OVERVIEW

CASE: Ruptured Appendicitis

Procedure: Explorative Laparoscopy
Purpose: To explore the entire abdominal cavity to find the source of the problem
Cause: when abdominal pain or other abdominal symptoms are not clear. When there is an
emergency situation and there is no time for tests.
Uses: when having serious or long term abdominal symptoms, have had major abdominal trauma
Nursing Diagnosis: Acute pain related to disruption of skin tissue and muscle integrity as
evidenced by reports of pain
Complications: bad reaction to anesthesia, bleeding, infection, incision that doesn’t heal well,
injury to bowels or other organs, incisional hernia.
Characters:
Scrub Nurse- Paulene
Circulating Nurse- Gwen
Ward Nurse- Jizelle
Surgeon-Martin
Patient-Dhanna
Anesthesiologist- Andrea

SCENE 1 ENDORSEMENT
Ward Nurse: Good Morning Ms. Tanola. Endorsing Patient Carmona, 28 years old. With chief
complaints of abdominal pain on lower right side. VS are T=37.8C, P=102 bpm, R=22bpm,
BP=120/80 mmHg. With rebound tenderness. With a pain scale of 9/10. With ongoing IVF of
Normal saline 1L, regulated at 31gtts/min.
Circulating Nurse: How about ung labs po??
Ward Nurse: Ang mga ginawang lab tests sa patient ay CBC, UA and Xray. Mataas ang WBC
niya. At nakita sa CT scan ay ruptured na ang appendix. For explorative laparotomy performed
by Doctor Rosales as surgeon, and Doctora Alad as the anesthesiologist. NPO na si patient for 8
hours.
Circulating Nurse: Ok po Ma’am, thank you, receive ko na po si pt.
SCENE 2 INTERVIEW CHECKLIST
CN & SN: Hello po Ma’am, ako po si Ms. Gwen Tanola at Ms. Paulene Alcoreza ang magiging
nurse niyo po sa OR, for confirmation lang po ano po ang pangalan niyo?
Patient: Dhanna Carmona
CN: Ilang taon na po? Kelan po ang birthday niyo?
PT: 28 y/o. Feb 13
CN: Alam niyo po ba ang gagawin sa inyo ngayon?
PT: ooperahan ako, tatanggalin na ang appendix ko
CN: Ok po, may mga alahas pa po ba kayo sa katawan? Bawal po ang hikaw o bracelet, ang mga
daliri po ay dapat walang cutex, parehas po sa kamay at paa. Kung may pustiso po kayo ay dapat
tanggal na din po. Contact lens at singsing.
PT: opo wala na po.
CN: may mga allergies po ba kayo sa gamot o Anesthesia?
PT: wala naman po
SN: Sige po, ipapaliwanag ko na po sa inyo ang mangyayari po mamaya. Ang procedure na
gagawin po sa inyo ay Exploratory Laparotomy, ito po ay tumatagal ng mga 1 oras o mahigit pa
depende po sa magiging condition ng katawan niyo. Bibigyan ka po ng general anesthesia, ito po
ay through IV o oxygen mask, para po hindi niyo maramdaman ang paghiwa po sa inyo, kayo
naman po ay tulog sa buong procedure. Paalala lang po, pwede pong magkameron ng
complication sa operation na ito. Pwede pong maging complication ung masamang reaction
ninyo sa anesthesia, pagdurugo, infection, ung paghiwa po ay hindi gumaling ng maayos, o
injury po sa bituka o iba pang mga organs.

CN: Sabihin ko na din po ang mga kailangan niyo pong gawin pagkatapos kayong operahan.
Pagkatapos po kayong operahan, dadalhin na po kayo sa recovery room hanggang sa magising
po kayo, pwede po na makaramdam po kayo ng pagkahilo dahil po sa ituturok sa inyong
anesthesia. Immonitor po naming ang vital signs niyo po at ung tahi ng pinagoperahan sa inyo
kung may pagdurugo o infection, pansinin niyo din po kung magkakameron kayo ng allergic
reaction sa anesthesia. Pag stable na po kayo ay ililipat na po naming kayo sa room niyo.
Pagkatapos po kayong operahan ay hindi po muna kayo kakain ng mga solid foods hanggat hindi
pa po kayo nakautot ulit. Pag nasa room niyo na po kayo, pwede po kayong bumangin at
maglakad lakad ng pakonti kanito para po maiwasan ang pamumuo ng dugo. Huwag po munang
magbuhat ng mabibigat na bagay sa loob ng 6 weeks, mag ingat po sa mga signs ng infection
katulad ng pagkalagnat, pamumula o nana sa pinagoperahan. Ang recovery time po ay umaabot
ng 6 weeks pero depende padin po un sa tao.
May mga katanungan pa po ba kayo?
PT: Wala na naman.
CN: Makikibasa po ng inyong pangalan at makikiverify po na ito po ang inyong pirma na
nagpapatunay na kayo po ay pumapayag sa surgery na ito.
PT: Opo tama po.
CN: Ready na po ba kayo?
PT: Opo ready na.
CN: Sige po, mam Salamat po, ihahanda lang po naming ang or
SCENE 3 CALL THE SURGEONS
CN: Good Morning po Doc Rosales and Doctora Alad, remind ko lang po ung 10am po na
nakasched si Patient Carmona for Exploratory Laparostomy po. Thank you po
Surgeon/Anes: Ok salamat

