Y khoa, dược - Assisting with minor surgery

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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41Assisting with Minor Surgery41-2Learning Outcomes41.1 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.41-3Learning 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.41-4Learning 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.41-5Introduction Minor surgical procedures Ambulatory care settings Office practicesMedical assistantTypes of proceduresPatient preparationAssisting physician during the procedurePatient care following the procedure41-6The Medical Assistant’s Role in Minor Surgery AdministrativeCompleting insurance forms Obtaining signed informed consent formsPatient educationExplaining procedure to and answering questions from the patient Presurgical instructions41-7The Medical Assistant’s Role in Minor Surgery (cont.)Relative to surgical procedurePrepare surgical roomPrepare equipmentAssist during procedureUnsterile Sterile Ensure safety and comfort of the patientPostoperative proceduresPatient careDress woundPatient educationWound carePostoperative careClean room for next procedure41-8Apply 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 procedurePresurgical instructionsPostoperative instructionsWound careCorrect!41-9Surgery in the Physician’s OfficeMinor surgical procedureSafely performed in office or clinic without general anesthesiaUse local anesthetics affecting only a particular areaReasonsDiagnose illnessesRepair an injuryRemoval of small growthsCosmetic 41-10 Common Surgical Procedures in an OfficeDraining an abscess – collection of pus formed due to an infectionObtaining a biopsy specimenRemoval of a small amount of tissue for examinationSpecimens are placed in 10% formalin, a common preservativeMole (nevus) removalSmall discolored area of the skinDone if the mole changes shape, size, or color41-11Wound CareAccidental Laceration – jagged, open woundPuncture wound – deep wound caused by a sharp objectIntentional – surgical incisionCleaning a non-surgical woundWash with soap and waterIrrigate with sterile solutionDebridement – removal of debris or dead tissue 41-12Wound HealingInflammatory phase Vessels in area constrict – reduces bleedingPlatelets, clotting factors, and WBCs seal the wound, clot the blood, and remove bacteria and debrisProliferation phase New tissue forms, closing off woundPhase can be sped up if edges of wound are approximated Maturation phase – formation of scar tissue41-13Closing a WoundButterfly closures or sterile stripsSkin adhesiveSutures Absorbable – collagen fibersNonabsorbable – silk, nylon, polyesterStaples 41-14Special ProceduresLaser surgery Intense beam of light used to cut away tissueDoes less damage to surrounding tissueElectrocauterization Needle, probe, or loop heated by electric current to destroy the target tissueRequires a grounding plate or pad to prevent an electric shockCryosurgery Uses extreme cold to destroy unwanted tissuePatient education – wound care 41-15Apply 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  Smoking Very Good!41-16Instruments Used in Minor Surgery Cutting and dissecting instrumentsScalpelsScissors Curettes 41-17Instruments (cont.) Grasping and clamping instrumentsForcepsHemostats Towel clamps41-18Instruments (cont.) Retracting, dilating, and probing instrumentsRetractorsDilatorsProbes41-19Instruments (cont.) Suturing instrumentsNeedles Needle holdersPackaged sutures41-20Instruments (cont.) Syringes and needlesInject anesthetic solutionsWithdraw fluidsObtain needle biopsy specimensInstrument trays and packs Laceration repair tray Incision and drainage trayForeign body and growth removal trayOnychectomy (nail removal) trayVasectomy traySuture and staple removal trays41-21Apply 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!41-22Asepsis Priority during surgical proceduresCritical to heath and safety of the patientLevels Medical – clean techniqueSurgical – sterile technique41-23Medical AsepsisReduces the number of microorganisms and prevents the spread of diseaseHandwashing Personal protective equipmentProvides a barrier between wearer and infectious or hazardous materialsGloves, masks, gownsSharps and biohazardous waste handling and disposalPuncture and leak-resistant containersBiohazard symbol41-24Surgical AsepsisEliminates all microorganismsCommon procedures using sterile techniqueCreating a sterile fieldUsed as a work area during procedureKeep above waist levelAdding sterile