Asheville-Buncombe Technical Community College

ASHEVILLE-BUNCOMBE TECHNICAL COMMUNITY COLLEGE Course Outline

Course: SUR 111 Periop Patient Care

Credit Hours: (5-6-0-7) 7 Credit Hours Lecture Meeting Times Wednesday and Thursday 9:00am-11:20am LAB Times Wednesday OR Thursday 12:30pm-6:30pm Course Description: This course provides the surgical technology student the theoretical knowledge required to function in the pre-operative, intra-operative, and post-operative role. Topics include asepsis, disinfection and sterilization, physical environment, instrumentation, equipment, peri-operative patient care, and peri-operative case management. Upon completion, students should be able to apply the principles and practice of the peri-operative team member to the operative environment.

Course Notation: This course is a web-enhanced course. The student will need access to Moodle to retrieve class work, homework, Power-point lectures, and test material. Additionally, students are required to communicate with instructors exclusively via their ABTECH student e-mail accounts. Communication via e-mail is routine and frequent. The student is responsible for all material and communications delivered via e-mail.

Instructors: Robin Keith and Daniel Stokoe Phone numbers: Office: 828-398-7892 – Robin 828-398-7618 - Daniel Home: Robin 301-2353 (call or text before 8pm) Daniel 279-4800 (call or text before 8pm) e-mail: [email protected] [email protected]

OFFICE HOURS: Mondays 10am-1pm & Tuesdays 10am-12pm PREREQUISITES: Enrollment in the Surgical Technology Program

COREQUISITIES: SUR 110 & BIO 163 REQUIRED TEXTS:

ABTCC Surgical Technology Handbook

AST. (2008). Surgical Technology for the Surgical Technologist: A Positive Care Approach, (3rd ed.). Clifton Park, NY: Delmar.

AST. (2008). Study Guide to Accompany Surgical Technology for the Surgical Technologist: A Positive Care Approach, (3rd ed.). Clifton Park, NY: Delmar.

Gylys & Masters. (2011). Medical Terminology Express. Philadelphia, PA: F. A. Davis.

Pieknik, R. (2006). Suture and Surgical Hemostasis: A Pocket Guide. Philadelphia, PA: W.B. Saunders.

Rutherford, C. (2012). Differentiating Surgical Instruments, (2nd ed.). Philadelphia, PA: F. A. Davis Company.

Snyder & Keegan. (2012). Pharmacology for the Surgical Technologist, (3rd ed.). St. Louis, MO: Saunders Elsevier.

OPTIONAL TEXTS:

AORN. (2012). AORN Standards, Recommended Practices, and Guidelines. Denver, CO: AORN.

*Goldman, M. (2009). Pocket Guide to the Operating Room, (3rd ed.). Philadelphia, PA: F.A. Davis. (Required for spring and summer clinicals)

Rothrock, J. (2011). Alexander’s Care of the Patient in Surgery, 14 th ed.). St. Louis, MO: Mosby.

Prepared by: Daniel Stokoe & Robin Keith Revision Date: January 9, 2018

I verify that this course outline is accurate, complete and timely

_Robin B. Keith Chairperson

Dolly Horton Dean

2 COURSE POLICIES:

The instructor reserves the right to alter course content, presentation, or sequence. There will be no make-up tests or quizzes. Homework is due the week after it is assigned unless otherwise indicated on the syllabus. Late or incomplete homework will not be accepted and the student will receive a zero homework grade on that day. Homework is due at the beginning of class every Wed/Thur morning (depending on the day it was assigned). Failure to arrive on time will result in you not being able to turn in homework and paperwork on time or take the daily test; therefore, you will receive a grade of zero on ALL paperwork that was due. You are expected to arrive to class prepared and ready to start at 0900. Arriving before 0900 will ensure that you are able to be prepared. The classroom door will be shut and locked at 0900. The classroom will be accessible to you after the first class break.

Open Grade Book Policy: The Surgical Technology Program Faculty maintains an “open grade book” policy as well as an open door policy and will make every effort to keep students aware of their progress throughout the semester. If you at any time have a question about any grading procedure, status of your grade, or overall progress throughout the curriculum, please do not hesitate to ask!

Academic Dishonesty You may not deceive any official of the college by cheating on any assignment, exam, or paper. This includes plagiarism, which is the intentional theft or unacknowledged use of another’s words or ideas. Plagiarism includes (but is not limited to) paraphrasing or summarizing another’s words or works without proper acknowledgement, using direct quotes of material without proper acknowledgement, or purchasing or using a paper or presentation written or produced by another. The faculty at A-B Tech may also consider presenting as original work a paper written for one class to satisfy a requirement in another class to be academic dishonesty.

Approved by the Academic Affairs Committee on November 18, 2003

Disabilities Any student with a documented disability needing academic adjustments or accommodations is requested to speak with the coordinator of Disability Services in the Bailey building, Judith Harris (828-398-7141 or e-mail [email protected] ).

3 CLASSROOM ATTENDANCE POLICY

The Program Faculty believes that anytime a student is not in attendance at a didactic class, laboratory session, or clinical rotation, he or she is not able to receive the full benefits of a presentation or experience even if competencies are eventually met. It is also believed that regular and punctual attendance is expected of all students for them to achieve their potential in the surgical technology program and to develop desirable personal traits necessary to obtain employment in any Allied Health profession. These traits are among the first looked for by prospective employers. In fact, the student should be reminded that every time they put on their uniform and go for clinical instruction they may be completing part of an informal job interview whether they know it or not. For these reasons, fulltime attendance is expected in all didactic classes, laboratories, and clinical rotations.

