Objective and Management of OT III

Subject: Medical and Surgical Nursing II (Theory)

Overview

The OT assistant or nurse is in charge of keeping the patient from undergoing surgery.
There are several surgical postures used during an operation. Positioning is done to help the patient's airway, provide an accurate assessment for surgery and anesthesia, and provide access to monitoring equipment that is attached to the patient in a safe environment.
Among the many positions used for various surgical procedures are the supine position, prone position, modified reverse Trendelenburg position, jackknife or Kraske position, lithotomy position, lateral position, and modified fowler's position.

Positioning and Draping of the Patient

It is the duty of OT assistant or nurse to put the patient inappropriate of surgery. There are various surgical positioning during operation.

Purpose of Positioning

to properly assess the need for anesthesia, surgery, and to support the patient's airway.
to dispense medication, liquid, blood, etc.
to ensure the patient's safety.
access to the patient's monitoring equipment.

Different Position Used for Different Surgery

Supine Position

The majority of the procedure is done in this most popular posture. Both arms are at the side of the arms bodies, and the legs are uncrossed and spaced significantly apart. To reduce unnecessary muscle strain on the arms, the palms of the hands should be facing the body.

Indications

establishing general anesthesia
abdominal operations
open heart operations
surgeries on the mouth, neck, and face, with the majority of surgeons focusing on the extremities

The following equipment is needed for this type of position:

Pillow and padding materials
Shoulder roll for modification that required hyperextension of the patient’s neck
Padded footrest available for reverse Tredenleburg.

There are also disadvantages or possible hazards which may include skin breakdown, lumbar strains, circulatory compromise and nerve injury.

Prone Position

The patient is primarily positioned in supine and then log-rolled onto abdomen after the induction of anesthesia. The patient’s arms are either on the side or at the arm boards.

Indication

Those patients who are having surgery on the posterior part such as back or spine or at the back of his or her leg are placed in prone position. Other conditions include:

Administration of general anesthesia
Neurosurgery
Plastic surgery
Laminectomy ( spine surgery )
Prevent bed sore
Relieve abdominal distension

The following equipment is needed for this type of position:

Chest rolls
Pillows and padding materials
Headrest or support of head

Possible danger to the patient may include:

Skin breakdown
Reduced respiration
Eye or ear damage
Reduce circulation
Damage to breast or genitals

Modified Trendelenburg Position

In order to help gravity retain the intestines in the upper section of the abdominal cavity, the modified Trendelenburg position is typically employed to lower abdominal surgery. In order to help with hemostasis, this posture is frequently employed during lower extremity surgery. The patient is lying on his back with the operating table slightly tilted so that his head is 1 to 5 degrees lower than his feet. The table is turned so that the head end is tilted down and the foot end is raised in this position. Under the following circumstances, it is necessary:

Shock
If the patient is vomiting: to prevent aspiration

Indication

Lower abdominal surgery
Lower limbs surgery

Action

Allowing abdominal contents to fall away from the operative site

Precaution

If its position is made and arms are rested on arms rests, then care should be taken that they are not an angle more than 90 degrees.

Modified reverse Trendelenburg Position

Modified reverse Trendelenburg position is generally used for upper abdominal surgery and for the surgery of neck and face. This position allows improved operative exposure because gravity retains the intestines in the lower part of the abdomen.

Jackknife or Kraske Position

The patient is placed in supine position and log-rolled into the abdomen. OR table is flexed approximately 90 degrees. Arms are placed at the side or at the arm boards. This position is almost exclusively used for rectal surgeries.

The equipment needed during the surgery is the same as that of the prone position, but there is a needed for a wide adhesive tape.

Lithotomy Position

In procedures requiring a perineal approach, like genitourinary or gynecologic surgery, this position is frequently used. Both legs of the patient are raised into the stirrups while they are both in the supine position.

For this surgical position, stirrups, stirrup holders, and padding are required. Respiratory problems, skin deterioration, nerve damage, and musculoskeletal injuries could all be risks.

