clinical final exam

approaches: open

approaches: open

cut through skin or membrane

approaches: percutaneous

entry by puncture or minor incision, using instruments

approaches: percutaneous endoscopic

entry by puncture or minor incision, using instruments to VISUALIZE site of procedure

approaches: natural/artifical opening

entry through natural or artifical opening (etc: mouth, vagina)

approaches: natural/artifical opening endoscopic

entry through natural or artifical opening to VISUALIZE site of procedure (etc: mouth, vagina)

approaches: natural/artifical opening with percutaneous endoscopic assistance

entry through natural or artifical opening by puncture/minor incision through skin/membrane

approaches: external

procedure performed directly on skin/membrane by application of external force

paracentesis

• medical procedure that involves the insertion of a needle or catheter through the abdominal wall to remove fluid from the abdominal cavity, typically performed to relieve abdominal swelling caused by conditions

• patient lies down and local anesthesia is used to numb the area where the needle or catheter will be inserted

dilation and curettage

• patient is given general anesthesia, placed in dorsal lithotomy position, prepped, and draped before inserting successive dilators until the cervix is suitable for the suction cannula, which is then inserted to perform suction curettage

• the removed tissue was sent for pathological testing to exclude endometrial cancer

robot-assisted surgery

• using robotic technology to perform surgery with precision and control

• the surgeon controls the robotic arms and instruments to perform the surgery while viewing the procedure on a computer screen

computer assisted surgery (CAS)

set of methods that use computer technology for pre surgical planning, or guiding and preforming surgical interventions

imaging guidance

uses scope to provide direct visualization of body parts

positions: supine

patient lies on back

positions: trendelenburg

position lies on their back on a downward angle, with their head lower than their feet

positions: prone

patent lies on stomach

positions: lateral

patient lies on side

positions: fowler

patient lies on back, as if they are sitting on a chair, with legs bent

positions: lithotomy

patient lies on back with their legs in the air, bent

instruments: rongeur

strongly constructed instrument with a sharp-edged, scoop-shaped tip, used for gouging out bone

instruments: retractor

used to separate the edges of a surgical incision or wound, or to hold back underlying organs

instruments: clamps

used to occlude (e.g. blood vessels)

instruments: stapler

used to place sutures to close skin wounds, connect or remove body parts such as, bowels or lungs

laparoscopic instruments: trocar

instrument with sharply pointed edge used to introduce ports into the abdomen

laparoscopic instruments: endo-catch bag

designed to isolate and contain specimens during laparoscopic surgery

electrosurgery instruments: probe

cut through tissue, destroy tissue, control bleeding

electrosurgery instruments: surgical blade (Bovie/ bovieknife)

allows surgeons to rapidly cauterize and clear operative fields

surgical homeostasis

control of blood loss during surgery

surgical wound closure: sutures

a sterile thread or strand that is stitched through the edges of the wound to hold them together and promote healing

surgical wound closure: staples

thin, stainless steel staples that are inserted into the skin and tissues using a stapler device.

surgical wound closure: adhesives

typically in the form of liquid or semi-liquid substances that are applied to the edges of the wound and form a strong bond as they dry

postoperative drains

placed so the wound can drain freely of blood clots, body fluids, pus, and necrotic material that otherwise would collect in the wound and provide a rich medium for bacterial growth

how drains are inserted

at the operative site and exit through the incision or a separate stab wound adjacent to the incision

how drains are chosen

according to the location of wound, size of wound, and type of drainage anticipated

drains: penrose drain

a thin, flexible tube made of latex or silicone that is used in medical procedures to remove fluid or blood from a surgical site

drains: jackson pratt drain

a soft, flexible tube connected to a bulb-shaped reservoir that creates a gentle suction to help remove fluids

drains: hemovac drain

a clear plastic container with a flexible tube attached to it, used to remove excess fluid, blood, or pus from a surgical site or wound

sanguineous

pertaining to blood, containing blood

serosanguineous

containing or consisting of both blood and serious fluid

serous

thin, clear and a little thicker than water, serous drainage occurs during the healing process of the wound

