CH 25 - Minor Office Surgery

What is the purpose of inflammation?

Blood supply to the wound increases to assist in the healing process

Give at least three examples of minor surgical operations that can be performed in a medical office.

Insertion of sutures, sebaceous cyst removal, incision and drainage of infections, mole removal, needle biopsies, cervical biopsies, and ingrown toenail removal.

Which types of moles cannot be removed with laser mole surgery?

Raised moles, deep moles, large moles, or dysplastic nevi.

List the four local signs that occur during inflammation.

Redness, swelling, pain, warmth

What is a swaged needle?

A needle where the suture and needle are connected as one single unit.

List the postoperative instructions that must be relayed to the patient after a cervical punch biopsy.

1. A minimum amount of cramping and bleeding may follow the procedure and last up to 1 week. Contact the medical office if the bleeding lasts longer than 2 weeks. 2. A thick, dark-colored vaginal discharge may occur after the procedure (if Monsel solution was used to control bleeding) and may last for several days. 3. Do not douche, use tampons, or have intercourse for 1 week after the procedure to allow proper healing of the cervix to take place. 4. Contact the medical office if any of the following occurs: bleeding that is heavier than normal menstrual bleeding, a foul-smelling vaginal discharge, fever, or lower abdominal pain.

List two uses of cryosurgery.

1. A treatment for cervical dysplasia to destroy abnormal cervical cells that show changes that may lead to cancer. 2. Used for the treatment of chronic cervicitis

List five guidelines that should be followed in caring for instruments. NOTE: The actual guidelines provide a reason for each step, write down the actual guidelines in your notes!

1. Always handle instruments carefully 2. Do not pile instruments in a heap 3. Keep sharp instruments separate from the rest of the instruments 4. Keep instruments with a ratchet in an open position when not in use. 5. Rinse blood and body secretions off an instrument ASAP 6. Use the required instrument - DO NOT SUBSTITUTE! 7. Sanitize and sterilize instruments using proper technique.

List four signs that may indicate a bandage is too tight. (7 signs total)

1. Coldness 2. Pallor 3. Numbness 4. Cyanosis of the nail beds 5. Swelling 6. Pain 7. Tingling sensations

What are the postoperative instructions for toenail removal?

1. Elevate the foot for 24 hours following the procedure. 2. Keep the area clean and dry. 3. Cleanse the toe daily with warm water and gently dry the area. 4. Apply an antibiotic ointment daily until the wound has completely healed. 5. Wear loose-fitting shoes for 2 weeks after the procedure. 6. Avoid strenuous exercise for 2 weeks after the procedure. 7. Contact the medical office if any signs of infection occur

List three causes of an ingrown toenail. (4 possible answers total)

1. External pressure, such as from tight shoes 2. Trauma 3. Improper nail trimming 4. Infection

List two advantages of using surgical skin staples to approximate a wound. (4 possible answers)

1. It is the fastest method of closure of long skin incisions. 2. Trauma to the tissue is reduced because the tissue does not have to be handled much when the staples are inserted. 3. Produce excellent cosmetic results 4. Staples are easy to remove with a specially designed staple remover

What instructions should the medical assistant share with the patient after a sebaceous cyst removal?

1. Keep the dressing clean and dry. 2. Report any signs that the wound is infected, which include fever, increased pain, swelling, redness, warmth, and discharge. 3. Notify the medical office if the sutures become loose or break. 4. Provide written instructions on wound care to refer to at home 5. Instruct the patient when to return for removal of the sutures.

List the postoperative instructions that must be relayed to the patient after cervical cryosurgery.

1. Normal activities can be resumed the day after the cryosurgery. 2. On the first postoperative day, a clear, watery vaginal discharge occurs, which lasts for 2 to 4 weeks. The discharge is caused by the shedding of the dead cervical tissue and gradually diminishes as the healing progresses. 3. Use sanitary pads (rather than tampons) to absorb the watery discharge. 4. Do not douche, use tampons, or have intercourse for 2 to 3 weeks after the procedure to allow proper healing of the cervix to take place. 5. Contact the medical office if any of the following occurs: bleeding that is heavier than normal menstrual bleeding, a foul-smelling vaginal discharge, fever, or lower abdominal pain.

