Surgical Tech (Appleton & Lange) Part 5

A self-retaining retractor is a type of surgical instrument used to hold back tissues and organs during a surgical procedure. The Weitlaner retractor is a specific type of self-retaining retractor that features sharp, pointed prongs that can be adjusted to hold tissues in place. It is commonly used in orthopedic and general surgical procedures to provide access and maintain exposure to the surgical site. The Lincoln, Hibbs, and Deaver retractors are other types of surgical retractors, but they are not self-retaining like the Weitlaner retractor.

When positioning an aging patient, it is important to consider all of the factors mentioned: skeletal changes, limited range of motion of joints, and tissue fragility. Skeletal changes such as osteoporosis can make the patient more prone to fractures, while limited range of motion of joints can affect their ability to move and maintain proper positioning. Additionally, aging skin becomes more fragile and prone to damage, making it crucial to handle the patient with care to avoid skin tears or pressure ulcers. Considering all of these factors is essential for ensuring the safety and comfort of the aging patient.

The explanation for the correct answer, "yes," is that the question asks the learner to "Learn these instruments and pick 'Yes' to get this question correct." Therefore, selecting "yes" indicates that the learner has learned the instruments mentioned in the previous questions.

Positioning the patient for a procedure requires ensuring maximum patient safety and surgical site exposure. To achieve this, it is important that the patient's body does not touch any metal on the table, as this can cause discomfort or injury. Additionally, equipment, Mayo stand, or personnel should not rest on the patient to avoid unnecessary pressure or obstruction during the procedure. Lastly, padding bony prominences helps prevent pressure ulcers and provides added comfort for the patient. Therefore, all of the above measures contribute to maximum patient safety and surgical site exposure.

The correct answer is "only in front from chest to sterile field level, and sleeves from elbow to cuffs". This means that gowns are considered sterile only in the front area from the chest to the level of the sterile field, and the sleeves are considered sterile from the elbow to the cuffs. The rest of the gown, including the back and neck area, is not considered sterile.

The explanation for the given correct answer is that the answer to the previous question (which is not provided) must be "YES" in order to get this question correct.

The surgeon is ultimately responsible for obtaining consent because they are the one performing the procedure and have the most knowledge about the risks and benefits involved. They are the ones who will be directly responsible for the patient's care and outcomes, so it is important for them to have a clear understanding of the patient's consent before proceeding with any procedure. The operating room supervisor, circulating nurse, and unit charge nurse may also play a role in the consent process, but the ultimate responsibility lies with the surgeon.

Eyeware, goggles, and/or faceshields should be worn on every case as a precautionary measure to protect the eyes and face from potential hazards or splashes that may occur during any type of case. This includes orthopedic cases, vascular cases, and positive HIV cases. Wearing protective eyewear helps to prevent any potential injuries or exposure to infectious materials, ensuring the safety and well-being of healthcare professionals involved in the procedures.

When preparing a patient for a breast biopsy, the breast scrub is either eliminated or done very gently to avoid the dispersal of cancer cells. Scrubbing the breast vigorously can cause the cancer cells to spread to other parts of the breast or even to nearby lymph nodes, potentially leading to the spread of the disease. Therefore, it is important to handle the breast with care during the biopsy preparation to minimize the risk of cancer cell dispersal.

An Auvard is a speculum.

An effective surgical hand scrub involves scrubbing for a specific amount of time or a specific number of strokes, and the scrubbing motion should start from the hand and move towards the elbow. This ensures that all areas of the hands and arms are thoroughly cleaned and reduces the risk of contamination during surgery.

In the event that a child needs emergency surgery and the parents cannot be located to sign the permission, a written consultation by two physicians other than the surgeon will suffice. This means that if the parents cannot be reached, the medical team can seek the opinion and agreement of two other physicians to proceed with the surgery. This ensures that there is a consensus among medical professionals regarding the necessity of the surgery and helps to protect the child's well-being in urgent situations.

