Operating Room Observational Experience, Term Paper Example

Introduction

A discussion of preoperative, intraoperative, and postoperative approaches to surgical interventions requires nurses and other clinicians to provide education, guidance, and support to patients during these difficult experiences. The patient in question required a total hip replacement using Open Reduction Internal Fixation (ORIF) to repair the fractured bone. Therefore, the nursing staff was instrumental in providing the patient with an increased level of comfort prior, during, and after surgery so that she experienced a lower level of anxiety and expanded knowledge regarding the procedure and the required aftercare to promote a full recovery.

Preoperative

1.Prior to this procedure, the patient should have received education and guidance regarding the procedure, including its risks and benefits, how to prepare for the procedure, and the potential outcomes after the procedure, including pain and any other possible complications, as these efforts are likely to limit anxiety and improve the potential for success (McDonald et.al, 2008).

2.The patient signed the consent form since she has full cognitive abilities to understand and consent to the procedure. The physician in charge of this case should confirm that the consent form is signed prior to conducting the procedure, and the nurse is responsible for summarizing the form and obtaining the patient’s signature.

3.Prior to the procedure, the patient appeared somewhat anxious due to the wait time prior to the surgery. An assessment would require the patient to share her emotions regarding the upcoming surgery and to provide support as needed to the patient to alleviate any anxiety that is evident (Bailey, 2010).

4. In the holding area, the nurse is responsible for ensuring that the patient remains calm and as anxiety-free as possible by providing support and guidance regarding the procedure and what is expected to occur.

Intraoperative

1.The time-out procedure enables “the entire surgical team to verify the correct person, procedure, and site” (Nursezone, 2013). This enables the team to confirm that the current circumstances are correct before the procedure begins.

2.The members of the surgical team included the surgeon performing the procedure, an anesthesiologist to administer anesthesia and monitor the patient’s response, and two surgical nurses to assist as needed.

4. General anesthesia was given to the patient without any complications.

5. A time out procedure was conducted to ensure that the circumstances, personnel, and other environmental conditions were appropriate for the patient’s procedure.

5. Nursing diagnoses for this patient include acute pain in the hip area and limited mobility. Possible interventions include a detailed pain assessment, stabilizing the position of the hip to limit possible complications, improve comfort through therapeutic touch, and administer medication for pain on an as-needed basis (eNurse Care Plan, 2013).

6. EBL for this procedure is relatively high due to the nature of the procedure and its complexity, particularly when general anesthesia is used (Menezes et.al, 2011). Therefore, this surgery may require fluid replacement in the form of blood transfusions to restore any blood loss that has been identified (Menezes et.al, 2011).

Postoperative

1. After the surgery is complete, the recovery room nurse will be provided with information regarding the patient’s vitals, blood loss, prognosis, and a general overview of the surgery and its level of success. These efforts will provide important information for the nurse in administering the next phase of care for the patient.

2. Postoperative nursing management for this patient requires the following: 1) an hourly evaluation of homodynamic status, 2) routine evaluation of blood and any other type of fluid loss; 3) observe the incision site and determine the possible risk of infection; 4) maintain circulation in the lower limbs to sustain regular blood flow; 5) manage pain as needed; and 6) ensure that the patient is properly aligned (AADO, 2007). Each of these techniques will provide the patient with an optimal chance of recovery.

3. For this patient, the discharge instructions must be comprehensive and appropriate to achieve optimal recovery. Upon discharge from the hospital, if rehabilitation nursing care is not required, the patient will be discharged to the home environment. A walker or crutches will be required for a period of time, but as pain subsides and mobility returns, these devices may no longer be necessary (Medline Plus, 2013). The home environment should be adequately setup for recovery, including a low bed height, bathroom safety tools, and fall prevention whenever possible (Medline Plus, 2013).

References

AADO (2007). Post-operative nursing management: hip fracture surgery. Retrieved from http://www.aado.org/file/hip-fracture-seminar_jul07/7-Nursing-managment-Hip-surgery.pdf

Bailey, L. (2010). Strategies for decreasing patient anxiety in the perioperative setting. AORN J 92, 445-457.

eNurse Care Plan (2013). NCP Total Hip Replacement. Retrieved from http://www.enurse-careplan.com/2011/04/nursing-care-plan-ncp-total-hip.html

McDonald, S., Hetrick, S.E., and Green, S. (2008). Pre-operative education for hip or knee  replacement. The Cochrane Library, Published online 8 October 2008.

Medline Plus (2013). Hip replacement – discharge. Retrieved from

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000169.htm

Menezes, S., Manso, T., Seifert, I., Rodrigues, R., and Gil, G. (2011). Blood loss in total hip|knee replacement surgery: 6AP5-7. European Journal of Anesthesiology, 28, 92.

Nursezone (2013). Operating room nurses to ask for time out. Retrieved from http://www.nursezone.com/nursing-news-events/more-news/Operating-Room-Nurses-Ask-for-Time-Out_34414.aspx