Give two examples of antiseptic solution used to cleanse the operative site

1. Povidone-iodine (Betadine Surgical Scrub) 2. Chlorhexidine gluconate (Hibiclens)

List three functions of a sterile dressing.

1. Protect the wound from contamination and trauma 2. Absorb drainage 3. Restrict motion

What are two additional types of exudates? Provide a brief description for each.

1. Serosanguineous - Clear and blood-tinged drainage; common in surgical incisions 2. Purosanguineous - Pus and blood; seen in new, infected wounds

List and briefly describe the three major exudates.

1. Serous - Clear and watery serum; example: burn blister 2. Sanguineous - Red and consists of red blood cells; example: open wounds 3. Purulent - Pus; white in color w/hints of pink, green, or yellow, thick, has an unpleasant odor;

Many offices maintain index cards indicating the appropriate instruments and supplies for each minor office surgery tray setup. What information is included in the cards?

1. The appropriate instruments and supplies for each minor office surgery tray setup 2. The type of skin preparation 3. The position of the patient 4. The physician's glove size 5. The type of suture material 6. Preoperative instructions 7. Postoperative instructions

List advantages of using a swaged needle.

1. The suture material does not slip off the needle. 2. Tissue trauma is reduced.

List three advantages of adhesive skin closures. (4 advantages total)

1. They eliminate the need for sutures and a local anesthetic 2. They are easy to apply and remove 3. They have a lower incidence of wound infection compared with sutures 4. They result in less scarring than sutures.

List three functions of a bandage. (4 possible answers total)

1. To apply pressure to control bleeding 2. To protect a wound from contamination, 3. To hold a dressing in place 4. To protect, support, or immobilize an injured part of the body.

How long does the inflammatory phase last?

3 to 4 days

How long can the granulation phase last?

4 to 20 days

List the suture sizes from smallest to biggest

7-0, 6-0, 5-0, 4-0, 3-0, 2-0, 0, 1, 2, 3, 4, 5

What is the difference between a closed and an open wound?

A closed wound is when damage occurs to underlying tissue without skin or mucous breakage. An open wound is when the skin or mucous layer is broken and exposes the underlying tissue.

When is a colposcopy performed?

A colposcopy is usually performed 1 week after the end of the menstrual period.

What is the purpose of a fenestrated drape?

A fenestrated drape covers a wide area of skin around the operative area, leaving only the operative site exposed. This provides a sterile area around the operative site and decreases contamination of the patient's surgical wound.

What occurs during the inflammatory phase of wound healing?

A fibrin network forms, resulting in a blood clot that "plugs" up the opening of the wound and stops the flow of blood.

What is the function of a needle holder?

A needle holder is used to firmly grasp a curved needle for insertion of the needle through the skin flaps of an incision.

What is the scalpel used for?

A scalpel is used to make surgical incisions and can divide tissue with the least possible trauma to surrounding structures.

What causes a sebaceous cyst to form?

A sebaceous cyst forms when the outlet of a sebaceous (oil) gland becomes obstructed.

What is an exudate?

An exudate is material, such as fluid and cells, that has escaped from blood vessels during the inflammatory process.

What characteristics describe an infected sebaceous cyst?

An infected cyst is painful, tender, red, and swollen and may have a grayish-white, foul-smelling discharge.

What is an ingrown toenail?

An ingrown toenail occurs when the edge of the toenail grows deeply into the nail groove and penetrates the surrounding skin, resulting in pain and discomfort.

What areas of the body are difficult to adhere with adhesive skin closures?

Areas that harbor moisture (e.g., palms of the hands, soles of the feet, axillae) and hairy areas of the body (e.g., scalp, a man's chest).

What is the purpose of preparing the patient's skin before minor office surgery?

Because the skin has contains an abundance of microorganisms.

Why are sutures inserted in the head and neck generally removed sooner than other sutures?

Because they have a good blood supply, so those areas heal more rapidly

What are the casues and effects of a laceration?

Causes - Dull knives, large objects driven to the skin, and heavy machinery Effects - Profuse bleeding, scars

What occurs during the maturation phase of wound healing?