The correct answer is "from the incision site to the periphery in a circular motion." This is because washing and painting the skin in this direction helps to minimize the risk of contaminating the incision site. By starting at the incision site and moving outward in a circular motion, any potential bacteria or debris on the skin is pushed away from the incision, reducing the likelihood of infection.

In sterile environments, it is important for sterile persons to face each other when passing in order to maintain sterility. This is because facing each other reduces the risk of contamination from nonsterile areas or individuals. Therefore, the correct answer is that a sterile person faces a nonsterile person when passing. The other statements mentioned in the question are true and are related to maintaining sterility, such as discarding instruments or sutures hanging over the table edge and ensuring that wrapper edges are unsterile.

The instrument shown above is a dental mouth gag, which is commonly used in tonsillectomy procedures to hold the patient's mouth open and provide access to the tonsils. Therefore, it would be found in a tonsillectomy set.

The correct answer is "a form authorizing all treatments or procedures." A general consent form is a document that gives permission for various medical treatments or procedures to be performed on a patient. This form ensures that the patient understands the risks and benefits of the treatments and gives their informed consent for them to be carried out. It is a standard practice in healthcare settings to obtain a general consent form from patients before providing any medical intervention.

Cochlear implants are electronic devices that are used to restore hearing in individuals with severe hearing loss or deafness. These implants work by bypassing the damaged parts of the ear and directly stimulating the auditory nerve, allowing the person to perceive sound. The electrode device mentioned in the question is a crucial component of the cochlear implant system, as it is responsible for transmitting electrical signals to the auditory nerve, which then sends these signals to the brain for interpretation. Therefore, the correct answer is "to restore hearing."

Removing the gloves before the gown does not meet safe criteria because it can lead to contamination. The gloves act as a barrier between the hands and the gown, preventing any potential pathogens or contaminants from transferring onto the hands. By removing the gloves first, there is a risk of touching the contaminated gown with bare hands, increasing the likelihood of cross-contamination. It is recommended to remove the gown first, followed by the gloves, to ensure proper infection control procedures are followed.

The correct answer is to report it to the supervisor or proper administrative authority. This is because the surgeon performed an additional procedure without obtaining permission, which is a violation of medical ethics and legal requirements. The circulating nurse has a responsibility to report this incident to the appropriate authority to ensure that proper action is taken and the patient's rights are protected.

Contaminated areas should be scrubbed last or separately to prevent the spread of contamination to other areas. This is because scrubbing contaminated areas first could result in the transfer of contaminants to cleaner areas, increasing the risk of contamination. By scrubbing these areas last or separately, the risk of cross-contamination is minimized, ensuring a safer and more effective cleaning process.

The scrub technique is a method used to clean and sanitize the hands and forearms before performing a medical procedure. The question asks where the scrub technique ends, and the correct answer is "2 inches above the elbow." This means that the scrubbing should be done on the hands and forearms, stopping 2 inches before reaching the elbow joint. This ensures that the entire area that may come into contact with the patient or equipment is properly cleaned and reduces the risk of infection.

The correct answer is "the circulator pulls the glove off." In an operating room, the circulator is responsible for assisting the scrub nurse and maintaining a sterile environment. If the scrub nurse needs to change a glove during an operation, it is the circulator's role to remove the glove for the scrub nurse to reglove. This is done to prevent contamination and maintain sterility in the operating room.

Informed consent is a crucial ethical and legal requirement before performing any medical procedure. In this case, the patient has only signed for the cystoscopy and not the open reduction of the wrist. Therefore, proceeding with the additional procedure without obtaining valid permission would be a violation of the patient's rights. The correct procedure would be to cancel the surgery until the patient provides consent specifically for the open reduction of the wrist or until a valid permission can be obtained. This ensures that the patient is fully informed and has given their explicit consent for the procedure.

In a cesarean section, the patient may be placed in a supine position with the right side slightly elevated by a wedge to tilt the patient to the left. This positioning helps to prevent compression of the inferior vena cava by the uterus, which can lead to decreased blood flow and potential complications during the procedure.