1) Proper Callin Procedure

The student is responsible for contacting the program faculty regarding absences prior to the scheduled class time. Faculty offices are equipped with voice mail. The extension numbers are listed in this syllabus. When calling in, please leave your name, the time you called, the reason for your absence, and when you expect to return to class. If a phone call to the instructor's office should go unanswered, please call the Allied Health secretary at ext. 281 and leave a message. Her usual office hours are 8:30 AM-12 noon and 1:00-4:30 PM. Messages must not be sent through other people unless extenuating circumstances prevail. This is our attempt at beginning your acceptance of responsibility and accountability for your actions as a health care professional.

2) To receive course credit, a student should attend a minimum of 90 percent of the contact hours of the class. Upon accumulating absences exceeding 10 percent of the course contact hours, the student may be dropped from the class with a grade of “U” at the discretion of the instructor. Being tardy for class is a serious interruption of instructional time. It is not tolerated in this program. A tardy is defined as arriving late for class (any minutes), leaving early (any minutes,) or being away from class without permission during class hours. It is departmental and college policy that three tardies is the equivalent of one full day’s absence from class or clinic. For every third tardy, the student will have one full day’s absence counted for the course. These accumulated absences due to tardiness will count toward the 10% for that course. Students will NOT be admitted to class in the event of tardiness. The classroom door will be locked at the scheduled start of class. Tests will not be made up if missed due to tardiness. Homework will not be accepted due to tardiness. The student may enter the class at the first break, if they are present when that time comes.

3) The student is also responsible for adhering to the ABTCC Guidelines for Classroom Conduct. See the most current version of the ABTCC Student Events Calendar and Handbook.

PROLONGED ILLNESS

Students must notify the appropriate classroom or clinical instructor each day of an absence until it is established exactly how long the student will be out. Any student who misses more than three consecutive school days of class and/or clinic must obtain proper documentation for the missed time before they will be allowed to return to classes or clinic.

4 HOLIDAYS AND VACATIONS

Surgical Technology students are committed to one year of fulltime study. Within this time, students are eligible for holidays recognized by the College and vacation time during semester breaks. The student should consult the academic calendar that is published in the College Catalog and Student Calendar for the dates of recognized holidays and semester breaks. The student is reminded that up to three inclement weather days may made up at the end of fall or spring semester and semester breaks should be planned accordingly. APPOINTMENTS

Medical, dental, and other appointments should not be scheduled during didactic and clinical times. Appointments scheduled during these times will create a tardy or unexcused absence unless extenuating circumstances prevail.

EVALUATION CRITERIA

DIDACTIC LAB

Portfolio 10% Skill Assessments (3 attempts) Pass/Fail Homework*/Quizzes*/Tests*/Midterm* 50% Clinical Practicums (2 attempts) Pass/Fail Final (Comprehensive) 40% Lab Final Identification (2 attempts) Pass/Fail

TOTAL 100% * All testing for this class will be conducted in Balsam, Room TBD. Tests will be every Wednesday from 0900-0950. *All tests will have a time limit of 50 minutes. All tests are comprehensive. * Please report to Balsam, NOT Rhododendron, by 0900 each Wednesday to be eligible to take the daily exam. * Please refer to the class rules found in the SUR 110 PowerPoint Lecture #1. * All Clinical Education modules MUST be completed before you can go on a fieldtrip to that clinical site. Refer to your lab schedule for fieldtrip information. *Always keep all returned homework and papers for future use in this program! Throw nothing away!!!

(ALERT: We will have to do our VA field trip all in one day. You will need to make arrangements to attend lab both Wednesday and Thursday 10/03 and 10/04. To be fair to all, Wednesday Lab will be expected to attend the lab on Thursday 10/04. Thursday lab will be expected to attend the lab on Wednesday 10/03. Our visit with the VAMC is something we have to work around. Should you not attend, you will not be eligible to perform clinical there at all. Please make arrangements to be available for lab on both days. I apologize for any inconvenience this may cause. The date we will go to the VAMC is October 3rd. We will conduct lab skills and start clinical practicums on October 4th.)

GRADES

90-100 =A 5

80-89 = B 70- 79 = C 60- 69 = D

BELOW 60 =F

NOTE:  Skill Assessments: Three attempts will be allowed to correctly perform skill assessments. It is the student’s responsibility to be in attendance for all lab sessions. If for some reason a student cannot attend lab, it is the student’s responsibility to obtain assistance from a fellow classmate. It is the student’s responsibility to demonstrate the attained skill(s) on a day that is conducive to the lab and faculty’s schedule.  Clinical practicums: The highest grade that can be earned in SUR 111 by a student, who fails to score a minimum of 80% on either taped Clinical practicum, after two attempts, will be a grade in SUR 111 of “D”. This student will not be allowed to progress in the program to spring semester. This is to ensure the safety of the surgical patients that students are exposed to during spring clinical rotations. Students are given opportunities to come to lab and practice with and without an instructor. It is the student’s responsibility to take advantage of open lab times and to refine their skills. Students who require a second attempt on their clinical practicum may do so after all students have completed their first attempt. Clinical practicum retesting must be scheduled at a time when faculty and lab facilities are available. This is typically on open lab days and must be scheduled in advance with the faculty.  Lab Final Identification: One re-test is allowed. Failure to pass the identification portion of the lab final exam with a minimum of 70% will result in a grade in SUR 111 of “D”. This student will not be allowed to progress in the program to spring semester. Students are responsible for learning equipment, instrumentation, and supply items. This is to ensure the safety of the surgical patients that students are exposed to during spring clinical rotations. Students are given opportunities to come to lab and practice with and without an instructor. It is the student’s responsibility to take advantage of open lab times to learn and to read their texts. These lab identification final exam components cannot easily be duplicated. Therefore, the student may only make up the lab identification final exam when the availability of reconstructing that situation is possible. Lab identification final exam retesting must be scheduled at a time when faculty and lab facilities are available. The Faculty will coordinate make up lab identification final exam schedules. Students who fail to pass the final on either Wednesday or Thursday will be required to re-test on the Friday of that same week.

