Operating Room Committee

Definition

The Operating Room Committee is an interdisciplinary committee charged to coordinate and standardize the care of patients undergoing surgical or other invasive procedures. It is a committee of the medical staff. This Committee oversees clinical practice related to Preoperative, intraoperative and Postoperative procedure care. It has the authority to establish clinical procedure and policy within the Operating Rooms and recommend policy related to those procedures outside of the Operating Room. It works collaboratively with the quality improvement quality to monitor and improve care and ensure patient safety.

Members of the Operating Room Committee

1. Chief or director of the department of surgery ( a surgeon) – The Chair of this Committee shall be a Physician from one of the surgical specialties or subspecialties.
2. Director of the anesthesia department (in teaching hospitals only)
3. Other chiefs or representatives of the specialty services
4. OR nurse manager – shares with the OR committee, hospital administration and nursing service the responsibility for clarification, implementation and day-to-day enforcement of approved policies and procedures.
5. OR coordinator or OR business manager
6. Hospital administrator and director (optional)

Responsibilities and Duties

1. Responsible for professional practice and administrative activities within their respective departments.
2. Maintain continuing evaluation of the professional performance of all members of the medical staff.
3. Serve as liaison representatives between the medical staff and hospital administration.
4. Formulate policies and procedures pertaining to utilization of facilities, schedule of surgical procedures and maintenance of a safe environment. Policies and associated directives formulated and approved by the committee serve as guides for governing the actions of surgeons, anesthesiologists and the Operating Room nursing staff while in the OR suite.
5. Utilizes evidence-based medicine to recommend changes in the clinical practice.
6. Approves policy and procedures that are specific to the Operating Room.
7. Provides Institutional oversight and direction for staff and faculty education related to operative and invasive procedures and care of the surgical patient.
8. Ensures an effective process for patient and family education related to surgical care and informed consent.
9. Works collaboratively with the quality improvement quality to monitor and improve care and ensure patient safety.
10. Monitors adherence to policies and procedures.
11. Recommends corrective measures to the hospital administration for efficient functioning within the OR suite.

Standards of Professional Performance of Registered Nurses in Operating Room

The entry into the professional operating room (OR) nursing as the clinical practice setting of choice is as a staff nurse. A staff nurse should have a degree in Nursing (Nursing) who has successfully passed the nursing licensure examination (registered nurse or RN). A registered nurse should be competent to provide nursing care for all surgical patients and to ensure a safe environment to achieve desired outcomes of surgical interventions.

Eight standards of perioperative practice has been identified that may be used to measure professional performance of registered nurses (RNs) in the operating room (OR).

1. Quality of Care. The perioperative nurses are expected to systematically evaluate the quality and appropriateness of nursing practice. It is anticipated that RN’s in the OR should participate the quality assessment and improvement programs to promote a quality care.
2. Performance Appraisal. The practice of a perioperative nurse evaluates his or her own performance in context with the professional practice standards and relevant statutes and regulations. Defining and evaluating professional practice behaviors is an ongoing process. To provide a framework for future growth and development self-assessment and feedback from the health care team members should be gathered.
3. Education. The perioperative nurse acquires and maintains current knowledge in the nursing practice.
4. Collegiality. It is expected that a perioperative nurse contribute to the professional growth of his or her peers, colleagues and others by sharing knowledge and expertise through preceptor program, role modeling and mentorships. This assists the colleagues to attain a broader base knowledge.
5. Ethics. The decisions and the actions of a perioperative nurse on behalf of the patients are determined by the governing ethical principles. Delivery of care and services should be within the practice parameter of not violating the basic rights of the clients.
6. Collaboration. It is a standard obligation of a perioperaive nurse to collaborate not only with the patient but also with the significant others and health care providers in providing care. To attain the expected outcomes patient care should be a unified effort that is supported by internal and external forces that follows the same goal.
7. Research. The perioperative nurse uses research findings in carrying out his or her practice.
8. Resource Use. In the planning and the implementation of the patient care the perioperative nurse should consider factors relating to safety, effectiveness, efficiency, environmental concerns and cost.

