clinical final exam

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130 Terms

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approaches: open
cut through skin or membrane
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approaches: percutaneous
entry by puncture or minor incision, using instruments
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approaches: percutaneous endoscopic
entry by puncture or minor incision, using instruments to VISUALIZE site of procedure
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approaches: natural/artifical opening
entry through natural or artifical opening (etc: mouth, vagina)
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approaches: natural/artifical opening endoscopic
entry through natural or artifical opening to VISUALIZE site of procedure (etc: mouth, vagina)
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approaches: natural/artifical opening with percutaneous endoscopic assistance
entry through natural or artifical opening by puncture/minor incision through skin/membrane
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approaches: external
procedure performed directly on skin/membrane by application of external force
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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
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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
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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
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computer assisted surgery (CAS)
set of methods that use computer technology for pre surgical planning, or guiding and preforming surgical interventions
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imaging guidance
uses scope to provide direct visualization of body parts
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positions: supine
patient lies on back
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positions: trendelenburg
position lies on their back on a downward angle, with their head lower than their feet
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positions: prone
patent lies on stomach
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positions: lateral
patient lies on side
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positions: fowler
patient lies on back, as if they are sitting on a chair, with legs bent
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positions: lithotomy
patient lies on back with their legs in the air, bent
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instruments: rongeur
strongly constructed instrument with a sharp-edged, scoop-shaped tip, used for gouging out bone
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instruments: retractor
used to separate the edges of a surgical incision or wound, or to hold back underlying organs
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instruments: clamps
used to occlude (e.g. blood vessels)
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instruments: stapler
used to place sutures to close skin wounds, connect or remove body parts such as, bowels or lungs
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laparoscopic instruments: trocar
instrument with sharply pointed edge used to introduce ports into the abdomen
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laparoscopic instruments: endo-catch bag
designed to isolate and contain specimens during laparoscopic surgery
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electrosurgery instruments: probe
cut through tissue, destroy tissue, control bleeding
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electrosurgery instruments: surgical blade (Bovie/ bovieknife)
allows surgeons to rapidly cauterize and clear operative fields 
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surgical homeostasis
control of blood loss during surgery
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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
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surgical wound closure: staples
thin, stainless steel staples that are inserted into the skin and tissues using a stapler device.
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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
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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
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how drains are inserted
at the operative site and exit through the incision or a separate stab wound adjacent to the incision
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how drains are chosen
according to the location of wound, size of wound, and type of drainage anticipated
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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
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drains: jackson pratt drain
a soft, flexible tube connected to a bulb-shaped reservoir that creates a gentle suction to help remove fluids
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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
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sanguineous
pertaining to blood, containing blood
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serosanguineous
containing or consisting of both blood and serious fluid
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serous
thin, clear and a little thicker than water, serous drainage occurs during the healing process of the wound
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purulent
producing or containing pus, “milky” in appearance
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resection
general term for removal of part, or all, of the body part
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stoma/ostomies
an opening of some part of the bowel onto the skin, stool is collected in a bag
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lab reports are grouped by…
headings
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what lab results typically contain
test, result, range, unit of measure
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abnormal results
lower/higher than reference range
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critical values
dangerously abnormal
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no flag
indicates that the lab result is normal
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reference range
results typically seen in normal healthy reference populations
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unit of measure
units of measurement that labs use to report results can vary from lab to lab
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specimen source
identifies what body substance is being analyzed
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lab panels/profiles
represent ordering a group of lab tests at once
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basic metabolic panel
helps to identify several common acute conditions
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lipid panel
measures different types of fats in your blood
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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
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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
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pathology
medical specialty that deals with the study of diseases and their effects on the body
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diagnosis
info sent by physician that removed the specimen from the patient
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gross description
actual appearance of the tissue specimen as viewed by the pathologists' eyes
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microscopic description
record of what the pathologist views under the microscope
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comments
comment section may include further clarifying information about the diagnosis or inform other physicians that other studies are pending
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diagnostic imaging
use of various imaging modalities to aid in the diagnosis of disease
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examples of imaging tests
radiation, ultrasound, MRI, x-ray
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plain radiography (x-ray)
 x-ray beam is passed through the part body to be evaluated
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flouroscopy
show organs or structures as they function
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Barium Swallow
evaluation of esophagus and stomach
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angiography/arteriography
visualization of lumen of blood vessels and organs
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CT scans
sequence of x-rays are obtained, each representing a section (slice) of tissue at different levels
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pacemakers are classified by the…
number of chambers the device stimulates
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2 main examples of cardiac pacemakers
single and dual
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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
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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
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implantable cardioverter defibrillator (ICD)
electronic device designed to detect and treat life-threatening abnormal heart rhythms
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central venous access
provide ready access to the patient's circulation
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types of central venous access
peripherally inserted central catheter (PICC), non-tunneled catheter, tunneled catheter, implanatable port/reservoir
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different between non-tunneled catheter and tunneled catheter
tunneled is under the skin, non-tunneled isn’t
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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
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vascular access for hemodialysis
to maximize the amount of blood cleansed during hemodialysis treatments, vascular access allows continuous high volumes of blood flow
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AV fistula
an opening or connection between any two parts of the body 
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AV graft
an artery is connected to a vein using a synthetic tube, or graft, implanted under the skin (usually in the arm)
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arterial catheterization (arterial line/A-line)
catheter inserted into an artery to monitor blood-pressure in real time
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umbilical catheterization
inserting a catheter into an infant
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labor delivery: stage 1
cervical stage  (longest stage)

* cervix dilated
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labor delivery: stage 2
fetal expulsion

* full dilation until delivery of baby
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labor delivery: stage 3
placental expulsion

* time after delivery to the expulsion of the placenta and membranes
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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
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cervical exam check for 5 things:

1. dilation
2. effacement
3. station
4. presentation
5. fetal stations
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dilation
diameter of the cervical opening in centimeters
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effacement
thickness of the cervix
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station
relationship of the presenting fetal part to the maternal ischial spines  
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presentation
the anatomic part of the fetus leading through the birth canal
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fetal station
the level of the ischial spines in regard to infant’s head approaching
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fetal monitoring
assess fetal wellbeing in terms of oxygenation
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methods of delivery: spontaneous (manually-assisted)
mom pushes, doctor handles
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methods of delivery: forcep-assisted
forceps (resembles two large salad spoons) guide baby’s head out of the birth canal 
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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
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methods of delivery: cesarean
delivery of a fetus through a surgically created incision in the anterior uterine wall
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perineal or genital trauma
caused by either tearing or episiotomy; require repair
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degrees of tears: 1st
 injury to skin only
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degrees of tears: 2nd
injury to the perineal muscles but not the anal sphincter
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degrees of tears: 3rd
injury to the perineum involving the anal sphincter complex