How often  do you check the label when pouring sterile solution?

3x's

•  1st when gather off shelf
• 2nd before pouring
• 3rd after pouring

Always check for what on normal saline or sterile solution?

• expiration date
• date and time opened( if none throw away)

Sterile h20 & normal saline good for how long after opening

• 24 hours
• should have date and time opened ( if not throw away)

• cover label of bottle
• prevents dripping of contents over label

keep what between bottle and sterile/clean container your pouring into

• 1 inch distance

purpose of wet to dry dressing

nosocomial infection

• hospital acquired
• most bacterial: catheters,sugical,wounds,pneumonia

antiseptic

• stops growth of microbes

germacidal

• kills germs ( think homocide)

Fomite

• contaminated object that transfers pathogen

Abcess

• local, walled off, collection of puss

cellulitis

• spreading of bacterial infection of skin&sub-q tissues.

Empyema

• Collection of inflamed,infected fluid in 2 body cavity (usually pleural space) 

fistula

• abnormal tube-like passage between 2 body cavities or cavity and skin

granulation

• fleshy projections formed on the surface of a gaping wound that is healing by secondary intention

Medical asepsis

• clean technique
• inhibits growth/spread of pathogens

surgical asepsis

• sterile technique
• destroys all microorganisms and their spores

spores

• reproductive cells of some microorganisms

disinfection

• application of disinfectant to destroy all pathogenic microorganisms

Chemical disinfectent

• May cause metal corosion
• used on non-living surfaces
• lysol, cidex, bleach 1:10

1:germicide

2: bactericides

1. destroy germs
2. destroy bacteria

Antiseptics

• used on tissue pre-op
• used as post-op scrub

Sterilization

• process-completely removes-destroys all organisms and their spores

1. physical methods: chemical,autoclave, gas
2. boiling
3. dry heat

physical sterilization

• chemical
• autoclave
• gas
• most common, dependable,economical, quickest

autoclaving

• steam under pressure
• most rubber & plastic devices damaged by this process

Boiling sterilization

• clean then boil 15-20 min
• spores/some viruses still alive after

dry heat sterilization

• heat oven to 350° for 2 or more hours
• this disinfects> does not kill all organisms

sterile phrase

us surgical asepsis when protecting patnt.from pathogenic microorganisms in the enviroment:

• Inserting/irregating catheter*
• Iv insertion
• sterile dressing changes
• injections of medication
• trach care*

Never leave a:

• a sterile field
• always keep it within your vision range

throw sterile package out if:

• missing expiration date*
• outdated
• label blurred
• have touched contaminated object

position & open sterile package..:

• so you dont touch or reach across the package
• person and clothing considered contaminated

Keep sterile gloved hands....:

• above waistline & within eyesight
• hands together w/fingers intertwined

A wet sterile field is:

• considered contaminated

when opening package and setting up sterile field:

• stay within 1 inch margin from outer edge
• outer edge considered contaminated

Opening sterile packages

1. wash hands
2. check for:
   •  dampness
   •  holes
   • tears
   • expiration dates
   • autoclave tape
   • sterile indictor inside
3. open 1st w/ flap away from you,dont reach across
4. anything off table is considered contaminated

type of wrappers

• agency wrapped item
• commercially packaged item

glove what hand first in sterile gloving

• Glove dominant hand first using thumb & 1st 2 fingers of non-dominant hand>grasp inside surface of folded cuff of sterile glove

when removing sterile gloves...:

• 1st use dominant gloved hand to grasp non-dominant hand glove near cuff end.(remove>turning inside out)

primary intention

• Surgical wounds/small lacerations
• little loss of tissue
• straigt line>minimal scarring
• edges of wound well approximated

secondary intention

• a lot of tissue loss- edges cant be approximated
• heals w/granulation tissue
• gr8er chance of infection, longer healing,large scars

tertiary intention

• extended time btwn. occurrance and sutureing*
• left open to prevent infection

how aging affects wound healing

• vascular changes impair circulation
• liver function reduced>alters clotting
• inflammatory response slowed
• antibody/lymphocyte formation reduced
• less pliable collagen
• less elactic scar tissue

Nutrition affecting wound healing

• stress from wounds increase nutrition requirments
• offer fluids q hour

undernourished are...

