Transcript The Profession of Medical Assisting

CHAPTER
44
Assisting with Minor
Surgery
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44-2
Learning Outcomes (cont.)
44.1 Define the medical assistant’s role in minor
surgical procedures.
44.2 Describe surgical procedures performed in
an office setting.
44.3 Identify the instruments used in minor
surgery and describe their functions.
44.4 Describe the procedures for medical and
sterile asepsis in minor surgery.
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44-3
Learning Outcomes (cont.)
44.5 Discuss the procedures used in a medical
office to sterilize surgical instruments and
equipment.
44.6 Summarize the medical assistant’s duties in
preoperative procedures.
44.7 Describe the medical assistant’s duties
during an operative procedure.
44.8 Implement the medical assistant’s duties in
the postoperative period.
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44-4
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
– Surgical asepsis
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The Medical Assistant’s Role in
Minor Surgery
44-5
• Administrative
– Completing insurance forms
– Obtaining signed informed consent
– 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.)
44-6
• Relative to surgical procedure
– Prepare surgical room
– Prepare equipment
– Assist during procedure
– Ensure safety and comfort of the patient
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The Medical Assistant’s Role in
Minor Surgery (cont.)
44-7
• Postoperative procedures
– Patient care
– Dress wound
– Patient education
– Ensure patient has safe transportation
– Clean room for next procedure
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44-8
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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44-9
Surgery in the Physician’s Office
• Minor surgical procedure
– Safely performed without general anesthesia
– Use local anesthetics
• Reasons
– Diagnose illnesses
– Repair an injury
– Removal of small growths
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44-10
Common Surgical Procedures
• Procedures requiring an incision 
physician
• Draining an abscess
– Collection of pus covered by a protective
lining
–I&D
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44-11
Common Surgical Procedures (cont.)
• Obtaining a biopsy specimen
– Removal of a small amount of tissue for
examination
– Needle biopsy
– 10% formalin ~ preservative
• Mole removal
– Small discolored area of skin
– Removed if it changes shape, size, or color
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44-12
Common Surgical Procedures (cont.)
Caring for wounds
• Any break in the
skin
– Accidental
• Laceration
• Puncture wound
– Intentional
• Cleaning
– Soap and water
– Irrigate with sterile
solution
– Debridement
•
•
•
•
Surgical
Chemical
Mechanical
Autolytic
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44-13
Common Surgical Procedures (cont.)
• Wound healing
– Three phases
1. Inflammatory
phase
– Factors
• Age
• Blood vessels
constrict
• Nutritional status
• Wound seals
• Overall health
• Blood clots
• Bacteria and debris
are removed
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44-14
Common Surgical Procedures (cont.)
• Wound Healing
2. Proliferation
3. Maturation
phase
phase
• New tissue forms
• Formation of scar
tissue
• Sped up if wound
edges are
approximated
• Scar tissue
– No nerves or
blood vessels
– Not as resilient as
skin
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44-15
Common Surgical Procedures (cont.)
• Closing a Wound
– Sutures
– Ligature
• Absorbable
• Nonabsorbable
– Staples
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44-16
Special Minor Surgical Procedures
• Laser surgery
– Less damage to
surrounding tissue
– Promotes healing
– Prevents infection
– Medical assistant
• Position and drape
patient
• Assist as needed
• Clean wound and
apply dressing
• Patient instructions
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44-17
Special Minor Surgical Procedures
• Cryosurgery
– Extreme cold used to
destroy unwanted
tissue
– Patient education
• Wound care
• Blister may form; do not
break
• Ice and pain relievers
• Electrocauterization
– Needle, probe, or loop
heated by electric
current to destroy the
target tissue
– May require a
grounding plate or pad
– General wound care
instructions
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44-18
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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44-19
Instruments Used in Minor Surgery
• Cutting and dissecting instruments
– Scalpels
– Scissors
– Curettes
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44-20
Grasping and Clamping Instruments
• Forceps
• Towel clamps
• Hemostats
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44-21
Retracting, Dilating, and Probing
Instruments
• Retractors
• Dilators
• Probes
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44-22
Suturing Instruments
• Needles
• Needle holders
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44-23
Instruments Used in Minor Surgery (cont.)
