Jan Kathleen N.

Rafols RLE- OERATING ROOM

BSN-3- GROUP 1

Case Scenario:

A 35-years old mother G2P1 had previous caesarian section in her first child was admitted in OB
ward. She is 39th weeks pregnant and scheduled for elective caesarian section. She has history of
elevation of blood sugar during the course of pregnancy. The latest fasting blood sugar result is
120mg/dL. The latest vital signs are Blood pressure –120/85mmHg, temperature 370c,
Respiration- 21bpm, Pulse rate – 88bpm. Doctor order for cesarean section today after pre-op
preparation accomplished. The nurse started intravenous fluid of D5LRs 1 liter on the right
cephalic vein and regulated to 40gtts per minute. The ward nurse informs the operating room
staff about the patient’s schedule for operation. OR nurse ensure that the major set of
instruments, materials and equipment's for cesarean section is ready. The Operating room nurse
fetches the patient in OB ward accompanied by the nursing aide. Endorsement was done between
OB ward nurse Wenna and OR nurse Micah regarding the patient’s status, Physical and
psychological preparation and other necessary concerns.

OR nurse started the pre-op preparation in OR; transferring patient to OR table, psychological
and spiritual support provided. Setting up of the sterile field done by scrub nurse Lorie. The
scrub team were informed and proceed to scrubbing room. Induction of anesthesia was done by
anesthesiologist Dr. Hilotin assisted by Nurse Buddy. Skin preparation, draping of patient, and
counting of instruments done then followed by surgical “TIME OUT” by circulating nurse
Buddy. Continuous monitoring of patient and scrub team was done until the procedure finished
and immediate post op care was provided by Nurse Buddy.
Enumerate what are the important data to be asked
to patient and OB ward nurse during endorsement.
Preoperative preparations focus on a variety of nursing activities, including data
collection through patient assessment, patient or family teaching, emotional support, planning of
care for the intraoperative and postoperative periods, and communication of patient information
to healthcare team members which include the OB nurse.
PRE-OPERATIVE CHECKLIST
 Identification Band on hand
 Surgical consent signed
 Consultation
 History and physical on chart
 If the patient had a previous caesarian section
 History of illness such as has history of elevation of blood
 Allergies to drugs
 Surgical prep done and checked
 Knowledge of the patient gained through assessment in the preoperative period
 Assess current lab values outside of normal limits, medical or surgical history
relevant to Cesarean section, where can the patient’s family be reached, prosthetics,
missing information or documentation.
 Pre – op medication administered
 Endorsement of the latest fasting blood sugar result is 120mg/dL as well as the latest
vital signs which are Blood pressure – 120/85mmHg, temperature 370 c, Respiration-
21bpm, Pulse rate – 88bpm
 The doctor’s order of cesarean section.
 The IVF that was administered including the level of the IVF which is D5LRs 1 liter,
site of insertion on the right cephalic vein that is regulated to 40gtts per minute.
Enumerate the considerations to remember by the
scrub team prior to surgical scrubbing.
All members of the sterile surgical scrub team are required to perform a surgical hand
scrub and don sterile gown and gloves before touching sterile equipment or the sterile field. The
correct performance of these procedures helps to protect a patient from infection by preventing
pathogenic (disease producing) micro-organisms on the hands, arms and clothes of “sterile” team
members from coming into contact with a patients wound during an operation.
Preparation for scrubbing
Personal cleanliness is of extreme importance for operating theatre personnel. A daily
shower, frequent hair washing and attention to hands and fingernails are most important. Finger
nails should be kept short enough so that they are not visible over the tips of the fingers.
Jewelry
Jewelry is a hazard in theatres; wrist watches and jewelry of any kind (including dress
rings and bangles) must not be worn. Wedding rings harbor bacteria so should be removed when
scrubbing wherever possible. Earrings are dangerous in that they may fall into a wound and
therefore must not be worn at any time. All staff should adhere to “bare below the elbows” prior
to any form of clinical contact with patients.
Clothing
All operating theatre staff should wear a clean, short sleeved cotton scrub suit each day
before entering the operating department. The scrub suit should cover any other clothing such as
underwear, and trouser legs should not touch the floor as this may transport bacteria from one
place to another.
Footwear
Dedicated personalized closed toe non-slip footwear must be available for all regular
theatre staff in the theatre complex. Boots should be worn if there is a high risk of heavy
blood/body fluid loss. Observers to theatre procedure within the operating theatre must be
provided with spare theatre shoes.
Hats
Within the operating theatre hair must be completely covered with a clean disposable hat
that should be changed at least daily, on leaving the department or if visibly contaminated with
blood or other fluids and disposed of into a clinical waste receptacle. This is to prevent the
possible contamination of the sterile field by falling hair or dandruff. Beards must be covered
with a hood. Outside of the operating theatre but within the theatre complex, hats need not be
worn but hair must be tied back and up off the collar.
Masks
A surgical mask is worn primarily to protect the patient from bacteria exhaled by
operating room personnel. All members of the scrub team should wear a mask, but the wearing
of masks by other personnel should be at the discretion of the Consultant in charge. Every
individual in the operating theatre should wear a mask when prosthesis / implant surgery is
taking place.
Scrub Rooms
Scrub rooms must be stocked with a variety of types and sizes of sterile gloves, sterile
gown packs, antimicrobial cleansing solutions and sterile nail brushes/sponges with a nail pick.
These brushes are pre-packed, for single use only and some may already be impregnated with an
antimicrobial solution. Scrub brushes may be placed in dispensers next to sinks.
The Surgical Scrub
The following section outlines the surgical hand antisepsis procedure.
 Your initial scrub procedure should last 5 minutes.
 Subsequent procedures last 3 minutes.
 A clock should be provided for timing the scrub procedure.
Gowning
Surgical gowns are folded with the inside facing the scrub person. This method of folding
facilitates picking up and donning the gown without touching the outside surface. If the scrub
person touches the outside of the gown whilst donning it, the gown must be considered to be
contaminated. If this occurs discard the gown.
Surgical Glove Technique
Gloves act as a barrier to prevent transmission of infection between staff and patients.
Surgical gloves must fit appropriately for comfort, dexterity and sensitivity. Sterile gloves are
packaged so that the scrub person may don the gloves without contaminating the outer surfaces.

