Learning objectives and rationalePlan to achieve objectivesFinal evaluation Performing pre- operative surgical checklist to check consent, correct procedure and site and to avoid any mistakes. Pre-op check as per the checklist with preceptorPerformed full pre- operative checklist. Participating in surgical count to avoid any items being left inside the patientGet familiar with instruments. Participated in surgical count with some assistance. Collection of specimen, for further investigation. Read the hospital policy for collection of specimen.
Collected specimen of skin lesion. Take full care of a patient in PACU to provide full nursing care. Conduct full head to toe assessment and documentations while providing safe care to the patientProvided full nursing care to patient from arrival at PACU until discharge. Propofol –Exerts its sedative-hypnotic effects through GABA receptor interaction. GABA is the principle inhibitory neurotransmitter in the CNS (Bryant & Knights, 2011, p. 264). Adverse effects like hypotension, transient apnoea and bradycardia. IV dose for adults and children over 3 years is 2-2.
5mg/Kg (Bryant & Knights, 2011, p. 264). In theatre it was used for induction and maintenance of GA and conscious sedation. Ephedrine –It stimulates the release of noradrenalin from presynaptic nerve terminals, also acting directly on the alpha and beta-adrenoreceptors (Bryant & Knights, 2011, p. 216). Adverse effects palpitations, bradycardia and angina. Adult dosage 10-15mg and children dosage 3mg/kg/day (Bryant & Knights, 2011, p. 216). Ephedrine was administered to patient with blood pressure of 85/45 post spinal-anaesthesia.
Parecoxib – Parecoxib converts to valdecoxib after administration, inhibits COX-2 and reduces production of prostaglandins that are mediators of inflammation and pain. Adverse effects like nausea, anaemia and hypotension (Parecoxib, 2013). Adult dosage is 40mg and not recommended for children (Parecoxib, 2013). It was administered for post-operative pain. Suxamethonium – It is a short-acting depolarising neuromuscular blocking agent, combines with cholinergic receptors of the motor end plate to produce depolarisation and inhibits neuromuscular transmission (Suxamethonium, 2013).
Adverse effects like bradycardia, tachycardia and arrhythmias. Adult dose commonly 2. 5-4. 3mg/minute and children 1-2mg/kg (Suxamethonium, 2013). It was used during rapid intubation when the patient had not fasted. Midazolam – Short acting CNS depressant inducing sedation, amnesia and anaesthesia (Midazolam, 2013). Adverse effects like respiratory depression, apnoea and variation in heart rate and blood pressure. Dosage is determined by the reaction of the individual, approximately 0. 15-0. 2mg. kg (Midozalam, 2013).
It was administered to patient prior to removal of lesion on chest. Maxolon – Stimulates motility of the GIT increasing peristalsis of the jejunum and duodenum accelerating the emptying of gastric contents. Adverse effects like drowsiness, restlessness and weakness (Maxolon, 2013). Adult dosage 10mg-20mg and children ranging from 1mg-10mg as per age (Maxolon, 2013). Maxolon was used to prevent nausea and vomiting post- surgery. EMLA cream – Neuronal membrane is stabilized which prevents the conduction of nerve impulses, providing dermal anaesthesia (Emla, 2013).
Adverse effects like oedema, redness and paleness. Application of up to 2g in adults and 1g for children (Emla, 2013). It was used for children before insertion for IV access. Sevoflurane – Non-irritating and fast onset of action for inhalation anaesthesia. Minimum alveolar concentration decreases with age (Sevoflurane, 2013). Adverse effects like agitation, hypotension and postoperative nausea and vomiting. Inhalation dose is 5% in adults and 7% in children (Sevoflurane, 2013). It was used in most surgery to maintain and induce GA.
Reflecting back on one of my final placements as a student nurse, I have gained a lot of confidence, skills, knowledge and experiences that have helped me act and work in a professional way. All the experiences I have had during the three years of my student years have helped me in shaping me into a professional. In this essay I will be reflecting on my peri- operative placement and four of my objectives for the placement. I will also discuss my achievements and challenges I faced. During my three weeks placement I got to rotate in all three scrub/ scout, anaesthetic and PACU.
