19 Surgical Skills II: Intraoperative and Immediate Postoperative Period
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 19.1: Surgical Principles
- 1. Define the role of the surgical technologist during the intraoperative period
- 2. Discuss Halstead’s principles of surgery
- 3. Discuss different methods of hemostasis used during surgery
- 4. Demonstrate how surgical sponges are managed during surgery
Lesson 19.2: Sutures
- 5. Discuss the use of absorbable and nonabsorbable sutures
- 6. Demonstrate suture-handling techniques
Lesson 19.3: Wound Cleansing and Healing
- 7. Identify different types of wound drains
- 8. Identify commonly used wound dressing materials
- 9. Discuss postoperative wound complications
1.
Classroom Preparation
Lesson 19.1: Surgical Principles
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 1. Define the role of the surgical technologist during the intraoperative period
- 2. Discuss Halstead’s principles of surgery
- 3. Discuss different methods of hemostasis used during surgery
- 4. Demonstrate how surgical sponges are managed during surgery
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 19.1: Surgical Principles
STUDENT PREPARATION (1 hr)
| 1 | READ – Chapter Heading(s) • Introduction • Intraoperative Role of the Surgical Technologist • Skin Marking and the Incision Neutral Sharps Zone Extending the Incision Packing the Surgical Wound • Retraction Retraction Technique • Wound Irrigation • Management of the Sterile Field • The Management of Surgical Specimens Standards Cultural Considerations Preparation for Receiving Specimens Handling Specimens on the Field Preservatives, Containers, and Labeling Preparation for Transport to Pathology Documentation Tissue Biopsy Frozen Section Stones Amputated Limb Cells (Cytology) Products of Conception Forensic Specimens Medical Devices Cultures Body Fluids Muscle Biopsy Cord Blood, Umbilical Cord, and Placenta Radioactive Specimens Autologous Tissue for Implantation ANSWER – Textbook • Review Questions 6, 7, 8 ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 2 | READ – Chapter Heading(s) • Halstead’s Principles of Surgery ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 3 | READ – Chapter Heading(s) • Hemostasis During Surgery Methods of Hemostasis ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 4 | READ – Chapter Heading(s) • Management of Surgical Sponges During Surgery Raytec 4 x 4 Sponge Laparotomy Sponge Sponge Dissector Round String Sponge Flat Neurosurgical Sponges ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 19.1: Surgical Principles
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 1 | ST’S ROLE: SLIDES 4-10 | • Introduction • The Intraoperative Role of the Surgical Technologist • Skin Marking and the Incision Neutral Sharps Zone Extending the Incision Packing the Surgical Wound • Retraction Retraction Technique • Wound Irrigation • Management of the Sterile Field • The Management of Surgical Specimens Standards Cultural Considerations Preparation for Receiving Specimens Handling Specimens on the Field Preservatives, Containers, and Labeling Preparation for Transport to Pathology Documentation Tissue Biopsy Frozen Section Stones Amputated Limb Cells (Cytology) Products of Conception Forensic Specimens Medical Devices Cultures Body Fluids Muscle Biopsy Cord Blood, Umbilical Cord, and Placenta Radioactive Specimens Autologous Tissue for Implantation |
| 2 | HALSTEAD’S PRINCIPLES: SLIDE 11 | • Halstead’s Principles of Surgery |
| 3 | HEMOSTASIS: SLIDES 12-13 | • Hemostasis During Surgery Methods of Hemostasis |
| 4 | SURGICAL SPONGES: SLIDE 14 | • Management of Surgical Sponges During Surgery Raytec 4 x 4 Sponge Laparotomy Sponge Sponge Dissector Round String Sponge Flat Neurosurgical Sponges |
Learning Activities (choose one or more to equal 50 min)
| 1 | ANALYZE (30 min) • Split the class into groups and have them analyze these concepts: preventing injuries, wound irrigation, retraction, thermal and high-frequency coagulation, the pneumatic tourniquet, and autotransfusion. • Appropriate Settings: Traditional/online/flipped classroom DEMONSTRATE (50 min) • Demonstrate to the class the role of the surgical technologist at the end of surgery. Include breaking down sterile field, instruments, preparing for next case, and case cleanup. • Appropriate Settings: Traditional classroom DISCUSS (30 min) • Discuss as a class the role of the surgical technologist in wound management. • Break students into small groups and assign each group one of the specimen types discussed in the textbook. Have students discuss the proper handling of each type of specimen, as well as what type of information can be obtained from the specimen. Have students present their findings to the rest of the class. Appropriate Settings: Traditional/online/flipped classroom |
| 2 | DISCUSS (30 min) • Discuss as a class the elements of Halstead’s principles of surgery. Include the rationales for each element. • Appropriate Settings: Traditional/online/flipped classroom |
| 3 | DISCUSS (30 min) • Have students describe different methods of hemostasis and discuss when each is appropriate to use during surgery. Appropriate Settings: Traditional/online/flipped classroom |
| 4 | DEMONSTRATE (30 min) • Demonstrate to the students the different types of surgical sponges and what the uses are for each one. Appropriate Settings: Traditional classroom |
Critical Thinking Question
You have organized sutures on the Mayo stand based on your reading of the surgeon’s preference card. In the middle of the surgery, he asks for Dexon 2-0. You’re sure that the card said he wanted Maxon 2-0 and you do not have any Dexon 2-0 on the stand. You recall that these two sutures have similar properties and indications. What do you do?
