VILLANUEVA, Roccabeth J

NU 203 (Group 2)

OPERATING ROOM JOURNAL OF OBSERVATION

Part 1: Preparation of the Patient

1. Who is responsible for obtaining consent for the surgical procedure? Why?
During my rotation at Jose B. Lingad Hospital, I noticed that although the physician ideally leads
the informed consent process, other healthcare professionals are also involved. Specifically, the nurse in
charge collects the signature and the anesthesiologist confirms if the consent has been signed before
administering medication. However, I understand that it is important for all healthcare team members to
be aware of their role in ensuring that the informed consent is carried out properly.

2. Who identifies the patient when he or she is brought into the OR? Why?
Based on my observation during my rotation at the hospital where I was assigned, I noticed that
the healthcare team, particularly the circulating nurse and anesthesia provider, are responsible for
identifying the patient when they are brought into the OR. This practice is similar to what is considered
ideal in the healthcare industry, as it is critical to confirm the patient's identity to prevent errors during
surgery. The healthcare team follows a process of checking the patient's identification band and asking the
patient to state their name and date of birth, which is repeated multiple times throughout the surgical
procedure to ensure that the correct patient is being operated on.

3. What other patient data should be reviewed by a nurse when the patient is brought to the OR?
Why?
During my experience as a scrub nurse, I had a circulating nurse who happened to be my classmate. She
was able to successfully identify all the necessary patient data by reviewing the patient's chart with the
help of our clinical instructor before starting the surgery. This included the patient's medical history,
allergies, medications, and recent diagnostic tests or laboratory results. During the time in, all of these
data were mentioned, which helped ensure that the entire healthcare team was aware of any potential
complications or risks associated with the surgery. This practice is essential to ensure patient safety and to
reduce the risk of complications during the surgical procedure.

4. Who transfers the patient from the stretcher to the OR bed? Why are safety precautions taken
during this procedure?
During my rotation at the hospital, I observed that patient transport from the stretcher to the OR
bed was usually done by either the OR PACU Nurse or OR PACU N.A. I also noticed that in some cases,
transfer boards, slide sheets, or lift devices were not used, especially in Gyne cases where some patients
who were able to walk were just assisted in transferring from either the wheelchair or the bed to the OR
table. However, it is important to note that using proper lifting techniques and equipment can reduce the
risk of injuries or complications during the transfer. While some cases may not require the use of transfer
boards, slide sheets, or lift devices, it is still important for the healthcare team to take all necessary safety
precautions to ensure a smooth and safe transfer of the patient. It is also important to assess the patient's
ability to move and communicate any special needs or concerns to the healthcare team. By taking these
safety precautions, the healthcare team can ensure a safe and efficient transfer of the patient to the OR
bed.

5. What is the nurse’s role during anesthesia induction?

Ideally during induction, the nurse should monitor the patient's vital signs, including oxygen
saturation, heart rate, and blood pressure, and report any changes to the anesthesia provider. However,
from my observation during my rotation, I noticed that only the anesthesiologist was responsible for
monitoring the patient's vital signs from the start of the surgery until the end of the surgery. This is
different from what is considered ideal, where a team of healthcare professionals, including the
circulating nurse and anesthesia provider, work together to ensure the safety and comfort of the patient.

6. When is the patient positioned for the surgical procedure? Who does this? When is this done? What
safety precautions are taken?
Based on my experience as a student scrub nurse, I observed that the medical intern, PACU nurse,
surgeon, and anesthesiologist, were responsible for positioning the patient for surgical position after the
induction of anesthesia and before the procedure began. In my opinion, the healthcare team followed the
ideal protocol in ensuring that the patient was securely and comfortably positioned, with all pressure

 points padded to prevent pressure injuries. The team also ensured that the patient's head, neck, and spine
were properly aligned and supported to prevent injury to these areas. Additionally, the necessary restraints
or safety straps were used to prevent the patient from falling or moving during the procedure. The
healthcare team was also prepared to make any necessary adjustments to the patient's position during the
procedure to ensure optimal surgical access and the patient's safety and comfort. I believe that by taking
these necessary safety precautions, the healthcare team ensured a safe and effective surgical procedure for
the patient.

