Forensic Nursing Chronicles

As I instruct students in Online Forensic Nursing Certification, I felt that the following article contributed by one of them could be useful in terms of helping people understand what information is important for the staff to have when having surgery performed.

I work in a small community hospital. I am an operating room nurse. The topic of “Clients Having Surgery” is especially important to me. When clients see their doctors and get scheduled for a surgical procedure there are processes that they go through: preoperative, intraoperative, and post operative. Although these processes are streamlined for each patient it is important to get as much information either from the client or their significant other as is possible.

As a intraoperative nurse it is very important that the preoperative nurse get all of the pertinent information on the client. The information that is important to me as an operating room nurse and to anyone else involved in the procedure are; allergies, medications, previous surgeries, any complications with previous surgeries or anesthesia, past medical history, psychological history, and social history.

1) Allergies:

This is important to know because as a nurse in the operating room it is my responsibility to see that no harm comes to the client while in surgery. If I know that the client has a severe reaction to shell fish I am going to make sure that the operative prep, which is usually a betadine solution, is not done with betadine. If the client has allergic reaction to any antibiotics I am going to make sure that the anesthesia provider or the scrub nurse does not administer the antibiotics to the client. The allergy of the most importance is latex. This is a product that is still used in the operating room setting.

2) Medications:

It is important to know what the client takes for medications. I need to know this so that the client is not given other medications during the surgical procedure that might interfere or interact with the client intraoperative or post operatively.

3) Previous surgeries:

The previous surgeries are important because it will make a difference in how the patient is positioned for the surgery. An example of this is if there is a client that has had unilateral or bilateral hips or knee replacements; the positioning for this client is going to be much different than for the client who has not had total joint replacements. This surgery requires the client to be in the knee/chest position. This position requires the client to have their knees or hips at a greater than 90° angle. The client with a total knee replacement loses flexion in the knees and is not capable of bending their knees to that degree. The consequence of this could cause damage to the knee. I would also need to know about other hardware in the client because it will make a difference where the electrocautary pad will be placed for the cautary device. When the electrocautary is used the electrical current from the device will go to the path of least resistants, and if the current goes to a metal implant it will burn the patient from the inside out. Past medical history is very important.

4) Any complications with previous surgeries or anesthesia:

If a client has had any problems with previous surgeries such as they are a tough intubation or the have nausea and vomiting from anesthesia. As an operating room nurse It is also my responsibility to assist the anesthesia provider when the client is be intubated and extubated. If the client has experience nausea and vomiting after surgery I want to make sure that the client has been given antiametic medications before waking up. I do not want to have this client aspirating on vomit.

5) Past medical history:

Past medical history is important because I want to know if the client has any diseases that can infect the operating room staff. If a client has any contagious disease I would need to know that to inform the operating room staff to take all necessary precautions to protect themselves.

6)Psychological and Social history:

Of these two the psychological history is the most important. I need to know what state of mind the client may be in when they come to the operating room. I need to know if the client is for example mentally retarded. If I have a mentally retarded client I am certainly going to respond to this client differently than I would to a client who might have dementia. How clients are dealt with intraoperativly can have a profound affect on them post operatively. My philosophy when dealing with clients in the operating room is I treat them the way I would want to be treated or how I would want my family to be treated in that situation.

The most important aspect of operating room nursing is to “do no harm”.

This entry was posted on April 30, 2006 at 12:40 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.