A Procedural Report on Total Abdominal

Hysterectomy Bilateral Salpingo-Oophorectomy

Submitted to:
Irene N. Lopez, RN, MN

Submitted by:
Pryll John O. Colita, BSN-III

August 2016

I.

DEFINITION
An open reduction internal fixation (ORIF) refers to a surgical procedure to fix a severe

bone fracture, or break. Open reduction means surgery is needed to realign the bone fracture
into the normal position. Internal fixation refers to the steel rods, screws, or plates used to keep
the bone fracture stable in order to heal the right way and to help prevent infection.
Open reduction internal fixation can also refer to the surgical repair of a joint, such as a
hip or knee replacement.
The surgical procedure is performed by a doctor who specializes in orthopedics, which is
a branch of medicine concerning the musculoskeletal structure of the body. Under general
anesthesia, an incision is made at the site of the break or injury, and the fracture is carefully realigned or the joint replaced. The hardware is installed, and the incision is closed with staples or
stitches. The steel rods, screws, or plates can be permanent, or temporary and removed when
healing takes place.

II.

ANESTHESIA ADMINISTRATION
Since the patient was a nine-year-old child, performing the surgery while the patient is

awake is quite tedious. Thus the anesthesia inducted was general anesthesia through injecting the
anesthesia intravenously. General anesthesia (GA) is the state produced when a patient receives
medications for amnesia, analgesia, muscle paralysis, and sedation. An anesthetized patient can
be thought of as being in a controlled, reversible state of unconsciousness. Anesthesia enables a
patient to tolerate surgical procedures that would otherwise inflict unbearable pain, potentiate
extreme physiologic exacerbations, and result in unpleasant memories.

III.

SURGICAL INCISION APPROACH

The surgical incision approach used was the posterior approach to the elbow. In the case of the
patient, the posterior approach used was the modified pediatric approach. The procedure is listed
as follows:

Posterior approach may be indicated for irreducible supracondylar fracture or for

displaced lateral condyle fracture

Posterior incision is made which curves along the medial side of olecranon;
Ulnar nerve is identified and protected;
Triceps tendon is transected 1 cm from its insertion (so that an adequate cuff of tendon is

left for closure);

Remaining triceps insertion is elevated medially or laterally;
The proximal portion of the tendon is mobilized proximally;
Posterior capsule is opened transversely from medial to lateral;
The fractured site is exposed and fixed appropriately;
Triceps tendon is closed securely w/ non absorbable sutures;
Arm is then immobilized in a cast (3 weeks for supracondylar fracture and 4-5 weeks for
lateral condyle fracture)

IV.

INSTRUMENTS, EQUIPMENTS, MACHINES

Army-navy used to retract shallow or superficial incisions

Kidney basin used to receive soiled dressings and other medical wastes

Blade holder used to hold the blade or knife

Clamps used for grasping and holding instruments or
even blood vessels and tissue

Towel clips used to secure the towel drapes over the patient

Thumb forceps - used to hold tissue in place when applying sutures,

to gently move tissues out of the way during exploratory surgery and to
move dressings or draping without using the hands or fingers.
Tissue forceps for holding and grasping soft tissues

Metzenbaum scissors used to cut delicate tissue and blunt dissection

Mayo scissors to cut thick tissues and sutures

Yankauer suction tip/set used to remove fluids and debris while

doing the surgery
V.

POSITION FOR SURGERY

Supine Position

VI.

Most common with the least amount of harm

Placed on back with legs extended and uncrossed at the ankles

Arms either on arm boards abducted less than 90o with palms up or tucked (not touching
metal or constricted)

Spinal column should be in alignment with legs parallel to the OR bed

Head in line with the spine and the face is upward

Hips are parallel to the spine

Padding is placed under the head, arms, and heels with a pillow placed under the knees

Safety belt placed 2 inches above the knees while not impeding circulation

NURSING RESPONSIBILITIES OF SCRUB & CIRCULATING NURSE

A. Pre-op

Scrub Nurse

Ensures the operating room is clean and ready to set-up.

Prepares the instruments and equipment needed for the surgery.
Counts all sponges, instruments, needles and other tools.
Preserves the sterile environment by scrubbing in, which requires washing his
hands with special soaps and putting on sterile garments, including a gown,

gloves and face mask.

Assists the surgeon in wearing gloves and gown.

Circulating Nurse

Ensures that the OR is set up correctly.

Assists the scrub nurse in wearing the gown.
Helps the scrub nurse in counting the instruments and equipment.
Checks the vital signs, IV fluid level and type, name, and age of the patient.
Ensures safety of the patient during transferring from the stretcher.

B. Intra-op

Scrub Nurse

Selects and passes instruments to the surgeon.

Must know which instruments are used for specific procedures and when they are

needed to quickly hand them to the surgeon.

Assists the surgeon and maintains patient safety.
Cleans and arranges tools after the surgeon uses them.
Initiates the counting of all accountables.

Circulating Nurse

Helps position the patient on the operating table.

Hooks up any necessary suction and cauterization equipment and assists the

anesthetist or anesthesiologist with intubation.

Provides the surgical team with sterile fluids and medications as needed
Replenishes the surgical team's supplies if they need additional disposables or

instruments.
Counts and checks the instruments with the scrub nurse.

C. Post-op
Scrub Nurse
Removes tools and equipment from the operating area
Applies dressing to the surgical site
Transports the patient to the PACU
Completes any necessary documentation regarding the surgery
Monitors the patient in the PACU until stable

Circulating Nurse

VII.

Helps the anesthetist with tube removal

Oversees the patient's removal to a post-anesthesia recovery area
Helps clean the operating room
Helps clean and brush the instruments used
May assist in monitoring the patient in the PACU

REFERENCES

http://www.wheelessonline.com/ortho/posterior_approach_to_the_elbow
http://emedicine.medscape.com/article/1271543-overview
http://www.orthopaedics.com.sg/treatments/screw-fixation