Collagen continues to be synthesized, and the granulation tissue eventually hardens to white scar tissue. The scar does not have nerves or a blood supply.

What is the difference between congenital nevi and acquired nevi?

Congenital nevi is when moles are present at birth, while acquired nevi is when moles are developed over time

Describe the appearance of dysplastic nevi.

Dysplastic nevi are usually larger than normal moles and have an irregular coloration and shape. The center of dysplastic nevi may be raised and darkened.

What is the purpose of adding epinephrine to a local anesthetic?

Epinephrine is a vasoconstrictor that prolongs the local effect of the anesthetic and decreases the rate of systemic absorption of the local anesthetic.

True or False: An incision is a jagged tearing of the tissues.

False - An incision is a smooth and clean cut

True or False: One of the local signs of inflammation is fever.

False - Inflammation is characterized by warmth, pain, redness, and swelling

True or False: A serous exudate is red in color.

False - Serous exudates are clear and watery

True or False: Sebaceous cysts are commonly found on the palm of the hand.

False - The palms of the hands do not have sebaceous glands, so sebaceous cysts cannot form there.

True or False: The physician would most likely order a tetanus booster for an abrasion.

False - The tetanus booster would be ordered for a PUNCTURE

What occurs during the granulation phase of wound healing?

Fibroblasts migrate to the wound and begin to synthesize collagen, which would strengthen the wound to prevent it from opening again. New capillaries grow in to supply blood.

How should an instrument be placed and handed over to the physician?

In a firm, confident manner so that the instrument does not slip out of the physician's hand and drop on the floor, and should be placed in the physician's hand in its functional position—that is, the position in which it is to be used.

What causes an abscess to form?

It is caused by a pathogen that invades the tissues, usually via a break in the skin.

What is the name of the local anesthetic most frequently used in the medical office during minor office surgery?

Lidocaine hydrochloride (Xylocaine)

Where are sebaceous cysts most likely and least likely to occur?

MOST LIKELY - Scalp, face, ears, neck, back, genital area LEAST LIKELY - Palms of the hands and soles of the feet—these areas do not contain sebaceous glands

What is the difference in function between mosquito hemostatic forceps and standard hemostatic forceps?

Mosquito hemostatic forceps are used to hold delicate tissue or to clamp off smaller blood vessels, whereas standard hemostatic forceps are used to grasp and compress larger blood vessels.

Give examples that may cause a puncture wound.

Nail, splinter, needle, animal bite, wire, knife, bullet

Where on the body is melanoma said to be found?

On the upper backs of men and on the lower legs of women.

List and briefly describe the use of the 4 types of scissors that can be utilized.

Operating - cut through tissue Suture - remove sutures Bandage - cut bandages and dressings Dissecting - divide or separate tissue

What is the difference between a plain surgical gut and a chromic surgical gut?

Plain surgical gut has a rapid absorption time, whereas chromic surgical gut is treated to slow down its rate of absorption in the tissues.

What are the characteristics of a local anesthetic?

Produces a loss of sensation in the tissue surrounding the operative site area and prevents the patient from feeling pain during the surgery

What are the effects of an incision?

Profuse bleeding, possible damage to muscles, tendons, and nerves

How long does it take for regeneration of the epithelial tissue to occur?

Regeneration of cervical tissue occurs within approximately 4 to 6 weeks after the procedure.

What is the purpose of reversing the spiral during a spiral-reverse turn?

Reversing each spiral turn allows for a smoother fit and prevents gaping caused by variation in the contour of the limb.

Give at least three examples of a nonabsorbable suture.

Silk (Sofsilk), nylon (Ethilon), polyester (Ti-Cron, Surgidac), polypropylene (Prolene, Surgipro), polybutester (Novafil and Vascufil), stainless steel, and surgical skin staples.

Describe how the diameter and texture of a suture varies with each size.

Size 7-0 sutures are finer in texture, and size 5 sutures are heavier in texture. Size 2-0 (00) sutures have a smaller diameter than size 0 sutures.

Where are skin tags most frequently found on the body?

Skin tags are most frequently found in body areas where the skin creases, such as the eyelids, neck, armpits, upper chest, and groin.

