CABAHUG, VICTORIA MAE I

SESSION 2

CHECK FOR UNDERSTANDING (60 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point
will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or
erasures in you answer/ratio is not allowed.
You are given 60 minutes for this activity:

Case Study: Read and examine the case thoroughly.

Patient Profile: T.M., a 76-year-old retired police officer, is admitted to the OR for an inguinal
hernia repair. He has a history of severe chronic obstructive pulmonary disease (COPD) and heart
failure. Therefore, the anesthesia care provider (ACP) has decided to administer spinal anesthesia.
The circulating nurse has verified the baseline data (vital signs, height, weight, age; allergies; level
of consciousness; NPO status; and comfort level). A signed informed consent is on the chart. T.M.
has no allergies.

Discussion Questions:
1. Priority Decision: What is the priority nursing actions that should be taken when T.M.
arrives in the OR?

Ensure that enough help is available to transfer the patient from the stretcher to the
OR table. Position the patient carefully to prevent injury. Apply safety straps. Place
electrocardiogram (ECG) leads, blood pressure (BP) cuff, and pulse oximetry. Check the
IV to verify insertion and patency. Ensure that the grounding pad is placed correctly.
Complete the patient safety checklist. Implement the Universal Protocol: take a surgical
timeout with the surgical team members to verify patient name, birth date, and operative
procedure and location and to compare the hospital ID number on the patient ID band with
the chart. Aseptic technique must be maintained by all surgical team members. A fire risk
assessment may also be completed.

2. What specific precautions should be taken when positioning T.M. for surgery?

The patient position should allow for operative site accessibility. Place in correct
musculoskeletal alignment. Be sure that no undue pressure is occurring to bony
prominences, nerves, earlobes, and eyes. Be sure that
there can be adequate thoracic wall movement. Prevent any pressure or occlusion of veins
and arteries. Secure the patient’s extremities and provide adequate padding. Respect patient
modesty. Respect the patient’s specific aches and pains or deformities.

3. What complications of spinal anesthesia should T.M. be monitored for during surgery?
 T.M. should be monitored for hypotension, bradycardia, nausea and vomiting,
respiratory difficulties, and apnea.

4. T.M. is 76 years old. What gerontologic considerations should be taken?

Monitor the effect of anesthetic agents and adjuncts

closely. Ensure clear communication and verify patient understanding. Closely monitor the
patient’s skin, especially where tape, electrodes, and pads have been applied. Position the
older patient carefully with close attention to patient alignment and joint support. Consider
using warming devices and monitor closely if these are used. Assess the postoperative
recovery from the anesthetic agents before the patient is transferred out of the
postanesthesia care unit (PACU).

5. Priority Decision: Based on the data presented, what are the priority nursing diagnoses?

Nursing diagnoses:
• Risk for infection
§ Risk for impaired skin integrity
§ Risk for injury
§ Risk for hypothermia

Reference: Medical-Surgical Nursing 9th Edition (Lewis, Dirken, Heitkemper & Bucher)

Multiple Choice (Answers only)

1. A.
Rationale: Keep the area free from microorganisms. The nurse should ensure the
surrounding and the items he is using there are free from bacteria to avoid worsening the
situation of the wound. This is because bacteria can enter wounds and form biofilms. They
release chemicals that prevent immune cells from killing these bacteria and this delays
wound healing. When the number of bacteria in the wound increase even more and the
infection becomes severe, it can lead to complications.
2. A.
Rationale: The surgical team is composed of sterile and non-sterile members. Circulating
nurses are part of the non-sterile members, which means that they work in the periphery of
the sterile surgical field and NOT directly in the surgical field. Furthermore, a circulating
nurse is also responsible for pre-op preparation, which involves ensuring that the operating
room is sterile and that all equipment to be used is functioning properly and are available.
Circulating nurses perform a variety of jobs. During an operation, a circulating nurse is
tasked to assist the scrub nurse and surgeon by doing tasks such as adjusting the OR light
every now and then, positioning kick buckets on the operating side, and replenishing
sponges and sutures, among many others. They monitor the procedure and ensure that
conditions within the OR are maintained to be safe and sterile for the patient. After an
operation, they help in tasks like preparing the patient for the recovery room and assisting
the scrub nurse in taking the instrumentations to the service (washroom).
 References (to supplement your readings):
• NursingCrib. (2008). Duties of Circulating Nurse. Retrieved from
https://nursingcrib.com/nursing-notes-reviewer/duties-of-scrub-nurse/
3. B.
Rationale: Anethesiologist and radiation technicians are the unsterile team members while
the surgeon, nurses are part of the sterile team.

