NARRATOR

SCENE I (Doctor sitting with table, Patient is infront)

Surgeon Ivy: The result of the imaging of your gallbladder indicates that you have
a condition called cholelithiasis which are gallstones deposits in the bile that is
stuck inside your gallbladder. We need to perform cholecystectomy which is the
removal of your gallbladder for permanent relief.
So are you willing to undergo the procedure?
Patient: Can you tell me more about gallbladder?
Surgeon Ivy: Gallbladder stores bile produced in the liver. Gallbladder releases the
bile into your small intestine in order to breakdown fats and help digest food.
Normal digestion is possible without a gallbladder. Bile will continue to reach your
small intestine it just wont be stored along the way in the gallbladder and the
removal of a gallbladder rarely causes problems
Patient: Yes I am willing to undergo the procedure if it means I wont be having any
more pain
Surgeon Ivy: Ok, we will need to prepare you for the surgery first and you will have
to undergo several tests to ensure you are healthy enough for the procedure. These
will include blood tests, imaging tests of your gallbladder, a complete physical and
medical history. We will set you an appointment for all these then we can proceed
with the operation
NARRATOR
3 Days prior to surgery
SCENE II (Patient sitting in the chair, Nurse standing for the interviews)
Nurse Kopila (Holding a chart and pen): Goodmorning Miss Mandy, my name is
Kopila and Im here to assess you in preparation for your laparoscopic
cholecystectomy
Nurse Kopila: Okay youre done with all the required diagnostic tests. Youre 35
years old right? Do you have any past medical history aside from gallbladder stone?
Patient: No
Nurse Kopila: Do you have any food, substance and drug allergeies?
Patient: No
Nurse Kopila: I will check your VS (CHECK VS)

Nurse Kopila: Do you smoke, drink or have any opioid addiction?

Patient: No
Nurse Kopila: Your temp is normal, 36.8 which indicates that there is no presence
of fever or presence of infection. Because if there is presence of infection we may
have to delay the procedure because the risks is too great
Nurse Kopila: Are you currently taking any drugs like aspirin, heparin, warfarin
Patient: No
Nurse Kopila: how do you feel about the surgery?
Patient: Im a little scared of the pain and discomfort
Nurse: its going to be okay maam the procedure is only about 1-2 hours and the
benefits of the procedure far out weighs the risk involved. And once you recover
everything will be back to normal
Nurse Kopila : (HEALTH TEACHING)
Nurse Kopila: you are scheduled for surgery on Friday at 9am, you shouldnt eat
fatty foods or heavy meal the night before the surgery. And you should not eat or
drink at all 12 hours prior to surgery because you have to empty your stomach in
preparation for the surgery. Also, no jewelries and contact lenses on the day of the
surgery and no make up and dark nail polish. You need to be here 2 hours prior to
the scheduled procedure.
Nurse2: Doctor Mandy your anesthesiologist is here to orient you about the
anesthesia you will undergo
Anesthesiologist Anne: Hi Miss Mandy, Im doctor Anne. Im here to orient you
about the anesthesia that I will be giving you on the day of the surgery. Do you have
any allergies on any drugs?
Patient: No
Anesthesiologist: Once you are in the OR you will be put in a supine position and
ill be administering cephalothin to relax you, it is given via IV, after that, I will
administer propofol to make you sleep and prevent pain. Once you are sedated I
will insert an endotracheal tube. For your breathing.
Patient: Ok doctor
Narrator
Scene III (Patient lying in bed with gown already, Nurse standing on the
side of the bed)

Surgeon Ivy (Holding paper): This is the operative consent, you have to sign
here in order for us to perform the procedure
Patient: (SIGN)
Surgeon Ivy: Okay Ill see you in a bit, nurse raksha here will prepare you for the
procedure
Nurse Raksha: When was the last time you ate or drink?
Patient: 12 hours ago
Nurse: when was the last time you voided?
Patient: 30 minutes ago
Nurse2: I will take your VS now maam
Nurse2: once you get inside the OR the anesthesiologist will give you a drug so you
wont feel anything, you will be asleep the whole procedure. The whole operation is
about an hour to two hours. After the procedure you will be transferred to the
recovery room. We will monitor you there and once your VS and everything is stable
we can now transfer you to your room. We will no go to the operating room

(TRANSFER PATIENT TO THE OR) (ENDORSEMENT)

Nurse2 (Holding chart): Patient Emma Wu, 31 yrs old, female Asian for
laparoscopic cholecystectomy. Hospital number 123456789. Here is the patient
consent, chief complaint of abdominal pain final diagnosis, cholelithiasis. The
patient describes her pain as a constant, sharp, 6/10 pain that radiates to her
abdomen and back. Patient denies use of alcohol or recreational drugs and smoking.
No past medical history of illness or surgery, no allergies on any drugs, food. NPO
12 hours last voided 45 minutes ago. Not taking any meds. Vital signs are *****.
CBC all normal, no signs of infection. Xray shows gallstones. ALT 229 iU/L, AST 174
IU/L, total bilirubin 1.3 mg/dL, Amylase 472 IU/L Lipase 1003 IU.
Nurse OR: Okay thanks, patient Wu ready for transfer in room 2
(OR Nurse transfer patient to the Operating Room)
INTRA-OPERATIVE PHASE
Scrub Nurse : (Prepare Equipments)
Circulating Nurse: (Holding paper counting equipments, transporting equipments,
putting contraptions)

