Assisting with Office/ Ambulatory Surgery

Name Date Score C H A P T E R 31 Assisting with Office/ Ambulatory Surgery CHAPTER PRE-TEST Perform this test without looking at your book. 1. The signs of inflammation are: a. Redness, drainage, pain, and swelling b. Redness, pain, and swelling c. Redness, pain, swelling, and tenderness d. Redness, pain, swelling, and warmth 2. An item that is free from all microorganisms and their spores is considered: a. Contaminated b. Sterile c. Decontaminated d. Clean 3. An informed consent should include what information? a. Risks of the procedure b. Alternate therapies c. Name and description of the procedure d. All of the above 4. The locking mechanisms on surgical instruments are known as: a. Hinges b. Ratchets c. Rings d. Teeth 5. The definition of anesthesia is: a. Loss of feeling or sensation b. Loss of consciousness c. Loss of control d. Loss of function 315 03047_sg_ch31_ptg01_hr_315_328.indd 315

316 Chapter 31 Chapter Assignment Sheets 6. Which statement best describes a dressing? a. Supportive material over a wound b. Sterile material applied directly over a wound c. A rigid material to support a damaged bone d. None of the above 7. When setting up for a surgical procedure, it is good to refer to surgery cards. What information can be found there? a. The name of the patient b. Specific instruments c. Supplies for the procedure d. b and c 8. Skin must be prepared prior to any invasive procedure. Which of the following is appropriate skin prep? a. Betadine b. Hibiclens c. 70% isopropyl alcohol d. All of the above 9. A specialized drape that has an opening for the surgical site is: a. Pleated b. Serrated c. Fenestrated d. Striated 10. Infected wound drainage is referred to as: a. Exudate b. Inflammation c. Stricture d. All of the above VOCABULARY BUILDER Misspelled Words Find the words in Column I that are misspelled; underline them, and correctly spell them in the spaces provided. Then match each of the vocabulary terms below with the correct definition in Column II. Column I Correct Spelling Column II H 1. inflamation inflammation A. The trade name for povidone-iodine, a topical anti-infective C 2. ephinephrine epinephrine B. Partial or complete loss of sensation, with or without loss of consciousness G 3. ligature C. A hormone secreted by the adrenal medulla in response to stimulation of the sympathetic nervous system; used in conjunction with a local anesthetic. It constricts blood vessels to help lessen bleeding during ambulatory surgery. 03047_sg_ch31_ptg01_hr_315_328.indd 316

Chapter 31 Assisting with Office/Ambulatory Surgery 317 F 4. Hibeclens Hibiclens D. A condition free from germs, infection, and any form of life B 5. anestesia anesthesia E. A narrowing or constriction of the lumen of a tube, duct, or hollow organ A 6. Betadine F. Trade name for chlorhexidine gluconate, a topical antiseptic I 7. isopryl alcohol isopropyl alcohol G. A thread or wire for tying a blood vessel or other structure to constrict or fasten it E 8. strictures H. The nonspecific immune response that occurs in reaction to any type of bodily injury D 9. surgical asepsis I. A clean, flammable liquid used in medical preparations for external use Definitions Match the vocabulary words below with their correct definitions. A 1. approximate H 2. cautery I 3. contamination D 4. infection E 5. informed consent F 6. Mayo stand/instrument tray G 7. ratchets C 8. suture B 9. swaged/atraumatic A. To bring together the edges of a wound B. A surgical needle is attached to a length of suture material C. Surgical material or thread; may describe the act of sewing with the surgical material and needle D. An invasion of pathogens into living tissue E. A voluntary agreement to have a procedure or surgery after a patient has been informed about the risks and benefits F. A portable metal tray table used for setting up a sterile field for minor surgery and procedures G. The locking mechanisms on the handles of many surgical instruments H. The destruction of tissue by burning I. To make something unclean, often used to describe a sterile area being made unsterile or exposing a clean area to a pathogenic substance 03047_sg_ch31_ptg01_hr_315_328.indd 317

