CPSS midterm Exam 80 Questions with Verified Answers,100% CORRECT

CPSS midterm Exam 80 Questions with Verified Answers What are the indications for performing veni puncture? - CORRECT ANSWER a) Indications: for the evaluation and management of many different disease processes -wh ...

CPSS midterm Exam 80 Questions with Verified Answers What are the indications for performing veni puncture? - CORRECT ANSWER a) Indications: for the evaluation and management of many different disease processes -when the quantity required for testing is > can be obtained by puncturing the skin with a lancing device. The primary purpose of phlebotomy is to obtain a sample of blood for Dx testing, and only rarely is phlebotomy utilized as a therapeutic modality what are the contraindications for performing venipuncture.? - CORRECT ANSWER b) Contraindications (relative bc other location can be selected): -skin infection, skin rashes, new tattoo -extensive scarring, phlebitis, sclerosed veins, -lymphedema (upper extremity on same side of mastectomy) -hematoma -IV cath distal to venipuncture site -arm w/ cannula or w/ vascular anomaly (AV fistula) Identify and describe the potential complications associated with venipuncture - CORRECT ANSWER a) Pain and discomfort b) Syncope c) Cellulitis and/or phlebitis d) Thrombosis e) Bruising f) Laceration of vein g) Hemorrhage/hematoma h) Prolonged bleeding in pts w/ coagulopathies or who are taking anticoagulants (not a contraindication) The pt should be advised that minor discomfort and discoloration at procedure site may be experienced for 48-72 hours after venipuncture 1) Describe the essential anatomy and physiology associated with the performance of venipuncture - CORRECT ANSWER a) Blood is 6-8% of total body weight, (serum= plasma -fibrinogen); main function is transport O2, nutrients, waste products, hormones, etc throughout body; also regulated body temp, fluids and acid-base balance; immune system response and coagulation b) 3 types of blood cells: RBC(erythrocytes), WBC (leukocytes), Platelets (thrombocytes) c) Cubital fossa (triangle on anterior aspect of elbow): cephalic and basilic veins (superficial) are prominent; median cubital vein crosses the bicipital aponeurosis -the site most frequently utilized for venipuncture. -The boundaries include imaginary line connecting medial and lateral epicondyles superiorly, pronator teres medially, and brachioradialis laterally. NOTE: The best veins for venipuncture, listed by order of preference, are as follows: 1. Median cubital vein, easily palpated, well anchored, least painful, least likely to bruise, and usually largest vein in the antecubital space. 2. Cephalic vein, large vein that is easily palpated, but poorly anchored; can be painful to pt 3. Basilic vein, easy to palpate, not well anchored, and very close to brachial artery and the median nerve 1) Identify the necessary materials and their proper use for performing venipuncture. - CORRECT ANSWER a) Gloves (At least 2 pairs of nonsterile gloves) b) Tourniquet (3⁄4 or 1 in for adults and 1⁄8 in for children. An adult or peds BP cuff may be utilized in place at mmHg >diastolic. Esp helpful in elderly to prevent excessive stress on the vein) c) Gauze pads d) Isopropyl alcohol pads e) Povidone-iodine (for blood cultures) f) Evacuated tubes g) Labels (prepare prior to procedure) h) Adhesive strips i) Sharps container, Biohazard waste container Venipuncture performed utilizing a Vacutainer requires the following materials: -Multisample needles (18 to 23 gauge) or butterfly infusion set (21, 23, or 25 gauge). -Vacutainer holder/barrel OR m) Single draw needle and syringe 1) Demonstrate the appropriate technique and sequence for performing venipuncture utilizing both a vacutainer system and a syringe - CORRECT ANSWER a) Check pt ID and orders b) Assemble equipment needed c) Wash hands d) Position pt (If possible, position in supine or recumbent position. If sitting up, extend arm straight down from shoulder to waist) e) Select vein (1. *median cubital vein, cephalic vein, basilic vein) [sense of touch should be refined by using palmar aspects of gloved finger pads] and apply tourniquet (3-4 in. above tourniquet site. Never leave on for >2 mins) f) Don gloves, secure vein by anchoring with finger, and clean skin (begin at venipuncture site and circle outward to a 2-in diameter) g) Stretch skin downward below anticipated venipuncture site w/ nondom hand to anchor vein. Insert needed into vein at 15-30° angle bevel side up and parallel to vein h) Move vacutainer down into barrel to puncture tube and fill until vacuum is exhausted (correct order of draw) i) For drawing into a syringe pull back gently on plunger, then transfer blood into vacutainer tubes what are Special Instructions for Blood Collection With a Syringe - CORRECT ANSWER Syringes may be used for venipuncture when the pt's veins are small or fragile and Vacutainer tubes may cause veins to collapse. Using a syringe w/ a 20- or 21-gauge needle or butterfly needle allows for greater control. The procedure follows same steps as for Vacutainer system except differs in the order of samples drawn, aspiration of blood into the syringe, and transfer of blood into the vacuum tubes. 1. make sure there is back flow in needle 2. pull back on the plunger and fill the syringe w/ desired amount of blood & release tourniquet 3. transfer blood in syringe to tubes by Attaching a Vacutainer blood transfer device to the syringe and proceed to engage and fill the evacuated tubes in the correct order. DONT USE THE PLUNGER TO FILL THE TUBES 1) Identify strategies for handling unsuccessful attempts at venipuncture - CORRECT ANSWER a) To find difficult veins: keep extremity below level of heart for a few mins, apply warm towel to promote vasodilation for no >2 mins, use BP cuff, rub/tap vein to promote vasodilation (before site is cleaned) b) If no blood is obtained, change position of needle carefully. Move it forward or backward, and consider adjusting the angle of the needle. Monitor for hematoma formation, stopping procedure if occurs & hold pressure for 10mins (15 min if on anticoags). c) If blood stops flowing into evacuated tube, vein may have collapsed. Resecure the tourniquet to increase venous filling. If this does not fix blood flow, remove needle, take care of puncture site, and redraw. d) Avoid leaving a tourniquet on for >2 mins.. e) When using a syringe, avoid drawing plunger back too forcefully. f) If venipuncture procedure is unsuccessful, do not attempt to repeat it at same site until healing has occurred. After 3 unsuccessful attempts, stop and ask for assistance. 