Nursing: Perioperative Assessment

Surgery for Herniated DiscPatient ProfileJ.A., a 68-year-old female with a herniated lumbar disc at L4, is scheduled to have an L4 lumbar laminectomy using a posterior approach. She has a history of low back pain, osteoarthritis in the left hip, and hypertension. She is taking the following medications:Metoprolol (Lopressor) 50 mg PO BID; last dose last nightIbuprofen (Motrin) 600 mg TID; last dose yesterday morningGarlic supplement daily; last dose yesterday morningSubjective DataHas low back pain that radiates down her right legHas pain in left hip which worsens with activityHas not had anything to eat or drink since midnight last nightSmokes one-half pack of cigarettes per day for past 47 yearsStates that she is allergic to sulfa and latexObjective DataPhysical ExaminationBlood pressure 140/82, pulse 84, temperature 98.6° F, respirations 20Height 5’ 5”, weight 195 lbs, BMI 32.4 kg/m2Diagnostic StudiesECG normal sinus rhythmLab valuesSodium               139.0 mEq/LPotassium           3.4 mEq/LHCO3                25.4 mEq/LChloride             99.5 mEq/LBUN                  10 mg/dLCreatinine           1.1 mg/dLWBC                 7,000/µLRBC                  4.3 million/µLHematocrit         36%Hemoglobin        12 g/dLPlatelets              164,000/µLGlucose              98 mg/dLDiscussion Questions1. After reviewing J.A.’s chart with the above data, what information should the perioperative/circulating nurse make the operating room staff, surgeon, and anesthesia care provider aware of?2. What position should J.A. be positioned in on the operating room table and what should be considered when positioning her for the surgical procedure?3. Just prior to bringing J.A.to the operating room, the surgeon comes to talk to her and marks the surgical site. You then put a hair-cover over J.A.’s hair, similar to that worn by the rest of the operating room staff and hang the ordered preoperative IV antibiotic. What is the purpose of the surgeon marking the operative site, the hair cover, and the administration of the antibiotic on the way to the operating room?4. What is involved in a surgical time-out?5. What is the circulating nurse’s role in the operating room?6. Describe a plan for J.A.’s anesthesia during surgery.:

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