Perioperative surgical experience: thyroidectomy

Members of the perioperative teamCirculating nurse The main role of the circulating nurse was to set up the OR correctly, which included checking all equipment needed during the procedure to verify they were functioning properly, and preparing the surgical equipment assuring sterility of the instruments. When the patient arrived, she verified the patient's identity and necessary consent forms and then reviewed the site and nature of the procedure with the surgeon. She also assisted the surgical technicians, to position and secure the patient to the operating table, making great emphasis on patient safety. Scrub nurse The scrub nurses main role was to maintain asepsis, thereby reducing the chance for infection. She was responsible for scrubbing the patients surgical site, to reduce the number of potentially pathogenic bacterial, managing the sterile field, and arranging the sterile instruments. There was a section in the operation room, with blue drapes, that was designated only for sterile instruments, therefore no one but the scrub nurse or the surgeon could be next to it.

Nurse anesthetistThe nurse anesthetist intubated the patient, administered anesthesia, and carefully monitored the patients vital life functions, including heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance. He also controlled the patients pain and level of consciousness.SurgeonHe performed the surgery and he definitely had the greatest legal responsibility for the patients well-being; however, all members of the surgical team worked diligently to anticipate potential problems, reduce surgical infection risk, and formulate interventions for the best possible patient outcome.Nursing DiagnosisImpaired tissue integrity r/t disruption of tissue associated with the surgical procedure AEB thyroidectomy.Risk for infection r/t surgical incision. Risk for aspiration r/t impaired swallowing AEB thyroidectomyPreoperative and Intraoperative phaseThe preoperative nurse has the responsibility of ensuring that he patient is physically prepared to undergo surgery, therefore she assessed the patients compliance with preoperative orders, performed patient testing, reviewed the release forms, and assessed the patients current level of wellness. In case of an illness the patient may not qualify for the procedure, and will require additional monitoring. The nurse also was responsible of taking the patients vital signs, administering intravenous fluids, and insertion of a urinary catheter while the 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 phaseAfter 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.