item to sterile fieldOuter one inch is “contaminated”Instruments and suppliesPouring sterile solutions41-25Surgical Asepsis (cont.)Perform a surgical scrubRemoves more microorganisms than handwashing2–6 minutesPut on sterile glovesSanitize, disinfect, and sterilize equipment 41-26Apply 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.Fantastic!41-27Preoperative ProceduresPreliminary dutiesPreoperative instructionsProcedure Dietary and fluid restrictionsBring someone to drive homeAdministrative and legal tasks – signed informed consentEasing the patient’s fears – education and communication41-28Preoperative Procedures (cont.)Preparing the surgical roomEquipment and supplies – check date and sterilization indicatorNeat, clean, and free of wasteAdequate lighting41-29Preoperative Procedures (cont.)Preparing the patientInitial tasksVital signsMedication ordersGown and position the patientSurgical skin preparationClean the areaRemove hair from the areaApply the antiseptic41-30Apply 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!41-31Intraoperative ProceduresAdministering a local anesthetic Topical applicationGels, creams, and spraysTakes 10 to 15 minutes to be effectiveInjectionsUsually administered by the physicianCheck label to verify correct medicationPotential side effects Dizziness, loss of consciousness, seizures, or cardiac arrestUse of epinephrineReduces bleeding Prolongs action of local anesthetic41-32Intraoperative Procedures (cont.) Assisting the physician during surgeryFloater Monitoring and recordingProcessing specimensOther dutiesPouring sterile solutionsKeeping the surgical area clean and neat during the procedureRepositioning the patient as necessaryAdjusting lighting41-33Intraoperative Procedures (cont.)Sterile scrub assistant Performs a sterile scrub and wears sterile glovesArranges instruments according to useCutting instrumentsGrasping instrumentsRetractorsProbesSuture materialsNeedle holders and scissorsOther dutiesSwab fluids from woundRetract woundCut suture material41-34Apply 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!41-35Postoperative ProceduresImmediate patient care is the top priorityAdminister medications as directedMonitor vital signsWatch for adverse reactionsKeep the patient lying down for the prescribed length of timeDocument all observations in the patient’s chart41-36Postoperative Procedures (cont.)Dressing the woundSterile material used to cover the incisionPurposeKeeps wound cleanReduces bleedingAbsorbs fluid drainageReduces discomfort to the patientSpeeds healing Reduces the possibility of scarring ProcedureClean examination glovesClean site with povidone-iodineAntibiotic ointment, if orderedSecure sterile dressing41-37Postoperative Procedures (cont.)Bandaging the woundA clean strip of gauze or elastic materialPurposeHolds the dressing in placeMay improve circulationProvides support or reduces tension on the woundPrevents the wound from reopeningPrevents movement of the area of the body41-38Postoperative Procedures (cont.)Postoperative instructionsGuidelines for pain managementInstruction for wound careDietary restrictionsActivity restrictionsWhen to call the physicianFollow-up appointmentHave patient repeat to verify understandingProvide written materials in a postoperative information packetPatient releaseFollow-up appt.Transportation arrangements41-39Postoperative Procedures (cont.)Surgical room cleanupPlace reusable instruments in a disinfectant soakDispose of waste and sharps appropriatelyDisinfect the counters, exam table, and trays according to OSHA guidelinesDisinfect small pieces of nonsurgical equipment41-40Postoperative Procedures (cont.)Follow-up carePhysician examines surgical woundThe dressing is changed and/or wound closures are removedSuture or staple removal is done 5 to 10 days after minor surgeryReady for removal when there is a clean, unbroken suture line There should be no scabs, seeping, or visible opening present41-41Apply 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!41-42In Summary41.1 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.41-43In 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.41-44In 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.41-45In 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.41-46In 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.41-47End of Chapter 41A wise doctor does not mutter incantations over a sore that needs the knife. ~ Sophocles

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