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Nursing Situation: Perioperative Assessment
Jasmine T. Rohoman
Christine E. Lynn College of Nursing, Florida Atlantic University
NUR 4716L
Dr. Priya Geevarghese
June 16th, 2022
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The perioperative or circulating nurse should make the operating room staff, surgeon, and
anesthesia care provider aware of J.A.’s sulfa and latex allergy, and that the patient has a history
of hypertension, obesity, and is a seasoned smoker. It should also be shared that the Potassium
level is low, so IV K replacement may be needed during surgery. Ibuprofen and garlic
supplements reduce platelet aggregation and can contribute to risk of breathing problems so the
surgeon and anesthesiologist are aware.
Since J.A. is scheduled for an L4 lumbar laminectomy using a posterior approach, they
should be positioned in a prone position on the operating room table. This would be the best
position for a spinal surgery so the surgeon has easy and clear exposure to the site, there is
minimal bleeding and harm of important body structures, and the patient can breathe properly on
anesthesia. When positioning the patient for the procedure, the nurse should consider correct
musculoskeletal alignment, avoid unnecessary pressure on nerves and skin over bony
prominences, making sure the patient has adequate diaphragm excursion, that the position
prevents occlusion of arteries and veins, offer humility in terms of exposure, and to respect the
patients’ previous pain and aches.
The purpose of marking the operative site and following up with documentation is to
prevent incision error and to make sure the patient is aware of the site being marked (Bernard,
2013). The patients’ hair is covered, as is everyone’s in the operating room because
microorganisms that cause surgical site infection may be present and can spread which would
break the sterile field. Antibiotics are administered 30-60 minutes prior to surgery to prevent
wound contamination and sepsis.
A surgical time-out is to prevent wrong site, wrong procedure, and wrong surgery. Before
any surgery is started, all members of the surgical team must stop what they are doing and verify
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the patients’ identity, the surgical procedure taking place, and the surgical site. Everyone must
agree over all aspects of the information before moving on (Stahel, 2009).
The circulating nurse's duties are performed outside of the sterile area in the operating
room. The nurse oversees all aspects of patient care in the operating room, aiding the team in
maintaining and providing a comfortable, safe environment for the patient while also keeping a
close eye on the team. He or she must guarantee that all members of the surgical team work
together. Because most patients are sedated or drugged during surgery, they are unable to make
decisions on their own. The circulating nurse can direct care and team activities in the patient's
best interest by using evaluation, diagnosis, critical thinking, and planning skills (Meier, 2018).
To provide the greatest patient care, the perioperative RN's role in the surgery environment is
critical. A good circulating nurse has the knowledge, abilities, and training needed to perform
circulating duties during surgery. The circulating nurse can assess and evaluate the patient's
needs utilizing sound judgment, interpersonal communication skills, and critical thinking
abilities, assuring a favorable outcome. Every invasive surgery requires the presence of a trained
perioperative nurse as the RN Circulator to ensure that the patient receives the best possible care.
Due to a history of smoking, anesthesia should be administered with caution and
respiratory status should be monitored throughout and after the surgery. Metoprolol is a blood
pressure medicine and since the last dosage was the night before, it shouldn't be an issue, but the
nurse should keep an eye on vitals to be sure. After the surgery, keep an eye on the patient for
signs of a bad reaction to the anesthetic.
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References:
Bernard, D. (2013). 6 steps to site marking success - staff & patient safety - october, 2013.
Association of periOperative Registered Nurses. Retrieved June 16, 2022, from
https://www.aorn.org/outpatient-surgery/articles/special-editions/2013/october-staff-andpatient-safety/6-steps-to-site-marking-success
Meier, K. (2018). What are the responsibilities of circulating nurses? Retrieved from
https://work.chron.com/responsibilities-circulating-nurses-15643.html
Stahel, P.F., Mehler, P.S., Clarke, T.J. et al. The 5th anniversary of the "Universal Protocol":
pitfalls and pearls revisited. Patient Saf Surg 3, 14 (2009). https://doi.org/10.1186/1754-9493-314