18 Surgical Skills I: Planning a Case, Opening, and Start of Surgery

18 Surgical Skills I: Planning a Case, Opening, and Start of Surgery

CHAPTER LESSON PLANS & OBJECTIVES

Lesson 18.1: Surgical Case Planning

1. List and define common terms used in surgical technique
2. Discuss the elements of a case plan
3. Explain surgical objectives and how they can be grouped into types
4. Discuss the purpose of preoperative case preparation

Lesson 18.2: Surgical Field Management

5. Describe the correct procedure for performing a count
6. Discuss the guidelines for preventing lost and retained items

Classroom Preparation

Lesson 18.1: Surgical Case Planning

INSTRUCTOR PREPARATION

Textbook Objectives Covered

1. List and define common terms used in surgical technique
2. Discuss the elements of a case plan
3. Explain surgical objectives and how they can be grouped into types
4. Discuss the purpose of preoperative case preparation

National Standards Covered

• See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.

Classroom Preparation

Lesson 18.1: Surgical Case Planning

STUDENT PREPARATION (1 hr)

1	READ – Chapter Heading(s) • Introduction • Surgical Terms ANSWER – Workbook • Chapter 18 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions
2	READ – Chapter Heading(s) • Surgical Case Plan Elements of a Case Plan ANSWER – Workbook • Chapter 18 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions
3	READ – Chapter Heading(s) • Types of Surgery by Objective Understanding the Name of the Surgical Procedure Diagnostic Procedure Repair Removal Reconstruction • Implant Surgery Planning for Implant Surgery Synthetic Implants Implant Materials • Tissue Grafts Skin Graft Porcine Dermis Amniotic Membrane and Umbilical Cord Engineered Skin Substitutes Bone Graft ANSWER – Workbook • Chapter 18 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions
4	READ – Chapter Heading(s) • Preoperative Case Preparation Surgical Schedule Supplies and Instruments Surgeon’s Preference Card • Nonsterile Room Preparation • Opening a Case Guidelines – Opening a Case Receiving the Patient • Sterile Setup Order of Use Suture Preparation Organizing the Instruments Mayo Setup Solutions and Drugs Completing the Setup ANSWER – Textbook • Review Questions 1, 2, 3 • Case Study 1 ANSWER – Workbook • Chapter 18 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions

50-Minute Lesson Plan

Lesson 18.1: Surgical Case Planning

LECTURE OUTLINE (50 min)

	POWERPOINT SLIDES	CHAPTER HEADING(S)
1	TERMINOLOGY: SLIDES 4-5	• Introduction • Surgical Terms
2	CASE PLAN: SLIDES 6-7	• Surgical Case Plan Elements of a Case Plan
3	SURGICAL OBJECTIVES: SLIDE 8	• Types of Surgery by Objective Understanding the Name of the Surgical Procedure Diagnostic Procedure Repair Removal Reconstruction • Implant Surgery Planning for Implant Surgery Synthetic Implants Implant Materials • Tissue Grafts Skin Graft Porcine Dermis Amniotic Membrane and Umbilical Cord Engineered Skin Substitutes Bone Graft
4	PREOPERATIVE CASE PREPARATION: SLIDES 9-15	• Preoperative Case Preparation Surgical Schedule Supplies and Instruments Surgeon’s Preference Card • Nonsterile Room Preparation • Opening a Case Guidelines – Opening a Case Receiving the Patient • Sterile Setup Order of Use Suture Preparation Organizing the Instruments Mayo Setup Solutions and Drugs Completing the Setup

Learning Activities (choose one or more to equal 50 min)

1	ANALYZE (30 min) • Have the students divide into groups and analyze the terms any surgical technologist should know. Have each group come up with an example of a real-world application in the field. Appropriate Settings: Traditional/online/flipped classroom
2	DISCUSS (30 min) • Discuss as a class the elements of case planning. Include preoperative, intraoperative, and postoperative. • Appropriate Settings: Traditional/online/flipped classroom
3	DISCUSS (30 min) • Divide students into small groups and assign each group one of the five major types of surgery. Have each group summarize the following aspects of its assigned surgery type and present its summary to the class. • What is meant by that type of surgery? • What is a specific example of that type of surgery? • What is one unique challenge or risk of that type of surgery? (Example: For a transplant surgery, the tissue or organ being transferred must be available at the correct time during the surgery.). Appropriate Settings: Traditional/online/flipped classroom
4	DISCUSS (30 min) • Discuss as a class preoperative case preparation. Remember to have the students include what the surgical technologist is responsible for preoperatively in this discussion. Appropriate Settings: Traditional/online/flipped classroom

Critical Thinking Question

You are working on opening a case to be performed in 20 minutes when you learn that an accident victim with multiple lacerations will be brought into the operating room (OR) in 5 minutes. What do you do?

