Patient modesty concerns pertaining to surgery

[creinkent]

Want to get feedback about how we all handle pt concerns about modesty and/or being naked as part of surgery. Concerns about who sees them and for how long? Why do they need to be naked? When is the gown removed, etc? How much do you tell them? How do you handle pt that is concerned about students practicing pelvic exams on them without concent? How to handle the situation when after the surgery they realize they had been "exposed"?

[canoehead, BSN, RN]

but if you purposefully omit facts, you dont have informed consent...

Yes,you are right.

Luckily the physician is responsible for getting the consent. I just verify the signature belongs to the right patient.

There are lots things that are not mentioned when patients go for surgery. Imagine if every nurse took it upon themselves to list off about five to every patient in the name of "informed consent." You know that once a couple surgeries got cancelled the hammer would come down to keep your mouth shut or lose your job. There wouldn't be any thought that gee...the patients should have been told, or practice should change. I work in reality, not legal utopia.

[GadgetRN71, ASN, RN]

Some people urinate or defecate involuntarily when they are asleep. The staff can clean the patient, but not her underwear, and it's tasteless to give her back soiled drawers (and embarrassing for her). There is also the issue of keeping track of personal belongings. That's why they take off all jewellery, including wedding bands. The OR staff don't want the responsibility or aggravation passing off clothing etc.

Also, there is no such thing as minor surgery-you say this to people, but they look at you like you're nuts. However, we have had people booked for what seems like a simple operation, then something happens and 3,4,5 hours later, you're still working on that patient. Also, many times the patient needs a foley, now you are trying to take underpants off of an unconscious patient. Not so bad on someone small, a real PITA when the patient is obese.

Actually, a good percentage of people soil themselves to some extent in surgery..this week seemed to be particularly bad for that. I cleaned up more Code Browns and Code Yellows...

[GadgetRN71, ASN, RN]

when i was in the a.f. working pacu we received one of the o.r. tech's post-op with all kinds of sweet drawings all over her body. the o.r. crew liked to take care of their own. we had 23 o.r.'s and they did about 120-150 surgeries a day.

Ha..one of our male techs had surgery and someone painted his toenails while he was out..he cracked up when he came to.

[dudette10, MSN, RN]

When I first read Cul2's question about a friend being naked for eye surgery, I thought, "I don't know anyone who isn't naked under a gown for surgery," then I remembered what type of surgery doesn't even make you gown up!

It's dental surgery under general anesthesia.

So, it does make one wonder about that practice if general anesthesia always makes you run the risk of defecation or urination while under.

[Intern67]

So, it does make one wonder about that practice if general anesthesia always makes you run the risk of defecation or urination while under.

When I learned about anesthesia in class, I decided to never ever undergo general anesthesia outside of a hospital setting. More concerned with ABC issues rather than incontinence.

[canoehead, BSN, RN]

So, it does make one wonder about that practice if general anesthesia always makes you run the risk of defecation or urination while under.

It's the same drugs and the same level of sedation, but for less time. So if you are under for 15 minutes your bladder is less likely to fill and release involuntarily. I haven't seen general anesthesia outside an operating room though, and in every operating room I know of they get the patients naked, no matter what the procedure. Maybe your hospital is different, or maybe they are just doing a moderate sedation?

[Cul2]

What criteria are used to insert a foley cath? Is it the length

of the surgery, the type of surgery, a combination of both?

Are there other factors entering into this decision?

[brokenvessel]

Three stories to share...yes, three... after the lady partsl delivery of my second baby (not a nurse at the time) the Dr told the nurse to "put her under". No explanation given, just "put her under". I worriedly turned to my husband to ask him to pray for me, because I was SCARED, and one nurse grabbed my left hand, restrained it, as the other nurse restrained my right one, and a mask was forced over my face to administer anesthesia!! The Dr then Shoved his Large Male sized Hand into my uterus and RIPPED the placenta from the wall of my uterus!!! I know, I know, you're thinking, she just delivered a Baby,how much of a Stretch (pardon the pun) is that anyway? He then proceeded to sew me up. I never went "under" and I remember the whole thing vividly. (20 something years later). Being a mild mannered person that I am (really, I normally AM) as soon as they took the mask off my face I gave the Dr a piece of my mind, (which I'm sure meant nothing to him, but it made me feel better).

[Anne36, LPN]

brokenvessel, omg, I had forgotten about a similar experience with my first baby until you told your story. Very painful, I had a natural delivery and no kind of medication at all. I still dont understand why that was done.

[brokenvessel]

Story #2: Went into have my gallbladder removed, laying on the table in OR, they tell me to count to ten backwards. 10 9 8 7 6...(OH GOD...I can't breathe!! God? do they know I can't breathe? Please God, I'm scared, please tell them I can't breathe!! :eek:What are they doing? I can feel that! Don't they know I can feel that??) As they are cutting my abdomen open I hear someone saying "did you see that? her stomach just jumped...is she under?"...

After that I don't know what happened, so apparently they put me UNDER! no one told me about intubation, what that meant, or that it would be done to me, and I didn't know enough to Ask prior to the surgery.

Holy crap! When I asked the surgeon about it when he came to check on me he looked over at the intern who was working on me, and they both just looked at each other, and didn't say a word. Needless to say, the anesthesiologist was in my room in no time at all apologizing, and we never did get billed for his 'services'.

FYI, they now have monitors that are placed on your temples and scalp to monitor for some type of brain activity that indicates paralysis versus being "under".

Now I never want to have surgery again!! Hope I never have to.

[brokenvessel]

Story #3 My 20 yr old dtr w/ 18cm 'fluid filled cyst' on her ovary prepping for surgery. They give her Valium to relax her (she's a bit of a fraidy-cat). The anesthesiologist comes in, introduces himself to her and she says "Please don't treat me like just another pt. don't talk about me while I'm under...please treat me w/ respect". The Dr looks at me, and the OB-GYN & says "Of course I'll treat you w/ respect! Why would you say that?" "When I was in high school I took a class & we went & rotated through the hospital. I saw a lady have her eye operated on, and everyone just tossed her around like she was a piece of meat on the table, because she was under anesthesia. I don't want to be treated that way, even if I'm"under".

The anesthesiologist came out after he got her sedated, and said "It took us quite a while to get her safely sedated, she was fighting the anesthesia to the point that I was afraid to give her any more! But finally, it kicked in, and she did fine.":up:

We never know how our actions will affect others. we need to always be mindful to treat others as we want to be treated. ALWAYS...even if they're 'under'!! Thanks for your ear! goodday y'all

[TDCHIM]

Okay, brokenvessel, all those stories made my insides curl up and shrink into each other. My God, being AWAKE but having everyone think you're out?? I feel like I'm going to be sick just imagining it. I'm glad there's a method to detect such situations now, but it makes it no less terrifying an experience for you!