Lecture Clinical procedures for medical assisting (4/e): Chapter 10 – Booth, Whicker, Wyman

Chapter 10 - Assisting with minor surgery. Minor surgical procedures are frequently performed in ambulatory care settings and office practices. As a medical assistant, you must be knowledgeable of the types of procedures performed where you are employed. In this chapter you will learn: Define the medical assistant’s role in minor surgical procedures, describe types of wounds and explain how they heal, describe special surgical procedures performed in an office setting,...

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10

Assisting with Minor

Surgery

Learning Outcomes

10.1 Define the medical assistant’s role in minor surgical

procedures

10.2 Describe types of wounds and explain how they heal

10.3 Describe special surgical procedures performed in an

office setting

10.4 List the instruments used in minor surgery and

describe their functions

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Learning Outcomes (cont.)

10.5 Describe and contrast the procedures for medical and

sterile asepsis in minor surgery

10.6 Describe the medical assistant’s duties in preparing to

assist in minor surgery

10.7 Describe the medical assistant’s duties in preparing a

patient for surgery

Learning Outcomes (cont.)

10.8 Describe the types of local anesthetics for minor

surgery and the medical assistant’s role in their administration

10.9 Describe the duties of the medical assistant as a

floater and as a sterile scrub assistant

10.10 Describe the medical assistant’s duties in the

postoperative period

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• Medical assistant

– Types of procedures– Patient preparation

– Assisting physician during the procedure– Patient care following the procedure

The Medical Assistant’s Role in Minor Surgery

• Presurgical instructions

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– 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

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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

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

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non-– Wash with soap and water

– Irrigate with sterile solution

– Debridement – removal of debris or dead tissue

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

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Closing a Wound

• Butterfly closures or sterile strips

• Skin adhesive

• Sutures

– Absorbable – collagen fibers

– Nonabsorbable – silk, nylon, polyester

• Staples

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

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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:

 Poor circulation  High stress levels

 Diabetes  Weakened immune system

Instruments Used in Minor Surgery

• Cutting and dissecting instruments

– Scalpels

– Scissors

– Curettes

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sutures

Instruments (cont.)

• Syringes and needles

– Inject anesthetic

solutions– Withdraw fluids

– Obtain needle biopsy

– Onychectomy (nail removal) tray

– Vasectomy tray– Suture and staple removal trays

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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!

• Priority during

surgical procedures

– Critical to heath and

safety of the patient – Levels

• Medical – clean technique

• Surgical – sterile technique

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Medical Asepsis

• Reduces the number of microorganisms

and prevents the spread of disease

• Gloves, masks, gowns

– Sharps and biohazardous waste handling and

disposal

• Puncture and resistant containers

leak-• 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

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Surgical Asepsis (cont.)

– Perform a surgical

scrub

• Removes more microorganisms than handwashing

• 2–6 minutes

– Put on sterile gloves

– Sanitize, disinfect, and

sterilize equipment

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.

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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

Preoperative Procedures (cont.)

• Preparing the surgical room

– Equipment and supplies –

check date and sterilization indicator

– Neat, clean, and free of waste

– Adequate lighting

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Preoperative Procedures (cont.)

• Preparing the patient

• Clean the area

• Remove hair from the area

• Apply the antiseptic

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!

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– Use of epinephrine

• Reduces bleeding

• Prolongs action of local anesthetic

Intraoperative Procedures (cont.)

• Assisting the physician during surgery

– Repositioning the patient as necessary – Adjusting lighting

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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

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.

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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

Postoperative Procedures (cont.)

• Dressing the wound

– Sterile material used to cover

• Speeds healing

• Reduces the possibility

– Procedure

• Clean examination gloves

• Clean site with povidone-iodine

• Antibiotic ointment, if ordered

• Secure sterile dressing

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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

Postoperative Procedures (cont.)

• Postoperative

instructions

– Guidelines for pain

management– Instruction for wound

care– Dietary restrictions

materials in a postoperative information packet

• Patient release

– Follow-up appt

– Transportation arrangements

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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

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

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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!

In Summary

10.1 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

10.2 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

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In Summary (cont.)

10.3 Several special surgical procedures are performed in

an office setting These include laser surgery, cryosurgery, and electrocauterization

10.4 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.)

10.5 Medical asepsis involves reducing the number of

microorganisms to prevent the spread of disease The goal of surgical asepsis is to eliminate all

microorganisms

10.6 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

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In Summary (cont.)

10.7 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

10.8 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

In Summary (cont.)

10.9 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

10.10 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

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End of Chapter 10

A wise doctor does not mutter incantations 

over a sore that needs the knife. 

~ Sophocles