22 General Surgery
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 22.1: The Abdominal Wall
- 1. Identify the anatomical regions and structures of the abdominal wall
- 2. Discuss specific elements of case planning for abdominal wall hernias, including instruments and repair materials
Lesson 22.2: The Gastrointestinal System
- 3. Discuss specific elements of case planning for gastrointestinal surgery
- 4. Discuss the purpose and procedure of isolation technique
Lesson 22.3: General Surgery
- 5. Discuss specific elements of case planning for general surgery procedures
Classroom Preparation
Lesson 22.1: The Abdominal Wall
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 1. Identify the anatomical regions and structures of the abdominal wall
- 2. Discuss specific elements of case planning for abdominal wall hernias, including instruments and repair materials
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 22.1: The Abdominal Wall
STUDENT PREPARATION (1 hr)
| 1 | READ – Chapter Heading(s) • Introduction • Anatomy Abdominal Wall Tissue Layers Inguinal Region Abdominal Incisions ANSWER – Textbook • Review Questions Section I: 1, 2, 3 ANSWER – Workbook • Chapter 22 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 2 | READ – Chapter Heading(s) • Anatomy General Surgery Instruments • Procedures of the Abdominal Wall Hernia Repair Case Planning Open Repair of an Indirect Inguinal Hernia Laparoscopic Repair of a Direct Inguinal Hernia (TAPP Approach) Robotic Repair of an Indirect Inguinal Hernia Open Repair of Incisional Hernia Umbilical Hernia Repair (Open) Repair of Umbilical Hernia (Laparoscopic) ANSWER – Textbook • Review Questions Section I: 4, 5, 6 ANSWER – Workbook • Chapter 22 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 22.1: The Abdominal Wall
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 1 | ABDOMINAL WALL ANATOMY: SLIDES 4-6 | • Introduction • Anatomy Abdominal Wall Tissue Layers Inguinal Region Abdominal Incisions |
| 2 | ABDOMINAL WALL SURGERY: SLIDES 7-9 | • Anatomy General Surgery Instruments • Procedures of the Abdominal Wall Hernia Repair Case Planning Open Repair of an Indirect Inguinal Hernia Laparoscopic Repair of a Direct Inguinal Hernia (TAPP Approach) Robotic Repair of an Indirect Inguinal Hernia Open Repair of Incisional Hernia Umbilical Hernia Repair (Open) Repair of Umbilical Hernia (Laparoscopic) |
Learning Activities (choose one or more to equal 50 min)
| 1 | DISCUSS (30 min) • Ask students to name the four quadrants of the abdomen and the organs associated with each quadrant. In addition, have the students identify the nine regions of the abdomen. • Review Table 22.2 in class. Have students name the organs that can be accessed by each incision. Ask students to name each layer entered when performing specific incisions. • Appropriate Settings: Traditional/online/flipped classroom DEMONSTRATE (50 min) • Break the class into small groups, giving each a blank transparency and marker. Using Figure 22.5, copy the inguinal anatomy and label with terms from textbook. This activity can also be used for the other types of hernia. • Appropriate Settings: Traditional classroom |
| 2 | DISCUSS (20 min) • Discuss as a class the basic pathology related to abdominal wall hernias. • Appropriate Settings: Traditional/online/flipped classroom DEMONSTRATE (50 min) • Draw a large rectangle on the board to depict a Mayo stand. Have the class populate the tray with instruments used for an abdominal hernia repair. Allow the class to use general terms such as suture rather than such terms as 3-0 silk if they have not studied sutures yet. • Demonstrate to the students specific elements of case planning for abdominal wall hernias. Include setting up the room, instruments, and special equipment. • Appropriate Settings: Traditional classroom |
Critical Thinking Question
Why does a hernia repair necessitate an instrument count? Do all hernia repairs necessitate a count?
Discussion Guidelines: Whenever the peritoneum is entered, an instrument count is required. Instruments should be counted before all hernia repairs because of the possibility that the peritoneum could be accessed.
How and why might the depth of abdominal wall tissue layers differ from one patient to another?
Discussion Guidelines: Obese patients will have a heavy subcutaneous fat layer and might have a thinner layer of muscle tissue. Elderly or emaciated patients will have thinner layers of fat and musculature. Toned, physically fit patients will have heavy muscle layers.
