41 Assisting with Minor Surgery

(1)

CHAPTER

41

Assisting with Minor

Surgery

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.

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.

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. 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

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

(2)

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

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

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

41-10

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 41-11

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 41-12

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

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41-13

Closing a Wound

• Butterfly closures or sterile strips

• Skin adhesive

• Sutures

– Absorbable – collagen fibers – Nonabsorbable – silk, nylon, polyester

• Staples

41-14

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

41-15

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

41-16

Instruments Used in Minor Surgery

• Cutting and dissecting instruments

– Scalpels

– Scissors

– Curettes

41-17

Instruments

(cont.)

• Grasping and clamping instruments

– Forceps

– Hemostats

– Towel

clamps

41-18

Instruments

(cont.)

• Retracting, dilating, and probing

instruments

– Retractors

– Dilators

– Probes

(4)

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

41-21

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!

41-22

Asepsis

• Priority during

surgical procedures

– Critical to heath and

safety of the patient

– Levels

• Medical – clean technique • Surgical – sterile technique 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 leak-resistant containers

• Biohazard symbol

41-24

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

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41-25

Surgical Asepsis

(cont.)

– Perform a surgical

scrub

• Removes more microorganisms than handwashing • 2–6 minutes

– Put on sterile gloves

– Sanitize, disinfect, and

sterilize equipment

41-26

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, 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.

41-27

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

41-28

Preoperative Procedures

(cont.)

• Preparing the surgical room

– Equipment and supplies – check date and sterilization indicator

– Neat, clean, and free of waste – Adequate lighting

41-29

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

41-30

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.

(6)

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

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

41-33

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

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.

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

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

(7)

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

41-38

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

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

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 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

41-41

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!

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.

(8)

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.

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.

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.

41-47

End of Chapter 41

A wise doctor does not mutter incantations over a sore that needs the knife.