List the characteristics of a minor surgical procedure.
A minor surgical procedure is performed in an ambulatory health care facility; can be performed in a short period of time; requires either a local anesthetic, topical anesthetic, or no anesthetic; can be performed safely with a minimum of discomfort to the patient; and does not, under normal circumstances, pose a major risk to life or the function of an organ or body parts.
List the responsibilities of the medical assistant during a minor surgical operation.
Explaining the patient preparation required for the procedure, obtaining the patient's signature on a consent form, preparing the treatment room, preparing the patient, preparing the minor surgery tray, assisting the physician during the procedure, administering postoperative care of the patient, and cleaning the treatment room after the procedure.
What is the purpose of serrations found on some instruments?
Serrations are saw-like teeth that grasp tissue and prevent it from slipping out of the jaws of the instrument.
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. Standard hemostatic forceps are used to grasp and compress larger blood vessels.
List five guidelines that should be followed in caring for instruments.
Handle instruments carefully.
Do not pile instruments in a heap.
Keep sharp instruments separate from other instruments.
Keep instruments with a ratchet in an open position when not in use.
Rinse blood and body secretions off an instrument as soon as possible.
Always use the instrument for the purpose for which it was designed.
Sanitize and sterilize instruments using proper technique.
What is the difference between a closed and an open wound?
A closed wound is an injury to the underlying tissues of the body without a break in the skin surface or mucous membrane, whereas an open wound has a break in the skin or mucous membrane that exposes the underlying tissue.
Why does a puncture wound encourage the growth of tetanus bacteria?
Tetanus bacteria grow best in a warm anaerobic environment as would be found in a puncture wound.
What is the purpose of inflammation?
To destroy invading microorganisms and to remove damaged tissue debris from the area so that proper healing can occur.
List the four local signs that occur during inflammation.
Redness, swelling, pain, warmth.
What occurs during the inflammatory phase of wound healing?
A fibrin network forms, resulting in a blood clot that plugs the opening of the wound and stops the flow of blood.
What occurs during the granulation phase of wound healing?
Fibroblasts migrate to the wound and synthesize collagen, which provides strength to the wound. There is also a growth of new capillaries during this phase to provide the damaged tissue with an abundant blood supply.
What occurs during the maturation phase of wound healing?
Collagen continues to be synthesized. The granulation tissue eventually hardens into white scar tissue.
What is an exudate?
Material, such as fluid and cells, that has escaped from blood vessels during the inflammatory process.
Describe the appearance of the following types of exudates:
a. Serous:
b. Sanguineous:
c. Purulent:
d. Serosanguineous:
e. Purosanguineous:
a. Serous: Contains serum and appears clear and watery.
b. Sanguineous: Has a red color and is composed of red blood cells.
c. Purulent: Contains pus and is usually thick and has an unpleasant odor. It is white but may acquire tinges of pink, green, or yellow.
d. Serosanguineous: Consists of clear and blood-tinged drainage.
e. Purosanguineous: Consists of pus and blood.
List two functions of a sterile dressing.
To protect the wound from contamination and trauma, to absorb drainage, to restrict motion.
The names and sizes of sutures are listed. In each set, circle the suture that has the smaller diameter:
a. 4-0 silk* 2-0 silk 2
b. 0 chromic surgical gut 3-0 chromic surgical gut c. 2-0 polypropylene 2 polypropylene
List five examples of materials used for nonabsorbable sutures.
Silk, nylon, polyester, polypropylene, polybutester, stainless steel, surgical skin staples.
What is a swaged needle? List advantages of using a swaged needle.
A swaged needle is permanently attached to the end of the suture. The suture material does not slip off the needle, and tissue trauma is reduced because only a single strand of suture must be pulled through the tissue.
Why are sutures inserted in the head and neck generally removed sooner than other sutures?
This area has a better blood supply and heals more rapidly.
List two advantages of using surgical skin staples to approximate a wound.
It is the fastest method of closure for long skin incisions, and trauma to the tissue is reduced because the tissue does not have to be handled much during insertion.
List three advantages of adhesive skin closures.
They eliminate the need for skin sutures and a local anesthetic, are easy to apply and remove, and result in less scarring than skin sutures.
What is the purpose of preparing the patient's skin before minor office surgery?
To reduce the risk of surgical wound contamination.
What is the purpose of a fenestrated drape?
To provide a sterile area around the operative site to decrease contamination of the surgical wound.
What are the characteristics of a local anesthetic?
It produces a loss of sensation in a localized area and prevents the patient from feeling pain. When first injected, it causes the patient to experience a brief burning or stinging sensation at the injection site. It begins working in 5 to 15 minutes and has a duration of 1 to 3 hours.
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.
What is the name of the local anesthetic most frequently used in the medical office during minor office surgery?
Xylocaine [lidocaine hydrochloride].
Explain how an instrument should be handed to the physician during minor office surgery.
In its functional position and in a firm, confident manner so that it does not slip out of the physician's hand.
What is a sebaceous cyst, and what causes it to form?
