ATENEO DE DAVAO UNIVERSITY

SCHOOL OF NURSING

STRUCTURE OF ACTIVITIES
STUDENT NURSE PATIENT ASSIGNMENT
STUDENT NURSE ROLES
ANECDOTAL REPORT

SUBMITTED TO:
MRS. MAYCHEL ANCOG, RN, MN

SUBMITTED BY:
SAMER ANN D. SUMALINOG
BSN -4A

PROCEDURAL REPORT

Definition: Augmentation mammoplasty, or breast augmentation is a surgical procedure to

increase the size, shape or fullness of a woman's breasts. The surgeon places silicone, saline or
alternative composite breast implants under the chest muscles or breast tissue.

Purpose:
Breast augmentation is done to:

Enlarge breasts that are naturally small.

Restore breast size and shape after pregnancy, weight loss or breastfeeding.
Restore symmetry when the breasts are asymmetrical
Restore the breast(s) after surgery as treatment for breast cancer or some other

condition or event that affected the size and shape of the breast.
Breast enlargement boosts self-esteem - women usually experience a significant boost
in self-esteem and positive feelings about their sexuality after undergoing breast
enlargement, researchers from the University of Florida reported in Plastic Surgery
Nursing.

Instruments:
Steel Ruler 6

Round Scalpel Handle Straight

Surgical Stainless

Round Scalpel Handle is

Steel

a straight handle that can

Ruler

measures 6 inches

be

(15.5

blades #10, #11, #12, and

cm)

and

shows
measurements

used

with

scalpel

#15.
in

inches and centimetres.

Emesis Basin 10 oz

Mayo Dissecting Scissors 6 3/4"

1.

Mayo scissors are a type of surgical scissor,

often used in the cutting off fascia. It usually
have

semi-blunt

ends,

feature

that

distinguishes them from most other surgical

scissors.

2.

a shallow basin of curved, kidneyshaped design, used to collect body fluids or as

a container for various other liquids.

Mosquito Forceps 3

Kocher Straight Forceps 1x2 5

A small, straight or curved

hemostatic forceps used to hold delicate tissue
or compress a bleedingvessel.
Ratchet-handled, scissor
type, artery forceps with curved blades with cr
ossgrooved faces.
The tipsof the blades have one pair of interlock
ing, sharp teeth.
Tissue Forceps 1x2 4

Needle

Holder
5
also

called needle

driver,

is

a surgical

it

s by doctors and surgeons to

rr needle for closing wounds during suturing and

ed blades and with or without teeth.

instrument, similar to a hemostat, used

surgical procedures.

hold

a suturing

Goldman-Fox Scissors 5

Allison
Tissue
Forceps
4x5 6

Tissue
pliers
Goldman-Fox standard scissors with 1 serrated used to grasp and stabilize soft tissue.
blade used for trimming tissue or cutting
sutures.
Iris Straight Scissors s/s 4 1/2

Joseph Hook 2/Pr Sh 6 1/4" 2mm

Joseph Skin Hook is a handheld retractor

commonly used for holding back the edges of
Iris Straight standard scissors with 1 serrated
blade used for trimming tissue or cutting
sutures.

skin

during

intranasal

Backhaus Towel Clamp 3 1/2"

Frazier Suction Tube 8Fr

procedures.

and

pharyngeal

Frazier Suction
Tube is a thin,
angled
instrument used for removing fluid and debris
from confined surgical sites such as the nasal
cavity,

lumbar

and

cervial

regions

or

intracranially. Suction is controlled by a small

hole on the handle and multiple tip sizes are
available.
Backhaus Towel Clamp is a perforating clamp
used for grasping tissue, securing towels or
drapes, and holding or reducing small bone
fractures.
Adson Dressing Forceps 4
Adson Tissue
Forceps 1x2

Adson Dressing Forceps are

thumb
holding

forceps
dressing

used

for

materials

Adson Tissue such as cotton and gauze during surgical

Forceps are for holding and manipulating procedures, changing dressings, or packing
delicate tissues. These forceps have a wide, flat wounds. They have a wide thumb grasp for
thumb grasp area that is commonly serrated. increased precision and control. This product is
The jaws are short and the tips are narrow.

straight with serrated tips and a length of 4-3/4

inches.

