Last Week Stuff

Question 1

Is some escape of blood from a wound normal?

Answer 1

Yes

Question 2

Hematoma =

Answer 2

A localized collection of blood - appears as reddish blue swelling

Question 3

How can internal hemm be detected?

Answer 3

Swelling or distension in area of wound and possible sanguineous drainage from surgical site

Question 4

When is greatest risk for hemm post op?

Answer 4

First 48 hours

Question 5

What systemic factors predispose someone to infection?

Answer 5

Vascular disease
Edema
Malnutrition
DM
Alcoholism
Prior sx or radiation
Drugs (steroids)
Inherited immune defects

Question 6

Local factors that predispose someone to infection?

Answer 6

Large wound area
Increased wound depth
Degree of chronicity
Antomical location (distal extremity, perineal)
Presence of foreign bodies
Necrotic tissue
Reduced perfusion
Degree of postwound contamination

Question 7

Additional signs beyond the cardinal ones that are subtle indications of infection of a wound?

Answer 7

Friable (jelly-like) granulation tissue
Unstable epithelial bridges
Failure to respond to therapy

Question 8

Health care-assocaited infections that occur in post surgical pts = ?

Biggest cause of this?

Answer 8

SSI’s (surgical site infections)

Mostly d/t pt’s own flora entering surgical site

Question 9

Risk factors for SSI?

Answer 9

Hyperglycemia
Smoking
Prolonged preoperative hospital stay
Using shaving for hair removal
Intra and post-operative hypothermia (less than 36 degrees)

Question 10

When is an SSI most likely to become evident?

Answer 10

2-11 days post-op

Question 11

Are systemic antibiotics used for pressure ulcers that display only local signs of infection?

Answer 11

No - but may be used for bacteremia, sepsis, advancing cellulitis, or steomyelitis
* Topical antibiotics can be used may be given a 2-week trial in case of clean p ulcers that do not show evidence of healing or are continua=ing to produce exudate after 2-4wks of optimal treatment

Question 12

What is nurse to do with hemmorhage?

Answer 12

Is emergency! Apply extra sterile pressure dressings to area and monitor client’s vital signs. Likely to need stat operation

Question 13

What factors heighten client’s risk of wound dehiscence?

Answer 13

Obesity
Smoking
Poor nutrition
Multiple traumas
Failure of suturing
Excessive coughing 
Vomiting
Dehydration

• Those at risk may be prescribed abdominal binder for suppport

Question 14

When is dehiscence most likely to be seen?

Answer 14

4-5days post op, before extensive collagen is deposited in the wound

Question 15

What might indicate impending dehiscence?

Answer 15

An increase in the flow of serosanguinous drainage into the wound dressing

Question 16

How to position patient if dehiscence occurs?

Answer 16

In bed with pt knees bent to decrease pull on incision.

Question 17

When donning sterile gloves, always make sure to have ____ when preparing for the procedure?

Answer 17

An extra pair

Question 18

Which hand do you donn gloves onto first?

Answer 18

Dominant hand

Question 19

When donning the first glove, what surface of the glove are you touching?

Answer 19

Only the inside

Question 20

How to position hand when donning gloves to ensure don’t contaminate outside?

Answer 20

Keep thumb tucked against palm

Question 21

Should you unfold the cuff of the glove?

Answer 21

No, leave cuff turned down to avoid risk of contamination

Question 22

Complications that drains are assoc with?

Answer 22

Hemorrhage
Tissue inflamation
Retrograde bacterial migration
Drain entrapment

Question 23

What are drains

What the differenced between closed and open drains?

Answer 23

Perforated silicone tubes which exit through the surgical incision or through a separate small stab wound

drain either into a sterile vacuum device (closed drain)
Or into dressings (open drain)

Question 24

Why are those drains situated away from the primary incision preferable to those that exit the wound itself?

Answer 24

help to prevent transmission of infectiosn between operation site because can dress them separately

Question 25

Diff between superficial and deep drains?

Answer 25

``` Superficial = placed in the wound Deep = may be intra-peritoneal, in a hollow organ or duct, or positioned in deep cavity such as abscess or haematoma ```

Question 26

Why are drains used?

Answer 26

Prevent formation of haematoma To remove accumulation of fluid - Primary purpose is to drain blood or serous fluids that may become infected and result in tissue irritation and breakdown of overlying tissues - May also be used to monitor leakage (eg: bile leak following biliary operations) or to divert body fluids away from particular surgical site

Question 27

When are drains removed?

Answer 27

When drainage has ceased, typically 24-48hrs following surgery (if used to cover perioperative bleeding and hematoma formation) - If drain inserted to prevent accum of serous fluids, removal will depend on size and nature of wound and potential for complications - Decided by surgeon

Question 28

Are blocked drains removed? Why are drains removed as soon as possible?

Answer 28

Yes | In order to limit risk of infection + so granulation tissue doesn't develop around drain

Question 29

When might a sample be taken of wound with drain removal?

Answer 29

May be useful in pts whose drain sites may be infected or in pats who are pyrexial

Question 30

How to monitor discharge from drain site post removal once dressing is applied?

Answer 30

Draw line and put date so can see how rapidly this leakage is occuring

Question 31

When are dressings applied post drainage removal typically removed?

Answer 31

3-5 days (when drain site has healed)

Question 32

Use of ____ technique is essential when caring for and removing drains?

Answer 32

Aseptic (not sterile?)

Question 33

Procedure for drain removal

Answer 33

- Remove dressing with clean gloves + throw away - If has vacuum bottle, clamp tubing to release vacuum - Note amount of drainage in bottle - Put on sterile gloves - Cleanse site if necessary - Place sterile dressing under drain tubing - Remove sutures if necessary - Fold up sterile gauze swab and position over drain site - Warn pt of pulling sensation - Grasp drain close to skin using sterile gloved hand or forceps - Gently withdraw drain onto sterile towel - Check that entire drain has been removed - Maintain p on site until bleeding and/or drainage is minimal - Dress with sterile dry dressing

Question 34

What supplies are needed for shortening a drain?

Answer 34

``` Clean gloves • Sterile gloves • Face shield • Dressing supplies • Dressing set • Suture removal supplies (if required) • Sterile pin • Sterile forceps • Sterile normal saline • Sterile scissors ```

Question 35

How do you know how much to shorten a drain?

Answer 35

drs orders

Question 36

Procedure for shortening a drain

Answer 36

Clean incision and drain area with sterile normal saline. - If drain is sutured, remove sutures. - Support skin around drain site with sterile forceps. Using second sterile forcep, pull ordered amount of drain out. Move supporting forceps to bottom edge of visible part of drain. Using second forceps, insert new sterile pin into drain close to bottom of visible drain (see Figure 1). Leaving 2 cms of drain above newly inserted pin, take sterile scissors and cut drain between the 2 pins (see Figure 2).