Major Issues on Surgical Procedures - Essay Example

Surgery and Day Surgery: Health Introduction Surgical procedures provide preventive, curative, promotive and rehabilitative servicesto patients. Watcher Goldman & Hollander (2005) stated that, surgeries are considered as the last options in most cases after other treatments have failed. This happens because it is not a thing to play about with. When complications set in or a mistake is done in the process, it can make a health practitioner sued. Hip fractures are common in young children and the old. According to Bhati, (2010), it occurs because young ones have fragile bones that are still forming. The oteoclasts have osteoblasts that are replicating to come up with a bone density and mass, if heavy weights fall on them, or dislocate, they are at a greater risk of getting the fractures. Hansen & Puder (2009) stated that in the elderly, the bones become weak as they advance in age in postmenopausal phase. Then, a process called osteoporosis occurs. Hip fractures are common in females because of depleted estrogen levels which predispose them to fractures. By this it means, the bone mass and density gets depleted and in turn leaves it weak. Bentley (2009) notes that, one will know they have hip fractures when they experience pain that starts in the groin or upper thigh. The pain makes the patient walk or may be unable to walk depending on the severity. For pediatrics, they cry a lot and seek attention. Since they do not talk, it may be difficult to tell what they are suffering from, but can point the areas affected. Leroith, Taylor & olefsky (2004) noted that, in the promotive aspect, both gamma nailing, also known as the sliding hip screw is a prosthetic device that is considered to be the best implant for hip fractures, Babhulkar & Tanna (2013). Ben david (2000) stated that, inguinal hernia “means there is an opening in the muscle wall that does not close, and leaves a weak area in the belly muscle.” Inguinal surgery help enhance a healthy lifestyle for the individuals. In rehabilitation, the individuals are helped to continue with their activities of daily living if not all, but at least partially and this prevents overdependence. Others get cured from the condition completely unless they provoke the recurrence. An example of this is the inguinal surgery. One presents with a bulge in the groin and complains of round lump feeling, accompanied with acute pain that is on and off. According to Heimlich (1962), he stated that, it is good to note that the surgical team, that is the Operating Department Practitioners (ODP) Hattis (2013). , should embrace teamwork and be free to communicate with each other so as to help do the right things, treat the patients with dignity by acting as patients’ advocates and ensure everything done to them is according to the stipulated ethical considerations, and competent. Competence should be in the scrub nurse to act as a guide and be ready to use their cognitive skills to tell when the surgeon is making a mistake and be quick to correct where necessary. The preventive part helps stop one from getting complications for example gamma nailing, frees a patient from having infections set in because the skin continuity is broken and if left open for long without any intervention, infections may set in and compromise ones health status. If the infection spreads, the hip may be removed surgically because it may cause it to swell and become septic. For inguinal hernia if not intervened earlier, it may make the patient dependent or even die out of pain, thus, it evades cases like losing someone, who is young, energetic and still needed to build the economy. Part One Part one of Driscoll Describing all that Happens before and in Surgery Mr. Patel 36 years old is coming in for hip reconstruction after a car accident. He says he was on his way home from work this morning, when another public service vehicle ran into his car crashing his side mirror. All he saw the next few minutes was his car rolling severally after he jumped out it. After the shock, is when he noted he could not move and felt some pain on the groin. Mr. Patel was then rushed to hospital only to discover his femur had dislocated and was booked for an emergency operation on gamma nailing. The circulating nurse confirmed all his details and ensured that he had no jewelry, dentures on and put on a hospital gown. The circulating nurse also made sure the put cannular was patent for intravenous drugs and fluids to be infused. Blood was taken for grouping and cross matching. This would help in case the patient lost a lot of blood during the surgery; vital signs like temperature, blood pressure, pulse rate and heart rate were taken to act as the baseline. Before the operation, vitals are expected to be stable so as not compromise the patient’s condition or cause the spread of infections. Mr. Patel complained