The patient is wheeled through the double doors into the alien and frightening operating room suite. He may be a newborn with a pyloric stenosis, so food cannot travel the normal digestive route, or she may be an octogenarian with a fractured hip. Or it could be any one of the thousands of elective or emergency surgeries in between. Each one has its own special needs to be met by the registered perioperative nurse for their care.
I am a registered perioperative nurse. I must greet this person, assess his vital signs, mental and physical status, and range of motion. His level of consciousness and apprehension, along with any other medical or physical problems such as allergies, must be evaluated. I must plan how these needs are to be met.
Implementation of the necessary nursing care and the evaluation of the effects of this plan on my patient is another aspect I must take into consideration. This assessment will be done in the holding (pre-op) area, sometimes in as few as five minutes if this is an emergent situation. I must also speak to, reassure, and gain the trust of my patient.
I am the patient advocate. I must be sure she and I are in understanding as to the reason she is here, and that her wishes will be carried out. When she understands and has all other questions answered, we move on.
In the operating room itself, I further reassure my patient, by my presence, while a blood pressure cuff and heart and oxygen monitors are applied. I often hold their hand and my eyes are usually the last sight they see as they drift off to sleep for their surgical nap. I assist the anesthesiologist with the induction and insertion of a breathing tube.
Now, if ordered, a catheter (Foley) is inserted into the bladder. I must be constantly assessing any changes, for they are asleep and cannot tell me if they are cold or uncomfortable. Proper body alignment must be adhered to during positioning. This positioning is to accommodate the surgeon for access to the surgery. Body areas must be cushioned to prevent any skin breakdown.
A return electrode is applied at this time for the electrocautery used by the surgeon. All the technical equipment must be in proper working order, so my patient isn’t injured. Along with the sterile supplies and instruments the surgeon needs to complete the surgical procedure, counts, specimens and strict adherence to sterile technique are more of my many priorities.
After he is clean, dry, warm, breathing unassisted, and with dressings, intravenous lines and drains intact, he is moved safely to his bed. He is then delivered into the competent care of the registered post-anesthesia nurse, along with a report on the whole procedure and pertinent life and medical history. I then start all over again with my next patient.
Every patient deserves a registered perioperative nurse.
Janet Donnelly
Millstone