Operating Room Observational Experience NUR 320: Inguinal Hernia Repair, Term Paper Example

Preoperative:

1. In most cases, the attending nurse in the preoperative stage should provide pre-operative instructions and information to the patient regarding 1), the basic nature of an inguinal hernia in physical terms; 2), the basic procedures that the surgical team will follow during the operation; 3), the cause for the existing inguinal hernia in the patient; and 4), any possible complications related to the operation.
2. The consent form was first given to the patient by the attending physician/surgeon and was then signed by the patient. The nurse then checked the consent form for accuracy and asked the patient if he had any questions about the operation.
3. Before the start of the operation and after talking with the attending nurse for a few minutes, the patient showed no signs of anxiety. However, if the patient had exhibited signs of anxiety, the nurse would have asked him the reasons for the anxiety and whether he had experienced any previous anxieties over earlier operations. As to interventions, the nurse would have assured the patient that the recovery rate is only a few days and that the patient can usually go home in a day or so after the operation and that complications are usually associated with lifestyle and taking care of oneself at home.
4. In this case, the role of the circulating nurse in the holding area included meeting the immediate family members of the patient and answering any questions they might have about their loved one’s upcoming operation, re-checking the preoperative data and information on the patient for accuracy, and maintaining the patient’s baseline hemodynamic status (Dunn, 1997).

Intraoperative:

1. As is the case with almost all surgical operation, the “time out” procedure was done in order to accomplish several important goals, such as making sure that all of the surgical instruments and sharp objects are in one place and easily accessible for the surgeon, and re-checking (or double triple-checking) the preoperative data and information for accuracy related to having the right patient and the right procedure for the operation.
2. The members of the surgical team for this operation included the surgeon (a gastroenterologist), the circulating nurse whose duty it was to keep everything in order for the surgeon and do some general checking before the operation, the anesthesiologist who administered the sedative to the patient, the scrub nurse or RN technician who assists the surgeon during the operation, and a medical resident student who was on hand to witness the operation and to learn from it.
3. The types of anesthesia used during this operation included fentanyl, a potent narcotic analgesic used as a sedative, versed which acts as a depressant on the central nervous system, and propofol, another powerful narcotic used as a sedative. Overall, I did not observe any complications related to the anesthetic and the patient’s response to it.
4. Some of the safety measures used during the operation were making certain that all of the surgical instruments were in one place and not scattered about the operating room; that each surgical team member was wearing protective clothing, latex gloves, and gauze masks; and that the anesthesiologist periodically check all of the connections on the gas cylinders to determine if any of the gas was escaping and affecting the surgical team.
5. For this operation, the circulating nurse made two diagnoses–1), that the patient would experience a moderate amount of pain after the operation because of tissue swelling; and 2), that there existed the chance of infection and injury to the surgical area after the operation. As to interventions, the circulating nurse performed the following–1), administered IV fluids and pain controllers as ordered by the surgeon; 2), closely monitored the patient’s vital signs; 3), kept the surgical area free of used swabs, needles, sutures, etc.; and 4), applied an anti-bacterial solution to the patient’s skin in and around the surgical site (Nursing Care Plan for Inguinal Hernia, 2011).
6. The EBL (estimation of blood loss) for this operation was about 100 ml, and the procedure for this hernia operation included the use of lactated ringer’s IV fluid

which is used as a replacement fluid for the loss of blood during the operation. As a fluid and electrolyte replenisher, this solution is used for correction of extracellular volume and electrolyte depletion.

Post-operative:

1. During the process of relocating the patient from the operating room to the recovery room, the circulating nurse informed the attending nurse that the patient responded well to the anesthetic gases and did not experience any complications related to the administration of the sedatives nor the pain controllers; that the patient has not complained so far of any discomfort and to be prepared to administer an analgesic to control the pain; to check the patient’s vital signs and watch for any indication of complications from the operation, such as bleeding or hemorrhaging; and to help support the patient from a state of dependence (i.e., still feeling the effects of the narcotic sedatives) and independence or when the patient becomes fully conscious (Lesson 8: Perioperative Patient Care, 2007).
2. With operations such as an inguinal hernia, the circulating nurse during the post-operative period of recovery from surgery performed the following actions–1), monitored the patient’s vital signs for an elevated temperature, weak or rapid pulse, and a decrease in blood pressure; 2), checked all medication orders from the physician; 3), prepared all medications by labeling them and calculating dosage amounts; 4), checked the patient’s ID wristband to “ensure positive identification before administering medications;” and 5), administered the medications (Lesson 8: Perioperative Patient Care, 2007). Other actions included 1), trying to make certain that the patient does not cough which can lead to pain and possible injury to the surgical site; 2), applying ice bags to the patient’s groin area in order to help reduce swelling and ease pain; and 3), asking the patient if he was experiencing any sort of discomfort which might necessitate the application of suspensory bandages or some other type of support device to ease discomfort and pain (Nursing Care Plan for Inguinal Hernia, 2011).
3. After the patient had spent two days in the hospital in order to partially recover from his hernia surgery, the attending nurse at discharge provided him with the following instructions–1), if he has been fitted with a truss, he must bathe daily and “apply liberal amounts of cornstarch or baby powder to prevent skin irritation”; 2), that he will most likely be able to return to work and his usual lifestyle within two to four weeks; 3), to be sure to obtain his doctor’s permission to return to work; 4), to watch for signs of infection, such as tenderness and redness at the point of surgery and to keep the incision as clean as possible; 5), to take all of his required medications and antibiotics; and lastly 5), to refrain from any heavy lifting and straining which could damage the repaired hernia area (Nursing Care Plan for Inguinal Hernia, 2011).

References

Dunn, D. (1997). Responsibilities of the preoperative holding area nurse.

AORN Journal. Retrieved from http://www.aornjournal.org/article/S0001-2092%2806%2962663-X/abstract

Lesson 8: Perioperative patient care. (2007). Retrieved from http://www.brooksidepress.

org/Products/Nursing_Fundamentals_II/lesson_8_Section_3.htm

Nursing care plan for inguinal hernia. (2011). Nursing Directory. Retrieved from

http://www.nursingdirectorys.com/2011/01/nursing-care-plan-for-inguinal-

hernia.html