1. Identify the anatomy associated with the insertion of a peripheral IV catheter - CORRECT ANSWER o Forearm is used if possible (Avoiding valves and bifurcations easier in lower arm) or dorsum of the hand offers good IV access o Assess bifurcations (visualize) and valves (palpate as knot-like lumps or tortuous areas) before IV placement o Commonly used: metacarpal, basilic, or cephalic veins -can use the foot in peds pts (bc good blood flow so no risk infection). Commonly used LE veins are the greater and lesser saphenous and medial marginal veins. what are indications for insertion of IV caths? - CORRECT ANSWER o Indications: fluid administration for illness, volume depletion, burns, blood loss, electrolyte disturbance, heat stroke, shock, trauma. -admin of Abx, chemotherapeutics, blood products -admin of Dx substances like dyes or contrast, -admin of nutritional fluids what are the contraindications for administration of IV caths? - CORRECT ANSWER o Contraindications: appropriate Tx can be given by less invasive route -extremities w/ significant burns, edema, injury, cellulitis or significant infection - no insertion distal to prior failed IV cath insertion attempt -avoid inserting distal to areas of preexisting phlebitis; -extremities w/ impaired circulation (mastectomy, axillary lymph node dissection, lymphedema, clot, PVD, venous insufficiency) -extremities w/ indwelling fistula consider if med is too caustic, hypertonic, a sclerosing agent, vasopressive agent or being given for >6 days; careful in pts w/ known bleeding risk 1. Identify common complications associated with IV catheter placement. - CORRECT ANSWER o Technique: -if no flash of blood cath probably not in vein, -flash of blood but can't advance catheter: vessel valve may be occluding cath --> remove & apply pressure -fluid not flowing freely: due to clot or kink --> remove & apply pressure o Local: -if fail to cannulate vein properly, may give med or fluid in surrounding tissue outside vessel -> pain, tissue irritation, and swelling. Certain meds can be caustic to adipose tissue & necrosis -minor bleeding -thrombophlebitis (can be minimized by avoiding trauma at time of insertion, securely taping cannula in place, and avoiding placing catheter near a joint line) -local site infection or cellulitis (use aseptic techniques and dont leave in place >72-96 hours) o Systemic: (RARE) -septicemia, bacteremia: MC if dont use aseptic technique -catheter embolization: results from distal portion of the cath end being shearing off by beveled end of needle. Can be avoided by not pulling catheter sheath back over needle once it has been threaded (advanced). -pulmonary emboli: w/ centrally placed peripheral lines -air emboli: if lines aren't properly flushed to remove air before connected to cath 1. Identify proper aftercare for an IV catheter insertion site. - CORRECT ANSWER o Instruct pt on signs of infection (discomfort, pain, redness, swelling) o Have pt notify caregiver immediately if experiencing signs o IV site should be changed every 96 hours to reduce likelihood of infection 1. Identify the material necessary to insert an IV catheter. - CORRECT ANSWER o Appropriate gauge IV catheter (over the needle catheters w/ safety devices are the MC used); size range is 24-14 gauge o Gloves and other PPE (eye protection) o IV fluid o Administration set (tubing w/ drip chamber that has been primed w/ IV fluid and has roller clamp flow regulator and standard connecting) o IV pole, Infusion pump o Antimicrobial cleanser o Tourniquet o Scissors o Tegaderm or other nonocclusive dressing o Gauze o Arm board (if needed) o Biohazard waste o Antiseptic ointment what consent must be obtained for inserting IV cath. - CORRECT ANSWER Verbal consent is sufficient. For the usage of intravenous catheters, the risk- benefit ratio and the indication for placing are considered to be common knowledge for a competent and alert patient. The patient is assumed to have consented if they extend the extremity to have the IV placed. Time should be taken to explain the indication, the pain involved the procedure, the expected time for the therapy and alternatives if available. what kind of needle is used for insertion of cath in infant? how about for blood transfusions? - CORRECT ANSWER A 24-gauge (small bore), 0.5-inch catheter is commonly used in a neonate or small infant. The delivery of blood products or trauma necessitates larger bore IV devices, such as 16 or 18 gauge describe the general procedure of insertion of IV cath (not objectives) - CORRECT ANSWER 1. Apply the tourniquet above the elbow (or ankle) both both arms (or feet). Choose most suitable vein 2. Palpate vein for stability and valves (a compressible, stable vein thats free of valves for 1 in is ideal). 3. Release tourniquet,turn on infusion pump, flush tubing w/ fluid, and ensure tubing is free of trapped air bubbles. 4. Apply tourniquet snuggly and well proxi- mal to the chosen site (less pressure on elderly sensitive skin) 5. Put on gloves and eye protection. 6. Allow vein to distend, place arm below heart 7. Cleanse site with approved aseptic cleanser (70% alcohol, tincture of iodine, an iodophor, or chlorhexidine gluconate). back-and-forth motion for a min of 30 secs and then allowed to dry. 8. W/ nondom hand, hold pt's hand (or foot) securely and use thumb to gently retract skin distal to insertion site 9. Puncture vein using direct or indirect entry -Direct (one step, used for larger veins): Hold assembly at 15-20 degrees above site and enter vein directly -Indirect (2 steps, used for smaller veins): hold assembly 15-20 degrees above site and 20 degrees lateral to vein, insert cath into skin, and then advance into vein. When vein is punctured, blood should appear in flash chamber. Once flash is seen, lower needle assembly to almost parallel w/ skin and thread the cath what is special care that should be considered for insertion of cath for peds or elderly? - CORRECT ANSWER The geriatric and pediatric populations are more likely to have smaller, more fragile veins, and fewer venous options may be present; thus, careful inspection of all options should be done before attempting IV placement. Avoid the LE in elderly or pt w/ vascular insufficiency. If blood products arent being given, use a smaller catheter, such as a 24 gauge. In geriatric may be equally difficult to start an IV in a very large vessel bc it may be sclerotic. Makes vein more difficult to puncture and catheter more difficult to thread. if <1 year of age, 24 gauge is the preferred cath size. In children, securing line is critical bc tend to be more active and remove the catheter. Describe the anatomy of the skin and underlying structures affecting the manner in which injections are administered. - CORRECT ANSWER -W/ ^ depth of needle penetration, systemic absorption of an injected agent is enhanced Below the epidermis is the dermis, which varies from 1-4 mm in thickness and is composed of connective tissue. The subcutaneous (adipose) layer lies directly beneath the dermis and above the muscles. This layer is composed of hair follicles, sebaceous glands, sweat glands, blood vessels that supply the dermis, and nerves of the autonomic nervous system. what does parenteral mean? - CORRECT ANSWER the administration of medical therapy is in a manner not involving the gastrointestinal or alimentary tract. -Specific routes of parenteral delivery include intradermal, subcutaneous, intramuscular, and intravenous what are the indications for injections? - CORRECT ANSWER injections are indicated for therapeutic treatment, Dx of medical conditions (i.e., allergen response, TB), and disease prevention (i.e., immunization). what are some risks/complications associated with injections? - CORRECT ANSWER unsafe injection practices may ^ risk of exposure to infectious dz such as HBV/HCV and HIV. Infection control is not limited to prevention of needlestick injuries. The CDC cited reinsertion of used needles into multidose vials or solution containers, such as saline bags and tubing, as a contributing factors. -Pain, burning, and erythema at injection site (to reduce pain: Ensure pt is relaxed, bc muscular contraction intensifies pain; allow antiseptic to dry completely before injection; gently massage area after injection) -Infection (reduced w/ proper aseptic technique) and abscesses from irritating solutions -Lipodystrophy (Pts administering multiple and repeated injections (i.e., insulin) may develop atrophy of subcutaneous fat, which may interfere w/ absorption. Rotation