The first week

What I learned in the first week of my residency program:

1.    OR nursing is where I am supposed to be.

2.    I have an atypical learning style for the OR, but I am pretty balanced (flexible and adaptable) in my learning style - it will work for me!

3.    The body has 3 natural defenses against injury and infection - the skin, chemical defense (inflammation) and immune response (cellular defenses).

4.    The (major) skin layers are - epidermis, dermis and subcutaneous layers (I also know that the epidermis consists of 5 - or 6 - layers depending on function and location on the body).

5.    There are 3 types of wound healing - primary, delayed primary and secondary.

6.    3 stages of wound healing - inflammatory stage, proliferative stage and remodeling

7.    Many things affect wound healing (nutritional status, how the tissue is handled, length of surgery, immobilization...the list is really long)

8.    Complications of wound healing are many, but the most important are those that lead to poor outcomes (infection, scar tissue, hematoma...)

9.    The 4 surgical wound classes are:
I: Clean - no entry into GI, GU or respiratory tracts, no previous open wounds, no signs of inflammation or infection, no breaks in aseptic technique
II: Clean-contaminated - Controlled entry (with no spillage into surgical site) into the GI, GU or respiratory tracts, no inflammation or infection, minor breaks in sterile technique.
III: Contaminated - spillage from GI, GU or respiratory tract into surgical wound, traumatic wound less than 4 hours old, inflammation present, infection not present
IV: Dirty - traumatic wound more than 4 hours old, inflammation and infection present, fecal contamination, purulent drainage.

10. Hemostasis can be achieved through mechanical, chemical or thermal methods

11. Suture comes in natural, synthetic, absorbable, non-absorbable. If a suture is not available stay within the category and look for a needle that is in the same group.

12. The number one method for preventing infection (anywhere, anytime) is to utilize proper hand washing. Can't say this enough!

13. The OR is dangerous, it has many chemicals and pieces of equipment that require training to make sure the user and patient remain safe. If in doubt, ask questions!
Also, the electrosurgical unit is great for "mad-science" demonstrations! :P

14. I know my surgical instrumentation, I know how to take care of it, inspect it, and prepare it for use! :)

15. I know how to properly decontaminate and process used surgical instrumentation, including terminal sterilization and sterilization for use at the surgical site.
16. There seems to be a lot of concepts that come in 3s!

17. There's a bunch of nice people in my cohort!

18. And so much more!