Surgical Nursing Skills Exam 1

leading questions

What kind of questions should you not ask when taking a history

temperament, attitude, BCS, possible anxiety

What things should you make note of during taking a physical

age, sex, repro status, breed

What should signalment always include

previous conditions

During a follow up history, what will be in the chart that you should ask about

consent form

Identifies the patient and the specific procedure that is to be performed, potential risks, vets name, estimate, signature of owner of patient, owner contact info

can not legally be in the hospital or receive treatment

What can not happen without a signed consent form

above the age of 18

how old do you need to be to sign a consent form

the owner of the animal

Who must the consent form be signed by

OR environment, operating team, surgical instruments, supplies, patient's endogenous flora

What are some sources of surgical infection to remember

the patient's endogenous flora

What is the most common source of surgical contamination

before surgery

Eating, Showering, Making fingernails short and clean, not putting on overpowering fragrances, put on clean scrubs, turn lights on, turn on heating devices, unwrap sterile instruments: should all be done ___

clean scrubs, surgical cap, surgical mask, shoe covers, no cellphone

Surgical Attire:

after the animal has been clipped, prepped, moved to surgery room, and is positioned

When should your scrub start

decrease the microbial load on hands during the surgical procedure

What is the Surgical Hand Scrub designed to do

open, closed, assisted

What are the 3 methods of gloving

surgical gloving

Open gloving should net be used routinely for

when the hands need to be sterile

When is open gloving most commonly used

minor procedures, bone marrow biopsy, catheterizations

When is open gloving used

closed gloving

preferred method of gloving for surgical procedures that provides assurance against contamination because bare skin is not exposed

assisted gloving

This method of gloving requires 2 people

a glove is contaminated during surgery

When do you use assisted gloving

maintaining a sterile environment, monitoring a patient, managing instrument table, passing proper instruments, maintaining tissues, maintain hemostasis

Responsibilities of a tech during surgery

continual monitoring of sterile field, handling sterile instruments, passing sterile instruments, sterile light covers

How does a tech maintain a sterile environment

loading needles properly, instrument count, sponge

How does a tech manage an instrument table

orderly arrangement, ring handles closest to surgeon, knowing what surgeon needs beforehand, knowing what each instrument does, proper passing of instruments

What is part of a tech handling instruments properly

needle holders to place on handle, never point toward any one when removing, cutting edge away from surgeon when passing, handed in a way that is ready to use

What are proper handling tips for a scalpel blade

place rings in palm of hand and ready to use, place very firmly

What are proper handling tips for ring instruments

laparotomy sponges, 4x4s, cautery, suction

How does a tech maintain hemostasis

6 mls of blood

How much blood does a 3x3 hold

10 mls of blood

how much blood does a 4x4 hold

100 mls of blood

how much blood does a laparotomy sponge hold

when counting the sponges and knowing how much blood each sponge holds, you will be able to effectively estimate how much blood the patient lost

why is a sponge count and knowing how much blood a sponge will hold important to know

alcohol

Never use ___ when doing cautery

monopolar cautery

need a grounding plate because the current passes through the patient toward the ground plate

bipolar cautery

No grounding plate is needed because the current passes from one tip to another

yankauer

poole

frasier

minimal reactivity with tissue, inhibits bacterial growth, holds securely, resists shrinking, absorbed with minimal reaction, non-capillary, non-allergenic, non-carcinogenic, non-ferromagnetic, inexpensive

