Surgical Tech Appleton & Lange Part 8

A purse-string suture is used to invert the stump of an appendix during an appendectomy. This type of suture involves placing a continuous stitch around the base of the stump, which is then tightened to create a purse-string effect. This technique helps to prevent leakage of fluid or contents from the stump, reducing the risk of infection or complications.

The condition regarding sterile technique that is NOT recommended is "sterile tables may be set up and safety covered until time of surgery." This is because sterile tables should be set up just before the operation, not beforehand and covered. This is to ensure that the tables remain sterile and free from any potential contamination.

Sitting or leaning against a nonsterile surface is considered a break in technique because it can potentially contaminate the sterile person or their equipment. Maintaining a sterile field is crucial in healthcare settings to prevent the spread of infection, and any contact with nonsterile surfaces should be avoided to ensure the integrity of the sterile environment.

Gynecomastia is the correct answer because it refers to the pathologic enlargement of the male breast. It is characterized by the development of glandular tissue in the male breast, leading to a breast-like appearance. This condition can be caused by hormonal imbalances, certain medications, or underlying medical conditions. Subcutaneous adenoma, hypoplasia, and cystic mastitis do not specifically refer to the enlargement of the male breast, making them incorrect choices.

Stones are not typically placed in a preservative solution because they are inanimate objects and do not require preservation. On the other hand, curettings, tonsils, and uterus are biological specimens that are often preserved in a solution to maintain their integrity and prevent decomposition.

McBurney is an incision commonly used for appendectomy, which is the surgical removal of the appendix. The incision is made in the lower right abdomen, at a point called McBurney's point, which is located between the navel and the right hip bone. This incision provides access to the appendix for its removal, as it is the most common surgical procedure for treating appendicitis, which is the inflammation of the appendix.

The Kraske position is also known as the jackknife position. This position is used in surgery and involves the patient lying face down with their hips flexed and their chest and knees resting on the operating table. The name "jackknife" refers to the shape the patient's body resembles when in this position, as it resembles the folding knife known as a jackknife.

During a cholangiogram, it is important to remove all air bubbles from the cholangiocath. Air bubbles can interfere with the visualization of the bile ducts and can lead to inaccurate results. Removing the air bubbles ensures that the cholangiogram provides clear and reliable images of the bile ducts, helping in the diagnosis and treatment of any abnormalities or blockages.

The scrub person should stand on the same side of the table as the surgeon when handing skin towels. This allows for efficient communication and coordination between the two individuals during the surgical procedure. Being on the same side ensures that the towels can be easily handed off without any obstruction or confusion. It also allows the scrub person to anticipate the surgeon's needs and provide the necessary support throughout the operation.

Moistening the Penrose drain with saline before handing it to the surgeon is important because it helps to lubricate the drain, making it easier to insert into the surgical site. The saline also helps to keep the drain moist, preventing it from drying out and becoming less effective. Additionally, moistening the drain with saline can help to minimize tissue trauma and discomfort for the patient during insertion.

A closed-wound suction system works by creating a negative-pressure vacuum. This means that the system creates a pressure lower than atmospheric pressure, which helps to remove fluids or air from a closed wound. The negative pressure allows the system to draw out any excess fluids or air, promoting healing and preventing infection. It is an effective method for drainage and maintaining a clean wound environment.

Thrombosed vessels of the rectum are known surgically as hemorrhoids. Hemorrhoids are swollen blood vessels that can form internally or externally around the anus. When these blood vessels become swollen and develop a blood clot, they are referred to as thrombosed hemorrhoids. This condition can cause pain, discomfort, and bleeding. Surgical intervention may be required to remove or treat thrombosed hemorrhoids.

A strangulated hernia occurs when the blood supply to the trapped contents of the hernia sac is compromised. This compromised blood supply puts the trapped contents at risk of necrosis, which is the death of the tissue due to lack of blood flow. This can be a serious and potentially life-threatening condition that requires immediate medical attention.

The scrub person should not recap injection needles as it increases the risk of needlestick injuries. Recapping needles can lead to accidental punctures and exposure to bloodborne pathogens. The CDC guidelines recommend using safer alternatives such as using a one-handed technique or a needle recapping device to prevent needlestick injuries.

