In OR room 7 today I got to watch four surgeries, it was amazing and so interesting to watch way better in person than watching surgeries on the TLC channel. I was astonished on how quick and efficient the surgeries were and how the surgical team was so organized. Nursing duties in the surgical setting were so different from what I had seen in the med surg. Floor. The one surgery that interested me the most that I saw today was the Arthroscopic debridement of the knee. This surgery was the most interesting to me because I know it is so common and how minimally invasive it is.
My grandfather is actually going to get that surgery in about two months so I am glad to tell him about what I saw so he will be more informed and less worried. Arthroscopic knee surgery is a procedure performed through small incisions in the skin to repair injuries to tissues such as ligaments, cartilage, or bone within the knee joint area. The debridement is the removal of dead or damaged tissue to smooth out the bone surfaces and tissue fragment. The surgery is conducted with an arthroscope, which is a very small instrument guided by a lighted scope attached to a television monitor.
This surgery is performed for acute injuries that destabilize the knee, and pain management for floating or displaced cartilage and rough bone. The patient I observed had a fall which tore her meniscus so the surgeon was to debride (remove) the damaged cartilage tissue to stabilize the knee and decrease the pain associated with the injury. The potential complications with this surgery are related to the use of anesthesia, including heart attacks, strokes, pneumonia, and blood clots. Complications are rare with this surgery but one that is not directly related is the pain not being relieved after time healed after surgery.
Today I learned by observations and questions about the roles and duties of the staff. The surgical technicians’ duties were to assemble tools, room, assist surgeon with tools, operate diagnostic machines, suctions and other equipment, cut sutures, handle drugs and maintain fluid supply, such as blood and plasma. The anesthesiologist role was to administer sedative drugs ( anesthesia, and monitor patients vitals throughout the procedure. The circulating nurse was responsible for charting, the instrument count, gathering supplies, ensuring equipment worked.
Also in pre- op the nurse makes sure all proper documentation is filled out such as the consent form, assessment of allergies, labs,diagnostics, health history, and baseline vitals . During pre op the patient is taught to not wear jewelry in surgery,leave valuables at home, be NPO according to physician time frame, and cleanse surgical area with chlorhexidine the night before. The patient is instructed that dentures, prosthetic devices, hearing aids, contact lenses, fingernail polish, and artificial nails must be removed before going into surgery.
Also during pre- op the surgeon explains the surgery to the patient and answers questions as well as initial and mark correct place of surgery just prior to procedure. In the post operative teaching the patient is informed on cough, turn, deep breath technique, dietary status, respiratory care when indicated, refrain from smoking during perioperative period, and activity post-surgery and any specialized post-op instruction including surgical site infection prevention.
Unfortunately I wasn’t able to be with the family and surgeon when the nurse was giving information prior or post-surgery because I was watching multiple surgeries one after another. Prior to surgery the room was cleaned (mopped, wiped down, trash and old supplies taken out) by the surgical tech, nurse, and cleaning person. The surgical tech brought in new tables with sterile supplies and drapes. The surgical technician set up all the surgical instruments on a sterile drape while wearing a sterile gown, gloves, mask and cap.
The nurse assisted in the count of all tools while setting up the room. The anesthesiologist came and prepared their supplies and area . The surgeon walked in and with freshly washed hands up while surg. Tech gave sterile towels to dry hands. Surgical technician helped put on gown and gloves of surgeon. Patient arrived in room and was put on surgical table. Patient was in hospital gown with no jewelry , undergarments, dentures or piercings. The nurse cleaned the knee and leg area with 2% chlorhexidine gluconate. This solution is used to prevent infection and cleanse the skin.
Before the surgery started the nurse called a time out and verified patient name, birthday , surgery, and right location with all staff at the same time. Patient was administered drugs: propofol,succinylcholine, and nitrous oxide gas by the anesthesiologist by IV and and the gas by mask. Propofol is an intravenous sedative-hypnotic agent for use in the induction and maintenance of anesthesia or sedation. Succinylcholine is a nicotinic acetylcholine receptor agonist, used to induce muscle relaxation and short-term paralysis, usually to facilitate tracheal intubation. Nitrous Oxide also known as laughing gas is a anesthetic pain killing gas.
These combination of drugs help put the patient to sleep, sedate them, and make sure they don’t feel during the surgery. During the whole surgery the patient was treated with dignity and respect. Warm blankets were placed on the patient and the patient was covered in all places except the knee and the staff conducted themselves in a professional respectful manner the whole time. The surgery barely had any blood since it was so minimally invasive , I was able to see what was being done on two screens which was feed from the tiny camera placed in the knee during the procedure.
I observed how the torn dead tissue was being removed with the tiny instrument, only three small holes were placed in the knee during the procedure and it only lasted a half hour. During the procedure the surgical tech handed surgeon all tools and the nurse charted and retrieved any extra needed supplies from outside the room from surgery. After surgery was completed nurse , surgery tech , and cleaning person disassembled and cleaned room again for next surgery. Patient was transferred to PACU. When the patient arrives to PACU hand off report is given to the nurse.
In hand off report information includes type and extent of the surgical procedure, type of anesthesia and length of time the patient was under anesthesia, tolerance to anesthesia, allergies, any health problems, vital signs, type/ amount of IV fluids , drugs administered, intraoperative complications, preoperative drugs and patient response, and special requests that were verbalized by the patient preoperatively. Priorities of admitting and caring for a patient in ICU are to keep the patient stabilized and evaluate any complications after surgery.
The PACU nurse closely monitors and the patient for any problems or emergencies. The PACU nurse is prepared and educated how to act in these emergency situations if they occur. The nurse calls the anesthesiologist or doctor if they need to. The head of the bed is raised up to promote a safe and effective airway while the patient is in PACU. Medications that control pain, nausea, and blood pressure are given in PACU to treat symptoms after surgery. Medications such as Dilaudid, Phenergan, Zotran and some antihypertensive are given these drugs are given as prescribed.
Overall today was a great insightful experience I will never forget. Today has definitely sparked my interest in surgical nursing. I am glad that I have firsthand information that I can describe to my grandfather about his upcoming surgery.
References McKenzie, N. (2007). Knee arthrscopic surgery. Retrieved from http://www. surgeryencyclopedia. com/Fi-La/Knee-Arthroscopic-Surgery. html Smart, B. (2011). Pacu nurses a vital aid to recovery. Retrieved from http://www. ncah. com. au/news-events/pacu-nurses-vital-aid-to-recovery/70/.