TAM Giamvattisia Suegcey | Rotation, fia [it This past Thursday I completed my surgery rotation at St. Elizabeth's Boardman Hospital, and it was truly an experience I will never forget. Leading up to that morning, I was very nervous about whether or not I would have the stomach for an OR room and be able to observe everything I wanted to. J arrived at 6:30am and met Shelly, who placed me in the specific OR rooms I was able to go in throughout the day. I met the pre-op nurses and they showed me everything they were responsible for doing to prep the patients for surgery. The specific patient I followed from pre-op to post-op I will refer to as Jane throughout this paper. Jane arrived NPO for her surgery, which was scheduled for 7:30am by Dr, Patel. Jane had been dealing with chronic cysts and fibroids throughout her ovaries, fallopian tubes, and most recently her uterus, These fibroids and cysts left her in excruciating pain and constant cramping, along with heavy bleeding. Jane, age 50, finally conferred with her doctor and they decided together that the best option for her was to get a total hysterectomy and bilateral salpingectomy (complete removal of uterus, cervix, and both fallopian tubes, leaving the ovaries to maintain hormonal balance in Jane’s body.) The procedure would be carried out using general anesthesia, completely paralyzing all of Jane. This included all of her bre jing muscles, meaning she would need to be fully intubated. ‘A week before Jane’s surgery, she was called by Pre-Admission and they went through all of her health history extensively: past surgeries, all medications to date, recent colds or fevers, any traveling taken place outside of the US, if diabetic! hypertensive, and all known allergies. They then informed Jane of everything to do in order to prep prior to her surgery: which medications to withhold, when to have her last drink/meal, what to wear/bring the day of, etc. When Jane arrived Thursday morning, most of these health history questions were already answered and updated in the Epic charting from Pre- Admissions. ‘After being brought back to the pre-op room, Jane changed into a gown. The pre-op nurse then ‘compared ID and allergy bands to the chart, collected all vitals, and made sure all consent forms were signed by the patient. She also had to make sure the doctor’s last H&P was within the last 24 hours, andif not send in a request to get this fulfilled before the OR. ‘The pre-op nurse was also responsible for starting the TV and the 0.9% normal saline solution pump. The anesthesiologist then came in, went through another extensive list of history questions relating to things such as smoking history, asthma, dentition records, ete... then he hung the antibiotic of choi to start infusion pre-operatively. ‘The surgeon also came in pre-op to greet the patient and make sure everything was good to go. then met up with John, the circulating nurse for Jane’s operation, and the CRNA, to take Jane baek to surgery. John was very experienced and informative in regards to his role in the OR. Prior to this moment, my nerves were building up and adrenaline was really pumping, but he set me at ease and gave me a rundown of everything that was about to occur. He explained to me that some surgeons do not like the door opening or closing throughout the surgery to decrease risk of infection, particularly in ‘an orthopedic procedure. He also told me about the positive pressure within the room so the air always flows out instead of in, which I found interesting, The room itself: there was myself, and John (circulating nurse), as well as Kristen (physician ass istant), Pam (scrub nurse), the student CRNA and his instructor, and Dr. Patel. ‘The scrub nurse had {just finished the initial count ofall the gauze, needles, and instruments... I was informed not to touch any of the three long tables covered with sterile covers and instruments for the procedure to come. ‘This hysterectomy was going to be done laparoscopically, meaning it was far less invasive than other surgeries. The communication in the room, generally speaking, was short and direct. The induction time, start time, and end time was all recorded by John... throughout the three-hour procedure, he was mainly responsible for adjusting the monitor screens (so Dr. Patel could view them appropriately) and charting every piece of information in the computer system. In addition, he also had to check in/out cach individual that was in the room at the time, He was also responsible for helping the scrub RN do the initial count as well as the end count; he also had to help everyone put on their sterile gowns and gloves. John left the OR multiple times for certain supplies in the supply room down the hall; he was the only one in the room unsterile, besides myself and the CRNA.v) ‘The serub RN, Pam, was right in there with Dr. Patel, although Dr. had a physician assistant ‘mainly helping her throughout the procedure. The scrub nurse started by doing a full iodine cleanse of the abdominal and vaginal area, as well as making sure Jane was in the correct positioning for the procedure. They put her in padded stirrups and strapped her body in to avoid sliding on the table. The serub RN also inserted the foley catheter at this time, now that the patient was fully under. From this time and for the next two hours, Dr. Patel made three small incisions for laparoscopy (RLQ, LQ, and umbilicus.) This allowed her to see inside the abdomen and have access to the uterus and tubes without having to make a large incision. At this point I had decided that I can stomach the OR, and was able to watch the entirety of the procedure! Everything that was removed from the patient ‘was appropriately labeled in formaldehyde solution to be sent down to pathology. During one part of the procedure, the circulating nurse stopped the scrub nurse and made her check to see if one of the surgical tables was crushing the patient’s foot in the stirrup. The circulating nurse was constantly checking position of the patient to avoid nerve and muscle damage from the three-hour surgery. In this, specific example, the nurse was definitely acting as the patient advocate. Because Jane was under general anesthesia, she had to go spend at least thirty minutes in the PACU, 1 followed her there to meet the PACU nurse and see everything they do. Their main. responsibilities included: vitals every five minutes, rating and managing pain, calling/updating family ‘members, and eventually calling a transfer to either Stage II post-op or the hospital floor in which they ‘would be admitted to. In my ease, it took Jane about 45 minutes to wake up and become stable, and she was headed to a med-surg floor. Within her time in PACU, she received six doses of fentanyl and one dose of Toradol. She was then sent up to her floor for admission and I said my farewells. ‘Thursday was definitely a day I will never forget. Surprisingly, everyone I met that day was not, ‘annoyed that I was there, which I initially feared. They were very informative and excited to show me i What exactly the OR is about! It was very different from a nurse's role on the floor; 1am happy YSU W/ * continues to give me such great experiences in the nursing world, oe ib Ry