318 Chapter 31 Chapter Assignment Sheets LEARNING REVIEW Short Answer 1. Identify each entry below as an example that follows strict sterile principles or in which the sterile area, field, or tray is contaminated. Write sterile or contaminated in the spaces provided. If the entry is contaminated, write what was done to render it contaminated. A. Bruce Goldman, CMA (AAMA), collects used instruments handed to him by Dr. Mark Woo during a minor surgical procedure to excise an infected sebaceous cyst by placing the instruments in a separate container or area out of view of the patient. Contaminated. Used surgical instruments must be soaked, scrubbed, rinsed, dried, and autoclaved. B. Ellen Armstrong, CMA (AAMA), sets up a sterile field for a minor surgical procedure. After setting up the field, she remembers that a sterile solution is required and leaves the room to obtain the solution to be poured into a sterile cup. Contaminated. Do not turn your back on a sterile field. If you cannot see the field, you cannot be aware of what it touched. If work must be interrupted, apply a sterile field cover and move the tray to a place where it will not be disturbed. C. Wanda Slawson, CMA (AAMA), removes a dressing from a wound on a patient s arm and then reaches over the sterile field to discard the used dressing in a biohazard waste container that she has placed on the other side of the sterile field that she set up for the procedure. Contaminated. Reaching over a sterile field with contaminated waste will contaminate the field. The biohazard container should be placed away from the sterile area and in a position that does not necessitate reaching over or near the sterile field. D. Patient Edith Leonard will not stop talking and asking questions as Liz Corbin, CMA (AAMA), removes sutures from a small wound on Edith s arm sustained during a recent fall. The medical assistant is careful to time her responses to Edith so that she is not talking when she is working directly over the sterile field. Sterile. E. Anna Preciado, CMA (AAMA), applies sterile gloves in preparation to assist Dr. Lewis with a minor surgical procedure. During the procedure, she comforts the patient and assists the provider as required. When Anna s hands are not in use, she keeps them down at her sides, careful not to touch her gloved hands to her clothing or any other nonsterile item. Contaminated. Anything below the waist is considered to be outside of the sterile field and, therefore, contaminated. All articles should be held above the waist; gloved hands should be held in front of and away from the body, above the waist. 2. Living tissue surfaces, such as skin, cannot be sterilized. Name two examples of ways that skin can be rid of as many pathogens as possible before the use of a sterile covering. (1) Preparing the patient s skin with a surgical scrub solution before applying sterile drapes around the intended surgical site. (2) Using surgical hand washing technique before applying sterile gloves. 3. Identify and describe the most widely used method of sterilization in the ambulatory care setting. Steam sterilization is the most widely used method of sterilization in the ambulatory care setting. This technique uses an autoclave, or pressure cooker, to achieve sterilization. Through conversion to steam, water reaches temperatures greater than boiling (270 F). This high heat and at least 15 pounds of pressure eradicate all microorganisms and their spores. 03047_sg_ch31_ptg01_hr_315_328.indd 318

Chapter 31 Assisting with Office/Ambulatory Surgery 319 4. List six general rules that ensure proper sterilization when using an autoclave. (1) Articles placed in the autoclave must have been sanitized, rinsed, and dried. (2) Articles are placed in such a way that all surfaces are adequately exposed. (3) Containers are placed on their sides with lids loosely in place to avoid trapping air pockets. (4) Only approved wrapping material is used. (5) Timing does not begin until gauges read 15 pounds of pressure and 270 F. (6) After the completed cycle, sterile, wrapped packs are left in the autoclave to cool and dry to prevent microorganisms from contaminating the items. 5. Identify the recommended requirements for effective sterilization in an autoclave. Temperature 270 F Time for sterilization of unwrapped items 20 minutes Time for sterilization of loosely wrapped items 30 minutes Time for sterilization of tightly wrapped items 40 minutes Frequency of draining of water and cleaning At least once a week; more frequently depending on use of autoclave Matching I Match the following equipment with the correct aseptic method. For each instrument or item below, identify the method used for proper asepsis: chemical disinfection (CD), chemical sterilization (CS), or steam sterilization (SS) in an autoclave. CD 1. Percussion hammer SS 2. Wrapped surgical instruments CD 3. Stethoscopes CS 4. Fiber-optic endoscopes CD 5. Countertops CD 6. Wheelchairs SS 7. Gynecologic instruments CD 8. Examination tables Matching II Identify each action that follows as an action appropriate to medical aseptic hand washing technique (MAH) or surgical aseptic hand washing technique (SAH). SAH 1. Do not apply lotion. SAH 2. Glove for sterility. MAH 3. 1 minute duration SAH 4. Hold hands up during washing and rinsing. MAH 5. Apply lotion. SAH 6. Wash hands, wrists, and forearms to the elbows. MAH 7. Hold hands down during rinsing. SAH 8. 3- to 6-minute duration 03047_sg_ch31_ptg01_hr_315_328.indd 319

