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Perioperative surgical experience: thyroidectomy

Members of the perioperative team


Circulating nurse
The main role of the circulating nurse was to set up the OR correctly,
which included checking all equipment needed during the procedure to verify
they were functioning properly, and preparing the surgical equipment assuring
sterility of the instruments. When the patient arrived, she verified the patient's
identity and necessary consent forms and then reviewed the site and nature of
the procedure with the surgeon. She also assisted the surgical technicians, to
position and secure the patient to the operating table, making great emphasis on
patient safety.
Scrub nurse
The scrub nurses main role was to maintain asepsis, thereby reducing the
chance for infection. She was responsible for scrubbing the patients surgical
site, to reduce the number of potentially pathogenic bacterial, managing the
sterile field, and arranging the sterile instruments. There was a section in the
operation room, with blue drapes, that was designated only for sterile
instruments, therefore no one but the scrub nurse or the surgeon could be next to
it.

Nurse anesthetist

The nurse anesthetist intubated the patient, administered anesthesia, and


carefully monitored the patients vital life functions, including heart rate and
rhythm, breathing, blood pressure, body temperature and body fluid balance. He
also controlled the patients pain and level of consciousness.
Surgeon
He performed the surgery and he definitely had the greatest legal
responsibility for the patients well-being; however, all members of the surgical
team worked diligently to anticipate potential problems, reduce surgical infection
risk, and formulate interventions for the best possible patient outcome.
Nursing Diagnosis
Impaired tissue integrity r/t disruption of tissue associated with the surgical
procedure AEB thyroidectomy.
Risk for infection r/t surgical incision.
Risk for aspiration r/t impaired swallowing AEB thyroidectomy
Preoperative and Intraoperative phase
The preoperative nurse has the responsibility of ensuring that he patient is
physically prepared to undergo surgery, therefore she assessed the patients
compliance with preoperative orders, performed patient testing, reviewed the
release forms, and assessed the patients current level of wellness. In case of an
illness the patient may not qualify for the procedure, and will require additional
monitoring. The nurse also was responsible of taking the patients vital signs,
administering intravenous fluids, and insertion of a urinary catheter while the

patient was under anesthesia. The preoperative nurse also has the important
task of patient education; this includes teaching regarding the surgical procedure,
medications to be administered, anticipated time of discharge, and post-operative
restrictions.
The nurse anesthesiologist works together with the preoperative nurse in
assessing a patients medical readiness for surgery. He interviewed the patient to
gather information related to allergies, he also performed a focused history and
physical examination, reviewed laboratory and test results, and assessed the
need for additional testing prior to proceeding with surgery. Both nurses play a
key role in assessing and managing the patients preoperative anxiety. They
explained that anxiety can lead to arrhythmias, high BP and pain, which
adversely influence the anesthetic induction and patient recovery. Teaching
regarding the preoperative procedures, surgery itself and recovery, and listening
to the patients concerns, give the patient a sense of control, decision making,
and reduces surgical anxiety.
The procedures for preparing this female patient for surgery consisted of
instructing the patient about refraining from eating or drinking at least 8 hours
before the procedure, as well as holding the medications. Aside from the routine
pre-operative tests, the evaluation of this patient prior the total thyroidectomy
surgery included a blood test to measure the level of thyroid-stimulating hormone
(TSH) in the bloodstream, and CT scan to determine the size of the thyroid gland
and location of abnormalities.

This type of surgery is generally safe, but like any other invasive
procedure also has its risks. After the procedure the patient may experience
hoarseness and change of voice, since the nerves that control the voice can be
damaged during the surgery. Other main complications can be bleeding,
respiratory distress, infection, hypocalcemia, and hypothyroidism. To avoid these
complications, an assessment of the patients voice is made prior to surgery; the
surgery team maintains strict aseptic techniques to avoid infection. The surgeon
also avoids traumatizing the thyroid tissue during the procedure; provide good
intraoperative hemostasis and periodic assessment to the surgical site to detect
hematoma formation.
The main principles of asepsis used in the operating room were:
- Pre-surgical hand preparation with solutions containing iodine or chlorhexidine.
- Sterile drapes are used to create a sterile field. They are placed on the patient,
furniture, and equipment to be included in the sterile field, leaving only the
incisional site exposed.
- Scrubbed (sterile) personnel function only within the sterile field. Non-sterile
personnel work in the periphery of the sterile surgical field.
Post-operative phase
After surgery, the nurse anesthetist main role was to awake the patient
and make sure it was a smooth transition out of anesthesia and that the patient

was able to breath by herself. She was then transferred to the PACU unit where
the patient continued to emerge from the effects of anesthesia under the watchful
eyes of the nurse. The nurse anesthetist gave a report to the nurse about how
the surgery went, they check for orders of pain medication, made sure the patient
was covered, SCD in place and they keep talking and calming the patient.
Evidence of recovery like activity level, breathing, circulation, and level of
consciousness were continuously monitored.
The recovery process includes teaching the patient about necessary
lifestyles changes to avoid complications. The patient is instructed to get plenty
of rest, avoid heavy lifting, to take the medication as directed, avoid soy products,
to detect and notify the physician of signs and symptoms of hypothyroidism
among other indications.