Enumerate the duties and responsibilities of the OR

health team.
The operating room (OR) team is responsible for the well-being of a patient throughout
the operation. This team should not only consider the patient’s privacy but will also promote
safety measures for the patient. One way of promoting safety of patients inside the OR is by
preventing infection from the surgical incision that will be done.
Patients undergoing surgery will be taken care of the operating room team. Safety and
privacy of patients in the OR is safeguarded by the operating room team members. Personnel
inside the OR consist of the operating surgeon, assistants to the surgeon, a scrub person, an
anesthesiologist and a circulating nurse. Each member of the OR team performs specific function
in coordination with one another to create an atmosphere that best benefit the patient. The team
is divided into two divisions according to the function of its members:
STERILE TEAM UNSTERILE TEAM
MEMBERS MEMBERS
Operating Responsibilities of a surgeon: Anesthesiolo Responsibilities of an
Surgeon 1. Preoperative diagnosis gist or anesthesiologist or anesthetist
and care of the patient Anesthetist 1. Choice and application
2. Performance of the of appropriate agents.
surgical procedure 2. Choice and application
3. Postoperative of suitable techniques of
management of care administration.
3. Monitoring of
physiologic function.
4. Maintenance of fluid
and electrolyte balance.
5. Blood replacement.
6. Helps in minimizing
the hazards of shock, fire
and electrocution.
7. Use and interpret
correctly a wide variety of
monitoring devices.
8. Overseeing the
positioning and movement
of patients.
9. Oversee the
postanesthesia care unit
(PACU) to provide
resuscitative care until the
patient has regained vital
functions.

Assistants The responsibilities of a Circulator Responsibilities of a circulator:

to surgeon surgeon’s assistant: 1. Monitor and coordinate all
1. Help maintain the activities within the room.
visibility of the surgical 2. Manage the care required
site for each patient.
2. Control bleeding 3. Provides assistance to any
3. Close wounds member of the OR team
4. Apply dressings with strict observation to
5. Handles tissues avoid a break in sterility.
6. Uses instruments 4. Creates and maintains a
 safe and comfortable
environment for the patient
through the implementation
of aseptic technique

SCRUB  Is scrubbed in at the field

PERSON  Set up sterile supplies and
instrumentation
 Assist the surgeon as needed
during the operative
procedure
 Performs all needed counts
with the circulating nurse
 Knowledge of aseptic
technique

The members of the OR sterile team will do the following things:

1. Perform surgical hand washing (arms are included).
2. Don sterile gowns and gloves.
3. Enter the sterile field.
4. Handles sterile items only.
5. Functions only within a limited area (sterile field).
6. Wear mask.
The unsterile operating room members are not allowed to enter the sterile field to prevent
contamination. The responsibilities of the members of this team are the following:
 Handle supplies and equipment that are considered unsterile.
 Touches unsterile surfaces only.
 Keep the sterile team supplied with supplies handled aseptically.
 Give direct patient care.
 Assist the sterile team member’s need with strict observation of avoiding contact to the
sterile field.
 Handles other requirements arising during the surgical procedure.