6 SUR 111 PERIOPERATIVE PATIENT CARE

COURSE OBJECTIVES: Upon completion of this course, the student will:

1. Recognize and demonstrate principles of asepsis related to the surgical environment. 2. Identify and discuss concepts related to cleaning, disinfection, and sterilization. 3. Describe and demonstrate the process and concepts involved in preparing for surgery in the surgical technologist role and assistant circulator role when establishing the sterile field, preparing other team members, and the patient. 4. Identify and recognize basic instrumentation according to classification and name for the following surgical tray types: Minor, Major, Abdominal Retractor, Laparoscopic, GYN, D & C, Urology/Cysto, Otorhinolaryngological, Orthopedic, Plastic, Tracheotomy, Ophthalmology, Neurosurgery, Cardiovascular, and Thoracic 5. Discuss and recognize various specialty equipment used in the operating room setting. 6. Identify and demonstrate basic positioning principles. 7. Recognize components of case management and categorize them as pre-operative, intra-operative, or post-operative. 8. Explain and demonstrate patient preparation related to vital signs and skin preparation. 9. Recognize appropriate timing of and demonstrate counting during simulated surgeries. 10. Anticipate the sequence of events for the following procedures: Open Umbilical Hernia Repair Laparoscopic Cholecystectomy Tracheotomy

GENERAL EDUCATION OBJECTIVES: Incorporated into course objectives:

1. Develop ability to communicate effectively in a team-oriented environment. 2. Develop ability to safely integrate all aspects of the surgical setting in preparation for spring clinical. 3. Demonstrate ability to function as a self-directed learner.

Learning activities that reinforce learning objectives: a. Team oriented surgical setting simulation b. Skills assessments demonstrated c. Clinical practicums 1 and 2 demonstrate ability to integrate all skills assessments d. Open lab times encouraged and taken advantage of by the student to reinforce learned skills

7 SUR 111 PERIOPERATIVE PATIENT CARE CONTENT OUTLINE

I. Introduction to the Educational Program A. General information 1. Introduction to course and program 2. Course and program objectives 3. Course and program policies

II. Asepsis in the Non-sterile or Sterile Role A. Surgical attire B. Basic Hand Wash-Hand Hygiene C. Asepsis and Sterile Technique 1. Microbiology Introduction and Key Concepts 2. Sterile Field 3. Sterile Team Member Attire 4. Movement in and Around the Sterile Field 5. Developing a Surgical Conscience

III. Sterilization and packaging A. Instrument preparation 1. Packaging material 2. General packaging materials B. Steam sterilization 1. Components of a steam sterilizer 2. Sterilization parameters 3. Gas Sterilization 4. Ionizing Radiation C. Event related Sterility D. Storage and Distribution

IV. Diagnostic Procedures A. Diagnostic Imaging B. Laboratory Findings C. Endoscopic Findings D. Electrodiagnostic Studies

V. Case Selection A. Sterile Supplies and Custom Packs B. Preference Card Usage C. Instrumentation 8 1. Classification 2. Care and Handling 3. Major and Minor Trays 4. Minimally Invasive 5. GYN/D & C/Urology 6. Tracheotomy 7. ENT/Plastics 8. Orthopedic 9. Vascular/Cardiac/Thoracic 10. Neurosurgical D. Operating Room Furniture and Placement

E. Equipment 1. Endoscopic 2. Power equipment 3. Electrosurgery and Electrosurgery Safety 4. Lasers and Laser Safety 5. Microscopes

VII. Pre-operative Case Management (Nonsterile Role) A. Patient Transfer and Transport B. In Room Patient Preparation 1. Vital signs 2. Thermoregulatory devices 3. Urinary catheterization C. Patient Positioning and Positioning Principles 1. Supine 2. Trendelenberg /Reverse Trendelenberg 3. Lithotomy 4. Fowler’s and Sitting Positions 5. Prone position 6. Jackknife (Kraske) Position 7. Lateral and Kidney Positions D. Patient Skin Preparation 1. Clean and Contaminated areas 2. Hair Removal 3. Skin Preparation Concepts and Solutions E. Sterile Team Member Assistance 1. Opening sterile supplies and instrumentation 2. Tying gowns 3. Counts 4. Equipment and Connecting Equipment 5. Draping concepts and boundaries F. Open glove technique

VIII. Pre-operative Case Management (Sterile Role) A. Furniture and Equipment Arrangement and Preparation B. Establishing the Sterile Field 1. Opening sterile packs, supplies and instrumentation 2. The Surgical Scrub 3. Hand Drying and Donning the Surgical Gown 4. Closed Gloving Technique 5. Gowning and Gloving another Sterile Team Member C. Preparing and Maintaining the Sterile Field