of acute pain that tend to be persistent on the groin and radiated to the thigh. The pain started after the car accident. Since Mr., Patel was conscious, he was asked to sign the consent. If it were a pediatric, john; the nurse would ask his parent or guardian to sign it, since he is not aware of what is happening. For elderly patients like Michael, he would do the signing if he would be of sound mind, but if not, someone would be assigned to do it on his behalf. As Mr. Patel was brought in, I as the scrub nurse got ready by being correctly scrubbed in surgical attire, I prepared the instruments, trolley and sterile supplies to be used on the patient, and ensured an aseptic environment for the patient was set. That is, the room was clean and properly ventilated, this helps reduce the spread of micro organisms and allow the procedure to take place in a micro organism free area. The same environment would be prepared for john (pediatric) or Michael (elderly). The circulating nurse made sure antibiotics were administered prophylactic ally to the patient, so as to help reduce the spread of micro organisms from the operating room or the to be used instruments, she also talked to the patient in a way to calm anxiety and asked if he knew the type of operation that was to be done. This helped to identify any potential risks that may arise, doing a careful assessment of the patient, any complications that may arise before surgery is started. She also ensured the operating room was prepared, in that, there was the surgeon, scrub nurse, and the assistant, equipment, supplies and tools were adequate. This activity would be the same for a pediatric and an elderly patient. I work as a Scrub Nurse not Forgetting the role of the Circulating Nurse I adjusted the temperature to 22 degrees because Mr. Patel is an adult, but might be hypothermic. Excessive temperatures of 24 could make all of us to sweat and affect the patient. For pediatrics like John and the elderly (Michael), temperatures of 24 degrees can be considered appropriate. John been a pediatric patient, he has a small body surface area and with the pain brought by, the hip fracture, he will lose a lot of heat as a result of coping which will make him hypothermic. For Michael, he is aging and so are the body responses atrophying, the heat centre will tend to respond slowly. This will leave us an option of why he needs high temperatures for him to be stable. I placed Mr. Patel on the fracture table, with the help of the circulating nurse and the surgeon; we put him supine, on a fracture table with the use of a manual traction, which is placed lateral on the fracture table. The position is preferred because the nailing is a prosthesis that is preferred for most closed fractures. With the patient placed in supine position, the ipsilateral arm is brought across the patient’s body and tied out of the way of instrumentation. I as the scrub nurse made sure that during positioning; the upper body was angled away from the fractured side, so as to create room for guide wire and nail that is to be inserted. The C-arm was then rotated over the top towards the surgeon in order to obtain a true anteroposterior position before draping was done. Since the theatre is in a public hospital, it is impossible to have pediatric fracture or radiolucent tables, all types of patients be they young, adults or the old are operated from the same type of table. This makes sure that proper positioning is done and the patients’ comfort is enhanced. An adult undergoing gamma nailing is positioned supine and left without extra support. This is opposite to a pediatric. They are at risk of falling because of the fear and anxiety, fear of being away from their mothers and may start disturbing. They are supported to prevent risks of falling. For the elderly like Michael, at this time he is weak because of muscle wasting and osteoporosis, and may also require support. Among the equipment is the gamma nail that was inserted in Mr. Patel’s hip. The nails used to reconstruct the hip bone have a proximal diameter of 15.5mm, so that it help shorten the incision length for minimal invasive surgeries, with an aim of providing enough strength that has no resistance. During surgery, the nail put for an adult should have the same diameter to an elderly person to ensure the bone is well secured while that of a pediatric may be a bit smaller because the femur is not long and hard enough to accommodate a large diameter of the nail. There should be no discrimination when it comes to ethical consideration, every patient has a right to be protected from infection, so, prophylactic antibiotics should not be exempted from any patient, be it a child, an adult or the elderly. I swab Mr. Patel with iodine to create a sterile field for the procedure. The solution was not warmed because his body can respond to the effects of the solution by producing heat