Runnin g H ead

Runnin g H ead : O UTP A TIE N T S U RG ER Y E X PER IE N CE

Outpatient Operating Room Experience
Tiffany Odums
Gaston College

NUR 101 Practical Nursing 1
Mrs. Simpson
October 12, 2018

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Abstract
Each and every day thousands of people in the United States go “under the knife” for surgery. If
an overnight hospital stay is unnecessary, patients may have their surgery performed at an
ambulatory surgery unit. This allows the patient to come in for surgery and go home the same
day. Recovery time is usually very limited and patients report little to no discomfort. Whether it
be minor or major, surgery is an invasive procedure that must be done with extreme precaution
and preciseness. From preoperative to postoperative, each operating room personnel have
assigned duties to uphold during the patient’s operating room procedure. These responsibilities
ensure optimal care for the patient before, during, and after their surgery.
Keywords ?: operating room, procedure, OR personnel, outpatient, ambulatory surgery

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Outpatient surgery
Each patient has specific reasons to undergo surgery procedures. Signs and symptoms
vary from one case to the next. However, the most common signs are pain and discomfort, which
will alert the patient that a visit to their primary care physician is needed. The physician will then
perform exams, testing, and laboratory analysis, to diagnose the problem. If the patient needs
minor surgery, an appointment will be made with outpatient surgery. The patient will come back
at their appointed day and time for a same-day surgery. A few outpatient surgeries can include
inguinal hernia repair with mesh placement, umbilical hernia repair with mesh placement, and a
hysteroscopy.
Inguinal hernia repair and umbilical hernia repair, both with mesh placement, are
procedures performed to fix a hernia in the groin or navel area of the body. A hernia is a
protrusion in the abdominal wall that cause cause significant pain, especially when the patient is
moving. During these surgeries, an incision of a around 2-4 inches is made to expose the existing
hernia. The surgeon then uses electric cauterization to disconnect the hernia from the tissue
surrounding it. The hernia is placed into a sterile specimen container to be sent to the lab for
diagnostic testing. After the hernia is carefully removed, the surgeon irrigates the incision with
sterile saline solution, inserts a mesh to help strengthen the abdominal wall, then stitches the
incision shut. After surgery and recovery of up to two weeks, the patient should be able to return
to normal with no pain or limitations.
A hysteroscopy is performed on a female patient that presents with symptoms of
abnormal or unexplained bleeding. During this procedure, the cervix must be dilated. The female

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is sedated and placed in a lithotomy position. The vaginal area is cleaned with betadine surgical
scrub. A liquid solution is inserted into the vaginal while the doctor inserts a hysteroscope, a
tubed camera with light, into the cervix. This provides a clear, videoed image of the inside of the
cervix and the openings of the fallopian tubes. This allows the doctor to observe any signs of
polyps, tumors, or malformations of the cervix. If any are found, they can be removed while the
hysteroscope is inside of the cervix. If no abnormalities are found, an intrauterine device can be
inserted. These produce hormones that limit bleeding and menstrual cycles.
Negative Effects of Surgery
Some negative effects often accompany surgical procedures. The risk of effects will vary
depending on health, age, and the type or location of the surgery. Effects can last from an hour to
several months. Four negative effects of surgery include: Pain, sore throat, anesthesia effects,
and wound infection.
Pain and soreness from surgery can occur because of the surgical procedure, during
which tissue and muscle are traumatized. After the local anesthesia weakens, the body’s nerve
pathway sensations are no longer blocked. Pain can be managed efficiently through nurse-patient
communication, verbal or nonverbal. If a patient cannot verbalize his/her pain rating on a scale
from one to ten, the nurse can observe the patient’s nonverbal facial expressions, such as
grimacing or crying. Pain medication or holistics approaches can help minimize the patient’s
pain. Pain can also persist months after the surgery, which is when a doctor can plan a pain
regimen for the patient, such as prescribed at-home medications.