The reason gowns, gloves, drapes, and instruments are changed following a breast biopsy and before incision for a mastectomy is to protect the margins of healthy tissue from tumor cells. By changing these items, any potential contamination from the biopsy procedure is eliminated, reducing the risk of spreading tumor cells to healthy tissue during the mastectomy. This ensures that the surgical site remains as clean and free from tumor cells as possible, improving the chances of successful removal of the cancerous tissue.

Applying the dressing before removing the drape is the correct procedure for sterile dressing application. This is because the drape acts as a barrier to prevent contamination from entering the wound during the procedure. Removing the drape before applying the dressing would expose the wound to potential contaminants, increasing the risk of infection. Therefore, it is essential to apply the dressing before removing the drape to maintain sterility and ensure proper wound healing.

Unfolding the drapes before bringing them to the OR table is not an acceptable technique when draping a patient. Drapes should be unfolded directly over the proper area to minimize the risk of contamination. Unfolding them before bringing them to the table increases the chances of contact with potentially unsterile surfaces, compromising the sterile field.

In extreme patient emergencies, such as when a patient's life is at immediate risk, certain protocols and procedures may be omitted or modified to prioritize saving the patient's life. In such cases, a sponge count, which is the process of keeping track of surgical sponges used during a procedure to ensure none are left inside the patient, may be omitted to expedite the surgery and save time. This decision is made with the understanding that the potential risks associated with a missed sponge are outweighed by the urgency of the situation.

Lap pads are commonly used intraabdominally during surgical procedures to absorb any fluids or blood that may be present. Moistening the lap pads with saline helps to enhance their absorbency and effectiveness in soaking up the fluids. Saline is a sterile solution of salt and water that is safe to use in the body, making it a suitable choice for moistening lap pads during surgery. Using saline helps to maintain a clean and sterile environment in the abdominal cavity, reducing the risk of infection or complications.

If a hair is found on the operative field, the correct procedure is to remove it with a clamp and cover the area. This is important to ensure a clean and sterile environment during the procedure, as any foreign object, including hair, can increase the risk of infection or other complications. Removing the hair with a clamp helps to prevent it from falling into the wound or contaminating the surgical site, while covering the area helps to maintain the sterile field. Notifying the circulator and completing an incident report may also be necessary steps to document the occurrence and ensure proper follow-up.

A Whipple operation, also known as a pancreatoduodenectomy, is a surgical procedure that involves the removal of the head of the pancreas, part of the small intestine, the gallbladder, and sometimes a portion of the stomach. This procedure is commonly used to treat pancreatic cancer, as well as other conditions such as chronic pancreatitis and tumors in the pancreas or bile ducts. It is considered a complex and extensive surgery that requires a skilled surgeon and a multidisciplinary team.

The correct answer is the discarding of instruments coming in contact with tumor after each use. This technique is important in surgery to prevent the spread of cancer cells to other areas of the body. By discarding instruments that have come into contact with the tumor, the risk of contamination and spreading of cancer cells is minimized. This helps to ensure that the surgery is as effective as possible in removing the tumor and reducing the chances of recurrence.

The Pfannenstiel incision is a curved transverse incision commonly used in pelvic surgery. It is made just above the pubic hairline, allowing access to the lower abdomen and pelvic region. This incision provides good cosmetic results as it is easily hidden by underwear or swimsuits. It also provides excellent access to the uterus, ovaries, and bladder, making it a preferred choice for procedures such as cesarean sections and hysterectomies. The other options mentioned, midabdominal transverse, Poupart, and McVey, are not commonly used incisions for pelvic surgery.

During surgery, cultures obtained are passed off the sterile field into a bag or container held by the circulator. This is done to maintain the sterility of the surgical field and prevent contamination. The circulator, who is responsible for handling and organizing instruments and supplies, takes control of the cultures to ensure they are properly collected and transported to the lab for analysis. This practice helps to maintain the integrity of the cultures and ensures accurate results in the laboratory.

The correct answer is chromic 4-0 or 3-0. Chromic refers to chromic gut suture, which is an absorbable suture material commonly used in gastrointestinal closures. The numbers 4-0 or 3-0 refer to the size of the suture, with smaller numbers indicating thicker sutures. These sizes are appropriate for closing the mucosa of the intestinal tract, providing adequate strength and support for the closure. Silk, Dacron, and Novafil are not commonly used for gastrointestinal closures, making them incorrect choices.