of injections sites can prevent atrophy) -Injury to surrounding structures such as nerves and arteries. Risk is ^ w/ IM injections. -Allergic reaction (including anaphylaxis) to injectant -Medical error what are important uses for: Intradermal Injections IM Injections subcutaneous injections - CORRECT ANSWER INTRADERMAL: Injected into the dermal layer of skin - Useful for conditions requiring skin testing, (TB and allergens) SUBCUTANEOUS -Useful for low-volume medication delivery (ex insulin or enoxaparin) and some vaccinations INTRAMUSCULAR (IM): Injected deep into musculature for distribution through the vasculature - Useful for higher volume medication delivery and some vaccinations what are potential contraindications for injections? - CORRECT ANSWER ■ Allergy to any component of injected substance (medication, preservative, etc.). When administering vaccines, ask pts about egg and or gelatin allergies. ■ Coagulopathy (esp for IM injections) ■ Pregnant pts should not be administered live virus vaccines (i.e., MMR, varicella, influenza vaccine). ■ Active infection at the injection site where is the optimal site for IM injections? for intradermal injections? for subcutaneous injections?q - CORRECT ANSWER • Intradermal: localized effect just beneath the epidermal skin layer; optimal site is ventral forearm 10cm from antecubital fossa (allergen testing may use lateral side of upper arm or upper back for ^ SA) • Subcutaneous: optimal absorption in adipose regions of lower abdomen, anterior or posterior thigh, upper buttocks, lateral lower back, and lateral upper extremities; rotate site to prevent lipodystrophy • Intramuscular: fastest/best absorption (bc contain BVs that transport med through CV system) -MCly use deltoid, ventrogluteal (lateral hip), and vastus lateralis (lateral thigh) -some injections are specifically manufactured to become activated w/in the muscle - to minimize injury, ensuring correct pt positioning, expose skin completely, and palpating landmarks where are the landmarks for IM common injection sites ? - CORRECT ANSWER Deltoid: Place 4 fingers across deltoid, w/ top finger lying along acromion process. Inject 2 to 3 fingers below the acromion process. *Risk for injury to radial and ulnar n. or brachial artery Ventrogluteal (Gluteus medius and minimus): Place heel of hand over greater trochanter, w/ thumb pointing toward groin and fingers toward head. Place index finger on anterosuperior iliac spine, extending the 3rd digit along iliac crest (a "V" is formed by first and third digits). Inject into center of the "V." **Advocated as 1st choice bc of distance from major nerves and blood vessels Vastus lateralis: Place hand above knee and then below greater trochanter of femur. The area between the hands is the vastus lateralis. Inject into middle 1/3 of the area. **Preferred choice by clinicians for infants & common in children/adults Dorsogluteal (Gluteus maximus): Draw an imaginary line btwn posterior superior iliac spine and greater trochanter of femur. Inject above and lateral to the imaginary line. Less reliable method: Divide butt into quadrants, inject into upper outer quadrant, 2-3 in below the iliac crest. *Most resources do not advocate routine administration in buttocks bc risk for sciatic n. and superior gluteal artery injury. 1) Recognize the importance of equipment preparation and proper technique when administering injections. - what are methods to ensure proper care? - CORRECT ANSWER -"rights of medication administration": -Right pt -right med (check med or vaccine label 3 times) -right dose, right time, right route, right site, -right documentation (A copy of a Vaccine Information Statement (VIS) required by law to be given to the pt and/or legal guardian for each dose) -Never administer meds from same syringe even if the needle itself was changed Before obtaining a verbal consent, inform the pt about the indication, benefits, and risks. Always verify allergies Inform pt about site of administration and potential sensations on needle insertion. (don't lie)• what is equipment needed for injections - CORRECT ANSWER Equipment: 2 or 3mL syringe, needle (according to route of admin and size of pt), injectable substance, alcohol pads, gloves, sharps container, gauze pad, bandage Size of needle: The larger the gauge, the smaller the diameter (26 gauge is thinner than a 20 gauge) Progressing from shorter length and thinner gauge -> longer length and larger gauge = intradermal, subQ, and IM needles. Commonly used sizes--> Intramuscular: 20 to 25 gauge, 1.5 inches Subcutaneous: 25 to 27 gauge, 3/8 to 5⁄8 inches Intradermal: 25 to 27 gauge, 0.5 to 5⁄8 inches -how are each of the following injection procedures done: *intradermal *subcutanous *IM - CORRECT ANSWER •Intradermal: after prepping site insert needle w/ bevel up at a 15° angle into upper layers of skin and inject slowly; wheal or bleb should appear (do not rub site/apply pressure) • Subcutaneous: after prepping site, bunch the skin w/ non dominate hand to pull subQ layer away from musculature and insert needle w/ bevel up at 45° angle into subQ layer, inject slowly and apply pressure w/gauze after needle removal •IM: after prepping site, ensure pt is relaxed, gently stretch skin pressing down slightly to reduce subcutaneous tissue and insert needle w/ a quick thrust at a 90° angle deep into muscle, apply pressure after needle withdrawal what is the recommended location for IM and SubQ injections in pediatric patients? - CORRECT ANSWER what are special ways for administering insulin? - CORRECT ANSWER Insulin preparations typically require that the vial be gently rolled in the palm of the hands to ensure proper distribution. Shaking the bottle can alter the potency. Pts need education on injection site rotation to limit lipodystrophy. Typically, sites such as the arms, abdomen, thighs, and buttocks provide effective absorption of insulin. Documentation and patient follow-up care after injections are : - CORRECT ANSWER The following documentation is required for any injected substance. -Name and manufacturer of agent, lot number, expiration date. Injection method (specific site, needle, route). Date, time, and person who administered injection. Vaccination Information Statement for vaccines **It is recommended to observe the pt for at least 15 mins after vaccination. Syncopal episodes may occur during or after a vaccination. Preceding sx- weakness, pallor, dizziness, palpitations, and diaphoresis. Adequate preparation includes having the pt seated or lying down during and after injection. *HCPs should report significant AEs after vaccination to the Vaccine Adverse Event Reporting System (VAERS) read the notes about how surgical knot tying procedures should be done on canvas - CORRECT ANSWER what are the advantages for plaster materials for casts? what are the advantages for fiberglass materials for casts? - CORRECT ANSWER PLASTER: easier to mold to an extremity, giving it an advantage when a snug and form-fitting cast is needed on an area w/ challenging contours, (ex. chubby, cone-shaped arm/legs of a toddler). Also absorbs ("wicks") underlying wound drainage, making it a desirable splinting material in trauma and postoperative settings. Although messy to apply, plaster is easily washed off with soap and water—making the wearing of gloves optional. Less expensive FIBERGLASS: The material of choice for majority of cast and splint applications, esp for weight-bearing ("walking") casts. its strength and flexibility, light weight, ease of application, and durability. Once hardened, it is fully