Patient condition warranting surgery

Pt is a 35 y/o female with complaints of abdominal pain, nausea and vomiting after
eating. She also complains of pain in the right upper abdomen that comes on very suddenly at
times and moves to her shoulder and back. She states she has been having these symptoms for
several months now but they are getting worse to the point where she does not even want to eat
for fear of pain. She has tried several varieties of antacids with no improvements of symptoms.
Patient had an ultrasound of the gallbladder performed which showed multiple stones building
up and one partially occluding the cystic duct. She has opted to have her gallbladder removed by
laparoscopic approach. Her physician has informed her of the slight possibility of having to
make a larger incision to remove her gallbladder if it not safe to remove it laparoscopically.
Surgery description
A laparoscopic cholecystectomy is the removal of the gallbladder through several small incisions
usually 1cm in length and trocars. Laparoscopic surgical equipment and instruments are used to
remove the gallbladder from under the liver. The cystic duct is stapled off and then
electrocautery is used to cut out the gallbladder. The gallbladder is then placed in a bag and
removed from the patient through the umbilicus. Common conditions that result in gallbladder
removal include cholecystitis, gallstones, obstruction of the cystic duct and a less common
condition gallbladder cancer.
Pre-Op Nurses Role

Applies correct armbands and verifies one already on patient

o Ensures the correct patient is being prepared for surgery, verifies any allergies the
patient may have as well as any other patient information that can be conveyed by
bands such as a fall risk, isolation status or limb alert.
Checks consent
o First of many checks to ensure the correct patient is having the correct surgical
procedure and that the patient agrees and understands what will be performed on
them.
Ensures working IV
o Patent IV is needed for IV fluids, anesthesia and medication administration.
Obtains baseline vital signs
o Baseline vitals gives the peri-operative team an idea of what is normal for this
particular patient and can watch for any trends or any abnormal readings.
Performs pregnancy test
o Patient is a 35-year-old female who has not had a hysterectomy. A pregnancy test
must be performed to rule out this condition before surgery can proceed.

Surgical Safety Equipment

Seat belt
o Adheres patient to OR table and prevents them sliding off.
Surgical Consent

o Ensures the correct procedure is being performed on the correct patient by the
correct surgeon and that the patient agrees to what is being performed on them.

Footboard
o During the surgery, the OR table is rotated so the patient is in Trendelenburg. The
foot board keeps the patient from sliding off the bed.
Arm straps
o When waking up from surgery, the patients unconsciously move their arms.
Keeping them strapped prevents them from injuring themselves.
Surgical cap
o Keeps patients hair from entering surgical field and decreases risk of infection.
Heel Pads
o Patient will not be moving extremities for at least one hour. Padding heels can
help prevent pressure ulcers.

Circulating Nurses Role

Checks consent
o Ensures the correct procedure is being performed on the correct patient by the
correct surgeon and that the patient agrees to what is being performed on them.
Counts with scrub
o Identifies any items that have the potential to be left in the patient during surgery.
Double checks the correct amount being counted.
Applies seatbelt
o Prevents patient from sliding off OR table.
Applies arm straps
o Keeps patients arms in a safe position, so upon induction or emergence patient
does not injure themselves.
Applies footboard
o Keeps patient from sliding off OR table when it is rotated.
Applies bovie pad
o Prevents patient from being burned when electrocautery is used.
Preps surgical area
o Since a break in the skin will be occurring, sterilely prepping where the breaks
will occur will decrease the risk of a surgical site infection.
Initiates Time Out
o Calls attention to room for all members to stop and discuss surgical plan, any
anticipated events to prepare for, ensuring all members agree to the correct
surgery on the correct patient, reviews any pertinent patient information, ensures
all equipment needed to perform the case is ready and working and to speak up if
anyone sees anything that is not in the best interest of the patient.
Handles specimen

o Makes sure the correct specimen has been removed from the patient that was
anticipated prior to surgery start. Verifies the correct tests that are to be conducted
on the specimen.
Gives report to post-op nurse
o Lets the next nurse who will be taking care of the patient any special or pertinent
information, including drains, lines, tubes, or patient information.