9 1. The Mayo Stand 2. Back Table 3. Economy of Motion 4. Organization, Placement of Items and Furniture Movement Concepts 5. Basin Stands and Prep Tables D. Counts E. Draping the Surgical patient 1. Principles of Draping 2. Laparotomy Draping 3. Lithotomy Draping 4. Extremity Draping 5. Craniotomy Draping F. “Timeout” Concepts and Content XI. Intra-operative Case Management (Sterile and Nonsterile roles) A. The Operative Sequence 1. Incision 2. Hemostasis 3. Dissection & Exposure 4. Exploration & Isolation 5. Surgical repair/Removal 6. Hemostasis & Irrigation 7. Specimen Collection 8. Closure and Dressing Application 9. Counts (at proper times during closure)

B. Surgical Wound Classification C. Emergency Patient Situations/Procedures D. Catheters and Drains E. Surgical Dressings F. Tissue Replacement materials G. Monitoring OR traffic H. Anticipation of sterile team needs I. Documentation

XII. Post-operative case Management (Sterile and Nonsterile Roles) A. Final Counts B. Keeping Field Sterile C. Table Breakdown and Transportation D. Preparing for the next Case E. Environmental-Cleaning and Disinfection of the OR F. Documentation

XIV. Case Reviews A. Open Umbilical Hernia B. Laparoscopic Cholecystectomy 1. Laparoscopic Tower 2. Operative laparoscopy C. Tracheotomy Emergency Cricothyroidotomy D. Life Threatening Surgical Emergencies

10 SUR 111 PERIOPERATIVE PATIENT CARE TENTATIVE SYLLABUS BASED UPON AVAILABILITY OF GUEST LECTURERS AND LEARNING AIDS

WEEK # CLASS # TOPICS RESOURCES

1 1 Introduction to course and program policies and procedures Microbiology Surgical Attire RESOURCES Surgical Technology Student Handbook AB TECH Student Handbook TEXT AST CH. #12 pgs. 305-312 AST Ch. # 7 pgs. 139-149 AORN REC. PRAC. Attire Surgical SUR 111 Course and content outlines, syllabus HOMEWORK #1-List and memorize the 8 AB-TECH principles of asepsis ST Workbook CH #12: Key Terms and Questions 3-36 (pages 166-168)

2 Asepsis and Sterile Technique Team members attire within the sterile field Movement in and around the sterile field Developing a Sterile Conscience RESOURCES TEXT AST CH #5 pgs. 81-89 & CH. #7 pgs. 153-155 AORN REC. PRAC. Sterile Field Maintaining

2 3 Cleaning and Disinfection Sterilization and packaging Instrumentation and packaging materials RESOURCES TEXT AST CH. #7 pgs. 156-162 AORN REC. PRAC. Disinfection, High level Packaging Systems-Selection Use

4 Steam Sterilization and the steam sterilizer Sterilization parameters and flash sterilization Gas sterilization / Ionizing Radiation Monitoring the Sterilization Process Event Related Sterility Storage and Distribution RESOURCES TEXT AST CH. #7 pgs. 167-183 AORN REC. PRAC. Sterilization in the Practice Setting Environmental Cleaning 11

HOMEWORK #2- ST Workbook Chapter #7 Key Terms through T/F (pages 50-54)

3 5 Establishing the Sterile Field Opening sterile supplies Supplies Sterile Packs RESOURCES TEXT AST CH. # 10 pgs. 266-276 & CH. #12 pgs. 313-315 Rutherford (Equipment & Supplies) CH #1, 2, 3, 5 & pgs. 177-178, 190 Rutherford (Instruments) CH #1 and #2 all but focus on minor tray instruments

6 The Surgical Scrub Hand drying and donning the surgical gown Open and Closed gloving techniques Turning the Gown RESOURCES TEXT AST CH. # 12 pgs. 317-324 AORN REC. PRAC. Hand Scrubs, Surgical

4 7 Gowning and gloving another team member Gown & glove removal RESOURCES TEXT AST CH. # 12 pgs. 357-358

HOMEWORK #3 ST Workbook Chapter 12 Page 169 Masks and Eyewear. Page 171 Matching 11-24

8 Maintaining the Sterile Field Preparing the Mayo Stand, Back Table, Prep Table, & Basin RESOURCES TEXT AST CH. # 12 pgs. 324-331

THIS IS CLINICAL PRACTICUM #1 TO HERE

5 9 Principles and draping Economy of motion Preoperative Case management Use of Preference Card Equipment Selection RESOURCES TEXT AST CH. # 12 pg. 357-359

HOMEWORK #4 ST Workbook CH # 12 Page 170 Preference Card Questions 5-9

10 Instrumentation Classification Care and Handling Minor & Major Trays RESOURCES TEXT AST CH. # 10 pgs. 254-263 TEXT Rutherford Chapter 1 HANDOUTS: MAJOR & MINOR AB-TECH TRAYS

HOMEWORK #5 ST Workbook CH# 10 Key Terms through Matching (pages 111-117)

12 6 11 Instrumentation GYN and D & C Trays Urology Trays RESOURCES TEXT AST Chap 15 pgs. 504-508 TEXT Rutherford Chapter 3 and 4

12 Specialty Instrument sets Orthopedic & Neurosurgery sets ENT, Oral/Maxillo-Facial, Plastic, Ophthalmic RESOURCES TEXT AST pgs. 856-860, 1030 TEXT Rutherford Chapter 6 and 7 and 12 (Just look over 8,9,10)

7 13 Specialty Instrumentation sets Tracheostomy, Peripheral Vascular, and Thoracic sets RESOURCES TEXT AST pgs. 486-488, 936, 987-988, 991 TEXT Rutherford Chapter 11

14 Specialty Equipment Endoscopic Equipment Powered Equipment Lasers and Microscopes RESOURCES TEXT AST pgs. 91-92, 263-265 TEXT Rutherford Chapter 2 AORN REC. PRAC. Instruments and Powered equipment Laser Safety in Practice setting

8 15 Electrosurgical Safety Pneumatic Tourniquets RESOURCES TEXT AST CH. # 10 pgs. 267-268 AORN REC. PRAC. Electrosurgery

HOMEWORK # 6 ST Workbook CH# 10 Short Answer 1-15 (pages 117-119)

16 Transportation and Transferring Patients Positioning principles Positioning Aids Functions and operating the OR table RESOURCES TEXT AST pgs. 83-84, 331, 333 AORN REC. PRAC. Positioning the patient in the perioperative setting.

