Running Head: OR Rotation

OR Rotation Journal

Gina Antonucci

Laura Calcagni MSN, RN, CNE

NURSG 4840: Complex Care

Youngstown State University

September 21, 2017

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While on the surgical unit, the procedure I observed was a right femoral popliteal bypass

surgery under general anesthesia on a male patient who was 56 years of age. The patient’s past

medical history consisted of a number of chronic conditions; however, the main reason for the

surgery was due to- arthrosclerosis and peripheral vascular disease (PVD). In addition, in terms

of the patient’s social history, it was indicated that the individual was a current heavy every day

smoker, which was also likely a contributing factor for why the patient presented to the operating

room today.

Interestingly, prior to the procedure itself, the patient’s chief compliant was pain at rest

and difficulty walking or intermittent claudication. Therefore, the purpose of the procedure was

to basically reroute the blood flow through a graft around the blockage in effort to restore

circulation. By doing so, it was not only the intent of the procedure to relieve the patient’s pain,

but to also avoid any further complications, such as limb amputation, in the process as well.

In order to achieve this goal, an ultrasound was first used to determine which vein was

the best to use prior to cutting two incisions into the patient. The one incision was located into

the patient’s groin and the other was located just above his knee. Interestingly, throughout the

procedure an activated clotting time (ACT) was also conducted by the CRNA at different

intervals to maintain a steady level of heparin anticoagulation. Overall, this number fluctuated

between 150 and 300. Finally, after the vascular surgeon attached the graft onto the diseased

artery, an arteriogram was also performed in order to ensure that proper blood flow was restored.

Other interesting things that I learned and observed throughout my rotation was how

positive end-expiratory pressure (PEEP) should not go above 20 during a surgical procedure

because this could cause air to enter into the stomach causing the patient to potentially aspirate,

how a patient with COPD can often have supra-normal respiratory drive which can be indicated
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by different levels on the monitor, and the importance of using Protamine Sulfate, especially

during cardiac surgeries.

On the other hand, in terms of ethical concerns, one potential issue that could arise in

general may be in determining who are the best candidates for this type of procedure. In other

words, similar to all other surgeries, it is vital to weigh the risks versus the benefits.

Unfortunately, in some instances, an amputation or even palliative and hospice care may be the

best route to go, whereas, others may simply argue that risks of the surgery, such as damage to

the nerves and excessive bleeding, can be controversial alone.

Lastly, with regard to nursing management priorities, one goal in the post-operative

period may be to simply maintain adequate tissue perfusion. As a result, one intervention may

be to assess vital signs including blood pressure, oxygen saturation, and pulsations in the legs

every two hours. This intervention is important because tachycardia and hypotension may

indicate signs of hemorrhaging. Therefore, it would also be important to monitor the surgical

site for any signs of bleeding as well as infection. Furthermore, in terms of patient teaching, it

would also be important to position the patient to promote tissue perfusion and discourage the

patient from crossing their legs as well as encourage mobility such as active foot and leg

exercises.

Overall, I thought today was a very educational experience! It certainly was not how I

anticipated the day to go; however, I feel that this experience will benefit me nonetheless

throughout the rest of the semester, especially with any patients that I care for with a similar

disease process. In addition, it was a good lesson to learn in general how unpredictable

healthcare can be and the need to be flexible as a result. That being said, I would strongly
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recommend this experience for future students; however, I feel that this procedure would align

more with professional 2 than complex care.