if child is uncooperative since this is the highest risk teeth)

§ Saliva contamination is okay

procedure for fluoride varnish application

§ Teeth may be discolored for 24-48 hours. Avoid hot, sticky, and hard foods the rest of the day

post-procedure instructions after fluoride varnish

-Educate all staff on caries risk assessment and the importance of fluoride varnish

-Train clinicians on application procedures

-Identify a varnish champion who answers questions, understands billing issues, assigns tasks, orders the varnish, and maintains supplies.

-Divide tasks among staff to avoid time burdens for one person.

-Store supplies in exam rooms or in a portable kit.

-CPT code effective January 2015 for fluoride varnish application is 99188. It is suggested to append a Z modifier for preventive services (e.g. Prophylactic fluoride administration Z29.3).

-Update billing forms with varnish code(s).

-Have copies of educational handouts preprinted to give to parents.

what are some strategies for a successful office-based fluoride varnish program?

strongly promote breastfeeding, infants should be held while feeding, avoid propping bottle, fill bottle with only breast milk or formula

what are some dietary strategies for infants to educate families on?

establish regular meal times, limit snacks to once in morning once in afternoon, only give milk or water between meals, restrict fruit juice to 4 oz per day at regular meal times, avoid snacks with added sugar, prepare healthy snacks like cheese, fruit/veg

what are some dietary strategies for older children to educate families on?

Twice a day as soon as teeth emerge, bedtime is most critical d/t decreased saliva

Caregiver brushes child's teeth until age 8 or 9

· Small smear (grain of rice) if under 3, pea sized if 3 and over

· Stand or sit behind child, lift lip, brush along gumline, spit out after brushing

toothbrushing guidance to educate families on

Dietary changes

toothbrushing

Dietary fluoride supplementation if water source deficient

Establish a dental home

general ways to prevent caries to educate families on

Microbial imbalance in the mouth creates acid that damages the tooth enamel

The mother of a 9-month old patient asks what causes early childhood caries (ECC). Which of the following is the most accurate reply?

The majority of ECC results from thin or "weak" tooth enamel inherited from the parents

Microbial imbalance in the mouth creates acid that damages the tooth enamel

A lack of protective saliva is the most common cause of ECC

A calcium deficiency during tooth formation produces teeth that lack a sufficiently thick covering of enamel

Having existing white spots or calcifications

Which of the following factors places a child at the most risk for developing early childhood caries?

Having a diagnosis of asthma.

Living with family members who smoke tobacco

Breast feeding for less than than six months

Having existing white spots or calcifications

Both B and C are true

Which of the following is the major mechanism of action of topical fluoride in caries prevention?

It promotes saliva release which neutralizes acids on the tooth surface

It promotes remineralization of the teeth

It inhibits demineralization of the teeth

Both B and C are true

Fluoride varnish can reverse early decay and slow enamel destruction

Which of the following is a benefit of fluoride varnish?

Fluoride varnish permanently seals the pits and fissures of teeth

Fluoride varnish decreases the need for routine dental care

Fluoride varnish can reverse early decay and slow enamel destruction

Fluoride varnish replaces the need to take systemic fluoride supplements

Recommend to use only a small smear of fluoridated toothpaste when brushing the child's teeth

What guidance would you provide the mother of your 20-month-old patient who expresses concern about her child developing fluorosis? The family lives in a town that adds fluoride to the water supply and the child has already had two cavities.

Recommend to use only a small smear of fluoridated toothpaste when brushing the child's teeth

Recommend to use a non-fluoridated toothpaste

Recommend to brush the child's teeth every other day

Recommend to only give bottled drinking water to the child

All children under age 6

According to the U.S. Preventive Services Taskforce (USPSTF) recommendations, which children should receive fluoride varnish in the medical office?

All children at high risk for caries

High risk children without a dental home

Children at low risk for caries

All children under age 6

The gauze is used to dry the child's teeth

When applying fluoride varnish to an infant, what is the most important function of the gauze?

The gauze is the vehicle used to apply the fluoride varnish to the teeth

The gauze is used to hold the tongue out of the way

The gauze is used to dry the child's teeth

The gauze is shown to the child to stimulate her to open her mouth

Avoid giving the child hot, sticky, or hard foods for at least 6 hours

What guidance do you give the grandmother of a child who has just had fluoride varnish applied to his teeth?