Indications

Many surgical procedures:

Gynecological
Urological dilatation curettage
Laparoscopy vaginal hysterectomy

Lateral Position

For procedures on the kidney, chest hips, or lungs, the lateral position is employed. The patient is laid out flat with his operation side up before being rolled into his side. The lower leg is flexed, and the upper leg is straight. Both arms are resting on a special arm pillow or support.

You'll need an axillary roll, a headrest or other form of head support, a bean bag or other stabilization device pillows, and any paddling materials. Skin breakdown, nerve damage, and reduced respiration are all potential risks.

Purposes

Surgical access to the hip, kidney, thoracic cavity
Neurosurgery
Access to the cervical spine and posterior fossa
Laminectomy
Administration of an epidural or spinal anesthesia
Hip surgery
Colonic irrigation

Modified Fowler’s Position

In neurosurgery, the modified Fowler's position or the sitting posture is frequently employed. In order to allow access to the skull, neck, or shoulder during surgery and to encourage drainage from the operative site, this posture is employed.

Air embolism, pneumocephalus, nerve injury, systemic hypotension, pressure ulcers, mid cervical quadriplegia, and face, tongue, or neck edema as a result of protracted neck flexion are possible side effects.

Things to remember

It is the responsibility of the OT assistant or nurse to prevent the patient from having surgery.
During an operation, there are several different surgical positions. The goals of positioning are to create a safe environment for the patient and access to monitoring equipment that is attached to the patient, as well as to provide an accurate assessment for surgery, anesthesia, and to assist the patient's airway.
Supine position, prone position, modified reverse Trendelenburg position, jackknife or Kraske position, lithotomy position, lateral position, and modified fowler's position are among the several positions utilized for various surgical procedures.

Questions and Answers

List the main Purpose of positioning ?

To make good assess for surgery, anesthesia and to support of the patient airway.
To administer drugs, fluid, blood etc.
To provide safety to the patient.
Access to monitoring equipment attached to the patient.

Write the different position used for different surgery ?

Supine position
The majority of the procedure is done in this most popular posture. Both arms are at the side of the arms bodies, and the legs are uncrossed and spaced significantly apart. To reduce unnecessary muscle strain on the arms, the palms of the hands should be facing the body.
Prone position
After the induction of anesthesia, the patient is initially positioned supine and then log-rolled onto the abdomen. Arms of the patient are either at the arm boards or on the side.
Modified reverse Trendelenburg position
Modified backward The Trendelenburg position is typically used for neck and face surgery as well as upper abdominal surgery. Because the intestines are kept in the lower part of the abdomen by gravity, this position enables better operative exposure.
Jackknife or Kraske Position
The patient is positioned supine with the abdomen log-rolled. The OR table is bent about 90 degrees. Arms are positioned at the arm boards or to the side. Rectal operations are almost the only procedures performed in this position. The same tools are required for the procedure as in the prone position, with the addition of a wide sticky tape.
Lithotomy Position
In procedures requiring a perineal approach, including genitourinary or gynecologic surgery, this posture is frequently used. Both legs are raised into the stirrups while the patient is in a supine position. For this surgical position, stirrups, stirrup holders, and cushioning are required. Respiratory compromise, skin disintegration, nerve damage, and musculoskeletal harm are all potential risks. For procedures on the kidney, chest hips, or lungs, the lateral position is used. The patient is laid out flat with his operative side up before being rolled into his side. The lower leg is flexed, and the top leg is straight. Both arms are resting on a specific arm pillow or support. You'll need an axillary roll, a headrest or other form of head support, a bean bag or other stabilizing device pillows, and any paddling materials. Skin breakdown, nerve damage, and impaired respiration are all potential risks..
Modified fowler’s position
In neurosurgery, the modified Fowler's position or the sitting position is frequently employed. In order to allow access to the cranium, neck, or shoulder during surgery and to encourage drainage from the operative site, this position is used. Air embolism, pneumocephalus, nerve injury, systemic hypotension, pressure ulcers, mid cervical quadriplegia, and face, tongue, or neck edema as a result of protracted neck flexion are possible side effects.