320 Chapter 31 Chapter Assignment Sheets CERTIFICATION REVIEW These questions are designed to mimic the certification examination. Select the best response. 1. Surgical instruments that have opposing cutting edges are classified as: a. hemostats b. probes c. scissors d. scalpels 2. Surgical instruments that have ratchets are used for: a. cutting b. clamping c. probing d. exploring e. opening 3. Thumb forceps may also be called: a. pickups b. towel clamps c. hemostats d. Allis forceps 4. The recommended temperature for effective sterilization in an autoclave is: a. 212 F b. 270 F c. 150 F d. 220 F 5. An acceptable border between a sterile and a nonsterile area is: a. 1 inch b. 2 inches c. 4 inches d. 5 inches 6. The preferred length for suture material, because it is manageable yet long enough to complete most suture procedures, is: a. 10 inches b. 8 inches c. 12 inches d. 18 inches 7. Suture material that is used when more time is needed for healing is coated with: a. magnesium b. chromium c. calcium d. iodine 03047_sg_ch31_ptg01_hr_315_328.indd 320

Chapter 31 Assisting with Office/Ambulatory Surgery 321 8. Application of a caustic chemical or destructive heat that burns tissue is called: a. cryotherapy b. evisceration c. approximation d. cauterization 9. The mechanism located between the rings of the handles of surgical instruments that is used for locking the instrument is called the: a. serration b. box-lock c. ratchet d. probe 10. Which of the following is considered a sterile principle? a. A sterile object may not touch a nonsterile object. b. Turning you back on a sterile field is allowable. c. Reaching over the sterile field is allowable with gloved hands. d. Some sterile objects are still considered sterile when wet. LEARNING APPLICATION Critical Thinking 1. What would be the rationale behind leaving a wound open rather than suturing it? On what basis would the provider make the decision? Students may need additional references to determine their answer to this question. Determining whether to suture a wound takes into consideration its location, depth, complexity, and size, as well as whether or not the wound is gaping. If a wound is gaping, it will usually heal quicker and with less scarring if the edges are approximated with sutures. Even if the wound is not gaping but is located on a portion of the body that bends, such as a knee or an elbow, suturing is desirable to minimize scarring. If a wound is deep or larger than a centimeter, suturing will probably aid healing and lessen complications. If a wound is several hours old, it is usually not suitable for suturing, due to the healing process that takes place in the first few hours. Sometimes a provider may choose to trim the healed edges to expose fresh tissue, and then proceed with suturing. If a decision is made not to suture a wound because of advanced healing, adhesive sterile strips may be used to pull the edges of the wound closer for the completion of the healing process. Sometimes a wound is infected and a decision will be made to leave a wound open to allow drainage. Occasionally a wick is placed into the wound to facilitate the drainage. Even though puncture wounds are often deep, they are usually not wide enough for suturing and are often left open for drainage. 2. While you are preparing a patient for surgery, he confides in you that he doesn t have anyone to drive him home, but he only lives three miles away and he can drive himself. How do you respond? If a patient is weak or impaired after surgery and hurts himself or herself or others while driving home, the provider may be held liable. If no one is available to drive the patient home, the patient should stay in the clinic until it is determined that he or she is no longer impaired. 03047_sg_ch31_ptg01_hr_315_328.indd 321

