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Clinical Assistant Chapter 57

Terms in this set (97)

cicatrix
early scar tissue that appears pale, contracted and firm
dehiscence
the separation of wound edges or rupture of a wound closure
infection
invasion of body tissues by microorganisms which then proliferate and damage tissues
sterilization
complete destruction of all forms of microbial life
autoclave
steam under pressure is the best method of sterilization. Kills pathogens and spores. Pressurized steam is fast, convenient and dependable
Two factors for effective autoclave
Pressure and moisture effective for killing all microorganisms
Autoclave fact 1
heat higher than boiling point, coagulates protein and explodes cells of microorganisms
Autoclave to be effective:
The steam moisture must come in contact with all surfaces being sterilized.
Recommended autoclave temperature
121° - 123°C or 250° - 255° F
How long do you autoclave for
unwrapped items 20 min. Small wrapped items 30 min. Large or tight wrapped 40 min.
When does autoclave processing time start
after the autoclave reaches correct temperature and 15 lbs per square inch pressure
Gravity Cycle (fast exhaust)
1. Sterilize stainless steel instruments &glassware
2.Fills with steam and held at set temp. for set period.
3. Valve opens and chamber rapidly returns to atmospheric pressure
4. Drying time may be added to the end of the cycle
5. Cycle most often used in Dr's office
Liquid cycle (slow exhaust)
1. Used to prevent sterilized liquids from boiling
2. Steam is exhausted slowly at end of cycle allowing liquids to cool
Prevacuum cycle
1. Used for Porous materials
2. Chamber is partially evacuated before introduction of steam for greater steam penetration
3. Not available on all machines
Errors of autoclave
1. Superheated steam (dried out)
2. Wet steam - failing to preheat chamber causes excessive condensation
3. Residual air around instruments
Wrapping autoclave materials
Wrapper must be permeable to steam and impervious to contaminants
Autoclave materials:
clean muslin, disposable autoclave paper, polypropylene bags
Wrapping instruments
Must allow for pack to be opened without becoming contaminated
What to check for with wrapping
1. Free of holes
2. Wrap all hinged instruments in the open position
3. Place a gauze sponge around the tips of sharp instruments to prevent piercing wrapper
4. Place a double folded towel on the tray then position instruments for large quantity
5. Polypropylene bags take longer then stainless steel pan
6. insert jaws of the instruments first to ensure that the grasping end of the instrument can be reached easily when bag is opened (opposite side)
7. Indicate on wrapper what is in the package
Label each pack with:
instrument contents, sterilization date, your initials
sterilization idicators
Achieved when steam reaches the optimum temperature
chemical sterilization indicator (autoclave tape)
contains a chemical dye that changes color when exposed to steam
Is the chemical sterilization indicator an absolute indication of proper sterilization
No.merely indicates that a high temperature was reached (not time, correct temp or steam were maintained)
Main function of autoclave tape
To verify that the package has been autoclaved
Biologic sterilization indicators
Used to test if autoclave is properly working
Spore strip indicator -
temperature sensitive dye that changes color when proper combination of steam, temperature and time achieved (placed in center of largest pack)
Test indicator kits use ampules of:
Bacillus stearothermophilus which is destroyed at 121° C (250° F). Then sent to lab for analysis
Quality Assurance Records for Office Sterilization
Log must be kept of type of control test done, when performed and testing result
Loading the Autoclave
1.Articles should be resting on their edges and not crowded
2. stainless steel racks prevent packing too tightly
3. jars, bottles trays must be wrapped and placed on their sides
Do instruments need to be always wrapped?
Not if they don't need to be sterile when used later
An example of a unwrapped instrument
vaginal speculum
Why isn't the vagina sterile
naturally open to the external environment
What should be done with vaginal speculum
sanitized, disinfected and sterilized unwrapped or placed on tray
What should the pressure gauge read on the autoclave to open
"0"
How long do you wait before unloading autoclave
at least 15 minutes (will vary)
capillary attraction
action that draws moisture through the surface of materials
When do you reautoclave
1. sterilization indicator strip fails
2. after a failed biologic test
shelf life of sterilized packs
1.muslin and autoclave paper packs 28 days from date
2. polypropylene bags sterile up to 6 months from date sterilized.
