QUESTION 7

Question 7
Mr. M is scheduled for
exploratory laparatomy under
GA.
a) State the different of GA and Local or
Regional Anaesthesia
• - prepare and check functioning order of anaesthetic machine
• - prepare and check functioning cycle circuit
• - prepare and check functioning order of Vaporizer
• - suction apparatus
• - monitoring
• - Pulse oxymeter
• - Capnograph
• - Prepare and check functioning order of intubation equipment
• - provide anesthetic drugs
• - Receive patient according to SSSL
• Assisting during induction of General Anaesthesia and intubation
• Receive patient according to SSSL
• Asses the patient general condition
• check consent form
• Anesthesia
• Surgery
• Blood
• Check for investigation results
• Check for pre-medication
• Inform and brief explanation to patient regarding the procedure
• Place warming blanket on patient
• placement of monitoring devices
• Ensue intravenous line patent
• assemble laryngoscope
• Identify correct size of blade to be used
• connect to laryngoscope handle
• light source is functioning and adequate
• Prepare for intubation
• Positioning of patient
• Pre oxygenate with 100% oxygen for 3-5 mins
• suction device is functioning
• assist the anaesthetist in intubation
• Pass the laryngoscope and ETT to the
anaesthetist
• Inflate the cuff when instructed
• secure ETT
• Connect to Ventilator
• Documentation
• Clean and dispose the equipment
Surgery has progressed till the vaginal vault. As a scrub
nurse :
Explain how would you help to reduce contamination
of abdominal cavity during this stage. (7m)

• Put dressing towel at ;

• top of surgery site to prevent strike through and to
prevent surgeon accidently put contaminated instrument
at the top of surgery site.
• below the surgery site to receive specimen dan
contaminated instrument.
• Bahagian atas kawasan pembedahan untuk persediaan
sekiranya surgeon ‘accidently’ meletakkan instrument
yang tercemar
• Bahagian bawah kawasan pembedahan untuk menerima spesimen
dan instrumen yang tercemar

• Minimize the usage of instrument;

• Use the needed instrument only to prevent contamination.
• (Gunakan instrumen yang diperlukan sahaja untuk mengurangkan
kontaminasi)

• Cover resection area with abdominal pack to absorb the spillage.

• Alas kawasan di bawah ‘resection’ menggunakan abdominal pack
untuk ‘collect specimen’ dan ‘prevent spillage’
•
• Practice non touch technique during add in another
instrument to reduce contamination.
• Amalkan ‘non touch technique’ semasa penambahan
instrumen untuk mengurangkan kontaminasi

• Receive specimen using kidney dish and cover the

kidney dish with dressing towel before passing the
kidney dish with specimen to circulating nurse without
crossing sterile area.
• Gunakan kidney dish untuk menerima specimen ;
• Kidney dish yang mengandungi spesimen dibalut dengan dressing
• towel dan diberikan kepada circulating nurse tanpa ‘cross’ kawasan
sterile.
• Passing used instrument to circulating nurse to reduce
contamination.
• Asingkan instrumen yang telah tercemar dan berikan kepada
circulating nurse agar tidak digunakan semula untuk mengurangkan
kontaminasi
• Change glove after resection of specimen to reduce contamination.
• Sediakan glove untuk sterile team member menukar glove selepas
spesimen dikeluarkan agar dapat mengurangkan kontaminasi
• Reinforce wet area with new drape or reinforce after washout to
prevent strike through.
• ‘Reinforced’ drapping yang baru pada kawasan
yang basah untuk mengelakkan ‘strike through’
(reinforced the drape after washout. )
•
• Use new instrument for the next procedure to
reduce contamination.
• Gunakan instrumen yang baru bagi
pembedahan yang seterusnya untuk
mengelakkan kontaminasi
• Kidney dish yang mengandungi spesimen dibalut
dengan dressing
• towel dan diberikan kepada circulating nurse tanpa
‘cross’ kawasan sterile.
•
• Passing used instrument to circulating nurse to reduce
contamination.
• Asingkan instrumen yang telah tercemar dan berikan
kepada circulating nurse agar tidak digunakan semula
untuk mengurangkan kontaminasi
•
• Change glove after resection of specimen to
reduce contamination.
• Sediakan glove untuk sterile team member
menukar glove selepas spesimen dikeluarkan
agar dapat mengurangkan kontaminasi
•
• Reinforce wet area with new drape or reinforce
after washout to prevent strike through.
close monitoring.
Described the specific nursing care that
will be provided for Mrs. Z in the
recovery room (8m)
• Preparation of recovery room
• Cleanliness
• Equipment such as suctions, monitors, emergency trolley, warming
blanket.
• Asked anesthesia teams what type of anesthesia has been given to
patient for planned of intervention.
• Take over case from anesthetist such as nature of surgery and
anesthesia, blood loss and level of consciousness.
• Assess level of consciousness patient for patient co-operation by calling patient name if patient given
general anaesthesia.
• Placed patient in lateral position to encourage secretion out and maintain airway open.
• Give oxygen according to anesthetist ordered to maintain oxygen saturation. Monitor the oxygen
saturation by putting the SPO2 probe.
• Monitor vital sign by applying electrode cable according to defect problem occur post-operatively such as
hypotension due to bleeding during surgery.
• Check vital sign every 5 minutes until patient fully conscious. Vital sign such as : blood pressure, pulse,
respiration rate and SPO2.
• Close monitoring to prevent any changes on patient condition.
• Pull up side rails to prevent patient fall.
• Checked IV fluid for flow and document inside post-op notes.
• Checked for drain inserted (if any) and record amount of blood loss.
• Checked operation site for sign of active bleeding inform.
• Record inside post-operative notes condition of patient, level of
• consciousness operation site and vital sign.
• Check if patient has catheter inserted for patient confortable due to amount of fluids given during surgery.
• If any abnormal observation, inform the doctor to take an action.
• Post op pain management as ordered by doctor.