The spleen is the organ that is removed either because of trauma, a blood condition, or as a staging procedure for malignancy. Trauma to the spleen can cause it to rupture, leading to severe bleeding and the need for removal. Certain blood conditions, such as certain types of anemia or blood cancers, may require the removal of the spleen to improve symptoms or prevent complications. Additionally, in some cases of malignancy, the spleen may be removed as part of the staging process to determine the extent of the cancer.

After a hemorrhoidectomy, petroleum gauge packing is placed in the anal canal. This is done to provide support and promote healing of the surgical site. The petroleum gauge packing helps to control bleeding, absorb any discharge, and prevent infection. It also acts as a barrier between the surgical site and the external environment, protecting it from contamination. By keeping the anal canal packed with petroleum gauge, it allows for proper wound healing and reduces the risk of complications.

When a sterile item is hanging or extending over the sterile table edge, the scrub nurse must not touch the part hanging below table level. This is because touching the part hanging below the table level can cause contamination and compromise the sterility of the item. The nurse should be vigilant and ensure that no one comes near the item to prevent any accidental contact that may lead to contamination. If the item is hanging or extending over the table edge, the nurse should pull it back onto the table to maintain its sterility. Using the item in this situation would also risk contamination and is therefore not the correct course of action.

An excisional biopsy refers to the complete removal of a tumor or mass from the body. This procedure is performed when a surgeon cuts out the entire tumor along with a margin of healthy tissue surrounding it. Unlike other types of biopsies, such as needle biopsy or incisional biopsy, an excisional biopsy allows for a more accurate diagnosis as it provides a larger sample for examination. This type of biopsy is commonly used when the suspicion of malignancy is high or when the tumor is small and easily removable.

A modified radical mastectomy is a breast procedure that involves removing the entire breast and axillary contents, including lymph nodes, but preserves the pectoral muscles. This procedure is commonly performed in cases of breast cancer, where the goal is to remove the tumor and any affected lymph nodes while preserving the surrounding muscles for better cosmetic outcomes and improved postoperative function. It is a less extensive surgery compared to a radical mastectomy, which involves removing the breast, axillary lymph nodes, and the underlying pectoral muscles.

When the drop technique is used for an intestinal procedure, contaminated instruments are discarded and gloves are changed. This is because the drop technique involves dropping instruments onto a sterile field, and if any instruments come into contact with non-sterile surfaces or are contaminated during the procedure, they must be discarded to maintain asepsis. Changing gloves is also necessary to prevent the spread of contamination. The use of two Mayo stands, not changing drapes and gloves, and using a separate setup for closure are not related to the drop technique and do not address the issue of contamination.

The Babcock instrument is commonly used to grasp the mesoappendix during an appendectomy. It is a versatile tool that allows for a secure grip without causing excessive trauma to the tissues. The Babcock instrument has a unique design with a rounded tip and a set of jaws that can be opened and closed. This allows the surgeon to safely handle and manipulate the mesoappendix during the procedure, facilitating its removal without causing damage to surrounding structures.

Bumpers or bolsters are used on retention sutures to prevent the suture from cutting into the skin. These devices provide a cushioning effect and distribute the pressure evenly, reducing the risk of the suture digging into the skin and causing damage. This helps to maintain the integrity of the suture and promotes proper healing of the wound.

A temporary colostomy is a procedure that is done to give the colon a rest. It involves creating an opening in the abdominal wall to divert the flow of stool from the colon to a stoma, which is a surgically created opening on the surface of the abdomen. This allows the colon to heal and rest, as well as provides a temporary alternative route for waste elimination. Once the colon has healed, the colostomy can be reversed by reconnecting the colon and closing the stoma.

A left subcostal incision is a surgical approach used to access the spleen. This type of incision is made on the left side of the abdomen, just below the ribcage. The spleen is located in the upper left quadrant of the abdomen, making it accessible through this incision. Surgery of the gallbladder, pancreas, and common bile duct would typically require different incisions or approaches. Therefore, based on the given information, the correct answer is spleen.

During an appendectomy, a purse-string suture is placed around the appendix stump to invert the stump of the appendix. Inverting the stump helps to prevent the leakage of any fluid or bacteria from the appendix into the abdominal cavity. This technique also helps to ensure that the stump is securely closed and reduces the risk of postoperative complications such as infection or abscess formation. By inverting the stump, the surgeon creates a more secure closure and promotes faster healing of the surgical site.