9 17 MIDTERM - Comprehensive Positioning the patient Common surgical positions; supine, prone, lithotomy, lateral, trendelenberg, reverse trendelenberg, sitting. RESOURCES TEXT AST pgs. 342-354 AORN REC. PRAC. Positioning the patient in the perioperative setting.

18 Hair removal Skin preparation Prep Set-ups/Types of Preps RESOURCES AST CH. #12 pgs. 357-357 AORN REC. PRAC. Skin Preparation of patients

10 19 In Room Patient Preparation Vital Signs, TPR and BP Urinary Catheterization RESOURCES TEXT AST CH. #12 pgs. 334-342

HOMEWORK #7 Answer these Questions: What are the indications for urinary catheterization? Who is responsible for placing the indwelling catheter? Is this a sterile procedure? What type of glove technique is employed in placing the catheter? State the most common reason for nosocomial infections.

20 Draping Drape Characteristics Principles of Draping Procedural Draping-Laparotomy, Lithotomy, Extremity, Etc. RESOURCES TEXT AST CH. # 12 pg 357-363, CH. #10 pg 268

AORN REC. PRAC. Gowns and Drapes Use and Selection of Barrier materials

HOMEWORK #8-Describe in detail the sequence of events in draping for a laparotomy using a universal drape and Laparotomy drape. Describe all variations the surgeon might use for each type of drape.

11 21 Intraoperative Case Management (APOS) Communication Surgical Counts Sponge, sharp, instruments Passing Instruments & Supplies TEXT AST CH. # 12 pg 364-370

AORN REC. PRAC. Counts-Sponge, sharp, instruments

22 The Operative Sequence 1-Incision 2-Hemostasis (principles/methods/techniques) 3-Dissection 4- Exposure (principles/devices/retractors) 5- Procedure (Specimen Collection possible) 6-Hemostasis 7- Irrigation 8-Closure 9- Dressing Application 14

RESOURCES AST CH.#8 p. 185-191, CH.#12 p. 306-307, 372-373

12 23 Specimen Collection Catheters and Drains Dressings RESOURCES TEXT AST CH. #10 p.270-274, CH. #12 p.370

24 Tissue Replacement Materials Wound Closure Surgical Wound Classifications RESOURCES TEXT AST CH. #11 pg. 278-285

13 25 Emergency Procedures Fluid and Hemodynamic Disorders Malignant Hyperthermia Trauma, Surgical Emergencies, CPR Hemolytic and Anaphylactic Reactions (Drugs & Latex) Blood replacement RESOURCES TEXT AST CH 5 pgs 98-99 CH. # 8 pg 185-197,

HOMEWORK #9 ST Workbook CH# 8 Key Terms through Short Answer (pages 69-72)

26 Postoperative case management Final counts, Table breakdown and transportation RESOURCES TEXT AST CH.#12 pg 371-375 AORN REC. PRAC - Counts, sponge, sharp, and instrument - Environmental Responsibility . 14 27 Patient Assessment/Interview History and Physical Examination Diagnostic Imaging Laboratory Findings Endoscopic & Electrodiagnostic studies RESOURCES TEXT AST CH#13

HOMEWORK #10-ST Workbook CH #13 Key Terms through Matching (pages 252-257)

28 Open Umbilical Herniorrhaphy

RESOURCES TEXT AST CH. #14 pg 414-420 15

HOMEWORK #11: Differentiate between ventral, inguinal, hiatal, Umbilical hernias. List operative sequence for each including description/location, prepping and draping for each.

A “HERNIORRHAPHY” IS CLINICAL PRACTICUM #2

16 29 Tracheotomy/Tracheostomy Appendectomy RESOURCES TEXT AST CH. #14 pg.485-488

HOMEWORK #12 ST Workbook Chapter 14 pg. Specific variations 1-29 (pages 289-294) (Add: Surgical Wound Classification and Incision Type to your report) Use the following case study and your textbooks/internet Case Study: Jimmy is a fifteen year old male. He was admitted to the ER with right lower quadrant pain, nausea, and a low grade fever. He has been diagnosed with an acute appendicitis. Surgery is scheduled.

30 Laparoscopic Cholecystectomy Open Cholecystectomy RESOURCES TEXT AST CH. #14 pg 460-462

17 31 D&C/HYSTEROSCOPY (Asepsis during Vaginal Procedures) RESOURCES TEXT AST CH. # 15 pgs 539-540, 553-556

32 COMPREHENSIVE FINAL EXAM

16 SUR 111 LAB SECTIONS 1 & 2

SUR 111 contains a 6 hour lab meeting either Wednesday or Thursday between 12:30pm and 6:50pm. We will divide the lab into two groups, each group consisting of eight students. Each block of time will be divided into two sections, section A and section B. Session A will go from 12:30pm until 3:20pm and session B will go from 3:30pm until 6:30pm. This is a 6 hour lab that is to be used to orient oneself to the clinical component of this program and to master the basic competencies for an entry-level surgical technology student about to begin their clinical training. Sessions will have scheduled field trips to some of the clinical affiliates which will be used for clinical training next semester. Two instructors, using lecture, video presentations, guest lecturers, and handouts will teach each of these labs. The main emphasis will be on demonstration and return demonstration of these basic practices as well as the ability to integrate these skills into a clinical practicum/mock surgery. The two practicum clinical examinations in this course will be videotaped and reviewed with the instructor and the student for critique and grading purposes.