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Sore throat is another negative effect of surgery. This is because some surgeries require a
patient to be intubated. This means a tube is placed down the throat to help with breathing while
the patient is under anesthesia. This is a short-term effect of surgery and should subside within
hours after surgery.
During surgery, anesthesia is required to keep the patient sedated. After surgery, the
anesthesia will wear off and side effects can occur. Side effects of anesthesia are headache,
fatigue, rash, low blood pressure, and confusion.The nurse monitors the patient for any severe
adverse effects from the anesthesia.
Wound care is a very important part of post-op. A patient needs to be educated on how to
properly clean the incision area. Improper care can lead to severe infection, which can then lead
to sepsis. If infection is present, an antibiotic will be prescribed for the patient.
Criteria and Advantages of Outpatient Surgery
Criteria for outpatient surgery includes: a minor surgery, little to no risk of postoperative
complications, patient-managed post-op care, and no need for post-op hospitalization.
Advantages of outpatient surgery are: reduced stress, no hospital time, ability to manage
own post-op care, reduced fees, and less time missed from work or school.
In general, outpatient surgery is more convenient and cost-efficient. It allows the patient
to be at home when recovering and manage their own care, sometimes with the help of family
members or friends, and allows for the patient to resume a normal routine faster than a
hospitalized surgery procedure.

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Preoperative Preparation
The major goal of preoperative preparation is to assess, question, and educate the patient
on the surgical procedure. During this phase, the doctor determines any conditions or vital sign
abnormalities that may interfere with optimal surgery expectations or anesthesia risks. The
doctor also educates the patient about the anesthesia, the procedure, and the post operative
recovery time. This helps reduce any anxiety and stress that the patient may have about being put
to sleep or undergoing operation. This allows for safe and easy transition throughout the
procedure for both patient and the preoperative, operative, and post-operative surgical team.
Special Considerations
Special considerations are taken for surgical patients who are obese, elderly, very young,
or diabetic. These patients are more at risk for complications during surgical procedures.
Obese patients may require more operating room team members to position them
correctly or move them from the preoperative bed to the operating room bed. Obese patients are
also at higher risk for complications from anesthesia due to obstructed airway. While in a supine
position on the operating table, an obese patient may have more difficulty breathing. During
surgery, certain body parts may be more difficult to reach to due excessive adipose tissue. After
surgery, the obese patient may require more monitoring and more pain medication than that of a
healthy person.
The elderly requires special consideration because they are more at risk for infection,
their bones and skin are more brittle due to aging, their oxygenation may be poor, and they may

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need help maintaining normal body temperature. Recovery time for the elderly often takes much
more time than younger people.
Very young patients need special consideration also. Infants will require less medication,
less sedative, and more monitoring than an adult. Infants and very young children have smaller
lungs and stomachs. It is also important to inform the child’s parent on the surgical procedure
and risks. The surgeon must take extreme precaution not to puncture through the small organs of
a child during a surgical procedure.
Doctors must assess diabetic patients and identify the safest method of anesthesia for
them. Diabetic patients are more likely to endure postoperative surgical complications. Wound
infections are more likely in diabetic patients, especially heel sores. These patients also have an
elevated risk of high blood pressure and stroke.
Surgical Asepsis
Surgical asepsis means the absence of all microorganisms. The surgical team takes great
precaution in maintaining a sterile environment. Before entering the operating room, team
members don operating room scrubs, shoe covers, face mask, and hair cover. Surgical hand
asepsis must be performed and mask, sterile gowns and gloves must be put on, with the help of
surgical assistants. Sterile fields are set up in the operating room ready for the doctor. Observers
are told to stand within 4 feet of the sterile fields, which are draped in blue. After the operation,
the rooms are sterilized again and set up for the next procedure.

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Roles of the Perioperative Team
Preoperative team members prepare the client for the surgery. During this phase nurses
monitor vital signs, assess the patient and their medical history, administer any preoperative
medications the doctor has ordered, educate the patient on the surgery, make sure they
understand the benefits and risk, and have the patient sign any forms or releases. At this time, the
doctor or anesthetic nurse may come in to educate the patient on the anesthesia being used.
Operative team members are involved in the actual operating procedure. Surgical
technicians setup equipment, prepare the operating room, and assist the surgeon during surgery.
The anesthesiologist administers the anesthesia to the patient and monitors the patient’s
breathing and vital signs throughout the entire procedure. The aesthetic nurse is responsible for
assisting the anesthesiologist. The circulating RN is responsible for documentation, keeping
count of supplies used during surgery, getting any extra supplies for the operating team, and
collecting patient specimen containers. The scrub nurse is responsible for handing tools or
supplies to the surgeon, when needed. A nurse practitioner may also be present to assist the
surgeon with stitching up the incision. And of course, the surgeon performs the surgery.
Postoperative team members care for the patient following the surgery. The postoperative
nurse is responsible for assessing the patient regularly, being sure that the patient is waking up
from anesthesia and vital signs are remaining normal, administering medications, if ordered, and
educating the patient on instructions for wound care, any limitations the patient may need to
follow, at-home medication education, and signing the discharge paperwork.

