1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 42 Assisting with Minor Surgery Lesson 4: Postoperative Patient Care

2. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. Explain the four types of wounds. Describe the stages of healing. Describe at least five surgical procedures that can be performed in the physician’s office, and indicate the responsibility of the medical assistant for each procedure.

3. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Elements of Postoperative Patient Care Monitoring the patient during recovery from anesthesia Wound care Applying dressings Communicating patient instructions

4. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.How might the type of anesthesia used affect a patient’s recovery?

5. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Topical and Other Local Anesthetics Affects usually wear off quickly Use of large amounts, beyond normal dosages, may result in an adverse reaction If a patient is allergic, the patient may experience an anaphylatic shock Drugs used to counteract shock should always be available

6. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Types of Local Anesthetics Benzocaine – Topical use only Chloroprocaine – Nerve block epidural Lidocaine (Xylocaine) – Infiltration or topical Mepivacaine – Infilitration nerve block Procaine (novacaine) – Infiltration, seldom used now Tetracaine – Infiltration, local nerve block, spinal

7. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Signs of adverse reaction to the anesthetic Bleeding Circulatory problems Vitals –Blood pressure, temperature, pulse, and respirations –Should be monitored immediately after surgery and then every 15 minutes for the first hour Areas to Observe on a Patient Recovering from Surgery

8. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Areas to Observe on a Patient Recovering from Surgery Inability to recover in a normal timeframe should be reported to the physician Immediately!

9. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Wounds Defined as any break in the skin Can occur from injury or a surgical incision An invasive procedure, such as surgery, creates a wound Wounds cause blood vessels to rupture and blood to seep into tissues Changes in skin color can occur

10. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Types of Wounds Abrasion –Outer layers of skin are rubbed away due to scraping –Will generally heal without scarring Incision –Smooth cut resulting from a surgical scalpel or sharp material, such as razor or glass –May result in excessive bleeding and scarring if deep

11. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Types of Wounds Laceration –Edges are torn in an irregular shape –Can cause profuse bleeding and scarring Puncture –Made by a sharp, pointed instrument such as a bullet, needle, nail, or splinter –External bleeding is usually minimal –Infection may occur due to penetration with a contaminated object –May be scarring

12. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Phases of a Healing Wound Inflammatory phase (3 days) –Blood clot forms to stop bleeding and plug the opening of the wound –Eschar or scab forms to keep out microorganisms Proliferating phase (3 to 21 days) –Fibrin threads extend across opening of the wound and pull edges together –Cells multiply to repair the wound

13. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Phases of a Healing Wound Maturation phase (21 days to 2 years) –Tissue cells strengthen and tighten the wound closure –A scar is formed –The scar eventually fades and thins

14. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Wound Complications Infection –Includes signs of inflammation, purulent or puslike drainage, fever Hemorrhage or bleeding Dehiscence –Separation of wound edges Evisceration –Separation of wound edges and protrusion of abdominal organs

15. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Wound Drainage Occurs as fluid and cells escape from the tissues during the inflammatory phase of wound healing The amount and type of drainage observed on a dressing should be charted

16. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Types of Wound Drainage Serous drainage –Clear, watery drainage, such as the fluid in a blister Sanguineous drainage –Bloody – bright red is fresh blood, dark red is older blood – The amount and color are important Serosanguineous drainage –Thin watery drainage tinged with blood Purulent drainage –Thick pus-like drainage that is green, yellow, or brown

17. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Cleansing a Wound Must be done before a sterile dressing is applied The product used for cleansing is determined by the physician Warm water and soap are used to remove surface dirt around the wound When cleaning the wound, use a sterile gauze or swab

18. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Cleansing a Wound Work from the clean area near the wound outward to less clean areas Wipe in one direction and then discard the sterile swab or gauze – Always clean at least 1 inch beyond the edge of the dressing to be applied If no dressing is to be applied, clean 2 inches beyond the edges of the wound Use a new gauze pad for each circle

19. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Cleansing a Linear Wound Start from top to bottom with one stroke per sterile gauze or swab Work outward from the wound in parallel lines

20. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Cleansing an Open Wound Work in circles, half or full Begin in the center and work outward

21. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Wound closure kit. Dressings Size and shape depends on the size, location, and amount of drainage from the wound Sterile 4 × 4 gauze pads (“four by fours”) are used for most dressings If drainage is expected, a prepared dressing may be used to prevent the dressing from sticking to the wound

22. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Sutures A thread used to sew together body tissues Sutures used to attach tissues beneath the skin are often made of an absorbable material Skin sutures are made of nonabsorable materials such as –Silk, cotton, linen, wire, nylon, Dacron (polyester fiber) Silver wire clips or staples can also be used

23. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Suture Removal Times Facial sutures –24 to 38 hours to prevent scarring Head and neck sutures –3 to 5 days Abdominal sutures –5 to 7 days Sutures over weight-bearing joints and large bones –7 to 10 days

24. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.Prior to removing a patient’s dressing and sutures, how can you help the patient feel more at ease?

25. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Removing a Dressing Each edge of the dressing is removed by pulling toward the suture line If the dressing is adhering to the suture line, use a small amount of sterile saline or hydrogen peroxide to moisten the dressing to ease removal

26. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan 1. Perform hand hygiene. 2. Assemble equipment and check expiration date on pack. 3. Identify the patient, explain the procedure, and assist patient into a comfortable position. 4. Perform hand hygiene and remove old dressing using proper technique. 5. Perform hand hygiene. Open suture or staple removal pack using proper technique. 6. Apply sterile gloves and cleanse the wound as needed. Steps to Removing Sutures

27. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan 7. Place a gauze square next to the wound for placement of sutures or staples as they are removed. 8. Grasp the knot of the suture with thumb forceps and lift gently. 9. Insert the suture scissors and cut suture at skin level. Pull out the sutures. 10. Place the cut suture on the gauze. 11. Repeat these steps until all the sutures are removed. 12. Count sutures to make sure that all have been removed. Steps to Removing Sutures

28. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Bandages for a Wound May be gauze, fabric, or elasticized Need not be sterile Available in various sizes, lengths, and shapes Some are self-adhering Elastic bandages are used to support an injured part and reduce swelling

29. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Minor Surgical Procedures Performed in a Medical Office Biopsy Cautery Colposcopy Cryosurgery Laser surgery Endocervical curettage Endoscopic procedures Suture removal Removal of foreign bodies Incision and drainage Vasectomy Removal of growths and tumors

30. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Electrosurgery The application of high frequency electrical currents Currents are used to heat tissue to cut, destroy, or remove it Most often performed in dermatological, gynecological, cardiac, ocular, ENT, and orthopedic surgical procedures

31. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Types of Electrosurgery Electrocoagulation –Destroys tissues and controls bleeding by coagulation Electrodessication –Destroys tissue by creating a spark gap when the probe is inserted into unwanted tissue Electrofulguration –Destroys tissue with a spark emitted from the tip of a probe positioned a short distance away from the unwanted tissue

32. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Types of Electrosurgery Electrosection –Uses electric current to incise and excise the tissue Electrocautery (or cautery) –Uses high-frequency, alternating electric current to destroy, cut, or remove tissue –Also used to coagulate small blood vessels, thereby reducing bleeding and cell loss

33. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Laser Surgery Laser is an acronym for Light Amplification by Stimulated Emission of Radiation Laser was originally used to treat diseases of the retina Laser surgery today is used to treat various diseases and conditions such as: –Vascular problems –Neurological problems –Orthopedic conditions –Dermatologic problems

34. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Colposcopy An examination of the vagina and cervix Performed using a colposcope Patient is in the lithotomy position Allows the physician to observe tissues of this area in greater detail through light and magnification Abnormal areas of tissue or cells can be removed for biopsy to detect cancer Cryosurgery using freezing temperatures may be used to destroy cells

35. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Endoscope An instrument used to look into a hollow organ or body cavity Used to examine the larynx, bladder, colon, sigmoid colon, stomach, abdomen, and some joints Other attachments such as a light source, suction, or mirror may be used

36. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Endometrial Biopsy (EMB) Performed with the patient in the lithotomy position After performing a bimanual examination of the uterus the physician administers a local anesthetic The specimen is taken by means of a curette or with a suction device to aspirate a specimen After the procedure the patient may experience mild cramping for which a mild analgesic may be taken

37. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Reasons for Performing an EMB To detect precancerous and cancerous conditions of the endometrial lining of the uterus To detect inflammatory conditions To determine if polyps are present To assess abnormal uterine bleeding To assess the effects of hormonal therapy To screen for early detection of endometrial cancer

38. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Incision and Drainage Performed to relieve the buildup of purulent (pus) material as a result of infection The purulent discharge may be cultured to determine what microorganism is causing the infection The appropriate antibiotic can then be selected The procedure is performed using sterile surgical technique

39. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Tray Setup for an I&D Scalpel handle and blades (No. 11) Curved iris scissors Tissue forceps Kelly hemostat Retractor Thumb dressing forceps 4 × 4 gauze squares

40. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Surgical tray setup for biopsy procedure. Foreign Bodies and Growths Foreign bodies –Can include small to large objects Growths –Include tumors, warts, moles, and cysts

41. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Vasectomy Tying and cutting of the vas deferens Is most commonly performed in a urologist’s office Provides a permanent form of birth control for the male As with all surgical procedures, a consent form must be signed The patient should have someone to drive him home after the surgery

42. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Surgical Tray Set Up for a Vasectomy Scalpel handle and blade (No.15) Dressing forceps Towel clamp Straight and curved mosquito forceps Curved tissue scissors Tissue forceps Retractor Needle holder and suture material Suture scissors

43. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?