Learning Outcomes 41.1 Define the medical assistant s role in minor surgical procedures. 41-2 CHAPTER 41 Assisting with Minor Surgery 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. 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. 41-3 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. 41-4 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 41-5 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 41-6 1
The Medical Assistant s Role in Minor Surgery (cont.) 41-7 41-8 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 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 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 41-9 Common Surgical Procedures in an Office Draining an abscess collection of pus formed due to an infection 41-10 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 41-11 41-12 Wound Care Wound Healing 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 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 2
Closing a Wound Butterfly closures or sterile strips Skin adhesive Sutures Absorbable collagen fibers Nonabsorbable silk, nylon, polyester Staples 41-13 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 41-14 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 41-15 Instruments Used in Minor Surgery Cutting and dissecting instruments Scalpels Scissors Curettes 41-16 Instruments (cont.) Grasping and clamping instruments Forceps Hemostats Towel clamps 41-17 Instruments (cont.) Retracting, dilating, and probing instruments Retractors Dilators Probes 41-18 3
41-19 41-20 Instruments (cont.) Suturing instruments Needles Needle holders Packaged sutures 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 Name at least one instrument for each of the following types: ANSWER: 1. Cutting and dissecting 2. Grasping and clamping scissors, scalpels, curettes forceps, hemostats, clamps 3. Retracting, dilating, and probing retractors, dilators, probes 4. Suturing needle holders, needles, packaged sutures SUPER! 41-21 Asepsis Priority during surgical procedures Critical to heath and safety of the patient Levels Medical clean technique Surgical sterile technique 41-22 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 41-23 Sharps and biohazardous waste handling and disposal Puncture and leak-resistant containers Biohazard symbol 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 41-24 4
Surgical Asepsis (cont.) Perform a surgical scrub Removes more microorganisms than handwashing 2 6 minutes Put on sterile gloves Sanitize, disinfect, and sterilize equipment 41-25 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. 41-26 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 41-27 Preoperative Procedures (cont.) Preparing the surgical room Equipment and supplies check date and sterilization indicator Neat, clean, and free of waste Adequate lighting 41-28 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 41-29 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! 41-30 5
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 41-31 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 41-32 Intraoperative Procedures (cont.) 41-33 41-34 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 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. Postoperative Procedures 41-35 41-36 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 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 6
41-37 41-38 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 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 41-39 41-40 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 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 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! 41-41 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. 41-42 7
41-43 41-44 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. 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. 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. 41-45 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. 41-46 End of Chapter 41 41-47 A wise doctor does not mutter incantations over a sore that needs the knife. ~ Sophocles 8