Minor Scrub

Case No.: Minor Scub #3

Name of Student: Mary Edella N. Acob
Year and Section: 3NUR1 / RLE-1

Name of Patient: C. N. F. Age: 84 Sex: F Civil Status: Widow

Date of Admission: 11/19/19 Time Started/ Ended: 9:40 AM – 10:40 AM
Date of Surgery: 11/25/19 Bed #: 210 A
Hospital number: 18-060000130578 Admission number: 19K002239

Surgeon: Dr. Teodoro Bautista Anesthesiologist: Dr. Chumacera

Assistant Surgeon: Dr. Supnet
Scrub Nurse: Irene Q. Rea, RN Circulating Nurse: Faye Angelica A. Fajardo, RN

Chief Complaint: Dyspnea

Rationale/ Definition: Due to pleural effusion, the patient experience easy fatigability
climbing 1 flight of stairs, walking or standing. There is difficulty in breathing while at rest.
It is also accompanied with chest tightness. It is most common symptom associated with
pleural effusion and is related more to distortion of the diaphragm and chest wall during
respiration.

Pathophysiology:

Risk Factor
Presence of
• 84 years old parapneumonic effusion
• Bacterial pneumonia

Permeability of the Release of inflammatory

capillaries mediators

Attracts WBC to the site,

Escape of albumin & other
pleural fluid
protein from the capillaries

Inflammation Presence of free-flowing,

worsens protein rich pleural fluid

Extensive
purulent exudate
Attracts more
production
WBCs to the site
 Adherence of the two Initiation of
pleural membranes fibroblastic activity

Adherence of the two

Formation of a peel
pleural membranes

Post-Operative Diagnosis: Empyema Thoracis

Rationale/ Definition: Empyema is also called pyothorax or purulent pleuritis. It’s a
condition in which pus gathers in the area between the lungs and the inner surface of the
chest wall. This area is known as the pleural space. Pus is a fluid that’s filled with immune
cells, dead cells, and bacteria.

Complete Surgical Procedure: Thoracentesis followed by thoracoscopy guided

deloculation left
Definition: Thoracentesis is the removal of fluid from the space between the lungs and
the chest wall that is the pleural cavity or diagnostic or therapeutic purposes using a
needle inserted between the ribs. Thoracoscopy is a procedure to look inside the chest
cavity. This is done with a thoracoscope, a thin, flexible tube with a light and a small video
camera on the end. The tube is put in through a small cut made near the lower end of the
shoulder blade between the ribs.
Indication: A pleural effusion is the build-up of excess fluid between the layers of the
pleura and the thin membrane that lines the outside of the lungs and the inside of the
chest cavity. The excess fluid is removed during a thoracoscopic procedure and may be
collected for analysis to indicate possible causes of pleural effusion.

Type of Anesthesia: Local Anesthesia

Specific Technique: Intercostal Nerve Block
Main Anesthetic Agent: Levobupivacaine HCl
Mechanism of Action: It blocks the generation and the conduction of nerve impulses,
presumably by increasing the threshold for electrical excitation in the nerve, by slowing
the propagation of the nerve impulse, and by reducing the rate of rise of the action
potential. In general, the progression of anesthesia is related to the diameter, myelination
and conduction velocity of affected nerve fibers. Specifically, the drug binds to the
intracellular portion of sodium channels and blocks sodium influx into nerve cells, which
prevents depolarization.

Position: Supine
Equipment Used for Positioning: knee strap and pillow
Incision: 2 to 3 cm transverse incision in the subcostal left
Skin Preparation: below the left breast up to the 7th rib
Drapes used: Lap sheet, OR scrub, towels
Sutures and Needles:

Tissue Layer Needle Name of Sutiure Used Suturing Technique

Cutting 2-0 Mersilk Anchor suture

Instruments:

Clamping Retracting Grasping Cutting Others

Kelly fine Weitlaner Tissue forceps Blades Needle holder

Kelly medium Allis Mayo straight Kidney basin
DeBakey Mayo curve Bowl
Russians Metzenbaum Medicine cup
Towel clip Knife handle
Trocar
Thoracoscope
Syringe