Medical and Surgical AspectsCHAPTER 1

Asepsis: Freedom from infection or prevention of contact with microorganism.

Antiseptic: An agent that will inhabit the growth and development of microorganism without necessarily killing them.

Autoclaving: It is the process of sterilization of articles by steam under pressure, using an apparatus called autoclave.

Bacteriostasis: It is a conditions in which bacterial growth is checked without killing them.

Bacteriostasis: It is agent that inhabits the growth of bacteria.

Bactericide is an agent which kill microorganism.

Contamination is the act of soling or making dirty.

Culture growth of microorganism. Urine culture requires a sterile sample of urine, which takes approximately 24 to 48 hours for laboratory to report findings and bacterial growth. Broad-spectrum antibiotic some time obtained. The test for sensitivity determines which specific antibiotics are effective.

Cross infection: Infection transmitted between individual injected with different pathogenic organism.

Carrier: A person who harbor pathogenic organism of a disease in his body without showing the signs and symptoms of that disease and distributor of that disease.2

Colonization occur when a microorganism is present grow and multiplies, there by does not cause disease.

Complications: A new illness arise during the course of another illness.

Disinfection means destroying all pathogenic organism.

Concurrent disinfection is immediate disinfection of all contaminated articles.

Terminal disinfection means disinfection of the client with all articles.

Disinfectant: An agent which kills microorganism.

Droplet infection: It is infection of an individual by means of fine particles of saliva.

Formites: Object which have been in contact with a contagious disease and capable for transmitting the disease, e.g. cup, spoons, etc.

Fumigation: It is process of disinfection by exposure to the fumes of vaporized germicide.

Garbage: Waste material arising from the preparation, cooking, etc.

Infection: The entry and multiplication of disease producing agent in the body.

Immunization: It is the act of creating immunity artificially against a particular disease.

Isolation: It is separation of infected person from non-infected person for a period for the preventing of transmission.

Mechanical: Work done by the use of force.

Nosocomial infection refers hospital acquired infection, e.g. catheterization or not following aseptic technique.

Pathogenic: Being capable to produce diseases in person.

Portals of entry: The pathway by microorganism enter the body, e.g. respiratory tract, skin, digestive, genitourinary, etc.

Prophylactic: Measures taken to prevent diseases condition.

Quarantine: It is isolation of well person who have come in contact with infection disease for a period of time equal to the longest incubation period.

Alkalosis is a condition that occurs with increase in blood bicarbonate or decrease in blood carbonic acid, blood pH above 7.45.

Abrasion is wearing a way of a structure such as the skin or teeth.

Atrophy is the decrease in the size of a tissue or organ caused by a decrease in the number of cells or deduction in the size of the individual cells.

Assessment refers to the collection, organizing, validating and recording data about a client's health status.3

Bronchoscope is a lighted instrument, used to visualize the bronchi of the lungs.

Bronchogram is an X-ray examination of the tracheobronchial tree produced after the instillation of iodine dye into the bronchi via a catheter or bronchoscope.

Thoracocentesis is an invasive procedure that involves the insertion of a needle into the pleural space for removal of fluid or air.

Lung scanning involves the use of a scanning device that records the patterns of pulmonary radioactivity after the inhalation or intravenous injection of Gamma Ray Emitting Radionuclides, thus providing a visual image of the distribution of ventilation or blood flow in the lungs.

Mediastinoscopy: In which a mediastinoscope is inserted through a small incision made at the suprasternal notch. The scope is passed into the superior mediastinum. It is a surgical procedure performed in the OT.

Pulmonary angiography: Injection of a Radiographic Contrast Material into the Pulmonary Arteries, pulmonary angiography permits visualization of the pulmonary vasculature.

Tomography of lung is a Radiography Technique by which a sequence of X-ray film each representing a slice of lung at different depth is taken.

Weber test: Compares BC of the two ears. It is particularly useful for testing unilateral deafness.

Transillumination test is performed in a dark room by placing a lighted bulb of a torch against the hard palate in the oral cavity.

Fistula test is used for detecting a fistula in the bony wall of the labyrinth.

ABC test: Absolute Bone Conduction Test is a measure of inner ear function. This test compares the ABC of the patient with that of the examiner, assuming that the examiner has a normal hearing. Thus he can detect sensorineural deafness in a patient.

Caloic test is a test of the vestibular function based on the principle of stimulating the labyrinth by temperature difference.

Platform posturography is a series of tests designed to detect the cause of problem with balance. The patient stands with each foot on a special sensor plate surrounded by a visual field wall. He is protected from falling by a safety belt. Sensor from each corner of the plate detects body sway and feed the data into the computer. The sensor plates on which the patient stands and the wall of the room on which he fixates can be removed. The test rely on the hypothesis that three sensory inputs are responsible for balance: the Labyrinthine, the proprioceptors and vision.4

Rotary Chair or Rotational Test is used as an adjacent to ENG. The physical force applied by the rotary chair on the semicircular canal mechanism can be measured precisely. It is useful for documenting recovery after a unilateral labyrinthine loss.

ENG-Electronystagmography is the measurement and graphic recoding of the electrical potentials of eye movements during spontaneous, positional or calorically evoked nystagmus. It is used to assess the oculomotor and the vestibular system and their corresponding interaction. Electrodes are placed on the skin immediately lateral to each eye and on the skin above bridge of the nose to detect horizontal eye movements, electrodes are placed above and below the eye to detect vertical eye movement.