DeBakey Atraumatic Tissue Forceps 2.0mm US Army Retractor

Jaw Straight

They

are US Army Retractor is used to expose surface

commonly used for grasping fine tissue and layers of skin, commonly in plastic surgery
blood vessels or soft tissue dissection. The procedures. It is a double-ended retractor with
narrow tips and atraumatic teeth cause little to a fenestrated handle. The blades at each end
no damage to the tissues.

are angled 90 degrees and also have a slightly

curved, rounded lip. The blades also face in the

Deaver Retractor

same direction.
Malleable Retractor

A retractor that can be bent and reshaped.

Used to retract and expand openings.

Senn Retractor, Double End, Sharp

Stevens Tenotomy Scissors

Senn Retractor is a handheld, double-ended

retractor used to retract primarily surface
tissue. It is often used in plastic surgery, small
bone and joint procedures, or thyroidectomy
and dissection of neck tissue. This instrument
has one angled, blunt end and, at the opposite
end, facing the opposite direction has a three
prong, rake tip. The prongs may be sharp or
blunt.

Stevens Tenotomy Scissors are used for

delicate dissection and cutting, commonly in
ophthalmologic,

neurological,

and

plastic

surgery procedures. Tenotomy scissors have

long handles and small, sharp blades with
sharp or blunt wedge-shaped tips. The long
handles allow the surgeon to have an adequate
grip and control while dissecting or cutting in

Schnidt Tonsil Forceps

small or narrow areas.

Metzenbaum Dissecting Scissors

Metzenbaum

Dissecting

Scissors are most commonly

used

for

dissecting

and

cutting tissue. These scissors

are not recommended for
Half-Curved Jaw forceps
Surgical Procedure:

cutting sutures, drains, or heavy tissue.

Inframammary Approach
1. The line of the incision is marked.
2. A 3-to-4-cm incision is made just above the inframammary crease.
3. A percutaneous is developed between the pectoralis fascia.
4. A plane is developed between the pectoralis fascia and the posterior capsule of the
breast.
5. A pocket is created by blunt dissection to accommodate the implant.
6. Meticulous hemostasis is obtained, and the implant is inserted andadjusted as needed.
7. The subcutaneous flap is approximated, and the skin is closed in a manner preferred
by the surgeon.
Periareolar Approach
1. The line of the incision is marked circumferentially.
2. The incision is made along the inferior border of the areola.
3. The subcutaneous tissue is dissected to the inferior border of the breast.
4. The retromammary space is enlarged by blunt dissection to accommodate the
prosthesis.
5. Hemostasis is accomplished, and the prothesis is inserted.
6. The inferior border of the breast is sutured to the pectoralis fascia.
7. The incision is closed according to the surgeons preference.
Transaxillary Approach
1. The incision line is marked in the axilla.
2. A vertical or oblique incision is carried down through the subcutaneous tissue.
3. Using blunt dissection, a pocket over the upper poles of the sternum is created;
hemostasis is achieved and the prosthesis is inserted.
4. The wound is closed in layers according to the surgeons preference.
Nursing Responsibilities:

Pre-op
1.

Secure consent.

2.

Monitor vital signs, then refer.

3.

Remove jewelries, dentures, and nail polish.

4.

Gather medical history, especially present allergies.

Intra-op
5.

Most implanted materials come sterile. However if they are not sterile, they should be
washed first in a mild soap solution, dried carefully, and sterilized.

6.

To avoid dust particles settling on the implant before use, cover it with a paper drape
sheet.

7.

Implants should be handled as little as possible and never with bare hands, since the oil
from the handlers skin could rub off onto the material.

Post-op
8. Monitor vital signs.
9. Check operative site regularly.
10. Keep site clean and dry.
11. Perform daily wound dressing.
12. Administer medications as prescribed.