• suceptible to infection & poor wound healing

obesity affecting wound healing

• fatty tissue:
  • lacks adequate blood supply
  • difficult to resist infection
  • difficult to deliver nutrients&cellular elements
  • hard to heal

impaired oxygen affecting wound healing

• causes decreased hemoglobin>reduces arterial o2 levels in capallaries>interferes w/tissue repair

Smoking affecting wound healing

• reduces amnt. of hemoglobin in blood>decreases tissue O2
• can cause hypercoagulability>prevent tissue oxygenation

Drugs affecting wound healing

(sterroids)

• reduce inflammatory response>
• suppresses:
  • protein synthesis
  • wound shrinking
  • epithelialization
  • inflammation

drugs affecting wound healing

(antibiotics)

• Lead to increase risk for superinfection

drugs affecting wound healing

(chemo drugs)

• depress:
  • bone marrow function
  • # of luekocytes
  • inflammatory response

Diabetes affecting wound healing

• causes small blood vessel disease>bad circulation
• hemoglobin hold on to O2>doesnt get2 tissues
• phagocytosis altered
• allows for fast or fungal infections

Rafdiation treatment affecting wound healing

• causes fibrosis & vascular scarring
• tissues become fragile & poorly oxygenated

symptoms of wound infection appear:

symptoms of wound infection are:

• Purrulent/increased drainage W/foul smell
• increase WBC count
• fever
• pain, redness,swelling in or around wound
• (PIFP)

Check dressing how often

• Frequently for 1st 48 hrs.
• q 8 hrs after that

serosanguineous drainage

• combo of bloody fluid and plasma

signs and symptoms of dehiscence and evisceration

• Increased serosanguineous drainage Btwn. post-op days 4-5(dehiscence)
• ptnt. verbalizes, something loose given way

treatment for dehiscence or evaseration

• cover with sterile towels soaked in normal saline
• notify physician ASAP

assess wound

• apporximated
• color of wound and surrounding areas
• drains/tubes
• sutures/staples

When assessing wound should appear :

• Edges clean/well approximated
• crust around edges
•  red/swollen in beginning
• by end of week 1>bruising, but skin normal

serous drainage

• clear/watery

sanguineous drainage

• bloody

purulent drainage

• made of
  • liquified dead tissue
  • WBC's
  • debris
  • live & dead bacteria

Assessment of drainage check:

• on wound
• in drains
• under patient

1. increasing pain
2. incisional pain

1. indicates need for futher assessment
2. unsually most sever 1st 2-3 post-op

clean dressing change is:

• most often used method
• can be used in home care

Montgomery straps

• Used to secure main dressings
• prevents skin breakdown

Need dr. order for:

• Suture/staple removal
• binders used for support(not if holding bandage in place)

Sutures/staples generally removed

7-10 day after surgery W/ dr. order

• Head/neck-3-5 days after insertion
• chest/abdmn.- 5-7 days "            "
• extremeties- 7-10 days"              "

Staples popularly used:

• places where scarring not important
• Jnts.
• abdominal/orthopenic surgerys

Suture/staple/incision care

• Use aseptic technique
• use clean gloves
• use sterile tools

When done removing staples

• count staples/sutures
• staples go in sharps container

specifics for suture removal

1. grasp knot
2. lift
3. cut under
4. repeat

 need to have how much space btwn. bone & suture

• Need 5 millimeter space

banages

• cloth strips
• gauze(kurlex,kling)
• self stick wrap( coban)
• elastic bandage( ace)
• very 1-6 inch. in width

binders

• designed for specific body part
• used for support & hold bandages in place
• slings
• chest & abdm. binders
• t- binders: 4 inbetween legs

purposes of bandages and binders

• Secure dressings
• apply pressure
• support
• immobalize part

S&S of impaired circulation

• cold
• cyanosis
• decreased pulse/capillary refill/movement
• numbness/tingling
• pain

with bandages/binders...leave what exposed?