All students must demonstrate successful completion of basic competencies and objectives on the program’s didactic and laboratory courses in the first semester, and have passed all SUR and BIO courses with a grade of C or better (SUR 110, SUR 111 and BIO 163) before gaining entry into SUR 122 and SUR 123. Before a student is eligible to begin clinical training the student MUST have successfully completed two videotaped practicum examinations with a grade of 80% or better within two attempts and mastered all 44 skills assessments (see Surgical Technology Study Guide). The highest grade that can be earned in SUR 111 by a student, who fails to score a minimum of 80% on either taped Clinical practicum, after two attempts, will be a grade in SUR 111 of “D”. This student will not be allowed to progress in the program to spring semester. This is to ensure the safety of the surgical patients that students are exposed to during spring clinical rotations. The student will score PASS OR FAIL for each Clinical practicum.

The student will have three attempts at each skill assessment if needed. Skills assessments will begin as soon as the student feels they are prepared to demonstrate they have mastered the skill to an instructor properly following each procedural step. The student will score PASS OR FAIL for SKILL ASSESSMENTS. If the student fails to demonstrate mastery on the third trial, the student must schedule an appointment with an instructor. All of these skills must be mastered before a student will be considered for Clinical practicum completion or clinical training. Some of these skills will be incorporated into the Practicum Exams and may be graded concurrently with the practicum examination review. Students are encouraged to attempt skills assessments when they feel ready and prepared for a proper demonstration and not fall far behind in these demonstrations. The lab will be available at times for student practice. Please see lab availability times on the door of RHO 412. Students are encouraged to make the best use of “open lab times”, which will be announced or posted on the lab door schedule. There will be an instructor available at these times to assist the student upon student request.

The Clinical Practicums will be done in the Surgical Technology Skills lab and will build upon each other. Clinical Practicum #1 will consist of scrubbing and gowning oneself and another, setting up back table, mayo stand, and basin stand. Clinical Practicum#2 will include all elements of practicum #1 along with prepping, draping and performing as a STSR (Surgical Technologist in the Scrub Role) for an Umbilical Hernia Repair with the instructor or another student in the surgeon role. This practicum will also include explanation of preference card usage, positioning principles, demonstration of laparoscopic equipment knowledge, procedures, and a variety of instrumentation. Clinical Practicum#2 will be timed from the point of towel grasping to completion of back table set-up, mayo stand draping, and initial counts. Ten minutes will be the time to get! All second attempts will be conducted on open lab days on a sign up basis.

If by the end of the semester the student has not successfully passed the two clinical practicum examinations, final lab identification, and the skills assessments, they will not be allowed to proceed to SUR 122 and SUR 123.

Equipment, videos, and handouts will also be available to help the student master the basic competencies of a surgical technologist. When doing clinical skills training in the lab, whether during official class lab time or open lab time, the lab should be considered an OR and appropriate surgical attire should be worn. There will be no eating or drinking in the surgical skills lab which is a Biohazardous area. Students will exhibit a professional attitude at all times.

17 Your weekly skill assessments follow on the next four pages. Please note in the SUR 111 Moodle lab section that each skill assessment has a corresponding video. You are responsible for reviewing the video and practicing your assigned skill(s) PRIOR to coming to lab the day the skill is assigned. The day the skill is assigned will be the day it is to be reviewed by the faculty for check-off.

Lab time will be NOT BE SPENT TEACHING YOU TO DO YOUR ASSIGNED SKILL(S). Lab time WILL be spent providing background information on skills, refining your skills, answering questions, and assimilating skill(s) each week into what will become your clinical practicals.

The “Open Labs are a great place to practice your skills between lab days. It is your responsibility to keep up with weekly skill assignments.

18 THIS IS A TENTATIVE SCHEDULE OF THE REQUIRED LAB SECTIONS FOR SUR 111 LAB SESSIONS WILL BE IN ROOM 412 OR A DESIGNATED CLINICAL SITE (SEE SCHEDULE) SECTION D-1

SESSION # DAY/DATE/TIME TOPICS COVERED SKILLS ASSESSED

1A WED 8-22 12:30PM OR attire 12-1 pg 191 Basic hand washing 7-1 pg 59 Disinfection/Sterilization Overview Peel pack packaging 7-4 pg 62 1B 3:30 PM Envelope fold wrap 7-2 pg 60 Square fold wrap 7-3 pg 61 Container system 7-5 pg 63

2A WED 8-29 12:30PM Initial Check offs 2B 3:30PM Glove oneself-open 12-12 pg 243 Remove soiled gloves 12-12A (insert RK)

3A WED 9-05 12:30PM Room preparation and Opening Sterile Supplies Back Table 12-2A pg 209 Small Wrapped 12-2B pg 211 Small Wrapped 12-2B pg 211 Large Wrapped 12-C pg 213 Peel Pack 12-2D pg 215 3B 3:30PM Open Sterile Supplies Instrument Set Container 12-2E pg 217 Surgical Hand Scrub 12-1-A pg 193