through vasoconstriction. For a pediatric and the elderly, the fluid could be warmed to prevent hypothermia. Cold fluids on their skin provokes vasoconstriction, this means if vitals are beyond the normal range by being too high or low, may alter the effects of the surgery. During the operation, the femur was approached through an incision in the anterior aspect of the greater trochanter and in line with the femoral shaft. I ensured we as the operating team worked from the surgical suit, after the surgeon made an incision, I assisted in keeping tissues moist so as not to provoke unnecessary pain to the patient. I handled and retracted tissues for the surgery to proceed swiftly, and made sure the used equipment was the required one. An example, if a retractor is needed, I made sure I directed my assistant scrub nurse to hand it in. The cotton wool was in short supply and I asked the scrub nurse to bring extra, for the suture material, we use vicryl 2 or monocryl types for all patients. This is because the sutures heal with the skin and do not damage body tissues. During this time, the circulating nurse ensured that a sterile procedure was followed when handling all instruments that were used on Mr. Patel, and in case something fell on the floor, she looked for extra equipment and placed in the operating tray to enhance the process of surgery. This helps reduce the spread of infection to the patient and protects them from complicating after surgery, and so, acts as an advocate for the patients’ health status and promote safety as the patient is handled with dignity and respect. After the surgery, with the help of the circulating nurse, we counted the instruments, dressings and gauzes to ensure nothing was left in the patient. The number of each equipment tallied with the written number before surgery began. I then recorded as the circulating nurse left the operating room to inform the family that the surgery was successful and the patients’ progress. I then cleared my operating table, put my instruments ready for decontamination, and degowned as the circulating nurse helped to transfer Mr. Patel to the recovery area which is also called Post Anesthetic Care Unit. The patient was accompanied by a report of the operation and his or her present condition, she then returned to assist with the clean-up of the operating room for the next patient. Part two of Driscoll All that happened in the operating room seemed scary. My experience as a scrub nurse learned a lot in terms of management of different patients with similar conditions. An example of the size diameter of the screw should be different when it comes to a pediatric, in that, the diameter should be less than 15.5 cm and a reduced length. If it were in my power, I would tell people how good it feels to avoid minor accidents especially if one can damage bones. In Part Three, The operation went on successfully having payed attention to all procedures and the surgical team each one doing what they are expected. There is nothing to add or subtract from what was done Part Two Daniel aged 26 years, has two conditions both inguinal hernia and diabetes. Ben david (2000) stated that, inguinal hernia “means there is an opening in the muscle wall that does not close, and leaves a weak area in the belly muscle.” The condition presented this late because of obesity. This means that overweight is one of the predisposing factors to hernias. The patient has presented with a bulge in the groin and complains of round lump feeling, accompanied with acute pain that has been on and off over the last one month. Driscroll 2008 reflective cycle has come up with three processes that give a guide when reflecting on what one has been practicing;  What ( description of all events) So what( analyse) and Now what  Using the framework as a guide, Daniel was in the clinic past two weeks for a follow up on his diabetic case, vitals done then presented him to be having some improvement because the weight had reduced from 80 to 75 kilogram’s, the then blood pressure was 140/80mmHg. Today, Daniel presented with inguinal hernia, when asked what he was doing before he felt the lump on the groin and the pain radiating, he said, he works as a masonry and is always carrying heavy stones, sand and water to construction sites. The problem began a yesterday night, and was not aware of what was happening in his body until this morning when he woke up and started vomiting. As he prepared for work, the pain became intense and was unable to move. That is when he called for help and was rushed in hospital. On arrival, I attended to him and discovered it was an emergency that required surgical incision to correct the weak tissues before things fell apart. In my pre-assessment, Daniel came in supported by two gentlemen, complaining of excessive pain in the groin, had vomited four times before arrival and was sweating profusely. I took