My day of observing same day surgery consisted of a day in the surgical unit at NNRH. This setting entails a very quick hectic- full of activity busy schedule. The perioperative period involves nurses in a variety of roles that help achieve that outcome of safe care during a surgical procedure. A collaboration and interdisciplinary effort helps maintain the safety of the patient, infection control, and provide family teaching. The day begins with the patient arriving in the surgery department the preoperative nurse verifies the patient using two identifiers; takes weight and height; escorts them to their room to undress into a gown. She then proceeds to take vital signs to provide a baseline and identify any abnormalities. A quick history of medical history, drug allergies, surgery being performed, and other relevant date is discussed. It is the role of the preoperative nurse to ensure that the consent form for treatment has been signed, and reinforce the previous teaching by the doctor. Any questions that the patient has about the procedure and the complication that can arise need to be addressed. The nurse educated the patient regarding the IV antibiotic; post op signs and symptoms; complications that she would need to be aware of (increase in fever, difficulty breathing, increase in bleeding, foul odor from puncture sites); a restriction of driving for the next 48hrs; and a brief discussion on diet restrictions (increase as tolerated, starting slow with soft, low-fat food).
In this case I was able to observe Dr. Ward explain the information to the patient, as well. The pt.’s IV to run NS and a piggyback of gentamycin (due to the pt.’s allergy to penicillin) was started using aseptic technique. Shortly thereafter the circulating nurse came into the room to receive handoff report from the pre-op nurse that included: allergies and pt. medical history. The circulating nurse identified the patient, insured bed rails where up, transported the patient into the operating room. Within the surgical room careful maintaining of the sterility required by the procedure was followed by the team involved in the surgery. The patient was placed onto the operating table, straps where placed to promote patient safety. The circulating nurse scrubbed the pt.’s ‘stomach with a betadine scrub and then iodine to decontaminate the surgical site. Meanwhile the other members of the team got ready for the procedure and the anesthesiologist administered general inhaled anesthesia. Oxygen via mask and endotracheal tube connected to a ventilator machine were set in place to assist the patient with breathing. One of the significant patient safety protocols followed in this setting is “time out” to go over patient’s name, diagnosis, type of surgery, location of surgery and any allergies noted.
The circulatory nurse functions included being aware of what was needed, keeping count of medical materials used and continuously monitoring the patient’s status. The potential complications that were monitored were decrease BP, temperature, heart rate, respiratory rate, excessive bleeding, positioning of the patient, and any discomfort the patient might exhibit. She also, made sure that sterile technique was maintained throughout surgery, fortunately no complications were observed. The gallbladder and various gall stones were removed and sent out for biopsy.
In the post-op recovery area, the PACU nurse immediately started taking vitals while receiving a hand off report form the anesthesiologist. The patient began coughing and stated pain in…