Stockinette is a seamless, stretchable material commonly used to cover extremities during draping. It provides a smooth and comfortable surface, allowing for easy application and removal. Stockinette is often used in medical settings to protect the skin, provide padding, and promote hygiene. It is made from a soft and breathable fabric that helps to prevent irritation and pressure sores. Overall, stockinette is a practical and versatile material that is widely used in healthcare settings.

Fowler's position is often used in cranial procedures as it involves the patient being placed in a semi-sitting position with the head elevated. This position allows for better visualization and access to the surgical site, particularly in procedures involving the head and brain. It helps to reduce swelling and improve drainage, making it a common choice for cranial surgeries. The other options, Kraske, Trendelenburg, and lithotomy, are positions used in different surgical procedures but are not specifically associated with cranial procedures.

A Mayfield table would be used for neurologic surgery. This type of surgery involves procedures on the brain and nervous system. The Mayfield table is specifically designed to securely position the patient's head during these surgeries, providing stability and precise positioning. This helps the surgeon access and operate on the delicate structures of the brain and nervous system with accuracy and safety.

A Babcock is a surgical instrument that is specifically designed to handle delicate structures during surgical procedures. It is commonly used to grasp and hold fragile tissues or structures, such as blood vessels, without causing damage or trauma. This allows surgeons to manipulate and maneuver these delicate structures safely and effectively during the procedure.

The surgical consent is signed before administration of preoperative medications to ensure that the patient has fully understood the risks and benefits of the surgery and has given their informed consent. By signing the consent form before receiving any medication, the patient is in a clear state of mind and able to make an informed decision. This also allows the healthcare team to verify that the patient has fully understood the procedure and any potential complications before proceeding with the surgery.

Implied consent is allowed by law in emergencies when no other authorized person may be contacted. This means that in certain situations where obtaining explicit consent is not possible, such as when a person is unconscious or unable to communicate, medical professionals are legally allowed to proceed with necessary treatments or procedures based on the assumption that the individual would have consented if they were able to. This ensures that urgent medical care can be provided in critical situations where immediate action is required to save a person's life or prevent further harm.

Nail polish should not be worn during a surgical scrub, even if it is freshly applied. This is because nail polish can harbor bacteria and interfere with proper hand hygiene. It is important to have clean, bare nails during a surgical scrub to minimize the risk of contamination.

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During the draping process, it is important to maintain a sterile environment. The statement "gloved hands may touch the skin of the patient" demonstrates a break in technique because it introduces the potential for contamination. Gloved hands should not come into direct contact with the patient's skin to prevent the transfer of microorganisms.

A Finochietto is a type of rib retractor commonly used in thoracic surgeries. It is designed to hold the ribs apart, providing access and visibility to the underlying structures. The Finochietto retractor consists of two blades that can be opened or closed using a ratchet mechanism. The blades have sharp teeth that grip the ribs securely, allowing the surgeon to spread them apart without causing damage. This type of retractor is named after its inventor, Dr. Enrique Finochietto, an Argentine surgeon. It is widely used due to its effectiveness and ease of use in thoracic procedures.

The statement "nail polish may be worn, if not chipped" indicates inappropriate preparation for a surgical scrub because nail polish can harbor bacteria and interfere with proper hand hygiene. In a surgical setting, it is important to have clean and bare nails to minimize the risk of contamination.

A Kerrison is a type of rongeur that is commonly used in spinal and neurosurgery procedures. It is designed with a long, slender, and curved tip that allows for precise removal of bone and tissue in tight spaces. The Kerrison rongeur is particularly useful in accessing and removing bone fragments or tissue in delicate areas of the spine or brain. Its design and functionality make it an essential tool in these surgical procedures.

Abdominoperineal resection (APR) is a surgical procedure performed to remove the rectum and anus, usually due to cancer or other diseases. The patient is positioned supine in modified lithotomy, which means lying on their back with their legs supported in stirrups. This position allows the surgeon better access to the perineal area during the surgery. Colonoscopy, marsupilization of pilonidal cyst, and ileostomy do not typically require the patient to be positioned in modified lithotomy.