water-resistant. Generates a much smaller exothermic reaction. Begins to harden in 3-4 mins and fully hardens in 1-2 hrs. Available in a wide variety of colors what are the disadvantages of using plaster materials for casts? what are the disadvantages of using fiberglass materials for casts? - CORRECT ANSWER PLASTER: much heavier, yet not as durable. Once hardened, it will soften and break down if gets wet, requiring cast reinforcement or replacement. Plaster begins to harden in 10-15 mins, but takes 6-8 hours (or more) to fully dry and harden. Plaster also emits quite a bit of heat as it cures. Bc of exothermic reaction generated, it poses potential burn risk in pts with sensory deficits or unable to communicate discomfort effectively (immaturity or cognitive impairment).To reduce amount of heat generated, cool water is used to wet the plaster, even though this increases the time to harden. FIBERGLASS: begins to harden in 3-4 mins so must be kept in its airtight foil package until immediately before application. Several times more expensive than plaster (sometimes justified bc lasts longer and requires fewer repairs and replacements). Gloves and an apron worn when applying fiberglass bc of sticky resin it contains Describe the proper procedure for selecting and applying a short-arm cast - CORRECT ANSWER **recognize a short-arm cast never completely immobilizes the wrist joint bc it does not prevent forearm pronation and supination elbow is typically flexed to 90 deg and forearm maintained in neutral pronation-supination (w/ thumb pointing upward). Wrist should be held in slight extension [position of function] should extend from ~2 fingerbreadths distal to the olecranon fossa to just proximal to the MCP joints of all fingers. Should immobilize hand, wrist, and distal forearm, yet allow full flexion at the elbow, full range of motion of all the MCP joints and an unobstructed thumb-index pinch. 1. position pt (above) 2. Apply stockinette to extend the stockinette ~4 in beyond the anticipated cast borders. 3. Apply cast padding, to extend ~2 in beyond anticipated cast borders so excess stockinette and padding can later be folded over the rough cast edges. apply additional padding over the radial and ulnar styloid process 4. Roll on fiberglass cast material, starting in narrow wrist area, then a couple of figure 8 around hand before proceeding up arm. When rolling fiberglass through narrow thumb-index web space, twist material 360-degrees (or cut it) so forms a small bridge <1 fingerwidth, allows for thumb finger opposition 5. After each roll of fiberglass applied, mold cast to arm (and hand) using your palms 6. Before rolling final layer of cast material, pull stockinette and cast padding over cast edges to create padded and rolled-edge borders. Secure border w/ final layer of cast material. Describe the proper procedure for selecting and applying a short-leg cast - CORRECT ANSWER should extend from tibial tubercle (or 2 finger widths below fibular head) to just proximal to the MTP joints of all toes. Should immobilize the foot, ankle, and lower leg, yet allow full flexion at knee and full ROM of all MTP joints, including the little toe. 1. Place in the proper position of function, 2. Apply stockinette, to extend stockinette ~4 in beyond anticipated cast borders. 3. Apply cast padding, to extend the cast padding ~2 in. Apply additional padding over tibial tubercle, anterior tibia, medial and lateral malleoli, metatarsal pad area, head of 5th metatarsal, and esp over heel. CAUTION: Dont pad heel by wrapping circumferentially around foot bc cast padding will bulk up at dorsal ankle area. Instead tear strips of cotton cast padding and lay them over the heel. 5. Roll on fiberglass cast material, beginning at distal foot. Make a few figure 8 passes around heel and ankle before proceeding up lower leg. To avoid heel area wrinkles, include only ~1/2 heel with each pass around foot. 6. After each roll applied, mold cast using your palms. Before rolling final layer, pull excess stockinette and cast padding over edge to create padded and rolled cast borders and secure themw/ final layer. 7. If cast to be used for walking, apply extra layers of reinforcement to bottom surface and heel for ^ strength and durability, and strap a cast shoe to the finished cast NOTE: Weight bearing must be restricted until material has fully hardened (1-2 hrs for fiberglass; 4-6 hrs for plaster) or will cause cracking or denting what is a cast? - CORRECT ANSWER A cast is an immobilization device that completely encases the circumference of an extremity. It consists of a rigid material (usually plaster or fiberglass) placed over several layers of padding and a cloth stockinette that together cover and protect the skin. Bc a cast is circumferential and rigid, it typically is not used until the acute swelling phase of the injury has subsided. what is a splint? - CORRECT ANSWER A splint is similar to a cast except that its rigid material encases only part of an extremity's circumference and must therefore be secured with an elastic wrap. Although a splint provides less mechanical support and protection than a circumferential cast, its main advantage is that it allows for soft-tissue swelling during the acute phase of an injury. Splints are most commonly applied in ED and other acute care settings. 3 general types of splints are discussed in this chapter: the "gutter," the "posterior mold," and the "sugar tong." what are the 3 general types of splints? - CORRECT ANSWER the "gutter": appropriately named for its gutter-like shape in supporting the extremity. the "posterior mold,":named bc it is molded to the posterior aspect of splinted extremity. Posterior mold splints of the short-leg, short-arm, or long-arm variety are commonly employed. the "sugar tong.": forms a U-shaped strap around an extremity, resembling the kitchen accessory. Can be used initially to immobilize the lower leg, lower arm, or upper arm. what are the contraindications for casts? - CORRECT ANSWER Cast (circumferential) immobilization should be avoided in the following situations: -During acute injury phase (usually 3-4 days), when acute swelling of extremity expected -When cast would cover or conceal a known skin or soft-tissue infection -When cast would cover or conceal an open wound, where infection may occur In these situations, a splint is much safer than a cast bc allows extremity to expand w/ swelling and provides access to skin so it can be periodically checked for wound healing and signs of infection what are the indications for casts and splints? - CORRECT ANSWER Casts and splints are used in the primary care setting as follows: To treat simple, acute, nondisplaced fractures To immobilize a dislocation after it has been reduced To treat soft-tissue injuries, such as severe ligament sprains and muscle strains To treat some congenital deformities (clubfoot or hip dysplasia) To help manage chronic foot and ankle ulcers what are potential complications from casting? - CORRECT ANSWER potential complications. These include compartment syndrome, cast dermatitis (occurs when air circulation is insufficient to clear residual moisture and perspiration from inside cast), pressure sores, nerve injuries, and DVT what is the most serious complication of casting? what are signs/sx of this? how is this managed? - CORRECT ANSWER The most serious complication after cast on is development of compartment syndrome- a buildup of pressure w/in the soft tissues that can impede or cut off the blood supply to an injured extremity causing permanent damage to muscles and