Therapeutic Therapy

A simple type of milieu therapy by which the total social structure of the treatment unit is involved in the helping process.

Goal and Objectives

1. To help the patient develop a sense of self-esteem and self- respect.
2. To help him learn to trust others.
3. To improve his ability to relate to others and with authority.
4. To return him to the community, better prepared to resume his role in living and working.

Elements

1. People
2. Organized activities
3. Environment

Characteristics of therapeutic community

1. Emphasis on social and group interaction
2. Focusing communication
3. Sharing responsibilities with patient
4. Living and learning abilities

Therapeutic Activities

1. Music appreciation thru arts
2. Craft and occupation therapy
3. Newspaper discussion
4. Bibliotherapy
5. Activities of daily living
6. Calisthenics
7. Indoor/ outdoor games
8. Play therapy

Therapeutic Meetings

1. Circle meeting – highlights of 24 hours
2. Small group – personal problems of patient
3. Community meeting – problems of patient encountered in the ward of general interest
4. Treatment planning – treatment regimen of a patient
5. Discharge planning conference – discharge plan for patient
6. Patient government meeting – officers of the patients discuss issue related to their welfare
7. Staff’s shift-to-shift meeting – discussion of the demotion and promotion of patient status

Attitude therapy

• Prescribed ways on how to handle mentally ill patients according to the behavior symptoms they manifest.

Types of attitude therapy

1. Active friendliness – withdrawn patient
2. Passive friendliness – paranoid patient
3. Kind-firmness – depressed client
4. Matter-of-fact – manipulative/ demanding client related
5. No demand – furious in rage

Characteristics of attitude therapy

1. Consistency must be used in order for the client to reach the maximum therapeutic value.
2. All persons who come in contact with the patient should have a uniform attitude.
3. Should be prescribed by the physician and should be individualized depending on the individual needs.

Group Therapy

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Definition

Group psychotherapy is a special form of therapy in which a small number of people meet together under the guidance of a professionally trained therapist to help themselves and one another. The therapy has been widely used and has been a standard treatment option for over 50 years. It provides a place where you come together with others to share problems or concerns, to better understand your own situation, and to learn from and with each other.

Group therapy helps people learn about themselves and improve their interpersonal relationships. It addresses feelings of isolation, depression or anxiety. And it helps people make significant changes so they feel better about the quality of their lives. Additionally, group therapists can apply the principles of group to other settings and situations such as businesses, schools and community organizations.

In group therapy approximately 6-10 individuals meet face-to-face with a trained group therapist. During the group meeting time, members decide what they want to talk about. Members are encouraged to give feedback to others. Feedback includes expressing your own feelings about what someone says or does. Group rules are established that all members must observe. These set of rules vary according to the type of group.

The Group Psychotherapist

Group psychotherapists are mental health professionals trained in one of several areas: psychiatry, psychology, social work, psychiatric nursing, marriage and family therapy, pastoral counseling, creative arts therapy or substance abuse counseling. In considering a therapist for group, make sure he or she is also qualified to lead group psychotherapy.


Purpose of a Group Therapy

1. It helps an individual gain new information or learning
2. It helps an individual gain inspiration or hope.
3. The group also allows a person to develop new ways of relating to people.
4. During group therapy, people begin to see that they are not alone and that there is hope and help. It is comforting to hear that other people have a similar difficulty, or have already worked through a problem that deeply disturbs another group member.
5. In a group, a person feels accepted.
6. Group therapy sessions allow an individual to interact freely with other members that shares the same past or present difficulties and problems. The individual then, becomes aware that he is not alone and that others share the same problem.
7. A person gains insight into one’s problem and behaviors and how they affect to others.
8. Altruistic behavior is practiced. Altruism is the giving of oneself for the benefit of others.

As the group members begin to feel more comfortable, they will be able to speak freely. The psychological safety of the group will allow the expression of those feelings which are often difficult to express outside of group. The client will begin to ask for the support he or she needs.

