ST 210 - The Surgical Patient

Credits: 2

     A.          Communicate in acceptable English and in terminology appropriate to the discipline.

                  1.    Understand and critically evaluate what is read.

                  2.    Write in a clear, organized, succinct, and effective manner.

                  3.    Demonstrate proper spelling, grammar, and sentence structure in formal writing.

                  4.    Use medical terminology accurately and appropriately.

     B.          Analyze data and discipline-based knowledge to formulate logical conclusions.

                  1.    Integrate and correlate concepts from different courses.

                  2.    Exhibit development of both inductive and deductive reasoning skills.

                  3.    Take a position on an issues and provide evidence or adequate rationale to support that position.

     C.          Work constructively within a group, demonstrating respect and consideration for others.

                  1.    Listen to, respect, and critically evaluate the ideas and opinions of others.

                  2.    Contribute to the product(s) of a study or work group, function within the guidelines established by the group, and accept responsibility
                          for one's own level of participation.

                  3.    Respect the perspectives, values, and choices of others.

     D.         Demonstrate the ability to apply conversion formulas and perform basic mathematical calculations.

 2.    Demonstrate understanding of the concepts of the continuity of care of the surgical patient and what is happening to the patient
        before, during, and after the operation, including the administrative or record-keeping aspects of surgical patient care.

     A.          Identify the components of a pre-operative check list for preparation of a surgical patient.

     B.          Explain the meaning, purpose and limitations of “informed consent.”

     C.          Differentiate various types of operative permits in terms of appropriate conditions and signatories.

     D.          Explain the use of other types of consents or records.

     E.          Define the two purposes of a shave prep.

     F.          Identify the areas to be shaved for various kinds of operations.

     G.         Discuss different authority’s opinions regarding the appropriate time, location and method for performing a “shave” prep or whether such a
                  prep is indicated at all.

     H.         Describe the proper attire for a patient entering the O.R. and explain the safety reasons for these rules.

     I.          Discuss the appropriate safeguarding of a patient’s personal possessions.

     J.          Explain the reasons for establishing baseline pre-operative vital signs.

     K.         Describe the purposes of pre-operative medications.

     L.          List the categories of drugs most commonly used as pre-operative medications.

     M.         Describe the proper safety measures to be taken while transporting a patient to the O.R., including special situations.

     N.         Describe the identification process of a patient entering the O.R. suite.

     O.         Identify the safety precautions involved in transferring a patient onto the O.R. table before surgery and onto a stretcher/gurney after
                  surgery.

     P.          Discuss the legal implications of operative record keeping.

     Q.         List the information elements commonly required for various kinds of O.R. records and forms.

     R.         Explain the purposes and uses of Incident Reports.

     S.          Define the circumstances that determine a Medical Examiner’s (Coroner’s) case, and recognize indications for such a case.

     T.          Describe the proper procedures for measuring intraoperative blood loss and urine output.

     U.         Discuss the proper methods for monitoring a patient receiving local anesthesia (in the absence of anesthesia personnel).

     V.          Describe the special procedural elements involved in intraoperative X-ray technique, bowel technique, cancer technique, and multiple
                  set-up technique.

 3.    Demonstrate knowledge of  incisional approaches for General Surgery procedures and the process of wound healing.

      A.          List the factors affecting the choice of the type of surgical incision.

     B.           For General Surgery incisions, describe the indications, uses, advantages and disadvantages for each.

     C.           Name the three stages of wound healing and describe the physiologic processes occurring during each one.

     D.           List factors that influence the rate of wound healing.

     E.           Differentiate healing by First, Second and Third Intentions and relate those to primary closure,  secondary union and delayed primary
                   closure.

