This week, I have finished my second week in my children's placement. It has been so interesting and once again I feel I have learnt so much. My mentor has been great in allowing me to experience different things in my placement. This week I have been assisting in admitting patients and discharging them. I have been able to follow patients through, from admission, preparation for surgery, anaesthesia, the surgery, recovery, return to the ward and then discharge. Seeing the patient's journey has been incredible. However, it has been hard getting used to having such a short period of time with the patients. I have worked in the community a lot, and it is something I enjoy. I like getting to know the patients / clients / service users and building up that relationship. So having patients come in and leave within a matter of hours takes some getting used to!
This week I have spent time in the theatres being able to watch some paediatric surgeries. I have seen dental extractions, ear, nose and throat surgeries and finally an appendectomy. I have loved it! I was warned that they have had several nursing students faint in theatres and that often its because some people have not eaten. So I was able to grab a bite to eat, then away down to theatres. My mentor contacted the surgeon to see if it was okay that I observe, and permission was gained from the child's parents. I was then shown where to change into my scrubs and then clean up ready for theatre. I was told to not touch anything blue or green, as these were sterile and would compromise the surgery.
In each surgery I observed the patient going under the anesthetic. With children this is very daunting for them. If they go under scared and upset, then they can have a tendency to then come back round upset too. The children were placed under via mask and then injection. Depending on the child they would find it easier with one or the other first. Once they were placed under, their airway was supported and they had a endotracheal tube or laryngeal mask. A laryngoscope may be used for placement of a endotracheal tube. Airway management is the responsibility of the anaesthetist.
Airway management:
Endotracheal tube
Laryngoscope
Oropharyngeal airway
Laryngeal mask
My first surgery was a tonsillectomy and adenoidectomy. I was able to look down the viewfinder of the microscope as the surgeon was operating as he explained what he was doing and what I was seeing. Utterly fascinating! I was fortunate to see them removing ear wax from a child's ears and then removing the adenoids and tonsils. This is a great surgery and was somewhat straightforward. Of course not all surgeries like this are straightforward. The surgeon informed me that although it looked simple, it can be the case where it is the exact opposite. Never be afraid to ask questions, the surgeon was so helpful and was more than happy to answer questions.
Enlarged tonsils.
My second surgery was dental extractions where children were having teeth removed. Although this sounds like it could be a simple trip to the dentist it was far from that. One child had some teeth removed and a gap left where the incoming tooth could move into. Then another child had to have their hard palate cut back and to the side of the maxillary labial frenum (that piece of muscle under your top lip at the front of your top teeth) cut to gain access to the cavity beneath the nose at the roof of the mouth. This was a longer and more complicated surgery but was good to see how this was done and the knowledge of the dental surgeon. Again the surgeon was able to explain each stage to me and show me what was involved.
My third surgery was an appendectomy. This was a little longer than the first two surgeries and a little more intricate and so interesting! Not recommended if you are somewhat squeamish. I watched as the cut was made after they had felt to see where the appendix would be. The child twitched so was put further under anaesthetic. This can be due to nerves and the body not being fully relaxed due to the adrenaline that will be surging through the body beforehand with the nervousness the patient will be feeling.
Once the cut was made, the layers of tissue, and the peritoneum were cauterised, then the appendix was located. Once this was located its blood supply was tied off. This was then removed and checked before being placed in a specimen pot to be sent to pathology. The various layers were then sutured back together. Suctioning was used at various points and the area washed with saline to ensure it was clean. The overall incision was a couple of inches and the surgery will have improved the quality of life for the patient. It was remarkable to watch. I don't however recommend if you can get queasy! Especially at the smell of the cauterising of flesh, that is something you will remember!
Once the surgeries were complete I was able to watch the patient being brought round from the anaesthesia. The nurses in the recovery room monitor the patient, note the patient's observations and ensure everything is as it should be. The patient will not be sent there if the anaesthetist is not happy. Once the patient comes round and everything is okay, then the patient's family are called in. Everything is recorded and even the machines monitoring the patient will give a print off for the patient's records. It is so important with anything now that it is all documented. As they say, if it isn't written down it didn't happen!
If you get the chance on a placement, I do recommend asking if you are able to, observing some surgeries. They are incredible and just reaffirms how amazing and intricate the human body is. And underneath it all, we are all the same.
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