322 Chapter 31 Chapter Assignment Sheets 3. You have thoroughly explained the postoperative instructions to the patient and caregiver. Are written instructions also necessary? Why or why not? Written instructions are always given to the patient and caregiver and are explained to each until they are clearly understood. The clinic or office phone number and an after-hours number should also be written for patients so they can call if they experience any complications or need further instructions. Assure patients that comfort and safety are very important and encourage them to call with concerns and questions. A follow-up call later in the day or the next day should be standard practice. 4. While pouring a sterile solution into a bowl on the sterile field, you accidentally splash a very tiny amount of the solution onto the field. What is your next step? Explain your actions. The area has become contaminated and must be set up again with new equipment and supplies. Microorganisms from the tray can go through the towel on the sterile field. 5. During an incision and drainage of a localized infection you notice a large amount of exudates from the side. What precautions should you take? An incision and drainage of a localized infection should alert you to the very strong possibility of an exudate being expelled from the operative site. Therefore, prior to assisting with the procedure, you must prepare by protecting yourself with PPE and handling all surgical instruments, equipment, and supplies during and after the procedure according to OSHA and CDC guidelines. Case Studies CASE STUDY 1 Joyanna Evans, CMA (AAMA), is responsible for maintaining and cleaning the autoclave at Inner City Health Care. Because this equipment is used every day to sterilize instruments, Joyanna cleans the inner chamber of the autoclave daily. Once a week she gives the autoclave a thorough cleaning. CASE STUDY REVIEW QUESTIONS 1. Describe Joyanna s daily cleaning procedure. On a daily basis, the inner chamber of the autoclave should be washed with a mild detergent and cloth, then rinsed and dried. The outer jacket should be wiped clean of dust and soil. The manufacturer s instructions and recommendations for cleansers should be followed. 2. Describe Joyanna s weekly cleaning procedure. The autoclave is drained, filled with cleaning solution, run through a 20-minute heated cycle, drained of solution, filled with distilled rinse water, run through another 20-minute heated cycle, drained of rinse solution, and filled with distilled water again. Then the inner shelves are removed and scrubbed and the inner chamber is wiped clean. During the cleaning process, the autoclave s rubber seal should be inspected for cracks or wear. 3. Why is proper maintenance and cleaning of the autoclave important? Proper cleaning and maintenance of the autoclave are essential to ensure the sterility of instruments and equipment used in the ambulatory care setting, preventing the use of contaminated instruments in patient care. 03047_sg_ch31_ptg01_hr_315_328.indd 322

Chapter 31 Assisting with Office/Ambulatory Surgery 323 CASE STUDY 2 Joyanna works with a variety of instruments and supplies as she assists in ambulatory care surgery. Answer the following questions related to surgical instruments and supplies. CASE STUDY REVIEW QUESTIONS 1. From the selection that follows, identify each instrument by name. In the spaces provided, give a brief description of each instrument s use. Instrument Instrument Name Uses Sound Probe used to determine the Cengage Learning 2014 Cengage Learning 2014 Cengage Learning 2014 Cengage Learning 2014 Cengage Learning 2014 Foerster sponge forceps or transfer forceps Iris scissors Lister bandage scissors Adson tissue forceps size and shape of the organ being examined or to detect the presence of an unseen foreign body Used to hold gauze sponges or to move sterile supplies Delicately bladed operating scissors, used to cut sutures Used to remove bandages without causing injury to the patient Thumb forceps with teeth; used to grasp tissue continues 03047_sg_ch31_ptg01_hr_315_328.indd 323