nerves The most predictive sx of compartment syndrome is pain that increases over time and is out of proportion to severity of the injury, gets much worse w/ passive motion of distal extremity and usually prevents active motion altogether. Less reliable sx in the involved limb include paresthesias, decreased 2-point discrimination, decreased capillary refill, pallor, and, ultimately, pulselessness -Normal soft-tissue compartment resting pressures are in the range of 5 to 10mmHg. As rise >30 mmHg can damage tissue. (Today, compartment pressure is MC measured w/ a special electronic hand held device) requires immediate loosening of cast by cutting and splitting it down both sides of the extremity and then separating the 2 halves to relieve pressure. This is known as "bivalving" a cast. (can be bivalved to create either anterior and posterior shells or medial and lateral shells). Underlying padding and stockinette layers are cut all the way down to skin. The 2 cut halves of cast are then kept separated by about 2-4 mm using cotton padding, and secured with an elastic wrap. If sx dont resolve w/in a few mins of bivalving surgical decompression what are pressure sores? How can these be prevented? - CORRECT ANSWER result from inadequate padding over bony prominences or from finger indentations that occur from improper handling of a cast or splint during application (To prevent plaster and fiberglass materials should be manipulated / the palms of hands (not fingertips) until sufficiently hardened). If not detected early, pressure sores may progress to pressure ulcers and require surgical debridement / skin grafting. Describe how to perform a proper assessment after cast or splint to determine if the device fits well, properly immobilizes the injured extremity, and is comfortable - CORRECT ANSWER The following should be taken into consideration in evaluating the pt after cast application: -Perform a careful assessment of cast or splint before sending the pt out of the casting area. -Make sure cast or splint extends to proper boundaries, yet doesnt interfere w/ ROM of necessary joints. -Check for finger indentations and sharp edges. Using the cast saw or bandage scissors, trim back the cast and repad or recast if necessary. -Be sure to ask pt how cast feels, allowing a few mins so can determine whether are areas of ^ pressure or sharp edges. If neglected, an unhappy pt will return hrs later for cast modification. describe how to apply short arm flutter splint - CORRECT ANSWER runs along ulnar border of hand and forearm, extending from tip of little finger to just below elbow. Forearm is placed in neutral position w/ wrist at 20 degrees extension, MCP joints flexed to 50 degrees, and the PIP and DIP joints in slight flexion. It immobilizes the 4th& 5th digits, the ulnar border of the hand, the wrist, and the distal forearm. (often used to tx fx of 4th/5th phalanges and metacarpals. 1. Consider applying stockinette to lower arm and hand unless concern may become constrictive from acute limb swelling. Bc prefabricated splints contain little padding, also consider placing additional padding over hand, forearm, and styloid processes for improved comfort. 2. Immerse splint in a bucket of cool water. 3. Remove excess water from splint by rolling it up tightly or by rolling like a jellyroll in a dry towel. 4. W/ help of an assistant, maintain pt's arm in position of function while properly positioning splint on pt's arm. If splint is too long, simply fold it away from arm at proximal end. Avoid making fingerprint indentations in splint. CAUTION: remember to place padded side of the splint toward the pt's skin. 5. Secure splint using an elastic wrap, beginning distally and proceeding proximally. 6. Gently mold splint around ulnar aspect of the arm and hand. 7. After sufficiently hardens, remove wrap and neatly rewrap it. To permit mobility of thumb, index, and middle fingers, exclude these 3 digits from the final elastic wrapping. 8. Perform a postapplication splint assessment. describe how to perform a short leg posterior mold splint - CORRECT ANSWER extends along posterior aspect of lower leg, from 2 finger widths distal to popliteal fossa to distal ends of toes. Should immobilize foot and ankle yet allow full flexion at knee. (commonly used for initial immobilization of severe ankle sprains and fx of distal leg, ankle, and foot) 1. Consider applying stockinette to lower leg unless concern of constrictive from acute limb swelling. Bc prefabricated splint, place additional padding over lower leg, medial and lateral malleoli, metatarsal pad area, head of 5th metatarsal, and esp heel. 2. Immerse the splint in a bucket of cool water. 3. Remove excess water from the splint. important to remove as much water as possible to prevent water from pooling at heel causing skin breakdown. 4. Help of an assistant, maintain pt's foot and ankle in position of function. Properly position splint on lower leg, starting at foot and progressing to behind knee. If too long, fold it back on itself, away from body, at proximal end. Carefully avoid making fingerprint indentations in the splint. CAUTION: remember to place the padded side against skin. 5. Secure splint using an elastic wrap, begin distally and proceeding proximally. To prevent pressure sores, ensure folds at the medial and lateral ankle bend are directed outwardly so they dont press againstskin. 5. Gently mold splint around posterior aspect of lower leg, ankle, and foot. 6. Perform a postapplication splint assessment. NOTE: A long-leg posterior mold splint constructed similar, except includes entire lower extremity w/ knee in extension. Often used for initial stabilization of tibia fx NOTE: A long-arm posterior mold is constructed similar, except arm splinted in 90 degrees of elbow flexion and neutral forearm pronation or supination. and additional padding over olecranon, medial and lateral epicondyles, and ulnar styloid pro describe placement of lower leg sugar tong splint - CORRECT ANSWER U-shaped splint starts at medial aspect of knee, passes under heel and proximal foot, extends to lateral aspect of knee. Provides great mediolateral support to ankle, while allowing full ROM of toes and knee. Is an alternative to the posterior mold when splinting the lower leg. 1. Consider applying stockinette unless concern constrictive from acute limb swelling. Place additional padding over lower leg and bony prominences, esp at medial and lateral malleoli and heel. 2. Immerse splint in a bucket of cool water. 3. Remove excess water from splint 4. w/ help of an assistant, maintain pt's foot and ankle in the position of function & position splint. Start by positioning just inferior to knee on medial side of leg, pass under heel and proximal foot, and then up along lateral side of the leg in a symmetrical fashion. If splint is too long, fold it back on itself, away from leg, at its lateral end. Carefully avoid making fingerprint indentations in the splint. CAUTION: place the padded side of splint against skin. 5. Secure splint using an elastic wrap, beginning distally and proceeding proximally. 