Lecture Medical assisting: Administrative and clinical procedures with anatomy and physiology (4e) – Chapter 41

CHAPTER 41 Assisting with Minor Surgery © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41-47 End of Chapter 41 A wise doctor does not mutter incantations over a sore that needs the knife ~ Sophocles © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed [...]... Bring someone to drive home – Administrative and legal tasks – signed informed consent – Easing the patient’s fears – education and communication © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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.. .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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 12 Wound Healing • Inflammatory phase –. .. and probing instruments – Retractors – Dilators – Probes © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 19 Instruments (cont.) • Suturing instruments – Needles – Needle holders – Packaged sutures © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 20 Instruments (cont.) • Syringes and needles – Inject anesthetic solutions – Withdraw fluids – Obtain needle biopsy... 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 34 Apply... 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 21 Apply Your Knowledge Name at least one instrument for each of the following ANSWER: types: scissors, scalpels, curettes 1 Cutting and dissecting... McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 23 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 leakresistant containers • Biohazard symbol ©... reserv ed 41- 16 Instruments Used in Minor Surgery • Cutting and dissecting instruments – Scalpels – Scissors – Curettes © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 17 Instruments (cont.) • Grasping and clamping instruments – Forceps – Hemostats – Towel clamps © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 18 Instruments (cont.) • Retracting, dilating, and probing... Sutures – Absorbable – collagen fibers – Nonabsorbable – silk, nylon, polyester • Staples © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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,... ed 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 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 41- 33 Intraoperative Procedures. .. (cont.) – Perform a surgical scrub • Removes more microorganisms than handwashing • 2–6 minutes – Put on sterile gloves – Sanitize, disinfect, and sterilize equipment © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 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,