For the duration of my surgical follow through experience, I had the pleasure of following RF. RF is a 49 year old male with an admitting diagnosis of cervicalgia cervical herniation, and a scheduled surgery for an anterior cervical discectomy and fusion at C4-C5 and C6-C7. According to Sharon Lewis in “Medical Surgical Nursing”, the cause of a cervicalgia cervical herniation is “the result of natural degeneration with age or repeated stress and trauma to the spine. ” (Lewis, 2011) The follow through process was observed from when the patient arrived in the pre-op holding area until the patient arrived at the PACU.
The expected outcome of the surgery for the patient is for the patient to be pain free within 6-12 weeks of the surgery. The radiating left arm pain should subside and the patient should be able to return to work. Immediately from the OR, the patient is expected to leave the room with immobilization of his neck as proper immobilization maintains the neck in a neutral position so there is no damage done to the spinal column during healing. (Lewis, 2011).
During the initial pre-op assessment, the nurse reviewed the patients past surgical history, medical chart, lab test results, and physical report as well as performing a physical assessment on the patient of her own. The nurse also performed duties such as: taking vitals, starting the IV, ensuring consent forms and all necessary paper work is filled out; making sure the patient has all belongings and jewelry taken off and put in a belongings bag, keeping the patient calm and comfortable, assisting the patient to the bathroom, and perform the blood sugar check. The patient had a history of an appendectomy for a ruptured appendix in 2002, a bowel resection in 2002, and a ventral hernia repair in 2010.
None of these past surgeries will affect the current scheduled surgery. From the nursing assessment, the nurse noted that the patient had no skin SURGICAL PAPER 3 alterations present. This assessment is relevant because the positioning of the patient may need to be altered if there are any skin alterations present as well as possible complications to the surgical site. The nurse read over the patients CT scan and MRI results that showed that the C4 and C6 vertebras were herniated, causing compression on nerves causing the patient to experience radiating left arm pain.
The nurse also questioned the patient about compliance with refraining from eating or drinking after midnight before the surgery. This information was important because of aspiration risks during the procedure if the stomach had contents. I would rate RF’s surgical risk as high because of the fact that the procedure is being performed from the anterior of the neck and reaching all the way back to the vertebrae. Because of the site of the incision and the presence of the spinal column, trachea, and carotid artery in the surrounding area, this surgery risk is high in my opinion.
The patient also has a history of hypertension, which adds to the bleeding risk during surgery. Medications given to the patient preoperatively were Chlorhexidine Gluconate and Midazolam. The Chlorhexidine Gluconate was given to the patient in an oral liquid form as an oral rinse to clean his mouth out and kill bacteria prior to the surgery. It was my understanding that he was given the Chlorhexidine Gluconate prophylactically as his mouth would be exposed to bacteria during the surgery from the intubation and nasogastric tube.
Prior to the administration, the nurse ensured that the patient was able to swish and swallow the medication efficiently and she monitored for any sign of aspiration after the patient was done. The midazolam was used as a pre op sedative for the patient approximately 10 minutes before the patient went into the OR. The nurse monitored all vitals before and after administration of the midazolam by the anesthetist until the patient arrived at the OR.
SURGICAL PAPER 4 While in the operating room, I was able to interact with the circulating nurse, scrub nurse, nurse anesthetist, the surgeon, and the surgical tech. Upon observation of the circulating nurse, I noticed that she was very interactive and involved in the surgery. One of the responsibilities of the circulating nurse is to retrieve any surgical supplies that are not available in the operating room and to make or receive any calls for the surgeon.
During the surgery, I noticed the nurse call for an x-ray for the surgeon, the laboratory for biopsy samples, and the operating room floor front desk to inform them that the surgery would be later than expected. This is her responsibility as the surgeon cannot break sterility by touching the phone and it is easier for him to communicate through her and not leave the surgical site.
Also in the operating room, I observed the scrub nurses’ roles. Before the operation, the scrub nurse opened all of the sterile packages, arranged them on the sterile field, and took count of what was there along with the circulating nurse. The scrub nurse did this because she is sterile during the entire procedure, and once the sterile packs are opened, the contents can only be handled by sterile personnel. The scrub nurse also was ready and waiting at the sterile field at all times to get the surgeon any equipment needed from the sterile field.
This is helpful to the surgeon because it enables the surgeon to stay at the surgical site and convenient for when the surgeon has their hands full. According to Ellie Williams in her article, “Roles of a Scrub Nurse,” the scrub nurse works from setting up the operating room and prepping it for the patient, to retrieving and handing equipment to the surgeon, to counting instruments at the end and completing necessary documentation. (Williams, 2015) From my observation, the scrub nurse that I observed did her job very well and effectively while keeping her sterility the entire time.
In order to keep the patient safe during surgery, the OR team performed several safety precautions for the patient. One safety precaution performed was putting padding under all SURGICAL PAPER 5 pressure points of the body during surgery. Since the operating table is not a soft surface, it is important to keep the patient padded to protect the skin integrity. Also, the patient performed numerous tasks that caused the patient’s body to rock, so not only could they develop pressure ulcers, but skin rash, burn, or tear in the patient’s skin.