7. What is the purpose of preoperative skin preparation of the operative site? When is it done? What
safety precautions are taken?
Preoperative skin preparation is done to remove bacteria from the skin to reduce the risk of
infection during surgery. It is usually done just before the surgery starts. To ensure patient safety, the
healthcare team takes safety precautions during skin preparation, such as using sterile techniques and
drapes to prevent contamination and avoiding contact between the skin and non-sterile objects or
surfaces. Any potential allergies or adverse reactions to the antiseptic solution used for skin preparation
are also identified and addressed. I can confirm that all these protocols were followed in the operating
room of JBL.

8. What is the purpose of draping the patient and equipment? What factors determine the type of
drape material used? Why are safety precautions taken? Who does the draping? Why?
Draping is done to maintain a sterile field during surgery and minimize the risk of infection or
injury. The type of drape material used is determined by the surgical procedure and any potential risks of
bacterial penetration. Safety precautions, such as proper positioning and securing of the drapes, are taken
to avoid contamination of the surgical site. In JBL, the surgeon or/and the scrub nurse usually does the
draping since it requires knowledge of sterile technique and familiarity with the surgical procedure.
Proper draping ultimately leads to better patient outcomes by reducing the risk of surgical site infections.

9. What nursing diagnoses are commonly identified for patients in the immediate preoperative and
early intraoperative phases?

There are several nursing diagnoses that are commonly identified for patients in the immediate
preoperative and early intraoperative phases. These include:

• Anxiety related to impending surgery, anesthesia, and potential complications.

• Risk for injury related to positioning, anesthesia, and surgical procedures.
• Risk for infection related to invasive procedures, immunosuppression, and exposure to microorganisms
in the surgical environment.
• Ineffective airway clearance related to anesthesia, endotracheal intubation, and mechanical ventilation.
• Risk for imbalanced fluid volume related to fluid shifts, blood loss, and inadequate fluid replacement.
• Risk for hypothermia related to exposure to cold surgical environment, anesthetic agents, and decreased
metabolic rate.

 Part 2: Roles of the Surgical Team Members

1. Surgeons and assistants

The role of the surgeon in the operating room (OR) is to perform the surgical procedure. This involves
making incisions, manipulating tissues or organs, and using surgical instruments to complete the
procedure. The surgeon is responsible for ensuring the safety of the patient during the procedure,
minimizing the risk of complications, and achieving the desired surgical outcome.

The role of the surgical assistant in the OR is to support the surgeon during the procedure. This may
involve holding instruments, suctioning blood or other fluids, retracting tissues, and performing other
actions as directed by the surgeon. The surgical assistant may also be responsible for preparing and
sterilizing equipment, as well as maintaining a sterile field during the procedure. In my case, there is a
medical intern assisting the surgeon in suctioning and retracting the tissues, however Ms. Dior the
assigned scrub nurse during that time also assisted in suctioning blood and other fluids and I as a student
scrub nurse assisted in passing the instruments as well as directed by the surgeon.

Both the surgeon and the assistant are responsible for ensuring patient safety during the procedure,
including maintaining a sterile environment, adhering to standard safety protocols, and communicating
effectively with the rest of the healthcare team. They work together to achieve the best possible outcome
for the patient

2. Nurses (scrub nurse / circulating nurse / PACU nurse and other OR personnel)

The role of nurses in the operating room (OR) can vary depending on their specific position and
responsibilities. Here are some common roles:

• Scrub Nurse: The scrub nurse is responsible for setting up the surgical field with the necessary
instruments, equipment, and supplies. They also assist the surgeon during the procedure by passing
instruments and sponges, retracting tissues, and maintaining a sterile field.

• Circulating Nurse: The circulating nurse is responsible for managing the overall care of the patient
during the surgical procedure. This includes, documenting the procedure, and communicating with
other members of the healthcare team. The circulating nurse is also responsible for ensuring that the OR
is properly set up and equipped for the procedure.

• PACU Nurse: The post-anesthesia care unit (PACU) nurse is responsible for managing the patient's
recovery immediately following the surgical procedure. This includes monitoring vital signs, assessing
pain and comfort, administering medications, and ensuring that the patient is stable before being
discharged from the PACU.

Other OR personnel may include anesthesiologist, OR PACU N.A. and other support staff. All members
of the OR team work together to ensure that the patient receives safe and effective care before, during,
and after the procedure.