Discussion Guidelines: Students might discuss their obligation to meet the patient’s needs first and figure out later what went wrong. Students might suggest telling the surgeon what is available on the stand and ask if it is satisfactory. It is possible that the surgeon misspoke (or was misheard) during his verbal request, in which case the correct suture is already there. It is also possible that the surgeon will be slightly miffed (regardless of who made the initial error), but will be willing to use the Maxon suture. If the surgeon needs a suture that is not in the sterile field, it must be requested from the circulator. Students might also discuss the need to review the card later to figure out what happened. If the fault was the surgeon’s (either he didn’t request the proper material or the card was illegible), the surgical technologist might want to verbally confirm the card with the surgeon before future operations.
Classroom Preparation
Lesson 19.2: Sutures
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 5. Discuss the use of absorbable and nonabsorbable sutures
- 6. Demonstrate suture-handling techniques
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 19.2: Sutures
STUDENT PREPARATION (1 hr)
| 5 | READ – Chapter Heading(s) • Sutures Modern Tissue Closure Technology Studying and Learning Sutures Physical Structure of Sutures Suture Size Characteristics of Sutures Handling Qualities Bioactivity Absorbability Selection of Suture • Surgical Needles Swaged (Atraumatic) Suture Eyed Needles Needle Shape and Size Needle Point • Suture Storage, Packaging, and Dispensing Packaging Presentation ANSWER – Textbook • Review Questions 1, 2, 3, 4 • Case Study 1 ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 6 | READ – Chapter Heading(s) • Suturing and Ligation Techniques Continuous Suture Locking Stitch Barbed Suture Subcuticular Suture Purse-String Suture Interrupted Suture Technique Retention Sutures Free Ties and Reels Suture Ligature Tie on a Passer Traction Sutures and Tags • Intraoperative Suture Management Suturing Instruments Passing Sutures Rapid-Sequence Suturing Threading Eyed Needles How to Cut Sutures Removing Embedded Sutures • Vessel Clips and Staples ANSWER – Textbook • Case Studies 2, 3 ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 19.2: Sutures
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 5 | SUTURES: SLIDES 16-21 | • Sutures Modern Tissue Closure Technology Studying and Learning Sutures Physical Structure of Sutures Suture Size Characteristics of Sutures Handling Qualities Bioactivity Absorbability Selection of Suture • Surgical Needles Swaged (Atraumatic) Suture Eyed Needles Needle Shape and Size Needle Point • Suture Storage, Packaging, and Dispensing Packaging Presentation |
| 6 | SUTURING TECHNIQUE: SLIDES 22-25 | • Suturing and Ligation Techniques Continuous Suture Locking Stitch Barbed Suture Subcuticular Suture Purse-String Suture Interrupted Suture Technique Retention Sutures Free Ties and Reels Suture Ligature Tie on a Passer Traction Sutures and Tags • Intraoperative Suture Management Suturing Instruments Passing Sutures Rapid-Sequence Suturing Threading Eyed Needles How to Cut Sutures Removing Embedded Sutures • Vessel Clips and Staples |
Learning Activities (choose one or more to equal 50 min)
| 5 | PRACTICE (50 min) • Lay out a number of suture types, along with photocopy enlargements of their packages, on a long table. (For safety during this exercise, remove needles from the sutures.) Encourage students to handle each of the sutures. As students view and handle the different suture types, they should review their corresponding flashcard. This will help them associate the written description with the look and feel of a particular suture material. • Appropriate Settings: Traditional classroom DISCUSS (20 min) • Discuss the structure and properties of sutures. Appropriate Settings: Traditional/online/flipped classroom |
| 6 | DEMONSTRATE (30 min) • Instructor demonstrates suture-passing techniques. • Appropriate Settings: Traditional classroom |
Critical Thinking Question
The use of swaged needles has greatly decreased the need for manual threading of free needles. What other advantages are there to using swaged needles? What safety problems may be associated with using swaged needles? How do you, as the scrubbed surgical technologist, help to minimize this problem?
