chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 4 assisting with minor surgery
TRANSCRIPT
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-2
Introduction
• Minor surgical procedures – Ambulatory care
settings – Office practices
• Medical assistant– Types of procedures
– Patient preparation
– Assisting physician during the procedure
– Patient care following the procedure
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The Medical Assistant’s Role in Minor Surgery
• Administrative– Completing insurance
forms
– Obtaining signed informed consent forms
– Patient education• Explaining procedure to and
answering questions from the patient
• Presurgical instructions
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The Medical Assistant’s Role in Minor Surgery (cont.)
• Relative to surgical procedure
– Prepare surgical room
– Prepare equipment
– Assist during procedure
• Unsterile
• Sterile
– Ensure safety and comfort of the patient
• Postoperative procedures
– Patient care
– Dress wound
– Patient education
• Wound care
• Postoperative care
– Clean room for next procedure
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Apply Your Knowledge
What are the medical assistant’s responsibilities in relation to patient education and minor surgical procedures?
ANSWER: The medical assistant may be responsible for providing patient education concerning the following:
Explanation of the procedure Presurgical instructions Postoperative instructions Wound care
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Surgery in the Physician’s Office
• Minor surgical procedure– Safely performed in office or
clinic without general anesthesia
– Use local anesthetics affecting only a particular area
• Reasons– Diagnose illnesses– Repair an injury– Removal of small growths– Cosmetic
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Common Surgical Procedures in an Office
• Draining an abscess – collection of pus formed due to an infection
• Obtaining a biopsy specimen– Removal of a small amount of tissue for examination– Specimens are placed in 10% formalin, a common
preservative
• Mole (nevus) removal– Small discolored area
of the skin– Done if the mole
changes shape, size, or color
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Wound Care
• Accidental – Laceration – jagged,
open wound– Puncture wound –
deep wound caused by a sharp object
• Intentional – surgical incision
• Cleaning a non-surgical wound– Wash with soap and
water– Irrigate with sterile
solution– Debridement –
removal of debris or dead tissue
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Wound Healing
• Inflammatory phase – Vessels in area constrict – reduces bleeding– Platelets, clotting factors, and WBCs seal the wound,
clot the blood, and remove bacteria and debris
• Proliferation phase – New tissue forms, closing off wound– Phase can be sped up if edges of wound are
approximated
• Maturation phase – formation of scar tissue
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Closing a Wound
• Butterfly closures or sterile strips
• Skin adhesive
• Sutures
– Absorbable – collagen fibers
– Nonabsorbable – silk, nylon, polyester
• Staples
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Special Procedures• Laser surgery
– Intense beam of light used to cut away tissue
– Does less damage to surrounding tissue
• Electrocauterization – Needle, probe, or loop
heated by electric current to destroy the target tissue
– Requires a grounding plate or pad to prevent an electric shock
• Cryosurgery – Uses extreme cold to
destroy unwanted tissue
– Patient education – wound care
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Apply Your Knowledge
A 65-year-old female has a wound on her left calf that is healing poorly. When reviewing her chart, what conditions would you look for that would indicate the reason for the poor healing?
ANSWER: Reasons for poor wound healing include: Age Poor nutrition Poor circulation High stress levels Diabetes Weakened immune system Obesity Smoking
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Instruments Used in Minor Surgery
• Cutting and dissecting instruments
– Scalpels
– Scissors
– Curettes
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Instruments (cont.)
• Grasping and clamping instruments
– Forceps
– Hemostats
– Towelclamps
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Instruments (cont.)
• Retracting, dilating, and probing instruments
– Retractors
– Dilators
– Probes
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Instruments (cont.)
• Suturing instruments
– Needles
– Needle holders
– Packagedsutures
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Instruments (cont.)
• Syringes and needles– Inject anesthetic
solutions
– Withdraw fluids
– Obtain needle biopsy specimens
• Instrument trays and packs– Laceration repair tray– Incision and drainage
tray– Foreign body and
growth removal tray– Onychectomy (nail
removal) tray– Vasectomy tray– Suture and staple
removal trays
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Apply Your Knowledge
Name at least one instrument for each of the following types:
1. Cutting and dissecting
2. Grasping and clamping
3. Retracting, dilating, and probing
4. Suturing
scissors, scalpels, curettes
forceps, hemostats, clamps
needle holders, needles, packaged sutures
retractors, dilators, probes
ANSWER:
SUPER!
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Asepsis
• Priority during surgical procedures– Critical to heath and
safety of the patient– Levels
• Medical – clean technique
• Surgical – sterile technique
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Medical Asepsis
• Reduces the number of microorganisms and prevents the spread of disease– Handwashing
– Personal protective equipment
• Provides a barrier between wearer and infectious or hazardous materials
• Gloves, masks, gowns
– Sharps and biohazardous waste handling and disposal
• Puncture and leak-resistant containers
• Biohazard symbol
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Surgical Asepsis
• Eliminates all microorganisms
• Common procedures using sterile technique– Creating a sterile field
• Used as a work area during procedure• Keep above waist level
– Adding sterile item to sterile field• Outer one inch is “contaminated”• Instruments and supplies• Pouring sterile solutions
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Surgical Asepsis (cont.)