3. Anesthesiologist

The anesthesiologist plays a crucial role in the OR by administering anesthesia to the patient,
monitoring the patient's vital signs, managing the patient's airway, ensuring the patient's safety and
comfort, managing pain, and responding to emergencies. They work closely with the surgeon and other
members of the OR team to ensure that the patient receives safe and effective care during the surgical
procedure.






 Part 3: Maintenance of Aseptic Technique

1. Movement of personnel (moving from one place to another)

To maintain aseptic technique in the OR during personnel movement, it is important to control
traffic, perform hand hygiene, avoid touching non-sterile surfaces, use sterile attire, and communicate
effectively. By following these guidelines, personnel can minimize the risk of contamination and ensure a
safe and effective surgical outcome.

2. Sterile areas and items (who are allowed to handle them)

To maintain aseptic technique in sterile areas and with sterile items, personnel should wear sterile
attire, establish and maintain a sterile field, handle sterile items with care, and ensure proper sterilization
and disinfection of all instruments and supplies. By following these guidelines, personnel can minimize
the risk of contamination and ensure a safe and effective surgical outcome.

3. Non-sterile areas and items (who are allowed to handle them)

Unlike the handling of sterile areas and items, non-sterile areas and items are managed by various
healthcare personnel, including anesthesiologists, circulating nurses, and clinical instructors and students.
These individuals are allowed to handle non-sterile areas and items as part of their responsibilities, which
include observing and monitoring the surgical process, maintaining a sterile environment, and ensuring
the safety of the patient, procedure, and surgical team.

4. Handling of sterile items

Sterile items used in surgery are prepared and maintained by a scrub nurse before the operation.
The nurse sterilizes themselves before opening non-sterile packs of items, dropping their contents into a
sterile area to keep them free of contamination. Although the surgeon, surgeon's assistant, and scrub nurse
handle these items during the operation, it is the scrub nurse who is responsible for their preparation and
maintenance. This process ensures that the items used in the surgery remain sterile and free of
contaminants.

Part 4: Equipment

1. Monitoring: What monitors are used? Who is responsible for setting up and watching this equipment?
During a Cesarean delivery, the monitors used include an ECG monitor, an anesthetic machine,
and a surgical suction machine. The ECG monitor is typically placed on top of the anesthetic machine.
The Anesthesiologist is responsible for setting up and monitoring the anesthetic machine and ECG
monitor during the procedure. The surgical team, including the Obstetrician, also keeps an eye on the
monitors to ensure the safety and well-being of both the mother and baby.

2. Blood and other fluid infusion: Who is responsible for setting up and monitoring this equipment?
Based on my observation during my rotation, the common equipment used for blood and other
fluid infusion during cesarean delivery includes IV catheters and infusion pumps. I also observed that in
one scenario involving a trauma patient, a central venous catheter (CVC) was used for infusion. The OR
PACU nurse set up the equipment, and the anesthesiologist was responsible for monitoring the infusion
throughout the surgery.

3. Electrosurgical unit: What is this equipment used for? Who is responsible for it? What safety
precautions are taken?

An electrosurgical unit (ESU) is a device used in surgical procedures to cut, coagulate, or ablate
tissue using electrical energy. Ideally, the ESU is operated by the surgeon or surgical team, and based
from what I observed during a caesarean delivery, the OR PACU Supervisor which happens to be the
circulating nurse for that procedure operates ESU. Various safety precautions are taken to minimize the
risk of injury to the patient and surgical team. These precautions include proper grounding of the ESU and
surgical equipment, using appropriate ESU settings and surgical techniques, maintaining a clear and dry
surgical field, monitoring the patient's vital signs, ensuring that personnel wear appropriate protective
equipment, and regularly inspecting and maintaining the ESU and associated equipment.

 4. Suction: What is this equipment used for? Who is responsible for setting up and monitoring it?

Suction is a medical device used to remove fluids or other substances from a patient's body
during medical procedures or treatments. The suction machine creates a vacuum that draws out unwanted
materials from the patient's airway or surgical site. The responsibility of setting up and monitoring the
suction machine usually falls on the surgical or medical team, and trained personnel are responsible for
ensuring that the machine is functioning properly before and during the procedure. In JBL, the OR PACU
Nurse is the one that is responsible for setting up the suction prior the procedure, and the suction machine
is being used by the scrub nurse or the assist to suction out the blood in the surgical site, the machine is
then being monitored by the circulating and the anesthesiologist for measurement of blood loss aside from
the gauze and abdominal pads.

