Rosalie Delfin

SUCTION MACHINE This usually refers to a portable suction apparatus used in wards and theatres for aspirating fluids and vomit from the mouth and airways, and from operation sites by sucking the material through a catheter into a bottle. The term could also apply to devices which operate from piped vacuum supplies or bottle gas cylinders but is more commonly used to mean electric suction units which contain a vacuum pump (piston, diaphragm, or rotary vane), bacterial filter, vacuum gauge, trap for moisture (or any debris accidentally drawn into the mechanism), a reservoir for the aspirated material, and a suction catheter or nozzle. They may be intended to provide high or low vacuum, and high and low flow rates. Low vacuum is used for post-operative wound drainage. The main reservoir is usually a glass bottle with volume marks up the side and sometimes this has a float valve so that the vacuum is cut off before the bottle becomes full enough to allow the contents to be drawn into the pipework of the pumping mechanism. However, frothing of the contents can sometimes defeat the float valve mechanism. They may sometimes be described as high-grade or low-grade suction machines, which relates to the degree of vacuum achieved. High-grade suction machines are used for rapid aspiration of fluids and debris (such as vomit), whereas low-grade machines are used for postoperative wound drainage.

Ma. Elma L. Dayanan BSN 3-B Cardiac Monitoring Refers to continuous monitoring with electrocardiography with assessment of the patients condition relative to their cardiac rhythm. The cardiac monitor is a device that shows the heart's electrical activity as a wave pattern on a monitor. It is a bedside monitor. The monitor provides a visual display of the patient's heart rhythm, which is particularly useful information during heart attacks, when patients can develop lethal cardiac arrhythmias. The monitor sounds an alarm if the patient's heart rate goes above or below a predetermined number. An automatic blood pressure cuff and a pulse oximeter, which measures the oxygen saturation in the blood, are also included with some monitors. Purpose: To continuously show the cardiac rhythm and sends the electrocardiogram (EKG) tracing to a main monitor in the nursing station. Most commonly used in emergency rooms and critical care areas, cardiac monitoring allows for continual observation of several patients. Continuous cardiac monitoring allows for prompt identification and initiation of treatment for cardiac arrhythmias and other conditions. Precautions The American Heart Association warns of potential interference between some pacemakers and cardiac monitors. Minute ventilation rate-adaptive pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment, causing the pacemakers to pace at their maximumprogrammed rate.. Preparation All electrical equipment and outlets are grounded to avoid electrical shock and artifact (electrical activity caused by interference). The nurse should plug in the monitor, turn on power, and connect the cable if not already attached. The nurse should open the electrode package, and attach an electrode to each lead wire. The hands should be washed and the procedure should be explained to the

patient. Privacy should be ensured for the patient, and the patient should be clean and dry to prevent electrical shock. Next, the chest should be exposed and the sites selected for electrode placement. Using the rough patch on the electrode, a dry washcloth, or gauze pad, each site should be rubbed briskly until it reddens, but care should be taken not to damage or break the skin. Dead skin cells are removed in this manner, thereby promoting better electrical conduction. Patients who are extremely hairy may need to be shaved prior to application of the electrodes. An alcohol pad is used to clean the sites in patients with oily skin. Areas should dry completely to promote good adhesion. Aftercare After placing all electrodes, the nurse should observe the monitor and evaluate the quality of the tracing, making size and tracing position adjustments as needed. He or she should confirm that the monitor is detecting each heartbeat by taking an apical pulse and comparing the pulse to the digital display. A rhythm strip should be recorded for the medical record, and labeled with patient name, room number, date, time, and interpretation of the strip. Complications There is a potential for skin breakdown at the electrode placement site. The patient may be allergic to the adhesive used, or the electrode may have been left on the skin too long. The electrodes should be removed and new electrodes applied, using hypoallergenic electrodes if necessary. Results A normal cardiac tracing shows a regular rate and rhythm with no deviations in the QRST complex (the combined waves of an electrocardiogram). Abnormal results may include bradycardia, or tachycardia, accompanied by the alarm. Q waves (the short initial downward stroke of the QRST complex) are abnormal, and may or may not signal an infarction.

