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Runnin g H ead : O UTP A TIE N T S U RG ER Y E X PER IE N CE Outpatient Operating Room Experience Tiffany Odums Gaston College NUR 101 Practical Nursing 1 Mrs. Simpson October 12, 2018OUTPATIENT SURGERY 2 Abstract Each and every day thousands of people in the United States go “under the knife” for surgery.

If an overnight hospital stay is unnecessary, patients may have their surgery performed at an ambulatory surgery unit. This allows the patient to come in for surgery and go home the same day. Recovery time is usually very limited and patients report little to no discomfort. Whether it be minor or major, surgery is an invasive procedure that must be done with extreme precaution and preciseness. From preoperative to postoperative, each operating room personnel have assigned duties to uphold during the patient’s operating room procedure.

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These responsibilities ensure optimal care for the patient before, during, and after their surgery. Keywords ?: operating room, procedure, OR personnel, outpatient, ambulatory surgeryOUTPATIENT SURGERY 3 Outpatient surgery Each patient has specific reasons to undergo surgery procedures. Signs and symptoms vary from one case to the next. However, the most common signs are pain and discomfort, which will alert the patient that a visit to their primary care physician is needed. The physician will then perform exams, testing, and laboratory analysis, to diagnose the problem.

If the patient needs minor surgery, an appointment will be made with outpatient surgery. The patient will come back at their appointed day and time for a same-day surgery. A few outpatient surgeries can include inguinal hernia repair with mesh placement, umbilical hernia repair with mesh placement, and a hysteroscopy. Inguinal hernia repair and umbilical hernia repair, both with mesh placement, are procedures performed to fix a hernia in the groin or navel area of the body.

A hernia is a protrusion in the abdominal wall that cause cause significant pain, especially when the patient is moving. During these surgeries, an incision of a around 2-4 inches is made to expose the existing hernia. The surgeon then uses electric cauterization to disconnect the hernia from the tissue surrounding it. The hernia is placed into a sterile specimen container to be sent to the lab for diagnostic testing. After the hernia is carefully removed, the surgeon irrigates the incision with sterile saline solution, inserts a mesh to help strengthen the abdominal wall, then stitches the incision shut.

After surgery and recovery of up to two weeks, the patient should be able to return to normal with no pain or limitations. A hysteroscopy is performed on a female patient that presents with symptoms of abnormal or unexplained bleeding. During this procedure, the cervix must be dilated. The femaleOUTPATIENT SURGERY 4 is sedated and placed in a lithotomy position.

The vaginal area is cleaned with betadine surgical scrub. A liquid solution is inserted into the vaginal while the doctor inserts a hysteroscope, a tubed camera with light, into the cervix. This provides a clear, videoed image of the inside of the cervix and the openings of the fallopian tubes. This allows the doctor to observe any signs of polyps, tumors, or malformations of the cervix.

If any are found, they can be removed while the hysteroscope is inside of the cervix. If no abnormalities are found, an intrauterine device can be inserted. These produce hormones that limit bleeding and menstrual cycles. Negative Effects of Surgery Some negative effects often accompany surgical procedures. The risk of effects will vary depending on health, age, and the type or location of the surgery. Effects can last from an hour to several months.

Four negative effects of surgery include: Pain, sore throat, anesthesia effects, and wound infection. Pain and soreness from surgery can occur because of the surgical procedure, during which tissue and muscle are traumatized. After the local anesthesia weakens, the body’s nerve pathway sensations are no longer blocked.

Pain can be managed efficiently through nurse-patient communication, verbal or nonverbal. If a patient cannot verbalize his/her pain rating on a scale from one to ten, the nurse can observe the patient’s nonverbal facial expressions, such as grimacing or crying. Pain medication or holistics approaches can help minimize the patient’s pain. Pain can also persist months after the surgery, which is when a doctor can plan a pain regimen for the patient, such as prescribed at-home medications.OUTPATIENT SURGERY 5 Sore throat is another negative effect of surgery.

This is because some surgeries require a patient to be intubated. This means a tube is placed down the throat to help with breathing while the patient is under anesthesia. This is a short-term effect of surgery and should subside within hours after surgery. During surgery, anesthesia is required to keep the patient sedated. After surgery, the anesthesia will wear off and side effects can occur.