Classroom Preparation
Lesson 22.2: The Gastrointestinal System
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 3. Discuss specific elements of case planning for gastrointestinal surgery
- 4. Discuss the purpose and procedure of isolation technique
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 22.2: The Gastrointestinal System
STUDENT PREPARATION (1 hr)
| 3 | READ – Chapter Heading(s) • Section II: Gastrointestinal Surgery – Surgical Anatomy Esophagus and Stomach Small Intestine Large Intestine (Colon) Rectum and Anus • Diagnostic Procedures Case Planning Instruments Equipment and Supplies Tissue Approximation and Hemostasis • Diagnostic and Procedural Endoscopy • Esophagoduodenoscopy • Colonoscopy • Sigmoidoscopy • Surgical Procedures Laparotomy Laparoscopy Gastrectomy, Billroth I and II (Open) Laparoscopic Band Gastroplasty Roux-en-Y Gastric Bypass (Laparoscopic) Nissen Fundoplication (Laparoscopic) Segmental Resection of the Small Intestine (Open) End Ileostomy Right Hemicolectomy (Open) Robotic-Assisted Low Anterior Resection (LAR) Appendectomy (Laparoscopic) Excisional Hemorrhoidectomy Surgical Treatment for Anal Fistula ANSWER – Textbook • Review Questions Section II: 2, 3, 4, 5, 6 ANSWER – Workbook • Chapter 22 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 4 | READ – Chapter Heading(s) • Surgical Techniques in Gastrointestinal Procedures Isolation Technique Single Setup Double Setup ANSWER – Textbook • Review Question Section II: 1 ANSWER – Workbook • Chapter 22 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 22.2: The Gastrointestinal System
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 3 | GASTROINTESTINAL SURGERY: SLIDES 11-16 | • Section II: Gastrointestinal Surgery – Surgical Anatomy Esophagus and Stomach Small Intestine Large Intestine (Colon) Rectum and Anus • Diagnostic Procedures Case Planning Instruments Equipment and Supplies Tissue Approximation and Hemostasis • Diagnostic and Procedural Endoscopy • Esophagoduodenoscopy • Colonoscopy • Sigmoidoscopy • Surgical Procedures Laparotomy Laparoscopy Gastrectomy, Billroth I and II (Open) Laparoscopic Band Gastroplasty Roux-en-Y Gastric Bypass (Laparoscopic) Nissen Fundoplication (Laparoscopic) Segmental Resection of the Small Intestine (Open) End Ileostomy Right Hemicolectomy (Open) Robotic-Assisted Low Anterior Resection (LAR) Appendectomy (Laparoscopic) Excisional Hemorrhoidectomy Surgical Treatment for Anal Fistula |
| 4 | ISOLATION TECHNIQUE: SLIDE 17 | • Surgical Techniques in Gastrointestinal Procedures Isolation Technique Single Setup Double Setup |
Learning Activities (choose one or more to equal 50 min)
| 3 | DISCUSS (30 min) • Discuss with the class common diagnostic procedures of the gastrointestinal system. • Discuss as a class the basic pathology related to gastrointestinal surgery. Appropriate Settings: Traditional/online/flipped classroom DEMONSTRATE (50 min) • Demonstrate to the student’s specific elements of case planning for gastrointestinal surgery. Include setting up the room, instruments, and special equipment. Appropriate Settings: Traditional classroom PRACTICE (50 min) • Have students practice assembling and disassembling end-to-end anastomosis (EEA) stapler and other GI stapling devices. Appropriate Settings: Traditional classroom |
| 4 | DISCUSS (30 min) • Discuss the purpose of isolation technique when performing surgery on the intestinal tract. What is the difference between the single setup and double setup? Appropriate Settings: Traditional/online/flipped classroom |
Critical Thinking Question
What are some special concerns when caring for patients undergoing bariatric procedures, such as vertical gastric banding and Roux-en-Y gastric bypass? How might you feel if you were undergoing this procedure?
Discussion Guidelines: Students should be reminded to be sensitive to these patients’ feelings. Be sure that the operating room (OR) has been properly prepared to receive the bariatric patient. Plan ahead and be certain that the bed will bear the patient’s body weight. Anticipate and plan for transferring the patient from cart to bed and have enough help to easily transport the patient to the OR. Calling for extra help in the patient’s presence or visibly straining to push the bed can increase the patient’s anxiety. Refrain from negative comments or jokes during the procedure at the patient’s expense—even if the patient is under anesthesia. We never know when patients might experience recall.
