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Nurse anesthetist
patient was under anesthesia. The preoperative nurse also has the important
task of patient education; this includes teaching regarding the surgical procedure,
medications to be administered, anticipated time of discharge, and post-operative
restrictions.
The nurse anesthesiologist works together with the preoperative nurse in
assessing a patients medical readiness for surgery. He interviewed the patient to
gather information related to allergies, he also performed a focused history and
physical examination, reviewed laboratory and test results, and assessed the
need for additional testing prior to proceeding with surgery. Both nurses play a
key role in assessing and managing the patients preoperative anxiety. They
explained that anxiety can lead to arrhythmias, high BP and pain, which
adversely influence the anesthetic induction and patient recovery. Teaching
regarding the preoperative procedures, surgery itself and recovery, and listening
to the patients concerns, give the patient a sense of control, decision making,
and reduces surgical anxiety.
The procedures for preparing this female patient for surgery consisted of
instructing the patient about refraining from eating or drinking at least 8 hours
before the procedure, as well as holding the medications. Aside from the routine
pre-operative tests, the evaluation of this patient prior the total thyroidectomy
surgery included a blood test to measure the level of thyroid-stimulating hormone
(TSH) in the bloodstream, and CT scan to determine the size of the thyroid gland
and location of abnormalities.
This type of surgery is generally safe, but like any other invasive
procedure also has its risks. After the procedure the patient may experience
hoarseness and change of voice, since the nerves that control the voice can be
damaged during the surgery. Other main complications can be bleeding,
respiratory distress, infection, hypocalcemia, and hypothyroidism. To avoid these
complications, an assessment of the patients voice is made prior to surgery; the
surgery team maintains strict aseptic techniques to avoid infection. The surgeon
also avoids traumatizing the thyroid tissue during the procedure; provide good
intraoperative hemostasis and periodic assessment to the surgical site to detect
hematoma formation.
The main principles of asepsis used in the operating room were:
- Pre-surgical hand preparation with solutions containing iodine or chlorhexidine.
- Sterile drapes are used to create a sterile field. They are placed on the patient,
furniture, and equipment to be included in the sterile field, leaving only the
incisional site exposed.
- Scrubbed (sterile) personnel function only within the sterile field. Non-sterile
personnel work in the periphery of the sterile surgical field.
Post-operative phase
After surgery, the nurse anesthetist main role was to awake the patient
and make sure it was a smooth transition out of anesthesia and that the patient
was able to breath by herself. She was then transferred to the PACU unit where
the patient continued to emerge from the effects of anesthesia under the watchful
eyes of the nurse. The nurse anesthetist gave a report to the nurse about how
the surgery went, they check for orders of pain medication, made sure the patient
was covered, SCD in place and they keep talking and calming the patient.
Evidence of recovery like activity level, breathing, circulation, and level of
consciousness were continuously monitored.
The recovery process includes teaching the patient about necessary
lifestyles changes to avoid complications. The patient is instructed to get plenty
of rest, avoid heavy lifting, to take the medication as directed, avoid soy products,
to detect and notify the physician of signs and symptoms of hypothyroidism
among other indications.