Case No: Name of Student: Mendoza, Rizielle Anne S.

Year and Section: 3-7 RLE 1 OR PREFERENCE CARD FOR CIRCULATING NURSE Name of Patient: Manlapaz, Francisco S. Age: 43 Sex: Male Civil Status: Married Date of Admission: 4/17/2013 Date of Surgery: 4/18/13 Time Started/Ended: 7:18am-9:30am Bed #: 309D Hospital #: 11-15-74 Surgeon: Dr. Jan Andrew Bueno Asst. Surgeon: Dr. Tan Anesthesiologist: Dr. Penelope Mapanao/ Dr. Pamela Marcelo Scrub Nurse: Ruvie Ellaine Valencia, RN Circulating Nurse: Michelle D. Romero, RN

Chief Complaint: left lower quadrant pain Rationale/Definition: an incarcerated left inguinal may present as LLQ pain. There will be tenderness and an irreducible swelling over the hernial orifice and symptoms and signs of bowel obstruction.

Post operative diagnosis: Hernia Inguinal Incomplete Indirect Incarcerated, Left Rationale/Definition: Indirect or congenital hernias occur when the inguinal canal entrance fails to close normally before birth. The indirect inguinal hernia pushes down from the abdomen and through the inguinal canal. Incomplete means the hernia has not yet protruded through a weak spot or opening and incarcerated if the intestines bulge through the hernia defect and become trapped.

Complete surgical procedure: Mesh Herniorraphy, Left Definition: Inguinal hernia repair is surgery to repair a hernia in the abdominal wall of the groin. A hernia is tissue that bulges out of a weak spot in the abdominal wall. The intestines may bulge out through this weakened area. During hernia repair, this bulging tissue is pushed back in. The abdominal wall is strengthened and supported with sutures and sometimes mesh. The aim is that the non-absorbable monofilament sutures and mesh give immediate strength and allow early mobilization.

Indication: Inguinal hernia repair is performed to close or mend the weakened abdominal wall of an inguinal hernia.

General Type of Anesthesia: General Specific Technique: Subarachnoid Block Items Used to Administer Anesthesia: Spinal Needle Main Anesthetic Agent: Bupivacaine Hyperbaric Mechanism of Action: Bupivacaine blocks both the initiation and conduction of nerve impulses reducing the permeability of neuronal membranes to Na ions resulting in inhibition of depolarization with resultant blockade of conduction. Other Medications Used: none Mechanism of Actions: N/A Position: Supine Equipments for Positioning: safety strap above the knee, grounding pad Incision: single long incision in the groin Skin Preparation: symphysis pubis down to the thighs Disinfectant used: Alcohol Draping: 4 towels, 1 small sheet, 1 lap sheet

Surgical Safety Checklist

TIME OUT: Before Skin Incision SIGN IN: Before Induction of Anesthesia Before Start of Procedure Is the patients identity, site, YES NO NA Confirm if all team members introduced procedure and consent CONFIRMED? themselves and their roles? Is the surgical site marked? _____ Yes _____ No Is the anesthesia machine and Patients identity and Procedure to be medication cart checked? done and site of operation confirmed by Is the pulse oximeter attached and Surgeon / Anesthesia / Nurse working? _____ Yes _____ No Equipment needed available and To Surgeon: Any anticipated critical events checked? ____________________________________ Does the patient has any: ____________________________________ Known Allergy To Anesthesiologist: Any patient specific Difficult airway/ aspiration risk concerns? Risk of blood loss ____________________________________ Has the Surgical Site Infection (SSI) bundle been ____________________________________ undertaken? To Scrub Nurse: Any instrument / suture Antibiotic prophylaxis within the 60 concerns? minutes ____________________________________ ____________________________________ Patient warming (temp checked) To Perfusion / Technician: Any equipment Hair removal/shave site? issues? Glycemic control ____________________________________ Has Venous Thromboembolism ____________________________________ prophylaxis been undertaken? Is essential imaging displayed? Is the initial count done and recorded?

SIGN-OUT: Before Skin Closure or Before End of Procedure Nurse verbally confirms: -the Name of the procedure to be recorded -if instruments, sponges, sharps and needles counts are complete: __ Yes __ No Has the specimen been labeled correctly (inc. patients name)? ___ Yes ___ No Specimen____________________________ ____________________________________ Pathologist ____________________________________ Any equipment problems identified? ____________________________________ ____________________________________ Surgeon / Anesthesiologist / Nurse concerns: Any key concerns for transfer to recovery? Any patient management issues? ____________________________________ ______________________________________ __________________________________