Surgeon and assistant surgeon: handwashing

Anesthesiologist: Maam Im doctor Mandy Im your anesthesiologist. Before I give
you general anesthesia I need to confirm again have you voided? And when?
Patient: about an hour ago
Anesthesiologist: Okay I will put general anesthesia now
*put via IV and after 2 minutes, inject something, put endotracheal tube
(Mask) connect it to the machine*
*Patient sleeping wait 1 minute*
Anesthesiologist: Patient is sedated ready for surgery doc.
*Scrub, Surgeon, Assistant Surgeon perform gowning, gloving and draping
and bethadine*
Circulating Nursing: Patient Emma Wu for laparoscopic cholecystectomy. Surgeon
Ivy Malubag, Assistant Surgeon Viola Huihui, Anesthesiologist Mandy, Scrub Nurse
Ann Magro, Circulating Nurse Erika. Time of operation started 9:00 am.

Knife
Os
11mm trocar
5mm excel bladeless trocar
(19secs)Grasping double action jaw
(Inspect)
(35secs)5mm trocar
(1:12)Grasping double action and Maryland dissector
(3:09)ER320 clip applicator
(4:02)Maryland
(4:21)Endo scissor
(4:41)Maryland
(5:53)ER320 clip applicator

(6:27)Endo scissor
(6:48)Cautery
(6:26)Maryland
(7:42)Cautery
(9:29)Maryland
(9:51)Retrieval bag
(10:35)Grasper and Maryland
(12:00)Trocar
(12:12)Grasper and Irrigation suction tube
(12:38)Cautery
(13:05)Irrigation suction tube
(13:45)Suction drain
(REMOVE TROCARS)
OS
Needle
Surgeon: Operation ended at 10:00am call for transfer to the Recovery room
(Everyone Undress gown)
( surgeon document on chart)
(Anesthesiologist remove mask)
(Circulating count equipments, remove contraptions to pt and transfer pt to RR)

NARRATOR

POST OPERATIVE PHASE

(Transfer patient to recovery room)

Nurse1: put pulse oximeter

Sir Alvin: Okay you check the vital sign every 15 minutes if its all stable for 1 hour
check it every 30 minutes for another hour
Student: Check VS
Nurse1: are you cold sir?
Patient Yes
Nurse1: (Put thermal blanket)
Anesthesiologist: How are you feeling? Do you feel any pain
Patient: Yes a little
Anesthesiologist: its normal once the anesthesia wears off, and you will feel cold.
Make sure to take the medicine I prescribed you when you leave the hospital to
lessen the pain.
Narrator
Nurse: okay maam wu everything are stable now, we will transfer you to your
room. And upon doctors order most of the patient with this procedure can go home
by tomorrow. Be sure to call your doctor if you have any fever, worsening pain,
redness or swelling around the incision, drainage from the incision.and if no urine
output after 6-8 hours.
Patient: when can I expect to return to work and resume normal activities?
Nurse: it varies among patients, you will be encouraged to return to normal
activities as soon as you feel comfortable. Some patients can return to work in a few
days. You should not engage in heavy lifting or straining for 6-8 weeks after the
surgery. And while taking narcotic medications for pain you should not drive. Your
diet should include clear liquids once bowel sounds return.
Narrator

Gallbladder problems are diagnosed through various tests. These may include:

Liver function tests (LFTs), which are blood tests that can show evidence of
gallbladder disease.

A check of the blood's amylase or lipase levels to look for inflammation of the
pancreas. Amylase and lipase are enzymes (digestive chemicals) produced in
the pancreas.

A complete blood count (CBC), which looks at levels of different types of

blood cells such as white blood cells. A high white blood cell count may
indicate infection.

The use of ultrasound testing which uses sound waves to image and make a
picture of the intra-abdominal organs including the gallbladder.

An abdominal X-ray, which may show evidence of gallbladder disease, such

asgallstones.

A computed tomography (CT) scan constructs a detailed X-ray images of the

abdominal organs.

A HIDA scan. In this test, a radioactive material called hydroxy iminodiacetic

acid (HIDA) is injected into the patient. The radioactive material is taken up
by the gallbladder to measure gallbladder emptying function. This test also is
referred to as cholescintigraphy.

Magnetic resonance cholangiopancreatography (MRCP), which uses magnetic

resonance imaging (MRI) to produce detailed pictures.

Endoscopic retrograde cholangiopancreatography (ERCP), a procedure in

which a tube is placed down the patient's throat, into the stomach, then into
the small intestine. Dye is injected and the ducts of the gallbladder, liver, and
pancreas can be seen on X-ray.