Reference: https://nursingcrib.com/perioperative-nursing/operating-room-team-sterile-
members/
4. D.
Rationale: The nurse is in charge of verifying and confirming that the patient or legal
representation has signed the permission document in their supervision and that the client
or legal representative is of legal age or competent to consent.
Informed consent is a communication process between you and your health care
practitioner that typically results in agreement or authorization for treatment, care, or
services. Before surgeries and treatments, the patient has the right to obtain information
and ask questions.
Nurses must respect people's confidentiality and privacy by getting informed
consent before sharing information, including legally documenting such consent where
possible, in order to maintain privacy and secrecy.

Reference
Wen, X., Feng, X., Ziyi, H. U., Jin, L. I., & Mei, F. R. (2017). Application of Subject-
Centered Informed Consent in Nursing Research. Chinese Medical Ethics, 30(9), 1130-
1132.
5. A.
Rationale: The scrub nurse's responsibilities begin well before the procedure begins. He
makes sure the operating area is clean and ready to go before preparing the surgical tools
and equipment. Before prepping the patient for surgery, the nurse assists the surgeon with
her gown and gloves.

References
Shields, J., Overstreet, M., & Krau, S. D. (2015). Nurse knowledge of intrahospital
transport. The Nursing clinics of North America, 50(2), 293-314.
6. C.
Rationale: The clear fluid which covers the brain and spinal cord is known as cerebrospinal
fluid (CSF). It protects the brain and spinal cord against injury while also acting as a
nutrition or waste delivery system for brain. It is generated continually and in huge numbers
by a group of blood arteries in the brain; this fluid is vital to the body, therefore when a
patient receives an anesthesia that reaches the spinal cord, the patient must be put in a
certain posture to avoid cerebrospinal fluid leaking.
7. D.
Rationale: The nurse should instruct the client to remain supine for the time specified by
the physician. Local anesthetics used in a subarachnoid block don't alter the gag reflex. No
 interactions between local anesthetics and food occur. Local anesthetics don't
cause hematuria
8. A.
Rationale: Open appendectomy usually requires general anesthesia but in some cases may
be performed with spinal anesthesia.
9. B. Nurses have an assortment of jobs and capacities related with the patient's careful
administration. Medical caretakers give care of a customer previously, during, and after
surgical operation, this is on the whole called as Perioperative Nursing. It is a specific
nursing region wherein an enlisted nurture functions as a colleague of other careful medical
services experts. Nonappearance or limit of preoperative arrangement and showing builds
the requirement for postoperative help as well as overseeing basic ailments.

Reference
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines
for individualizing client care across the life span. FA Davis.
10. B.
Rationale: Adjuvants are usually added to local anesthetics to prolong analgesia
following peripheral nerve blockade. Adding epinephrine to local anesthesia solutions for
peripheral nerve block potentiates and prolongs the action. Anesthesiologists often add
epinephrine to local anesthesia during peripheral nerve block procedures.
The advantages of this practice include; it reduces the Local Anesthesia plasma
concentration and thus minimizes the possibility of systemic toxicity and it improves
the quality and prolongs the duration of peripheral nerve block. epinephrine mediates this
prolongation of anesthesia action by its vasoconstrictive actions. By stimulating α-
adrenergic receptors on the neural vasculature, epinephrine mediates contraction of the
vascular smooth muscle, reduces local blood flow, and thereby slows clearance of the
anesthesia from the nerve.