Joshua Danko

Surgery

The experience I had for my day in surgery began in fast track. This is where all the

patients that were going to have a scheduled surgery that day arrived throughout the day. The

patients were prepared for surgery by first getting dressed into a hospital gown. After that, the

patients were assessed and the nurse also reviewed the history that was completed prior to the

hospital visit that day. There was one nurse that took care of this responsibility for the entire day.

In the morning there was an assessment being done on a different patient every fifteen minutes.

One of the main patient cases that I followed throughout the day was a patient having bilateral

knee replacements. The patient came into fast track with a pain rating of a seven. The patient

reported a constant aching pain in both knees. Although the patient was in a high amount of pain,

he was not medicated prior to surgery. The patient was going to end up getting nerve blocks in

both legs for control of the pain. The patient had very limited mobility due to the pain in his

knees. The nurse did an assessment on the patients body systems. She asked questions about the

last bowel and urine elimination, which is important for surgery. The patient would later be

catheterized during the beginning of surgery. After the nurse went through the body systems for

assessment, she went on to review the charting for the health history with the patient. The nurse

had found out if the patient had taken any medication today or if they needed to be medicated

prior to surgery. This period before surgery is when the advanced directives were acknowledged

and patient consent forms were signed. The nurse then had to prepare the patient for surgery.

After the assessment phase of fast track which goes very quickly, the patient is given

some care to prepare for surgery. One of the first things the nurse had to do was start an IV on the

patient. This nurse was very effective at inserting an IV into the patients and said she had plenty

of practice doing so as how she had gotten so good at it. After that the nurse gave normal saline

fluids and also an antibiotic prior to surgery. Further prepping for surgery was required for this
patient. The patient had to have their legs shaved for the procedure to be done in surgery. After

that the nurse put on a skin prep on the patients legs and then covered up the legs. The legs

would later be scrubbed in surgery. The nurses in fast track always seemed very rushed as there

was always a new patient arriving that needed to be cared for. I decided it would be better to let

the nurse do what she needed to get done and just observe the process and how the fast track

plays a role in the surgery process.

During surgery, there are a lot of moving parts in the form of many health care team

members doing their part in the surgery. There was a circulating nurse in the room was the nurse

that did not have to maintain sterility throughout the procedure. This nurse would grab anything

that the surgeon asked for and give it to the scrub tech. The scrub tech had to maintain a sterile

environment for many different tools and objects that the surgeon would use. The scrub tech

would hand all of the instruments directly to the surgeon needing them. In this surgery, there was

a doctor and two residents helping him out. Also there was an assistant that was a nurse that

helped as well. In all, there were four people that could touch the surgical site. Also in this

surgery was a drug rep for the knee replacement instruments and materials. This person would

assist everyone in the room with the surgery. He helped the scrub tech find and use certain parts

of the knee replacement. Also, he helped the surgeon make decisions on how to best use the

equipment provided. The drug rep would verbally do these things as he could not physically be

part of the surgery process. The last person in the room was the nurse anesthetist that monitored

the patient throughout the surgery.

The primary problems of a patient with a double knee surgery post-op would be pain in

bilateral lower extremities and loss of mobility, which could create a lot of trouble. This patient

will have trouble doing physical therapy because of having both legs affected during surgery.

Other problems faced by loss of mobility would include a risk for impaired skin integrity,

pneumonia, deep vein thrombosis, pulmonary embolism. Interventions need to be taken to

reduce the risk of the things from occurring. The patient should be given pneumatic compression

devices, incentive spirometry, and should ambulate and take part in physical therapy to help

prevent some of these possible complications from occurring. The patient could also be over or

under treated for pain with the prescribed pain treatment plan. This patient was given nerve

blocks in both legs which would help with the pain after surgery. The patient will most likely be

given some form of narcotic for pain after surgery. The main concern will be how the patient

responds to physical therapy as the double knee makes for an uncommon obstacle. The patient

should be encouraged to take part in the physical therapy plan of care as best as possible to

reduce the many risks involved post-op.

The patient did need some teaching during the fast track experience. The patients wife of

the double knee patient was worried about the nerve block that was going to be administered.

Her fears came from not knowing exactly what the procedure of the nerve block would entail.

She had asked if it would be injected into the spine which showed she was not aware of what a

nerve block was. The nurse had explained to the wife and the patient about what the nerve block

was it why it was being used. The nurse also assured them that it was a common procedure. After

the nurse explained what it was, then anesthesia took further questions about the nerve block and

then took the patient to have it done. It is important that all of the patients questions are

answered so that proper consent can be signed for the procedure. I would expect the patient to

have more questions post-op about pain and also mobility limitations.

Overall, I enjoyed this surgery experience. I liked seeing how a new surgery admit goes

from admission to discharge. During surgery I was able to see everything that happens before

that patient reaches the floor. It was also good to see all the different roles of nurses on the

surgery floor.