Identify the role and responsibilities of the various members of the surgical team
The surgical team was headed by the primary surgeon, Dr. K. Sheth. He was assisted in the physical performance of the procedure by a third-year resident, named Dr. Z. Huang. A circulating Registered Nurse named Diane Foster also assisted in the preparation of the instruments and during the procedure. The Scrub Technician Nancy Sullivan ensured that the procedures performed were done so in a sanitary manner and the anesthesiologist Dr. L.Crokovich administered the general anesthesia, and was assisted by a Certified Registered Nurse Anesthesiologist, William Maixlloux.
Although no surgery is complication-free, especially for an older individual, hernia surgery can vastly improve the patient’s life in terms of their gastrointestinal functioning and overall activity level. The surgery can be performed either with laparoscopic instruments or through traditional incision methods.
Describe application of the principles of surgical asepsis.
To ensure that freedom from infection or infectious material, the scrub nurse and RN had to insure that the implements were sterilized, along with the hands and garments of the presiding staff. The procedure involved antiseptic washes and the application of non-latex but antiseptic gloves to the hands of the surgeon and his assistants. Also to prevent sepsis the antibiotic chemoprophylaxis was used upon the patient, as it has been deemed “useful in abdominal incisional herniorrhaphy surgery” and “with implantation of prosthetic material for reducing local septic complications” (Rios, et. al. 2006). Although infection is a danger in any surgery, infection is of particular concern in hernia repair surgery.
Describe types of anesthesia observed, rational for choice, and the assessment data collected through the period of surgery.
General anesthesia was chosen to minimize the pain and psychological trauma of the operation because general anesthesia produces a state of unconsciousness, unlike a local anesthetic. It also “erases” any potentially traumatic memories the operation might leave in the mind of the patient. The LMA (laryngeal mask airway), a silicone mask for upper airway management, was used rather than an endotracheal tube because it was less invasive and a more effective seal than a face mask (“General anesthesia information, 2007). The patient has an allergy to latex, thus this material was not used in any of the implements involved in administering the anesthetic or during the rest of the surgery
Post operative, the patient’s temperature was 97.4, his blood pressure was 132/60, pulse was 63, and, oxygen saturation 100%. Later pain assessment was 2 out of 10, indicating the anesthetic treatment was effective, although the patient was prescribed pain killers upon discharge to deal with potential postoperative pain.
Describe one of the procedures observed and the reason for the surgery.
The pre-operative diagnosis of the patient was right inguinal hernia. Although with elderly and inactive patients, occasionally hernias are not dealt with through an operation, because of the individual’s moderately active lifestyle and occupation as a carpenter, an operation was deemed the best course of action. For a fifty-seven-year-old man with a fairly unremarkable past medical history, surgery was recommended. Also, performing the surgery could have a positive impact upon his diverticulosis, urinary hesitation, Gerd, BPH (benign prostrate hyperplasia, or enlarged prostate) and mild anemia. A surgery to correct the inguinal hernia had been successfully performed in 1998 without incident, as did the patient’s other surgeries, including his varicose vein stripping done in 1987 and eye surgery in 1995.
During an inguinal hernia repair procedure, first, the surgeon makes an incision and separates the muscle and tissues to expose the hernia sac. The sac is cut open and the contents are replaced into the abdomen, the neck of the hernia sac is tied, and the muscles and tissues are sutured. During a laparoscopic procedure the procedure is performed through tiny incisions, using an instrument with a camera attached and a video monitor to guide the repair. When the surgery involves reinforcing the weakened area with steel mesh, the repair is called hernioplasty (Culvert 2004). The piece of plastic mesh is used to reinforce the defect in the abdominal wall (Goverman, 2007).
Outline postoperative care for a client whose procedure you observed.
The patient returned with a large dressing over the surgical site, which was supposed remain in place for a day or two. It was suggested to the patient that a corset or another form of non-invasive support was used as needed during the recovery period to support weakened muscles. The primary potential complications of this procedure are infection and abscess formation at the site of the surgery. Although “postoperative testicular volume and blood flow measurements” usually show no significant change from preoperative levels in hernia patients, and “sexual disorders attributed to inguinal pain were significantly reduced following surgery,” 10 -14% of male hernia patients complain of postoperative limitation of sexual activity following surgery, including pain and loss of sensation (Walling 2001). There also may be frequent urges to urinate on the part of the patient.
One potential ‘social’ complication was the patient’s lack of fluency in English. Although not an insurmountable barrier, given that the postoperative orders could be translated into the patient’s native Portuguese, it was an important reminder that it is not merely enough that patients are dispensed with the correct orders, and that these orders are comprehensible to the patient.
Culvert, Lee L. (2004). “Inguinal Hernia Repair.” Gale Encyclopedia of Surgery.
General Anesthesia Information.” (2007). Surgery. Retrieved 15 Sept 2007 at http://www.justbreastimplants.com/surgery/general_anesthesia.htm
Goverman, Jeremy (23 Jan 2006). “Hernia” Medline Encyclopedia Online. Retrieved 15 Sept 2007 at http://www.nlm.nih.gov/medlineplus/ency/article/000960.htm
R’os, J. Rodr’guez, P. Munitiz, D. Alcaraz, P. Perez, Flores. (Sept 2001).”Parrilla using a prosthesis.” Hernia. 5(3): 1265-4906 (Print) 1248-9204 (Online). http://www.springerlink.com/content/a04wbnfjp82v60t2/
Walling, Anne D. (15 Oct 2001). “Does inguinal hernia repair affect sexual function?”
American Family Physician. Retrieved 15 Sept 2007 at http://findarticles.com/p/articles/mi_m3225/is_8_64/ai_79151910
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