Discussion Guidelines: Advantages are: they cause minimal tissue trauma (atraumatic), the suture strand at the eye does not strip and break, and some newer-type sutures can detach from the needle when needed and some are double-armed. Students might discuss that the availability of swaged needles increases the number of needles that are used, and as a result, the likelihood that a needle is retained in the patient. The surgical technologist works to decrease this likelihood by keeping the workspace as organized as possible, participating in counts, and passing needles on an “exchange” basis.
Classroom Preparation
Lesson 19.3: Wound Cleansing and Healing
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 7. Identify different types of wound drains
- 8. Identify commonly used wound dressing materials
- 9. Discuss postoperative wound complications
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 19.3: Wound Cleansing and Healing
STUDENT PREPARATION (1 hr)
| 7 | READ – Chapter Heading(s) • Wound Drainage Passive Drain Suction Drains Water-Sealed Drainage System Stoma Pouch ANSWER – Textbook • Review Questions 10, 11 ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 8 | READ – Chapter Heading(s) • Dressings Flat Dressing Rolled Dressing Packing Tape • Wound Closure and the Completion of Surgery Final Count Dressings Withdrawal of Anesthesia Postoperative Team Debriefing Patient Transfer Documentation and Signatures Disposition of the Specimen ANSWER – Textbook • Review Question 9 ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 9 | READ – Chapter Heading(s) • Wound Healing and Complications • Classification of Surgical Wounds • Process of Wound Healing Inflammatory Phase Proliferative Phase Remodeling Stage • Wound Complications Surgical Site Infection Seroma and Hematoma Dehiscence Evisceration Adhesions ANSWER – Textbook • Review Question 12 ANSWER – Workbook • Chapter 19 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 19.3: Wound Cleansing and Healing
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 7 | WOUND DRAINAGE: SLIDE 27 | • Wound Drainage Passive Drain Suction Drains Water-Sealed Drainage System Stoma Pouch |
| 8 | DRESSINGS: SLIDES 28-29 | • Dressings Flat Dressing Rolled Dressing Packing Tape • Wound Closure and the Completion of Surgery Final Count Dressings Withdrawal of Anesthesia Postoperative Team Debriefing Patient Transfer Documentation and Signatures Disposition of the Specimen |
| 9 | WOUND COMPLICATIONS: SLIDES 30-32 | • Wound Healing and Complications • Classification of Surgical Wounds • Process of Wound Healing Inflammatory Phase Proliferative Phase Remodeling Stage • Wound Complications Surgical Site Infection Seroma and Hematoma Dehiscence Evisceration Adhesions |
Learning Activities (choose one or more to equal 50 min)
| 7 | INVITE (50 min) • Invite a manufacturer’s representative to provide several examples of wound drains and dressing materials. Discuss the purpose of each and when it might be used. Appropriate Settings: Traditional classroom |
| 8 | PRACTICE (50 min) • Demonstrate the application of the different types of surgical wound dressings using a student volunteer to act as the “patient.” Under supervision, allow students (wearing surgical gloves) to practice applying skin closure dressings and barrier protection dressings on the arms of fellow students or a mannequin. (Students who know or suspect they have sensitivity to surgical tape or other dressings may elect not to have dressings applied to them.) • Appropriate Settings: Traditional classroom |
| 9 | DISCUSS (30 min) • Discuss as a class postoperative wound complications. • Appropriate Settings: Traditional/online/flipped classroom |
Critical Thinking Question
You are scrubbed in on a trauma case and the surgeon has spent several hours controlling bleeding and closing major abdominal wounds. The patient is now stable, and you expect the surgeon to turn his attention to a leg wound. Instead, he leaves the wound unsutured and asks for your help in packing it. Why would the surgeon decide not to close this wound?
Discussion Guidelines: Students might discuss the different types of wound healing and note that it is not always advantageous to suture a wound closed. In this case, the surgeon has judged that the wound has a high risk of developing (or maintaining) infection and is likely to heal more readily if it is left unsutured and protected with moist dressings.
Assessments
Chapter 19: Surgical Skills II: Intraoperative and Immediate Postoperative Period
ASSESSMENTS BY OBJECTIVE
| 1-9 | Workbook • Chapter 19 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 19 – Graded quizzes (Mastery Levels 1, 2, and 3) |
