1. Chapter 42: Assisting with Minor Surgery
Lesson 4
Postoperative Patient Care
© 2009 Pearson Education

2. Define and spell the terms to learn for this chapter.
Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
Explain the four types of wounds.
Describe the stages of healing.
Describe at least five surgical procedures that can be performed in the physician’s office, and indicate the responsibility of the medical assistant for each procedure.
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© 2009 Pearson Education

3. Elements of Postoperative Patient Care
Insert Figure 42-1 from
PCMA 2nd edition
Monitoring the patient during recovery from anesthesia
Wound care
Applying dressings
Communicating patient instructions
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4. Critical Thinking Question
How might the type of anesthesia used affect a patient’s recovery?

5. Topical and Other Local Anesthetics
Affects usually wear off quickly
Use of large amounts, beyond normal dosages, may result in an adverse reaction
If a patient is allergic, the patient may experience an anaphylatic shock
Drugs used to counteract shock should always be available
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Pts who were treated in the month or throat should be advised not to ear until the effects of the anesthetic wear off.

6. Types of Local Anesthetics
Benzocaine - Topical use only
Chloroprocaine – Nerve block epidural
Lidocaine (Xylocaine) – Infiltration or topical
Mepivacaine – Infilitration nerve block
Procaine (novacaine) – Infiltration, seldom used now
Tetracaine – Infiltration, local nerve block, spinal
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Table 42-3

7. Areas to Observe on a Patient Recovering from Surgery
Signs of adverse reaction to the anesthetic
Bleeding
Circulatory problems
Vitals
Blood pressure, temperature, pulse, and respirations
Should be monitored immediately after surgery and then every 15 minutes for the first hour
In ability recovery in a normal timeframe
should be report to the physician
Immediately!
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8. Wounds Defined as any break in the skin
Can occur from injury or a surgical incision
An invasive procedure, such as surgery, creates a wound
Wounds cause blood vessels to rupture and blood to seep into tissues
Changes in skin color can occur
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Typically skin coloration will change from erythema in a fresh wound to a greenish yellow color during the healing process.

9. Types of Wounds Abrasion Incision
Outer layers of skin are rubbed away due to scraping
Will generally heal without scarring
Incision
Smooth cut resulting from a surgical scalpel or sharp material, such as razor or glass
May result in excessive bleeding and scarring if deep
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10. Types of Wounds Laceration Edges are torn in an irregular shape
Can cause profuse bleeding and scarring
Puncture
Made by a sharp, pointed instrument such as a bullet, needle, nail, or splinter
External bleeding is usually minimal
Infection may occur due to penetration with a contaminated object
May be scarring
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11. Phases of a Healing Wound
Inflammatory phase (3 days)
Blood clot forms to stop bleeding and plug the opening of the wound
Eschar or scab forms to keep out microorganisms
Proliferating phase (3 to 21 days)
Fibrin threads extend across opening of the wound and pull edges together
Cells multiply to repair the wound
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Wounds pass through various stages of healing.
Signs of inflammation are redness or erythema, swelling, warmth, & pain.

12. Phases of a Healing Wound
Maturation phase (21 days to 2 years)
Tissue cells strengthen and tighten the wound closure
A scar is formed
The scar eventually fades and thins
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13. Wound Complications Infection Hemorrhage or bleeding Dehiscense
Include signs of inflammation, purulent or puslike drainage, fever
Hemorrhage or bleeding
Dehiscense
Separation of wound edges
Evisceration
Separation of wound edges and protrusion of abdominal organs
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Uneven or ragged-edged wounds & large wounds take more time to heal.

14. Wound Drainage
Occurs as fluid and cells escape from the tissues during the inflammatory phase of wound healing
The amount and type of drainage observed on a dressing should be charted
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15. Types of Wound Drainage
Serous drainage
Clear, watery drainage, such as the fluid in a blister
Sanguineous drainage
Bloody – bright red is fresh blood, dark red is older blood. The amount and color are important
Serosanguineous drainage
Thin watery drainage tinged with blood
Purulent drainage
Thick puslike drainage that is green, yellow, or brown
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The amount & type of drainage observed on a dressing should be charted.

