Med-Surg Nursing

Advance for Nursing • January 2017

ADVANCE FOR NURSING • January 2017 • 25 Med-Surg Nursing the patient using at least three identifiers, including name, date of birth and medical record number. Surgical and anesthesia consents are obtained along with a current history and physical. Important lab studies, such a CBC with differential, PT, PTT and INR are reviewed and any other critical diagnostic tests, such as electrocardiograms, MRIs, CT scans, ultrasounds, chest x-rays or mammograms, are examined by members of the team. The circulating nurse also assess the patient’s NPO status, which normally means the patient had nothing to eat or drink by mouth after midnight the night before surgery. An exception to this rule is if he or she has taken blood pressure medication (like a beta blocker) or thyroid medication that morning with a small sip of water. Preventing Interference The circulating nurse asks if the patient has any metal in their body (such as rods, plates, screws, pacemakers or orthopedic hardware, including total joints). This provides the nurse with valuable information about where to place the grounding pad when the electrocautery is used during surgery. It’s important to place the ground pad as far away from metals as possible so as to avoid a potential burn injury or complication. An ideal location is over a large muscle mass such as the quadriceps or gluteus maximus, avoiding any and all bony prominences such knees or elbows. With regard to patients who have a pacemaker or an automatic implantable cardioverter defibrillator (AICD), electrical interference from a monopolar cautery unit may cause these devices to malfunction. A magnet may have to be placed directly over the device so that the surgeon may use monopolar electocautery (although a bipolar cautery may be recommended for cauterizing bleeds) so the pacemaker won’t be affected. For patients with a pacemaker, the magnet would cause the device to continue to pace the patient at whatever rate it was initially set. With regard to patients with an AICD, the magnet’s effect would put it in a “standby” mode so it wouldn’t fire inadvertently Comfort and Care Once the patient receives clearance to go to the operating The Circulating Nurse’s Role Preparing patients for surgery is a careful task. By Nancy B. Cohen, RN, BSN THE PROCESS OF GETTING A PATIENT PREPARED OR “patient ready” for the operating room can be quite extensive. Over the years, I’ve noticed that the role of an operating room nurse has expanded. The operating room nurse had always been expected to fulfill many roles in the past, but I believe nurses play even more of an integral role nowadays. There are many safety checkpoints nurses must be aware of as the surgical patient winds their way through the operative maze. For the circulating nurse who will be caring for the patient while they’re undergoing surgery, every step is critical in ensuring that a patient may safely proceed to the operating room. Anesthesia, surgery and nursing carefully evaluate the patient once they leave the ambulatory procedure unit and head to the preoperative unit before entering the operating room. Right Patient, Right Time When a patient enters the preoperative unit from the ambulatory procedure unit, our tasks as a circulating nurse begin. We identify Thinkstock


Advance for Nursing • January 2017
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