Case study : J.A., a 68-year-old female with a herniated lumbar disc at L4, is scheduled to have an L4 lumbar laminectomy using a posterior approach.

Surgery for Herniated Disc

Patient Profile

J.A., a 68-year-old female with a herniated lumbar disc at L4, is scheduled to have an L4 lumbar laminectomy using a posterior approach. She has a history of low back pain, osteoarthritis in the left hip, and hypertension. She is taking the following medications:

Metoprolol (Lopressor) 50 mg PO BID; last dose last night
Ibuprofen (Motrin) 600 mg TID; last dose yesterday morning
Garlic supplement daily; last dose yesterday morning
Subjective Data

Has low back pain that radiates down her right leg
Has pain in left hip which worsens with activity
Has not had anything to eat or drink since midnight last night
Smokes one-half pack of cigarettes per day for past 47 years
States that she is allergic to sulfa and latex
Objective Data

Physical Examination

Blood pressure 140/82, pulse 84, temperature 98.6° F, respirations 20
Height 5’ 5”, weight 195 lbs, BMI 32.4 kg/m2
Diagnostic Studies

ECG normal sinus rhythm
Lab values
Sodium 139.0 mEq/L
Potassium 3.4 mEq/L
HCO3 25.4 mEq/L
Chloride 99.5 mEq/L
BUN 10 mg/dL
Creatinine 1.1 mg/dL
WBC 7,000/µL
RBC 4.3 million/µL
Hematocrit 36%
Hemoglobin 12 g/dL
Platelets 164,000/µL
Glucose 98 mg/dL
Discussion Questions

1. After reviewing J.A.’s chart with the above data, what information should the perioperative/circulating nurse make the operating room staff, surgeon, and anesthesia care provider aware of?

2. What position should J.A. be positioned in on the operating room table and what should be considered when positioning her for the surgical procedure?

3. Just prior to bringing J.A.to the operating room, the surgeon comes to talk to her and marks the surgical site. You then put a hair-cover over J.A.’s hair, similar to that worn by the rest of the operating room staff and hang the ordered preoperative IV antibiotic. What is the purpose of the surgeon marking the operative site, the hair cover, and the administration of the antibiotic on the way to the operating room?

4. What is involved in a surgical time-out?

5. What is the circulating nurse’s role in the operating room?

6. Describe a plan for J.A.’s anesthesia during surgery.