4A WED 9-12 12:30PM Field Trip Park Ridge Health 4B 3:30PM Surgical Hand Scrub 12-1-A pg 193 Dry, Self-Gown, & Closed Glove 12-3 pg 219 Remove Tray From Container (insert RK)

5A WED 9-19 12:30PM Field Trip Haywood Regional 5B 3:30PM Surgical Scrub 12-1-A pg 193 Dry, self-gown, closed glove 12-3 pg 219 Dress the Mayo 12-6 pg 225

6A WED 9-26 12:30PM Continue scrub, gown, glove 6B 3:30PM Prepare team member 12-4 pg 221 Disrobe to replace 12-1-C pg 197 Disrobe end of case 12-1-D pg 198

7A WED 10-03 12:30PM Field Trip VAMC 7B 3:30PM Fill a Bulb Syringe 12-6B pg 229 Pour Sterile Solution 12-6B pg 229 Case Management pre & post-scrub 12-7 pg 233 *Assistant Circulator 12-7

(ALERT: We will have to do our VA field trip all in one day. You will need to make arrangements to attend lab both Wednesday and Thursday 10/03 and 10/04. To be fair to all, Wednesday Lab will be expected to attend the lab on Thursday 10/04. Thursday lab will be expected to attend the lab on Wednesday 10/03. Our visit with the VAMC is something we have to work around. Should you not attend, you will not be eligible to perform clinical there at all. Again, please make arrangements to be available for lab on both 10/03 and 10/04. I apologize for any inconvenience this may cause. The date we will go to the VAMC is October 3rd. We will conduct lab skills and start clinical practicums on October 4th. 19 8A WED 10-10 12:30PM Assemble Instrument set 10-1 pg 130 Hand Signals 10-2 pg 132 Load, pass & unload knife 10-3 pg 134 Instrument Handling 10-4 pg 136 8B 3:30PM SKILLS ASSESSMENT REVIEW AND CATCH UP WE HAVE REVIEWED 31/44 SKILLS CLINICAL PRACTICUM #1 = 12-7 Pre & Post scrub to gowning MD

9A WED 10-17 12:30PM Field Trip Asheville Surgery Center 9B 3:30PM Load and pass NH 10-4C pg 140 Load & pass free needles 10-4C pg 140 Ties, reels, free tie on a passer 10-4D pg 142 Load & pass staplers 11-2 pg 161 CLINICAL PRACTICUM #1 Continued

10A WED 10-24 12:30PM Field Trip Mission Hospital 3:30PM Urinary catheterization 12-13 pg 245 Skin prep 12-14 pg 248 LAST CHANCE FOR CLINICAL PRACTICUM #1

11A WED 10-31 12:30PM Drape (Laparotomy) 12-8 pg 235 3:30PM Sellick’s maneuver 9-1 pg 103 Syringe off field 9-2 pg 104 Syringe into field 9-3 pg 106 Accept meds to field 9-4 pg 108

12A WED 11-07 12:30PM Case Management set-up Intraoperative 12-9 pg 237 12B 3:30PM *Intraoperative Assistant Circulator

13A WED 11-14 12:30PM POSITIONING LAB 13B 3:30PM CLINICAL PRACTICUM #2 is LP #1 and mock case (12-9)

11/23-11/25/2011 THANKSGIVING HOLIDAY BREAK

14A WED 11-28 12:30PM CLINICAL PRACTICUM #2 12-7 &12-9 14B 3:30PM Case management: Post –op 12-10 pg 239 *Case Management: Post-op Assistant Circulator

15A WED 12-05 12:30PM CLINICAL PRACTICUM #2 Continued 15B 3:30PM SKILLS ASSESSMENTS AND PRACTICUMS

16 A WED 12-12 12:30PM SKILLS ASSESSMENTS AND PRACTICUMS 16 B 3:30PM LAST CHANCE CLINICAL PRACTICUM #2 CLINICAL PAPERWORK SUR 123 LAB ID PORTION OF SUR 111 FINAL EXAM

20 THIS IS A TENTATIVE SCHEDULE OF THE REQUIRED LAB SECTIONS FOR SUR 111 LABS WILL BE IN ROOM 412 OR A DESIGNATED CLINICAL SITE (SEE SCHEDULE) SECTION D-2

SESSION # DAY/DATE/TIME TOPICS COVERED SKILLS ASSESSED

1A THU 8-23 12:30PM OR attire 12-1 pg 191 Basic hand washing 7-1 pg 59 Disinfection/Sterilization Overview Peel pack packaging 7-4 pg 62 1B 3:30PM Envelope fold wrap 7-2 pg 60 Square fold wrap 7-3 pg 61 Container system 7-5 pg 63

2A THU 8-30 12:30PM Initial Check offs 2B 3:30PM Glove oneself-open 12-12 pg 243 Remove soiled gloves 12-12A (insert RK)

3A THU 9-06 12:30PM Open Sterile Supplies Back Table 12-2A pg 209 Small Wrapped 12-2B pg 211 Small Wrapped 12-2B pg 211 Large Wrapped 12-2C pg 213 Peel Pack 12-2D pg 215 3B 3:30PM Open Sterile Supplies Instrument Set Container 12-2E pg 217 Surgical Hand Scrub 12-1-A pg 193

4A THU 9-13 12:30PM Field Trip Park Ridge Health 4B 3:30PM Surgical Hand Scrub 12-1-A pg 193 Dry, Self-Gown, & Closed Glove 12-3 pg 219 Remove Tray From Container (insert RK)