I have thoroughly enjoyed this placement and can see myself working in the peri- operative field later in the future. This clinical placement was my first experience in the peri- operative field and I was very excited and curious as to what I would see and experience. Walking into the theatre on my first day I felt overwhelmed by all the different types of machines and the very different layout compared to the wards. I also noticed that it was very fast paced in the theatres and it scared me that I would not be able to keep up and grasp the knowledge that I required.
One of my main objectives when I came into the placement was to participate and gain more knowledge in the surgical count process. During my first week I had the scrub/ scout rotation so I had the opportunity to achieve my first objective, to participate in the surgical count. For the first two cases in the theatre, I just observed and watched how the nurses worked with each other and communicated with the other health professionals in the theatre regarding the count. Surgical count is very important to avoid leaving any item in the patient’s body (Woodhead, 2009).
One of the difficulties I had during the surgical count was that I was not familiar with most of the instruments and had a hard time identifying the different surgical tools. Also being aware of the sterile field was challenging. My preceptor was very nice to go through all the instruments with me one at a time. I was exposed to various different cases like orthopaedics, plastics ad ENT and they all had different sets of instruments making it a bit confusing for me. I went back home and went through the names and pictures of instruments to familiarise myself.
By the end of the placement I did learn a fair bit of instruments. I feel that with experience and more exposure, it will help with identifying surgical tools and all other responsibilities and tasks of nurses. Also my clinical teacher was very supportive and gave me various learning packages to familiarize myself with the theatre, PACU and the anaesthetics. My clinical teacher had a very positive attitude which encouraged motivation in the students and also increased the opportunities to find practice sites (Silen-Lipponen, Tossavainen, Turunen & Smith, 2004).
One of the biggest challenges I faced was blending in because I must admit I felt very awkward in the beginning and being the shy girl that I am didn’t help as well. I felt like I should just listen and learn. Also I noticed that when I introduced myself to the surgeon, the anaesthetist and the technician they were more helpful and would get me to do things and really involved me, than when I was just quietly watching. Working as a team member can be challenging and inspiring (Silen-Lipponen et al. , 2004). I also started to tell my preceptor about my objectives for the day in the beginning of the shift and she made sure that I achieved them.
Taking initiative has given me more opportunity to learn new skills and I was able to build good rapport with my preceptor and other health professionals. During my three weeks in the hospital everyone has been very supportive and pleasant. During surgical procedures I noticed that specimens were taken from various cases. I found it very interesting so I made it one of my objectives to collect a specimen and follow the whole process as per the policy of the hospital. The only challenge I faced with this objective was that I actually didn’t know the process to collect it.
So, I made sure that I went through the policy and protocols of the hospital and cleared any questions I had with my preceptor. Then as per the policy I collected a specimen and sent it off to the pathology and completed the relevant documentations. One of my best experiences was in PACU where I got to do a lot of hands on work. In the PACU I carried out a lot of assessments like airway assessment, vital observations, neurovascular observations, pain assessment, a lot of removing of laryngeal mask and medication administration under supervision.
I must say it was very nerve wrecking in the beginning when I removed my first LMA but then I eventually got comfortable and removed several thereafter. Also I got to care for and monitor lots of children. This was my first time looking after children and it was a very challenging experience but I would say a very productive experience. Since I had no experience with children it was very scary. I think if I was a mother it would be not as scary. But, this did not stop me from caring for children alongside my preceptor.
Many children after waking up in the recovery cried inconsolably and were very restless (Key, Rich, DeCristofaro & Collins, 2010). I noticed that all nurses would call their parents to the recovery which would decrease the child’s anxiety (Smith & Dearmun, 2006). I have gained a lot of knowledge out of this placement and learnt that as a student it is advantageous to be initiative. I would definitely want to work in the peri- operative setting in the future. As I transition from a student to a graduate, I will definitely benefit from the knowledge and my experiences during this placement.