Discussion Guidelines: Students might discuss the concepts of priority setup versus secondary preparation. While establishing and maintaining the sterile field, the most important instruments should be quickly identified and made available for the case to start. With guidance and experience, the surgical technologist will learn which equipment is typically required for stabilizing a patient (e.g., controlling bleeding). Other instruments and supplies can be obtained as the case progresses.

Classroom Preparation

Lesson 18.2: Surgical Field Management

INSTRUCTOR PREPARATION

Textbook Objectives Covered

5. Describe the correct procedure for performing a count
6. Discuss the guidelines for preventing lost and retained items

National Standards Covered

• See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.

Classroom Preparation

Lesson 18.2: Surgical Field Management

STUDENT PREPARATION (1 hr)

READ – Chapter Heading(s) • Surgical Count Responsibility for the Count When to Perform the Count Procedure for the Count Incorrect Count: Packaged Items Counting Systems Waived Counts During a Surgical Emergency How to Document the Surgical Count
ANSWER – Textbook • Review Questions 4, 5, 6
ANSWER – Workbook • Chapter 18
PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions

READ – Chapter Heading(s) • Surgical Count Lost and Retained Items How to Search for a Lost Item Preventing Retained Items • Start of Surgery • Universal Protocol (Timeout) Site Marking
ANSWER – Textbook • Case Study 2
ANSWER – Workbook • Chapter 18
PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions

50-Minute Lesson Plan

Lesson 18.2: Surgical Field Management

LECTURE OUTLINE (50 min)

	POWERPOINT SLIDES	CHAPTER HEADING(S)
5	PERFORMING A COUNT: SLIDES 17-18	• Surgical Count Responsibility for the Count When to Perform the Count Procedure for the Count Incorrect Count: Packaged Items Counting Systems Waived Counts During a Surgical Emergency How to Document the Surgical Count
6	PREVENTING LOST AND RETAINED ITEMS: SLIDES 19-22	• Surgical Count Lost and Retained Items How to Search for a Lost Item Preventing Retained Items • Start of Surgery • Universal Protocol (Timeout) Site Marking

Learning Activities (choose one or more to equal 50 min)

PRACTICE (50 min) • Choose one student to help you demonstrate the proper procedure for a sponge count. Have the student scrub in and repeat the demonstrated setup with the instructor doing the sponge count. Students who are not scrubbed should back up the instructor by doing their own count. Small groups of students should practice the sponge count procedure under supervision of the instructor and fellow students. • Instructor and students should demonstrate the passing of a number of different surgical instruments. Put the students in a circle around the OR table and send around an instrument so students can practice side-to-side or cross-table passing. Small groups of students (wearing surgical gloves) practice passing of surgical instruments under supervision of the instructor. Appropriate Settings: Traditional/online/flipped classroom

DISCUSS (30 min) • Discuss as a class the rationale for development of the surgical Universal Protocol. What are the steps of the protocol, and when is it performed? Who leads the process and what is its purpose? • Appropriate Settings: Traditional/online/flipped classroom

Critical Thinking Question

Should the surgical technologist pass the knife to the surgeon before TIMEOUT has been performed?

Discussion Guidelines: Explain that TIMEOUT is documented and that it is the responsibility of all surgical team members to participate. This pause is to prevent serious error or injury to the patient before the surgical incision. Passing the knife to the surgeon allows the surgeon to start the skin incision without performing TIMEOUT.

Assessments

Chapter 18: Surgical Skills I: Planning a Case, Opening, and Start of Surgery

ASSESSMENTS BY OBJECTIVE

1-6	Workbook • Chapter 18 Evolve Instructor Resources • Test Bank Create a quiz using ExamView; sort by objective. Evolve Student Resources • Mock Certification Exam • Review Questions
All	Elsevier Adaptive Quizzing • Chapter 18 – Graded quizzes (Mastery Levels 1, 2, and 3)

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