Side effects of anesthesia are headache, fatigue, rash, low blood pressure, and confusion.The nurse monitors the patient for any severe adverse effects from the anesthesia. Wound care is a very important part of post-op.

A patient needs to be educated on how to properly clean the incision area. Improper care can lead to severe infection, which can then lead to sepsis. If infection is present, an antibiotic will be prescribed for the patient. Criteria and Advantages of Outpatient Surgery Criteria for outpatient surgery includes: a minor surgery, little to no risk of postoperative complications, patient-managed post-op care, and no need for post-op hospitalization.

Advantages of outpatient surgery are: reduced stress, no hospital time, ability to manage own post-op care, reduced fees, and less time missed from work or school. In general, outpatient surgery is more convenient and cost-efficient. It allows the patient to be at home when recovering and manage their own care, sometimes with the help of family members or friends, and allows for the patient to resume a normal routine faster than a hospitalized surgery procedure.OUTPATIENT SURGERY 6 Preoperative Preparation The major goal of preoperative preparation is to assess, question, and educate the patient on the surgical procedure.

During this phase, the doctor determines any conditions or vital sign abnormalities that may interfere with optimal surgery expectations or anesthesia risks. The doctor also educates the patient about the anesthesia, the procedure, and the post operative recovery time. This helps reduce any anxiety and stress that the patient may have about being put to sleep or undergoing operation. This allows for safe and easy transition throughout the procedure for both patient and the preoperative, operative, and post-operative surgical team. Special Considerations Special considerations are taken for surgical patients who are obese, elderly, very young, or diabetic. These patients are more at risk for complications during surgical procedures.

Obese patients may require more operating room team members to position them correctly or move them from the preoperative bed to the operating room bed. Obese patients are also at higher risk for complications from anesthesia due to obstructed airway. While in a supine position on the operating table, an obese patient may have more difficulty breathing. During surgery, certain body parts may be more difficult to reach to due excessive adipose tissue.

After surgery, the obese patient may require more monitoring and more pain medication than that of a healthy person. The elderly requires special consideration because they are more at risk for infection, their bones and skin are more brittle due to aging, their oxygenation may be poor, and they mayOUTPATIENT SURGERY 7 need help maintaining normal body temperature. Recovery time for the elderly often takes much more time than younger people. Very young patients need special consideration also. Infants will require less medication, less sedative, and more monitoring than an adult.

Infants and very young children have smaller lungs and stomachs. It is also important to inform the child’s parent on the surgical procedure and risks. The surgeon must take extreme precaution not to puncture through the small organs of a child during a surgical procedure. Doctors must assess diabetic patients and identify the safest method of anesthesia for them. Diabetic patients are more likely to endure postoperative surgical complications. Wound infections are more likely in diabetic patients, especially heel sores.

These patients also have an elevated risk of high blood pressure and stroke. Surgical Asepsis Surgical asepsis means the absence of all microorganisms. The surgical team takes great precaution in maintaining a sterile environment.

Before entering the operating room, team members don operating room scrubs, shoe covers, face mask, and hair cover. Surgical hand asepsis must be performed and mask, sterile gowns and gloves must be put on, with the help of surgical assistants. Sterile fields are set up in the operating room ready for the doctor.

Observers are told to stand within 4 feet of the sterile fields, which are draped in blue. After the operation, the rooms are sterilized again and set up for the next procedure.OUTPATIENT SURGERY 8 Roles of the Perioperative Team Preoperative team members prepare the client for the surgery. During this phase nurses monitor vital signs, assess the patient and their medical history, administer any preoperative medications the doctor has ordered, educate the patient on the surgery, make sure they understand the benefits and risk, and have the patient sign any forms or releases. At this time, the doctor or anesthetic nurse may come in to educate the patient on the anesthesia being used.