gas sterilization
OSHA concerns of reproductive organ damage and cancer (unrealistic to use in office)
Chemical sterilization
When cannot be exposed to high temps of steam, submerged in chemical bath with a closed lid for 8 hours or longer. Remove with sterile forceps and rinsed with sterile water
Fenestrated drape
eye sheet, surgical drape with an opening in the center
electrosurgery-electrocautery
high frequency current to cut through tissue and coagulated blood vessels
cauterize
burn or destroy
electrosurgery may be used to destroy:
granulations and small polyps
laser surgery
Light Amplification by Stimulated Emission of Radiation
Microsurgery
Major uses in ophthalmologic surgery
endoscopic procedures
miniature camera mounted on a flexible tube with an optical system and a light source
cryosurgery
very low temperature probe to destroy tissue by freezing it on contact
Medical Assistant assisting with surgical procedures
prep of patient
setting up sterile field
preoperative preparation may include
1.blood and urine tests
2.completion of a consent form (maintain...lol)
3.gathering of the current history of illnesses 4.medications and allergies
5. shave prep, cleansing enemas
No shaving of area
clipped or buzzed
Where should you place hand on bottle
on label
pick up second glove by
slipping gloved fingers under the cuff
two methods of suturing
continuous running suture and interrupted suture (separate knots)
open wound
outward opening where the skin is broken exposing the underlying tissues
closed wound (non penetrating)
underlying tissues are damaged
aseptic wound
clean wound not infected with pathogens
septic wound
infected with pathogens
laceration
jagged, irregular breaking or tearing of tissues, blunt trauma
puncture
piercing of the skin by a pointed object
abrasion
superficial wound made by scraping of the skin
avulsion
tissue forcibly torn or separated
surgical incision
a neat clean cut
hypodermic puncture
an injection under the skin
contusion
a closed nonpenetrating wound in which blood from broken vessels accumulates in tissues
incision
a neat clean cut from sharp objects
lag phase (wound healing)
phase 1 - when the blood vessels contract to control hemorrhage and blood platelets form and act as glue to plug wound
Fibrin
released into wound and clotting begins, collects RBCS and form a scab
Macrophages
arrive about 12 hours after to clear away bacteria and dead tissue
fibrin threads
1-4 days pull edges of wound together under scab
proliferation (wound healing)
Phase 2-new growth period lasts 5 - 20 days. Tissues repair themselves, new cells form and wound continues to seal. Cicatrix forms
Remodeling phase (wound healing)
Final phase - day 21 and on - larger wounds build a bridge of new tissue to close the gap of the wound. Cells produce protein call collagen that gives wound strength and forms a scar tissue
collagen
connective tissue
scar tissue
not true skin, very strong but lacks elasticity and void of normal blood supply and nerves
first intention
clean surgical wound that has been sutured closed and heals quickly
second intention
tissues that are severely damaged or purposely kept open.
granulation
healing from the bottom of the wound outward
debridement
removal of debris
open wound healing advantages
circulate air
not irritated by dressing
stays dry, inhibits growth
Dressing
sterile covering placed over a wound
Bandages
hold dressings in place and help maintain even pressure
types of bandages
gauze, cloth or elastic rolls
Medical assistant's main responsibility
carrying out sanitation, disinfection and sterilization procedures
sanitization
cleaning of instruments and the environment to reduce the number of pathogens
disinfection
destruction of pathogens by physical or chemical means
sterilization
destruction of all microorganisms
asepsis
condition of being free of infection or infectious material
medical asepsis
destruction of organisms after they leave the body
surgical asepsis
complete destruction of organisms on instruments or equipment that will enter the patient's body
perforated wound
penetrating wound that passes through to a body organ or cavity such as a gunshot wound
open wound classifications
laceration, puncture, abrasion, avulsion, incision, puncture, contusion
incised wound
clean edge and is made with a cutting instrument. Result of surgery, accident or knife wound
lacerated wound
torn or mangled tissues made by a dull or blunt instrument
puncture (penetrating) wound
sharp slender object such as a needle or ice pick passes through the s kin into the underlying tissues
packing
long think packing material impregnated with an antiseptic or lubricant
steri strips
used on areas of the body that are protected from movement and stress, don't leave scars, reduce chance of infection
when can a medical assistant apply steri strips
if they are applied after suture removal for support for healing tissues.
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