Module 5: General Patient Care Part 2

Surgical asepsis

sterile technique, when sterility of supplies and environment is required

surgical handwashing (scrub), sterile gloves, etc…

Mayo stand

movable stainless steel tray on stand which should be disinfected and allowed to dry

where sterile field is set up on

Opening sterile packet

first flap farthest away, then the sides, then flap closest without reaching over

Sterile field donts

dont reach over a sterile field

don’t leave a sterile field unattended

don’t turn away from a sterile field

What if sterile field instruments have to be rearranged?

use sterile forceps

What if a sterile item must be opened?

Then someone wearing sterile gloves must open it

What if healthcare provider wants an additional instrument while performing procedure?

open a sterile packet and drop the instrument carefully onto the sterile field

Minor surgeries that can be performed in office

biopsy, removal of foreign bodies, endoscopy, colonoscopy, cryosurgery, incision and drainage

Biopsy

The surgical removal of tissue for later microscopic examination

diagnose cancer, skin conditions, or other dieseases

can be done in office

Removal of a foreign object

Surgical removal of an object (small splinter) or larger objects (wood or metal)

splinter forceps are used

purpose is to relieve pain and prevent infection

can be done in office

Removal of a small growth (cyst, mole, wart)

surgical removal of a small growth to conduct further examination or prevent future growth

can be done in office

Endoscopy

endoscope to view a hollow organ or body cavity

evaluate a patient having - stomach pain, difficulty swallowing, GI bleeding, diarrhea, constipation, colon polyps

can be done in office

colposcopy

examination of cervix and vagina using colposcope and specialized type of endoscope

patient in lithotomy position

Examine abnormal tissue when Pap smear is abnormal

can be done in office

Cryosurgery

local application of intense cold liquid to destroy unwanted tissue

destroy abnormal cells (with liquid nitrogen) and cryoprobe

can be done in office

Incision and drainage

lancing a pressure buildup caused by pus or other fluid

can be done in office

suturing

use of a device to close/sew together tissue after injury or surgery

use of specialized thread (sutures)

Absorbable sutures

don’t need to be removed and are digested by tissue enzymes and absorbed by body tissues

usually for tissues beneath the skin

How fast does absorption occur for absorbable sutures?

5-20 days after insertion

Size of suture material

measured by gauge (diameter) in terms of 0s → the more 0s the smaller the gauge

0 is thicker than 6-0 (000000)

Most used suture size

2-0 through 6-0

Suture size for delicate tissue

5-0 to 6-0

smaller to prevent scarring

Heavier sutures size

2-0

chest or abdomen to remain stronger and not break

Staples

used to close wounds, made of stainless steel and applied with surgical stapler

Shorten closure time and used to rapidly close incision (decrease risk of infection)

Dont’s for staples

not used for delicate tissues

not used for wounds in finely contored areas

not in highly mobile areas

not for bony prominences

Use for staples

trunk, extremities, and scalp

For high tension wounds

Removal of suture

Use disposable suture removal kit

Includes suture scissors, forceps along with sterile gauze, forceps, sterile gloves, antiseptic

create sterile field, thoroughly cleanse skin with antiseptic and allow dry

cut suture with scissors below knot (as close to skin as possible), remove every other suture and then go back and remove remaining suture, pull out remaining suture out (never through skin)

Staples

Staple removal kit

begin with second staple and place lower tip of sterile staple remover under staple

advance lower jaw under staple and squeeze handle together until they are completely closed

this will bend staple in middle and pull the edges out of the skin

Don’t lift the staple remover during this

remove every other staple then go back.

What if there is gaping, bleeding, or exudate (fluid)

stop removal and notify provider

After removal

clean wound with antiseptic and allow to dry then dress the wound as ordered

count the number of staples or sutures that were removed *number must be documented in health record)

dispose in biohazard waste container, and staples in sharps waste container.

Butterfly closures

provide reinforcement of wound after removal of sutures or staples (depending on condition)

What to do with wounds that have crusting blood or exudate

soak in saline prior to removal of suture or staples

if any problems have health care provider inspect before starting procedure

golden hour

first hour after the time of injury/appearance of symptoms

most critical and correlates with possibility of recover

however there is no evidence of survival rates declining after 60 minutes

life threatening situations

cardiac arrest (heart attack), respiratory arrest, uncontrolled bleeding, head injury, poisoning, open chest/abdominal wound, shock, 3rd-4rth degree burns

MA’s first step in emergency

what is patient’s name, contact information, and location

what situation is and when did it start

what is status of patient (conscious, breathing, pulse)

remain on phone until EMS arrives

spinal injury

instruct to not move the patient

penetration wound

don’t remove the object

bleeding

apply pressure and elevate body part

Sever hypoglycemia

low blood glucose levels (insulin reaction/insulin shock) occurs when imbalance between insulin levels and blood glucose

Mild case: irritability moodiness, hunger, sweating, rapid heart rate

Severe: fainting, seizures, confusion, headache, coma, death

treatment: consuming foods high in glucose, or hypoglycemia medication is administered

Hypovolemic shock

when patient loses excessive amount of body fluids/blood caused by hemorrhaging, prolonged vomiting, diarrhea, severe dehydration

Symptoms: thirst, muscle cramping, lightheadedness, chest pain, confusion, lethargy, death

control blood loss, blood transfusion, IV fluid replacement

Heat exhaustion or heat stroke

when body temps varies too much over normal range

symptoms: muscle cramping (electrolyte imbalance caused by loss of sodium), pale and clammy skin

treatment: remove from warm temperatures, apply cold compress

Hypothermia (frostbite)

exposure to cold temperatures, frostbite is when skin//tissue is exposed to freezing temps and cannot get oxygen due to freezing (tissue death)

most susceptible tissues: nose, ears, fingers, toes

Symptoms: redness, tingling, pale, numb, shivering, numbness, confusion, paleness, loss of consciousness

remove any wet clothing, cover with blanket, provide warm/dry compress and any warm beverages