Operative team members are involved in the actual operating procedure. Surgical technicians setup equipment, prepare the operating room, and assist the surgeon during surgery. The anesthesiologist administers the anesthesia to the patient and monitors the patient’s breathing and vital signs throughout the entire procedure. The aesthetic nurse is responsible for assisting the anesthesiologist. The circulating RN is responsible for documentation, keeping count of supplies used during surgery, getting any extra supplies for the operating team, and collecting patient specimen containers. The scrub nurse is responsible for handing tools or supplies to the surgeon, when needed.

A nurse practitioner may also be present to assist the surgeon with stitching up the incision. And of course, the surgeon performs the surgery. Postoperative team members care for the patient following the surgery. The postoperative nurse is responsible for assessing the patient regularly, being sure that the patient is waking up from anesthesia and vital signs are remaining normal, administering medications, if ordered, and educating the patient on instructions for wound care, any limitations the patient may need to follow, at-home medication education, and signing the discharge paperwork.

OUTPATIENT SURGERY 9 Common Anesthesia Techniques For outpatient surgeries there are four types of anesthesia techniques: general anesthesia, local anesthesia, monitored anesthesia, and regional anesthesia. The anesthesia used will depend on the patient and what surgery is being performed. General anesthesia is administered through inhalation via facial mask or intravenously. This method allows you to be completely unconscious throughout the entire procedure and have no recollection of the surgery.

Local anesthesia is used for very minor surgeries. It is injected at the incision site. A surgeon can inject this type of anesthesia, so an anesthesiologist is not required to be present for this. Local anesthesia has very little side effects.

Monitored anesthesia is administered through an IV line by an anesthesiologist. Local anesthesia may also be used while under monitored anesthesia. This method is used for more moderate to severe surgical procedures. The anesthesiologist must be present during the entire sedation to monitor the patient’s vital signs. Regional anesthesia is used as a nerve block and provides complete numbness to the area where it is injected.

This type of anesthesia includes the epidural, which is used for pain during labor and delivery.OUTPATIENT SURGERY 10 Client Assessment During Surgery Each perioperative team member is responsible for ensuring the surgical procedure is performed with the clients safety in mind. During surgery, the client is continuously assessed and monitored.

Before the surgery starts, the operative members take a “time-out” to identify the patient again, restate the type of surgery being performed, and verify the client’s allergies. After all information is verified, the surgery begins. The patient’s airway, breathing, and vital signs are monitored the entire time to ensure the client is responding positively to the anesthesia. If more anesthesia needs to be administered during a lengthy procedure, the anesthesiologist will handle that so that the patient does not wake during surgery. Nursing Responsibilities in Client Care After Surgery Postoperative care begins immediately after surgery. Nurses must ensure the client is awakening from the anesthesia and that vital signs and oxygen saturation are remaining within normal limits.

Pain management for the client is very important after surgery because if the patient is experiencing pain it can cause respiratory rate, blood pressure, and pulse rate, to increase. If any abnormalities are assessed, it is the nurse’s responsibility to notify the doctor right away. Culturally Competent Client-Centered Care for the Surgical Patient Culturally competent care is a very important part of nursing. It means the nursing team has the ability to meet cultural and communication needs of a patient. Cultural competence is crucial when caring for a surgical patient. A nurse must be aware of the language, dietary needs, beliefs, values, and medicinal views of a patient’s culture.

Certain cultures do not allow bloodOUTPATIENT SURGERY 11 transfusions to be performed, some believe prayer works better than surgery, some do not believe in ingesting medicines, and so on. Therefore, each nurse must be aware of the patient’s specific beliefs to ensure no boundaries are overstepped. Being knowledgeable in many languages is great asset to have as a nurse. Being able to clearly communicate with a client is the main way to ensure their needs are met.

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clevelandclinic.org/health/treatments/10142-hysteroscopy/procedure-details Outpatient Surgery. (n.d.).

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, & Boaler, J. (1977, May 07). The nurse's role in immediate postoperative care. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1606846/ Tidy, C., Dr. (2016, December). Precautions with Patients with Diabetes Undergoing Surgery. Retrieved from https://patient.info/doctor/precautions-for-patients-with-diabetes-undergoing-surgery Yang, R., Wolfson, M., & Lewis, M. C. (2011, March). Unique Aspects of the Elderly Surgical Population. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597305/

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