Surgery for Herniated Disc

Patient Profile

J.A., a 68-year-old female 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 (Lopressor) 50 mg PO BID; last dose last night
• Ibuprofen (Motrin) 600 mg TID; last dose yesterday morning
• Garlic supplement daily; last dose yesterday morning

Subjective Data

• Has low back pain that radiates down her right leg
• Has pain in left hip which worsens with activity
• Has not had anything to eat or drink since midnight last night
• Smokes one-half pack of cigarettes per day for 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
  • Sodium               139.0 mEq/L
  • Potassium           3.4 mEq/L
  • HCO3                25.4 mEq/L
  • Chloride             99.5 mEq/L
  • BUN                  10 mg/dL
  • Creatinine           1.1 mg/dL
  • WBC                 7,000/L
  • RBC                  4.3 million/L
  • Hematocrit         36%
  • Hemoglobin        12 g/dL
  • Platelets              164,000/L
  • Glucose              98 mg/dL

Discussion Questions

1. After reviewing J.A.s chart with the above data, what information should the perioperative/circulating nurse make the operating room staff, surgeon, and anesthesia care provider aware of?

2. What position should J.A. be positioned in on the operating room table and what should be considered when positioning her for the surgical procedure?

3. Just prior to 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 nurses role in the operating room?

6. Describe a plan for J.A.s anesthesia during surgery.