Case Study: Kamryn Moss

My case study is about MR. She is a 44-year-old woman scheduled to have a

robotically assisted hysterectomy and bilateral salpingectomy. MR was in pre-op with her
neighbor seemed more nervous than her. MR's preprocedural complaint was menorrhagia
and severe pelvic pain. She was diagnosed with uterine fibroids and decided to have the
procedure. MR stated that she had no known allergies to any food, contact, medication, or
the environment and had been NPO since 1900 the night before. MR has a past medical
history of depression, anxiety, anemia, arthritis, hypertension, obesity, and
hyperlipidemia. So, paying close attention to her hemoglobin level, being careful with
sedation due to her obesity, and monitoring her blood pressure were essential due to her
underlying conditions. The labs completed before the procedure included hemoglobin and
hematocrit, a pregnancy test, type and screen, COVID test, a CBC, and CMP. All were
within normal range, with her hemoglobin at 10.5 grams per deciliter. She also had an
electrocardiogram completed with her cardiologist to ensure safety throughout the
procedure. Consents for surgery, anesthesia, and blood products were signed by the
patient, witnessed by the nurse, and signed by the doctors.

The nurses placed an 18-gauge peripheral IV in MR's left hand for medication and
fluid purposes. Preoperative medications included Versed IV, Pepcid IV, Celebrex PO,
Neurontin PO, Flagyl IV, Acetaminophen IV, and Pyridium PO. SCD's were placed on
MR preoperatively for VTE prophylaxis. Risk factors for this surgery included risk for
injury and risk for infection. Equipment for the procedure included the Davinci Robot, air
seal for insufflation during the laparoscopic procedure, lights, a camera, vision cart,
console, and patient cart. Instruments used were the laparoscopic Davinci tray, Davinci
instruments, and scope, as well as the laparoscopic scope and camera. There were no
hemostatic agents ordered or used for the surgery. The procedure had a fire risk of one
because of the electrosurgery units being used. A pre-procedure count was done between
the circulator RN and scrub tech.

MR was safely placed in the lithotomy position on a pink pad with safety straps.
Her arms were placed in bilateral arm padding for safety and support. The ASA for MR
was a three due to her comorbidities and her BMI being 40.6. MR was sedated by general
anesthesia, which included lidocaine, propofol, and zemuron. Ancef 2grams was given as
well for prophylactic reasoning. After anesthesia was given, MR's legs were put into
stirrups by two nurses ensuring safety and proper positioning. The patient's abdomen was
draped with towels to prevent pooling of the 4% CHGx3 used. MR was then draped with a
laparoscopic abdominal drape with leggings. A 16 French Foley catheter was placed at the
beginning of the procedure to calculate the precise output. The surgery went very well,
and MR was sutured with two types of sutures. Before the closure of the sites, another
surgical count was completed by the circulator RN and scrub tech. Stratafix 2-0 sutures
were used for the internal suturing of what was the uterus. Monocryl 4-0 was used to
suture the four laparoscopic skin sites on MR. On top of the skin suture sites was
Dermabond to ensure tissue adhesion. MR's uterus, cervix, and bilateral fallopian tubes
were correctly labeled, placed in 10% Formalin, and sent to pathology. The circulator RN
and scrub tech performed the last surgical count. MR was extubated and safely transferred
to the gurney, where she was transferred to PACU for recovery.