16. Cleansing a Wound Must be done before a sterile dressing is applied
The product used for cleansing is determined by the physician
Warm water and soap are used to remove surface dirt around the wound
When cleaning the wound, use a sterile gauze or swab
Work from the clean area near the wound outward to less clean areas
Wipe in one direction and then discard the sterile swab or gauze.
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17. Cleansing a Wound
Always clean at least 1 inch beyond the edge of the dressing to be applied
If no dressing is to be applied, clean 2 inches beyond the edges of the wound
Use a new gauze pad for each circle
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18. Cleansing a Linear Wound
Start from top to bottom with one stroke per sterile gauze or swab.
Work outward from the wound in parallel lines
Insert Figure 42-27
From Chapter 42
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19. Cleansing an Open Wound
Wipe in one Work in circles, half or full
Begin in the center and work outward
Insert Figure 42-28
From Chapter 42
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20. Dressings
Insert Figure from
PCMA 2nd edition
Chapter 42
Size and shape depends on the size, location, and amount of drainage from the wound
Sterile 4 X 4 gauze pads (“four by fours”) are used for most dressings
If drainage is expected, a prepared dressing may be used to prevent the dressing from sticking to the wound
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Each pt should be asked how long it has been since he/she received a tetnus shot. They are received every 10 years.
Wound closure kit

21. Sutures A thread used to sew together body tissues
Sutures used to attach tissues beneath the skin are often made of an absorbable material
Skin sutures are made of nonabsorable materials such as
Silk, cotton, linen, wire, nylon, Dacron (polyester fiber)
Silver wire clips or staples can also be used
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Inserted at the end of a procedure by the surgeon to hold tissues in alignment during the healing process.
If they remain in the body too long, they can cause skin irritation & infection.
Suture acts as a wick to carry bacteria through the skin & into the subcutaneous tissues.

22. Suture Removal Times Facial sutures Head and neck sutures
24 to 38 hours to prevent scarring
Head and neck sutures
3 to 5 days
Abdominal sutures
5 to 7 days
Sutures over weight-bearing joints and large bones
7 to 10 days
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23. Critical Thinking Question
Prior to removing a patient’s dressing and sutures, how can you help the patient feel more at ease?

24. Removing a Dressing
Each edge of the dressing is removed by pulling toward the suture line
If the dressing is adhering to the suture line, use a small amount of sterile saline or hydrogen peroxide to moisten the dressing to ease removal
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25. Steps to Removing Sutures
6. Apply sterile gloves and cleanse the
wound as needed.
5. Perform hand hygiene. Open suture or
staple removal pack using proper technique.
4. Perform hand hygiene and remove old
dressing using proper technique.
3. Identify the patient, explain the procedure, and
assist patient into a comfortable position
2. Assemble equipment and check expiration date
on pack.
Page
Procedure 42-10
Sometimes MAs are permitted to remove sutures.
1. Perform hand hygiene

26. Steps to Removing Sutures
12. Count sutures to make sure that all
Have been removed.
11. Repeat these steps until all the sutures
are removed.
10. Place the cut suture on the gauze.
9. Insert the suture scissors and cut suture at skin
level. Pull out the sutures.
8. Grasp the knot of the suture with thumb forceps and
lift gently.
Page
Procedure 42-10
7. Place a gauze square next to the wound for placement
of sutures or staples as they are removed.

27. Bandages for a Wound May be gauze, fabric, or elasticized
Need not be sterile
Available in various sizes, lengths, and shapes
Some are self-adhering
Elastic bandages are used to support an injured part and reduce swelling
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Care must be taken not to bandage too tightly & restrict circulation.

28. Minor Surgical Procedures Performed in a Medical Office
Biopsy
Cautery
Colposcopy
Cryosurgery
Laser surgery
Endocervical curettage
Endoscopic procedures
Suture removal
Removal of foreign bodies
Incision and drainage
Vasectomy
Removal of growths and tumors
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Saves the pt time & expense of having to go into an ambulatory surgical facility or hospital.
The MA will assist with these and therefore must understand & know their effects.

29. Electrosurgery The application of high frequency electrical currents
Currents are used to heat tissue to cut, destroy, or remove it
Most often performed in dermatological, gynecological, cardiac, ocular, ENT, and orthopedic surgical procedures
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30. Types of Electrosurgery
Electrocoagulation
Destroys tissues and controls bleeding by coagulation
Electrodessication
Destroys tissue by creating a spark gap when the probe is inserted into unwanted tissue
Electrofulguration
Destroys tissue with a spark emitted from the tip of a probe positioned a short distance away from the unwanted tissue
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5 types of currents used in electrosugery.

