Brooke Morgan

NURS3741L

21 October 2021

Dr. Fusco

Surgery Observation Journal

Today I completed my surgical observation clinical rotation. The surgery that I will focus

on in this clinical journal is a dilation and curettage of a 45-year-old female. This woman

presented to her doctor complaining of extremely heavy vaginal bleeding. Before her surgery,

the patient's hemoglobin level was 7.2, and her hematocrit level was 28%; therefore, she was

experiencing anemia as a result of the bleeding in her uterus. The patient had a previous history

of uterine fibroids and has had this procedure done every year for the past ten years. This patient

has struggled with infertility and is trying every option to try to conceive. The procedure itself

consisted of a narrow dilation of the cervix, so that the uterus could be accessed, and the surgeon

could scrape the uterine walls of blood and tissue. The purpose of this patient’s D&C was to

diagnose vaginal /uterine bleeding and to remove uterine tissue and blood clots. The goal of this

procedure was to lighten or stop the heavy vaginal bleeding. Next, I will discuss the preparation

for the surgery and what I observed. 

The only preparation that was done the day before the surgery was having the patient

NPO after midnight. In the operating room, before the procedure began, I watched as the scrub

nurse performed the surgical prep of the patient’s legs and perineum using an iodine solution and

sponge swabs both externally and internally in the vagina. Upon arrival in the operating room, I

watched as the certified registered nurse anesthetist administered the anesthetic agent, propofol.

Next, I watched as the CRNA intubated the patient. Then, as mentioned previously I watched as
the scrub nurse performed the surgical prep using the iodine solution. During this step of the

procedure, the scrub nurse removed a large blood clot from the vagina that was roughly six

inches long. After the surgical prep was completed, the surgeon began the procedure by inserting

a hysteroscope and irrigating the uterus with 0.9% normal saline. The surgeon utilized several

tools to open the vagina and cervix so he could better visualize the uterus. I watched as the

surgeon utilized tools to remove pieces of tissue that were being sent for biopsies. In the middle

of the procedure, the patient’s anesthesia began wearing off prematurely, causing her to jerk her

legs and disturb the procedure. When this occurred, I watched as the CRNA quickly reacted to

paralyze the patient's limbs. In the operating room, the staff consisted of the surgeon, the scrub

nurse, the OR nurse, the nurse anesthetist, and myself. The scrub nurse was responsible for the

surgical prep as well as handing the surgeon instruments throughout the procedure. The OR

nurse was responsible for gathering needed supplies throughout the procedure, adjusting

equipment as needed, as well as documentation. The nurse anesthetist’s role was administering

anesthetic agents to the patient, intubating, and extubating the patient, and monitoring vital signs

throughout the duration of the procedure. The surgeon’s role was actively completing the dilation

of the cervix and curettage of the uterus. Out of all the surgeries and endoscopies that I have

observed, I felt that this particular procedure had the best communication among the team

members. The surgeon was very clear on what he expected from the surgical team and worked

collaboratively with both the nurse anesthetist and the nurses. Lastly, I will discuss how the

nurse protected the patient from harm and acted as a patient advocate. 

Before the surgery, the nurse verified the patient using two identifiers, explained details

about what to expect from the procedure, as well as asked the patient if she had any questions or

concerns regarding the surgery. By doing this she confirmed that we had the correct patient and
decreased patient anxiety which could result in harm to the patient. During the procedure, the

nurses and nurse anesthetist worked collaboratively to protect the patient's arms and legs by

using light restraints to prevent any safety concerns. The team also worked together to ensure

proper lithotomy position and protection of privacy as much as possible. The OR nurse acted as a

patient advocate by being knowledgeable about the patient's condition prior to the procedure,

maintaining proper positioning, infection control practices, proper interdisciplinary

communication, and by just being present during the procedure. Since this is a very invasive

procedure in regard to personal privacy, the nurse advocated by providing support before, during,

and after the procedure. In some cases, having a male surgeon perform this procedure may be

uncomfortable for some women. If this is the case, having female nurses present may make this

experience easier for patients emotionally. One thing that I would be sure to do if I were the

nurse during this procedure is, always minimize exposure of the woman's upper body. As I

mentioned, this procedure is an invasion of personal privacy, and by keeping the patient covered,

this speaks volumes about what the patient would want. Although the procedure went very

smoothly, there were several times where the woman's breasts were exposed, when there was no

reason she should have been uncovered. In conclusion, I felt that I learned much more

information about surgery in general in today’s clinical rotation. I observed a total knee

replacement, an adenoidectomy with ear tubes placement, and the dilation and curettage. All

three of these procedures were very different from each other, which provided me with an

abundance of learning opportunities.