Ideal suture properties

12-0

What is the smallest suture size

7

What is the largest suture size

memory

Flexibility often refers to ___

memory

inherent capability of suture to return to, or maintain, its original gross shape

torsional stiffness, diameter

____ and ___ also play a part in flexibility of the material

steel

Least flexible suture material

silk

most flexible suture material

tissue drag

When considering surface characteristics and coating, it is important to decrease ___

drag

the amount of friction created as suture is pulled through the tissue

more micro-trauma to the tissue

Greater drag creates ____

braided suture

____ drags more in general than monofilament

Capillarity

braided suture often is coated to reduce ____ but it also promotes a smoother surface

capillarity

The degree to which absorbed fluid is transferred along a suture. It is the process by which fluid (and potentially bacteria) are carried into the interstices of multifilament fibers

braided sutures, monofilament

____ have a degree of capillarity, whereas ___ are considered non-capillary

water soluble, insoluble

Coatings may be ____ or ____

triclosan, vicryl plus, PDS plus

Name some antibacterial coatings

a zone of inhibition around the suture

What does antibacterial coating create

tensile strength

a measurement of the ability of a material (or tissue) to resist deformation and breakage

over time as suture is absorbed, stretches, has constant load applied to it

When does tensile strength diminish

from the suture to the tissue

As tissue heals, its tensile strength returns and the load is transferred

relative knot security

holding capacity of a suture

braided material

What suture material generally has better knot security

instruments

Suture tensile strength is micro-damaged by ____ causing the suture to weaken. NEVER grasp suture with ____

elasticity

the degree to which suture will deform under stress or load and return to its original form when the load is removed

plasticity

the degree to which suture will deform without breaking and will maintain its shape after removal of the deforming force

pliability

the ease of handling and the ability of the suture to change shape

creep

tendency of a suture to slowly and permanently deform under constant stress

taperpoint

used for very soft tissue and does not cause much damage

tapercut

has to cut its own way through the skin

swage

Where the suture is attached to the needle

regular cutting

absorbable suture

a suture that loses most of its tensile strength within 60-90 days in living mammalian tissue

inflammatory reaction in tissue

Both absorbable and non-absorbable sutures promote ___

silk, catgut

What are the natural fiber sutures

cardiac surgery

Silk sutures are most commonly used on ___ surgeries

catgut

type of suture that is manufactured from the small intestine submucosa of sheep

chromic catgut

What is the recommended catgut because it decreases the inflammatory response

dexon, vicryl, monocryl, PDS, maxon

Name some absorbable sutures

nylon, prolene, stainless steel

Name some non-absorbable sutures

hydrolysis

Most sutures degrade by

cleavage of chemical bonds by the addition of water

What is hydrolysis

proteolysis

Catgut degrades by

breakdown of proteins into peptides and amino acids

what is proteolysis

absorbable

What kind of suture should you use for buried sutures

non-absorbable

What kind of sutures should you use to repair skin trauma

smallest

You should use the ____ suture necessary to do the job

knot failure

Suture failure is usually due to

gain in tissue strength

Tensile strength reduction corresponds to ___

tissue holding the suture, not the suture holding the tissue

What does strength come from

augment surgical repair of slow healing tissue

What are surgical meshes used to do

ingrowth of capillaries and fibroblasts

Small pore size of surgical mesh inhibits ___

it encounters anion in the moisture around a wound edge

Liquid monomer form of tissue adhesive polymerizes when

it will create a foreign body reaction and inflammation results secondary

Why should you not drop glue into the tissue incision

pinch skin edges together and apply to the surface on top of the skin

What is the correct way to apply tissue adhesive

simple interrupted pattern, simple continuous pattern, cruciate pattern, horizontal mattress pattern, buried interrupted and continuous patterns

Basic suture patterns:

simple interrupted pattern

easiest pattern to learn, appositional, provides secure closure, avoid excessive tension on tissue

simple continuous pattern

appositional, tied off only at ends, saves time and suture material, not generally used for skin, avoid over-tightening, provides secure closure

cruciate pattern

appositional, too much tension will cause tissue to invert, faster than simple interrupted, gives a strong closure

horizontal mattress pattern

tension relieving pattern, distributes forces away from the incision, too much tension will cause tissue to evert and damage blood supply to incision

buried patterns

absorbable suture material, appositional, closes dead space, skin sutures support this layer of closure, knot is always at deepest layer

knots

various knot conformations depends on tissue and suture material