Perioperative Nursing Experience

Rachel Carter
Clinical Date: 1/27/2011

During my last clinical experience, I had the opportunity to go to the OR and sit in on
two surgeries: a radical prostatectomy and a thyroidectomy. I had a great advantage in that one
surgery was performed using new ROBOT technology, and the other was performed manually
by the surgeon himself. Although I was only able to see the intraoperative phase of both
surgeries, the nurses were great educators and thoroughly explained the steps taken during both
the preoperative and postoperative phases of the operations. The majority of my day was spent
watching the prostatectomy due to its prolonged length, as it was the surgeon’s first time using
the ROBOT, so he required extensive help and guidance from a fellow, more experienced
surgeon.
I: Preoperative Phase
The preoperative phase of a surgery takes place from the time when the patient is
scheduled for surgery until the patient is transferred to the OR suite. I was able to look at the
preoperative checklist used for surgeries which included the following:
 obtaining the surgical consent form
 thorough documentation of the patient’s history and physical examination
 patient education, including risk factors, pain management, expected recovery
time, and exercises to help prevent postoperative complications
 patient’s pre-procedure labs, x-rays, and EKG
 list of patient’s medical allergies
 documentation of preparation including removal of clothing and jewelry
 time of last PO intake
 time of last urination and bowel movement
 administering pre-procedure medications
The most critical aspect related to the legal issues of this phase is obtaining the consent form. It
is very important that the nurse ensures that the physician has explained the surgery in detail to
the patient, and that the patient’s actual signature is on the consent form. Regarding safety issues,
patient education and proper documentation of all pre-procedure activities (labs, radiological
reports, obtaining list of allergies) be completed. For the prostatectomy, the nurse showed me the
consent form which contained the patient’s signature. The consent form included a detailed
description of the procedure as well as the risk factors, which included urinary incontinence and
erectile dysfunction. Both risk factors had been explained to the patient, who decided to go ahead
with the surgery due to the radical and invasive nature of his cancer. The patient had opted for
the ROBOT surgery over the manual surgery because of the extensive benefits of the surgery,
which had been explained by the physical during an education session. Such benefits included:
 high success of cancer control
 early return of sexual function and continence
 minimal invasiveness
 less pain, blood loss, and scarring
 shorter recovery time (patient discharged home the following day, skipping the
usual 4-5 day postop hospitalization)
The nurse then showed me the section of the patient’s chart which included his labs, radiology
reports, EKG, and history and physical exam. The patient was a 51 year old white male who had
no medical history other than degenerative joint disease, for which he had a hip replacement in
2005. His social history included extensive tobacco abuse and moderate ETOH use; however it
was documented that the patient had ceased smoking within the last 6 months with the aid of
Chantix. The patient’s labs were unremarkable (WBC 5.1, HGB 15.9, HCT 46, INR 0.9, K 4.4),
as were his EKG and chest x-ray, and his vital signs were stable. After the pre-procedure
medications had been delivered, he was ready for transfer to the OR.
II: Intraoperative Phase
The intraoperative phase is the phase of the surgical process which requires the most
attention and competency on the part of the surgical team involved, in my opinion, because there
are so many opportunities for things to go wrong (i.e. wrong legs cut off, instruments left inside,
inadequate suturing, major breaks in sterility which go unchecked… they’ve all happened!). The
two nursing roles, the scrub nurse and the circulating nurse, play a major role in safety
precautions and preventing unnecessary mess-ups (like those mentioned above). Anesthesia itself
presents a major safety risk. Although complications related to anesthesia are handled by the
anesthetist or CRNA, it is important for the nurse to be aware of the risk factors, the most
important being severe respiratory depression.
 The surgical position the patient had to be placed in for the prostatectomy posed a risk in
itself: he was placed in the highest Trendelenberg possible (between a 30 and 45 degree angle),
which the nurse stated always resulted in postoperative eye swelling, but could also lead to the
patient literally slipping off the table. The nurses ensured the patient was adequately strapped to
the table, and added two large shoulder harnesses to prevent the patient from sliding backwards.
The two nursing intraoperative nursing roles include the scrub nurse and the circulating
nurse. The scrub nurse constantly monitors aseptic technique, aids in setting up the sterile field,
and handles all of the surgical equipment. The circulating nurse plans and coordinates the
surgery – she keeps track of all documentation, monitors who is in the room, calls the “Timeout”
(this is patient ____, here for radical prostatectomy, surgery to be performed by Dr. Shelton;
patient in room at 0806, intubated at 0810”), and provides send-off report to the PACU nurse and
the end of the surgery. I sat with Carol, the circulating nurse, for the duration of the surgery (I
had not “scrubbed up” and was therefore not sterile, so I remained clear of the scrub nurse and
surgeons). She was a fantastic educator and walked me through the entire procedure as it was
occurring.
Other roles of the health team present for this surgery included two surgeons (one who
was very familiar with the ROBOT technology and was assisting the other surgeon) who were
responsible for completing the actual surgery itself, and the CRNA, who was responsible for
anesthetizing the patient and monitoring his status throughout the surgery.
III: Postoperative Phase