Student Nurse Blog Year 3 - Week 41

May 30th 2007

Posted 30/05/2007

Well, my final clinical placement in theatres is going great, I am really enjoying it, although I do miss working on the wards at times. Last week I was in recovery and anaesthetics - it was really good. The first day I revised the A, B, C, D, E assessment of the critically ill patient, covered some anaesthetics and skills in looking after the unconscious/anaesthetised patient.

Then I was taught all about airway and intubation equipment. I was also taught about the anaesthetic machine and was able to carry out the daily checks on it, that are carried out at the start of each day. I was able to have my own patients in recovery (under supervision) and was able to hand these patients over to the ward nurses when they came to collect them.

I spent one day working with an anaesthetic nurse in one of the theatres and I really did enjoy that. I think anaesthetics is definately an area I would like to work in once I am qualified, but I think I will have to work as a scrub nurse for about a year before applying to do a course in anaesthetic nursing.

Near the end of the week I was involved with a couple of patients in recovery who deteriorated rapidly and it was interesting (and a good learning experience) to be involved in the care of these patients.

I was able to spend the afternoon with another anaesthetic nurse in the obstretrics theatre in the delivery suite, where we had an emergency c-section. I was able to help out quite a lot by that time, as I had an idea what I was doing with regard to the role of the anaesthetic nurse.

I am hoping to set up three or four weeks of this placement working in recovery and anaesthetics to gain some more experience of the area.

I was off at the weekend and also on Monday because of the Bank Holiday. Yesterday I was back in the general theatre for an 8-4 shift. Today I start the first of three night shifts in theatres with my mentor. That should certainly be interesting. I have been told that night shifts in theatres can either be very busy or really quiet, depending upon how many emergencies come in.

 

 

Posted 04/06/2007

Last week was my stretch of nights in theatres. I was off on the Monday (28th May) because it was a Bank Holiday. On the Tuesday (29th May) I worked an 8am - 6pm shift. The Wednesday (30th May) was the start of a three night stretch. The nights start at 830pm and I arrived prompt at 815pm. When I arrived at theatres there was nothing on the ‘CEPOD' (Confidential Enquiry into Perioperative Deaths) board. This is the board for the emergency theatre. Any potential emergency surgery or urgent surgery cases are listed on the board. The shift finished at 8am.

The shift started with my mentor showing me around the CEPOD theatre and the usual checks that were carried out at the start of the night shift (checking all the necessary packs and equipment were set up for any listed emergencies on the board - two had been written up on the board since the shift had started), as well as checking that the CEPOD theatre was all set up for any possible emergencies that may come in overnight.

At around 1150pm we had an emergency evacuation D+C (Dilatation and Curettage). It seemed that she was eighteen days post normal vaginal delivery and there were still signs of postpartum bleeding. The Gynaecologist/Obstetricians finally decided that they would do the procedure and the decision was made at 1130pm. The patient arrived to theatres at 1150pm. I was able to scrub up with the scrub nurse (my mentor) for this procedure. I was also shown through the D+C pack for the procedure and talked through the equipment used.

After that procedure we didn't have anything else for the rest of the night. This gave me chance to do my intermediate interview with my mentor (which I passed) and also to do some reading and a little bit of studying.

My second nightshift was Thursday 31st (May). It started at the usual time, 830pm and I got there promptly at 815pm. Unfortunately I found out that there was again nothing on the CEPOD board (which is very good for patients, as it means there is no one in need of emergency surgery, but not very good for me from a learning perspective). Luckily (but not for the patient!) there was a case in the obstetric theatre, which I joined the Anaesthetic nurse for. It was a manual removal of a placenta. It had been a couple of hours post normal vaginal birth and for some reason the placenta had not followed through. It seems that this is not an uncommon thing. I went down to the delivery suite and went to the obstetric theatre with the anaesthetic nurse. By the time the anaesthetic nurse and I got down there the procedure was almost halfway through. The anaesthetic nurse took a handover from the anaesthetic nurse from the previous shift and we then took over the care of the patient. By this time the consultant was already stitching up a grade 2 tear from delivery of the placenta. The patient was then patslided from the table to the trolley and taken into recovery. There the anaesthetic nurse and I recovered the patient as we would do for any patient under general anaesthetic. Once the patient was recovered and all the observations were within normal ranges, we returned the patient to the postnatal ward.

The rest of the night was quiet with no cases on. My mentor and I set up some of the packs in one of the theatres for the following day's cases. I then spent the rest of the night just reading.

The Friday (1st June) was a more active night - although still relatively quiet. When the shift started there was nothing on the board. However, within two hours of the shift starting the anaesthetist's bleep went off. There was an anaesthetic emergency in A+E Resus. The anaesthetist responded, followed by the anaesthetic nurse and me. When we got down there we found a 69yr old male patient who had been brought in following a collapse, with query LVF (Left Ventricular Failure) who had a PMH (Past Medical History) of AF and Diabetes, among other things. The patient was having problems maintaining his own airway and oxygen saturations were around 80%. It was very interesting. The SHO anaesthetist shortly arrived after we did. After several attempts at intubation and resuscitation with fluids and medications, the patient's airway was patent and the patient was a little more stable, but still in a critical condition. After being in A+E Resus for over an hour and a half, the anaesthetist, anaesthetic nurse and I left to return to theatres.

That was it for the rest of the night and no cases came in. Then, around 5am, the anaesthetic nurse bleep went off. There was a patient in the delivery suite that had been prepared for an emergency C-section. The anaesthetic nurse and myself went down there and I was able to follow the procedure through from the general anaesthetic (unfortunately the epidural didn't work and there were no blocks, as the patient still had sensation, so the anaesthetist had to use general anaesthetic), to the procedure in the obstetric theatre through to recovery and then taking the patient, newborn baby and dad to the postnatal ward. We were finished and back in theatres for 630am. There was nothing else going on in the main theatres, so I spent the rest of the time reading until handover.

 

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