Hana had gastroscopy before twice. The first time was when she complained of pain in her stomach. Tofind out what the cause was she was given sedation so that the surgeon can have a look in to her stomachand duodenum if there is any bacterial infection. Gastroscopy is performed to see if there is any abnormalities in the upper gut.
Presenting Complaint:
Hana is having hysteroscopy to diagnose abnormal bleeding due to heavy length menstrual flow.
Anaesthetic Management:
Hana had three previous anaesthetics which did not have ill effect Hana induction was achieved by using.Hana had general anaesthetic blood pressure cuffs was put on her to monitor her blood pressure. She first had iv access in to her arm a cannula was inserted for fluid. The type of drugs she was give whereondansetron fentanyl and propol. Once she moved into theatre she was given sevoflurane According trust policy and also with the national guideline an accurate contemporaneous record of anaesthesia is documented for every patient the record is kept which should document.
Surgical Management:
Hana was put in lithotomy position her body in supine position. betadine antiseptic
was used to prep. Warming blanket was to keep Hana temperature from falling from safe levels due to
anaesthesia. Sterile instruments where prepared on trolleys. Warm saline was used for irrigation. The
saline was pressureized using pressure bags 300mmHg
Discussion:
The sending slip was sent to the ward with her details. The sending slip was delivered by the porter. The nurse brought Hana to the anaesthetic room with her medical note. The Operative Theatre Practitioner (ODP) opened the medical records and proceeded checklist and showed Hana the consent form to confirm the right patient was in theatre and asked if the signature was hers and she replayed that is correct. Also the name corresponded to Hana name tag. There was little spoken by the nurse who was handing over the patient.
Health professionals must have obtained valid consent from the patient for any examinations/surgery/treatment or care in accordance with Department of Health policy and guidance for England (DH 2009).
When Hana came to the theatre it was a different setting for her from the ward. When Hana was met on the ward in her room she was with her husband. They were both very welcoming. Hana was forthcoming for the type of information I was looking for to be able to complete the study case. If she was worried about the procedure she was not showing it. Being accompanied by her member of family may have put her at ease. Although position of Hanas hands clasped may have been sings of anxiety about her procedure from my experience.
This was Hanas second time to have this type of surgery and in the same operating place. She was familiar with the hospital The fact that the day of the operation was in the afternoon and the weather was warm She felt less anxious about the surgery. She felt on her first visit to this hospital; the lights were not on. she felt confused as why was no one here to meet her. Patients need to know who is expecting them. She was the happy easy going character she explained about her previous experience how she felt the first time she came to the hospital. It was winter time everything was dark in the reception where patient usual wait. The reason they remain in the reception area in the morning was so they can be escorted to the floor when they have been allocated a room.
This procedure was a standard general anaesthesia which was done on the table using the pat-slide. The doctor supported the head end and two people one each side of the table and one was at foot ready to transfer Hana. The transfer to the table was completed.
The surgeon and scrub staff went through the WHO checklist (WHO 2009) and documented by circulating the correct book this was done before Hana was put in lithotomy position.
As she had a red band this meant she was allergic to Elastoplast to confirm with the patient the ODP showed Hana the type of plaster and she confirmed it correctly. It is good practice to involve the patient in their care after all it the patient who will have direct information.
Identifying allergies on a patient is vital as it has serious conscious to patient health.
During the hysteroscopy procedure Hana lied supine with legs raised onto lithotomy boots. These can support the calf to the ankle or just the ankles are secured. The patients arms are secured across their chest while the end of the table was removed. The legs were elevated and positioned simultaneously to prevent lower back injury sacroiliac ligament damage and pelvic asymmetry (Adedeji R. Oragui E. Khan W. & Maruthainar N. 2010).
Nerve damage can occur from pressure applied directly from lithotomy strips that are inadequately padded to the medial or lateral side of the leg. A lumbar support should prevent.
Hana was physically well supported at all times during transfer and positioning while she was anesthetized. Injury to the radial nerve can occur if the arms are left dropping down over the edge of the operation table. In families that support the patients should be given information to care for the patient needs referred to as patient-centred care (NICE 2003).
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