Classroom Preparation
Lesson 22.3: General Surgery
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 5. Discuss specific elements of case planning for general surgery procedures
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 22.3: General Surgery
STUDENT PREPARATION (1 hr)
| 5 | READ – Chapter Heading(s) • Section III: Surgery of the Biliary System, Liver, Pancreas, and Spleen—Surgical Anatomy Liver Biliary System Pancreas Spleen • Diagnostic Procedures • Case Planning Instruments Special Equipment and Supplies • Surgical Procedures Cholecystectomy (Laparoscopic) Cholecystectomy (Open) Splenectomy Splenectomy (Laparoscopic) Pancreaticoduodenectomy (Whipple Procedure) Segmental Resection of the Liver (Open) • Section IV: Breast Surgery—Surgical Anatomy • Breast Cancer • Case Planning Psychological Considerations Position and Draping Instruments and Supplies • Surgical Procedures Wire Localization and Breast Biopsy Sentinel Lymph Node Biopsy Breast-Conserving Surgery for a Mass (Lumpectomy, Segmental Mastectomy) with Axillary Dissection Modified Radical Mastectomy • Section V: The Thyroid and Parathyroid Glands • Thyroid Gland Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) Related Procedure: Parathyroidectomy Thyroidectomy (Open) ANSWER – Textbook • Review Questions Section III: 1-6; Section IV: 1-8; Section V: 1-3 ANSWER – Workbook • Chapter 22 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 22.3: General Surgery
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 5 | GENERAL SURGERY: SLIDES 19-25 | • Section III: Surgery of the Biliary System, Liver, Pancreas, and Spleen—Surgical Anatomy Liver Biliary System Pancreas Spleen • Diagnostic Procedures • Case Planning Instruments Special Equipment and Supplies • Surgical Procedures Cholecystectomy (Laparoscopic) Cholecystectomy (Open) Splenectomy Splenectomy (Laparoscopic) Pancreaticoduodenectomy (Whipple Procedure) Segmental Resection of the Liver (Open) • Section IV: Breast Surgery—Surgical Anatomy • Breast Cancer • Case Planning Psychological Considerations Position and Draping Instruments and Supplies • Surgical Procedures Wire Localization and Breast Biopsy Sentinel Lymph Node Biopsy Breast-Conserving Surgery for a Mass (Lumpectomy, Segmental Mastectomy) with Axillary Dissection Modified Radical Mastectomy • Section V: The Thyroid and Parathyroid Glands • Thyroid Gland Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) Related Procedure: Parathyroidectomy Thyroidectomy (Open) |
Learning Activities (choose one or more to equal 50 min)
| 5 | DISCUSS (30 min) • Lead a class discussion about emergency surgery. Ask what other types of instrument sets might be needed. Which should be open and set up and which might just be ready in the room? Discuss worst-case scenarios and the scrub’s role. The students should mention losing needles, uncontrolled bleeding, calling for other surgeons to scrub in for difficult dissections, etc. • Ask the class how breast tissue might differ from other tissues encountered earlier in this chapter. How does this affect instrumentation? Students should note the increased amount of adipose tissue. Explain that instruments are more slippery when exposed to adipose tissue, and students should take care to not drop instruments or be injured by sharps. • On the board, diagram the steps for conversion from a biopsy to a radical procedure. Have the class call out the steps as the instructor diagrams them. • Think about the other procedures or exams that the patient has experienced before entering the OR. How might the patient be feeling at the point of surgery? It’s important to realize that no matter how much the patient has previously had the breast exposed, one may never become accustomed to it. Be sure to provide plenty of privacy and coverage until exposure is absolutely necessary. Also, the patient needs emotional support – this requires listening to the patient and acknowledging feelings. Appropriate Settings: Traditional/online/flipped classroom DEMONSTRATE (50 min) • In the classroom, prepare a back table for a laparotomy and splenectomy. Have the class select no more than five objects (combination of instruments and supplies). Review answers aloud and lead a class discussion on the rationale for each response. • Demonstrate to the student’s specific elements of case planning for liver, biliary system, pancreas, and spleen. Include setting up the room, instruments, and special equipment. • Pass selected breast surgery–specific instruments around for the class to call out name and function. Be sure to use proper handling and passing techniques. • Demonstrate to the student specific elements of case planning for breast surgery. Include setting up the room, instruments, and special equipment. Appropriate Settings: Traditional classroom PRACTICE (50 min) • Have T-tubes and tissue forceps available for class members to handle. Discuss how the tube is inserted to decompress the common bile duct and how it allows bile to be collected outside the body as the wound heals. Have the class generate ideas for how bile collecting inside the abdomen might adversely affect the patient’s outcome? Appropriate Settings: Traditional classroom |
Critical Thinking Question
You have just been notified that the hemicolectomy (for which you are preparing the OR right now) will be delayed. Instead, you are receiving an emergent exploratory laparotomy and possible splenectomy. Before the words leave your circulator’s mouth, the patient is in the OR, along with the surgeon. The patient is obviously in critical condition with several intravenous (IV) medications and blood infusing. As you set up the instrumentation, you recall the four steps required to stop bleeding in acute hemorrhage. What are they? If you had time to grab only enough instruments or supplies to fit in both of your hands, which items would they be?
Discussion Guidelines: The four steps are access, visualization, lighting, and clamps. Answers should relate to these concepts. Possible responses for the items to start the case might include a knife (access), large hand-held retractor such as Deaver or Richardson (access and visualization), sterile light handle (lighting), and large hemostatic clamp (clamps).
When a procedure is scheduled as an excisional biopsy with possible mastectomy, how many setups are used? Defend your answer.
Discussion Guidelines: Two setups are required so that cancerous cells from the biopsy specimen do not contaminate the mastectomy procedure.
Assessments
Chapter 22: General Surgery
ASSESSMENTS BY OBJECTIVE
| 1-5 | Workbook • Chapter 22 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 22 – Graded quizzes (Mastery Levels 1, 2, and 3) |
