Case No: Minor Scrub 2 CI: Sir Junnile Paat

Name of Student: .John Raphael Sanchez Date of Submission: 10/13/2017

Year and Section: 3NUR-8
OR Preference Cards
Name of Patient: J.R.G. Age: 28 Sex: Female Civil Status: Single
Date of Admission: OP Date of Surgery: October 7, 2017 Time Started/Ended: 3:20pm/4:15pm
Bed #: OPD Registration/Receipt #: 17-070000097161
Surgeon: Dr. Pio JR. V. Purino, MD Assistant Surgeon: Dr, C. Lacson Anesthesiologist: Local
Scrub Nurse: Paube Nerlime G. Abaya, RN Circulating Nurse: Weldon H. Ola, RN
Chief Complaint: Atriovenous Fistula creation
Pre-Operative Chronic Kidney Disease Secondary to DM nephroschlerosis
Pathophysiology:

Decreased Hypertrophy of
Age: 28 Decreased renal glomerular filtration
remaining nephrons
Chronic hypertension blood flow rate

Loss of excretory Further loss of Inability to

renal function nephron function concentrate urine
Rationale/Definition: As blood pressure increases, the blood vessel resistance also increases; thus, making it harder for the blood to
travel through the blood vessels. Due to this condition, decreased tissue perfusion results and as there is decreased oxygen going to the
kidneys, it results to kidney tissue damage then to the loss of renal function
Post-Operative Diagnosis: Atriovenous Fistula Creation
Rationale/Definition: As blood pressure increases, the blood vessel resistance also increases; thus, making it harder for the blood to
travel through the blood vessels. Due to this condition, decreased tissue perfusion results and as there is decreased oxygen going to the
kidneys, it results to kidney tissue damage then to the loss of renal function

Complete Surgical Procedure: Atriovenous Fistula Creation

Rationale/Definition: Due to the kidney's loss of excretory function, there will be decreased or total inability to excrete nitrogenous
wastes, decreased sodium excretion and reabsorption leading to either water loss or water retention, heart failure, increased serum
potassium levels leading to possible dysrhythmias, decreased phosphate excretion leading to hypocalcemia, and decreased hydrogen
excretion leading to metabolic acidosis. Therefore, a catheter was used for hemodialysis, a procedure to filter wastes products in the
blood, and in that day, the catheter was removed.

Type of Anesthesia: Local

Specific Technique: Local
Anesthetic Agent: Lidocaine (inducted at 3:20pm)
Mechanism of Action: inhibits excitation of nerve endings or blocks conduction in peripheral nerves. This is achieved by anesthetics
reversibly binding to and inactivating sodium channels. Sodium influx through these channels is necessary for the depolarization of
nerve cell membranes and subsequent propagation of impulses along the course of the nerve. When a nerve loses depolarization and
capacity to propagate an impulse, the individual loses sensation in the area supplied by the nerve

Position: Supine
Tools for Positioning: Surgical table, knee strap, arm board strap, and arm cradle
Incision: Simple continuous Incision over (L) wrist
Skin Preparation: Wiping of disinfectant from distal to proximal arm, as well as axillary area
Drapes used: Disposable towels and Laparotomy sheets
Sutures and Needles:

Tissue Layer Suture Used Needle Suturing Technique

Skin Surgipro 4-0 Cutting Needle Interrupted suturing

Muscle Mersilk 6-0 Round needle Interrupted suturing

Instruments Used:

Cutting Grasping Retracting Clamping Others:

Blade Tissue forceps Myerding retractor Kelly fine clamp OS 2/3’s

Knife handle Thumb forceps Mosquito straight/curve
Mayo straight Needle holders Allis
Metzenbaum Allis forceps Mixter
Mayo curve De bakey Babcock
Patz scissors