The child's teeth will be discolored for about a week

Do not brush the child's teeth for at least 48 hours

Brush the child's teeth in about 1 hour

Avoid giving the child hot, sticky, or hard foods for at least 6 hours

-Collect uncontaminated/sterile urine specimen

-Obtain a post void residual

-Accurate urine output monitoring in surgical patients and critically ill patients- "Is and Os"

diagnostic indications for urinary catheterization

Facilitating urinary drainage- Acute urinary retention, Chronic obstruction causing +/- hydronephrosis, Intermittent bladder decompression for neurogenic bladder

Continuous bladder irrigation after bladder or prostate surgery-to prevent clotting in the bladder

Deliver topical medications to bladder mucosa

Chronically bed-ridden or incapacitated patients

therapeutic indications for urinary catheterization

Appearance of blood at urethral meatus s/p pelvic trauma- Partial/total transection of the urethra

Allergy to, Latex*, Rubber, Tape*, Lubricants

Inability to pass catheter or inflate balloon

C/I to urinary catheterization

Urinary tract infection (#1!!!)

Urinary structural trauma:

-Creation of false passage (dead-end)

-Patient induced trauma-pulling or tripping on tubing

Urethritis- Inflammation secondary to the procedure

Urethral stricture

Catheter “U-turn” or “double-back” if there is obstruction or bladder neck spasm

potential complications to urinary catheterization

dorsal lithotomy

female position for urinary cath

supine with legs flat

male position for urinary cath

Drainage bag will be either pre-attached or attachment tubing will be included

Syringe to inflate balloon

what additional equipment is needed for foley cath

straight (robison) catheter

"In-and-out"-designed for one-time use

Obtain a specimen or episodic relief or chronic obstruction (intermittent catheterization)

coude

Bent at the distal tip, allows for catheter to follow the anterior surface of the male urethra and avoid false posterior passages

foley

Long term catheterization, balloon-secured

Balloon is inflated with sterile water (5cc typically)

Use of saline discouraged due to possible crystallization and subsequent balloon malfunction

3

1 mm is how many french units

16-18 F (14 is more comfortable for females)

what size catheter is used for adults

18 F Coudé

what size/type of catheter is used for prostate obstruction in male

5-12 F

catheter size for kids

5 F feeding tube used

what is used for catheterization in infants <6 months

Larger 20-30 F

what catheter is used in patients bleeding from kidneys or bladder

urinary tract infection (UTI)

What is the most common complication of urethral catheterization?

A. Retained catheter

B. Urinary Tract Infection (UTI)

C. Urinary calculi

D. Catheter "double back"

Foley catheter

Which type of catheter is designed to remain in place in the bladder for continuous drainage?

Robinson catheter

Coude catheter

Foley catheter

Straight catheter

Urinary tract infection

Which of the following is NOT an idication for urethral catheterization?

Urinary retention

Urinary tract infection

Bedridden or incapacitated patients

delivery of topical chemotherapy to the bladder mucosa

Blood at the urethral meatus

Which of the following is a contraindication to placement of a urinary catheter?

Blood at the urethral meatus

Prostate Cancer

Bladder calculi

Pregnancy

Mechanism of injury

Site of injury

Time and place of injury

Contamination status/foreign body

Allergies, current medications, tetanus status, implants

Risk factors for healing

components of history during a wound assessment

What does it look like?

Measurements: length, width, depth

Are deep structures involved? (Neurovascular compromise, tendon or muscle involvement)

What does the wound bed look like? (Necrotic, granular, associated exudate)

Is there evidence of contamination or foreign body?

What does the surrounding skin look like?

what should you be looking for on exam of the wound?

Distal pulses

Sensation: two-point discrimination

Pain rating

components of neurovascular testing during wound assessment

Observe wound while testing muscle and tendon function

component of MSK testing during wound assessment

clean

surgical incision not involving GI, respiratory, or GU tracts

clean-contaminated

surgical incision involving GI, respiratory, or GU tracts

contaminated

surgical incision involving gross spillage; fresh, accidental wounds

infected

Established infection before wound is made or heavily contaminated wounds

Does the wound need to be closed?

Can the wound be closed in the office, ER, OR?

Is there a contraindication to closing the wound, or a reason to delay closure?

considerations for wound intervention

Decrease time required to heal

Reduce likelihood of infection

Decrease amount of scar tissue

Repair loss of form and function

Improve cosmetic appearance

indications for wound intervention

Location of wound (delayed closure)

Presence of foreign body

Extensive wounds (nerve, tendon, muscle involvement)

Bleeding disorder

Contaminated

Avulsion injury

(relative) contraindications to wound intervention

Infection

Scarring

Loss of form and function

Loss of cosmetically desired appearance

wound dehiscence

Tetanus

complications to wound intervention

primary intention

all layers are closed

best chance for minimal scarring

clean and clean-contaminated wounds

secondary intention

deep layers are closed, superficial layers are left open to granulate

Prolonged process often leaving wide scar are requiring frequent care

utilized when there is infection or extensive tissue loss

third intention (delayed primary)

deep layers closed primarily, superficial layers left open until reassessed

On reassessment: irrigated and closed if clean appearing with granulation tissue; left open if it appears infected

These wounds often arise from contaminated wounds