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41. Assisting with Minor Surgery. 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.

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41

Assisting with Minor Surgery


Learning outcomes
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.


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.

Learning Outcomes (cont.)


Learning outcomes cont1
Learning Outcomes sterile asepsis in minor surgery.(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.


Introduction

Minor surgical procedures sterile asepsis in minor surgery.

Ambulatory care settings

Office practices

Medical assistant

Types of procedures

Patient preparation

Assisting physician during the procedure

Patient care following the procedure

Introduction


The medical assistant s role in minor surgery
The Medical Assistant’s Role in Minor Surgery sterile asepsis 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


The medical assistant s role in minor surgery cont

Relative to surgical procedure sterile asepsis in minor surgery.

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

The Medical Assistant’s Role in Minor Surgery(cont.)


Apply your knowledge

What are the medical assistant’s responsibilities in relation to patient education and minor surgical procedures?

Apply Your Knowledge

  • ANSWER: The medical assistant may be responsible for providing patient education concerning the following:

  • Explanation of the procedure

  • Presurgical instructions

  • Postoperative instructions

  • Wound care

Correct!


Surgery in the physician s office
Surgery in the Physician’s Office relation to patient education and minor surgical procedures?

  • 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

Mole (nevus) removal relation to patient education and minor surgical procedures?

Small discolored area of the skin

Done if the mole changes shape, size, or color

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


Wound care

Accidental relation to patient education and minor surgical procedures?

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

Wound Care


Wound healing
Wound Healing relation to patient education and minor surgical procedures?

  • 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


Closing a wound
Closing a Wound relation to patient education and minor surgical procedures?

  • Butterfly closures or sterile strips

  • Skin adhesive

  • Sutures

    • Absorbable – collagen fibers

    • Nonabsorbable – silk, nylon, polyester

  • Staples


Special procedures

Laser surgery relation to patient education and minor surgical procedures?

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

Special Procedures


Apply your knowledge1
Apply Your Knowledge relation to patient education and minor surgical procedures?

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

Very Good!


Instruments used in minor surgery
Instruments Used in Minor Surgery relation to patient education and minor surgical procedures?

  • Cutting and dissecting instruments

    • Scalpels

    • Scissors

    • Curettes


Instruments cont
Instruments relation to patient education and minor surgical procedures?(cont.)

  • Grasping and clamping instruments

    • Forceps

    • Hemostats

    • Towelclamps


Instruments cont1
Instruments relation to patient education and minor surgical procedures?(cont.)

  • Retracting, dilating, and probing instruments

    • Retractors

    • Dilators

    • Probes


Instruments cont2
Instruments relation to patient education and minor surgical procedures?(cont.)

  • Suturing instruments

    • Needles

    • Needle holders

    • Packagedsutures


Instruments cont3

Syringes and needles relation to patient education and minor surgical procedures?

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

Instruments (cont.)


Apply your knowledge2
Apply Your Knowledge relation to patient education and minor surgical procedures?

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

ANSWER:

scissors, scalpels, curettes

forceps, hemostats, clamps

retractors, dilators, probes

needle holders, needles, packaged sutures

SUPER!


Asepsis
Asepsis relation to patient education and minor surgical procedures?

  • Priority during surgical procedures

    • Critical to heath and safety of the patient

    • Levels

      • Medical – clean technique

      • Surgical – sterile technique


Medical asepsis

Sharps and biohazardous waste handling and disposal relation to patient education and minor surgical procedures?

Puncture and leak-resistant containers

Biohazard symbol

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


Surgical asepsis
Surgical Asepsis relation to patient education and minor surgical procedures?

  • 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


Surgical asepsis cont
Surgical Asepsis relation to patient education and minor surgical procedures?(cont.)

  • Perform a surgical scrub

    • Removes more microorganisms than handwashing

    • 2–6 minutes

  • Put on sterile gloves

  • Sanitize, disinfect, and sterilize equipment


Apply your knowledge3
Apply Your Knowledge relation to patient education and minor surgical procedures?

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.

Fantastic!


Preoperative procedures
Preoperative Procedures relation to patient education and minor surgical 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
Preoperative Procedures relation to patient education and minor surgical procedures?(cont.)

  • Preparing the surgical room

    • Equipment and supplies – check date and sterilization indicator

    • Neat, clean, and free of waste

    • Adequate lighting


Preoperative procedures cont1
Preoperative Procedures relation to patient education and minor surgical 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


Apply your knowledge4
Apply Your Knowledge relation to patient education and minor surgical procedures?

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!


Intraoperative procedures

Administering a local anesthetic relation to patient education and minor surgical procedures?

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


Intraoperative procedures cont
Intraoperative Procedures relation to patient education and minor surgical 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


Intraoperative procedures cont1

Sterile scrub assistant relation to patient education and minor surgical procedures?

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

Intraoperative Procedures(cont.)


Apply your knowledge5

What are the duties of a floater? relation to patient education and minor surgical procedures?

Apply Your Knowledge

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 procedures
Postoperative Procedures relation to patient education and minor surgical 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

Procedure relation to patient education and minor surgical procedures?

Clean examination gloves

Clean site with povidone-iodine

Antibiotic ointment, if ordered

Secure sterile dressing

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


Postoperative procedures cont1
Postoperative Procedures relation to patient education and minor surgical 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 cont2

Postoperative instructions relation to patient education and minor surgical procedures?

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

Postoperative Procedures(cont.)


Postoperative procedures cont3
Postoperative Procedures relation to patient education and minor surgical 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 cont4
Postoperative Procedures relation to patient education and minor surgical 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


Apply your knowledge6
Apply Your Knowledge relation to patient education and minor surgical procedures?

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!


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.

In Summary


In summary cont
In Summary 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.(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 cont1
In Summary 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.(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 cont2
In Summary 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.(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.


In summary cont3
In Summary 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.(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.


End of chapter 41
End of Chapter 41 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.

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

~ Sophocles


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