WOUND DRAIN

1. Removal of wound drainage
2. Types
1. closed drain
1. drain attached to collection system
2. uses vacuum to draw drainage into system
3. example: Jackson-Pratt, Hemovac
4. specific nursing interventions
1. maintain patency of drain
2. empty collection system and reactivate suction device
3. record amount and characteristics of drainage
4. asepsis
5. standard precautions
2. open drain
1. removes drainage from wound, deposits it on skin surface
2. example: Penrose drain
3. safety pin usually attached to outside end of drain
4. specific nursing interventions
5. prevent inadvertent removal of drain
1. protect skin
2. record characteristics of drainage
3. asepsis
4. standard precautions
6. protect skin surface from irritating effects of drainage
7. wound vacuum
1. removes and collects infectious material from wound
2. computer controlled
3. requires a seal at wound site with pressure distributing wound packing
4. client may be discharged with device 

HIGH RISK GROUPS FOR POST-OP INFECTIONS

1. Impaired immunologic system
2. Extremes of age
3. Diabetes mellitus
4. Corticosteroid therapy
5. Chemotherapy
6. Infection elsewhere in the body
7. Malnutrition
8. Presence of staphylococcus aureus on client
9. Contaminated environment where injury or trauma occurred

CLASSIFICATIONS OF SURGICAL WOUNDS RELATIVE TO RISK OF INFECTION

The higher the class, the higher the risk: a class IV wound carries much more risk than a class I.

1. Class I (clean wound)
1. No break in sterile technique
2. No inflammation encountered
3. GI, Respiratory or GU tract not entered
2. Class II (clean-contaminated wound)
1. GI, GU or respiratory tract entered with no spillage of contents
2. Minor breaks in technique
3. Operations involving the biliary tract, appendix, vagina, and oropharynx
3. Class III (contaminated wound)
1. Acute inflammation without pus
2. Spillage from a hollow viscus occurs
3. Trauma from a clean source
4. Class IV (dirty)
1. Pus or a perforated viscus
2. Trauma from a dirty source
3. Organism causing infection present before surgery
4. Surgical variables that increase risk of infection
5. Prolonged preoperative hospital stay
6. Body location of surgery
7. Surgical technique: delayed wound closure, excess blood loss, presence of drain, improper suture tension
8. Presence of bacteria at closure

Principles of Surgical Asepsis

1. A sterile object remains sterile only when touched by another sterile object.
• Sterile touching sterile remains sterile.
• Sterile touching clean becomes contaminated.
• Sterile touching contaminated becomes contaminated.
• Sterile touching questionable is contaminated.
• Only sterile objects may be placed on a sterile field.
2. A sterile object or field out of range of vision, or an object held below a person's waist, is contaminated.
3. Never turn your back on a sterile field.
4. A sterile object or field becomes contaminated by prolonged exposure to air.
5. When a sterile surface comes in contact with a wet, contaminated surface, the object or field becomes contaminated by capillary action.
6. Always hold your hands above the level of your elbows.
7. The edges of a sterile field or container are considered contaminated.

Cardiovascular Anatomy and Physiology

CARDIOVASCULAR SYSTEM     

A. Anatomy

              1.Layers

                   a.Pericardium: fibrous

                   b.Epicardium: covers surface of heart

                   c.Myocardium: muscular portion of the heart

                   d.Endocardium: lines cardiac chambers and covers surface of heart valves

              2.Chambers of Heart 

                   a.Right atrium: collecting chamber for incoming systemic venous system

                   b.Right ventricle: propels blood into pulmonary system

                   c.Left atrium: collects blood from pulmonary venous system

                   d.Left ventricle: thick-walled, high-pressure pump that propels blood into system

              3.Heart Valves: membranous openings that allow one way blood flow

                   a.Atrioventricular valves: prevent backflow from ventricles to atria during systole

                   b.Tricuspid - right heart valve

                   c.Mitral - left heart valve

                   d.Semilunar valves prevent backflow from aorta and pulmonary arteries into ventricles during diastole

                        1.Pulmonic

                        2.Aortic 

             4.Blood supply to heart 

                   a.Arteries

                        1.Right coronary artery supplies right ventricle and  part of left ventricle

                        2.Left coronary artery supplies mostly left ventricle

                   b.Veins

                        1.Coronary sinus veins

                        2.Thebesian veins

              5.Conduction system 

                   a.SA (Sinoatrial) node

                   b.Junctional tissue

                   c.Bundle branch Purkinje system

        

B. Physiology

              1.Function of the heart is the transport of oxygen, carbon dioxide,  nutrients and waste products

              2.Cardiac cycle consists of:

                   a.Systole - The phase of contraction during which the chambers eject blood

                   b.Diastole - The phase of relaxation during which the chambers fill with blood. When heart pumps, myocardial layer contracts and relaxes.

              3.Blood flow: 

                   a.Deoxygenated blood enters the right atrium through the  superior and inferior vena cava

                   b.Enters the right ventricle via the tricuspid valve

                   c.Travels through the pulmonic valve to pulmonary arteries and lungs

                   d.Oxygenated blood returns from lungs through the pulmonary veins into left atrium and enters the left ventricle via bicuspid (mitral) valve.

                   e.From the left ventricle, through the aortic valve through the aorta to the systemic circulation

              4.The heart itself is supplied with blood by the left and right coronary arteries

              5.The vascular system is a continuous network of blood vessels.

                   a.The arterial system consists of arteries, arterioles and capillaries and delivers oxygenated blood to tissues

                   b.Oxygen, nutrients and metabolic waste are exchanged at the microscopic level

                   c.The venous system, veins and venules, returns the blood to the heart