• Syringes and needles
– Inject anesthetic
solutions
– Withdraw fluids
– Obtain biopsy
specimens
• Instrument trays and
packs
– All items needed are
packaged together
– Sterilized
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44-24
Apply Your Knowledge
Name at least one instrument for each of the following
ANSWER:
types:
scissors, scalpels, curettes
1. Cutting and dissecting
2. Grasping and clamping
forceps, hemostats, clamps
3. Retracting, dilating, and probing retractors, dilators, probes
4. Suturing
needle holders, needles, packaged sutures
SUPER!
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44-25
Asepsis
• Critical to heath and safety
• Levels of asepsis
– Medical ~ clean
technique
– Surgical ~ sterile
technique
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44-26
Asepsis (cont.)
• Personal protective equipment
– Gowns
– Gloves
– Masks
– Protective eye wear
or face shield
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44-27
Asepsis (cont.)
• Biohazardous waste handling and disposal
– Sharps ~ puncture-resistant container
– All other items
• Leakproof plastic bag or container
• Red or labeled with orange-red
biohazardous symbol
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44-28
Surgical Asepsis
• Eliminates all microorganisms
• Sterile field
– Used as a work area
during procedure
– Know when to redo
the sterile field
– Keep field above
waist level
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44-29
Surgical Asepsis
• Adding sterile item to sterile field
– Outer one inch is
“contaminated”
– Instruments and
supplies
– Pouring sterile
solutions
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44-30
Surgical Asepsis (cont.)
• Surgical scrub
– Removes more microorganisms than routine
handwashing
– Different than aseptic handwashing
• Donning sterile
gloves
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44-31
Surgical Asepsis (cont.)
• Sanitizing, disinfecting, and sterilizing
equipment
– Sanitization ~ cleaning with germicidal soap
and water
– Disinfection and/or sterilization ~ dependent
on use
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44-32
Apply Your Knowledge
Will you use medical or surgical asepsis when
assisting with minor surgery?
ANSWER: You will use both levels of asepsis.
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44-33
Sterilization
• Required for all instruments or supplies that
– Penetrate the skin
– Contact normally sterile areas of the body
– Any item used in a sterile field
• Items are sterile or not sterile
• Prior to sterilization
– Sanitize
– Disinfect
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44-34
The Autoclave
• Primary method of
sterilization
– Pressurized steam
– Use Standard
Precautions
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44-35
The Autoclave (cont.)
• Wrapping and labeling
– Porous fabric, paper, or plastic
– Sterile pack ~ instruments used together
– Label with non-toxic marker
• Identity of items inside wrapping
• Person completing
the procedure
• Expiration date
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44-36
The Autoclave (cont.)
• Preheating
– Check unit
– Follow
manufacturer’s
guidelines
• Settings
– Most units operate
automatically
– Manual autoclaves
• Jacket pressure
gauge
• Chamber pressure
gauge
• Temperature gauge
• Timer
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44-37
The Autoclave (cont.)
• Sterilized supplies
– Store in clean, dry
area
– Shelf life
• Cleaning autoclave
• Cleaning work area
– Sterile and
unsterile
– Move all sterile
items to avoid
contamination
– After each use
– Check unit for
signs of wear
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44-38
The Autoclave (cont.)
• Sterilization indicators
– Do not guarantee
sterilization
– Show that proper
temperature, pressure,
and duration occurred
• Quality control – uses biological indicators
to ensure sterilization
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44-39
The Autoclave (cont.)
• Preventing incomplete sterilization
– Correct timing
– Adequate temperature
– Properly wrapped packs
– Adequate steam levels
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44-40
Apply Your Knowledge
What items need to be sterilized?
ANSWER: Sterilization is required for all instruments
or supplies that penetrate the skin or come in contact
with normally sterile areas of the body.
Right!
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44-41
Preoperative Procedures
• Preliminary duties
– Preoperative instructions
•
•
Procedure
Restrictions
– Administrative and legal tasks
• Insurance forms and preauthorization
• Signed informed consent
– Easing fears – education and communication
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44-42
Preoperative Procedures (cont.)
