chapter 25 (ma)

approximated

(uh PROK si may ted) Near, close together.

cicatrix

(SIK uh triks) Early scar tissue that appears pale, contracted, and firm.

hemostasis

(hee muh STAY sis) The stoppage of bleeding.

plume

Vapor, smoke, and particle debris produced by laser procedures.

vigilance

(VIJ uh lahns) Keen watchfulness to detect danger.

What is a fenestrated drape?

A surgical drape with an opening in the center, the size of which depends on the surgical field.

What is the purpose of skin preparation and draping in surgery?

To create a sterile environment for the surgical procedure.

What is performed after achieving suitable local anesthesia?

The provider opens the skin with an incision.

What happens during cyst removal?

The provider dissects around the cyst and tries to 'deliver' it from the wound intact.

What occurs immediately after the skin is incised during an I&D?

Foul matter will start oozing from the wound.

What is done with a specimen taken during a biopsy?

It is placed in a specimen container with preservative, labeled with patient information, and sent to the laboratory for microscopic examination.

What is electrosurgery also known as?

Electrosurgery is also known as electrocautery.

What is the function of an electrosurgical unit (ESU)?

An ESU uses high-frequency current to cut through tissue and coagulate blood vessels.

How does the process of electrosurgery minimize bleeding?

It seals blood vessels, minimizing cellular oozing and bleeding.

What types of conditions may electrosurgery be used to treat?

Electrosurgery may be used to destroy granulations, small polyps, or take a tissue sample for pathology examination.

What does the loop electrosurgical excision procedure (LEEP) involve?

LEEP uses a wire loop heated by an electric current to remove cells and tissue from the uterine cervix.

What are the necessary components of an ESU?

The components are the power source, grounding cable and pad, and the active electrode.

What is the function of the grounding pad in electrosurgery?

The grounding pad provides a safe return path for the electrosurgical current.

What are the two most commonly used electrode tips in electrosurgery?

The two most commonly used tips are the needle and flat designs.

What is an important tip for preparing the grounding pad?

Carefully inspect the pad, cable, and skin before the procedure.

Where should the grounding pad be placed?

The pad should be placed close to the operative site.

How should the grounding pad be applied to the patient's skin?

The pad must be tight against the patient’s skin.

Where is the best location to apply the grounding pad?

Apply the pad to a fleshy area, such as the thigh.

Where should the grounding pad NOT be placed?

Do not place the pad over a bony area.

What should be avoided when applying the grounding pad?

Do not place the pad over body hair.

What caution should be taken regarding implants when using the grounding pad?

Do not place the pad over metal implants or a pacemaker.

What should be done after the procedure regarding the grounding pad site?

Carefully inspect the pad site on the skin after the procedure for signs of burns.

What happens when the provider holds the pencil-like instrument during electrosurgery?

The provider touches the tissue with the tip and activates the electric current with a switch on the instrument.

What occurs when the electric current is delivered to the tissues in electrosurgery?

Tissue is vaporized at the site of contact, or a specimen can be removed for pathology.

What does the use of the tip of the pencil-like instrument in electrosurgery involve?

It involves activating an electric current to vaporize tissue or obtain a specimen for pathology.

What does LASER stand for?

Laser is an acronym for Light Amplification by Stimulated Emission of Radiation.

Why is the precision of a laser beam beneficial in medical procedures?

A laser beam is small and precise, allowing for safe treatment of specific tissue with minimal damage to surrounding tissues and limited scar formation.

What were lasers first used for in medicine?

Lasers were first used to treat diseases of the retina.

What are some procedures that utilize lasers?

Procedures include excision of lesions, cauterization of blood vessels, removal of warts or moles, and cosmetic surgical procedures.

What are examples of types of lasers used in medical procedures?

Types of lasers include carbon dioxide lasers, yttrium-aluminum-garnet (YAG) lasers, and pulsed dye lasers.

What is required from a medical assistant before assisting in laser surgery?

A medical assistant must complete a laser safety program and receive special training in lasers.

What are some responsibilities of a medical assistant during laser surgery?

Responsibilities include protecting the patient's eyes, observing the surgical field through safety goggles, keeping wet sponges ready, removing flammable items, assisting with suctioning plume, providing sterile saline solution, and anticipating the need for protective supplies.

What is the significance of the color of the laser light beam?