List the abbreviations used to identify features of scissors

Straight blades - str Curved blades - cvd Sharp tip - s/s Blunt tip - b/b One blunt and one sharp tip - b/s

How are sutures measured?

Sutures are measured by their gauge, which refers to the diameter of the suturing material.

How are swaged needle packages labeled?

Swaged suture packets are labeled to specify the gauge, type, and length of suture material, the type of needle point (cutting or noncutting), and the needle shape (curved or straight).

How long does it take for a suture to be absorbed?

The amount of time can range from 7 days to several months, depending on the type of tissue being sutured and the size and type of absorbable suture being used.

What is an important thing to check on the suture storage boxes?

The expiration date

What are the responsibilities of a medical assistant during a minor surgical operation?

The medical assistant is responsible for preoperative instructions and for obtaining the patient's signature on a written consent to treatment form. Additional responsibilities of the medical assistant include preparing the treatment room, preparing the patient, preparing the minor surgery tray, assisting the physician during the procedure, administering postoperative care to the patient, and cleaning the treatment room after the procedure.

Why should the medical assistant be careful when applying an elastic bandage?

The medical assistant must be extremely careful when applying an elastic bandage because it is easy to apply it too tightly and impede circulation.

If the physician applies sterile gloves before administering the antiseptic, what steps should the medical assistant follow?

The medical assistant should first show the label of the vial to the physician and should then hold the vial securely while the physician withdraws the medication.

Explain how an instrument should be handed to the physician during minor office surgery.

The medical assistant withdraws the anesthetic into the syringe and hands it to the physician, who has not yet applied sterile gloves. The physician injects the anesthetic into the patient's tissues and then applies sterile gloves to begin the surgery.

What are the most common methods used to remove moles?

The most common methods include shave excision, surgical excision, and laser surgery.

What is a patient told to do before a colposcopy?

The patient should be told not to douche; use tampons, vaginal medications, or spermicides; or have intercourse for 24 hours before the examination.

When labeling a specimen by hand, what information should be written onto the label?

The patient's name and date of birth, the date and time of collection, the medical assistant's initials, and any other information required by the laboratory, such as the source of the specimen.

What is the purpose of performing a colposcopy?

The purpose of colposcopy is to examine the vagina and cervix to detect areas of abnormal tissue growth

What is the purpose of performing a cervical punch biopsy?

The purpose of the biopsy is to detect the presence of cervical dysplasia or cancer of the cervix and to remove a cervical tissue specimen for examination by a pathologist.

Why does a puncture wound encourage the growth of tetanus bacteria?

The tetanus bacteria grow best in a warm anaerobic environment, such as the one in a puncture.

List all the information that is found on the suture packages.

The type of suture material (e.g., surgical silk), the size (e.g., 4-0), the length of the suturing material (e.g., 18 inches), the date of manufacture, and the expiration date of the suture.

What are absorbable sutures frequently used for?

They are frequently used to suture subcutaneous tissue, fascia, intestines, bladder, and peritoneum and to ligate vessels.

What concern exists with dysplastic nevi?

They are more likely than ordinary moles to develop into malignant melanoma.

How are items from a peel apart package placed into the sterile field?

They may be flipped onto the sterile field or placed into the field with a sterile glove.

List and briefly describe the use of the 6 types of forceps.

Thumb - pick up or hold adjacent tissue Tissue - grasp tissue and identified by number of teeth Splinter - remove foreign objects Dressing - apply and remove dressing Hemostatic - clamp off vessels Sponge - holds sponges

What is the purpose of a biopsy?

To determine whether a tumor is malignant or benign; and, to be used as a diagnostic aid for other conditions.

What is the purpose of serrations found on some instruments?

To grasp tissue and prevent it from slipping out of the jaws of the instrument.

What is the purpose of using gauze packing or a rubber Penrose drain after incising a localized infection?

To keep the edges of the tissues apart; this facilitates drainage of the exudate.

List two reasons for performing a colposcopy.

To prevent cervical cancer by detecting precancerous lesions early and treating them.

True or False: A biopsy is usually performed to determine if an infection is present.

True

True or False: An ingrown toenail can be caused by shoes that are too tight.