     F.           List and define complications that may occur during wound healing.

4.    Demonstrate knowledge of different kinds of surgical specimens.

     A.          Define “Frozen Section” and explain why such a specimen may be requested.

     B.          Describe the proper methods for handling various types of surgical specimens:

                  1.    Frozen sections

                  2.    Permanent (paraffin) sections

                  3.    Cultures

                  4.    Bronchial washings or other fluids

                  5.    Cytology specimens

                  6.    Stones

                  7.    Foreign bodies

                  8.    Amputated limbs

                  9.    Legal evidence

                  10.  Tissue for banking/preservation

 5.    Demonstrate competence in preparing medications and solutions on the sterile field.

     A.          Describe the proper method for dispensing, identifying, and handling back-table medications and solutions.

     B.          Identify various types of syringes and their uses.

     C.          Explain the sizing (gauge) of hypodermic needles.

     D.          Calculate simple conversions for weights, measurements, and temperature.

 6.    Demonstrate knowledge of environmental risks to Operating Room personnel.

     A.          Compare Septic Case Technique with the use of Standard Precautions.

     B.          List and differentiate the types of hepatitis viruses and know how they are transmitted.

     C.          Discuss Hepatitis B and C viruses and the risks to Operating Room personnel.

     D.          Discuss the Human Immunodeficiency Virus and the risks to Operating Room personnel.

     E.          Discuss the risks of other microbial hazards for Operating Room personnel.

7.    Demonstrate familiarity with current theories concerning neoplastic growth, and with the uses of ionizing radiation as an alternative
       therapeutic modality or as an adjunct to surgery.

     A.          Differentiate neoplastic (tumor) growth from hypertrophy, hyperplasia and metaplasia.

     B.          List the essential differences between benign and malignant tumors.

     C.          Explain how neoplastic growths are named and classified.

     D.          Discuss the intrinsic factors and extrinsic factors that may contribute to the etiology of cancers.

     E.          Compare and contrast the three types of cancers: sarcomas, carcinomas and mixed tumors.

     F.           Define “grading” vs. the TNM method of “staging” malignancies.

     G.          Differentiate between “curative” and “palliative” therapy.

     H.          Compare surgery, radiation therapy, and chemotherapy as modalities for treating cancers.

     I.           Explain what ionizing radiation does to both normal and malignant tissue, including the dangers of underdosage and overdosage in
                  therapeutic use.

     J.          Review the electromagnetic spectrum, the elements of radioactive disintegration, and the concept of half-life.

     K.          Define and characterize radionuclides (radioisotopes) and discuss their uses.

     L.          Identify the sources, attributes, and uses of external radiation methods.

     M.         Identify the uses and methods of administration of internal radiation sources.

     N.          Compare the half-lives of commonly used radioactive elements and relate those to therapeutic dosages.

     O.         List the general safety rules for handling radioactive materials; describe radiation hazards to personnel and proper monitoring precautions.

     P.          Discuss the concept of stereotactic radiosurgery (“gamma knife”).

     Q.         Identify the characteristics of irradiated tissue and their relevance to subsequent surgical intervention.

 8.    Be conversant in the concepts and terminology of legal, moral and ethical responsibilities toward patients.    

     A.          Define various legal concepts as they apply to the O.R. situation.

     B.          List ways that the Standard of Care may be determined in a court of law.

     C.          Discuss how the principles of legal responsibility apply to a student.

     D.          Give examples of common acts of negligence in an O.R. setting.

     E.          Discuss moral and ethical responsibilities and obligations, as opposed to legal precepts.

  9.    Recognize the special needs of pediatric and geriatric patients.

     A.          Discuss psychological concerns in different age groups of Pediatric patients facing surgery.

     B.          List and describe the special needs of infants and young children undergoing surgery, in terms of both anatomical and physiological
                   considerations.

     C.          Discuss the physiologic changes associated with aging and identify the special needs of a geriatric patient undergoing surgery.

10.    Be familiar with the different conditions involved in ambulatory surgery.

     A.          Discuss the advantages of Ambulatory/Out-Patient surgery and the types of procedures for which it may be indicated or desirable.

     B.          List the four major types of settings for ambulatory surgery and their relative merits and disadvantages.

     C.          Describe the differences in pre-operative, intra-operative and post-operative routines for ambulatory surgery patients.

 11. Demonstrate knowledge of the concepts of operative care of orthopedic patients.

     A.          Define terminology associated with bone fractures and their treatment, and with bone healing.

     B.          Define the various uses of casts, including types of cylinder casts, spica casts, and splints.

     C.          Define different types of traction and differentiate traction from an external fixation device.

     D.          Discuss the specific indications for internal fixation and list the various general methods, giving examples of each.

     E.          List factors affecting the healing of fractures.

     F.           Discuss the problem of non-union and the use of bone grafts, electrical stimulation, and other treatment methodologies.

     G.          Describe the proper method of preparing plaster for cast application.

     H.          Compare fiberglass casting materials with plaster casts.