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Lesson 4
Postoperative Patient Care
Chapter 42: Assisting with Minor Surgery
© 2009 Pearson Education
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.
© 2009 Pearson Education
Lesson Objectives
Upon completion of this lesson, students should be able to …
Elements of Postoperative Patient Care Monitoring the
patient during recovery from anesthesia
Wound care Applying dressings Communicating
patient instructions
Insert Figure 42-1 fromPCMA 2nd edition
Critical Thinking Question
How might the type of anesthesia used affect a patient’s recovery?
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
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
Areas to Observe on a Patient Recovering from Surgery 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
In ability recovery in a normal timeframeshould be report to the physician
Immediately!
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
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
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
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
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
Wound Complications
Infection• Include signs of inflammation, purulent or puslike
drainage, fever
Hemorrhage or bleeding Dehiscense
• Separation of wound edges
Evisceration• Separation of wound edges and protrusion of
abdominal organs
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
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 puslike drainage that is green, yellow, or
brown
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 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.
Cleansing a Wound
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
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
Insert Figure 42-27From Chapter 42
Cleansing an Open Wound
Wipe in one Work in circles, half or full
Begin in the center and work outward
Insert Figure 42-28From Chapter 42
Dressings
Size and shape depends on the size, location, and amount of drainage from the wound
Sterile 4 X 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
Insert Figure 42-29 fromPCMA 2nd edition
Chapter 42
Wound closure kit
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
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
Critical Thinking Question
Prior to removing a patient’s dressing and sutures, how can you help the patient feel
more at ease?
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
Steps to Removing Sutures
1. Perform hand hygiene
2. Assemble equipment and check expiration dateon pack.
3. Identify the patient, explain the procedure, andassist patient into a comfortable position
4. Perform hand hygiene and remove olddressing using proper technique.
5. Perform hand hygiene. Open suture orstaple removal pack using proper technique.
6. Apply sterile gloves and cleanse thewound as needed.
Steps to Removing Sutures
7. Place a gauze square next to the wound for placementof sutures or staples as they are removed.
8. Grasp the knot of the suture with thumb forceps andlift gently.
9. Insert the suture scissors and cut suture at skinlevel. Pull out the sutures.
10. Place the cut suture on the gauze.
11. Repeat these steps until all the suturesare removed.
12. Count sutures to make sure that allHave been removed.
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
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
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
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
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
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
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
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
© 2007 Pearson Education
MEDB152 Health and Safety/Intro to Microbiology
Cryosurgery
Use of subfreezing temperatures to destroy tissue.
Also known as cyrocautery. Probe used in cryosurgery must be sterilized
immediately after use according to manufacturer’s instructions.
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 taking by means of a curette or
with a suction device to aspirate a specimen which is then placed in a container of 10% formalin preservative solution.
After the procedure the patient may experience mild cramping for which a mild analgesic may be taken.
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
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 microorganisms is causing the infection
The appropriate antibiotic can then be selected The procedure is performed using sterile
surgical technqiue
Tray Setup for an I&D
Scalpel handle and blades (No. 11) Curved iris scissors Tissue forceps Kelly hemostat Retractor Thumb dressing forceps 4 X 4 gauze squares
Foreign Bodies and Growths
Foreign bodies Can include a small
to large objects.
Growths Include tumors,
warts, moles, and cysts.
Insert Figure 42-38 inChapter 42 of the
textbook
Surgical tray setup for biopsy procedure
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
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
© 2007 Pearson Education
MEDB152 Health and Safety/Intro to Microbiology
Summary
Assisting with surgery includes maintaining aseptic technique, a thorough knowledge of gowning, gloving, surgical hand hygiene, setting up sterile instrument trays, passing equipment to the physician, packaging and surgical setup, and preparing the patient for the procedure. Assisting with surgical procedures carries with it a grave responsibility to maintain absolute sterile technique. The medical assistant incorporates a variety of clinical skills when assisting with a surgical procedure.
Questions?