Question

J.A., a 68-year-old female with a herniated lumbar disc at L4, is scheduled to have an L4 lumbar laminectomy using a posterior approach. She has a history of low back pain, osteoarthritis in the left hip, and hypertension. She is taking the following medications:

Metoprolol 50 mg PO BID; last dose last night

Ibuprofen 600 mg TID; last dose yesterday morning

Garlic supplement daily; last dose yesterday morning

Subjective Data

Has low back pain that radiates down her right leg

Has pain in left hip which worsens with activity

Has not had anything to eat or drink since midnight last night

Has smoked one-half pack of cigarettes per day for past 47 years

States that she is allergic to sulfa and latex

Objective Data

Physical Examination

Blood pressure 140/82, pulse 84, temperature 98.6° F,respirations 20

Height 5’ 5”,weight 195 lbs, BMI 32.4 kg/m2

Diagnostic Studies

ECG normal sinus rhythm

Lab values

Sodium 139.0 mEq/L

Potassium 3.4 mEq/L

HCO3 25.4mEq/L

Chloride 99.5mEq/L

BUN 10mg/dL

Creatinine 1.1mg/dL

WBC 7,000/µL

RBC 4.3 million/µL

Hematocrit 36%

Hemoglobin 12 g/dL

Platelets 164,000/µL

Glucose 98mg/dL

Discussion Questions

After reviewing J.A.’s chart with the above data, what information should the perioperative/circulating nurse make the operating room staff, surgeon, and anesthesia care provider aware of?.

Just prior to bringing J.A.to the operating room, the surgeon comes to talk to her and marks the surgical site. You then put a hair cover over J.A.’s hair, similar to that worn by the rest of the operating room staff and hang the ordered preoperative IV antibiotic. What is the purpose of the surgeon marking the operative site, the hair cover, and the administration of the antibiotic on the way to the operating room

What is involved in a surgical time-out?

What is the circulating nurse’s role in the operating room?

Answer 1

The circulating nurse should make the surgical team aware of the following

• Allergic to latex because in surgery the preferred s is latex gloves
• Allergic to sulpha drugs because the anaesthetist may administer medication which can cause an allergy
• Has taken garlic supplement yesterday because it is a blood thinner
• The weight and BMI of the patient to the anesthesiologist to determine the dose of anesthesia to be administered

The purpose of the surgeon to mark the surgical site is to avoid error(surgical error) in the operating room ,to avoid confusion and diellema,to perform surgical incision on the right site.

The hair cover for the patient is used to prevent any hair fall from the patient which can contaminate the surgery or the surgical room.In addition to it can also reduce the transmission or contamination by any microorganisms from the head.

The administration of antibiotics on the way to operating room is to prevent any surgical site infection

The things involved in the surgical time out is a silence by the surgical team in the operating room to confirm the exact identify of the patient before starting the surgery done.In simple it is the time between surgical team scrubbing and getting draped to the surgical incision innthe patient by confirming patient and their surgical details.

The role of the circulating nurse are

• To ensure adequate supply are their for the surgery
• They act as the patient advocate
• Stock checking
• Monitor the patient status throughout the surgery and inform any abnormal ranges.