324 Chapter 31 Chapter Assignment Sheets Cengage Learning 2014 Cengage Learning 2014 Cengage Learning 2014 Jones towel clamp Thumb dressing forceps Suture removal or stitch removal scissors Used to attach surgical field drapes to each other Used to grasp dressing or sutures Has a small hook to slip under sutures/stitches for ease in cutting 2. Joyanna will be removing stitches today. Which two instruments from above will she need for removing sutures? Joyanna would use thumb dressing forceps and suture removal or stitch removal scissors for removing sutures. Preparing Surgical Packs Pretend the areas outlined below are labels on surgical packs that you have just wrapped. Label them with the proper information. a. Iris scissors and 4 3 4 gauze. b. Needle driver and a #3 scalpel handle. c. Thumb tissue forceps and a #3 scalpel handle. 08-06-20XX 08-06-20XX 08-06-20XX Iris scissors with 4 3 4 gauze Needle driver and scalpel handle (#3) Thumb tissue forceps and scalpel handle (#3) S. Thomas, CMA (AAMA) S. Thomas, CMA (AAMA) S. Thomas, CMA (AAMA) 03047_sg_ch31_ptg01_hr_315_328.indd 324

Chapter 31 Assisting with Office/Ambulatory Surgery 325 Web Activities Search the Internet to explore the most current ambulatory surgical procedures for varicose veins, cataracts, and cholelithiasis. 1. Using a search engine of your choice, go to a Web site about ambulatory care. a. Look for the criteria that the patient must meet to be discharged after surgery. b. What are some common complications that can occur in the ambulatory center after any surgical procedure? c. Name two other surgeries other than those listed in your book that can be performed in an ambulatory center. Discuss them. d. List three to four advantages and disadvantages of ambulatory surgery. CHAPTER POST-TEST Perform this test without looking at your book. 1. Which of the following is not a method of sterilization? a. Boiling sterilization b. Gas sterilization c. Steam sterilization d. Dry heat sterilization 2. When loading an autoclave, it is important to leave how much space between packages? a. 1 to 2 inches b. 1 to 3 inches c. 2 to 3 inches d. 2 to 4 inches 3. Thermolabile is a term that refers to: a. a type of dye that changes color when exposed to steam at the proper temperature and pressure and for the proper amount of time b. a type of dye that remains the same color when exposed to steam at the proper temperature and pressure and for the proper amount of time c. a biological indicator that contains spores to determine an autoclave s efficacy d. a culture strip containing heat-resistant spores 4. When an electric current is used to cut or destroy tissue, it is called: a. incision b. electrosurgery c. cryosurgery d. laser surgery 5. Select the gauge of the finest suture material: a. 0 b. 2-0 c. 3-0 d. 4-0 03047_sg_ch31_ptg01_hr_315_328.indd 325

326 Chapter 31 Chapter Assignment Sheets 6. Which of the following is a cutting instrument? a. Scissors b. Scalpel c. Forceps d. a and b 7. When cleaning sharp instruments it is good practice to wear: a. heavy duty rubber gloves b. non-latex gloves c. non-sterile disposable gloves d. sterile gloves 8. Sterile surgical wicks or wound packing strips are used: a. to dress a sutured wound b. to close sterile packages c. to keep an infected wound open for drainage d. all of the above 9. Which of the following is used to create a sterile field over and around the operative site? a. Dressing b. Sponges c. Drapes d. Wicks 10. When assisting the provider with a minor surgery, which is the correct order of the activities listed below? 1. Set up sterile field 2. Wash hands 3. Place sterile instruments and supplies on the sterile field 4. Gather equipment and supplies a. 2, 4, 1, 3 b. 1, 2, 3, 4 c. 2, 1, 3, 4 d. 4, 2, 1, 3 SELF-ASSESSMENT Think of a time when you or a family member experienced a surgical event. If you have not had a personal surgical experience, interview a friend or family member and gather answers to the following questions. 1. Did the doctor or his or her staff explain the procedure clearly? Answers will vary according to the students individual experiences. The purpose of this exercise is to raise the student s awareness of how patients might be feeling when having a surgical procedure. 03047_sg_ch31_ptg01_hr_315_328.indd 326

Chapter 31 Assisting with Office/Ambulatory Surgery 327 2. Were your questions answered to your satisfaction? 3. What was of greatest concern to you (financial concerns, pain, recovery, results, etc.)? 4. Did the recovery go as expected? 5. Were the results what you expected? 6. What could have made the experience better? 03047_sg_ch31_ptg01_hr_315_328.indd 327

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