Who Can Benefit

Like individual therapy, group therapy can benefit almost anyone. Some of the issues typically addressed include: 

• Difficulties with interpersonal relationships
• Problems facing children and adolescents (such as impact from a divorce, peer issues, learning or behavioral problems)
• Aging
• Medical illness
• Depression and anxiety
• Loss
• Trauma
• Lifestyle issues within a traditional culture
• Personality disorders
• Addictive disorders

The Group Therapy Session

The group therapy session is a collaborative effort in which the therapist assumes clinical responsibility for the group and its members. In a typical session, which lasts about 75-90 minutes, members work to express their own problems, feelings, ideas and reactions as freely and honestly as possible. Such exploration gives the group the important information needed to understand and help one another. Members learn not only to understand themselves and their own issues but also become "therapeutic helpers" for other members.


Types of Group Therapy

1. Psychotherapy Groups
2. Family therapy
3. Education groups
4. Support groups
5. Self-help groups

Cord Prolapse

Overview of the umbilical cord

The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby’s lifeline to the mother. It transports nutrients to the baby and also carries away the baby’s waste products. It is made up of three blood vessels – two arteries and one vein.

Definition

Umbilical Cord Prolapse is an emergency condition where the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. It is an obstetric emergency during pregnancy or labor that imminently endangers the life of the fetus. Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. The cord can then become trapped against the baby’s body during delivery. An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.

Frequency

• Cord prolapse occurs in 0.4 – 0.6 % of deliveries.
• It occurs in 1 of 200 pregnancies

Risk Factors

• Fetal malpresentations
• Premature infants
• Multiparous women

Causes

• A fetus that remains at a high station
• A very small fetus
• Breech presentations. The footling breech is more likely to be complicated because the feet and the legs are small and do not fill well the pelvis.
• Transverse lie
• Polyhydramnios – Excessive amniotic fluid
• Premature rupture of the membranes
• Placenta previa
• Intrauterine tumors preventing the presenting part from engaging
• CPD preventing firm engagement
• Multiple gestation – Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Premature delivery of the baby
• An umbilical cord that is longer than usual

Signs of Cord Prolapse

• The umbilical cord seen or felt during a vaginal examination as it pulsates synchronously with fetal heart
• Fetal bradycardia (sustained) with deceleration (variable) during contraction
• Client reports feeling the cord within the vagina

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captopril (Capoten)

Brand Name: Capoten

Classification: Angiotensin Converting Enzyme (ACE) Inhibitor, Antihypertensive

Indications

• Hypertension
• Management of congestive heart failure (CHF)
• Reduces the risk of death or development of CHF after myocardial infarction (MI)
• Slows the progression of left ventricular dysfunction  into overt heart failure
• Used to decreased the progression of diabetic neuropathy

Mechanism of Action

• Captopril (Capoten) is an angiotension converting enzyme inhibitor. An Angiotensin-Converting Enzyme converts angiotensin I to angiotensin II. Angiotensin II is a potent endogenous vasoconstrictor substance.
• ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. It also inactivates the vasodilator bradykinin and other vasodilatory prostaglandins.
• ACE inhibitors also increase plasma rennin levels and reduce aldosterine levels. This is due to the suppression of the rennin-angiotensin-aldosterone system resulting in decreased serum concentrations of angiotensin I and aldosterone. The reduction of angiotensin I leads to decreased aldosterone secretion and as a result small increases in serum potassium may occur along with sodium and fluid loss.

Contraindications

1. Hypersensitivity
2. Cross sensitivity among Ace inhibitors
3. Pregnancy
4. Angioedema (hereditary or idiopathic)

Use cautiously in

1. Renal impairment
2. Hepatic impairment
3. Hypovolemia
4. Hyponatremia
5. Elderly patients
6. Concurrent diuretic therapy
7. Surgery or anesthesia
8. Lactation
9. Children

Side Effects

1. Dizziness or lightheadedness
2. Fatigue
3. Headache
4. Insomnia
5. Weakness or excessive tiredness
6. Cough
7. Hypotension
8. Tachycardia or fast heartbeat
9. Taste disturbances: salty or metallic taste or decreased ability to taste
10. Diarrhea
11. Nausea
12. Proteinuria
13. Hyperkalemia
14. Sore throat
15. Fever
16. Mouth sores
17. Unusual bruising

