Wandering in Waterford

Hello! So I have been off the radar for quite sometime, not just here but my book blog. I have been busy trying to qualify myself as a nurse here in Ireland. It has been a very long journey (talk about almost a 24-hour plane ride), and of course I am still getting used to the cold here (can get up to 5 degrees in the morning). It's a bit rough especially when you came from a tropical country where the coldest than you can get is about 20 or so.

Waterford in Ireland is a wonderful place. It's pretty laid-back and relaxed, reminds me of home. If I want to go to Dublin, then it's just a two our three-hour bus ride which I really don't mind. Coming here was like a dream, especially when it came to me as a birthday present. It was like yesterday I was still processing my papers, and now, I am finally here! In this country rich with culture and architecture - not to mention, really amazing people!!

I was sort of expecting I'd be at the wards for the adaptation program. (It's a six-week program that tests/checks your competencies), IF I pass it, I will have the pin and can practice here in Ireland, if not, I'm going back to the Philippines (which is not an option really). Not all passes it - so working hard is really a must. Now, back to the first statement - it was a pleasant surprise that I get to do my adaptation in the theater. They said I was the first in a very long time which made me really thankful, and I felt so blessed. I asked God for it - told HIM that I didn't need a love life for now, but I needed this. I'm so happy he granted the request. So no love life is somewhat okay because I get to do this, and I get to be in the place that I love and most comfortable in.

They say experience is the best teacher - but wait! My eyes were wide, and I can hear my heart pounding - WTF?! I'm felt lost, and like a newbie (it's a little foreign to me now) seeing all the tools and equipment in front of me. Some, I know, but some aren't familiar. So hey, wish me luck! I got 3 weeks to go before my adaptation ends. Hope all ends well.

Methods of Sterilization

So what are the methods of sterilization inside the operating room?

Steam Sterilization. This is the most common method of sterilization for operating room instruments If steam alone is used, it is not enough for sterilization. But, when it is pressurized, its temperature would rise. This moist pressurized read causes the destruction of microbes by coagulation and denaturation of protein inside the cells. The relationship between the temperature, exposure time and pressure are the contributory factors in the destruction of microbes. When steam is limited in a closed-compartment and the pressure is increased, the temperature will also increase provided that the volume of the compartment remains the same. Items will be considered sterile if it is exposed long enough to steam at a specific temperature and pressure. Autoclave is a unit used to create this atmosphere of high temperature.

Read more: Methods of Sterilization | Res Ipsa Loquitur - OR Nurse 

The Surgical Team

The surgical team are composed of the surgeon, anesthesiologist, assistant surgeon, circulating nurse and scrub nurse. These are the basic roles of the surgical team inside the operating room:

SURGEON

• Head of the surgical team
• Perform operative procedure safely and correctly
• Visits the patient before anesthesia is inducted, if needed, assist in the positioning of the patient
• Responsible for being certain that all team members are aware of what they need during the procedures and that all necessary equipments are available. 
• If he/she is responsible to give the anesthesia (in cases of local anesthesia), it will either be given before scrubbing or after the patient has been draped
• After the operation: surgeon secures the dressings in place
• After the anesthesiologist gives his/her permission, the surgeon should assist in moving the patient to the stretcher to be brought to the Post Anesthesia Care Unit (PACU)

ANESTHESIOLOGIST/ANESTHETIST

• Person who gives the anesthesia to the patient
• Must be properly attired in the operating room, although there is no need to scrub
• Responsible for making sure that all equipment and supplies necessary for the induction of anesthesia are available and then checks the patient and the chart for any last minute changes
• Monitoring equipments such BP apparatus, cardiac monitor are attached to the patient
• Helps position the patient
• During the surgery: monitors the patient's vital signs, reponsible for keeping the surgeon aware of the condition of the patient, he/she gives the fluids and blood transfusion needed during the operation
• Responsible to inform the operating nurse of the time for the next patient to be pre-medicated
• Determines if the patient is to be brought to the PACU after surgery is completed. Usually checks the patient's airway or vital signs before moving the patient to PACU

ASSISTANT SURGEON

• Help the surgeon in any way possible
• Must be properly attired
• May help with the drapes and final placement of equipment and supplies
• May close the incision and help with the dressing
• In our hospital, the assistant surgeons are usually the residents.

CIRCULATING NURSE

• He/she does not need to scrub, but a good hand washing technique should be done
• In charge of the over all running of the OR before, during and after surgery
• One of the most important duty: Sterility is maintained at all times
• Preparing the operating room
• Assisting the scrub nurse, especially during sponge count
• Caring for the patient before and after the operation
• Assisting the anesthesiologist
• Positioning the patient and preparing the operative site
• Assisting the scrub team before and during surgery
• Caring for the patient after surgery
• Cleaning the operating room after the surgery has been completed

SCRUB NURSE

• Must be properly attired, scrubbed, gowned and gloved
• Assist the circulating nurse in the preparation of the operating room 
• Must familiarize itself with the procedure and supplies & equipments needed to avoid delay
• Set up back table 
• Assist surgeon & assistant surgeon in their gowns and gloves,
• Drapes the operative site
• Should anticipate the surgeon's needs
• Wash the instruments

The Principles of Sterile Technique

The principles of sterile techniques are considered to be the Holy Commandments inside the Operating Room and should be strictly followed at any given operation. 

