Surgery for Herniated Disc
Patient Profile
J.A., a 68-year-old woman with a herniated lumbar disc at L4, is scheduled to have an L4 lumbar laminectomy using a posterior approach. She has a history of low back pain, osteoarthritis in the left hip, and hypertension. She is taking the following medications:
•Metoprolol 50 mg PO twice daily; last dose last night
•Ibuprofen 600 mg PO three times daily; last dose yesterday morning
•Garlic supplements daily; last dose yesterday morning
Subjective Data
•Has low back pain that radiates down her right leg
•Has pain in left hip that worsens with activity
•Has not had anything to eat or drink since midnight last night
•Has smoked one-half pack of cigarettes per day for the past 47 years
•States that she is allergic to sulfa and latex
Objective Data
Physical Examination
•Blood pressure 140/82, pulse 84, temperature 98.6°F, respirations 20
•Height 5′ 5″, weight 195 lbs., BMI 32.4 kg/m2
Diagnostic Studies
•ECG normal sinus rhythm
•Lab values
•Sodium139.0 mEq/L
•Potassium3.4 mEq/L
•HCO325.4mEq/L
•Chloride99.5mEq/L
•BUN10mg/dL
•Creatinine1.1mg/dL
•WBC7000/µL
•RBC4.3 million/µL
•Hematocrit36%
•Hemoglobin12 g/dL
•Platelets164,000/µL
•Glucose98mg/dL
Discussion Questions
1.After reviewing J.A.’s chart with the above data, what information should the perioperative or circulating nurse make the operating room staff, surgeon, and anesthesia care provider aware of?
2.What position should J.A. be positioned on the operating room table and what should be considered when positioning her for the surgical procedure?
3.Just before bringing J.A.to the operating room, the surgeon comes to talk to her and marks the surgical site. You then put a hair cover over J.A.’s hair, similar to that worn by the rest of the operating room staff and hang the ordered preoperative IV antibiotic. What is the purpose of the surgeon marking the operative site, the hair cover, and the administration of the antibiotic on the way to the operating room?
4.What is involved in a surgical time-out?
5.What is the circulating nurse’s role in the OR?
6.Describe a plan for J.A.’s anesthesia during surgery.