True

True or False: An instrument with a ratchet should be kept in a closed position when not in use.

True

True or False: Colposcopy is frequently used to evaluate lesions of the cervix.

True

True or False: Cryosurgery can be performed without an anesthetic.

True

True or False: Cryosurgery is used in the treatment of cervical cancer.

True

True or False: Hemostatic forceps are used to clamp off blood vessels.

True

True or False: If the medical assistant prepares the anesthetic injection, the needle and syringe are not placed on the sterile field, but are assembled off to the side.

True

True or False: If the physician withdraws the anesthetic, the needle and syringe are placed on the sterile field.

True

True or False: Inflammation is the protective response of the body to trauma and the entrance of foreign substances.

True

True or False: One of the functions of a bandage is to hold a dressing in place.

True

True or False: Reaching over a sterile field is a violation of sterile technique

True

True or False: Size 4-0 sutures have a smaller diameter than size 3 sutures.

True

True or False: Something that is sterile is contaminated if it comes in contact with a pathogen.

True

True or False: Surgical asepsis refers to practices that keep objects and areas free from all microorganisms.

True

True or False: Sutures approximate the edges of a wound until proper healing occurs.

True

True or False: The skin is the first line of defense of the body.

True

What type of bandage turn is used to anchor a bandage?

Two circular turns are used to anchor a bandage.

In each of the groups, pick whichever suture gauge is smaller in diameter: a. 4-0 silk or 2-0 silk b. 0 chromic surgical gut or 3-0 chromic surgical gut c. 2-0 polypropylene or 2 polypropylene

a. 4-0 silk b. 3-0 chromic surgical gut c. 2-0 polypropylene

What does the abbreviation DSD stand for?

dry sterilized dressing

What are the characteristics of a sebaceous cyst?

movable; dome-shaped; filled with a thick, fatty-white, cheesy material that has a foul odor; size between 1/4 inch to 2 inches

Give at least three examples of surgical gut that absorbable sutures consist of.

polyglycolic acid (Dexon), polyglactin 910 (Vicryl), polydioxanone (PDS II), polyglyconate (Maxon), and poliglecaprone (Monocryl), lactomer (Polysorb), and Caprosyn

What are the three common types of moles?

skin tags, flat moles, and raised moles

What is an additional instruction that the physician might require the patient to do after the cryosurgery procedure?

the patient will be required to have a Pap test every 3 to 6 months for a period of time determined by the physician.

List two uses of the figure-eight bandage turn.

used to hold a dressing in place or to support and immobilize an injured joint

Lis the minor characteristics of a minor medical procedure.

• Are performed in an ambulatory health care facility, such as a physician's office or clinic • Can be performed in a short period of time, usually in less than 1 hour • Require a local anesthetic, a topical anesthetic, or no anesthetic • Can be performed safely with a minimum of discomfort to the patient • Do not, under normal circumstances, pose a major risk to life or to the function of an organ or body parts

List the characteristics of melanoma.

• Asymmetric • Irregular border: the edges of the mole are notched, uneven, or blurred rather than round or distinct. • Color varies from one area of the mole to another • Diameter is larger than 6 mm • Other signs: the mole is painful or tender, itches, bleeds, oozes, or has a scaly appearance.

Give a list of ALL items that should be placed TO THE SIDE of the sterile field.

• Clean disposable gloves • Antiseptic solution • Surgical scrub brush • Antiseptic swabs • Sterile gloves • Local anesthetic • Antiseptic wipe to cleanse the vial • Tetanus toxoid with needle and syringe

Give a list of ALL items that should be placed WITHIN the sterile field.

• Fenestrated drape • Syringe and needle for drawing up the local anesthetic • Hemostatic forceps • Thumb forceps • Tissue forceps • Dissecting scissors • Operating scissors • Needle holder • Suture • Sterile 4 × 4 gauze

What are the characteristics of benign moles?

• Usually range in color from brown to nearly black but can be a pinkish flesh color to dark blue or even black. • Shape is usually round or oval and may be smooth or rough. • Size is usually smaller than a pencil eraser but can range from barely visible to quite a large area. • May form a raised area on the skin or may be flat. • May sometimes have hairs growing out of them.