2. CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 4 Assisting with Minor Surgery

3. © 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

4. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-3 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

5. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-4 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

6. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-5 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

7. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-6 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

8. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-7 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

9. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-8 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

10. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-9 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

11. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-10 Closing a Wound Butterfly closures or sterile strips Skin adhesive Sutures –Absorbable – collagen fibers –Nonabsorbable – silk, nylon, polyester Staples

12. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-11 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

13. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-12 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

14. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-13 Instruments Used in Minor Surgery Cutting and dissecting instruments –Scalpels –Scissors –Curettes

15. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-14 Instruments (cont.) Grasping and clamping instruments –Forceps –Hemostats –Towel clamps

16. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-15 Instruments (cont.) Retracting, dilating, and probing instruments –Retractors –Dilators –Probes

17. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-16 Instruments (cont.) Suturing instruments –Needles –Needle holders –Packaged sutures

18. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-17 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

19. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-18 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!

20. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-19 Asepsis Priority during surgical procedures –Critical to heath and safety of the patient –Levels Medical – clean technique Surgical – sterile technique

21. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-20 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

22. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-21 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

23. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-22 Surgical Asepsis (cont.) –Perform a surgical scrub Removes more microorganisms than handwashing 2–6 minutes –Put on sterile gloves –Sanitize, disinfect, and sterilize equipment

24. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-23 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.

25. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-24 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

26. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-25 Preoperative Procedures (cont.) Preparing the surgical room –Equipment and supplies – check date and sterilization indicator –Neat, clean, and free of waste –Adequate lighting

27. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-26 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

28. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-27 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!

29. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-28 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

30. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-29 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

31. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-30 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

32. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-31 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.

33. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-32 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

34. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-33 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

35. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-34 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

36. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-35 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

37. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-36 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

38. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-37 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

39. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-38 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!

40. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 41-39 End of Chapter 41 A wise doctor does not mutter incantations over a sore that needs the knife. ~ Sophocles