The color of the laser light beam is directly related to the type of surgery performed.

Why is careful handling and maintenance of laser equipment important?

Improper handling can destroy tissue and harm the patient, the provider, and the assistant.

What is microsurgery?

Microsurgery involves the use of an operating microscope to perform delicate surgical procedures.

In which areas is microsurgery commonly used?

Microsurgery is used in ophthalmologic, otologic, rhinologic and sinus, laryngologic, neurosurgical, microvascular, gynecologic, and genitourinary procedures.

What must a medical assistant acquire before assisting in microsurgery?

A medical assistant must acquire a basic knowledge of the operation and care of a microscope.

What are the basic components of an operating microscope?

The basic components of an operating microscope are the light source, eyepieces (oculars), lenses, and cord.

What are some accessory pieces used with an operating microscope?

Accessory pieces include assistant and observer lenses, cameras, video recorders, television monitors, and printers.

What is the purpose of accessory pieces for an operating microscope?

Accessory pieces are valuable for documentation and teaching purposes.

What type of drapes are used on the microscope during surgical procedures?

Disposable sterile drapes and handle covers are used on the microscope during surgical procedures.

Why do surgical microscopes require extreme care?

Surgical microscopes are expensive, delicate instruments that require extreme care in handling and cleaning.

What should be done with lenses and cords before and after each use of an operating microscope?

All lenses and cords should be carefully inspected before and after each use.

What is an endoscope?

An endoscope is a medical device consisting of a miniature camera mounted on a flexible tube with an optical system and a light source used to examine the area inside an organ or a cavity.

What are endoscopes named according to?

Endoscopes are named according to the organs or areas they are used to explore, such as the urinary bladder, bronchus, larynx, colon, stomach, uterus, abdomen, and various joints.

What can be done through an endoscope?

Small instruments can be used to take samples of suspicious tissues through the endoscope.

What are endoscopes used for?

Direct visualization with an endoscope is used for diagnostic purposes or to perform surgical procedures.

What are the different types of endoscopes?

Endoscopes may be rigid (e.g., laparoscope or hysteroscope), semirigid, or flexible (e.g., colonoscopes, bronchoscopes, gastroscopes).

What equipment is used with endoscopes?

Accessory equipment includes fiberoptic light cables, light sources, irrigators for solution instillation and suction, cameras, monitors, printers, and video recorders.

What is a key feature of fiberoptic light cables?

The fiberoptic light cable consists of hundreds of glass fibers and must be protected from being bent, dropped, kinked, squashed, or smashed.

What caution must be taken with the light source in endoscopy?

The light source can become very hot and must be kept out of contact with the patient, provider, staff, and any flammable material.

What should be done with endoscopic equipment before and after use?

All equipment must be checked before and after use, and the manufacturer's recommendations for care and maintenance should be followed.

What should be avoided when sanitizing endoscopic instruments?

Endoscopic instruments would be damaged by the high temperature and steam under pressure in autoclaves.

What precautions should be taken after each procedure with endoscopes?

Special care must be taken in sanitizing and using high-level disinfectants to destroy pathogenic organisms and prevent cross-contamination to subsequent patients.

What is cryosurgery?

Cryosurgery involves the use of a very low-temperature probe to destroy tissue by freezing it on contact.

What is the typical temperature of the probe used in cryosurgery?

The probe’s temperature is usually below 4°F (−20°C).

How is the cold temperature achieved in cryosurgery?

This cold temperature is achieved by circulating liquid nitrogen through the tip of the probe.

What type of anesthesia is typically used before cryosurgery?

A local anesthetic is usually administered before cryosurgery.

What conditions can cryosurgery be used to treat?

Cryosurgery is used to treat cancers of the skin and warts.

How is cryosurgery compared to traditional surgery?

Cryosurgery is often less invasive than traditional surgery and generally has fewer associated complications.

Where is cryosurgery typically performed?

Cryosurgery is often performed in an ambulatory setting or an outpatient surgery center.

What is a joint aspiration?

A joint aspiration, also known as an arthrocentesis, involves the removal of fluid from a joint, most commonly from the knee.

Why might a joint aspiration be performed?

It may be done to reduce swelling from an injury or infection and to help diagnose arthritis or other conditions of the joint.

What is a therapeutic injection?

A therapeutic injection involves injecting medication, such as corticosteroids, into the joint to relieve pain.