Nursing Management

1. Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. (for patients treated with hypertension)
2. For patients treated with CHF, monitor weight and assess patient routinely for resolution of fluid overload. Signs of fluid overload are: peripheral edema, rales or crackles, dyspnea, weight gain and jugular vein distention.
3. The nurse should keep in mind that Captopril may cause false-positive result for urine acetone.
4. The drug should be administered 1 hour before or 2 hours after meals. It may be crushed if the patient has difficulty swallowing.
5. Keep this medication in the container it came in, tightly closed, and out of reach of children.
6. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
7. Throw away any medication that is outdated or no longer needed.
8. Inform the patient that Captopril tablets may have a slight sulfur odor (like rotten eggs).
9. Instruct the patient to notify the physician immediately when the following manifestations are experienced:

• chest pain
• swelling of the face, eyes, lips, tongue, arms, or legs
• difficulty breathing or swallowing
• fainting
• rash

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Prenatal Development

PRE-EMBRYONIC PERIOD

Cell Division Stage

The first two weeks after conception is called the preembryonic period. By the fourth day after conception takes place, the fertilized ovum is now called zygote. This structure is the one that enters to the uterus. The zygote undergoes cell division that divides into 2, then 4 then 8 cells and so on. The cells become tightly compacted with each division until the 16-cell stage where they occupy the same amount of space as the original zygote. When 12-16 cells are present, the zygote is then called the morula.

The outer cells of the morula (termed as morula because it resembles a mulberry) secrete fluid which forms a balstocyst. A blastocyst is a sac of cells within an inner cell mass placed off within the sac. The inner cell mass develops into the fetus. The outer cell layer develops as the placenta and the fetal membranes.

Zygote Entering the Uterus Period

When the blastocyst contains 100 cells it now enters the uterus. However, implantation does not take place immediately as the blastocyst lingers in the uterus for another 2 to 4 days. During this period, the endometrium is now termed as decidua. The endometrial glands are secreting at their maximum at this time. This is to provide rich fluids to nourish the conceptus before placental circulation is established.

Implantation

Implantation, also called nidation, is the gradual process that occurs between the sixth and the tenth day after conception takes place. During this lengthy process, the embryonic structures continue to develop.

Maintaining the Decidua

Successful implantation and survival of the conceptus would be possible when a continuing supply of estrogen and progesterone is present. To signal the woman’s body that pregnancy has begun, the zygote secretes human chorionic gonadotropin (hCG). The production of hCG by the conception results to the continuous and persistent secretion of estrogen and progesterone by the corpus luteum until the placenta takes over this function at about 8 weeks age of gestation (AOG).

Implantation Location

The best area for implantation and placental development is the upper portion of the uterus. Normal implantation occurs in the upper part of the uterus, more often on the posterior wall than the anterior wall. There are three reasons why the site is ideal:

• The upper portion of the uterus is supplied with blood for optimal fetal gas exchange and nutrition
• The uterine lining is thick in this area which is helpful in preventing the placenta from attaching too deeply into the uterine muscle and facilitating easy expulsion of the placenta after full-term birth.
• When implantation takes place in this area, blood loss is limited because interlacing muscle fibers in this area compress open endometrial vessels after the placenta detaches.

Kleihauer-Betke Test

Definition

The Kleihauer-Betke (KB) test is a blood test that measures the amount of fetal hemoglobin transferred from a fetus to the mother’s bloodstream. It is usually done for the purpose of determining the RhoGam dose. This test is used to predict certain types of pregnancy complications, particularly after a mother has suffered a traumatic injury. Kleihauer-Betke Test is usually performed on Rhesus-negative mothers to determine the required dose of Rho (D) Immnuglobulin (RhIg) to inhibit the formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive children.

