Scrub Nurse Preparation for a Cesarean Section

Scrub Nurse Preparation For a Cesarean Section

Nspo 7430

Perioperative / Perinatal Nursing

A Case Study detailing the care of Anne, a 34 year old woman undergoing a Caesarean Birth, with specifics of care directed to assisting her during surgery with problems related to hypertension, obesity, specific allergies, prematurity and her related anxiety.

Pawandeep Dhaliwal

RN. BSN

The purpose of this assignment is to explore the role of the scrub nurse as it applies to the patient in this case study. Anne, a 34 year old woman, is scheduled to undergo a caesarean section for her second child at 37 weeks gestation due to maternal hypertension. The planning and prioritising of her care will be discussed with solutions related to the challenges of this case that are supported by relevant current literature. The general duties of the scrub nurse will be explained first, followed by a discussion of how I would meet the specific challenges presented by Anne.

General Duties related to a C-section with specialised care for Anne

Pre C-section preparations in the operating room:

At the start of the day, the duties of the circulating and scrub nurse should be planned and communicated so the day runs efficiently. The operating room should be inspected to ensure preparation of the environment such as cleanliness, furniture, and appropriate equipment. Duties for the scrub and circulating nurse will be assigned. Depending on who the members of the perioperative team were, I would pull out the doctor's preference cards and arrange the appropriate supplies. The time for the surgery would be confirmed with the perioperative team to make sure the supplies were opened at the correct time.

Preoperative assessment: This will help me plan and prioritize Anne's care. I will become aware of Anne's potential problems and be able to gather additional equipment that may be needed.

Establishing rapport: I would introduce myself to Anne and her husband James, and make small talk with them asking them if they had any concerns. This would help me establish a trusting relationship and they would get to know me before I met them in the operating room. It would also ensure that I am not a stranger to them in the OR and give them a chance to voice their concerns and clarify any doubts and fears they may have. This will enable to feel calm and relaxed before her surgery, assisting in a better surgical outcome.

Identification and other checks: I would check the identification band on Anne's wrist and make sure that the consent forms for the surgery and blood transfusion were signed as Anne is at a risk for bleeding during her surgery and her consent is essential for legal purposes. I would go over the pre operative checklist along with the circulating nurse as a second check after the primary nurse has completed it.

History: I will review Anne's chart including her history, medical health, allergies, current medications and blood work (CBC, platelet count, INR, liver enzymes). According to Gilbert, "Abnormality of blood coagulation can cause DIC; hepatic ischemia is a complication of PIH). She is allergic to kiwi and chestnuts, which is a red flag for latex sensitivity (Dyke, 1999, p.166). I would ask Anne if she had any latex sensitivity during her first caesarean section. Any significant events that may have occurred during her last pregnancy and childbirth would be looked at as it could have an impact on her present surgery.

Clinical assessment: I will assess for signs of hepatic involvement such as right upper quadrant pain or epigastric pain. Because of Anne's hypertension, she is at risk of bleeding during surgery. I will make sure that the cross match has been done and blood is available in the blood bank.

I will assess Anne's pulmonary function by assessing for shortness of breath because pulmonary edema is a complication of PIH (Gilbert & Harmon, 2003, p.453). I would like to review her ultrasound results because PIH causes constriction of blood vessels and increases the risk of IUGR (Gilbert & Harmon, 2003, p.449).

Anne now weighs 120 kg, I would like to know her prepregnant weight, and assess her for oedema that may be caused by fluid retention is caused by PIH.

Vital signs: I will review Anne's vital signs especially her blood pressure, to get to know her baseline vitals. I would ask her if she was taking any blood pressure medications and when she took her last dose.

After completing Anne's preoperative assessment, I will go back to the OR to prepare the necessary supplies for Anne's surgery such as the case cart, caesarean section tray, a forceps or head extractor for delivery, appropriate gloves, and preferred suture supplies. I will ensure the suction machine; lights and ECU are in good working condition. A wedge would be needed for the elevation of the patient's right side to prevent aortocaval compression (Rothrock, 2007, p.465).

Because of Anne's risk of bleeding during surgery, I will ensure that additional supplies such as extra sponges, oxytocin, durotocin and a blood administration set are available. Since Anne's allergies increase her risk of developing a latex sensitivity, I would use latex free supplies and remove all items containing latex from the OR. I will make sure that the perioperative team is aware of this risk factor. Also, Anne's lower abdominal segment might be difficult to access; deep retractors might be needed to retract her abdomen. A radiant warmer, resuscitation equipment and the neonatal team should be ready for newborn because of risk of IUGR and PIH.

Ensuring asepsis in the OR:

Before the sterile supplies are opened, the integrity of each package must be examined for tears (Phillips, 2007, p.258). After opening the appropriate packages and gowns, I can proceed to the scrub sink. Before scrubbing, I would remove all jewellery because jewellery may harbour micro organisms. The skin under the rings is heavily colonized, and necklaces and earrings can fall on the outside of the sterile scrub gown into the sterile field (ORNAC, 2006, Module 2, p.27). The head should be covered with a surgical hat and masks and protective eyewear should be adjusted for proper fit prior to beginning a surgical hand scrub (ORNAC, Module2, p.29). Scrubbing enacts a focussed lengthy