DRUG STUDY
Generic Name: Propofol
Brand Name/s: Diprivan
Classification: Sedative
Dosage/Route: The drug is usually administered in 40-mg
bolus q10 seconds until the desired response is obtained.
Mechanism of Action: Propofol produces a dose-dependent
CNS depression similar to benzodiazepines and barbiturates.
However, it can be used to maintain anesthesia through careful titration of infusion rate.

Indication/s:

Induction and maintenance of monitored anesthesia care (MAC) sedation;

combined sedation and regional anesthesia

ICU sedation of intubated,mechanically ventilated adult patients

Induction of general anesthesia in patients 3yrs of age

Maintenance of general anesthesia in patients 2 months of age.

Contraindication/s:
Contraindicated in patients hypersensitive to propofol or any components of the
emulsion, including soy bean oil, egg lecithin, and glycerol.
Not recommended for patients with increased intracranial pressure or impaired
cerebral circulation because the drugs effect in reducing systemic arterial pressure
may substantially reduce cerebral perfusion pressure.

Adverse reaction/s:
CNS:

Headache
Dizziness
Twitching
clonic/myoclonic movement

Nausea
Vomiting
Abdominal cramping
Respiratory:
Apnea
Cough

CV:
Hypotension
Bradycardia
Hypertension
GI:

Skin:
Flushing

Interactions:
Drug-drug:
Inhilational anesthetics (such as enflurane, isoflurane, and halothane) or
supplemental anesthetics (such as nitrous oxide and opiates): may be expected to enhance the
anesthetic and cardiovascular actions of propofol.

Opiate analgesics, sedatives: may cause a more pronounced decreased of systolic,

diastolic, and mean arterial pressure and of cardiac output; may also decrease the induction dose
of requirements.

Nursing Considerations:
10 rights
Monitor vital signs
Not recommended for use in obstetric anesthesia because the safety has not been
established.
Medication should only be administered by licensed anesthetist.
Monitor patient for signs of significant hypotension or bradycardia.
Prepare under strict aseptic technique. The vehicle for profolol is fat emulsion, and it
contains no preservatives. Rapid microbial growth is possible if the solution is
contaminated.
Medication must not be mixed with other drugs or blood products.
ANECDOTAL REPORT
OBJECTIVES:

General: At the end of our exposure to the area assigned to our group, I will perform
interventions related to our Leadership and Management concept.
Specific: At the end of our 8-hour exposure in the community, I will perform skills
related to our Leadership and Management scope, such as:
Portray the role of a Head Nurse:
A
B
C
D
E

Make a structure of activities

Disseminate patients to student nurses (staff)
Lead during rounds
Recheck charting of assigned staff nurses
Recheck every patient

TIME AND MOTION:

December 20, 2014 (friday) & December 21, 2014 (Saturday)
6:30-7:00 am
7:01-8:00 am
8:01-8:10 am
8:15-11:00am
11:01-11:30 am
11:31-12:00pm
12:01-1:30pm
1:30-2:00pm
2:01-2:20pm
2:21-3:00pm
3:00pm

Circle Time/ Checking of Paraphernalia

Endorsement
Rounds
Bed Side Care/Vital Signs taking
Lunch Break (1st batch)
Lunch break (2nd batch)/ vital signs taking
Bedside care/closing of intake and output
Charting
Endorsement
Post-conference / quiz
End of shift

STRENGTHS:
Majority of my classmates loved being the head nurse, almost every gave me positive
feedbacks. Although its still my first, I already felt excited. Fortunately, both days were nontoxic and there were only few patients. While we were not doing anything, we talked about the
gifts that we wanted to receive this January 10, 2015. Everyone was happy and I could truly feel
the Christmas spirit.

WEAKNESSES:
Since our exams are over, and its our last two days going on duty before our Christmas
break, everyone was not enthusiastic to go on duty, including me. Even if Im excited to portray
the role of the head nurse, my mind was preoccupied with Christmas, new year, and getting lots
of rest over the holidays.

LEARNINGS:
Being the head nurse takes a lot of responsibility, and I learned that I have to be extra
careful and organized with everything. I have to know everything thats going on with my staff,
and my patients.

RECOMMENDATIONS:
I recommend myself to stay focused even if I am not in the mood to go on duty and my
mind is filled up with something else.