• Preparing the
Room
• Preparing the
Patient
– Neat, clean, and
free of waste
– Gown and position
the patient
– Adequate lighting
– Drape properly
– Equipment and
supplies
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44-43
Preparing the Patient (cont.)
• Surgical skin preparation
– Clean the area
• Circular motion
• Surgical site outward
– Remove hair
– Apply the antiseptic
• Same circular technique
• Allow to air dry
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44-44
Apply Your Knowledge
What are some of the medical assistant’s duties
preoperatively?
Good Answer!
ANSWER: some of the duties are:
 Patient education
 Vital signs
 Completing insurance forms and obtaining
preauthorization
 Ensuring informed consent form is signed
 Easing patient fears
 Preparing the room
 Assisting patient into position and draping
 Preparing the surgical site
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44-45
Intraoperative Procedures
• Administering a local anesthetic
– Topical application
– Injections
• Check label
• Assist as needed
– Epinephrine
• Constricts blood
vessels
•  bleeding and 
action of anesthetic
– Inform patient of
potential side effects
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44-46
Assisting the Physician During Surgery
• Floater
– Monitoring and recording
– Processing specimens
– Other duties
as necessary
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44-47
Assisting the Physician During
Surgery (cont.)
• Sterile scrub assistant
– Handling instruments
• Arrange them according to use
• Pass them to the physician
– Other duties
• Swab fluids from a
wound
• Retract edges of a
wound
• Cut suture
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44-48
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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44-49
Postoperative Procedures
• Immediate postoperative care
– Administer medications as directed
– Monitor vital signs
– Watch for adverse reactions
– Keep the patient lying down
– Document all observations
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44-50
Postoperative Procedures (cont.)
• Wound dressing – sterile material used to
cover the incision
• Bandaging the wound – holds
dressing in place
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44-51
Postoperative Procedures (cont.)
• Postoperative
instructions
– Pain management
– Wound care and
signs of infection
– Any restrictions
– Follow-up
• Patient release
– Assist as needed
– Schedule follow-up
appointment
– Confirm
transportation
arrangements
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44-52
Surgical Room Cleanup
• Place reusable instruments in a
disinfectant soak
• Dispose of waste and sharps appropriately
• Disinfect the counters, exam table, and
trays
• Disinfect small pieces of nonsurgical
equipment
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44-53
Follow-up care
• Physician examines surgical wound
• The dressing is changed
• Wound closures removed
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44-54
Apply Your Knowledge
What is the difference between a dressing and a
bandage?
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.
Excellent!
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44-55
In Summary
44.1 The medical assistant’s role in minor surgery
includes both administrative and clinical tasks.
These include but are not limited to
completing insurance forms, obtaining signed
patient consent, preparing the surgical room,
and assisting during a procedure.
44.2 Several special surgical procedures are
performed in an office setting, including laser
surgery, cryosurgery, and
electrocauterization.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
44-56
In Summary
44.3 Various categories of instruments are used in
minor surgery including instruments for cutting
and dissecting, grasping and clamping,
retracting, dilating and probing, suturing, and
injecting, withdrawing fluids, and obtaining
specimens.
44.4 Medical asepsis involves reducing the
number of microorganisms to prevent the
spread of disease. The goal of surgical
asepsis is to eliminate all microorganisms.
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44-57
In Summary (cont.)
44.5 Instruments and equipment that must be
sterilized before use should be sanitized to
remove blood and gross tissue, and then
sterilized either in an autoclave or by chemical
means
44.6 A medical assistant’s preoperative duties
include providing preoperative instructions to
the patient, ensuring all necessary paperwork
is completed, easing the patient’s fears, and
preparing the surgical room.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
44-58
In Summary (cont.)
44.7 A medical assistant may serve in one of two
capacities during a surgical procedure: either
as an unsterile assistant known as a floater or
as a sterile scrub assistant.
44.8 A medical assistant's postoperative duties
include giving immediate patient care,
dressing and bandaging the wound, giving
postoperative instructions, assisting with
patient release, and cleaning the surgical
room.
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44-59
End of Chapter 44
A wise doctor does not
mutter incantations over
a sore that needs the
knife.
~ Sophocles
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.