WEEK 1: DAY SURGERY

Day Surgery Patient Room

• This week I did my clinical observations with an anesthesiologist. He was on a surgical team that included a doctor, charge nurse and scrub nurse. Together they were working on a patient in need of a cystolith (bladder stone) removal.
• Things I learned-
• Members of a surgical team
• The duties of a charge nurse during surgery is to work with the anesthesiologist to prep patient for the procedure.
• Cystolith (bladder stone) causes and cures.
• The Best thing that happened at the unpaid work-based learning site this week was actually getting to watch a procedure being done on a patient and all the workers were very courteous and actually enjoyed having me there which ironically was the exact opposite of how I thought they would feel.
• The Worst thing that happened at the unpaid work-based learning site this week was at the beginning of my visit I approached one of the ladies at the desk and asked if I could do clinical observations and she responded by saying yes and told me to come around and that she would help me as soon as she finishes one last thing and got consent form the patients. Well that one last thing took a lot longer than expected and she ended up being too busy. 
•  I just found someone to shadow on my own.

This week was:       GOOD

What I observed...

• Technology-
• Pylograph
• Roller
• Pulse Oximetry
• Laryngeal Mask Airway
• Cystoscope
• Diagnostic Procedures-
• Cysto X-Ray
• Vital Signs
• Therapeutic Procedures-
• Probes with cameras used with the X-Ray
• Steps associated with the anesthesia
• Diseases/ Disorders-
• Cystolith 
• Medical Terminology/ Abbreviations encountered-
• Cystolith (bladder stone)
• LMA (Laryngeal Mask Airway)
• "Clean Case" (does not need excessive amounts of steralization)
• Other
• Measures done immediately after the procedure in the PACU 

Laryngeal Mask Airway

Pylograph

I.    We worked initially in the Day Surgery Room ,but the procedure was done in the Cysto- Room  where the doctor could observe the Pyelogram (a form of imaging the renal pelvis and ureter). The surgical team consisted of an Anesthesiology, scrub nurse, charge nurse, a doctor, and another nurse that  came in at the end for clean up after the procedure. The procedure consisted of  probing the cystolith in order to remove the fluid that was building up inside the bladder in order to clear it so they can move on to remove the infection then destroy and remove the stone with lasers. The anesthesiologist used an LMA(Laryngeal Mask Airway) during the patients prep to prevent the tongue from falling back and chocking the patient. He also injected the patient with an IV dye for the Pyelogram for the doctor to us to illuminate the stone on the X-Ray. The X-Ray included a Pyelogram on the left and on the right was the cystoscope (view of the bladder from the camera that was connected to the probe used to remove the fluid.)

II.     The Anesthesiologist- in charge of anesthesia, IVs and oxygen masks. All of the anesthesia for this procedure were IV; including IV dye for the pyelogram, one for numbing of the patient that causes ringing in the ears, prophal which puts patients to sleep and may cause burning. After the IV administration insersts the LMA, tapes down the eyes and gives measured amounts of O2, N2, and CO2. He works with the charge nurse*.

     Charge Nurse- Preps the patient. Uses a roller to transport the patient onto the gurney then into the Cysto room and onto the new patient bed. He then sterilizes the area of entry. This procedure was a "clean Case" so he only needed to wipe the bladder area down with hydrogen peroxide. He remains in the room during the procedure and hands the doctor certain equipment. Afterwards he assists with minimal clean up and transporting of the patient to the PACU.

     Doctor- Actually performs the procedure. Works with scrub nurse*.

     

     Scrub Nurse- Preps sterilized equipment and hands this equipment to the doctor. Uses PPE.

III.     A cystolith is the crystallization of a bladder stone. It is caused by dehydration and is either passed through the bladder or blocks it and causes fluid buildup that if not treated for a long time causes the bladder to have a coiled up shape. During the draining of the fluids in the bladder because there was an infection to clean it out they sprayed sterilized water. After the procedure, in the PACU, they undergo all the same procedures done by the anesthesiologist in order to monitor the patient's levels. This monitoring included the pulse oximetry, breathing levels, as well as re-taking the vital signs.

IV.     Overall I had a very positive experience. Each member in the room were all trying to give me loads of information with words I had never heard before. My note taking was more like my hand was having a frantic spasm trying to get everything down because I knew so little I was trying my best to absorb everything.