Elective Caesarean Hypotension

For this essay I will be reflecting on the influences on, how the role of the operating department practitioner (ODP) has developed within the multi-professional healthcare team. I will also be discussing in this text some of the historical, political, legal, social, and cultural influences of the ODP. And I will be reflecting on my personal experience working within the operating department for the first time as a student, using the Gibbs cycle (1988.).

As a clinical requirement for my Adult 1: Medical-Surgical course, I had the opportunity to observe a patient in the Operating Room and in the Post Anesthesia Unit of Advocate Good Samaritan Hospital. The procedure that I observed was a left total knee replacement. The patient needed this surgery because she was experiencing osteoarthritis, and this surgery could alleviate her pain and discomfort. I was with the patient from the end of her stay in the pre-operative holding area to the Operating Room, and then to the Post Anesthesia Care Unit. This paper will include background inquiry, preoperative and operative

Use of daily spontaneous breathing trials to assess the patient’s ability to sustain ventilation, oxygenation, and breathing.

This essay discusses and reflects upon patient care in the post anaesthetic care unit (PACU) and is linked to my experiences on placement. It discusses how my approach to patient care has been challenged and analyses how evidence based practice can create a change in the way patients are cared for. It reviews the processes of managing the perioperative environment and evaluates the implications for practice when applying a change in healthcare. Wicker and O’Neill (2010) state that “The lack of immediate medical support in the recovery room means that practitioners work in a more autonomous role than any other area of the operating department” (p.379). By reflecting upon my experiences I am able to link practical and theoretical aspects of the operating department practitioner (ODP) job role. This will provide me with a greater understanding of professional practice and it will develop my personal knowledge and self-awareness (Forrest, 2008). Using a model of reflection is important as it provides a framework that can be systematically followed and acts as a guide through the process of reflection. For this essay I have chosen to use the Gibbs’ Reflective Cycle (1988) as it provides a methodical guide to reflection using a series of ordered questions that each lead to the next stage of the cycle (Forrest, 2008).

The role of PACU nurse is to monitor and care for patients during the immediate postanesthesia period. Their goal is to identify prospective problems that may arise as a result of anesthesia and surgery and to mediate applicably.

Compared to the general adult population the maternal airway management can be more challenging as changes during pregnancy can increase the difficulty of intubation (Brien and Conlon, 2013). Its makes hard to insert laryngoscope when the patient have a large breast, the chance of bleeding and swelling increases due to oedema and vascularity of the upper respiratory tract, and the patient desaturate quicker as there is increase in oxygen requirements and there is reduced in functional residual capacity (Mushambi et al, 2015). As a result of all the changes during pregnancy, if the problems encountered during the intubation of Mrs D were to happen to an obstetric patient, it is important to provide optimal surgical condition for to progress rapidly while aiming for a good neonatal outcome (Local theatre policy, 2015b). In obstetric patients, much of the issue is about the urgency with which the foetus must be delivered and the surgical operation must be done as quickly as possible - therefore making decisions in the event of certain clinical situations occurring will require a much quicker decision making process because there is an immediate threat to the life of the woman or foetus (Mushambi et al, 2015). This is why emergency obstetric anaesthesia is such a potentially hazardous

(History of Nurse Anesthesia Practice. 2010, May), (Koch, E., Downey, P., Kelly, J. W., & Wilson, W. 2001).

The relationship between the perioperative nurse and the patient has suffered a long process of mutation throughout the last decades. If before all the dynamics experienced within an operating theatre were based upon organizational and logistical aspects, these days the focus lies on the patient and all the comfort and security demanded throughout a process that already reveals itself aggressive for the patient. Being the front-line person in this dynamic, the anaesthetic nurse plays a crucial and intense role on the patient’s experience.

Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally

The values such as communication, innovation, quality, and collaboration is key to the growing field of perioperative nursing (AORN, 2015). During surgery communication is important between surgeons, anesthesia and nursing. Surgeons are focused on surgery, anesthesia takes care of breathing and vital signs, nurses are at the bedside or circulating and can assess the OR and what is happening during the procedure. The ARON believes that every patient has the right to receive the highest quality of perioperative nursing care of every surgical or invasive setting; all health care providers must collaborate and strive to create an environment of patient safety; and every patient experiencing a surgical or invasive

A commonly known procedure when it comes to hospital births are epidurals. An epidural is an injection of a drug between the “epidural space” which causes

Learning about the potential complications of epidural reinforced my knowledge in being able to choose the right anaesthetic monitoring equipment. Knowing that Spinal and epidural anaesthesia can cause unpredictable and profound arterial hypotension necessitate the use of adequate monitoring like the; Pulse oximetry, ECG and Blood pressure cuff. This knowledge will help me to be able to select appropriate monitoring devices during epidural catheter insertion. Also it goes without saying that an epidural must be performed in a work area that is equipped for airway management and resuscitation.

A surgical nurse is responsible for monitoring and ensuring quality healthcare for a patient following surgery. Assessment, diagnosis, planning, intervention, and outcome evaluation are inherent in the post operative nurse’s role with the aim of a successful recovery for the patient. The appropriate provision of care is integral for prevention of complications that can arise from the anaesthesia or the surgical procedure. Whilst complications are common at least half of all complications are preventable (Haynes et al., 2009). The foundations of Mrs Hilton’s nursing plan are to ensure that any post surgery complications are circumvented. My role as Mrs Hilton’s surgical nurse will involve coupling my knowledge and the professional

Although , ephedrine was considered as the drug of choice as a vasopressor in obstetrics it not take the superiority. [21-23] It was reported that the administration of ephedrine increases the blood pressure of the mother by its beta-adrenergic action , so preserving uterine and placental blood flow, while other vasopressors which have a pure alpha-agonist were associated with a decrease in this blood flow.[7] However, previous studies observed that ephedrine has a similar efficacy as other vasopressor and causes fetal acidosis.[24] As regard to ephedrine group, this study observed hypotension in 37.9% of

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.