6. Gently mold splint around medial and lateral aspects of lower leg, ankle, and foot. 7. Perform a postapplication splint assessment. NOTE: upper arm sugar tong splint similar, but starts at proximal medial upper arm, passes under elbow, and extends to distal lateral aspect of upper arm. Additional padding over medial and lateral epicondyles. Provides good stabilization of upper arm while allowing some pronation or supination and full ROM of wrist and hand. Often used for initial stabilization of humeral fractures. NOTE: lower arm sugar tong splint similar, but starts at mid-palmar crease, along volar forearm and elbow, and extends to MCP joints on dorsum of hand. Additional padding over bony prominences, esp medial/lateral epi 1. Identify the important aspects of patient education and cast care after a casting and splinting application. - CORRECT ANSWER o If given a sling for cast tell pt to remove it briefly 3-4 times/ day and perform shoulder and elbow ROM to prevent stiffness and loss of function o Give open or closed toe cast shoe w/ fastener straps to protect short leg cast. o Give pt crutches, a walker, or another assistive device o Advise pt to avoid getting cast wet (Before showering, wrap towel around top of cast, followed by a plastic bag thats tightly secured w/ tape) o Don't insert anything into the cast to relieve itching o Return for cast or splint check in 3-7 days; can replace splint w/ cast at this time o Notify provider if any numbness, tingling, weakness, skin lesions, or discoloration or ^ pain in immobilized extremity Explain the proper use of an oscillating cast saw to remove a cast without causing injury to the patient - CORRECT ANSWER o Demonstrate to pt that saw doesn't cut skin, padding, or stockinette o Press saw blade firmly against cast at a 90° angle until it is felt to have passed through the cast shell; lift saw out and move to adjacent spot to repeat sawing o If saw becomes too hot turn it off and let it cool o Cut cast down both sides then use a cast spreader to widen the cut until the two cast shells can be separated and removed o Avoid sawing over bony prominences (can put hard material between cast and skin for protection) 1. Recognize new technology that will likely replace plaster and fiberglass in the future. - CORRECT ANSWER o 3D printer casts what does the word suture mean? - CORRECT ANSWER The word suture describes any strand of material used to ligate (tie) blood vessels or approximate (sew) tissues. what are indications for wound closure? - CORRECT ANSWER Most superficial wounds heal w/o intervention. However, a superficial skin laceration extending into the subcutaneous tissues should be considered for closure to avoid undesirable outcomes. Suture, staple, or skin adhesive closure of wounds may be warranted for the following reasons: ■To decrease time required for the wound to heal ■To reduce the likelihood of infection ■To decrease amount of scar tissue likely to form ■To repair loss of structure, function, or both of the tissue ■To improve cosmetic appearance what are contraindications for wound closure? - CORRECT ANSWER all wounds, no matter how minor they may appear, can be result of serious injury to underlying structures. CI to suture closure of wounds largely to risk for infection and disruption of underlying structures (nerves, arteries, and tendons). Wounds that have following characteristics should be left unclosed, or at least very careful consideration should be given before electing to suture the wound: ■Wounds that require suturing to minimize infection and scar potential should be closed w/in 8 hours of the injury. Some wounds can be closed up to 24 hrs after if the anatomic location is highly vascular (face, neck, scalp), and the cosmetic appearance is an important consideration. ■Wounds that have a high likelihood of contamination should not be closed w/ sutures. Doing so may mask a developing underlying infection, thus delaying appropriate tx. ■ presence of FBs in underlying tissues is a consideration bc may remain a source of repeated infections if not thoroughly removed through irrigation, exploration, and extraction or debridement of devitalized and contaminated tissue. ■ Extensive wounds involving tendons, nerves, or arteries should be carefully considered before closure what are potential complications of wound closure? - CORRECT ANSWER ■ Infection ■Scarring, including keloid formation ■Loss of function and structure (scarring of an eyelid repair, resulting in incomplete closure of the eyelids) ■Loss of a cosmetically desirable appearance ■Wound dehiscence (wound margins separate and wound reopens) ■Tetanus Describe the epidermis? - CORRECT ANSWER epidermis is a thin layer of squamous epithelial cells, outermost surface of skin. Layer is void of blood vessels or nerve endings. Provides an excellent protective barrier when healthy and intact. The stratum germinativum (basal layer), is the parent layer for new cells & provides cells for new epidermis formation during wound healing describe the dermis? - CORRECT ANSWER dermis is much thicker than the epidermis. It is composed largely of connective tissue, such as fibroblasts; macrophages, lymphocytes, and mast cells. Some small blood vessels and nerve fiber endings are present at this level describe the superficial fascia describe the deep fascia - CORRECT ANSWER Deep to dermis is a layer of loose connective tissue that comprises the superficial fascia or subcutaneous tissue. Many blood vessels and nerve endings are located at this level. Subcutaneous fat is present, and quantity varies depending on region of body. Sensory nerve branches to the skin travel in the superficial fascia just deep to the dermis, which makes it ideal for injecting local anesthetic bc anesthetic spreads easily along this plane and abolishes sensation in the overlying skin The deep fascia is a relatively thick, dense, and discrete fibrous tissue layer. It lies just above muscle, tendon, or bone. If disrupted by the injury, it should be repaired to reestablish the supportive function of this layer. Failure to do so may result in disfiguration of the surrounding area. what are skin tension lines? how do these relate to wound closure? - CORRECT ANSWER aka Langer lines or lines of cleavage, are linear clefts in skin that indicate the direction of orientation of underlying collagen fibers. If skin is disrupted parallel to long axis of fibers, the wound tends to reapproximate. However, if wound crosses long axis of fibers perpendicularly --> disrupted in a manner that causes wound to gape open &, greater tension required to close the wound. Lacerations that run parallel to these lines naturally reapproximate the skin edges. Lacerations that run at right angles to the tension lines tend to gape apart what is a clean wound? what is a clean-contaminated wound? what is a contaminated wound? what is an infected wound? - CORRECT ANSWER ■ Clean: Incisions made during a surgical procedure in which aseptic techniques were followed, w/o involvement of GI, respiratory, or GU tract; likelihood of infection <2% and warrants routine primary closure. ■Clean-contaminated: Similar to clean wounds, except that GI, respiratory, or GU tract is involved ■Contaminated: Similar to clean and clean-contaminated, except theres gross spillage (bile, stool); traumatic wounds fall into this category. ■ Infected: Established infection before wound is made (I&D of an abscess) or heavily contaminated wounds (gross spillage of stool) what is primary intention wound closure? what is Secondary intention wound closure? what is Third intention or delayed primary intention wound closure? - CORRECT ANSWER Primary intention: All layers are closed. ■Best chance for minimal scarring ■Usually performed in clean and clean-contaminated wounds Secondary intention: deep layers are closed, superficial layers left open to granulate on their own from inside out. ■Often leaves wide scar and requires frequent wound care, consisting of irrigation and types of packing and dressings ■Prolonged process ■Reasons for use