SCENE 4 Prep OR
NARRATOR: The scrub nurse performed the sterile handwashing technique. Circulating Nurse
performed medical handwashing
CN: *Medical handwashing
SN: *Surgical handwashing, gloving, gowning
CN: *check the OR light, OR table, anesthesia machine, Prepare OR table: clean sheet, pillow,
bucket and pail.
SN: *draping: prepare instrument given by the CN to the mayo table
INSTRUMENT COUNTING
SN:
- Scalpel (2)
-Weitlaner retractor (2)
- Langenbeck Retractor (2)
-Curved mayo scissor (1)
-Straight mayo scissor (2)
-Mosquito forcep (2)
-Babcock forcep (1)
-Needle (3)
-Needle holder (2)
-Kidney basin (1)
-Sponge (4)
-Towel (2)
-Bandage (2)
CN: *Documenting the instruments while being counted by SN
SCENE 5 ANESTHESIA and SKIN PREP and DRAPING
Narrator: Patient is now transferred to the OR table. CN will assist Anesthesiologist
CN: Good morning po doc, ang vs po ng patient ay T= 37.6C, P=97bpm, R=18bpm, BP=120/80
Anesthesiologist: Patient Carmona has confirmed consent. No allergies for medications. Will be
giving general anesthesia intravenously
CN: Assist the anesthesiologist in positioning the client as per the instruction.
Narrator: CN will perform skin prep after that, SN will perform draping
CN: Skin prep 3 times, circular stroke using betadine then wipe using alcohol
SN: draping

SCENE 6: The surgical team has arrived in the operating room

Surgeon: Let’s have a time out. I am doctor Rosales the surgeon for today. This is Patient
Carmona, with a diagnosis of ruptured appendicitis. we will be doing exploratory laparostomy.
This surgery will be for 1 hour.
SN: I am Paulene Alcoreza, the SN. Equipments are sterile, prepared na po ang mga intruments:
- Scalpel (2)
-Weitlaner retractor (2)
- Langenbeck Retractor (2)
-Curved mayo scissor (1)
-Straight mayo scissor (2)
-Mosquito forcep (2)
-Babcock forcep (1)
-Needle (3)
-Needle holder (2)
-Kidney basin (1)
-Sponge (4)
-Towel (2)
-Bandage (2)
CN: I am Gwen Tanola, the CN. I will be documenting the operation today. With signature na po
ang consent ng patient.
Anesthesiologist: I am Doctora Alad. I have given a general anesthesia sa patient. Pwede na
ioperate and patient
Surgeon: Okay, magstart na tayo

SCENE 7: EXPLORATORY LAPAROSTOMY PROCEDURE

Surgeon: This is patient Carmona, 28 years old. The procedure is explorative laparoscopy
Surgeon: Scalpel
SN: *hands over scalpel
Surgeon: Weitlaner
SN: *puts Weitlaner
Surgeon: Curved mayo
SN: *hands over curved mayo
Surgeon: Scalpel
SN: *hands over scalpel
Surgeon: Hemostat
SN: *hands over hemostat
Surgeon: Straight mayo
SN: *hands over straight mayo
Surgeon: Langebeck
SN: *holds langenbeck
Surgeon: Sponge
SN: *hands over sponge
Surgeon: Babcock
SN: *hands over babcock
Surgeon: Forcep
SN: *hands over forcep
Surgeon: Scalpel
SN: *hands over scalpel
Surgeon: Appendix removed
SN: *hands over kidney basin
Surgeon: Needle
SN: *hands over needle
Narrator: The surgeon puts on suture

SCENE 8 AFTER THE OPERATION

Narrator: SN and CN will count the instrument before closing the incision
INSTRUMENT COUNTING
-SN:
- Scalpel (2)
-Weitlaner retractor (2)
- Langenbeck Retractor (2)
-Curved mayo scissor (1)
-Straight mayo scissor (2)
-Mosquito forcep (2)
-Babcock forcep (1)
-Needle (3)
-Needle holder (2)
-Kidney basin (1)
-Needle (3)
-Needle holder (2)
-Sponge (4)
-Towel (2)
-Bandage (2)
CN: Kumpleto na po ang mga gamit
Surgeon: Sige, I will be closing na the incision
Surgeon: needle and needle holder
SN: *hands over needle and needle holder
Surgeon: scissors
SN: *hands over scissors
Surgeon: Proceed to dressing
SN: *Assists in dressing
Surgeon: Operation is done. Good job everyone!

SCENE 9: POST OPERATIVE

SN
-arrange instrument before putting into solution
-degowning, degloving, handwashing
-prepare the patient for the recovery room
-complete documentation
CN
-get VS of patient before transporting to PACU
-document all the procedure VS
-transferring of specimen to the laboratory
-transfer patient to PACU

SCENE 10: PACU

Narrator: Patient will be endorsed to the Post Anesthesia Care Unit
CN: Endorsing patient Carmona. explorative laparostomy was performed. The surgeon is Doctor
Rosales, anesthesiologist is Doctora Alad. Patient was NPO 8 hrs before surgery. General
anesthesia was given thru IV. The operation took exactly 56 minutes. Latest vital signs T=37.3C,
P=90bpm, R=18bpm, BP=120/70
Ward Nurse: Received thank you
*END*
Chart
Patient Carmona, 28 years old had an explorative laparotomy on the lower right abdomen. No
allergies noted, preoperative checklist has been made, patient has confirmed the signed consent
form.
Instruments are counted. Skin prep was done by CN, followed by draping the pt by the SN. The
patient is in supine position. The surgeon is Dr. Rosales, Anesthesiologist is Dra. Alad, SN is
Nurse Alcoreza, Cn, is Ms. Tanola. General anesthesia was given thru IV. The operation started
at 10 am and finished at 10:56 am.