purulent

producing or containing pus, “milky” in appearance

resection

general term for removal of part, or all, of the body part

stoma/ostomies

an opening of some part of the bowel onto the skin, stool is collected in a bag

lab reports are grouped by…

headings

what lab results typically contain

test, result, range, unit of measure

abnormal results

lower/higher than reference range

critical values

dangerously abnormal

no flag

indicates that the lab result is normal

reference range

results typically seen in normal healthy reference populations

unit of measure

units of measurement that labs use to report results can vary from lab to lab

specimen source

identifies what body substance is being analyzed

lab panels/profiles

represent ordering a group of lab tests at once

basic metabolic panel

helps to identify several common acute conditions

lipid panel

measures different types of fats in your blood

blood gases

measure the levels of oxygen, carbon dioxide, and other gases in your blood to assess how well your lungs and kidneys are working

therapeutic drug monitoring

process of measuring the concentration of a medication in a patient's blood to ensure that it remains within a safe and effective range

pathology

medical specialty that deals with the study of diseases and their effects on the body

diagnosis

info sent by physician that removed the specimen from the patient

gross description

actual appearance of the tissue specimen as viewed by the pathologists' eyes

microscopic description

record of what the pathologist views under the microscope

comments

comment section may include further clarifying information about the diagnosis or inform other physicians that other studies are pending

diagnostic imaging

use of various imaging modalities to aid in the diagnosis of disease

examples of imaging tests

radiation, ultrasound, MRI, x-ray

plain radiography (x-ray)

x-ray beam is passed through the part body to be evaluated

flouroscopy

show organs or structures as they function

Barium Swallow

evaluation of esophagus and stomach

angiography/arteriography

visualization of lumen of blood vessels and organs

CT scans

sequence of x-rays are obtained, each representing a section (slice) of tissue at different levels

pacemakers are classified by the…

number of chambers the device stimulates

2 main examples of cardiac pacemakers

single and dual

permanent pacemakers are self-contained, meaning…

they are battery operated, implanted devices that send electrical stimulation to the heart through one or more implanted leads

cardiac resynchronization therapy pacemakers (CRT-Ps)

long, thin tube that is inserted into a large vein in the body to provide access for medical treatments such as medication administration, blood transfusions, or kidney dialysis

implantable cardioverter defibrillator (ICD)

electronic device designed to detect and treat life-threatening abnormal heart rhythms

central venous access

provide ready access to the patient's circulation

types of central venous access

peripherally inserted central catheter (PICC), non-tunneled catheter, tunneled catheter, implanatable port/reservoir

different between non-tunneled catheter and tunneled catheter

tunneled is under the skin, non-tunneled isn’t

complications of central line placement

1. Vascular Injuries: Arterial puncture, Bleeding, Air embolism, Catheter embolus

2. Cardiac Complications: Cardiac arrhythmias

3. Thoracic Injuries: Injury to the thoracic duct, Pneumothorax

   1. Nerve Injury: Injury to surrounding nerves

vascular access for hemodialysis

to maximize the amount of blood cleansed during hemodialysis treatments, vascular access allows continuous high volumes of blood flow

AV fistula

an opening or connection between any two parts of the body

AV graft

an artery is connected to a vein using a synthetic tube, or graft, implanted under the skin (usually in the arm)

arterial catheterization (arterial line/A-line)

catheter inserted into an artery to monitor blood-pressure in real time

umbilical catheterization

inserting a catheter into an infant

labor delivery: stage 1

cervical stage  (longest stage)

• cervix dilated

labor delivery: stage 2

fetal expulsion

• full dilation until delivery of baby

labor delivery: stage 3

placental expulsion

• time after delivery to the expulsion of the placenta and membranes

labor delivery: stage 4

uterine contraction

• hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents

cervical exam check for 5 things:

1. dilation

2. effacement

3. station

4. presentation

5. fetal stations

dilation

diameter of the cervical opening in centimeters

effacement

thickness of the cervix

station

relationship of the presenting fetal part to the maternal ischial spines

presentation

the anatomic part of the fetus leading through the birth canal

fetal station

the level of the ischial spines in regard to infant’s head approaching

fetal monitoring

assess fetal wellbeing in terms of oxygenation

methods of delivery: spontaneous (manually-assisted)

mom pushes, doctor handles

methods of delivery: forcep-assisted

forceps (resembles two large salad spoons) guide baby’s head out of the birth canal

methods of delivery: vacuum extraction

soft plastic cup is applied to the baby's head and stays in place by suction, guides baby through birth canal

methods of delivery: cesarean

delivery of a fetus through a surgically created incision in the anterior uterine wall

perineal or genital trauma

caused by either tearing or episiotomy; require repair

degrees of tears: 1st

injury to skin only

degrees of tears: 2nd

injury to the perineal muscles but not the anal sphincter

degrees of tears: 3rd

injury to the perineum involving the anal sphincter complex