flat when patients are positioned s...

flat when patients are positioned strictly for surgery, some obstacles may arise. A patient's shape and weight can instant a challenge for optimal positioning. Vigilant observation of a patient's position, preoperatively and intraoperatively, is imperative to obviate dire consequences.

CASE STUDY

M J was scheduled for a posterior lumbar decompression and fusion. M J is morbidly obese with a height of 5 ft 6 inches and weight of 253 lb Her size not absented some concern about how surgical team members would position her tending on the spinal surgery and imaging table.

During M J's interview, the circulating feed verified consent and determined that M J understood the measure This procedure may include placing pedicle wrenchs in the lumbar area. At the time this patient was undergoing surgery the hospital was undertaking a application of mind of this procedure, so the patient also signed a cogitation consent form. The circulating pamper assessed the patient's laboratory originates to identify abnormalities, such as below normal hematocrit and hemoglobin horizontals and prolonged prothrombin time and partial thromboplastin time. The circulating nourish verified the availability of children products by ensuring that the patient's progeny had been typed and cros matched, because a significant amount of house loss can occur during this impressed sign of procedure.

The circulating succor and anesthesia care provider discussed postoperative expectations, like as would drainage; indwelling urinary catheter placement; dressings; and invasive lines, like as IV arterial lines, with M J The patient and her family members were informed that the process might last eight hours or more. Family members were told that they could contact the OR to receive an update upon the progress of the course and Ms J's status from patient relations personnel

POSITIONING THE PATIENT

After the anesthesia care provider complet intubation and placed venous and arterial lines, the circulating supply with nourishment inserted the indwelling urinary catheter and applied antiembolism stockings and a sequential compression device. With the patient forward a stretcher next to the spinal surgery and imaging table, support pads for her chest, hips, and thighs were placed in their approximate locations. The patient then was transferred with the anesthesia care provider at her head, sum of two units team members on either side, and single in kind team member at her feet At least six populace are needed to safely transfer a patient from the stretcher to the spinal surgery and imaging table.

M J's gown was remov immediately before she was useed to prevent any wrinkling of the gown underneath her, which could cause skin irritation. The patient was transfered using the log roll [i]modus operandi[/i] Her head was placed face down forward a foam prone pillow to secure pressure points, such as her forehead and chin. The anesthesia care provider lubricated and clos M J's watchs and secured eye pads upon top for protection.

The circulating cherish and anesthesia care provider worked cooperatively to strictly align Ms J's arms forward the arm boards--her shoulders were not posteriorly or superiorly augmented her elbows were at a 90-degree angle, and her hands were pronated to obstruct brachial nerve damage. Her arms were placed forward egg crate foam to shield the pressure points of the turns and wrists.

The chest pad, with a gel pad forward top to protect the patient's chest urgency points, was adjusted so that the top of the chest pad was at the patient's suprasternal notch. The circulating promote and surgeon ensured that the load of the patient's chest was mainly onward the superior aspect of the chest to minimize press on her breasts. This also facilitates ventilation. This position also is better tolerated when the patient's breasts are medial and cephalad.

The circulating give suck to placed hip pads with stimulate crate foam under the patient's iliac ridge to prevent hyperextension of her lower back. The thigh pads with stimulate crate foam were adjusted in subordination to the patient's thighs and up against the hip pads for lower visible form [i]or[/i] frame support. The patient's legs were placed forward pillows to bend her knee slightly to impede peroneal and popliteal nerve damage. A suspension sling and provoke crate pads were placed subordinate to the patient's feet to fortify pressure points. The circulating promote placed a safety strap padded with a blanket comfortably around the patient's thighs. The circulating promote then prepped the patient, after which the mean fellow person and surgeon draped the patient, and the performance began.

REPOSITIONING THE PATIENT

In the position phase of the procedure, the anesthesia care provider stated that he was no longer satisfied with the patient's position. The circulating nourish noticed that Ms J's position was no longer optimum; her neck was hyperextend and lordosis was actual pronounced.

The anesthesia care provider assumed that because the surgeon were well into the performance the patient could not be repositioned. If the patient was not repositioned, however, she could experience bitter injuries. With her neck hyper-extend her airway might become closeed and nerve damage could fall out Her shoulders were overextended, which could cause brachial courage damage. The anatomical position of her spine could not be viewed optimally because of the pronounced lordosis, and this could protract the procedure. If action was not taken to correct these question s further changes to her position and skin sheering could occur