I also observed the team pump the gastric contents out of the patient using a nasogastric tube. This was done to prevent aspiration during the surgery as the patient was lying supine and no control over his swallowing. There were numerous other tasks done by the OR team to keep the patient safe that I would never have thought of until I saw it done. The anesthesia process for the patient started at the pre-op stage when the patient received midazolam to sedate him. The patient immediately became drowsy and entered a half- sleeping state until he was taken into the OR.
As the nurse entered the OR, he was given Propofol to slow his nervous system and relax him by causing conscious sedation. However, potential side effects of Propofol are: ventricular asystole, bucking/jerking/twitching, headache, dizziness, and hypotension. (Wilson , 2014) During post op, the nurses observed the consciousness and alertness of the patient and monitored vital signs. The patient was drowsy and oriented x2 to person and place. Blood pressure was 131/77. To enable that the anesthetist could put down the nasogastric tube and perform intubation on the patient, he gave the muscle-relaxing drugs Succinylcholine and ROcuronium.
I was literally able to almost immediately watch this make the patient’s jaw and throat relax as the anesthetist intubated the patient and inserted the nasogastric tube. As maintenance for the anesthesia, the anesthetist gave: O2, N2O (Nitrous Oxide), Fentanyl, ROcuronium, Sevoflurane, and Decadron. RF received general anesthesia for his surgery because it was being performed on his neck and they needed to eliminate any chance of the patient moving during the procedure.
Decadron is a corticosteroid used in surgery to help SURGICAL PAPER 6 reduce swelling and inflammation in the body and help the body recover post operatively faster by preventing the accumulation of inflammatory cells at sites of infection. Potential side effects of Decadron are: hyperglycemia vertebral compression fracture, oral candidiasis, bowel perforation, edema, and insomnia. (Wilson , 2014) None of these symptoms were expressed in the post op period.
Upon arrival in the recovery room, the nurses immediately hooked my patient up to a continuous vitals machine, keeping a close eye on them. The nurses needed to make sure that my patient was coming out of anesthesia properly by resuming to normal body functions such as breathing independently and becoming alert and oriented.
I also observed the recovery room nurses putting socks on the patient and covering him up with a blanket to warm up. During the surgery, his temperature dropped from the cold OR room. In my eyes, it seems like that would be something that could easily get overlooked. As nurses, we get place a high importance on the patient’s consciousness and blood pressure and heart rate. For the patient’s pulmonary function, the nurse auscultated lung sounds, noting decreased or absent sounds, crackles, or wheezes as this can indicate altered breathing pattern and difficulty coming out of amnesia.
(Ackley, 2011) Also, the nurse monitored oxygen saturation continuously. Low oxygen saturation levels indicates significant oxygenation problem. For cardiovascular function, the nurse needs to check vital signs like heart rate and blood pressure. Low blood pressure and increased heart rate can indicate blood or fluid loss. The nurse also implemented safety precautions on the patient. When coming out of anesthesia, patients are susceptible to falls, which can cause severe injuries that may lead to bleeding or injury of the surgical site.
When it comes to fluid and electrolytes, the nurse monitored for dehydration in the patient by assessing skin moisture, turgor, and mucous membranes. Patients typically lose fluid SURGICAL PAPER 7 during surgery and although it can be replaced by IV fluids, sometimes they lose more than they’ve taken in. The nurse started charting the patients input and output from his foley bag, IV fluids, and any oral intake he consumed in the post op holding area. This keeps an accurate and precise record of how balanced the patient’s fluid and electrolyte balance was. To check neurological status, the nurse asked the patient to state his name, date of birth, and where he currently was.
This shows the nurse whether or not the patient was alert and oriented. The nurse also checked PERRLA on the patient’s eyes. This makes sure his nervous system that is controlling his eyes is functioning properly. To keep the patient safe, the nurse restricted any ambulation during the post op period because the patient could think that they are safe to walk, when the effects of the medication are still present. The nurse put sequential compression devices on both of the patient’s legs to help prevent formation of a deep vein thrombosis.
To promote comfort, the nurse provided a quiet, comfortable environment for the patient. This let them come out of anesthesia without noises or any other stressors. The nurse was also able to put the patient in a safe, but comfortable position to wake up in. Laying supine let the patient be in a normal position and enabled his body to rest without discomfort from how he was positioned. In conclusion, my experience of observing the surgical follow through really opened my eyes to a new kind of nursing that I have not been exposed to before.
I learned that it takes a hard working individual who loves their job to work efficiently on a floor like the surgery floor. It showed me a few of the many different roles that nurses can have throughout the surgery floor. And when it comes to being in nursing school, it pays off to see what we are working so hard to achieve. Being a nurse requires a substantial amount of critical thinking and awareness of the situation at hand.
Every single nurse that I observed throughout my whole surgical follow SURGICAL PAPER 8 through experience helped and inspired me in their own way to work hard to be the best nurse I can. Although I ended my day with a sore back from the constant standing, I came away from the experience with a great learning experience and significant interest in possibly trying to work in an operating room someday. . SURGICAL PAPER 9 References Ackley, B. (2011).
Nursing diagnosis handbook. (9th ed. , p. 170,194,399). Lewis, S. (2011). Medical surgical nursing . (Vol. 8th, p. 1553, 1628). Williams, E. (2015). Roles of a scrub nurse. Retrieved from http://www. nursesource. org/perioperative. html Wilson , B. (2014). Pearson nurses drug guide 2014. (p. 436, 1290).