A sebaceous cyst is a thin, closed sac or capsule located just under the surface of the skin containing secretions from a sebaceous gland. It forms when the outlet of a sebaceous gland becomes obstructed.
What is the purpose of using gauze packing or a rubber Penrose drain after incising a localized infection?
To keep the edges of the tissue held apart to facilitate drainage of the exudate.
What is the difference between congenital nevi and acquired nevi?
Congenital nevi are moles that an individual is born with. Acquired nevi are moles that develop over time.
What are the characteristics of benign moles?
Usually range in color from brown to nearly black in color 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
What are skin tags? Where are they most frequently found on the body?
Skin tags are small, painless, benign growths that project from the skin on a narrow stalk [peduncle]. They are most frequently found in body areas where the skin creases, such as the eyelids, neck, armpits, upper chest, and groin.
Describe the appearance of dysplastic nevi. What concern exists with dysplastic nevi?
They are usually larger than normal moles and have an irregular coloration and shape. The center may be raised and darkened. They are more likely than ordinary moles to develop into malignant melanoma.
List the characteristics of melanoma.
The mole is asymmetrical, has an irregular border, varies in color from one area to another, is larger than 1⁄4 inch in diameter, and is painful or tender, itches, bleeds, oozes, or has a scaly appearance.
What are the postoperative instructions for toenail removal?
Elevate the foot for 24 hours following the procedure.
Keep the area clean and dry.
Cleanse the toe daily with warm water and gently dry the area.
Apply an antibiotic ointment daily until the wound has completely healed.
Wear loose-fitting shoes for 2 weeks following the procedure.
Avoid strenuous exercise for 2 weeks following the procedure.
Contact the medical office if any signs of infection occur, which include increasing pain, redness, swelling, and drainage from the toe.
What are the most common methods used to remove moles?
Shave excision, surgical excision, laser surgery.
What is the purpose of a biopsy?
To determine whether a tumor is malignant or benign or to determine whether infection is present.
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.
List three causes of an ingrown toenail.
Tight shoes or hose, trauma, improper nail trimming, infection.
List two reasons for performing a colposcopy.
To follow up on abnormal Pap test results and to evaluate a vaginal or cervical lesion observed during a pelvic examination.
What is the purpose of performing a cervical punch biopsy?
To detect the presence of cervical dysplasia or cancer of the cervix; also used to diagnose polyps on the cervix and genital warts.
List the postoperative instructions that must be relayed to a patient after a cervical punch biopsy.
a. 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.
b. If Monsel's solution is used to control bleeding, a thick, dark-colored vaginal discharge may occur following the procedure and last for several days.
c. Do not douche, use tampons, or have intercourse for 1 week after the procedure to allow proper healing of the cervix to take place.
d. Contact the medical office if the following occur: bleeding that is heavier than normal menstrual bleeding, a foul- smelling vaginal discharge, fever, or lower abdominal pain.
e. An appointment is scheduled approximately 1 week following the procedure to make sure that healing is taking place and to discuss the biopsy results.
List two uses of cryosurgery.
To treat cervical dysplasia, to treat chronic cervicitis.
List the postoperative instructions that must be relayed to a patient after cervical cryosurgery.
a. Normal activities can be resumed the day after the cryosurgery.
b. On the first postoperative day, a clear, watery vaginal discharge occurs, which lasts for 2 to 4 weeks.
c. Use sanitary pads [rather than tampons] to absorb the watery discharge.
d. 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.
e. Contact the medical office if any of the following occur: bleeding that is heavier than normal menstrual bleeding, a foul-smelling vaginal discharge, fever, or lower abdominal pain.
f. The patient must schedule a return visit 6 weeks after the procedure to ensure that proper healing has occurred.
List three functions of a bandage.
To apply pressure; to control bleeding; to protect the wound from contamination; to hold a dressing in place; to protect, support, or immobilize an injured part of the body.
List four guidelines to follow when applying a bandage.
Observe the principles of medical asepsis.
Make sure the area to which the bandage is applied is clean and dry.
Do not apply a bandage directly over an open wound.
Do not allow the skin surfaces of two body parts to touch.
Pad joints and prominent parts of bones.
Bandage the body part in its normal position with joints slightly flexed.
Apply the bandage from the distal to the proximal part of the body.
As you apply the bandage, ask the patient if it feels comfortable.
If possible, leave the fingers or toes exposed when bandaging an extremity to check for signs of circulation impairment.
Obtain a new bandage if the bandage roll has dropped during the procedure.
List four signs that may indicate a bandage is too tight.
Coldness, pallor, numbness, cyanosis of the nail beds, swelling, pain, tingling sensations.
Why should the medical assistant be careful when applying an elastic bandage?
It is easy to apply it too tightly and impede circulation.
What is the purpose of reversing the spiral during a spiral-reverse turn?
Allows for a smoother fit and keeps the bandages from gaping because of the variations in the contour of the limb
List two uses of the figure-eight bandage turn.
To hold a dressing in place and to support and immobilize an injured joint.
What type of bandage turn is used to anchor a bandage?
Circular.