the Vitals the weight and height 75 kilogram’s and a height of 15centimeters then the BMI done and showed that the patient was still obese weight divided by height squared. Blood pressure was 165/100, this was out of the normal range, and temperatures were 37 degrees Celsius, heart rate 60 breaths per minute. This baseline data were out of range probably due to the increased weight. The obesity has predisposed the patient to high sugar levels in blood to cause diabetes. The blood sugars were well controlled and were 6.5. Before surgery, we needed to stabilize Daniel in order to prevent any complications. First, an intravenous access was established by putting a line, where fluids like normal saline were infused to help restore the lost electrolytes like sodium, potassium when the patient vomited and sweat a lot. Due to the high temperatures, antipyretics like brufen was administered to help lower the body temperatures, the high blood pressure, was controlled by administering anti hypertensives like calcium channel blockers, of nifedipine. The patient was then asked to rest in bed and a catheter inserted and a fluid chart started to help measure the input and output, this will be able to show whether the patient is improving and fluid is retained in the body or is lost. When asked if the given antihypertensive were similar to the ones he had been using at home, he said they are different and these seem to be effective. The vitals were then taken after four hours, and showed to be within normal range. The patient was then prepared ready for theatre, he was asked to change into the operation gown, shaved in the operation site, that is the groin area, this helped to create the best surface area for surgical procedure more fluids infused. The patient was starved for about 6 to 8 hours before surgery but put on fluids. This helps to prevent secretions from been removed from the effects of some drugs like anesthetics, which may stimulate the vagal reflexes from the vagus nerve and cause some nausea and vomiting effects. Blood samples were taken and put ready for grouping and cross-matching just in case the patient bled a lot intra-operatively. Prophylactic antibiotics were administered to help protect the patient from nosocomial infections and in case there was contamination from the used instruments. Since the patient was aware of his condition, he was asked to sign the consent. Signing meant he was ready for the operation and would not blame anyone in case the operation went out unsuccessfully; it is also a sign of giving trust to the surgical team to take control and correct the problem he presented with. This gave room for the ‘Now what,’ to take place. With the above done, the patient was reassured that all woul be well, and was then wheeled into the operating room ready for surgery that took four hours. After four hours of a successful surgery, Daniel was then transferred into the post anesthetic care unit (PACU) by the circulating nurse and the records of the operation plus his general health progress handed in to the nurses in Post Anesthetic Care Unit. In the recovery area, I monitored Daniel for stability before been transferred to the ward. Post operative care here refers to care given to a patient following a surgical procedure. It may include pain management and wound care. In this area, it is fully equipped with the recommended drugs, antibiotics, analgesics and fluids not forgetting resuscitation equipment and drugs just in case a patient complicates or condition worsens and there is need for resuscitation. Patient was brought in a recovery position and monitored for any signs of bleeding in the surgical site, any redness or swelling, if any of the mentioned signs would be present, antibiotics would be administered to control any chances of infection that would be setting in. This enables the health practitioner to monitor the patient for any signs of infection, any problems at the surgical site, any form of blood clot that may hinder sufficient perfusion from taking place and in turn, slow the rate of healing. I monitored vital signs every half hourly to help me note the patients’ progress from any deviation. By this time, the patient was connected to an electrocardiogram, which is an electronic machine that gives readings of the vitals automatically. It also helps to measure the saturation point of oxygen. It is important to monitor the patients’ vitals, like the blood pressure, breathing rate, temperature and pulse rate, should fall within the normal ranges as earlier stated. For this patient, they were all stable. Daniel then woke up after two hours and I asked him to take in deep breaths; this helped to assess the functioning of their respiratory system and prevent them from contracting hospital acquired pneumonia, because it may delay healing. I checked the intravenous line for patency, and more fluids like volume expanders