Scrub Nurses/Techs Role

Prepares back table

o Sterilely opens equipment and supplies and arranges items on table and mayo
stand for use during surgery.
Maintains sterility of back table
o There is much movement in the operating room and the potential for table
contamination.
Verifies all equipment and materials that are needed for procedure.
o Allows circulator to focus on other aspects of the procedure and avoids any
pauses in procedure.
Checks instruments for proper working condition
o Ensures the integrity of all equipment, is proper working order and determines if
equipment is safe to use on the patient.
Counts with circulator
o Identifies any items that have the potential to be left in the patient during surgery.
Verifies consent
o Ensures the correct procedure is being performed on the correct patient by the
correct surgeon and that the patient agrees to what is being performed on them.
Participates in Time Out
o Stops any activity and participates in discussion about the surgical plan, any
anticipated events to prepare for, agrees to the correct surgery on the correct
patient, reviews any pertinent patient information, ensures all equipment needed
to perform the case is ready and working and agrees to speak up if anything is
seen that is not in the best interest of the patient.
Confirms Specimen
o Makes sure the correct specimen has been removed from the patient that was
anticipated prior to surgery start.

Surgical Assistants Role

Performs pre-op check of patient

o Ensures the correct patient is having the correct procedure, verifies allergies and
any special patient information. Asks patient these questions to assess their

understanding of what will be occurring and that all questions have been
answered.
Checks consent
o Ensures the correct procedure is being performed on the correct patient by the
correct surgeon and that the patient agrees to what is being performed on them
Applies surgical cap
o Keeps patients hair from entering surgical field and decreases risk of infection.
Applies SCDs
o The patient will not be moving for several hours during and after surgery. SCDs
help with blood flow to lower extremities so a clot will not develop.
Applies heel pads
o Pads heels to help prevent pressure ulcers. Inspects skin prior to application.
Positions patient
o Prepares patient for optimal surgical exposure while making sure the patient will
not sustain any surgery due to position during surgery.
Participates in Time Out
o Stops any activity and participates in discussion about the surgical plan, any
anticipated events to prepare for, agrees to the correct surgery on the correct
patient, reviews any pertinent patient information, ensures all equipment needed
to perform the case is ready and working and agrees to speak up if anything is
seen that is not in the best interest of the patient.
Closes incisions
o Brings skin back together to close wound whether with suture or glue. Makes sure
incisions look aesthetically pleasing.
Applies dressing
o Provides protection to freshly closed skin to prevent infection.
Ensures safe transport of patient to post-op area
o Patients are typically monitored only by watching them when leaving the OR to
go to the post-op area. Assesses patient during transport to ensure safety.

Anesthesias Role

Monitors vital signs

o Continuous evaluation of heart rate, blood pressure, respirations and oxygen
saturation to ensure the body is functioning in response to anesthesia medications.
Applies eye protection
o Prevents corneal abrasions
Applies warming device
o Anesthesia medications, patient exposure, OR temperature can cause a decrease in
body temperature. Warming device helps maintain nomothermia.
Checks consent
o Ensures the correct procedure is being performed on the correct patient by the
correct surgeon and that the patient agrees to what is being performed on them.
Ensures safe intubation

o Maintains an airway and does not damage any teeth or other oral structures.
Performs assessment of patient
o Reviews patients history and medications to determine if further workup is
required and how patient will respond during and after anesthetics administration.
Participates in Time Out
o Stops any activity and participates in discussion about the surgical plan, any
anticipated events to prepare for, agrees to the correct surgery on the correct
patient, reviews any pertinent patient information, ensures all equipment needed
to perform the case is ready and working and agrees to speak up if anything is
seen that is not in the best interest of the patient.
Administers the following drugs:
o IV anti-biotics
Prevents post-operative infections
o Anesthesia medications
Sedates patients, evokes amnesia and keeps patient asleep during surgery.
o IV Fluids
Patients will have been NPO prior to surgery. Fluids help maintain
electrolyte balance and keeps patient hydrated.
o Pain medications
Decrease pain patient may feel during or after surgery.
o Anti-nausea medications
Anesthesia and pain medications can cause vomiting and nausea.
Medications are given before to keep this at a minimum.

Post-Op Nurses Role

Verifies procedure performed

o Ensures the correct procedure was performed on the correct patient by the correct
surgeon and any variations to surgical plan that were conducted.
Monitors vital signs
o Continuous evaluation of heart rate, blood pressure, respirations and oxygen
saturation to ensure the body is functioning following anesthesia medications.
Assesses surgical site and dressing
o Checks dressing to make sure it is intact and that there is no excessive bleeding or
drainage.
Initiates incentive spirometer
o Encourages use to open up lungs and breathe deep to expel anesthesia and prevent
any lung illnesses.
Administers pain medications
o Decrease pain patient may feel after surgery.