Ma. Elma L. Dayanan BSN3-B Anaesthetic machine or Anesthesia machine is used by anaesthesiologists and nurse anaesthetists to support the administration of anaesthesia. The most common type of anaesthetic machine in use in the developed world is the continuous-flow anaesthetic machine which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a safe pressure and flow It has three major components: a gas mixing and delivery system; an anaesthetic breathing system ( circuit) and a ventilator; and an array of monitors. What does "Anaesthesia"mean? an = without aesthesia = sensation What does it do? The anaesthesia machine mixes the correct concentrations of gas and drugs to be inhaled and exhaled by the patient so they lose consciousness. They are held unconscious and have no sensation while being operated on, then regain consciousness after the operation. Physiology *Anesthetic gas affects the nervous system, resulting in a numbing of the nerve pathways. The patient becomes unconscious, unaware of what is happening, has no pain, is immobile (may need breathingsupport) and free from memory while under the influence of the anaesthetic agent. How it works Air, Oxygen, and Nitrous Oxide are supplied from wall outlets or cylinders. The pressures are reduced by pressure regulators then pass through an O2 failure alarm. The flow of gas is controlled by flowmeters. The gas is mixed and passed over a vaporiser containing the anaesthetic agent. An Anti-hypoxic device ensures that the flowmeters deliver a minimum of 25% O2 to the agent vaporizer. The gas then goes through an over pressure relief valve and back flow valve, then to the common gas outlet (CGO), ready to be given to the patient. There is an emergency O2 flush valve connected to give 100% O2 if required. The gas then enters a patient circuit and ventilator. Expired gas can be stripped of CO2 in a soda-lime filter and recirculated, or scavenged out of the

room. Units of measurement Flow: L/min, Pressure: kPa and cmH2O Typical values Dependant on patient size, rate and strength of breathing, circulation and solubility of the anaesthetic.

Sutures Surgical sutures, or stitches, are used to sew an incision or a wound closed. Much like sewing fabric, a strand of material is used to connect the edges of a wound, pulling them closer together so that they may heal. Types: Absorbable and non-absorbable sutures Sutures can be divided into two types those which are absorbable and will break down harmlessly in the body over time without intervention, and those which are non-absorbable and must be manually removed if they are not left indefinitely. The type of suture used varies on the operation, with the major criteria being the demands of the location and environment and depends on the discretion and professional experience of the Surgeons. Sutures to be placed internally would require re-opening if they were to be removed. Sutures, which lie on the exterior of the body, can be removed within minutes, and without re-opening the wound. As a result, absorbable sutures are often used internally; non-absorbable externally. Sutures to be placed in a stressful environment, for example the heart (constant pressure and movement) or the bladder (adverse chemical presence) may require specialized or stronger materials to perform their role; usually such sutures are either specially treated, or made of special materials, and are often non-absorbable to reduce the risk of degradation. Absorbable sutures include: -Polyglycolic Acid sutures, Polyglactin910, Catgut, Poliglecaprone 25 and Polydioxanone sutures. Non-Absorbable sutures include: - Polypropylene sutures, Nylon (poylamide), Polyester, PVDF, silk and stainless steel sutures. Absorbable: 1. Surgical Gut Surgical guts are also known as a catgut and is made from the submucous layer of a sheep's intestine. Once cleaned, dried and twisted into threads of various sizes they are prepared for use by special processes, that include innumerable inspections of gauze and tensile strength and scrupulous sterilization. The length of time for complete absorption of surgical gut in a

wound varies according to the action of certain hardening agents. 2. Fascia Lata This muscle connective tissue of beef has been used in reconstructive orthopedic surgery and for the repair of hernias. It is not a true absorbable suture, but becomes part of the tissue after the wound has healed. Non Absorbable: 1. Silk This is prepared from the thread spun by the silkworm larva in making its cocoon. It may be twisted or braided, and it comes in sizes comparable with surgical gut. - High tensile strength - Relatively inexpensive - Less tissue reaction 2. Cotton This is made from cotton fibers. The strands are twisted and used for both internal and external suture. It should always be used wet for maximal strength. 3. Nylon - Monofilament - Multifilament - Braided - The chief disadvantage is that a triple knot must be tied 4. Wire This material has maximal flexibility and tensile strength, yet causes little or no local reaction in the tissue in which it is placed. 5. Dacron This is a synthetic polyester fiber that has greater tensile strength, minimal tissue reaction, maximal visibility, non-absorbent and non-fraying qualities. 6. Linen This is made of twisted line thread; it has sufficient tensile strength but is rarely used as suture material. 7. Silver Wire Clips Many styles of clips are available for the purpose of holding the edges of the tissue in approximation. They tend to produce some scarring when used in the skin, but may be used when the wound is infected. 8. Silkworm Gut This is made from the fluid secreted by the silkworm when they are ready to form their cocoons. The disadvantage is that they must be soaked in normal