of Hartmann solution infused to help replace the lost blood during the operation also, normal saline would be infused to restore electrolytes while 5% dextrose will supply the patient with enough glucose in the body for energy. The patient was not left to feed immediately after the operation, but until the bowel sounds were heard, this gave a clear view of why he should have the intravenous access patent, because he depended on fluids. On the other hand a urine bag was put and fluid measured to see how much he was able to retain and whether the kidneys were functioning properly. To manage pain from the patient, all classification of analgesics were administered to help work on different pain receptors. The drugs were administered intravenously, intramuscularly or orally depending on the patients’ condition after surgery. This drugs help control, pain from anxiety, psychological, from anesthesia that was injected earlier or the operation performed. Examples are, NSAIDS (brufen), acetaminophen (parecetamol) and morphine among others. After he was stable, I gave Daniel some health messages. I taught him on ways to prevent such cases and any complications that may arise. For example, I advised him to refrain from heavy tasks for at least six months so as to enhance healing of the operated site. In as much as he could be the bread winner, his family members were also counseled on the risks that may present and can complicate to an extent of losing him. Family members should see it wise to also help him get a new job once he healed. He is also advised on the importance of exercises, this could be walking short distances so as to enhance healing, and the patient should remain active to prevent the disuse of tissues that may make them dormant and dependent to others. He together with the family, they were advised on the need for hygiene especially at the surgical site. This help to enhance healing and reduce the spread of bacteria that may bring in complications and cause hospital readmission. The diet should be balanced, the patient should try taking much of carbohydrates since they are energy giving foods and little of fats with adequate amounts of vitamins and proteins, this will enhance healing and allow the patient return to activities of daily living soon. It is important that I advised Daniel on the need for follow up visits to the nearest hospital, this will help monitor the progress of his condition and will be easy to note if there are any deviations so as to come up with better ways of managing him. If he is stable, during the visits he is left to start fending for himself. The part of follow up will help the patient in a way to prevent recurrence. But if it occurs by chance, a different approach should be done, first, it is wise to help the patient from doing heavy tasks, and should quit such strenuous jobs. According to McDowell & Brown (2007), “before the patient is released to the ward for further intervention until he is stable, it is important to counsel them on diabetes since a part from obesity; it also contributed to the effects of the hernia.” I advised Daniel to always watch his blood sugars and adhere to diabetic drugs like insulin, besides treatment and good diet free from sugars, it is important to do exercises to help him reduce the overweight and in turn, have a recommendable Basal Metabolic Rate (BMI) which will be a good indicator of healthy living. Another key thing, I told him was that, with diabetes, it is wise to prevent wounds within the body because the high sugars in bold delay healing of wounds and so this gives a good reason as to why they are expected to be extra careful in order to prolong their lives and live healthy Peacock (2000).  He was then discharged to the ward still under fluids after three hours of observation in the recovery room. The ward nurse came for the patient so as to monitor him for the next twenty four hours before discharging him home. Conclusion In conclusion, surgical procedures provide preventive, curative, promotive and rehabilitative services to patients. Watcher Goldman & Hollander (2005) stated that, surgeries are considered as the last options in most cases after other treatments have failed. This happens because it is not a thing to play about with. When complications set in or a mistake is done in the process, it can make a health practitioner sued. Hip fractures are common in young children and the old. According to Bhati, (2010), it occurs because young ones have fragile bones that are still forming. The oteoclasts have osteoblasts that are replicating to come up with a bone density and mass, if heavy weights fall on them, or dislocate, they are at a greater risk of getting the fractures. Hansen & Puder (2009) stated that in the elderly, the bones become weak as they advance in age in postmenopausal phase. Then, a process called osteoporosis occurs. Hip fractures are common