A frozen section is not sent to the lab in any liquid or solution. It is sent dry, without any additional substances such as formalin, saline, or water. This is because a frozen section is a technique used in histology where a tissue specimen is frozen and then cut into thin slices for microscopic examination. Adding liquid to the specimen would interfere with the freezing process and compromise the quality of the section. Therefore, the correct answer is "dry".

The correct answer is EEA. EEA stands for End-to-End Anastomosis, which is a surgical technique used to connect two tubular structures after resection. The disposable circular staple mentioned in the question refers to the EEA stapler, which is specifically designed for this purpose. It allows for a secure and efficient connection between the tubular structures, promoting proper healing and functionality.

The correct answer is mucosa, submucosa, serosa. The mucosa is the innermost layer of the intestine, responsible for absorption and secretion. The submucosa is the layer beneath the mucosa, containing blood vessels, nerves, and connective tissue. The serosa is the outermost layer, providing protection and support to the intestine.

A hernia occurring in Hesselback's triangle is called a direct hernia. Hesselback's triangle is a region in the groin where direct hernias typically occur. Direct hernias protrude through the posterior wall of the inguinal canal, which is formed by the transversalis fascia. In contrast, indirect hernias occur when the hernial sac enters the inguinal canal through the deep inguinal ring and follow the path of the spermatic cord. Therefore, in this context, the correct answer is "direct."

Sutures placed in a wound to prevent wound evisceration are called retention. This term refers to the act of keeping something in place or preventing it from moving or being removed. In the context of wound care, sutures are used to hold the edges of a wound together, promoting healing and preventing the contents of the wound from protruding. Therefore, the term "retention" accurately describes the purpose and function of sutures in this scenario.

Thrombin is the correct answer because it is an enzyme that plays a key role in the blood clotting process. When applied topically, it can help control bleeding by promoting the formation of blood clots. Oxytocin is a hormone involved in labor and breastfeeding, tannic acid is a compound found in plants, and collagen is a protein found in connective tissues. None of these substances have the same hemostatic properties as thrombin.

A Gore-Tex patch can be used to reconstruct an abdominal wall defect. Gore-Tex is a synthetic material that is commonly used in medical procedures due to its biocompatibility and durability. It is often used as a patch to close and reinforce defects in the abdominal wall, providing strength and support to the area. This patch can help to prevent hernias and other complications that may arise from the defect.

Shoulder pain is a common postoperative complaint following a laparoscopic procedure. This is because during laparoscopy, carbon dioxide gas is used to inflate the abdomen, which can irritate the diaphragm and cause referred pain to the shoulder. This pain is usually temporary and resolves on its own. Headache, diarrhea, and gastric upset are not typically associated with laparoscopic procedures.

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A hysterectomy is a surgical procedure to remove the uterus. Unlike plastic surgery, knee surgery, and radical mastectomy, a hysterectomy does not involve any incisions or removal of tissues that would require a pressure dressing to control bleeding or promote healing. Therefore, a hysterectomy would not require a pressure dressing.

Glove powder can lead to the formation of granulomata, which are small nodules that develop in response to foreign substances. When the powder enters a wound, it can cause an inflammatory reaction, leading to the formation of these nodules. Infection and inflammation are also possible complications, but in this case, the specific complication attributed to glove powder is granulomata. Keloid formation refers to the excessive growth of scar tissue and is not directly related to glove powder entering a wound.

Peanuts and dissecting sponges are generally moistened with saline because saline solution is isotonic to the body's fluids and tissues. This means that it has the same salt concentration as the body, making it less likely to cause damage or irritation. Moistening them with saline also helps to keep them moist and prevent them from drying out, which could potentially cause discomfort or complications during use.

A catheter commonly used in a gastrostomy is a mushroom.

In a cholecystectomy, the structures that are ligated and divided are the cystic duct and cystic artery. This procedure involves the removal of the gallbladder, and the cystic duct and cystic artery are the structures that connect the gallbladder to the common bile duct and hepatic artery respectively. By ligating and dividing these structures, the surgeon is able to safely remove the gallbladder without causing any damage to the surrounding organs.