include excessive tissue loss and infection Third intention or delayed primary intention: deep layers may be closed primarily, superficial layers are left open until reassessment on day 4-5 after initial closure, at which time wound is inspected for signs of infection. ■If looks clean and has begun to granulate, is irrigated and closed. ■If looks as may be infected, left open to heal by secondary intention. ■These wounds often arise initially from contaminated wounds How can a pt be prepped for wound closure - CORRECT ANSWER ■Involves irrigating wound, which is major step in reducing the likelihood of infection. cleansing wound with 1% povidone-iodine and then, w/ the pt properly anesthetized, suturing the wound ■ Immunize the patient against tetanus, if necessary. describe the materials and procedure necessary for wound irrigation and cleansing? - CORRECT ANSWER 1. Don gloves and goggles 2. IRRIGATION- perhaps most important step in wound closure 60mL syringe w/ splash guard 21 gauge plastic IV catheter or irrigation needle w/ blunted end for fluid irrigation (squirt NS in short bursts to dislodge remaining matter, minimally 250-500mL but Several liters of saline solution may be needed CLEANSING 3. ■ A cleansing agent may be considered, but bc of tissue toxicity and lack of evidence, cant be routinely recommended. - if used apply to wound edges and surrounding skin using a bull's-eye/circular motion, inside moving outward and repeat 3 times. Avoid agent entering wound. 4. ■ Sterile, fenestrated drape -place over wound site and several sterile square or rectangular drapes to create a sterile field. NOTE: If on a limb, sterile drape should be placed under extremity before other drapes are applied. 5. DEBRIDEMENT- if necessary to remove dead or devitalized tissue ■ Scalpel or sharp tissue scissors -take care to preserve tissue, yet conversion of a jagged laceration to a surgical one may be required for optimal closure to occur. Sometimes subQ tissue may need to be undermined to allow for adequate closure of tight wound edges. how can you determine what type of suture material is necessary for closure of wound? - CORRECT ANSWER first item to consider is absorbable or nonabsorbable suture based on anatomic location and healing potential. ■ Absorbable suture used in mucosal areas (Vicryl, chromic) ■Nonabsorbable suture (silk, stainless steel, nylon, polypropylene, polyester fiber) can be further classified into monofilament (single strand) or multifilament (several strands, which are often braided). -advantage of monofilament suture= passes through tissue more easily than braided suture. disadvantage = has less tensile strength than a multifilament suture. -advantage of multifilament suture= better flexibility, disadvantage =may harbor organisms more easily w/in braid. how is suture size noted? Which is smaller, which is larger? - CORRECT ANSWER Suture size is denoted by the number of zeros, and increases in number as the diameter of suture decreases; for example, 7-0 is smaller than 1-0. what suture size is indicated for: vagina scrotum penis scalp ear eyelid eyebrow nose lip oral mucosa face/forehead trunk extremities hand extensor tendon foot/sole - CORRECT ANSWER Vagina—Deep 4-0 absorbable Scrotum— Deep 5-0 absorbable Penis 5-0 monofilament * Nonabsorbable monofilaments include nylon (Ethilon, Dermalon), polypropylene (Prolene), and polybutester (Novafil). † Absorbable materials for dermal and fascial closures include polyglycolic acid (Dexon, Dexon Plus), polyglactin 910 (Vicryl), polydioxanone (PDS [monofilament absorbable]), and polyglyconate (Maxon [monofilament absorbable]). ‡ Absorbable materials for mucosal and scrotal closure include chromic gut and polyglactin 910 (Vicryl). when should a conventional cutting needle be used? when should a reverse cutting needle be used? when should a taper needle be used? - CORRECT ANSWER The type and shape of needle should be considered: ■A conventional cutting needle is often used for skin and has three cutting edges (two lateral and one on the inner concave curve). ■A reverse cutting needle is often used for tough tissue, such as ligament, and also has three cutting edges (two lateral and one on the outer concave curve). ■A taper needle is circumferentially rounded, with a point, and is useful intraoperatively on delicate tissue, such as peritoneum. what is a tetanus prone wound? - CORRECT ANSWER Greater than 6 hours old Greater than 1 cm deep Stellate or have an avulsion configuration Associated with devitalized tissue Contaminated with soil, feces, or saliva From a missile (e.g., gunshot wound) From a puncture or crush Associated with a burn or frostbite **if tetanus prone wound: -if pt w/ UTD immunization-> immunization w/ Td if has been >5 years -if not UTD --> require both passive immunity w/ tetanus immunoglobulin (TIG) and active immunity with Tdap Td (Tdap is once in lifetime so if had before give Td) [place them in diff syringes and deliver at separate anatomic locations] **in a non-tetanusprone wound in an adult --> Td if it has been 10 years since last immunization. Identify the important aspects of post-procedure care after wound closure. - CORRECT ANSWER Keep the wound site clean and dry (dry for at least 48 hours) Elevate area if applicable Remove dressing and check wound twice a day for signs of infection, maybe apply abx ointment, depending on wound either cover again or leave open Cold compress for 1st 48 hours after surgery in sites w/ soft tissue involvement Describe infection and warning signs to patient Advise pt when should return for a wound check and suture or staple removal. Educate pt scars take 1 yr to mature and after initial healing best to avoid strong sunlight & apply sunscreen Abx for high risk wounds: - >12 hours old at initial presentation, esp on hands -Human or animal bites, including intraoral laceration -Crush wounds - Heavily contaminated wounds - If involve avascular areas, (cartilage of ear) - involve joint spaces, tendon, or bone -Severe paronychia and felons - in pts w/ Hx of valvular heart disease or w/ immunosuppression (DM, chronic steroid use, HIV) SUTURE REMOVAL Anatomic location dictates length of time sutures should be left in place [add 2-3 days for extensor surfaces] adults heal more slowly than children Using sterile instruments, cut the suture to minimize dragging contaminated suture through pt's body. what is follow up care instructions for closure of a wound with wound adhesive? - CORRECT ANSWER Notify pt that adhesive naturally starts to slough off 5-10 days after placement. Caution pt to avoid scratching, rubbing, or picking Instruct pt that area shouldnt be scrubbed, soaked, or exposed to prolonged wetness (kept dry; quick shower can be taken, if necessary). Advise pt not to apply medication in liquid or ointment form to site. The cost of skin adhesives is comparable when costs for suture kits, suture materials, clinician time, and f/u visits for suture removal are considered. who does the CDC recommend using standard precautions for? what are standard precautions? - CORRECT ANSWER The CDC recommends standard precautions for the care of all patients, regardless of their Dx or presumed infection status. Standard precautions should be followed when performing any procedure in which exposure to, or transmission of, infectious agents is possible. These guidelines attempt to minimize exposure to infectious body fluids. Standard precautions are a set of infection control practices used to reduce the risk of transmission of diseases that can be acquired by contact with blood, body