– Perform a surgical scrub
• Removes more microorganisms than handwashing
• 2–6 minutes
– Put on sterile gloves
– Sanitize, disinfect, and sterilize equipment
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Apply Your Knowledge
What is the difference between medical and surgical asepsis?
ANSWER: Medical asepsis reduces the number of microorganisms present. It requires good handwashing, the use of personal protective equipment, and proper disposal of sharps and biohazardous waste.
Surgical asepsis is the elimination of microorganisms through sanitizing, disinfection, and sterilization. Requires performing a surgical scrub and donning sterile gloves.
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Preoperative Procedures
• Preliminary duties– Preoperative instructions
• Procedure • Dietary and fluid restrictions• Bring someone to drive home
– Administrative and legal tasks – signed informed consent
– Easing the patient’s fears – education and communication
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Preoperative Procedures (cont.)
• Preparing the surgical room– Equipment and supplies –
check date and sterilization indicator
– Neat, clean, and free of waste
– Adequate lighting
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Preoperative Procedures (cont.)
• Preparing the patient– Initial tasks
• Vital signs• Medication orders
– Gown and position the patient
– Surgical skin preparation
• Clean the area• Remove hair from the
area• Apply the antiseptic
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Apply Your Knowledge
Mr. Smith is having a minor surgical procedure on his forearm. You notice that he has a lot of hair at the site. What should you do?
ANSWER: You should use a scissors or electric trimmer to trim the hair just prior to surgery.
Good Answer!
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Intraoperative Procedures
• Administering a local anesthetic – Topical application
• Gels, creams, and sprays
• Takes 10 to 15 minutes
to be effective
– Injections• Usually administered
by the physician• Check label to verify
correct medication
– Potential side effects • Dizziness, loss of
consciousness, seizures, or cardiac arrest
– Use of epinephrine• Reduces bleeding • Prolongs action of local
anesthetic
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Intraoperative Procedures (cont.)
• Assisting the physician during surgery– Floater
• Monitoring and recording• Processing specimens• Other duties
– Pouring sterile solutions– Keeping the surgical area clean and neat during the
procedure– Repositioning the patient as necessary– Adjusting lighting
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Intraoperative Procedures (cont.)
– Sterile scrub assistant • Performs a sterile scrub
and wears sterile gloves• Arranges instruments
according to use– Cutting instruments– Grasping instruments– Retractors– Probes– Suture materials– Needle holders and
scissors
• Other duties– Swab fluids from
wound– Retract wound– Cut suture material
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Apply Your Knowledge
What are the duties of a floater?
ANSWER: During a procedure, the floater monitors the patient, documents, processes specimens, adds items to sterile field, pours sterile solutions, assists with additional anesthetic, keeps the area clean during the procedure, repositions the patient, and adjusts lighting.
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Postoperative Procedures
• Immediate patient care is the top priority
– Administer medications as directed
– Monitor vital signs
– Watch for adverse reactions
– Keep the patient lying down for the prescribed
length of time
– Document all observations in the patient’s
chart
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Postoperative Procedures (cont.)
• Dressing the wound– Sterile material used to cover
the incision
– Purpose• Keeps wound clean• Reduces bleeding• Absorbs fluid drainage• Reduces discomfort to
the patient• Speeds healing • Reduces the possibility
of scarring
– Procedure• Clean examination
gloves• Clean site with
povidone-iodine• Antibiotic ointment, if
ordered• Secure sterile dressing
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Postoperative Procedures (cont.)
• Bandaging the wound– A clean strip of gauze or elastic material
– Purpose• Holds the dressing in place
• May improve circulation
• Provides support or reduces tension on the wound
• Prevents the wound from reopening
• Prevents movement of the area of the body
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Postoperative Procedures (cont.)
• Postoperative instructions
– Guidelines for pain management
– Instruction for wound care
– Dietary restrictions
– Activity restrictions
– When to call the physician
– Follow-up appointment
– Have patient repeat to verify understanding
– Provide written materials in a postoperative information packet
• Patient release– Follow-up appt.– Transportation
arrangements
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Postoperative Procedures (cont.)
• Surgical room cleanup– Place reusable instruments in a
disinfectant soak– Dispose of waste and sharps
appropriately– Disinfect the counters, exam table, and trays
according to OSHA guidelines– Disinfect small pieces of nonsurgical
equipment
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Postoperative Procedures (cont.)
• Follow-up care– Physician examines surgical wound– The dressing is changed and/or wound
closures are removed• Suture or staple removal is done 5 to 10 days after
minor surgery• Ready for removal when there is a clean, unbroken
suture line • There should be no scabs, seeping, or visible
opening present
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Apply Your Knowledge
ANSWER: A dressing is a sterile material used to cover the incision, whereas a bandage is a clean strip of gauze or elastic material used to hold the dressing in place.
What is the difference between a dressing and a bandage?
Excellent!