Y khoa - Dược - Chapter 44: Assisting with minor surgery

44Assisting with Minor Surgery44.1 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. Learning Outcomes (cont.)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.Introduction Minor surgical procedures Ambulatory care settings Office practicesMedical assistantTypes of proceduresPatient preparationAssisting physician during the procedurePatient care following the procedureSurgical asepsisThe Medical Assistant’s Role in Minor Surgery AdministrativeCompleting insurance forms Obtaining signed informed consent Patient educationExplaining procedure to and answering questions from the patient Presurgical instructionsThe Medical Assistant’s Role in Minor Surgery (cont.)Relative to surgical procedurePrepare surgical roomPrepare equipmentAssist during procedureEnsure safety and comfort of the patientThe Medical Assistant’s Role in Minor Surgery (cont.)Postoperative proceduresPatient careDress woundPatient educationEnsure patient has safe transportationClean room for next procedureApply Your KnowledgeWhat 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 procedurePresurgical instructionsPostoperative instructionsWound careCorrect!Surgery in the Physician’s OfficeMinor surgical procedureSafely performed without general anesthesiaUse local anestheticsReasonsDiagnose illnessesRepair an injuryRemoval of small growthsCommon Surgical ProceduresProcedures requiring an incision  physicianDraining an abscess Collection of pus covered by a protective liningI & D Common Surgical Procedures (cont.)Obtaining a biopsy specimenRemoval of a small amount of tissue for examinationNeedle biopsy 10% formalin ~ preservativeMole removalSmall discolored area of skinRemoved if it changes shape, size, or colorCommon Surgical Procedures (cont.)Caring for woundsAny break in the skinAccidental LacerationPuncture woundIntentional CleaningSoap and waterIrrigate with sterile solutionDebridement SurgicalChemicalMechanicalAutolytic Common Surgical Procedures (cont.)Wound healingThree phases FactorsAge Nutritional statusOverall healthInflammatory phaseBlood vessels constrictWound sealsBlood clotsBacteria and debris are removedCommon Surgical Procedures (cont.)Wound HealingProliferation phaseNew tissue formsSped up if wound edges are approximatedMaturation phase Formation of scar tissueScar tissue No nerves or blood vesselsNot as resilient as skinCommon Surgical Procedures (cont.)Closing a WoundSutures Ligature Absorbable Nonabsorbable Staples Medical assistantPosition and drape patientAssist as neededClean wound and apply dressingPatient instructionsSpecial Minor Surgical ProceduresLaser surgery Less damage to surrounding tissuePromotes healingPrevents infectionSpecial Minor Surgical ProceduresCryosurgery Extreme cold used to destroy unwanted tissuePatient education Wound care Blister may form; do not breakIce and pain relieversElectrocauterization Needle, probe, or loop heated by electric current to destroy the target tissueMay require a grounding plate or padGeneral wound care instructionsApply 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 nutritionPoor circulation  High stress levelsDiabetes  Weakened immune systemObesity  SmokingVery Good!Instruments Used in Minor Surgery Cutting and dissecting instrumentsScalpelsScissors Curettes Grasping and Clamping InstrumentsForcepsHemostats Towel clampsRetracting, Dilating, and Probing InstrumentsRetractorsDilatorsProbesSuturing InstrumentsNeedles Needle holdersInstruments Used in Minor Surgery (cont.) Syringes and needlesInject anesthetic solutionsWithdraw fluidsObtain biopsy specimensInstrument trays and packsAll items needed are packaged togetherSterilized 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. Suturingscissors, scalpels, curettesforceps, hemostats, clampsneedle holders, needles, packaged suturesretractors, dilators, probesANSWER:SUPER!Asepsis Critical to heath and safety Levels of asepsisMedical ~ clean techniqueSurgical ~ sterile techniqueAsepsis (cont.)Personal protective equipmentGownsGloves MasksProtective eye wear or face shieldAsepsis (cont.)Biohazardous waste handling and disposalSharps ~ puncture-resistant containerAll other items Leakproof plastic bag or containerRed or labeled with orange-red biohazardous symbolSurgical AsepsisEliminates all microorganismsSterile fieldUsed as a work area during procedureKnow when to redo the sterile fieldKeep field above waist levelSurgical AsepsisAdding sterile item to sterile fieldOuter one inch is “contaminated”Instruments and suppliesPouring sterile solutionsSurgical Asepsis (cont.)Surgical scrub Removes more microorganisms than routine handwashingDifferent than aseptic handwashingDonning sterile