in females because of depleted estrogen levels which predispose them to fractures. By this it means, the bone mass and density gets depleted and in turn leaves it weak. Bentley (2009) notes that, one will know they have hip fractures when they experience pain that starts in the groin or upper thigh. The pain makes the patient walk or may be unable to walk depending on the severity. For pediatrics, they cry a lot and seek attention. Since they do not talk, it may be difficult to tell what they are suffering from, but can point the areas affected. Leroith, Taylor & olefsky (2004) noted that, in the promotive aspect, both gamma nailing, also known as the sliding hip screw is a prosthetic device that is considered to be the best implant for hip fractures, Babhulkar & Tanna (2013). Ben david (2000) stated that, inguinal hernia “means there is an opening in the muscle wall that does not close, and leaves a weak area in the belly muscle.” Inguinal surgery help enhance a healthy lifestyle for the individuals. In rehabilitation, the individuals are helped to continue with their activities of daily living if not all, but at least partially and this prevents overdependence. Others get cured from the condition completely unless they provoke the recurrence. An example of this is the inguinal surgery. One presents with a bulge in the groin and complains of round lump feeling, accompanied with acute pain that is on and off. According to Heimlich (1962), he stated that, it is good to note that the surgical team, that is the Operating Department Practitioners (ODP) Hattis (2013). , should embrace teamwork and be free to communicate with each other so as to help do the right things, treat the patients with dignity by acting as patients’ advocates and ensure everything done to them is according to the stipulated ethical considerations, and competent. Competence should be in the scrub nurse to act as a guide and be ready to use their cognitive skills to tell when the surgeon is making a mistake and be quick to correct where necessary. The preventive part helps stop one from getting complications for example gamma nailing, frees a patient from having infections set in because the skin continuity is broken and if left open for long without any intervention, infections may set in and compromise ones health status. If the infection spreads, the hip may be removed surgically because it may cause it to swell and become septic. For inguinal hernia if not intervened earlier, it may make the patient dependent or even die out of pain, thus, it evades cases like losing someone, who is young, energetic and still needed to build the economy. Bibliography BABHULKAR, S., & TANNA, D. D. (2013). Proximal femoral fractures BABUK , S., & KANNA, D. D. (2013). Proximal femoral fractures BENDAVID, R. (2000). Abdominal wall hernias: principles and management. New York, Springer. .. BENERD, L. (2000). Abdominal wall hernias: principles and management. New York, Springer. BENTA, G. (2009). European Instructional Lectures. Berlin, Heidelberg, Springer Berlin Heidelberg. http://dx.doi.org/10.1007/978-3-642-00966-2. BENTLEY, G. (2009). European Instructional Lectures. Berlin, Heidelberg, Springer Berlin Heidelberg. http://dx.doi.org/10.1007/978-3-642-00966-2. BHATIA, S. (2010). The surgery book: for kids. 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(2004). Diabetes mellitus: a fundamental and clinical text. Philadelphia, Lippincott Williams & Wilkins. Lewis, Keir E. stopping minor accidents. Oxford: Oxford University Press, 2010. Print. Mel med. 2013. “Founder, Context Communication Consulting.” What is good for patients MIENY, C. J., & MENNEN, U. (2003). Principles of surgical patient care. Claremont, South Africa, New Africa Books. MURRAY, M. J. (2002). Critical care medicine: perioperative management. Philadelphia, Lippincott, Williams & Wilkins. Obesity. London: Stationery Office, 2004. Print. OBRANT, K. (2000). Management of fractures in severely osteoporotic bone: orthopedic and pharmacologic strategies. London, Springer. PEACOCK, J. (2000). Diabetes. Mankato, MN, LifeMatters. PURI, P., & HÖLLWARTH, M. E. (2006). Pediatric surgery. Berlin, Springer. http://site.ebrary.com/id/10143392. Silverstein, Alvin, Virginia B. Silverstein, and Laura S. Nunn. Inguinal hernia: Conquering a Deadly Disease. Brookfield, Conn: Twenty-First Century Books, 2004. Print. Surgical Testing for Patients Attending General Medical Services: National Guidelines. London: Clinical Effectivenss & Evaluation Unit, Royal College of Physicians, 2005. Print. TANNA, D. D. (2010). Interlocking nailing. Wallace, Girl & Serrano. 1995. “Health Care of elderly & Children in Developing WATCHER, R. M., GOLDMAN, L., & HOLLANDER, H. (2005). Hospital medicine. Philadelphia [etc.], Lippincott Williams & Wilkins World Health Organization. 1948. “As Adopted by the International Health Conference.” New York. Read More