fluids, secretions, mucous membranes, and nonintact skin from both recognized and unrecognized sources of infection. -practices include: appropriate/consistent hand hygiene, use of PPE, and appropriate isolation procedures, if needed. "Implementation of standard precautions constitutes the primary strategy for the prevention of healthcare-associated transmission of infectious agents and health care personnel." What is body substance isolation? - CORRECT ANSWER An entirely different approach to isolation, referred to as body substance isolation (BSI), required personnel, regardless of pt infection status, to apply clean gloves immediately before all pt contact w/ mucous membranes or nonintact skin and to wear gloves if contact w/ any moist body substances was likely. An apron or other barrier was also to be worn to keep the provider's own clothing and skin clean. - Recommendation also made that personnel be immunized if proof of immunity could not be documented when barriers, such as masks, could not prevent transmission by airborne routes. In addition, when immunity was not possible, as with TB, masks were to be worn during all pt contact. Goggles or glasses, hair covers, and shoe covers were also used as barriers. -Careful handling of all used sharps and the disposal of used items in rigid puncture-resistant containers were stressed. -Trash and soiled linen from all pts bagged and handled in the same manner. This approach sought to protect the pt from contracting nosocomial infections and provider from bacterial or viral pathogens that might originate with the pt what are the 10 standard precautions? - CORRECT ANSWER 1. Hand Hygiene 2. Personal Protective Equipment (PPE) 3. Respiratory Hygiene/Cough Etiquette 4. Patient Placement 5. Patient-care Equipment and Instruments/Devices 6. Care of the Environment 7. Textiles and Laundry 8. Safe Injection Practices (apply to the use of needles, cannulas that replace needles, and, where applicable, IV delivery systems) 9. Infection Control Practices for Special Lumbar Puncture Procedures 10. Worker Safety: Adhere to federal and state requirements to protect from exposure to blood-borne pathogens what are the indications and principles of sterile technique? - CORRECT ANSWER The goal of asepsis is to provide an environment in which to perform an invasive procedure on a patient that prevents exposure to infectious agents, thereby minimizing recovery time and maximizing healthy healing. The most obvious indication for the use of sterile technique is surgery. Aseptic practice, however, should also be maintained outside the operating room for a variety of bedside procedures, including biopsies, central line placements, various dressing changes, LPs, thoracentesis, and paracentesis. According to the WHO's Global Guidelines for the Prevention of Surgical Site Infection (SSI), theres overwhelming evidence that SSIs are a leader in health care-acquired infections, representing a significant burden in terms of pt M&M, ^ in drug-resistant microorganisms, and additional costs to health systems and service payers worldwide. When in doubt, be as clean as possible—no one will ever be faulted for using extra precaution and implementing an aseptic technique for infection prevention. what are parts of the aseptic technique? - CORRECT ANSWER Gowns are considered sterile in front from shoulder to waist level, and the sleeves are considered sterile to 2 inches above the elbow. ■ Sterile property, including hands, instruments, and the table, are considered sterile above table or waist-height only. Nonsterile personnel must remain at least 12 inches away from the sterile field. Remain facing the sterile field when moving within or around the sterile field to avoid accidental contamination. What are contraindications and Potential Complications to using aseptic technique ? - CORRECT ANSWER A documented allergy or allergic dermatitis to a specific aseptic agent or a material used in the drapes, gloves (e.g., latex), or other protective wear are the only relative contraindication to sterile technique. In most instances, another agent or product may be substituted. The major culprits of aseptic agents leading to skin breakdown are associated with CHG (chlorhexidine gluconate) cleansers and iodine sealants, whereas allergic reactions to more simple alcohol-based products are uncommon. 5 Skin reaction severity directly correlates with contact time and concentration of the antiseptic. If skin irritation does occur, it is not always evident immediately. Skin breakdown is a known risk of infection; therefore, as soon becomes apparent, should be addressed with appropriate tx what materials are necessary for maintaining aseptic technique? - CORRECT ANSWER For preparing the patient ■Hair clippers to remove hair from the procedure site if necessary (no razors) ■ Antiseptic soap, preferably alcohol-based combo agents such as CHG or povidone-iodine. These are rapid-acting, broad-spectrum antimicrobials effective against gram-positive and gram-negatives. Each is prepared in combo w/ a detergent to give a cleansing action and antimicrobial effect ■ Sterile towels, gauze sponges, large clamp or ring forceps to hold the preparation sponge or gauze For the provider ■ Sterile surgical gowns. These can be purchased as sterile disposable gowns, or reusable gowns can be obtained through a laundering service that utilizes gas sterilization. ■ Sterile gloves, Mask that fits snugly over the nose and mouth ■ Hat, whether skullcap or bouffant, that covers all hair except for minimal exposure at the nape of the neck or modest sideburns. The benefits of cloth versus disposable scrub hats and skullcaps versus bouffant have not yet been studied. 6 ■Handwashing materials ■Chlorhexidine gluconate or povidone-iodine solutions ■ Sterile disposable scrub brushes or sponges impregnated with chlorhexidine gluconate, povidone-iodine, or other CDC-approved products describe the procedure of the surgical scrub - CORRECT ANSWER 2 methods of surgical scrubbing typically used are the timed, or anatomic, scrub, which lasts for a total of 3 to 5 minutes ; and the counted, or numbered, scrub in which there is an allotted number of strokes for each body part. In the latter method, 30 strokes are needed for the fingernails and 20 strokes are needed for each surface of the fingers, hands, wrists, arms, and elbows, respectively. Both methods begin with scrubbing of the fingernails, followed by each of the four surfaces of the fingers, then to the palmar and dorsal surfaces of the hand and wrist, then to the forearm, and finally extending to 2 inches above the elbow. One hand and forearm should be completed first before moving on to the next and never return to a previously scrubbed area. Studies demonstrate that scrubbing for 5 minutes reduces microbial counts as effectively as the previously used 10-minute scrub, which resulted in skin damage. Alternatively, a 2- to 3-minute scrub also reduces the bacterial load, therefore being as effective as the 5-minute scrub. It is recommended to follow one's institution's protocol, but that no scrub should be less than 2 minutes. what should be done if a glove is punctured? - CORRECT ANSWER If a glove is punctured during a procedure, promptly remove it, wash hands with soap and water or an alcohol-based hand rub, rescrub using the timed or counted method, and replace with a new glove. Immediate washing is important in case of skin exposure. If an injury from a sharp instrument or device does occur, hospital protocols for stick injuries should be implemented immediately.