glovesSanitizing, disinfecting, and sterilizing equipmentSanitization ~ cleaning with germicidal soap and waterDisinfection and/or sterilization ~ dependent on use Surgical Asepsis (cont.)Apply Your Knowledge Will you use medical or surgical asepsis when assisting with minor surgery?ANSWER: You will use both levels of asepsis.Fantastic!SterilizationRequired for all instruments or supplies that Penetrate the skinContact normally sterile areas of the bodyAny item used in a sterile fieldItems are sterile or not sterilePrior to sterilizationSanitizeDisinfectThe AutoclavePrimary method of sterilizationPressurized steam Use Standard PrecautionsThe Autoclave (cont.)Wrapping and labeling Porous fabric, paper, or plasticSterile pack ~ instruments used togetherLabel with non-toxic markerIdentity of items inside wrappingPerson completing the procedureExpiration date The Autoclave (cont.)Preheating Check unit Follow manufacturer’s guidelinesSettings Most units operate automatically Manual autoclavesJacket pressure gaugeChamber pressure gaugeTemperature gaugeTimer The Autoclave (cont.)Sterilized suppliesStore in clean, dry areaShelf lifeCleaning autoclave After each useCheck unit for signs of wearCleaning work areaSterile and unsterile Move all sterile items to avoid contaminationThe Autoclave (cont.)Sterilization indicators Do not guarantee sterilizationShow that proper temperature, pressure, and duration occurredQuality control – uses biological indicators to ensure sterilizationThe Autoclave (cont.)Preventing incomplete sterilizationCorrect timingAdequate temperatureProperly wrapped packsAdequate steam levelsApply Your KnowledgeANSWER: Sterilization is required for all instruments or supplies that penetrate the skin or come in contact with normally sterile areas of the body.What items need to be sterilized?Right!Preoperative ProceduresPreliminary dutiesPreoperative instructionsProcedure Restrictions Administrative and legal tasks Insurance forms and preauthorizationSigned informed consentEasing fears – education and communicationPreoperative Procedures (cont.)Preparing the RoomNeat, clean, and free of wasteAdequate lightingEquipment and suppliesPreparing the PatientGown and position the patientDrape properlyPreparing the Patient (cont.)Surgical skin preparationClean the area Circular motionSurgical site outwardRemove hair Apply the antisepticSame circular techniqueAllow to air dryApply Your Knowledge What are some of the medical assistant’s duties preoperatively? ANSWER: some of the duties are:Patient educationVital signsCompleting insurance forms and obtaining preauthorizationEnsuring informed consent form is signedEasing patient fearsPreparing the roomAssisting patient into position and drapingPreparing the surgical siteGood Answer!Intraoperative ProceduresAdministering a local anesthetic Topical applicationInjectionsCheck labelAssist as neededInform patient of potential side effectsEpinephrineConstricts blood vessels bleeding and  action of anestheticAssisting the Physician During SurgeryFloater Monitoring and recordingProcessing specimensOther duties as necessaryAssisting the Physician During Surgery (cont.)Sterile scrub assistant Handling instrumentsArrange them according to usePass them to the physicianOther duties Swab fluids from a woundRetract edges of a woundCut sutureApply Your KnowledgeWhat 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.Bravo!Postoperative ProceduresImmediate postoperative careAdminister medications as directedMonitor vital signsWatch for adverse reactionsKeep the patient lying down Document all observationsPostoperative Procedures (cont.)Wound dressing – sterile material used to cover the incisionBandaging the wound – holdsdressing in placePostoperative Procedures (cont.)Postoperative instructionsPain managementWound care and signs of infectionAny restrictionsFollow-up Patient releaseAssist as neededSchedule follow-up appointmentConfirm transportation arrangements Surgical Room CleanupPlace reusable instruments in a disinfectant soakDispose of waste and sharps appropriatelyDisinfect the counters, exam table, and trays Disinfect small pieces of nonsurgical equipmentFollow-up carePhysician examines surgical woundThe dressing is changed Wound closures removedApply 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!In Summary44.1 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. In Summary44.3 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. 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 means44.6 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. 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. End of Chapter 44A wise doctor does not mutter incantations over a sore that needs the knife. ~ Sophocles