5A THU 9-20 12:30PM Field Trip Haywood Regional 5B 3:30PM Surgical Scrub 12-1-A pg 193 Dry, self-gown, closed glove 12-3 pg 219 Dress the Mayo 12-6 pg 225

6A THU 9-27 12:30PM Continue scrub, gown, glove 6B 3:30PM Prepare team member 12-4 pg 221 Disrobe to replace 12-1-C pg 197 Disrobe end of case 12-1-D pg 198

7A THU 10-04 12:30PM Field Trip VAMC 7B 3:30PM Fill a Bulb Syringe 12-6B pg 229 Pour Sterile Solution 12-6B pg 229 Case Management pre & post-scrub 12-7 pg 233 *Assistant Circulator 12-7

(ALERT: We will have to do our VA field trip all in one day. You will need to make arrangements to attend lab both Wednesday and Thursday 10/03 and 10/04. To be fair to all, Wednesday Lab will be expected to attend the lab on Thursday 10/04. Thursday lab will be expected to attend the lab on Wednesday 10/03. Our visit with the VAMC is something we have to work around. Should you not attend, you will not be eligible to perform clinical there at all. Again, please make arrangements to be available for lab on both 10/03 and 10/04. I apologize for any inconvenience this may cause. The date we will go to the VAMC is October 3rd. We will conduct lab skills and start clinical practicums on October 4th. 21 8A THU 10-11 12:30PM Assemble Instrument set 10-1 pg 130 Hand Signals 10-2 pg132 Load, pass & unload knife 10-3 pg 134 Instrument Handling 10-4 pg 136 8B 3:30PM SKILLS ASSESSMENT REVIEW AND CATCH UP WE HAVE REVIEWED 31/44 SKILLS CLINICAL PRACTICUM #1 = 12-7 Pre 7 Post Scrub to gowning MD

9A THU 10-18 12:30PM Field Trip Asheville Surgery Center

9B 3:30PM Load and pass NH 10-4C pg 140 Load & pass free needles 10-4C pg 140 Ties, reels, free tie on a passer 10-4D pg 142 Load & pass staplers 11-2 pg 161 CLINICAL PRACTICUM #1

10A THU 10-25 12:30PM Field Trip Mission Hospital 3:30PM Urinary catheterization 12-13 pg 245 Skin prep 12-14 pg 248 LAST CHANCE FOR CLINICAL PRACTICUM #1

11A THU 11-01 12:30PM Drape (Laparotomy) 12-8 pg 235 3:30PM Sellick’s maneuver 9-1 pg 103 Syringe off field 9-2 pg 104 Syringe into field 9-3 pg 106 Accept meds to field 9-4 pg 108

12A THU 11-08 12:30PM Case Management set-up Intraoperative 12-9 pg 237 12B 3:30PM Case Management set-up *Intraoperative Assistant Circulator

13A THU 11-15 12:30PM POSITIONING LAB 13B 3:30PM CLINICAL PRACTICUM #2 is LP #1 and mock case (12-9)

11/23-11/25/2011 THANKSGIVING HOLIDAY BREAK

14A THU 11-29 12:30PM CLINICAL PRACTICUM #2 12-7 & 12-9 14B 3:30PM Case management: Post –op 12-10 pg 239 *Case Management: Post-op Assistant Circulator

15A THU 12-06 12:30PM SKILLS ASSESSMENTS AND PRACTICUMS 15B 3:30PM CLINICAL PRACTICUM #2 Continued

16A THU 12-13 12:30PM SKILLS ASSESSMENTS AND PRACTICUMS 16B 3:30PM LAST CHANCE CLINICAL PRACTICUM #2 CLINICAL PAPERWORK SUR 123 LAB ID PORTION OF SUR 111 FINAL EXAM

22 *Assistant Circulator Role

As part of the surgical technologist student skill assessments there will be additional formal expectations to address the role of the “assistant circulator.” Students will be expected to be able to function in both the sterile role and nonsterile role throughout the peri-operative period. Additional skill assessments will be conducted for the following as part of the routine skill assessments and clinical practicums. Students will work in pairs (sterile and non-sterile role) to perform lab skill and practicum evaluations.

Pre-operative case management (*Part of Skill Assessment 12-7)  Setting up the room for a surgical procedure (damp dusting/positioning of equipment, opening sterile supplies and instruments)  Tying the sterile team member’s gown and turning with them  Performing initial counts  Connecting and working equipment  Patient transfer  Patient positioning

Intra-operative case management (*Part of Skill Assessment 12-9)  Monitoring OR traffic  Anticipation of sterile team needs  Counts  Specimen handling and care  Documentation

Post-operative case management (*Part of Skill Assessment 12-10)  Dressings and drains  Transport  Documentation  Room break down and turn over

Both the sterile (surgical technologist) and non-sterile roles (assistant circulator) will be assessed in the form of a check-off list of having performed these activities to the satisfaction of the program faculty. See Moodle for skill assessment check-off list. This list will be provided to each student at the beginning of the first lab day. It is the student’s responsibility to maintain a record of instructor signatures validating completion of the skill. The record will be turned in at the end of the semester to be retained in the student file.

Sterile Processing Role

Students will be spending one week in the sterile processing department at Mission Hospital. This out-rotation will serve to provide hands on exposure with the disinfection and sterilization process that are covered in SUR 111 lecture (see page 12 of this syllabus) and lab (see pages 19 & 21 of this syllabus).

Disinfection/Sterilization Introduction and Overview

 Disinfection  Gross Decontamination and Ultrasonic Cleaning  Washer Decontamination  Inspection and Assembly  Preparation for sterilization  Sterilization  Storage 23 24