Case Study #7: Colon Cancer
Place: Pre-Surgery Admissions
“Hello, I’m Fred Johnson. I’m here to have surgery today.”
Jag, the unit coordinator for Pre-Surgery Admissions, looks up from behind his desk .“Ok, let me just check here. Oh yes, Dr. Baker, scheduled for later this morning. Have you had anything to eat or drink today?”
“Nothing to eat, just a few sips of water to get my normal pills down. They said that would be ok.”
“Yes, yes, more than fine. Ok, please follow me, and let’s get you a bed to relax in until your surgery.”
Fred follows Jag through a hallway of curtains to an unoccupied stretcher.
“There is a gown on the stretcher. Please remove your clothes and put them in the bag at the end of the stretcher. The gown goes on with the opening in the back. I’ll let Tracey know you’re here and she will come by and check on you.”
“Ok. My partner is parking the car. Can he come up and stay with me before I have surgery?”
Fred draws the curtains closed. He nervously looks around to ensure he has privacy and slowly removes each article of clothing and folds it before placing it in the bag. Looking at the gown, he grimaces and slides his arms in. He struggles to tie the gown behind his neck, thinking, They certainly make it tough to get dressed.
“Mr. Johnson, would you like a hand with the ties on your gown?”
Startled, Fred spins around. “Ahhh, yes. I guess so.”
“My name is Tracey and I’m the nurse helping you get ready for your surgery.”
“Hi, Tracey. You haven’t caught me at my best today, and yes, I need help with this incomplete shirt.”
Tracey laughs softly as she helps with the gown. “Yes, they are a bit challenging. This is your first time for surgery?”
“Yes. Do people come here more than once?”
Tracey replies, “Yes, unfortunately. Some people require our assistance multiple times.”
“Well, I’m hoping all I’ll need is this one time.”
Tracey lowers the stretcher to make it easier for Fred to get on the narrow bed.
“I know it’s not the most comfortable bed, but it’s only for a short period of time. I realize this is also pretty stressful. What’s going to happen next is that I’ll step out and grab all your paperwork, and then return to ask you questions and make sure you understand what is happening today. The lab assistant will be by to draw some lab work, so we have some comparison during and after your surgery. I’ll start an intravenous and give you an antibiotic, along with a medication to relax you. A few minutes before 11 o’clock, a porter will come by and take you to the operating room. Ok?”
“Sure. My partner will be up shortly. Is that ok?”
“Yes. I’ll be right back with your paperwork.”
When Tracey returns to Fred’s stretcher, she finds his partner, Eric, sitting on the side of the stretcher holding his hand.
“Hi, I’m Tracey, the nurse caring for Fred before he goes to surgery.”
“Hi, Tracey. I’m Eric. Pleased to meet you.”
“Ok, Mr. Johnson. First I’ll take your vital signs and then I will ask you 20 questions, and you get to give me all the answers. There are no prizes, sorry.”
“Ok, I guess.”
|Day: 0||Pulse Rate||Blood Pressure||Respiratory Rate||Temperature||O2 Saturation|
|Time: 07h30||84||140/80||16||36.5°C||99% on RA|
Tracey then goes through all the pre-op questions including, “have you eaten anything”, “have you washed your abdomen with the proper soap”, “do you know what surgery you are having?”, and “who do we contact when the surgery is over?”
Fred answers all the questions and Tracey records the answers on the pre-op checklist.
“Ok, that was great. I have all the information I need and it appears you are good to go from my point of view. There is nothing that would mean we have to postpone.”
“Thank goodness. So the lab is next?”
“Yes, a lab assistant will come by and draw some blood, and after that I will get your intravenous started and antibiotic. Eric, you can stay until the porter comes to take Fred to the operating theatre.”
Carol, the lab assistant for pre-op, checks in at the desk and sees that there are five patient requests. Looking through the requests, she sees that Fred Johnson is scheduled for surgery at 11am, which is earlier than the other four patients.
Ok, Johnson first, she thinks to herself. Singh will be second, and for the others, I’ll check with nursing to see who should be drawn next.
Looking around for directions, Carol sees Tracey sitting at the desk computer and typing rapidly. “Hi, I’m Carol from the lab. I’m looking for Mr. Fred Johnson.”
Tracey looks up. “He’s four stretchers down in the area to your right. His partner is sitting with him. I believe he is the only patient with a family member with him right now, so he should be easy to find.”
“Ok, thanks.” Carol slowly walks down the curtain hallway, counting out to herself. When she reaches number four, she finds the only stretcher occupied by both a patient and a visitor.
“Good morning. Are you Mr. Johnson?”
“Yes, he is. Are you from the lab? Do I need to leave?”
“Yes, my name is Carol and I’m from the lab. No, please stay, unless you have issues with seeing blood.”
“No. As long as it’s Fred’s and not mine, I’m ok.”
Carol smiles and nods. She checks Fred’s ID band against the requisition, asks the usual questions to ensure she has the right patient, and efficiently draws blood from Fred.
“Ok, I’m all done. Let me place a band-aid on your arm here. Press two fingers over the band-aid for a few minutes. That will ensure no bruising.”
Fred nods as he stares at the band-aid on his right forearm and places his fingers on it.
Carol gathers up her lab basket and waves goodbye.
Tracey walks into Fred’s area, accompanied by two others.
“Mr. Johnson, it’s time. This is Nancy from the operating room. She will be present during your surgery and this is Jack who will help get you to the OR. Eric, I’ll show you where you can wait while Fred is having his surgery.”
Eric leans over and kisses Fred on the forehead. “Good luck. You’ll do fine.” Fred nods his head and smiles weakly.
Tracey leads Eric off to the Post Anaesthesia Care Unit (PACU) waiting room.
Nancy, holding the chart in her hand, compares the consent to the ID band on Fred’s right wrist.
“Ok, just a couple more questions and we’re off. Nothing to drink? Dr. Baker is your surgeon? Type of surgery is removing your lower bowel for cancer?”
For each question, Fred mumbles “yes” and nods affirmatively.
“Ok, then, we’re off. Please keep your hands inside the rails as we don’t want them pinched in the doorways.”