Other Names of Kleihauer-Betke Test

• Fetal RBC determination
• Fetomaternal haemorrhage calculation, Kleihauer-Betke method
• Fetomaternal hemorrhage calculation, Kleihauer-Betke method
• Haemoglobin F cytochemical demonstration test
• Hemoglobin F cytochemical demonstration test

Purpose of Kleihauer Betke Test:

• Complication related to pregnancy. This test is used to predict certain types of pregnancy complications, particularly after a mother has suffered a traumatic injury.
• Measures fetal cells in maternal circulation. Staining of postpartum maternal blood for identification of percentage of fetal cells present
• Used in assessing for Rh Sensitization ( Maternal blood Rh negative, Large antepartum bleed)
• Determine possible fetal maternal hemorrhage in the newborn, aid in diagnosis of certain types of anemia in adults; assess the magnitude of fetal maternal hemorrhage; calculate dosage of Rh immune globulin to be given.

Normal Range or Value

Full-term newborns: Hb F cells are > 90%; normal adults Hb F cells are < 0.01%.

Before the Procedure

1. Assess for latex allergy.
2. Assess for bleeding disorders.
3. Note any medication or supplement taken by the patient that may cause excessive bleeding.

During the procedure

1. The nurse selects a vein that will be used in the test. In most cases, the vein in the arm is usually selected.
2. A tourniquet (large rubber strap) is secured above the selected vein.
3. The skin over the vein is cleaned, and a needle will be inserted.
4. Instruct the client to hold very still while the blood is collected.
5. After blood is collected into one or more tubes, the tourniquet is removed.
6. Expose blood smear to acid bath (this removes adult hemoglobin, which is acid-sensitive) but not fetal hemoglobin. Stain smear (fetal cells appear pink; maternal cells look like “ghosts”).
7. Count lots of cells and report percentage of cells that are fetal (specifically: you count the number of fetal blood cells per 50 low power fields. If you see 5 cells per 50 low power fields, that’s equivalent to a 0.5 mL fetomaternal hemorrhage).

After the Procedure

1. A bandage, cotton ball or gauze is placed on the area where the needle was inserted.
2. Apply pressure to the area.
3. Strenuous exercises should be avoided after the test is done.
4. Pain, redness, swelling or discharges from the puncture site should be reported to the physician immediately.

Ethical Behavior

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Overview

Ethics refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues. It comes into play when we work, when we play, and at any time that we are interacting with others. Ethics is a set of rules that we each live by, essentially, although they are generally unwritten rules.

Definition

Ethical behavior is acting in ways that are consistent with one’s personal values and the commonly held values of the organization and society. It is the continuous effort of studying ones own moral beliefs and moral conduct, and striving to ensure that he or she lives up to standards that are reasonable and solidly-based.

Development of an Individual’s Ethical Behavior

Each individual has his or her own set of moral code. The sense of right and wrong for each person is based on what the individual sees around him or her. Often, despite what you were raised with, you can redevelop your moral code and practice ethical behavior as a grown up. This is first done by establishing what ethical behavior or unethical behavior is exactly in the world that you live or work in.

Ethical Behaviors

Ethics are basic to the establishment of a moral obligation. The following are few principles and conduct that defines an ethical behavior.

1. Taking responsibilities sincerely for which an individual is morally and legally accountable for.
2. Identifying and knowing the importance of decisions. The individual then, considers the effect of his or her decision on others and on him or herself.
3. Stating the fact.
4. Being true to oneself.
5. Respecting the rights of others.
6. Stating honest statements when another individual wants and needs to know the truth as the basis for self-determination or participation in decision making.
7. Communicating feelings openly.
8. Promoting honest relations to other individuals to foster effective communication and establish trust and confidence.
9. Abiding not only to personal values but also to professional standards, codes, institutional policies and procedures and societal and legal responsibilities.
10. Assessing interventions done and what will be the benefits of those actions and the possible harm it can cause.
11. Evaluating the alternatives in choosing decisions and choosing an intervention.
12. Differentiating right from wrong and acting accordingly.
13. Showing genuine concern and interest in the welfare of others and in oneself.

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