Week 3

Question 1

Informed consent implies that the patient completely understands what issues?

Answer 1

The nature of the treatment
All material risks for the treatment
The possibility of risk
Alternative treatment(s) available and associated risks of those treatments
Consequences of going untreated

Question 2

Know the meaning of PARQ and how to use it for “informed consent”

Answer 2

P Procedure - a description of the proposed procedure, how it is to be done with as much detail as the patient wants or desires

A Alternatives - a description of any and all alternatives (and their risks) to doing the procedure this way (i.e. homeopathy as an alternative to surgery, etc…)

R Risk - a description of any and all possible risks associated with this procedure (i.e. infection, hypopigmentation, etc…)

Q Questions - Let the patient ask questions about the procedure. Write down their questions and your answer to the questions in the chart.

*written informed consent plus an oral PARQ with patient before surgery is key

Question 3

Know what/what not to include in the Procedure Note portion of the MS Report

Answer 3

SOAP note required for all procedures
Pre-operative diagnosis (justify why you are doing procedure)
Describe skin prep, recored amounts of anesthesia and bicarb mixed, and amount used
Describe suture type, size, location and number
List the duration of the procedure and the amount of blood lost
Write a brief description of the actual procedure
Include as much detail as needed

Question 4

Understand the concept of “free margin” on a Pathology report

Answer 4

free margin means cancer cells are found at the outer edge

Question 5

Understand the concept of “dead space”

Answer 5

a space formed between tissues that are normally anatomically connected.

Question 6

Understand the concept(s), logic and importance of undermining

Answer 6

Undermining allows the skin to slide over the subcutaneous tissue more easily and stretch enough to close the opening with less tension, resulting in less scarring.
usu done between skin and subcutaneous tissue
undermine each side ½ the length of the incision

Question 7

Understand the basics of suture removal

Answer 7

• Grasp one end of the suture or knot, shift it back and forth to free it up so you can see clearly where to make your cut
• Cut the suture with a scissors or scalpel blade (at the arrow) and pull the freed knot ACROSS the suture line
• Pulling the suture out in this manner helps reduce wound “stress” and helps avoid dehiscence.

Question 8

Name the four reasons for/advantages of using the Subcutaneous Suture (Buried Stitch)? What type of suture would you typically use?

Answer 8

provide wound stability
close dead space
help to evert the edges
relieve tension on the wound edge