What technique is used for both joint aspiration and therapeutic injection?

Sterile technique is used for both procedures.

How is the needle guided during a joint aspiration or therapeutic injection?

Ultrasound is usually used to help guide the needle within the joint.

What happens to the fluid removed during a joint aspiration?

A sample of the fluid removed will be examined under the microscope to help determine the cause of the accumulation of fluid in the joint.

What should a patient do after a joint aspiration or therapeutic injection?

The patient should remain sitting for several minutes to make sure that they are not dizzy.

What is vital for a procedure to go smoothly?

Proper preparation of the patient and the procedure room.

What might happen if patients do not understand their pre-procedure requirements?

The procedure may have to be postponed.

What can cause delays in the procedure aside from patient understanding?

If the room is not properly prepared, the procedure may be delayed.

What is important for patients facing surgery regarding their concerns?

They need both psychological and physical support.

Why might a patient feel anxious about surgery?

Patients may be concerned about pain, disfigurement, and possible diagnosis.

How can a medical assistant help alleviate patient fears before surgery?

By ensuring the patient understands the procedure details and encouraging them to voice concerns.

What should be done if the medical assistant cannot answer a patient's question?

The assistant should assure the patient that the question will be relayed to the provider before the procedure.

What are some components of preoperative preparation?

Blood and urine tests, completion of a consent form, gathering current history concerning recent illnesses, medications, and allergies.

What may patient preparations before surgery include?

Patient preparations before surgery may include a shave prep, cleansing enemas, food intake restrictions, special bathing, and the administration of a sedative medication.

What instructions are given to the patient on the day of surgery?

On the day of surgery, the patient is instructed to empty the bladder and undress and gown as requested. The vital signs are recorded in preparation for the procedure.

What are some preoperative instructions for office surgery?

1. Having the necessary consent forms ready to sign.
2. Giving the patient the necessary preoperative instructions, such as medications to be used and special skin-cleansing instructions.
3. Telling the patient to bring a relative or friend to drive him or her home after the surgery.
4. Instructing the patient to leave jewelry and other valuables at home.
5. Calling the patient the day before the scheduled surgery to confirm any special instructions.

When must the patient's written informed consent be obtained?

The provider must have the patient’s written informed consent before the sedating medication is given and surgery begins.

What must the patient understand to sign an informed consent form?

To sign an informed consent form permitting the provider to legally perform the surgery, the patient must understand certain details about the procedure.

What must the discussion with the patient include regarding surgery?

The discussion must include what procedure will be performed, why it should be done, the potential risks and benefits of the surgery, alternative treatments (including no treatment), and possible risks of any alternative treatment.

What is required for a patient to legally consent to surgery?

The patient must have a discussion with the provider, understand the information provided, and either consent to or refuse the surgery before signing the consent form.

What must be documented in the patient’s health record after the consent discussion?

The discussion must be fully documented in the patient’s health record, and a copy of the signed consent form must also be included.

What should be ensured about the patient at the time of signing the consent form?

The patient must not be under the influence of any sedative medication at the time of signing the consent form.

What should be done if the patient does not understand English?

An interpreter must be used if the patient does not understand English.

What is important to ensure about the patient's clothing before a surgical procedure?

Have the patient disrobe sufficiently to expose the surgical site completely to prevent accidental contamination.

What role does patient positioning play in a surgical procedure?

The patient needs to be positioned as comfortably as possible for the procedure to avoid movement and discomfort during the procedure.

What factors should be considered when deciding on the patient's position for surgery?

Consider where you and the provider will stand or sit, where the instruments will be placed, and where other needed equipment will be located.

What should be done if the patient has an open wound while assisting with positioning?

Wear gloves to assist the patient into position.

What precautions should be taken if there is active and profuse bleeding?

Wear an impermeable gown and gloves.

What should you wear if there is a danger of blood and body fluid contamination to your face or eyes?

Wear a face shield.

What is the goal of adequate skin preparation for a surgical procedure?

To reduce the number of transient floras so that any transfer of harmful organisms at the incision site is limited.

What does skin prep involve before surgery?

Cleansing the patient’s skin with surgical soap and an antiseptic and shaving the area if needed.

What may be required of the patient regarding skin cleansing before surgery?

The patient may be instructed to repeatedly cleanse the surgical area with bacteriostatic or antiseptic soap several days before the surgery.