saline for about 10 minutes before use to make them pliable. 9. Mesh This type of suture is made of stainless steel, usually used for hernia repairs and large defects. It is rarely used. 10. Tantalum This is a bluish bray metal that is non-irritating to the body tissues. It is used because of its high tensile strength and its inert reaction to tissues. Monofilament and Multifilament Sutures Sutures can also be divided into two types on the basis of material structure i.e. monofilament sutures and multifilament or braided sutures. Braided sutures provide better knot security whereas monofilament sutures provide better passage through tissues. In general, Monofilament sutures elicit lower tissue reaction compared to braided sutures. Monofilament sutures include: - Polypropylene sutures, Catgut, Nylon, PVDF, Stainless steel, Poliglecaprone and Polydioxanone sutures. Multifilament or braided sutures include: - PGA sutures, Polyglactin 910, silk and polyester sutures. Synthetic and Natural Sutures Surgical sutures can also be divided into two types on the basis of raw material origin i.e. natural and synthetic sutures. Natural sutures include silk and catgut sutures whereas all other sutures are synthetic in nature. Needles Surgical needles are classified in three categories: :: Round bodied :: Cutting :: Trochar. Within these categories, there are hundreds of different types. Use cutting needles on the skin, and for securing structures like drains. Use round bodied needles in fragile tissue, for example when performing an intestinal anastomosis. Do not use a cutting needle in this situation. Trochar needles have a sharp tip but a round body. They are useful when it is necessary to perforate tough tissue, but when cutting the tissue would be undesirable, as in the linea alba when closing the abdominal wall. Techniques: :: Interrupted simple- one in which each stitch is made with a separate piece of material. :: Continuous simple- one in which a continuous, uninterrupted length of material is used.

:: Vertical mattress- stitches at right angles to the wound edges. :: Horizontal mattress- stitches parallel to the wound edges :: Subcuticular- method of skin closure involving placement of stitches in the subcuticular tissues parallel with the line of the wound. :: Purse string- a continuous running suture being placed about the opening, and then drawn tight. :: Retention/tension. - Used to relieve pressure on the primary suture line and to decrease the potential for wound dehiscence. Regional Anesthesia Regional anaesthesia (or regional anesthesia) is anaesthesia affecting only a large part of the body, such as a limb or the lower half of the body. Regional anaesthetic techniques can be divided into central and peripheral techniques. The central techniques include so called neuraxial blocks (epidural anaesthesia, spinal anaesthesia). The peripheral techniques can be further divided into plexus blocks such as brachial plexus blocks, and single nerve blocks. Regional anaesthesia may be performed as a single shot or with a continuous catheter through which medication is given over a prolonged period, e.g. continuous peripheral nerve block. Regional anaesthesia can be provided by injecting local anaesthetics directly into the veins of an arm (provided the venous flow is impeded by a tourniquet.) This is called intravenous regional techniques (Bier block). It is loss of sensation in a region of the body produced by application of an anesthetic agent to all the nerves supplying that region (as when an epidural anesthetic is administered to the pelvic region during childbirth) This differs from Local anaesthesia, which, in a strict sense, is anaesthesia of a small part of the body such as a tooth or an area of skin, and Conduction anaesthesia is a comprehensive term which encompasses a great variety of local and regional anaesthetic techniques.Contents . Indications and applications Regional anaesthesia may provide anaesthesia (absence of feeling, including pain) to allow a surgical operation, or provide post-operative pain relief. Various brachial plexus blocks exist for shoulder and arm procedures. Methods similar to routine regional anaesthetic techniques are also often used for treating chronic pain. In labour and childbirth, epidural or combined spinal epidurals provide effective pain relief. Regional anaesthesia is now more common than general

anaesthesia for Caesarean section procedures. Nerve blocks are widely used in veterinary medicine to diagnose lameness. A very common application is the diagnosis of navicular disease in horses. Relationship to other anaesthetic techniques Unlike general anaesthesia, patients may remain awake during the procedure, resulting in reduced side-effects and enabling the surgeon to converse with the patient during the procedure if required. However, many patients prefer to receive sedation either during the block, the procedure, or both. There is a spectrum of complexity between simple local anaesthetic infiltration and major regional blocks, such as the 'central neuraxial blocks' (spinal and epidural), with nerve blocks lying in the middle. Nerve blocks affecting major peripheral nerves such as the femoral nerve and sciatic nerve are also sometimes viewed as regional anaesthetic techniques. Complications Unlike a minor local anaesthetic infiltration to allow a wound to be sutured, or a skin lesion to be excised, regional anaesthesia may involve large doses of local anaesthetic, or administration of the local anaesthetic very close to, or directly into the central nervous system. Therefore there is a risk of complications from local anaesthetic toxicity (such as seizures and cardiac arrest) and for a syndrome similar to spinal shock. Most regional anaesthetic techniques, even in expert hands, have a failure rate of 110%. Therefore, general anaesthesia may become necessary even when a procedure was initially planned to be conducted under a regional technique. For these reasons, regional anaesthesia is only ever conducted in an environment that is fully equipped and staffed to provide safe general anaesthesia should this be needed.