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Common Anesthesia Techniques
For outpatient surgeries there are four types of anesthesia techniques: general anesthesia,
local anesthesia, monitored anesthesia, and regional anesthesia. The anesthesia used will depend
on the patient and what surgery is being performed.
General anesthesia is administered through inhalation via facial mask or intravenously.
This method allows you to be completely unconscious throughout the entire procedure and have
no recollection of the surgery.
Local anesthesia is used for very minor surgeries. It is injected at the incision site. A
surgeon can inject this type of anesthesia, so an anesthesiologist is not required to be present for
this. Local anesthesia has very little side effects.
Monitored anesthesia is administered through an IV line by an anesthesiologist. Local
anesthesia may also be used while under monitored anesthesia. This method is used for more
moderate to severe surgical procedures. The anesthesiologist must be present during the entire
sedation to monitor the patient’s vital signs.
Regional anesthesia is used as a nerve block and provides complete numbness to the area
where it is injected. This type of anesthesia includes the epidural, which is used for pain during
labor and delivery.

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Client Assessment During Surgery
Each perioperative team member is responsible for ensuring the surgical procedure is
performed with the clients safety in mind. During surgery, the client is continuously assessed and
monitored. Before the surgery starts, the operative members take a “time-out” to identify the
patient again, restate the type of surgery being performed, and verify the client’s allergies. After
all information is verified, the surgery begins. The patient’s airway, breathing, and vital signs are
monitored the entire time to ensure the client is responding positively to the anesthesia. If more
anesthesia needs to be administered during a lengthy procedure, the anesthesiologist will handle
that so that the patient does not wake during surgery.
Nursing Responsibilities in Client Care After Surgery
Postoperative care begins immediately after surgery. Nurses must ensure the client is
awakening from the anesthesia and that vital signs and oxygen saturation are remaining within
normal limits. Pain management for the client is very important after surgery because if the
patient is experiencing pain it can cause respiratory rate, blood pressure, and pulse rate, to
increase. If any abnormalities are assessed, it is the nurse’s responsibility to notify the doctor
right away.
Culturally Competent Client-Centered Care for the Surgical Patient
Culturally competent care is a very important part of nursing. It means the nursing team
has the ability to meet cultural and communication needs of a patient. Cultural competence is
crucial when caring for a surgical patient. A nurse must be aware of the language, dietary needs,
beliefs, values, and medicinal views of a patient’s culture. Certain cultures do not allow blood

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transfusions to be performed, some believe prayer works better than surgery, some do not believe
in ingesting medicines, and so on. Therefore, each nurse must be aware of the patient’s specific
beliefs to ensure no boundaries are overstepped. Being knowledgeable in many languages is
great asset to have as a nurse. Being able to clearly communicate with a client is the main way to
ensure their needs are met.

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References
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of anesthesia/anesthesia for ambulatory surgery
Cultural Competence in Health Care: Is it important for people with chronic conditions? (n.d.).
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Dority, J., Hassan, Z., & Chau, D. (2011, December). Anesthetic Implications of Obesity in the
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How it's Performed: Umbilical Hernia Repair. (n.d.). Retrieved from
https://www.nhs.uk/conditions/umbilical-hernia-repair/what-happens/
Hyperarts, R. M. (n.d.). Inguinal Hernia. Retrieved from
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Outpatient Surgery. (n.d.). Retrieved from
https://www.hopkinsmedicine.org/healthlibrary/conditions/surgical_care/outpatient_surge
ry_85,P01404

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Side effects of surgery – Canadian Cancer Society. (n.d.). Retrieved from
http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/surgery/side-effects
-of-surgery/?region=on
Smetana, G. W., MD. (2018, May 04). Preoperative Medical Evaluation of the Healthy Adult
Patient. Retrieved from
https://www.uptodate.com/contents/preoperative-medical-evaluation-of-the-adult-healthy
-patient
Stephens, D. S., & Boaler, J. (1977, May 07). The nurse's role in immediate postoperative care.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1606846/
Tidy, C., Dr. (2016, December). Precautions with Patients with Diabetes Undergoing Surgery.
Retrieved from
https://patient.info/doctor/precautions-for-patients-with-diabetes-undergoing-surgery
Yang, R., Wolfson, M., & Lewis, M. C. (2011, March). Unique Aspects of the Elderly Surgical
Population. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597305/