1. Only Sterile Technique are used within the Sterile Field

2. Sterile person are gowned and gloved

3. Tables are sterile only at table level

4. Sterile person touch only sterile items and areas. Unsterile person touch unsterile one

5. Unsterile person avoid reaching over sterile field, while sterile person avoid learning over unsterile area.

6. The edge of anything that encloses sterile contents are considered unsterile.

7.Sterile field is created as close as possible to the time of use.

8. Sterile areas are continuously kept in view. 

9. Sterile person keep well within sterile area

10. Sterile person keep contact with sterile area to a minimum

11. Unsterile person avoids sterile area

12. Destruction of the integrity of microbial barriers result in contamination

13. Microorganism is kept to an irreducible minimum.

Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (TAHBSO)

This was the first operation that I had assisted when I was still a student in the university. I personally volunteered myself because I wanted to see what this operation is. My mother underwent TAHBSO when I was still young and she stayed in the hospital for over a week. I didn’t know why in the world would someone open her and take all of her reproductive system when she’s not yet in her menopausal.

Total Abdominal Hysterectomy and Bilateral Salphingo-Oophorectomy (TAHBSO) is the removal of the uterus including the cervix, tubes and ovaries using an abdominal incision.

First, let us review the basic medical terms:

Hysterectomy is the surgical removal of the uterus. This may be total (removing the body and cervix of uterus) or partial which is also called supra-cervical.

Salphingo refers to the fallopian tubes which connects the ovaries to the uterus.

Oophorectomy is the removal of a single or both ovaries via surgery.

WHEN IS TAHBSO INDICATED?

·         This is often performed on cancer patients or to relieve severe pelvic pain and heavy menstrual cycles from patients suffering from endometriosis or adenomyosis.

·         This is also used as a last option for post partum obstetrical hemorrhage or uterine fibroids that cause heavy or unusual bleeding and discomfort for some women

Side Effects & Risk of TAHBSO

·         Estrogen levels will fall, thus protective effects of this hormone on the cardiovascular and skeletal system is removed

·         Hysterectomy has been found to be associated with increased bladder function problems

·         Menopausal women have three times greater risk of developing cardio disease such as peripheral artery disease, atherosclerosis compared to premenopausal women

·         This also increases the risk of developing osteoporosis.

OR MEMOIRS

When I was in the operating room, I had fun assisting the OB residents and consultants with TAHBSO, especially those with PFC & BLND (Peritoneal Fluid Cytology and Bilateral Lymph Node Dissection). It can sometimes consume the whole 8 hour shift if you are that lucky. What I prepare when I scrub for this operation are:

·         Major Basic Set

·         Kocher Curve        

·         Heaney Forcep

·         Spencer Wells (I prefer to prepare the curve one)

·         Long Allis Forceps, Mixter Forceps

·         DeBakey forceps

·         Balfour retractor

·         Sutures such as Chromic 1, Vicryl 1, Silk 3/0 & 2/0 Multistrands

·         Round & Cutting needles

·         BLND will need malleable retractor

, vein retractor, 

deavers

The whole procedure often follows a pattern: “kochers curve, kocher’s curve, kocher’s straight, metz, suture, suture scissor". You are never going to get lost or get pissed by the surgeon if you are just paying attention.

WHY EVERY WOMAN IS BEAUTIFUL

Her heart loves a roller coaster ride.
She cries. She laughs.
She falls in love.
Sometimes, cautiously.
Oftentimes, recklessly.
Her mind is on a constant marathon.
Running. Running away.
Changing pace.
Turning around.
But never stopping.
Her dreams keep on flying.
They may not reach the sky
but will never ever take a dive.
Her hands touch other people's lives.
Constantly.
As if that is the reason
for their being.
But most of all,
every woman is beautiful
because she is both steel and cotton candy
and everything in between.

- Anonymous

Capgras Syndrome : Forgetting VIPs in your Life.

Have you ever had the feeling that the friend you have known for ages may not be the one who's standing in front of you?

Weird, right? you are pretty sure the person is not your friend, and yet everyone is telling you that he or she is.

Before you start debating with everyone else and insists on your thoughts, let me tell you about a certain theory that had caught my attention these past few days -- CAPGRAS DELUSION THEORY or the Capgras Syndrom

The syndrome is a disorder in which a certain person believes that a friend or a relative has been replaced by an identical-looking impostor. This is classified under the delusional misidentification syndrome, a certain kind of delusional beliefs that involves misidentification of people, places or objects. It may be acute, transient or chronic. 

This is commonly seen in patients diagnosed with schizophrenia, although it can also occur with brain injury and dementia. 


One of the earliest study regarding the cause of Capgras Delusion suggested that prospagnosia may be have caused it as shown by the study of brain-injury patients. In this condition, the patient cannot recognize faces consciously but are able to recognize other types of visual objects. 


Recent studies shows that although these patients can consciously recognize the faces, they do not show the usual autonomic emotional arousal response (Ellis, 1997). Further, patients can still feel emotions and recognize familiar faces but can't feel emotions when recognizing those faces which are familiar to him. The study states a hypothesis that the origin of Capgras syndrome is the disconnection between the temporal lobe (part of the brain in charge in the recognition of faces) and the limbic system (emotions).


Since the patient could not put memories and feelings, he believed objects in a photograph are new everytime he sees it, though they normally should have triggered feelings (Ramachandran).