• leave fingertips, toes exposed, but not larger body parts

skin surfaces

• should not be bandaged directly together

use what kind of material for bandages

heat/moisture may cause skin to:

when bandaging/binding place/support body part in:

• normal functioning position

bandage extremities :

before bandaging do what to extremity?

• elevate 15-30 min if possible

types of applicating roller bandages

• circular
• spiral-for fingers/wrists/trunk
• figure 8- jnts.
• recurrent stump

To remove bandage:

• cut up length of bandage away from injured site

t-binder

•  single 4 women, DBL for men,
• used to secure dressings
  • rectum
  • perineum
  • groin

slings

straight binder

• usually 6-8 inches
• 4 chest or abd. support
• also to secure dressings
• held together by pins/velcroe

general documenting

• date/time
• what used, why, and how many

documenting for staples/sutures

• how many removed
• cleanses with what
• what aseptic used
• drainage (should be little to none)
• condition of wound edges

documenting with bandages & binders

• Type used
• CMS check

aims of nursing in applying heat/cold

1. promote wound healing
2. facilitate comfort
3. use knowledge & skill
4. follow safety measures

Heat causes

• vasodialation>causing increased circulation

Heat results in

• Accelerated inflammatory response to promote healing

viscocity

• thickness of fluid

Will see what in systemic effects of heat?

• ↑ pulse,cardiac output
• ↓BP
• sweating

systemic effects with heat occur because:

• When heat applied to large body area>increases blood flow to that area>depressing it to other areas

Heat/cold generally=

• 15-20 min
• need dr. order

cold application causes

• vasoconstriction>reduces blood flow
• ↓ local release of pain producing sub.(histamine,saratonin,bradykinin)
• reduces edema/inflammation
• increases coagulation @ wound site>controls bleeding.

Systemic effects of cold app.

• ↑ BP
• shivering/goosebumps
• prolonged may cause injury

rebound phenomenon

• Heat: max. dialation in 15 min.>then constricts
• COLD: max vasoconstriction in 15. min>then dialates

Moist heat/cold

• more penetrating/intense than dry

heat shouldnt be applied :

• to open wound imme. after trauma(cause bleeding)
• to localized malignant tumors
• over metalic implants
• to testes
• abdomen of pregnant women

• for open wound
• 2 ptnt. with impaired peripheral vascular circulation

application of hot water bottle

• Advantages:
  • easy
  • inexpensive
• Disadvantages:
  • leaks
  • weight, uncomfortable
  • danger of burns

application of electric heating pad

• Advantages:
  • easy
  • relativly safe
  • constant/even heat
• Disadvantages:
  • can cause burns

Aquathermia pads

• water-flow pads
• attached to H2O container(distilled),has fill line
• looks like heating pad but rubber(cover w/pillowcase)
• temp. not above 105 degrees
• allow to warm for 2 min
• should go over person>Not under

aquathermia pad used for:

• 20-30 min
• for back pain, muscle spasms,thrombophlebitis,inflammation

heat lamps placed:

Heat cradle

• semi-circular metal cradle>fits on bed
• 16-18 inches from ptnt. for 15 min

sitz bath

• moist heat to pelvic/perineal area
• 105-110 degrees
• 20-30 min

warm soaks

• like whirlpool
• can have medicated solution

Ice bag

• Simple/inexpensive
• but leaks
• apply only 20 min>remove for 1 hour>reapply

Cold packs

• commercially prepared
• gel remains pliable
• molds to area

cooling blanket

• Place Under ptnt*
• reduces high temps.>reduce BMR 
• place another blanket over them

cold compress

• cold washcloth
• put on 20 min> take off 1 hour> reapply

Documentation of heat/cold application*

• What applied
• why doing, how often, and how long.
• responses & toleration'
• results/effectivness
• signature
• vital signs