Part 5: Intraoperative Nursing Diagnoses

1. Provide two (2) nursing diagnoses are likely to be identified for this patient in the intraoperative
period?

The procedure that I handled is cesarean delivery due to breech position and the two nursing
diagnoses that may be identified for this patient in the intraoperative period are:

• Acute pain related to surgical incision and tissue trauma.

- This nursing diagnosis is common for patients who undergo a cesarean delivery, as surgical
incision and tissue trauma can cause significant pain and discomfort. Effective pain management
strategies, such as medication and positioning, should be implemented to address this diagnosis.

• Risk for decreased cardiac output related to changes in blood volume and fluid shifts during
surgery.
- This nursing diagnosis may be applicable for patients who undergo a cesarean delivery, as the
surgical procedure and anesthesia can cause fluid shifts and changes in blood volume, which can impact
cardiac output. Monitoring of the patient's vital signs and fluid balance is essential to address this
diagnosis.

Part 6: Conclusion of the Procedure

1. Provide three (3) nursing diagnoses are likely to be identified for this patient in the early postoperative
period?

Three nursing diagnoses that may be identified for a patient who underwent a cesarean delivery in the
early postoperative period are:
• Risk for infection related to surgical incision and disruption of skin integrity.
- This nursing diagnosis is common for patients who undergo surgery, including cesarean
delivery. The risk of infection can be increased by factors such as obesity, diabetes,
prolonged rupture of membranes, and prolonged labor. Proper wound care and
monitoring for signs and symptoms of infection, such as fever and increased pain or
redness around the incision site, are important to address this diagnosis.

• Impaired mobility related to pain and surgical incision.

- This nursing diagnosis is also common for patients who undergo cesarean delivery, as
the surgical incision can cause pain and limit mobility. Effective pain management
strategies, such as medication and positioning, can help to improve mobility and prevent
complications such as blood clots and pneumonia.

• Risk for ineffective breastfeeding related to surgical and anesthetic effects on lactation.
- This nursing diagnosis is applicable mainly to JBL as this hospital really promotes breastfeeding
even after cesarean delivery and the patient is a 16 year old teenage mom. The effects of
anesthesia and surgery can impact lactation, and the patient may need support and education on
proper breastfeeding techniques and strategies to enhance milk production.

 Part 7: Integration of Core Values

1. What do you think has been the most defining moment(s) in this experience?
The most defining moment for me in this experience was when I scrubbed in as a student nurse
with the surgical team. It was a surreal moment for me, as I had only seen scenes like this in movies, but
now I was experiencing it first-hand with the help and guidance of our clinical instructor. Being able to be
part of a surgical team and witness such a significant event was truly amazing. I may not have been
perfect in my skills and knowledge during that time, but I will forever treasure those moments and
remember them as I continue my journey to become a registered nurse in the future.There were also many
other wonderful moments that I will cherish, such as being able to see the teamwork and collaboration
among the healthcare professionals in the operating room, and witnessing the joy and relief of the new
parents when they heard their baby's first cry. These experiences have reinforced my passion for nursing,
and I am grateful for the opportunity to have been a part of such a memorable event.

2. What HAU core values did this experience help solidify for you?
As a student nurse during my rotation in the OR/DR, I was able to witness firsthand the
healthcare team's commitment to the core values of Holy Angel University, namely excellence, integrity,
and Christ-centeredness. The team's dedication to providing the highest quality of care for their patients,
even in high-stress situations, reinforced the value of excellence in nursing practice. I also witnessed the
team's professionalism and integrity in their actions, even in difficult situations. This reminded me of the
importance of maintaining integrity in my nursing practice and doing what is right for the patient at all
times. Moreover, the team's compassionate and caring attitudes towards the patient and their family
emphasized the value of Christ-centeredness in nursing practice. Witnessing this reinforced the
importance of treating patients and their families with kindness, empathy, and respect. Overall, my
experience in the OR/DR solidified the core values of Holy Angel University in my nursing practice, and
I will always strive to uphold these values throughout my nursing career.

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