Surgery

When I arrived at surgery there were no surgeries scheduled until 7am. The first surgery I

had an opportunity to witness was performed on a deviated septum. I only saw 4 surgeries

consisting of a septoplasty, the removal of a vein in a leg, bicep surgery, and placement of a med

port.

I followed the patient who had a septoplasty performed pre-op to post-op. During the pre-

op phase the nurse gathered information on the patient and inserted an IV into his hand to

prepare him for intra-op. Once the pre-op nurse was done, the nurse anesthetist and circulating

nurse came to get the patient for surgery. They asked the patient his name, date of birth, who his

surgeon is, and why he was having the procedure done before taking him to surgery. The nurse

anesthetist also administered fentanyl before taking him to the OR. Once in the OR we moved

the patient from the pre-op/post-op bed into the surgery bed. They prepped the patient for

surgery, connected him to a telemetry monitor, and a continuous monitor for vitals. The

circulating nurse called out a surgical time-out and everyone agreed that it was the right patient.

The circulating nurse placed restraints on the patients’ legs and arms and the nurse

anesthetist gave him anesthetics that put him in a paralyzed state. Once in the paralyzed state

they removed the restraints from his arms and tucked them to his sides with blankets. The doctor

needed the patient to be temporarily paralyzed so there were no muscle spasms or body

movements. Since the anesthesia paralyzed him, the nurse anesthetist needed to put an artificial

airway in through his mouth. The artificial airway induced breathing and prevented blood from

entering the patients’ lungs. Without the artificial airway, the patient would not have been able to

breathe.
 The reason the patient was having a septoplasty was to correct his deviated septum that

was blocking his nose and affecting airflow. A deviated septum occurs when the septum bends in

one direction causing the nose to become crooked. This patient’s septum was bent to his left

naris. It can also make breathing difficult. The patient was less worried about his nose being

crooked and more concerned about his breathing being obstructed.

There was a resident performing the procedure and the doctor watched and guided her

when needed. The circulating nurse gathered all supplies needed before and during surgery. Due

to the nose being a very vascular area, the scrub nurse inserted 2 patties with cocaine in each

nostril to prevent and reduce bleeding. The resident used lidocaine to numb the nose after the

patties were removed. The resident then removed some of the patient’s septum cartilage and the

circulating nurse placed each piece in separate specimen containers with a liquid preservative.

Once enough of the septum and cartilage was removed the resident broke the nose to straighten

it. After the nose was patent and straight the resident packed each nasal vestibule and stapled and

sutured it in correct alignment. Once secured on the inside, the resident then formed a brace for

additional support on the exterior nose. The scrub nurse worked next to the resident providing

her with the sterile tools needed, and the circulating nurse assisted them by performing all

unsterile tasks. Once the nose was reconstructed, the resident then suctioned blood from the

patients’ stomach to prevent irritation and vomiting.

After the procedure was finished and the patient was awakening from the anesthesia, he

was taken to the PACU unit. The post-op nurse monitored the patient in PACU for 30 minutes.

After there were no signs of complications the patient was taken to the post-op second phase.

The patient and girlfriend stayed in this room until the doctor came to consult and discharge.
 I observed the healthcare team protect the patient from harm pre-op to post-op. They used

identifiers, performed their checks, closely monitored the patient and his vitals, and ensured

patency of the airway. The nurses were advocates for the patients in many ways. The

communication was sufficient, and everyone worked together to maintain safety and satisfactory

care.

Overall, it was a good clinical day. I didn’t realize how many surgeries are now done

laparoscopically. I wish I would have seen something like an open-heart surgery or a gall bladder

removal that was more invasive, but it was still extremely gratifying seeing the procedures that I

had the opportunity to see.