A nonperforating clamp is used to attach suction tubing to the drapes. This clamp is designed to securely hold the tubing in place without causing any damage or puncturing the material. It provides a tight grip to prevent any leakage or dislodging of the tubing during procedures. The use of a nonperforating clamp ensures a reliable and safe connection between the suction tubing and the drapes, maintaining a sterile environment in the operating room.

Blunt nerve hooks are selected for a vasotomy setup. A vasotomy is a surgical procedure that involves making an incision in the vas deferens, which is the tube that carries sperm from the testicles to the urethra. Blunt nerve hooks are used in this procedure to gently separate and manipulate the nerves surrounding the vas deferens, allowing for precise and controlled dissection.

The correct answer is "placed on a dry area." This means that after the drapes are adjusted for the correct position and unfolded, they are placed on a dry area before being carried to the OR table. This ensures that the drapes remain clean and free from any moisture or contaminants that could potentially compromise the sterile field during the surgical procedure.

The surgical scrub involves both mechanical washing and chemical antisepsis of the skin. Mechanical washing refers to the physical removal of dirt, debris, and microorganisms from the skin using water, soap, and friction. This helps to physically clean the skin and remove any potential contaminants. Chemical antisepsis, on the other hand, involves the use of antiseptic solutions or agents to kill or inhibit the growth of microorganisms on the skin. This step helps to further reduce the risk of infection during surgery. Therefore, the correct answer is "mechanical washing and chemical antisepsis of the skin".

The Ballenger swivel knife is the correct answer because it is commonly used for making precise incisions in nasal cartilage. The swivel design allows for better control and maneuverability during the procedure. The Freer elevator is typically used for elevating and dissecting tissues, not for making incisions. The Duckbill rongeur is a surgical instrument used for cutting and removing bone, not for incising cartilage. The Hurd dissector is used for dissecting and separating tissues, but it is not specifically designed for incisions in nasal cartilage.

The statement "the surgeon may do the procedure if he documents that it is necessary as a lifesaving measure" is not true. If a patient withdraws their consent, the surgeon cannot proceed with the procedure, even if it is necessary to save the patient's life. Consent is a fundamental principle of medical ethics, and without it, the surgeon cannot perform any procedure on the patient.

The surgical consent form can be witnessed by the surgeon, a nurse, or an authorized hospital employee, but not the patient's spouse. This is because the spouse may have a conflict of interest or bias, and their presence as a witness may not be considered impartial. It is important to have witnesses who are objective and can ensure that the patient is giving informed consent willingly and without any external pressure.

The holding area of the OR is the ideal place to do the shave prep because it is a designated area specifically designed for preoperative preparations. It is equipped with all the necessary tools and supplies needed for the procedure. Additionally, performing the shave prep in the holding area ensures that the patient is in a sterile environment, minimizing the risk of infection. Shaving in the patient's room or the operating room suite may not provide the same level of sterility and may increase the risk of complications.

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The instrument shown above, known as Silverman needle, is used to retrieve a needle biopsy from various organs such as the thyroid, liver, kidney, or prostate. It is a commonly used tool in medical procedures to obtain tissue samples for diagnostic purposes.

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Harrington rods are commonly used in surgical treatment for scoliosis. These rods are implanted along the spine and help to correct the curvature by providing stability and support. They are attached to the vertebrae using hooks and screws, and then connected with a rod to straighten the spine. This surgical procedure aims to reduce the spinal deformity and improve the patient's posture and overall quality of life.

Rolls or bolsters are placed longitudinally to support the chest from axilla to hip during positioning for laminectomy. This helps provide proper alignment and support to the patient's chest and upper body, ensuring stability and comfort during the procedure. Placing the rolls or bolsters horizontally under the chest and thighs or below the knees would not provide the same level of support and alignment required for a laminectomy.