Enumerate the Nursing responsibilities of Nurse Buddy

after the procedure was done.
Post-operative nurses provide intensive care to patients as they awaken from anesthesia
after a surgical procedure. Because they typically have significant experience in a medical-
surgical environment or in emergency medicine, they’re equipped to identify complications and
intervene quickly.
Transferring Patients
Following surgery, the post-op nurse evaluates the patient’s condition and assesses when
he’s ready to move to the post-anesthesia care unit, also called the PACU. For example, if her
vital signs are not stable or if the surgical team encounters difficulties sealing off the incision
site, the patient might need to remain in the operating room so the surgeon can intervene if
complications arise. Once the post-op nurse determines the patient can safely be moved, the
nurse transfers her to the PACU for continued care.
Monitoring Patients
In the PACU, post-op nurses continually evaluate patients until they wake up and help
them understand where they are and what’s going on as they awaken from the anesthesia. They
typically oversee only a few patients at a time, allowing them to give the patients their undivided
attention and quickly notice if anything goes wrong. By checking pulse and heart rate, post-op
nurses can ensure the patient remains stable and that she’s coming out of the anesthesia as
expected. They also ensure the patient stays comfortable, covering her with a blanket if she gets
cold, a common side effect of anesthesia. In addition, they monitor the patient’s IV line, which
delivers pain medication and other necessary drugs.
Addressing Complications
While many patients awaken from anesthesia without incident, post-op nurses are
prepared to respond to nearly any complication. If the patient is frightened, the post-op nurse will
speak to him in a reassuring voice to calm him. Patients sometimes have trouble breathing upon
waking up, due to lying flat and in one position for great lengths of time. The post-op nurse will
help the patient sit up, cough and breathe deeply to prevent pneumonia and aid in the elimination
of anesthesia from the system. In dire circumstances, she might also insert a breathing tube or
line.
Patient Education
Post-op nurses sometimes meet with patients and family members prior to surgery to
explain how the anesthesia works and what they can expect. They'll also explain potential side
effects or complications that can occur, such as a reaction to the medication or difficulty waking
up from the anesthesia. The post-op nurse answers any questions patients or family members
have and verify they’re prepared for the surgery and for the after-effects of general anesthesia.

Describe the operating room set-up.

OR Environment
Operating rooms are sterile environments; all personnel wear protective clothing called
scrubs. They also wear shoe covers, masks, caps, eye shields, and other coverings to prevent the
spread of germs. The operating room is brightly lit and the temperature is very cool; operating
rooms are air-conditioned to help prevent infection.
The patient is brought to the operating room on a wheelchair or bed with wheels (called a
gurney). The patient is transferred from the gurney to the operating table, which is narrow and
has safety straps to keep him or her positioned correctly.
The monitoring equipment and anesthesia used during surgery are usually kept at the
head of the bed. The anesthesiologist sits here to monitor the patient's condition during surgery.
Depending on the nature of the surgery, various forms of anesthesia or sedation are
administered. The surgical site is cleansed and surrounded by a sterile drape.
The instruments used during a surgical procedure are different for external and internal
treatment; the same tools are not used on the outside and inside of the body. Once internal
surgery is started, the surgeon uses smaller, more delicate devices.
Operating room equipment
An operating room has special equipment such as respiratory and cardiac support,
emergency resuscitative devices, patient monitors, and diagnostic tools.

Life support and emergency resuscitative equipment

 Heart-lung bypass machine, also called a cardiopulmonary bypass pump—takes over
for the heart and lungs during some surgeries, especially heart or lung procedures.
 Ventilator (also called a respirator)—assists with or controls pulmonary ventilation.
Ventilators consist of a flexible breathing circuit, gas supply, heating/humidification
mechanism, monitors, and alarms. They are microprocessor-controlled and
programmable, and regulate the volume, pressure, and flow of respiration.
 Infusion pump—device that delivers fluids intravenously or epidurally through a
catheter. Infusion pumps employ automatic, programmable pumping mechanisms to
deliver continuous anesthesia, drugs, and blood infusions to the patient. The pump hangs
from an intravenous pole that is located next to the patient's bed.
 Crash cart—also called resuscitation cart or code cart. A crash cart is a portable cart
containing emergency resuscitation equipment for patients who are "coding" (i.e., vital
signs are in a dangerous range). The emergency equipment includes a defibrillator,
airway intubation devices, resuscitation bag/mask, and medication box. Crash carts are
strategically located in the operating room for immediate accessibility if a patient
experiences cardiorespiratory failure.
 Intra-aortic balloon pump—a device that helps reduce the heart's workload and helps
blood flow to the coronary arteries for patients with unstable angina, myocardial
infarction, or those awaiting organ transplants. Intra-aortic balloon pumps use a balloon
placed in the patient's aorta. The balloon is on the end of a catheter that is connected to
the pump's console, which displays heart rate, pressure, and electrocardiogram (ECG)
readings. The patient's ECG is used to time the inflation and deflation of the balloon.
Patient monitoring equipment
 Acute care physiologic monitoring system—comprehensive patient monitoring systems
that can be configured to continuously measure and display various parameters via
electrodes and sensors connected to the patient. Parameters monitored may include the
electrical activity of the heart via an ECG, respiratory (breathing) rate, blood pressure
(noninvasive and invasive), body temperature, cardiac output, arterial hemoglobin
oxygen saturation (blood oxygen level), mixed venous oxygenation, and end-tidal carbon
dioxide.
 Pulse oximeter—monitors the arterial hemoglobin oxygen saturation (oxygen level) of
the patient's blood with a sensor clipped over the finger or toe.
 Intracranial pressure monitor—measures the pressure of fluid in the brain in patients
with head trauma or other conditions affecting the brain (such as tumors, edema, or
hemorrhage). Intracranial pressure monitors are connected to sensors inserted into the
brain through a cannula or bur hole. These devices signal elevated pressure and record or
display pressure trends. Intracranial pressure monitoring may be a capability included in
a physiologic monitor.

