Case No: Major Scrub 3

Name of Student: Irish Queenie L. Malimban

Year and Section, RLE: 4NUR6, RLE6.3

Name of Patient: R.L.L. Age: 24 years old Sex: Female Civil Status: Single
Date of Admission: 10/09/17 Time Started/Ended: 9:15-9:45 AM
Date of Surgery: 03/23/19
Bed #: 3019 Hospital No: 17070000097303 Admission No: 17J0227

Surgeon: Dr. A. Molano Anesthesiologist: Dr. Edgardo Tan

Assistant Surgeon: Drs. B. Lorenzo/J. Evangelista Scrub Nurse: Jenina Wong, RN
Circulating Nurse: Sarah Jane Palo, RN
Chief Complaint: Hearing loss, left ear
Rationale/ Definition:
Fracture; closed right radial ulnar

Predisposing Factors Stress placed on the bone,

Precipitating Factors
Predisoposing factors
- Trauma exceeds the bone ability
-
Non-modifiable
Falls
Fall
to absorb it
-- Pre-existing
Accident allergies
- Slide

Injury in the bone

Fractured right radial ulnar

Pain Loss of Function Inflammatory response Shortening Crepitus
Post-Operative Diagnosis: Chronic Otitis Media
Rationale/Definition: It is usually caused by acute otitis media, blockage of the eustachian tube (which
connects the middle ear and the back of the nose), an injury to the ear, or blast injuries.

Complete Surgical Procedure: Mastoidectomy with mastoid obliteration followed by

Tympanoplasty Type I; Post Auricular approach
Definiton: It is a surgical technique to repair a defect in the tympanic membrane with the placement of
a graft, either medial or lateral to the tympanic membrane annulus.
Indication: It is indicated for patient with Chronic Otitis Media.
Type of Anesthesia: General Anesthesia
Specific Technique: General Endotracheal Anesthesia
Skin Preparation/Assistance Done: From the back of the head to the both ears
Items Used to Administer Anesthesia: Endotracheal tube
Main Anesthetic Agent: Sevoflurane
Mechanism of Action: Sevoflurane is a volatile halogenated general anesthetic that has a minimum
alveolar concentration value ranging from 1.4% to 3.3%. It alters the activity of fast synaptic
neurotransmitter receptors like nicotinic acetylcholine, GABA and glutamate.
Other Medications Used: Fentanyl, Midazolam
Mechanism of Actions:

Midazolam are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA),
which is one of the major inhibitory neurotransmitters in the brain. Benzodiazepines increase the
activity of GABA, thereby producing a calming effect, relaxing skeletal muscles, and inducing sleep.
Benzodiazepines bind to the benzodiazepine site on GABA-A receptors, which potentiates the effects of
GABA by increasing the frequency of chloride channel opening.

Fentanyl Binds with stereospecific receptors at many sites within the CNS, increases pain threshold,
alters pain reception, inhibits ascending pain pathways. Fentanyl binds to brain receptors, relieving
pain. It decreases the feeling of pain and a person's response to pain
Position: Left Lateral
Equipment Used for Positioning: Arm rest, Body strap
Incision: Post Auricular
Skin Preparation: Dr. Dela Rosa
Disinfectant Used: Betadine, cutasept
Draping: Disposable Towels, Disposable small sheet and Disposable laparotomy sheet

Surgical Safety Checklist:

SIGN IN TIME OUT SIGN OUT
Patient’s identity, site,
procedure and consent
confirmed. The surgical site
was marked. The anesthesia
machine and medication cart
was checked. Pulse oximeter
attached to the left index finger.
Equipment was available and
working. Patient has no known
allergies, no aspiration risk and
no risk of blood loss. Antibiotic
prophylaxis within 60 minutes,
patient was not warmed, site
was shaved, no glycemic
control. No venous
thromboembolism prophylaxis
TIME OUT, Good Morning!
Our patient is Angelyn C.
Yturzarita, 40 years old
scheduled for Mastoidectomy
with mastoid obliteration
followed by tympanoplasty,
meatoplasty under the service
of Dr.G. Gotamco. Surgical
team, kindly introduce
yourselves, Surgeon, Dr.
Gotamco, Assistant Surgeon,
Drs. Dela Rosa/Borleo
Anesthesiologist, Drs.
Aldave/Roldan, Scrub Nurse,
Jenina Wong, Student Scrub
Nurse, Ernesto Joven,
Nurse verbally confirmed the
name of the procedure to be
recorded and instruments,
sponges, sharps and needle
counts are complete. No
specimen and no equipment
problems are identified. No key
concerns for transfer to
recovery and no patient
management issues noted by the
surgeon, anesthesiologist and
nurse.
and no essential imaging was Circulating Nurse, Sarah Jane
displayed. Initial count done Palo and I am your student
and recorded. circulating nurse, Irish
Malimban.

To the surgeon are there any

anticipated critical events?
NONE. To the anesthesiologist,
are there any specific concerns?
NONE. To the scrub nurse, are
there any instruments or suture
concerns? NONE.

Antibiotics, Omeprazole was

given at 12MN