31. Types of Electrosurgery
Electrosection
Uses electric current to incise and excise the tissue
Electrocautery (or cautery)
Uses high-frequency, alternating electric current to destroy, cut, or remove tissue.
Also used to coagulate small blood vessels, thereby reducing bleeding and cell loss
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Electrosurgical unit (ESU) or the ultrasonic surgical unit (USU) are replacing the electrocautery.
ESU provides a more controlled, less damaging form of electric current.
USU uses high-frequency sound waves to break apart calcified or sclerosed tissue that can be removed in small segments.

32. Laser Surgery
Laser is an acronym for Light Amplification by Stimulated Emission of Radiation
Laser was originally used to treat diseases of the retina
Laser surgery today is used to treat various diseases and conditions such as:
Vascular problems
Neurological problems
Orthopedic conditions
Dermatologic problems
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Emits an intense beam of light.
Advantage of promoting quick healing & not destroying surrounding tissue.
Everyone including the pt needs to wear safety goggles.

33. Colposcopy An examination of the vagina and cervix
Performed using a colposcope
Patient is in the lithotomy position
Allows the physician to observe tissues of this area in greater detail through light and magnification
Abnormal areas of tissue or cells can be removed for biopsy to detect cancer
Cryosurgery using freezing temperatures may be used to destroy cells
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Performed when abnormal tissue development is observed during a pelvic examination, when a Pap smear result is abnormal, for magnified visualization, & to obtain a biopsy specimen.

34. Endoscope
An instrument used to look into a hollow organ or body cavity
Used to examine the larynx, bladder, colon, sigmoid colon, stomach, abdomen, and some joints
Other attachments such as a light source, suction, or mirror may be used
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Most instances, the pt needs preparation prior to the examination.

35. Cryosurgery Use of subfreezing temperatures to destroy tissue.
Also known as cyrocautery.
Probe used in cryosurgery must be sterilized immediately after use according to manufacturer’s instructions.
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36. Endometrial Biopsy (EMB)
Performed with the patient in the lithotomy position
After performing a bimanual examination of the uterus the physician administers a local anesthetic.
The specimen is taking by means of a curette or with a suction device to aspirate a specimen which is then placed in a container of 10% formalin preservative solution.
After the procedure the patient may experience mild cramping for which a mild analgesic may be taken.
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37. Reasons for Performing an EMB
To detect precancerous and cancerous conditions of the endometrial lining of the uterus
To detect inflammatory conditions
To determine if polyps are present
To assess abnormal uterine bleeding
To assess the effects of hormonal therapy
To screen for early detection of endometrial cancer
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38. Incision and Drainage
Performed to relieve the buildup of purulent (pus) material as a result of infection
The purulent discharge may be cultured to determine what microorganisms is causing the infection
The appropriate antibiotic can then be selected
The procedure is performed using sterile surgical technqiue
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39. Tray Setup for an I&D Scalpel handle and blades (No. 11)
Curved iris scissors
Tissue forceps
Kelly hemostat
Retractor
Thumb dressing forceps
4 X 4 gauze squares
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40. Foreign Bodies and Growths
Insert Figure in
Chapter 42 of the
textbook
Foreign bodies
Can include a small to large objects.
Growths
Include tumors, warts, moles, and cysts.
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The most frequent growth removal procedure in the office is for cysts, which are fluid filled sacs.
Surgical tray setup for biopsy procedure

41. Vasectomy Tying and cutting of the vas deferens
Is most commonly performed in a urologist’s office
Provides a permanent form of birth control for the male.
As with all surgical procedures, a consent form must be signed
The patient should have someone to drive him home after the surgery
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Pt will be uncomfortable for 2-3 days following the procedure.
Should be given detailed instructions on home care including activity level & sexual intercourse.

42. Surgical Tray Set Up for a Vasectomy
Scalpel handle and blade (No.15)
Dressing forceps
Towel clamp
Straight and curved mosquito forceps
Curved tissue scissors
Tissue forceps
Retractor
Needle holder and suture material
Suture scissors
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43. Summary
Assisting with surgery includes maintaining aseptic technique, a thorough knowledge of gowning, gloving, surgical hand hygiene, setting up sterile instrument trays, passing equipment to the physician, packaging and surgical setup, and preparing the patient for the procedure. Assisting with surgical procedures carries with it a grave responsibility to maintain absolute sterile technique. The medical assistant incorporates a variety of clinical skills when assisting with a surgical procedure.
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44. Questions?