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Industry: Email Alert RSS FeedAnterior cervical discectomy and fusion for cervical disc disease
AORN Journal, Dec, 2002 by Cecile Cherry
Table 1
EQUIPMENT, INSTRUMENTS, AND SUPPLIES FOR ANTERIOR CERVICAL DISCECTOMY
AND FUSION
Equipment
Neurosurgical operating microscope
Bipolar/monopolar electrosurgical unit and hand piece
Portable fluoroscopy unit
Lead aprons for surgical team members
Supplies
Microscope drape
Portable fluoroscopy unit drape
Monopolar electrosurgical unit grounding pad
Iodine-impregnated drape
Temperature-regulating blanket
Drape sheet with small fenestrated opening
Bone wax
Compressed rayon cotton pledgets or strips
(ie, cottonoids)
Peanut dissectors (ie, Kitners)
14-mm cervical distraction pins
Medications
Thrombin
Absorbable gelatin sponge
Rayon-like cellulose gauze
Instruments
Anterior cervical fusion tray to include
* kerrison rongeurs
* pituitary rongeurs
* nerve hooks (blunt and micro hook)
* freer elevator (ie, Woodson or hockey stick)
* insulated bipolar electrosurgical forceps
* vertebral body distractor
* distraction pin drill and drill sleeve
* 0, 2-0, and 3-0 angled curettes
Cervical allograft sizers and impactors
Pneumatically powered high-speed drill
Self-retaining cervical retractors
Bone graft and Implants
Cortical ring bone allografts in the following sizes
* 12 mm x 6 mm
* 12 min x 7 mm
* 12 mm x 8 mm
* 12 min x 9 mm
* 12 mm x 10 mm
Titanium locking cervical plates and instrumentation to
include
* bone taps,
* drill and drill sleeves,
* plates in a wide range of sizes,
* screwdrivers, and
* standard and rescue cortical screws (ie, 12, 13, 14,
15 mm)
Positioning aids
Foam padding
Round foam headrest
Folded and rolled sheet
3-inch silk tape
Pillow to place under patients thighs
Table 2
NURSING CARE PLAN FOR PATIENTS UNDERGOING ANTERIOR CERVICAL DISCECTOMY
Nursing
Diagnosis Interventions
Anxiety and fear * Assesses coping mechanisms based on
related to surgi- physiological and psychological status.
cal intervention * Elicits perceptions of surgery.
* Develops individualized plan of care.
* Evaluates psychological impact of plan of care.
* Evaluates response to instruction.
Risk of * Performs preoperative evaluation to include
ineffective baseline bleeding profile.
airway * Provides preoperative treatments to include
clearance holding aspirin and aspirin-containing products.
related to airway * Provides intraoperative care to include ensuring
obstruction adequate hemostasis before wound closure and
secondary to providing a surgical drain, if needed.
postoperative * Assesses surgical site for development of
edema hematoma or edema during immediate postoperative
period.
* Provides postoperative care to include
* elevating head of bed to decrease venous
pressure;
* collaborating in maintenance and corrective
therapy of bleeding problems (eg, monitoring
blood thinning therapy, administering reversal
agents);
* monitoring for tracheal deviation should
bleeding or hematoma occur; and
* monitoring for neurological status
(eg, mobility).
Risk of injury * Verifies procedure with patient, surgical
related to consent, OR schedule, surgeon, documentation on
surgical patient chart, and radiology results.
procedure * Verifies allergies and NPO status.
* Applies safety devices when positioning patient
for surgical site exposure to include placing a
pillow under the knees to relieve low back
strain and providing a head donut and shoulder
roll for neck hyperextension.
* Evaluates for signs and symptoms of physical
injury.
* Uses all equipment (eg, pneumatic drill) in safe
manner following manufacturer recommendations.
* Performs appropriate sponge and needle counts.
* Documents implants according to hospital policy.
Risk for * Assesses patient's susceptibility to infection
infection (eg, skin condition, chronic diseases).
related to * Maintains aseptic technique and monitors
surgical sterility throughout procedure.
procedure * Administers antibiotic therapy as ordered (eg,
IV antibiotic in holding area, intraoperative
antibiotic irrigation.)
Interim Outcome
Diagnosis Outcome criteria Statement
Anxiety and fear The patient The patient
related to surgi- verbalizes an demonstrates
cal intervention ability to cope knowledge
throughout the of the psycho-
perioperative logical response
period. to the surgical
procedure.
Risk of The patient's The patient
ineffective respiratory demonstrates no
airway function is signs of airway
clearance maintained or compromise
related to airway improved from due to postoper-
obstruction baseline. ative bleeding or
secondary to edema.
postoperative
edema
Risk of injury The patient's The patient is
related to function, sensa- free of signs
surgical tion, and motion and symptoms
procedure are maintained of physical
or improved injury.
from baseline
levels.
Risk for The patient's The patient is
infection wound is dry and free of signs
related to temperature and symptoms
surgical remains normo- of infection.
procedure thermic through-
out the periopera-
tive period
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