Diagnostic equipment
The use of diagnostic equipment may be required in the operating room. Mobile x ray
units are used for bedside radiography, particularly of the chest. These portable units use a
battery-operated generator that powers an x ray tube. Handheld portable clinical laboratory
devices, called point-of-care analyzers, are used for blood analysis at the bedside. A small
amount of whole blood is required, and blood chemistry parameters can be provided much faster
than if samples were sent to the central laboratory.

Other operating room equipment

Disposable OR equipment includes urinary (Foley) catheters to drain urine during
surgery, catheters used for arterial and central venous lines to monitor blood pressure during
surgery or withdraw blood samples), Swan-Ganz catheters to measure the amount of fluid in the
heart and to determine how well the heart is functioning, chest and endotracheal tubes, and
monitoring electrodes.

Members of the surgical team work hard to coordinate their efforts to ensure the safety
and care of their patients. The surgical team is in charge of the OR and makes decisions
regarding patient care procedures. The OR environment has sterile and non-sterile areas, as well
as sterile and non-sterile personnel. It is important to know who is sterile and who not, and which
areas in the OR are sterile or non-sterile.
Describe the sequence of donning and doffing of
PPE in OR
Donning
1. Perform hand hygiene.
2. Put on gown.
o Fully cover your torso from your neck to knees and your arms to the end of your
wrists, then tie at the back.
o The gown should be large enough to allow unrestricted movement without
gaping.
o Fasten at the back of the neck and waist.
3. Put on surgical mask or P2/N5 respirator.
o Secure the ties or elastic bands at the middle of the head and neck.
o Fit flexible band to the nose bridge.
o Fit mask snug to face and below the chin.
o Fit-check respirator according to manufacturer instructions.
4. Put on protective eyewear or face shield.
o Place over eyes/face and adjust to fit.
5. Put on gloves.
o Extend the gloves to cover the wrist of the gown.
If at any point your gloves become contaminated, you must dispose of them, perform hand
hygiene and then replace them with new gloves (CEC 2020).

Doffing
1. Remove gloves.
o Using one hand, grasp the palm of the other hand and peel off the first glove.
o Hold the removed glove in the gloved hand.
o Slide fingers of the ungloved hand under the remaining glove at the wrist and peel
it off over the first glove.
o Discard gloves in a waster container.
2. Perform hand hygiene.
 3. Remove gown.
o Unfasten the ties, ensuring the sleeves don’t make contact with your body.
o Pull the gown away from the neck and shoulders, touching the inside only.
o Turn the gown inside out.
o Fold or roll the gown into a bundle and discard in the waste container.
4. Perform hand hygiene.

5. Exit the patient’s room and close the door.

6. Remove goggles/face shield.

o Remove from the back of the head by lifting headband or ear pieces.
o If reusable, place in the designated reprocessing receptacle. If not, discard in
waste container.
7. Perform hand hygiene.

8. Remove mask/respirator.
o Grasp the bottom ties/elastics, then the top ones, and remove without touching the
front of the mask.
o Discard in the waste container.

9. Immediately perform hand hygiene.

Note: PPE must be disposed of after use unless it is marked as reusable. Reusable PPE
must be reprocessed before being used again (DoH 2020).

Using PPE Effectively

 Healthcare workers must be thoroughly informed about any infections and updated on the
current policies, procedures and protocols of their organization.
 Workers must have access to the necessary equipment to carry out the specified task
correctly and safely.
 You may consider having a second clinician present to supervise the donning and doffing
process and ensure it is performed correctly.
 Healthcare organizations must apply both standard and transmission-based precautions as
they are applied individually.
 Workers must have a thorough understanding of contact, droplet and airborne
precautions.
 Strict hand hygiene must be performed