Transcript Assisting with Minor Surgery

CHAPTER
41
Assisting with Minor
Surgery
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-2
Learning Outcomes
41.1 Define the medical assistant’s role in minor surgical
procedures.
41.2 Describe types of wounds and explain how they heal.
41.3 Describe special surgical procedures performed in an
office setting.
41.4 List the instruments used in minor surgery and
describe their functions.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-3
Learning Outcomes (cont.)
41.5 Describe and contrast the procedures for medical and
sterile asepsis in minor surgery.
41.6 Describe the medical assistant’s duties in preparing to
assist in minor surgery.
41.7 Describe the medical assistant’s duties in preparing a
patient for surgery.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-4
Learning Outcomes (cont.)
41.8 Describe the types of local anesthetics for minor
surgery and the medical assistant’s role in their
administration.
41.9 Describe the duties of the medical assistant as a
floater and as a sterile scrub assistant.
41.10 Describe the medical assistant’s duties in the
postoperative period.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-5
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-6
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-7
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-8
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-9
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-10
Common Surgical Procedures in an Office
• Draining an abscess –
collection of pus
formed due to an
infection
• Mole (nevus) removal
– Small discolored area
of the skin
– Done if the mole
changes shape, size,
or color
• Obtaining a biopsy specimen
– Removal of a small amount of tissue for examination
– Specimens are placed in 10% formalin, a common
preservative
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-11
Wound Care
• Accidental
– Laceration – jagged,
open wound
– Puncture wound –
deep wound caused
by a sharp object
• Intentional – surgical
incision
• Cleaning a nonsurgical wound
– Wash with soap and
water
– Irrigate with sterile
solution
– Debridement –
removal of debris or
dead tissue
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-12
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-13
Closing a Wound
• Butterfly closures or sterile strips
• Skin adhesive
• Sutures
– Absorbable – collagen fibers
– Nonabsorbable – silk, nylon, polyester
• Staples
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-14
Special Procedures
• Laser surgery
– Intense beam of light
used to cut away tissue
– Does less damage to
surrounding tissue
• Electrocauterization
• Cryosurgery
– Uses extreme cold to
destroy unwanted
tissue
– Patient education –
wound care
– Needle, probe, or loop
heated by electric current
to destroy the target tissue
– Requires a grounding plate
or pad to prevent an
electric shock
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-15
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-16
Instruments Used in Minor Surgery
• Cutting and dissecting instruments
– Scalpels
– Scissors
– Curettes
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-17
Instruments (cont.)
• Grasping and clamping instruments
– Forceps
– Hemostats
– Towel
clamps
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-18
Instruments (cont.)
• Retracting, dilating, and probing
instruments
– Retractors
– Dilators
– Probes
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-19
Instruments (cont.)
• Suturing instruments
– Needles
– Needle
holders
– Packaged
sutures
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-20
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-21
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-22
Asepsis
• Priority during
surgical procedures
– Critical to heath and
safety of the patient
– Levels
• Medical – clean
technique
• Surgical – sterile
technique
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-23
Medical Asepsis
• Reduces the number of microorganisms
and prevents the spread of disease
– Handwashing
– Personal protective
equipment
– Sharps and biohazardous
waste handling and
• Provides a barrier between disposal
• Puncture and leak-resistant
wearer and infectious or
containers
hazardous materials
• Biohazard symbol
• Gloves, masks, gowns
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-24
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-25
Surgical Asepsis (cont.)
– Perform a surgical
scrub
• Removes more
microorganisms than
handwashing
• 2–6 minutes
– Put on sterile gloves
– Sanitize, disinfect, and
sterilize equipment
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-26
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-27
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-28
Preoperative Procedures (cont.)
• Preparing the surgical room
– Equipment and supplies –
check date and sterilization
indicator
– Neat, clean, and free of waste
– Adequate lighting
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-29
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-30
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-31
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-32
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-33
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-34
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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-35
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-36
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-37
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-38
Postoperative Procedures (cont.)
• Postoperative
instructions
– Guidelines for pain
management
– Instruction for wound
care
– Dietary restrictions
– Activity restrictions
– When to call the
physician
– Have patient repeat to
verify understanding
– Provide written
materials in a
postoperative
information packet
• Patient release
– Follow-up appt.
– Transportation
arrangements
– Follow-up appointment
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-39
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-40
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
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-41
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!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-42
In Summary
41.1 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.
41.2 Wounds are defined as either surgical or accidental
and include incisions, lacerations, and puncture
wounds. Wounds heal in three phases: inflammatory
phase, proliferative phase, and maturation phase.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-43
In Summary (cont.)
41.3 Several special surgical procedures are performed in
an office setting. These include laser surgery,
cryosurgery, and electrocauterization.
41.4 Various categories of instruments are used in minor
surgery. These include instruments for cutting and
dissecting, grasping and clamping, retracting, dilating,
and probing, suturing, injecting, withdrawing fluids,
and obtaining specimens.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-44
In Summary (cont.)
41.5 Medical asepsis involves reducing the number of
microorganisms to prevent the spread of disease. The
goal of surgical asepsis is to eliminate all
microorganisms.
41.6 A medical assistant’s preoperative duties include
providing preoperative instructions to the patient,
ensuring that all necessary paperwork is completed,
easing the patient’s fears, and preparing the surgical
room.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-45
In Summary (cont.)
41.7 The medical assistant’s role in preparing the patient
for surgery includes determining whether the patient
has followed presurgical instructions, obtaining the
patient’s vital signs, checking medication orders,
gowning and positioning the patient, and preparing
the patient’s skin for surgery.
41.8 Local anesthetics are used during most minor surgical
procedures and may be either injected or applied
topically. The medical assistant will prepare the
anesthetic so that the physician can administer it.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-46
In Summary (cont.)
41.9 A medical assistant may serve in one of two
capacities during a surgical procedure. One is as an
unsterile assistant known as a floater and the other is
as a sterile scrub assistant.
41.10 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.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
41-47
End of Chapter 41
A wise doctor does not mutter
incantations over a sore
that needs the knife.
~ Sophocles
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.