Anterior Rhinoscopy is performed with the help of thudichum nasal speculum held in the left hand. The palm of the hand faces the examiner and the hook of the speculum is held on the index finger which is pointing towards the examiner with the thumb pressing the hook down on the finger. The spring of the speculum is controlled by the middle finger and the ring finger on either side. The blades of the speculum point towards the patient. The speculum is introduced into the nose with its blades approximated to each other by compressing the spring with the two fingers. Once the speculum is introduced in the nose, the spring is released gently and the blades separate out. Indicated in Rhinitis, Sinusitis.

Antral puncture: Procedure for drainage consists of inserting a cannula into the maxillary sinus for pumping water into the sinus which flows out through the ostium along with the exudates of the sinus.

Otoscopy is a magnified inspection of the external canal and tympanic membranes using an otoscope.

Audiometer is a hearing test performed in a soundproof room by an audiologist. An electronic instrument called an audiometer produces sounds of varying tones and loudness, which are used to test the patients hearing. For test the patient wears earphones and is asked to signal the audiologist by raising a hand. The responses are plotted on a graphs, called as an audiogram.

Electroretinogram: ERG when a flash of bright light is shown from a source into the eye a series of electrical changes takes place in the retina which can be recorded by electrodes placed on or around the eye.

Rubin's test is the procedure of transuterine passage of gas or air through the fallopian tubes per vagina. Known as tubal patency test.

Liver scan is a radionuclide procedure and is used to outline and detect structural changes of the liver.5

Cardiac arrest is a sudden cessation of heart beat resulting in the cessation of effective circulation. All heart action may stop.

Cardiopulmonary resuscitation is an artificial stimulation of the heart and lungs.

Dehiscence is the partial or total rupturing of a sutured wound.

Direct contact: Organism can transmit directly from person to person through kissing, sexual contact, droplet infection and infected hands.

Indirect contact: Contact with secretions and excretions of the infected person.

Through formites like instruments, utensils, etc.

Through contaminated food and water.

Through insects.

Through dust.

Through carriers.

Hospital should be well ventilated.

Maintain general cleanliness of the hospital sweeping and mopping with antiseptic solution daily. All articles should be kept clean and dry. Roof should be swept to remove cobwebs once in a week bed, lockers, stools, etc. washed and cleaned. Mattress and pillow exposed to sunlight and aired.

Safe food and water supply: Kitchen and pantry are protected from flies.

Safe disposal of excreta, urine stool, sputum, bedpans, urinals, sputum cups, etc. should be cleaned and disinfected before use.

Safe disposal of refuse discarded dressing garbage, etc.

Destruction of rodents and insects play a major role in the spread of diseases, so they should be destroyed.

Prevention of direct contact with the infected person/carrier nursing isolation-technique.

In case where the pathogens spread on droplets from the respiratory tract. In this, nurses generally wear masks/gowns are also worn particularly when handling the small infants. The nose and mouth cover with tissue paper and dispose properly. If handkerchief is using clean and disinfect it.6 Restrict member of visiting, take precaution while collecting sputum, keep restorable distance from the patient from the droplet infection and nurse who is having respiratory diseases should not attained the patient and sick.

Enteric Isolation: It is indicated when pathogens is transmitted feces. For this type of isolation there is no need to wear mask, but wear gowns and gloves while handling soiled articles. Handwashing emphasized both the clients and nurses. The excreta may be disinfected by adding lime (is a disinfectant agent that destroys microorganisms) before disposal. The soiled articles such as linen should be disinfected before it is sent to dhobi.

Wound and Skin Isolation: In this pathogens are found in wounds and can be transmitted by the contact with wound discharges. Usually gloves and gowns are used of this type of isolation, safe disposal of dressing and discharges from the wound and disinfection of articles are very important strict isolation. Techniques should be followed while coming for client with Abscesses, Boils, Infected burns, Gas Gangrene, Anthrax, Rabies, Tetanus, Venereal Disease, Scabies, etc. All articles should be kept separate. Great care should be taken by the nurse to prevent cuts or abrasions on their hands. Frequently and thoroughly handwashing reduces the chances of infection.

Blood Isolation: This is intended to prevent transmission of pathogen that are found in the blood. So any equipment that comes in contact with the clients blood should be carefully disinfected before touching another object or person.

Maintain high degree of cleanliness.

Health teaching are to be taught to client and relatives, about spread of infections and its prevention.

Minimize number of visitors, children under 10 years should not be allowed in hospital ward.

Emphasize on handwashing, wash hands after elimination, before eating and after handling the client or articles.

Keep articles separate for each person.

Personal caring for sick, should have immunization against communicable diseases.

Persons with lower resistance like anemia or after radiation should be protected.7

If possible, clients should be nursed in separate rooms, otherwise there should be at least a sufficient space between the beds, screens may be provided to separate one client from the other.

Medical aseptic practices refers to all practices used to protect the client and his environment from the transmission of diseases producing organisms.

An article considered to be clean when it is free from pathogenic organism.

Rinse the articles first with cold water to remove the organic material. Hot water coagulates the organic matter and ends to make it strict with articles.

Then wash with hot water and soap, it has emulsifying action and reduces surface tension, which facilitate removable of dirt, rinsing with water, assists in washing the dirt away.

Use an abrasive, such as bristled brush, paste or powder to wash articles, brush helps to remove the dirt from the grooves and corners.

Rinse the article with clean water.

Dry them, when it is dry, there is less chance of dirt and pathogens to lodge in.