Obstructed airway/choking

food aspiration while eating (when food enters trachea) or children putting small objects that obstruct airway

Symptoms: patients will place hand on throat (conscious choking)

chest thrusts and back slaps for children younger than 1 year and abdominal thrusts for adults

Syncope (fainting)

brief episode of unconsciousness

Symptoms: pale, perspiring, complain of nausea or dizziness

Treatment: aromatic sprits of ammonia capsules (not directly under patients nose but 6 inches away waving back and forth)

Sprains

stretched or torn ligament

causes: falling, twisting, landing in uneven surface

symptoms: pain, swelling, bruising, unable to move joint, may feel pop or tear

treatment: resting, elevating, cold compress, bandage or brace, anti-inflammatory medications

Strain

stretched or torn muscle/tendon

symptoms: pain, muscle spasms, swelling, trouble moving muscle

treatment: resting, elevating, cold compress, bandage or brace, anti-inflammatory medications

Dislocations

when bone end slips out of socket or when capsule surrounding joint is torn/stretched

Most common: shoulder

others: ankles, knees, hips, elbows, jaw, finger

joints are swollen, painful, visibly out of place, patient may not be able to move it

Shock

response of cardiovascular system during adrenaline to constrict capillaries

inadequate circulation of blood to tissues, lowered blood pressure, decreased kidney function

results from trauma, electrical injury, insulin shock, hemorrhage, reaction to drug

anaphylactic shock

response to allergen, emergency medical care is critical (911 contacted), lay patient down and elevate legs.

symptoms: pale and clammy skin ,weakness, restlessness, pulse/respiratory rate are rapid, vomiting

late signs: apathy, unresponsiveness, dilated pupils, mottled skin, loss of consciousness

Seizure

uncontrolled muscle activity

high body temp, head injury, drugs, epilepsy

prevent injury to patient: help them to floor don’t restrain them, move objects out of the way, turn to side to prevent aspiration or choking

after they might have headache, confused, or be tired - let them rest

Poisoning

ingested, inhaled, absorbed, injected, radiation

symptoms: discoloration or burns on lips, unusual odor, vomiting, suspicious container

call 911 if: patient is unconscious, having difficulty breathing, can’t breathe, having seizures

Abrasion

outer layers of skin are rubbed away because of scraping

will heal without scaring

Incision

smooth cut resulting from surgical scalpel or sharp material (razor or glass)

excessive bleeding and scarring if deep

Laceration

edges are torn in irregular shape, profuse bleeding and scarring

puncture

made by sharp pointed instrument (bullet, needle, nail, splinter), external bleeding is minimal but infection can occur

Arterial bleeding

most severe and urgent type of bleeding

penetrating injury, blunt trauma, damage to organs/blood vessels

high pressure, bleeding is bright read in spurts (if large artery (aorta) for several minutes then it is life threatening)

put pressure with sterile gauze, elevate site of bleeding (tourniquet above site)

venous bleeding

steady flow of dark red blood

covered with clean cloth/gauze with pressure

elevated site should clot within minutes

inflammatory phase

wound healing phase 1,

3-4 days

pain, swelling, and loss of function at site of wound

blood clot forms to stop bleding and plug opening of wound

proliferating phase

4-21 days

fibrin threads extend across wound and pull edges together, cells multiply to repair wound, and scab begins to form to keep out microorganisms

Maturation phase

21 days to 2 years

tissue cells strengthen and tighten wound closure forming scar, scar eventually fades and thins

wound complications

infection (inflammation, swelling, puslike drainage, fever)

hemorrhage or bleeding

Dehiscence (separation of wound edges)

Evisceration (separation of wound edges and protrusion of abdominal organs)

10% rule

burns that cover more than 10% of body’s surface require hospitalization

first degree

superficial burn that only affects outer layer of skin tissue

skin becomes red and discolored with some slight swelling

rapid healing

Second degree

breaks the surface of skin and injures underlying tissues

severe sunburn or exposure to hot liquids or heat

blisters and skin is red or mottled in appearance

skin can become wet when plasma is lost

Third degree burn

deep enough to damage nerves and bones

tissue is charred and white, may cause less pain because nerves are damaged

exposure to fire, hot water, hot objects, electricity

Fourth degree burn

though both layers of skin, underlying tissue and deeper tissue, possibly involving muscle and bone

no feeling in area because nerve endings are destroyed

caused by flames or chemicals

myocardial infarction

heart attack, when flow of blood that brings oxygen to heart is blocked, and heart doesn’t get enough oxygen

symptoms: chest pain, heaviness, discomfort in center/left side of chest, pain or discomfort in one or both arms, back, shoulders, neck, or jaw, shortness of breath, excessive sweating, unusually tired, nausea/vomiting, light headedness/dizziness, rapid/irregular heartbeat

Use AED, and if not available do CPR when…

no pulse for more than 10 seconds

Durable medical euiptment (DME)

medical devices that can be used repeatedly

might be written as DMEPOS (to include prosthetics, orthotics, and supplies)

• must serve medical purpose

• be prescribed by providor

• use repeatedly

• life expectancy of three years

• used in home

  • only useful to patients with the injury or disability

Not DMEPOS

determined by medicare, medicaid, and insurance companies

compression leggings, incontinence pads, ramps in home aren’t DMEPOS

To be eligible for DMEPOS

health care provider must order item through prescription/medical order

must state that it is needed for the patient’s condition and is for home use

some need face-to-face encounter where visit is required 6 months before order